cortisone injections & ITB Syndrome

[rob]

So, this is something that I've struggled with since forever. It usually starts to act up, and then takes FOREVER to get under control, and then stays dormant again until I sustain some kind of injury.

 

Last summer I was basically out of commission for about 4 months doing the PT thing. I (thought I) finally got it under control with a strict regimen of stretching and exercises, plus orthotics. After about 8 months (total), I had nursed myself back to ~15-20 miles per week. I figured I had beaten it!

 

A few weeks ago I sprained my knee. The sprain has healed -- but the ITB thing is back with a vengeance. I can't stand the thought of another 4 months of PT, I don't think I can do it!

 

I'm seriously considering getting cortisone injections now. Anybody done this? Thoughts?

 

It's like a curse.

 

[archenemy]

I was just talking with my mother about cortisone injections last weekend and learned something new. She had previously had mixed results with cort injections, but found a new doc who uses a different method. He uses sonogram to locate the exact spot to inject, and then injects specifically into the area that needs the cortisone. My mom said it was exquisitly painful, but very effective.

 

Hope that little bit of info helps.

[rob]

Can you PM me the Doc's contact info?

[downfall]

By 15-20 miles per week I'm assuming you are referring to running?

 

Maybe stop running?

 

There is better, more applicable, less likely to end up with stress injury, training available these days (like crossfit).

 

Also fish oil + asprin has helped prevent and heal stress injuries I end up with from climbing.

 

PM me if you are interested in more info. Maybe doesn't help your immediate problem but might help you break the cycle.

 

[tyree]

Sounds like chronic inflammation. I hope that you are icing every chance you can get. I would hold off on the cortisone shot until you give the ice a chance to break the inflammation cycle. If the knee sprain is all healed up take large doses of IBP for a week or so, if not let the knee heal first. IBP will slow the healing process down a bit by reducing the # of fibroblasts to the injury. Also look out for other gait compensations that may be settling in from the sprained knee. This can also contribute to ITB syndrome as well. Good luck. Heres to a speedy recovery!

PS running is really bad for your knee's and ITB, FWIW

[layton]

Expect for it to recur w/the injections. Listen to downfall's advice. You need to change something...

[rob]

yeah, well, if I could only figure out what to change....

 

I've tried not running (I've lived with this since long before I ever started running). I've tried PT, stretches, rolfing, ultrasound, deep tissue massage, ice/IBP, braces, orthotics, excercising, hip abductor therapy, etc. No luck. Some of it works for a while, and then I take a tumble in showshoes, and my ITB hates me again.

 

OK, so expect it to recur w injections? Well, I expect it to recur anyway. I'm just looking to get another few months without pain.

[rob]

I've never seen a chiro -- Layton, think a chiro could help me out?

[layton]

Yes and no....if you saw someone who could find the weak link, it wouldn't matter what their title was. As far as having your knee or foot adjusted, hell it's worth a try, but no promises. An adjustment to the fibular head can really help some people...like a person I treated today for ITB. Have you tied "Graston" technique (a glorified x-fiber or gua sha therapy)

 

If you get the injections, just try to limit the amount. One time only. If you're fed up, you're fed up and it's about 50/50 if it's gonna work or not...and if it doesn't you need to be careful about tissue damage for a while.

[layton]

oh, and a lot of time the medial part of your quads (the VMO) is weak and causes a patellar tracking dysfunction leading to ITB. One good exercise is to squeeze a medicine ball (basketball or smaller size) between your knees and do squats leaning against the wall. Hold an isometric contraction at 90degrees for a while on each rep.

 

Taping your patella medially can also help. Lots of stuff you may not have tried.

[kevino]

IT band syndrome is usually developed by muscle weakness in the hip and or knee. This unevenness in strength then causes and uneven pulling on the IT band, causing it to rub against the knee bone, hence the swelling and inflammation. By no means is does this explain all, but most. In past experiences, you need to find which muscles are weak, and you'll be surprised which are, and use mechanically correct exercises. Training your legs to operate in a biomechanically efficient way is the best way to reduce injures. In addition keep up with exercises/weights to keep those areas strong and buy a foam roller, which helped me a lot. If you want some more details on what I did, let me know and I'll dig up my old list.

 

PS. These exercises are not something that you finish when your pain is gone - you probably know but just thought I would reinforce the fact that you continually keep this area strong no only to heal this problem, but then prevent it from happening again.

Edited April 28, 2007 by kevino

[layton]

Add to kevino's statement, biomechanical issues in the foot are the 3rd most contributing factor 1 being overuse 2 being hip muscle imbalance 4 being pelvic distortion or leg legnth discrepancy 5 congenital abnormality of the location of your patella, acetabulum, tibia/fibula, and tarsals.

[i_like_sun]

Maybe I do need to be a Chiropractor.......

[rob]

I think there is something definitely up with my pelvis/hip. My right hip doesn't move in all the same directions my left hip does, or as easily. I'm not sure it's a muscular problem though; I've been doing all sorts of hip exercises and shit that my docs and PT have put me on for years, it's just always been less mobile, like the joint just doesn't rotate right.

 

I wonder if that's related.

[kevino]

Very good chance those are related...Years of your body compensating for your inflexible hip would set off the IT problem...