For the second time in as many years I was struck down with Iliotibial Band Syndrome (ITBS). This time in my left knee. This bout came on during the 2015 Rollercoaster Run. I really attacked the downhills and this made me pay, not only on the day, but for the next 6 weeks with ITB issues.

I’m not a medical professional, but from my limited understanding, ITBS occurs when the ITB gets tight and starts rubbing against the outside of the knee causing inflammation and pain. This is caused, well at least in my case, by having very weak glutes and hip flexors. So because the glutes and hips can’t take care of the abduction, the IT band ends up being put under undue stress. Well that’s my understanding in a completely non technical, non medical, nutshell.

I saw the excellent Ross Kinsella of Freedom Sports Medicine who confirmed my suspicions. Incredibly weak glutes, weak hips and an overactive TFL. The result being my glutes were doing no work at all. The remedy? Lots of strength work to firstly activate the glutes, then build some strength in them. This involved lots of single leg bridges, which I hate, lots of clam shells which are moderately less hateable and step ups. Lots of spiky ball into the TFL to relax the bugger, and lots and LOTS of foam rolling of the ITB itself.

The prescribed therapy trundled along for two weeks and I felt no pain so tried out a Lillydale Lake Park Run, just an easy 5k around the flat Lillydale Lake. 3.5km’s in and the pain was back, seriously back! It was now that I decided that if I was to have any hope of making Melbourne Marathon, I had to stop running full stop for at least 4 weeks. I had to get the inflammation around the knee down. And more importantly, I had to get strong.

So I did. I took the four weeks off and dedicated 4-5 nights a week to strength work and spiky ball/foam roller. I wouldn’t say I’m now strong in the glutes, but there is a definite difference, I can actually knock out 20+ single leg bridges, I couldn’t even do 10 before.

I did find that the foam rolling of my actual ITB seemed to be aggravating the injury. Each morning after a foam rolling session, the pain would just be a little bit worse than the previous day. This was particularly the case if I had been aggressively rolling around the outside of my knee, where the actual pain was. I did some reading and found some interesting points of view that I thought I would try. One of these said, don’t actually roll the ITB. More importantly, get into the areas that connect to the ITB to take some strain off the ITB itself. So I now concentrate a lot more on getting the spiky ball into the TFL and hips. It’s a weird feeling. When I get the right spot I can feel the release of pressure all the way down the outside of my leg and into my knee. This was a VERY good thing. I still roll on the ITB itself, but it’s a lot less aggressive and I also tend to avoid the outer knee completely. In contrast, I really get into my hips and TFL with the spiky ball. This can be really quite painful at times, especially after a run.

I took off for my first, short run after 4 weeks and everything felt good, so I went back to see Ross to see what the next step is. Ross got me on the treadmill to check out my running. Well, it took him all of 5 seconds to point out my terrible heel striking and my sllooooow cadence. The prescribed remedy, concentrate on getting running cadence up to 180. The warning, this will take time. Months in fact to get used to the higher cadence. But Ross assured me this was one of the best technique changes a runner can make. So I worked on that, and continue to work on the cadence every run I do. The higher cadence in theory reduces any heel striking and promotes the foot strike to be as close to directly under your centre of gravity as possible.

Things are pretty happy in the knee at the moment. Now that I’m back running and distance is back up to normal, I’m focussed now on maintenance. There is no doubt I got lazy before this injury flared up and I don’t want it to happen again. So I currently try and roll/spiky ball every day, even if just for 5 minutes. Especially targeting the TFL and hip flexor areas. Strength work I try to fit in twice in a week. One of the sessions is a heavier, 1 hour weights session incorporating sumo squats, lunges, single leg deadlifts and other leg exercises. I also squeeze in a few core exercises in there too. The other is a shorter, lighter body weight/thera band session with bridges, t-kicks, clam shells etc….I have also introduced a 15 minute stretching routine every other day plus after any long run, focusing on problem areas such as hips, itb, quads and calves.

So far so good for Melbourne Marathon and my attempt to at least get to the start line fit and healthy this time.