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About ten days ago, I had a rather depressing marathon training run. I had intended to run sixteen miles, but I could only make it three before pain in my knee forced me to quit. I then walked three miles back to the car — in physical and mental agony the entire way. This chronic injury to my IT band sent me into a deep funk for four days.
On the fifth day, though, I pulled myself out of the pit I’d made for myself and got on with life. I went to the gym. While I was there, the owner and one of the employees gave me tips. They described some exercises I might want to try.
On the following day — last Thursday — I had an appointment with a physical therapist.
Physical therapy, day one
“What’s the problem?” Dana asked me after she’d taken my basic information.
“My IT band,” I said. “Except it doesn’t hurt right now.” And it didn’t. In fact, it hadn’t really hurt since my abysmal experience on Saturday afternoon. I spent five minutes giving Dana my entire exercise history. (It was probably way too much information, but she didn’t complain.)
After we’d talked, Dana had me show her the different stretches I’ve been doing. Next, I laid on examination table while she manipulated my legs and massaged various muscles. When she’d finished, she went over the results.
“Your flexibility isn’t great,” she said, “but I’ve seen worse. If it really was as bad as you say, you’ve made progress. Also, the IT band in your left leg does seem to be a problem, but I think what’s really the matter is your left quad. You have some tenderness and weakness right here.” She pushed on a tender, weak spot.
“You say this is the spot where you hurt yourself during a 10k run. Well, I think the muscle hasn’t fully healed, and that’s causing all of the other problems. It’s causing the IT band syndrome, and everything else.”
New exercises
To test this hypothesis, she led me to the weight room. She had me perform a couple of exercises, first with the right leg and then with the left.
“Do you see how your right leg is stronger than your left leg?” she said. I did, in fact, see this. It was obvious.
“This is probably the source of your problems,” she said. “Your body is out of balance. Your left quad hasn’t fully recovered. It’s still a little sore, a little weak, and that’s throwing everything else off balance. When we run, there are many different systems that have to work in concert with each other. If one of them is off, it throws everything else off. A sore quad can ruin your bio-mechanics.”
We sat down, and Dana gave me a list of exercises to try. “Keep stretching,” she said. “Be good about it. Don’t cheat. And add these four exercises to the mix.”
“I will,” I said. “But what about the marathon. It’s just over two months away. Do you think that’s a realistic goal?”
“Well, I don’t know,” she said. “I do think you can probably do it, but you need to be careful. You shouldn’t be jumping back to sixteen miles this weekend, that’s for sure. Run six or eight. Maybe do some cross-training.”
She thought about it a little more. “You may be running in the wrong pace group,” she said. “You’re not having trouble with the cardio-respiratory aspect, right?” I shook my head. “It’s very possible that you’re running too slow. People have natural running paces, just like they have natural walking paces.”
“Really?” I said. “I didn’t know that, but it makes sense. When I’m on my own, I have a fast pace that I fall into [about 9:10] and a normal pace [about 10:30]. I can’t make myself run as slow as we do in training.”
“Right,” said Dana. “And I think that when you do, you might actually be forcing your body to do things that seem unnatural. You may want to consider moving up to a faster training group. Or maybe you should just run on your own.”
Theory into practice
For the past week, I’ve been following my new lower-body stretching/strength routine. It’s actually kind of challenging. Dana has me holding each stretch for two full minutes. After the first 90 seconds, I can really feel the burn. Meanwhile, I’ve started running again, but by myself. It’s not as fun, but I feel like I have greater control.
Also, the “monster walk” — walking sideways with an elastic band hobbling the legs — is very tough. The guys at the gym think I look funny, but I tell them they should try it.
I haven’t actually been able to get as much stretching is as I’d like. A family crisis is demanding a lot of my time (twelve hours on Tuesday). But I’m doing what I can when I can.
Yesterday, I went for a my first run in many days. After a week off, my legs felt great. Nothing was sore. And for the first part of the run, everything was working perfectly. After half a mile, I was positively ebullient. After .58 miles, I was sighing in resignation. The pain in my knee had returned. I finished a mile, and then walked home.
Physical therapy, day two
Yesterday afternoon, I met with Dana again. “How are things going?” she asked.
“Both good and bad,” I said. I explained that I hadn’t stretched as much as I’d liked, but that I did feel like the routine was good. I also told her about my run.
Dana had me lay on a table as she used her thumbs to “massage” the IT band around my knee. (I put that in quotes because it wasn’t really a massage. It was more like some sort of diabolical torture.) “Yeah, you’re tight there,” she said. She showed me how to do the “massage” myself, and asked me to do it while I watched TV (which isn’t often).
“And I don’t want you to run,” she said. I gave her a look. “No running for a couple of weeks. You can bike, if you want, or walk. Or better yet, swim. But no running. Okay?”
“Okay,” I said. “I guess that kind of puts running the marathon on hold. But maybe I can walk it.”
“Maybe,” she said. And then we made an appointment for next week…
Mac
16 responses so far ↓
1 brad // Jul 31, 2008 at 7:38 am
The pace group advice is interesting. When I ride my bike by myself I can ride forever with no pain, but when I ride with my girlfriend (who rides much more slowly than I do) my left foot goes numb after a while and I develop a lot of pain around my sit bones. By experimentation I’ve learned that I can make those problems go away by tearing off at a high pace for a few miles and then waiting for her to catch up, so that’s what we do — we ride together until I can’t take it anymore, and then I do a long sprint at my own pace. Now if I can just get her to stop apologizing for being so slow, everything would be perfect. On our last long bike ride she apologized 18 times (I was counting)!
2 Red // Jul 31, 2008 at 8:07 am
What a bummer! Well, I suppose delaying a marathon is better than a permanent injury.
Hopefully you start feeling better soon!
3 steve // Jul 31, 2008 at 8:15 am
ugh, the dreaded IT band.
here’s what helped me:
http://www.cymru66.com/running/itbs-a-ray-of-hope/
who’d have thought a 6″ foam roller would be so effective?
good luck in your recovery!
–steve
4 Metroknow // Jul 31, 2008 at 9:16 am
Wow - that is an interesting concept that you are running too slow…I wouldn’t have guessed that increasing pace would improve an injury. It seems counterintuitive to theoretically stress your IT band more by running faster, but there are lots of things like that which seem to go opposite of what you would think, so who knows?
In my experience, both the stretching and Steve’s suggestion above are really the key - not increasing your exertion. Steve’s recommendation on the foam roller I think is the best for IT band - it does work. It’s excruciating, but it’s worth it when you know it will get you back on the road.
Ah, the life of an endorphin junkie.
I do truly hope that your Mom recovers quickly (read about on GRS). Please take good care.
5 steve // Jul 31, 2008 at 9:25 am
“excruciating” is the word, but it’s a nice “excruciating”
and JD i’d agree with your original point about running slower too. my current marathon training has me running recovery days at speeds i’m not really comfortable running - i’m much happier and feel more natural at my usual speedier pace.
when my wife accompanies me on her bike on my easy days, she always comments that i look “funny” running slow. i think we all have our “sweet spot” where pace is concerned.
6 Andrew is getting fit // Jul 31, 2008 at 10:03 am
A valuable lesson to learn from your experience is that it pays to go see the professionals.
I think we have a tendency to self diagnose a lot of the time and we often focus on symptoms rather than causes.
7 Fit Bottomed Girls // Jul 31, 2008 at 10:08 am
Sounds like Dana is a gift from the big man upstairs. Can I have one?
The “monster walk” is a killer. I call it the “munchkin walk.” Is that wrong? lol.
8 Him // Jul 31, 2008 at 10:25 am
Hey J.D.,
There’s no shame in putting off a marathon because you’d destroy your body otherwise. There will be one next year as well. Remember, the point is to Get Fit Slowly, right?
Taking on a marathon after years of relative inactivity is a pretty big goal. This year I’m running my 2nd HALF-marathon because it was only last year that I STARTED getting into shape.
As for the pace - your PT may be correct. When Her and I run, she complains that I run too slow; only recently have our “natural paces” matched up.
Listen to your body, eat well, love the monster walk (I had to do a million miles of those after my ACL reconstruction), and remember not to lose the forest for the trees.
9 workout mommy // Jul 31, 2008 at 11:15 am
good for you for getting this taken care of now. I ignored a few problems for way too long and now I need surgery to resolve them. Had I listened to my body, I would be running today instead of watching all my friends train for fall marathons.
So listen and delay, you are much better in the long run!
10 greenman2001 // Jul 31, 2008 at 7:04 pm
Something that stands out for me in this post is the sentence “I’ve started running again, but by myself. It’s not as fun, but ….” I think the social component of marathon training carries a lot of value for you.
11 greenman2001 // Jul 31, 2008 at 7:16 pm
It sounds like there are three physical issues you’re dealing with:
(1) Your right leg is stronger than your left. This may be causing your body to compensate when you run, causing a biomechanical problem and causing a cascade of compensating muscular adjusments that may have led to a hamstring injury.
(2) You have a hamstring injury.
(3) You have IT Band Syndrome
On top of this, you’ve got two technique problems:
(1) You’re not using correct form in running downhill.
(2) You may be running too slow
The equipment problem — old shoes — has been resolved.
The treatment plan has several parts:
(1) Weight training to strengthen your left leg
(2) Stretching to increase hamstring and IT band flexibility
(3) After two weeks of rest, resume running shorter distances and at a faster pace.
12 Zack // Aug 1, 2008 at 7:54 am
Sorry to hear that. All the comments above are right though. It’s all about getting fit SLOWLY. Just like with Finances, unexpected things will come up, but if you keep your goals in mind you can dodge around them. You’re ultimate goal is to run a marathon, even if it isn’t this marathon, and I have no doubt you’ll get there.
13 Christopher // Aug 1, 2008 at 6:58 pm
JD,
I think you should probably be working with a certified strength and conditioning coach, not a physical therapist. But that’s just me.
Anyway, some interesting reads on knee health:
http://www.t-nation.com/article/performance_training/olympic_vs_powerlifting_squats&cr=
http://www.t-nation.com/article/performance_training/18_tips_for_bulletproof_knees&cr=
Also, Mike Robertson has an oustanding manual out on knee health, and is one of the leaders in his field.
http://www.bulletproofknees.com/
Be sure to ask your physical therapist about Active Release Techniques (ART probably what she’s doing for you already) and foam rolling (self myofacial release).
My knees feel like CRAP if I do not warm up properly before doing anything. I also have had a lot of luck avoiding the “butt kick” knee stretch and sticking to stretching only the hip flexors. I tend to like a dynamic warm up before doing anything running/sprinting/lifting wise. Something like…
-brisk walk or stationary bike for 5-10 mins
-split squats 10 each leg
-Lateral Squats 10 each leg
-Rotational Squats 10 each
-Ankle Mobility Drills
-Leg Swings if I need them
Remember that you should be getting fit to run. That means building a strong base of muscle to support and strengthen that joint. Get good at lifting heavy shit, and your knee will likely feel a lot better.
14 Leah // Aug 2, 2008 at 6:59 am
I do sideways walking with a band in PT too. Definitely feel the burn after three laps around the PT exercise area.
I definitely think PT is awesome. I’ve got shin splints caused by back pain and a weak core, and I’m glad I went to PT to find that out. Before PT, I just thought I wasn’t stretching enough, but the pain would always come back.
15 Mastro’s Steakhouse and Fogo De Chao Reviewed (and some weekend links) // Aug 3, 2008 at 11:39 am
[...] J.D. went to physical therapy this week. When he talked about being out of balance, I instantly thought of my Wii Fit. It talks about how important balance really is. Perhaps J.D. can add a little more Wii Fit into his stretching routine. [...]
16 Dusty // Aug 5, 2008 at 9:26 am
There will be one next year as well.
There’s not only a marathon next year, there’s probably another one next week. There are dozens out there if you’re willing to travel a few hours, along with hundreds of 5K, 10K, trail running and half marathon events.
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