Now I've Done It

The knee hurts pretty badly today. I did go to the gym and managed about 2.5 miles on the treadmill, doing a combination of a shuffle and the circular motion that I discovered yesterday. I've iced my knee, and am back on Aleve for awhile, and plan to stretch the ITB and hamstring like crazy. May even get the ultrasound unit back out. This is ridiculous. Stupid tight ITB. 2 steps forward, 1 step back. Feels like that's been my mantra for my entire running career.

Now My Blisters Have Blisters

Using the combination of athletic tape and moleskin taped over my arch blisters worked out very well. On my 18.2 mile run today, my arches did not hurt at all thankfully. However, now I have blisters on my right foot where the tape seams were located. So I have blisters as a result of my blisters. Ei Yi Yi! What next? On the bright side, the blister on top of my toe did OK. I managed to paint it with a few layers of liquid bandage last night, which helped to seal it tight, and I also managed to get a corn pad to stick this morning before putting on my shoe. It may have bled a drop or two, but overall, did great.

I can't say the same for my knee though. Last week after my 16 mile long run, I had a lot of knee pain the next couple of days. It was the same old pain that I had during the Vegas Marathon. I think I've reached my limit of combining speed workouts and increasing my distance. I'm on the verge of breaking myself again, likely a result of a tight ITB. I've been stretching really well, and the mid week runs felt great though. But, near the end of my 18.2 mile run today, I knew I had pushed it too far. I ran 15 of the 18.2 at marathon pace, (it feels better during the run if I run faster), but I'll pay for it after the run. The last 3 miles were kind of a death march, so I definitely went "too" far. Ugh. I did find a way to swing my leg in a circular motion though to help prevent the pain, but I fear the damage has been done.

On a bright note, even though I may have "broken" my knee again, I did manage to break my weekly mileage personal record with 51 miles. Yay me? Hmm.

Tonight's Run Felt Great

On  my daily shuffle this evening, I may have had another breakthrough.  Over the last couple of days, I've been focusing on strengthening my tibialis anterior muscle, since my pain in my knee has been below my knee joint (reference the video in the previous post).  Also, I put my ITB strap below the knee joint tonight, instead of above it.  The ITB strap really should be placed over your ITB above the joint, but if this really is a tibialis issue instead, the strap need to be below the knee joint to eliminate the floppage at the insertion point.

Anyhow, long story short, I was able to run my best pace yet since the marathon 3 1/2 weeks ago, with virtually no pain at all.  I did stop to walk for just a minute or so, but overall, had a great run on the treadmill at the gym.  I'm going to rest tomorrow just to give it some extra time, but am hoping that my run on Thursday will be OK too.

Otherwise, a new 18 week marathon training plan was supposed to start this week. I decided to delay that at least one week, to try to give my knee some additional rest.  Since I've got the benefit of experience, even delaying my training by a week or more shouldn't hurt me overall, as I should easily be able to make up some progress as my knee continues to strengthen.

ITBS Cures

The thought occurred to me that I need to document how I recovered from the pain in my left ITB, so mainly I don't forget and can use that info for my right leg.  Primarily, what helped on the left leg was a series of strengthening exercises that helped improve my glutes, my hip abductors, my hamstrings, and of course, stretching the connectors to the ITB in my hip  One of the main stretches that I was doing was a form of the Walt Reynolds stretch, where I would step up on a phone book with my affected leg (bad leg), and step down on the floor with my good leg.  Then I would rotate my affected hip up and out, which effectively put my zipper line over my big toe.  This is kind of a wobbly stretch, but I think it helps to stretch the hip muscle (abductor) that attaches to the ITB.  I also would simulate this action any time I was standing around, just without the phonebook, which engaged the hamstring, and also stretched the hip.  Using a theraband also helped to strengthen my hip abductors, lying on my side, then wrapping the theraband around my knees, and doing knee lifts. Of course, constant icing after runs helps, even at other times of day, along with taking NSAIDs (Aleve seems to work best), and continued use of the ultrasound with medicated ultrasound gel seems to help keep the inflammation down.

I've also stumbled across a video that hints that the reason could be inflammation in the tibialias anterior muscle, since the pain often presents itself below the knee cap. The doctor in the video theorizes that if it were true ITB pain, you should have anterior knee pain above the knee joint, which I've never had.  Hmm, it's worth a shot.

Initially, I also started with a shoe insert, the green Super Feet insoles.  This helped, and the PT thought that custom orthotics would also help.  I wholeheartedly agreed since I do have insurance coverage for orthotics, but come to find out, my insurance denied the claim, although I don't know why.  But, the custom orthotics were a big step I think, but they didn't prevent me from injuring my right leg in the same manner. 

Bottom line, I've got to get this ITBS in my right leg under control, and fast. I don't necessarily need to run fast, but I do want to run pain free.  I'm doing it all, but just don't seem to be making much progress.

Intense Stretching Routine Starts Tomorrow

I've still been battling ITBS in my right leg.  Last week, I thought I might have turned a corner, as a couple of my jogs were relatively pain free.  But, it was short lived as I still have pain in my knee when I run, and it's all a result of straining my ITB during the marathon, I'm positive of that.  Granted, the marathon was only 3 weeks ago (almost seems like a lifetime ago, weird), so I'm still in recovery mode from that no doubt.

But, a new marathon training cycle is supposed to begin tomorrow, and I've got a half marathon race in Huntington Beach, CA in 6 weeks.  I was able to run 5 miles today, and I don't have a doubt that I can finish this upcoming HM race, but I really need to get rid of this ITBS.  I think I may also consider going back to the PT, to make sure to get the right combination of stretches to help facilitate healing.

For once, I'd like to have a solid marathon training cycle without any injuries and do an intense training program, but that may have to wait for my fall marathon.

Also, regarding long term goals, even though I've only got intentions of doing 2 marathons this year, since I want to focus on quality rather than quantity this year, perhaps next year, I might try to run a marathon a each month.  That would be fun!

Making Progress

10 days post marathon, and I feel am making progress regarding my ITBS.  I did not run for about 3 days after the marathon, mainly because of the blizzard we received, and dealing with the aftermath of that.  But, by last Thursday, I was ready to start again, and have done a run/walk every day since then, either doing 3, 4, or 5 miles. The first run was pretty tough, with a immediate pain in my knee whenever I jogged, but walking at the same pace did not hurt.  So, I started doing my stretches, and just took it easy, gradually doing a little more each day.  This is a very mild case of ITBS, certainly not as bad as I had in my left leg earlier this year, hence the reason I am able to do a little bit more.  Today, I was able to fully run half my distance, so am making improvements a little each day. I've still got another couple of weeks of recovery runs lined up before a new marathon training cycle starts, and I'm OK with that.  So, I will probably be doing a daily run of 3 or 4 miles, with nothing longer until I can get to a pain-free point again in my knee.  I'm also stepping up my stretching regimen, so that will likely help too.

It's a weird feeling, knowing I've run so much, and have recently just done 3 marathons, and now I can't even run more than 1/4 mile without pain.  I long to be 100% healthy again, where I can just run, and run, and run.  It will come, I have to have faith that it will.

The Psychological Impacts of Being Injured

Well, I tried another run last night with the same results.  If I run, at any speed, I have immediate pain in the lateral side of my right knee.  Classic ITBS.  Eff.  But, I seemingly can walk forever without any issues, and this certainly isn't as bad as the ITBS I had in my left knee.  But, it's also frustrating at the same time.

I look back on what I've accomplished, at how many miles I've run, and it now angers me that I can't run at all without pain.  I've got a secret goal in mind of keeping a 100 mile-per-month running streak going.  Last month, I ran 145.5 miles, without any pain at all.  Now I can't even run a block.  Is my 5-month 100 mile streak in jeopardy?  It could be.

I'm doing what I need to do to get this better.  I'm using my home ultrasound unit to zap it whenever I can.  I'm stretching.  I'm taking anti-inflammatory meds. It's just going to take time, but time is something that's not on my side.  I had hopes of starting a new marathon training cycle on December 28th, to run the Lincoln, NE 2010 marathon in early May.  And, I've registered for the Surf City HM in early February, hoping for a chance at a PR.  So, ITBS in my right leg may have sidetracked those plans.

I've got 3 weeks. In that time, I hope to baby my right leg along, and hope to continue to strengthen it to the point that the ITB becomes flexible enough, just like my left leg has. I intend to do more walking than running.  I intend to do some pool running.  Bottom line, now is not the time to go for long or hard runs, that will only make the situation worse.  A dose or two of dexamethasone would should feel nice, so I may give the PT a call to see if they can get me in. 

Simply put, ITBS sucks, and it's a huge psychological hit when you want to run, but can't.

Testing My Knee

Decided to test my knee today on a short run. After the 12 inches of snow that we got two days ago, I wasn't really excited to run in the snow or cold. So the treadmill won out. Immediately upon starting to run, I had pain in the knee. Walking does not hurt, but running at 4.7 mph does. So, I did a very slow jog, and stopped to stretch every 1/2 mile. It's just going take time, and a lot of stretching, ice, ultrasound, and patience for this to heal, just like my left knee did earlier this year. I still don't know why I'm prone to ITBS anyhow. It sucks.  The knee does not hurt otherwise during the day, or when walking, only when running.

Home Ultrasound Unit

After some debate about whether it was a worthwhile purchase, I decided to buy a home-use ultrasound unit.  As I mentioned before, I truly believe in the power of ultrasound to create deep heat in your muscles and joints, which ultimately causes cavitation in the cells at a microscopic level, which ultimately makes the blood vessels get bigger. This brings more blood to the affected area, and also helps to carry away more waste, which also helps to eliminate the underlying inflammation, the most important thing. So, after doing some research, and a cost analysis, for me, it was worth the expense.  I have to say, after a week of using it once (and occasionally twice) a day, I think it's really helping, and a lot of my pain in my knee is gone.  I still get pain in my knee on longer and more intense runs, but it's getting much, much better, and I have to think it's a combination of everything I've been doing. 

The unit I purchased appears to be the most common, and from all accounts, the most reliable.  It's sold by the Mend Me Shop, and comes with a special blend of medicated gel.  Yes, the unit is somewhat pricey, but given it's potential use over several years, it's an investment in my overall health and well-being, which I personally can't put a price-tag on. After using it for more than a week, I have nothing but good things to say about this unit!  It has 3 level of intensity, has 3 different timer settings, and has a continuous and pulse setting.  It also came with a detailed instruction manual on how and where to use it.  I'd definitely not be hesitant to recommend this to someone who is dealing with their own aches and pains, and I feel comfortable in the quality of the product.

Last PT Visit

Today was my last PT visit I think.  After the Okoboji HM yesterday, my knee is a little sore, but essentially, I believe that additional PT visits won't be that productive.  I know what to do and how to manage the pain.  Although, I may consider purchasing a home-use ultrasound unit, as I feel that really helps to knock out the inflammation, on a microscopic cellular level.  They seem to be somewhat affordable, and given my recent experience with no-pain runs after the ultrasound therapy, it's worth a shot.  I also opted to get fitted for custom orthotics today. The PT feels that it would only help, to make sure that my feet are in proper alignment, which will help with any pains I might have elsewhere.  Plus, insurance will cover 85% of the cost, so I might as well take advantage of that benefit while I've got the chance.  The orthotics used here are made by Sole Supports and utilize the MASS approach (Maximum Arch Supination Stablization).  I think they will really help me in the long run, and are worth a shot in my opinion.

Another PT Visit

Another PT visit today, same routine, just a different day.  Full round of ionophoresis (ultrasound), an Empi patch (iontophoresis), and out the door.  Since the pain is nearly gone, I don't think I'll have many more visits, at least that's what I'm thinking right now.  It seems that I'm getting a real handle on the pain, what caused it, how to treat it, and how to manage it.  When I'm running, if I feel the pain coming on in the insertion point on the lateral (outside) of my knee, I just stop and stretch my left hamstring, and also do an ITB stretch for my left hip.  That usually helps keep the pain at a minimum during my run, and I can keep going.  The pain is much, much better than it has been, but still there from time to time.  I also ice my knee after every run, no matter what!  Keeping the inflammation to a manageable point is the most important thing.  There is no pain during normal activities, like bike riding, walking, etc, so as long as I just keep doing what I'm doing, I think I'll be OK!

Wow, Knee Pain is Much Better

I have to admit, my knee pain is improving greatly!  I think a combination of everything is working!  I was able to run this evening, 8 miles, without any pain until near the end.  Amazing!  Woohoo, finally on the road to recovery.

Today was also Independence Day.  I did have to work, and we had no solid plans for the evening.  It was a cloudy, drizzly, cool day today, so we decided to just do a BBQ at home, then go to a movie.  After work, I decided to "run" to the movie theater to buy tickets, then run home.  The round-trip was 8 miles.  We then had a great BBQ, and we all enjoyed, as a family, Ice Age 3.

Bottom line, I'm a firm believer in both phonophoresis and iontophoresis as treatments for ITBS.  They work!

Second PT Visit, Pain Improving

Had my second PT visit today.  Today, she did a round of phonophoresis with dexamethasone, which uses ultrasound (sound waves) to inject or enhance the delivery of the medicine into my ITB insertion point. She also gave me another Empi patch with dex too.  The Empi patch is a multi-hour therapy, which electrically injects the anti-inflammatory into my joint over a 5 hour period (it's powered by a  ring of watch batteries).  This, in combination of Aleve twice a day, along with the various stretches that she has given me, and continued icing of the knee after every run is really helping with the pain. I feel that I might actually me making a significant improvement.

First PT Visit

Today, I visited a physical therapist in hopes of getting some help with my ITBS.  I've been dealing with this on my own for the last 6 weeks, with not much improvement, despite my best effort to try various stretches, etc.  After visiting with the PT for a bit (she's a very competitive marathoner, and now has a doctorate in PT), she's given me several stretches to try to get my body back in alignment.  She feels that my hips may be slightly out of align, and has given me a toolbox of things that I can do to get back on the mend, including stretches, and also hip positioning techniques.

I guess I was perhaps looking for a smoking gun, and a magic bullet to get me on the road to recovery, but in the end, I think it will just take time.  One thing she did do was give me an Empi patch, which essentially micro-treats the pain location with an anti-inflammatory medicine called dexamathasone.  This technique is called iontophoresis, which uses a small electric charge to deliver a medicine directly through the skin. But, this should really help to knock down the inflammation in my knee.  She also suggested a full course of Aleve, twice a day for 10 days.  The pain is a result on inflammation in the insertion point of my ITB, and until that goes away, neither will the pain.  Icing my knee after every run will also help.  She also suggested that I think about custom orthotics, since my feet pronate a bit.  At the very least, she suggested I try some OTC orthotic inserts like Superfeet, to start getting my feet in the right position.

Hopefully, all of these things will lead to a solid recovery!  At this point, I need all the help I can get.

Decided to Visit the Doctor

I decided to visit a sports medicine doctor today since my knee pain just doesn't seem to be getting better.  After the run at the Rocky Mountain Half Marathon in Denver this past Sunday, I guess I need to get this checked out.  In hopes of avoiding the middle man, I skipped a visit with my family doctor, and went straight to a well-known sports-medicine group here in town.

The good news, after taking a series of x-rays, the doctor is sure that I haven't really torn anything and that I just have a very tight ITB.  This puts pressure on the knee, which leads to the the pain on the lateral side at the insertion point where the ITB connects.  My knee-cap is slightly displaced on the lateral side (just grew that way), which also compounds the problem.

The solution is to see a physical therapist, since there's no real damage that a doctor needs to repair.  I've made an appointment for June 25 with one of the leading running PTs in the area.  She has run numerous marathons, winning 8, and has qualified for the last 3 Olympic Trials.  I'm pretty sure she knows her stuff.

2009 Rocky Mountain Half Marathon

Short version: I finished my 3rd Half Marathon with a time of 2:24:11. While that’s 24 minutes off my PR pace, that’s OK! My knee hurt throughout the race due to a flare-up of ITBS, so I’m just thankful to have finished and wasn't really concerned with my time!

Long version: I was a little nervous about this race because I’ve been dealing with a case of ITBS in my left knee over the past few weeks, and it hurts pretty badly when I run longer distances or run really hard. But, I had registered for the race a few months ago (prior to straining my ITB) and our hotel was already paid for, so I decided to do the race anyhow. Was that smart?  Probably not, but I'm still learning. We spent a couple of days in Colorado prior to the race to get acclimated to the higher elevation and also visited some family and friends and enjoyed a small family vacation in downtown Denver.

The couple of days prior to the race, I made sure to stay super hydrated since we were up in the mountains, and also got in a lot of walking and some good swimming at the hotel pool, and felt really good up to the race with no major ills.  Note, the knee does not hurt, unless I run.  I slept really good the night before the race (oddly enough) and woke up promptly at 6am when the hotel wakeup service called. I ate my usual breakfast of a bagel, peanut butter, banana, and some Powerade, then dressed and walked the 1 mile to the race start.

I did some light jogging around the block to warm up near the starting line, and did some stretching to loosen up my muscles. Since I was particularly nervous about my knee and how well it would hold up, I had to use the porta potties not once, but twice to take a pee, finishing the second time about 3 minutes before the race started. Yikes, that was close!  ha  The weather was perfect, with sunny blue skies and temps around 60, along with light winds. It was a gorgeous day! The race started soon enough and we were running. My knee immediately began to hurt within the first few blocks, and I knew at that point that it was going to be a very, very long run. :(

My wife and daughter were able to meet me along the course at about 1 mile, and I was so thankful to see them. I waved and kept running. My motto lately has been, “Run when you can, walk if you have to, crawl if you must, but never give up,” a quote by Dean Karnazes, and I just kept repeating this over and over in my head as the miles ticked off and the pain continued in my left knee. I ran mostly, but did stop to walk occasionally every mile or two, and mainly to stretch my left hamstring, which really seemed to help with the pain in my knee. I did have to stop at about mile 5 to use the porta potty again, but otherwise, the remainder of the run was OK and really fun, other than my knee just ached non-stop. The knee pain wasn’t severe, just a nagging dull ache that kept my pace pretty slow overall.

The course started in downtown Denver and continued for about 4 miles amongst the sky scrapers, then along the South Platte River, then past Elitch Gardens, past the Denver Broncos stadium, then to and around Sloan’s Lake (which was awesome with snow-capped mountain vistas in distance), then back into downtown Denver.  Overall, it was a beautiful run!

I was also initially worried how the higher elevation would affect me since I’m a flatlander from Omaha, but I wasn’t really running hard enough to even be significantly winded. Unfortunately, what was slowing me down was my stupid knee and the pain it was causing. The last mile of the race was especially painful as I kind of hobbled toward the finish line, but I did cross it with a big smile on my face, as I again saw my wife and daughter cheering me on about 500 feet before entering the finisher’s chute. Ironically enough, as I saw them, the song “Taking Care of Business” by Bachman Turner Overdrive came onto my Ipod, which really pumped me up too to get me to the finish line.

I had a finish time 2:24:11 (well, well within the back of the pack), but you know what, I was still really happy with that. While it’s 24 minutes off my PR pace, that’s OK! I never expected a PR in this race because of the altitude and my ITBS, and I’m just super happy I was able to finish it, and despite the pain in my knee, I had an awesome time and am so glad that I persevered.  The medal was also very cool, and certainly worth the effort put into the race!

After munching on a bagel, a banana, and drinking both a bottle of water and Gatorade after the race, we walked the 1 mile back to our hotel, I enjoyed a super hot shower and changed clothes, and then we hit the Interstate for an 8-hour car ride home to Omaha. Ugh. It was also lunchtime, so we decided to stop at Ihop for a much-deserved celebration meal. I enjoyed a huge stack of chocolate chocolate-chip pancakes (yes, double chocolate), 2 scrambled eggs, hash browns, bacon, and about 4 cups of coffee. I then proceeded to eat the rest of my wife’s breakfast, including her left over pancake, another egg, and also polished off the remainder of my daughter’s hamburger and French Fries. In other words, I ate like a pig, and it felt good with no guilt!

At that point, I let my wife do the driving so I could stretch out in the back seat and iced my knee all the way home. We did stop every once in awhile so I could stretch, and keep the legs moving.  When we got to Omaha, my knee felt great, and I have no major aches and pains anywhere else in my body. Yeah!

And now, marathon training possibly begins next week for a fall marathon in either September, October or November. I need to let my knee rest a bit, but I definitely feel confident that after 3 half marathons under my belt, I’m ready to try a full. We’ll see. Race on!


This is a photo of me about 1 mile into the race. Since it was Flag Day today, I decided to wear a flag running outfit, with a flag visor, a stars and stripes singlet, and flag running shorts and flag socks. I got a ton of crowd support which was cool! Note the knee brace on my left knee, which helped, but certainly didn't eliminate the pain.

Pro Tec ITB Strap

Since my knee is still hurting pretty badly, and I still want (need) to run, I decided to try out an ITB strap.  Now this isn't really a solution to my problem, more of a bandaid if you will, but at least it will help get me through the pain.  Essentially, it's a strap that you wrap around your knee, slightly above the insertion point of the ITB (where the pain occurs).  This is supposed to keep your ITB from vibrating too much, or to keep the ITB from bouncing flopping against the bone, which should help alleviate some of the inflammation.  Again, it's not the solution, but I'm willing to try anything at this point.  While there are a couple of different brands, the most common one that I've seen is the Pro Tec band.  But, they all work the same way, as far as I know.

Iliotibial Band Syndrome??

After my second half marathon race in as many weeks, I believe I may have stressed my Illiotibial Band (ITB). It's a tendon that runs the length on the outside of the thigh and connect your hip to your knee. This typically causes knee and hip pain if you strain it, and is a result of possibly running too much, too fast, too many hills, or on a cambered road, running downhill too much, or simply from having a tight ITB to begin with. It can also be caused by leg length differences.

In my case, in may be a combination of all of the above, since during my race on Sunday, I did start off with some knee and hip pain, but then it went away during the race, but then came back on strong after I got home. The race course itself was pretty hilly, I was running beyond my comfort zone to try and reach a PR, I did another race just 2 weeks ago, and I do have leg length issues. When you combine "all" of those into one day, it's no wonder I have issues. Doh!

To alleviate this, I used some ice on Sunday, took Ibuprofen, and have been doing various stretches to help make my ITB more pliable. It seems to be working since I was able to do a 3 mile recovery walk/jog today at the gym, after doing some light non-impact swimming on Monday. The stretches I've been doing involve doing side lunges, step downs, a lying ITB stretch, the piriformis stretch, wall bangers, and a couple of standing ITB stretches, and also using the stick to massage the thigh muscles and ITB crossways (not up and down), and also using a foam roller to roll out any kinks and knots and break down any scar tissue that might be developing there. It all seems to be working OK, so I hope to continue on the path to recovery. I also may start taking a glucosamine supplement, but I'm not sure if there's any scientific evidence that it actually works, but I don't believe there are any serious side effects either.

I have another 5 mile Boystown Fun Run on Memorial Day that I've registed for, to run with a coworker, but I have no intentions of racing it, I just need to run it for fun. My wife and daughter will be doing the 1 mile fun run/walk that day too. 

This knee pain sucks though, it's not fun.