It's been a while since my last post. Thats because things have really slowed down due to the IT band, but here's a quick recap of the past 6-8 weeks:
- I decided to forego the marathon this year. At the time, it was mid-September, and I was still limited to just a few miles. That was six weeks into trying to treat the IT band with rest, and it wasn't helping much - so I didn't see how things would magically get better in the next four.
- I went to the doctor to confirm the diagnosis, and get started on a treatment plan. The doctor was able to isolate and feel the point of irritation/inflammation - which is nice because it was a definitive diagnosis, as opposed to being purely based on symptoms. Also, in feeling the left vs right IT band, she found that the left was definately tighter, although both were generally tight.
- Initial treatment would be going through a course of physical therapy. The doctor said that results can often be seen in 4-6 weeks. There was also the option of an injection at the point of irritation. I'm not sure whether it'd be a cortizone shot or something else - but it was generally agreed upon that the PT course should be tried first. The PT prescription would include a running evaluation in order to determine if there was any imbalance during the running stride, or core strength imbalance that might be a contributing factor.
The first day of PT started out with a massage of the area and general analysis of knee and kneecap operation and movement. The therapist found that my left knee cap does not move laterally inward as much as my right knee cap. Since the knee cap is attached to the IT band, it was another sign that all the connective tissue in that general area is fairly tight.
The first exercise was what I'll refer to as the 10:30 leg raises, where you lay on your back with your left toes pointed to the 10:30 position. With weights on the ankles (3 lbs to start off with), raise and lower the leg vertically about 18". Three sets of 10. I found that it didn't really start to burn at all until mostly through the second set. But at the end of the third set, the muscle was definately fatigued. I believe the purpose of this exercise is to strengthen the muscle that pulls inward on the kneecap.
Next was what I'll refer to as the 3:30 leg raises, where you lay on your unaffected side (in this case, my right side), with the legs stacked and the left toes pointed slightly downwards to the 3:30 position. With weights on the ankles (3 lbs again), raise and lower the leg about 18". However, instead of raising and lowering vertically, raise the leg up and back. Once again, it was at the end of the 3rd set of 10 that I felt the muscle was fatigued. The purpose of this exercise was to strengthen the some of the gluteus muscles that normally don't get isolated during normal activity (and thus it is common for them to be rather weak).
Next was a look at quad flexibility. I've generally been pretty good about stretching my quads, but I found I've been isolating the quad muscle, but not the quad connective tissue that makes up the hip flexor. For this stretch, she had me lay on a table with the left butt cheek hanging off the edge, and just let the left leg hang. Apparently the angle of the lower leg hangs around 70 degrees for most people, and I was closer to 50 degrees. So there is a bit of tightness there. For this stretch, I remained in that position, and with the aid of a loop of rope around the ankle, simply reach for the rope and pull back. Stretch for 30 seconds 3 times.
Lastly, there was the foam roller stretch. I had done my own version of this a few times using a piece of 4" PVC tube (her reaction was one of 'ouch! That must hurt!'), but I quickly found out that I need to do a LOT more of this stretch. When I was doing this on my own, I'd spend maybe a minute rolling it up and down the leg - she had me start with 5 minutes, specifically concentrating on areas that felt sore and tight as the roller moved along. I asked about the idea of using a hand-held roller, but she indicated that for this, you really want to get the body weight to help and get a good stretch. Speaking of body weight, I started off supporting a good portion my weight with my other leg - but I won't be surprised if by the end of things the stretch will be done with the legs stacked and for a longer period of time, like 10-15 minutes.
Since this was just the first PT session, things weren't turned up to 11 in terms of intensity. The therapist said that they introduce exercises gradually so that if there is lingering soreness or a problem, it can be more easily tracked down to a specific action, as opposed to throwing everything out all at once.
All of these exercises were assigned to be done at home, once per day. Actually, there was an additional one assigned - the standing leg crossover ITB stretch. That was to be done for 30 seconds 3 times per day.
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