Iliotibial Band Syndrome (ITBS)

liotibial Band Syndrome (ITBS) is one of the most common overuse injuries among runners — and it is an injury that I have been suffering from ever since running my last half marathon.

ITBS happens when the ilotibial band — the ligament that runs down the outside of your thigh from your hip to your shin — is tight and/or inflamed.  The IT band attaches to the knee and it helps stabilize and move the join.  When your IT band stops working properly, moving the knee becomes painful — and you have a lot of knee movement while running, which usually means you begin to have a painful running experience! Trust me, it is not fun!  If not treated properly, IT band pain can be bad enough to completely sideline a runner for days, weeks, or even longer.  (Talk about bad timing as I am currently training for a full marathon on December 1st.)

ITB

How do you identify the symptoms of ITBS?

The most noticeable symptom of ITBS is typically the swelling and sharp pain on the outside of the knee, which as a result many runners will mistakenly think they have knee injury.  The best way to test if you have ITBS is to bend your knee at a 45-degree angle and if you have an IT band problem you will feel the pain on the outside portion of your knee.

What type of injury is ITBS?

Technically, IT band syndrome is an overuse injury; however, this is kind of a misleading classification since there are usually other factors that contribute towards the injury — but approaching IT band syndrome as an overuse injury is an important step towards recover.

After icing the side of your knee and resting (yes, that means not running!) for a few days, you may need to change up your training regime.  Sometimes this can be as easy as avoiding repetition — try changing your running route or getting away from the treadmill or track for a jog outside. If you normally run outside try going indoors and running on the treadmill for a while.  If getting in shape or building up your endurance is your goal, try some cross-training while you slowly ramp up your mileage.

What are the common causes or ITBS?

IT band syndrome can result from any activity that causes the leg to turn inward repeatedly.  This can include wearing worn-out shoes (or the wrong type of shoes), running downhill or on banked surfaces, running to many track workouts in the same direction, or simply running too many miles.  Unlike other runners injuries — the IT band pain that runners experience will affect seasoned runners almost as much as it affects beginning runners.  IT band syndrome is also more common in women than it is in men — possibly because some women’s hips tilt in a way that causes their knees to turn inwards.

How do I treat ITBS?

Even though we runners try hard to avoid injury — they happen.  It is a fact of life as a runner! (Bummer, I know!)  Once you notice you are experiencing IT band pain the best way to get rid of the pain for good is to rest immediately — something that runners (both seasoned and beginners) rarely like to hear.  That means you need to run fewer miles or if the pain is bad enough — no running at all.  (I took almost three weeks off from running after my last half marathon, and when I began running earlier this week I am still experiencing IT band pain after going over 3 miles.)  I know how hard it can be to take it easy when trying to train for an upcoming race!  I have a 10k in two weeks and I am debating whether or not I should race or pull myself.  If you do not give yourself a break from running and let your IT band repair — ITBS can become chronic.

I am sure hearing that you need to rest or back off your mileage is causing you to worry.  I know it worries me!  But that does not mean that you have to be inactive.  While you are backing off your running mileage you can cross-train.  Try swimming, pool running, cycling and rowing.  Stay away from the stair-climbers at the gym because those are too much like running. (Repeated knee movement!)

Stretches focused on working the IT band will also help — as will treating the side of the knee with ice and/or a heating pad.

If your IT band problem does not getting better after several weeks you should seek help from a sports medicine professional.

Prevention is always the best medicine!! 

I am a firm believer that prevention is always the best medicine.  As a runner we are constantly trying to do everything we can to prevent as many injuries as possible.
Here are some steps you can take to try and prevent IT band syndrome:
  • The most important thing you can do – If you begin to feel any pain on the outside portion of your knee(s) is immediately decrease your mileage or take a few days off.
  • Walk at least a 1/4 of a mile to ensure you have a good warm-up in before you start your runs.
  • Make sure you are wearing the proper shoes and ensure that your shoes are not worn out along the outside of the sole.  If either of these of happening, replace your shoes immediately!
  • Try to run in the middle of the road where it is flat.  To do this safely you will need to find roads with little to no traffic on them and roads that have excellent visibility.  Sidewalks are often tilted or uneven so try to avoid sidewalks unless necessary.
  • Avoid running on concrete or hard surfaces.
  • If you are running on a track — make sure you are changing directions constantly!!

Had a Bad Race Experience: Now What?

Last weekend I ran the Duo at the Ledges Half Marathon — and it was literally the worst race I have ever ran.  For three years now I have been talking to other runners, along with reading lots of online blogs, forums, articles, etc and everyone who has been running for a while will tell you that eventually you will have that a bad race.

For three years I never believed then. “What do you mean have a bad race?” I thought.  I love race day!  Waking up early, getting to the starting line and  the rush and thrill of running with hundreds of other runners — is just amazing.  I have always been able to run a 10 mile race better than I could do a 6 mile training run.

Although I had experienced bad training runs — which I have talked about before (Having a Bad Run) — I have never had a bad race…. Until this past weekend!  The evening before the race I ate a great pre-race meal, I slept well, woke up excited and ready to run, and felt great when the race started.  So what exactly happened?  What exactly went wrong?

Looking back throughout the race I am not exactly sure what happened or where things went wrong.  The only thing I did differently this race was at the 2 mile marker I drank the water at the water station a little faster than I normally do.  All I know is from mile 2.5 through mile 8 I felt like I was dying.  My stomach felt like someone was in there playing twisties with it while a professional boxer punched away. I was miserable! 

Why Do You Have a Bad Race?

There are hundreds of reasons to answer this question!  Maybe the weather was bad, you were injured or sick, you did not train enough for the race, you did not eat properly to fuel your body, you mentally are exhausted — I could continue to list ideas forever.  If you would like to try and pinpoint why you had a bad race ask yourself some of these questions:

  • Did I really train myself properly?
  • Did I do anything different during the race than I normally do?
  • Did I wear clothes, socks or shoes that I have never wore before while training?
  • Did I supplement with something during the race that I have never tried while training before?
  • Did I eat enough food/fuel for breakfast on race morning and/or for dinner the night before?
  • Did I eat the right type of food/fuel for breakfast on race morning and/or for dinner the night before?
  • Was the weather drastically different than you were used to running in?
  • Were you mentally prepared for the race?
  • Are you injured or does your body feel tired at all?
  • Did you start the race too fast and burn yourself out to soon?

What Should You Do When You Have a Bad Race?

If you have not yet experienced a bad race, count yourself luck — but prepare yourself because if you continue to run one day it will happen to you!  If the race is more mentally challenging than it is physically challenging that you should push yourself through the race to the finish line.  If there is something that happens to you physically throughout the race and continuing on would cause yourself major injury — do the right thing and pull yourself from the race taking a DNF (did not finish).  I can tell you from experience that causing yourself injury to finish is race is just not worth it!  

What Happens Once You DNF or Finish a Bad Race?

Running is a mental sport as much, if not a little bit more, than it is a physical sport! Getting past the self-doubt that a bad race or a DNF can leave you with is difficult.  The first thing you need to do is ask yourself the questions above and try to figure out the reason you had a bad race/DNF.  If the reason is something beyond your control — such as weather or sickness — you cannot let yourself dwell on the bad race.  If the answer is that you did something different or turns out to be something you can control that’s easy — just adjust your preparation and plans for future races and make sure you avoid making the same mistakes in the future! 

Here are 5 tips for helping you get past a bad race experience or having a DNF:

1. IMMEDIATELY AFTER: WALLOW (A LITTLE) — More than likely have spent weeks and months training for your race and not getting the results you expected — and have been training for — can be very disappointing and upsetting.  Expressing your frustrations is natural and should be part of your recovery process.  Cry, mope, blog, vent — do what you need to do for the next or two to help you emotionally get back on track. 

2. THE NEXT MORNING: FIND YOURSELF A POSITIVE — Were you able to push yourself through to the finish regardless of how horrible the race was?  Did you save yourself from having an injury which would have sidelined you for days, weeks or possibly even months?  Although my race this past Saturday was the worst race I have ever ran — I realized that the saying I love so dearly “Pain Is Temporary, Quitting Lasts Forever” is something I can live through!  Now, when I am having a bad race I can think back to that race and I know I will be able to push myself through to the end.

3. A WEEK LATER: ANALYZE WHAT HAPPENED — A week later your emotions will have settled down and you can begin to look at your training plan, diet, race day strategy and the race to see if there is anything you can improve and do better for next time.  Just remember — each and every race is different.  Even if you are running the same race each year, each year your experience will be different!  A race is like a puzzle and to know what went wrong you have to look for clues to help you solve the puzzle.  The questions listed above (and others) should help you solve the puzzle. 

4. A FEW WEEKS LATER: SET YOURSELF A NEW GOAL OR TWO —  Every runner has — or eventually will have — a bad race. (Trust me!) Even professional runners have bad races! Use your disappointment to to fuel you towards your next success.  When setting your next race goal, make sure you make it a manageable goal!  If you struggled to get your training miles in for your last half marathon (or other race), you might want to set a goal to do better training — or set a goal to do better at a shorter distance first. Remember — small victories will help you rebuild your confidence after a disappointing experience! 

5. BEFORE YOU NEXT RACE: MANAGE YOUR EXPECTATIONS — You should start every race knowing full well that when running, there is a chance that something can (and eventually) will not go right — or as according to your plan!  Before the race starts make sure you remind yourself that your performance — good or bad — will not nor does not define who you are!  Running is part of a healthy lifestyle — it can make you feel stronger, happier and is a huge stress reliever.  You are out there doing something that a majority of people couldn’t! Those benefits should outshine any poor race performance you may experience.

Just remember — having a bad race happens to everyone — and how you can push yourself past this experience is what will make you a better and stronger runner! 

Cross Training: Biking

A few months ago we talked about one of my favorite cross training activities — swimming! Although I focus a lot of time and effort on running there is a secret that this girl keeps…. I love triathlons. So far I have only completed one sprint distance triathlon; however, I have really made it a goal of mine to train for a Half Ironman — along with doing a Century Ride (100 mile bike ride)!

I have come to the conclusion that doing a Half Ironman just isn’t going to happen this year. The swimming portion will be the most difficult part and I have not spent near enough time in the lake/pool training for the swim.  However, I am registered for the Tour de Livingston bike ride this coming October. (I am super excited to be riding in this event!!) The Tour de Livingston offers a 5, 10, 27, 38, 62 or 100 mile loop.  I have not decided yet if I am going to aim for 62 mile course or if I am going to shoot for the works — and sign up for the 100 mile course!!!

Regardless of which course I decide to ride — this means that not only do I have to make sure I fit in my running training schedule for my upcoming marathon — the Space Coast Marathon in December — I also have to fit in a ton of miles on the bicycle.  (My legs already begging me to stop, lol!)

I am sure most of you are sitting there saying to yourself, “There is no way I am going to do a triathlon, so why do I care about biking?”

Well, there is a secret that many of us who run and cycle know — biking is hands down one of the best cross training activities you can do to complement your running.  It roughly simulates the motion of running and it can actually help you improve your running speed.

While running benefits your calves and hamstrings, it largely ignores the front leg muscles that biking helps workouts — muscles like the quadriceps and if you are using clip-in shoes your shins. By strengthening the muscles opposite those exercised by running, biking will help you improve your running performance and help you avoid injury. The benefits should also show in your race times — as studies have shown that regular intense biking workouts can shave as much as 10 percent off your 10k finish time!

In terms of fitness benefits, three or four miles of biking equals about one mile or running. The real trick to biking is to find a place where you can really push your pace enough to get your heart rate up as high as you would with a run. If possible, you want to find a route that requires you to slow down as little as possible — no turns, no pedestrians, no stop lights, no traffic. I know it is not an easy task, and at the end of the day you just have to ride where you have available.

HOW CAN BIKING MAKE YOU A BETTER RUNNER??? 

1. It is a great form of active recovery — It is a story that is as old as running itself: You do a long run on Sunday and come Monday morning, you can’t force yourself to get off the couch much less do any sort of any activity.  For many runners, an easy jog the day (or two) after a long-hard run is about as much fun as having a root canal done. (Fun, right!)  But active recovery, such as moving your legs with an easy bike ride can increase blood flow, flush out lactate, reduce muscle and joint stiffness, and can help you get back on the road sooner than if you were to just sit on the couch.

2. You will build strength in complementary muscles — If your workouts are exclusively consist of running you are only building up certain sets of muscles to perform certain functions. Though your running muscles will become stronger initially at some point you will plateau.  Doing the same thing every day will eventually mean you will stop yielding results.  When you start to bike you are using muscles in your legs and core that complement the muscles used for runner, which makes you a stronger, more efficient, and yes — faster runner!

3. Your ankles, knees and hips will thank you — Runners, especially those who do longer races (like marathons and ultras) put a pounding on their bodies.  Because of this it is hard for some runners to maintain high weekly mileage without causing repeating injuries.  Biking will give you a good workout without the impact of running. If you are not comfortable with replacing an entire run workout with a session on the bike, even substituting a portion of your run with a bike ride can make your joints happy.

4. You can replicate the feeling of a long run without actually doing a long run — The secret to this something called the “Brick Workout” where you go from a bike to a run with no interruption in between. Though the term “brick” really refers to the two disciplines pushed together into one workout, some athletes (myself included) will swear it actually refers to the fact that running immediately after you get off the bike will make your legs feel like bricks (after they are done feeling like jello)!

If you have never done a brick workout before, you really should ease into doing these very gradually. Start with a 10 mile bike ride at a decent pact, and immediately follow your ride up with a 1 mile run. Your legs will feel sluggish, as if you have already ran a long way, but they won’t have taken the pounding they otherwise would have. Focus on maintaining good form and finishing strong.  If the 10:1 brick feels good then you can gradually increase your mileage for the bike and run.

TIPS FOR GETTING STARTED CYCLING

  • Some will tell you it does not matter if you have mountain bike, a road bike, a hybrid or a triathlon bike; however, I would strongly suggest you invest in a road or hybrid bike if you plan on riding further than 10-15 miles at a time. The most imporant factor is that you buy a bike that fits you! Visit your local bike store to check out all the options!
  • Make sure you have the essential items for biking: a helmet, bike shorts (these are lifesavers, trust me!), and a seat bag!
  • Here are some optional items: bike shoes and pedals which clip together (I use them a love them!) and a biking computer.
  • Before you go on your first ride make sure you know how to change your tires if you get a flat. If you do not have a friend who bikes and can teach you, visit your local bike store and they will be happy to teach you!
  • The most important tip: be safe and obey the rules of the road!!!  Make sure you ride with traffic, not against it!

The weather in Michigan has finally improved enough for me to pull my brand new bicycle out for the first ride of the year, and I am super excited. For the last two years I have ridden a 20 year old road bike and this winter I finally talked Mark into letting me buy a new bicycle.  Early in the year we made a trip down to Performance Bicycle in Novi, MI to pick out my new bike.  After two hours of looking at all of my different options, Mark having a heart attack that a $1,300 bicycle does not even come with the pedals (which we had to purchase separately for an additional $40), and weighing all my options I finally pick out a Scattante Carbon Road Bike.

Performance Bicycle has great staff to work with, great purchase and return policies, and when you purchase a new bicycle it comes with a free bike fitting.

Bike Fitting

Having my free bike fitting done with my new road bike.

For those who are seriously interested in bicycling, I would strong suggest you get pedals that allow you to use “clip-in” shoes.  As a newer bicyclist I was not fully ready to commit to riding with clip-in shoes, because honestly — I am not even close to graceful!  (Mark always teases me and says if he could wrap me in bubble wrap before I left the house he would!)  I really wanted to try the clip-in shoes but I wanted to make sure I had the option to still ride in tennis shoes if I wanted — so at the end of the day I bought a type of pedal that allows me to do both!  Here is an example of the type of pedal I bought.

So, why should you look into clip-in pedals?

Clip-in pedals (as I call them) are a two-part system for you and your bicycle. Part one is the pedal with the locking mechanism and the second part is a cleat that is attached to the bottom of your bike shoes.  The shoes clip into the pedals which give you a very solid connection to your bike.  While I call them “clip-in” pedals — their real name is “clipless” pedals.

A sample pair of clipless biking shoes with the clip attached to the bottom of the shoe.

A sample pair of clipless biking shoes with the clip attached to the bottom of the shoe.

Although the real name sounds a little silly here are just a few of the reason why I would suggest you at least give them a try —

1. You will get better power transfer: One of the best things about going to clipless pedals is you will have an extremely solid connection to your bike’s power. With normal pedals there is only one thing keeping your foot on the pedal when you are on your upstroke — pressure.  As a rider you have to maintain constant contact with the pedal throughout every rotation and to do that you have to apply a little bit of pressure on your downward movement.  With clipless pedals your foot cannot go flying off the pedal and you can fully unweight your feet on every recovery stroke, so all your energy is dedicated to propelling you and your bicycle forward.

2. You will greatly increase your efficiency: When you are using the traditional platform pedals, there is only one section of the rotation where you can apply pressure to them — the downward stroke.  While the downward stroke is generally the most powerful part of your stroke, clipess pedals make it was better. Not only can you have a powerful downward stroke, but because your feet are anchored to the pedals you can sweep back up and pull.  It will take some getting used to, as you will be asking your legs to do more things at once then they are used to doing when bicycling. Once you adjust to the timing though, you will find yourself going a lot faster with much less effort.

Even though there are upsides to clipless pedals, there are also a few downsides

1. Disengagement: It is possible for your foot to accidentally become disengaged, and if that small, sharp pedal whips around and hits you in the shin — well, it is going to hurt, and hurt badly!  There is also the off-chance that you will want (or need) to bail and get off your bike in a hurry — a major hurry. Well, while using clipless pedals there is an extra step to getting your feet off of the pedals now. Practice training yourself to disengage your feet lighting quick so when you need to you can detach yourself quickly.

2. Heavy traffic: Clipless pedals can be an issue for riders who ride in the city or encounter a lot of heavy traffic.  Every time you stop you will have to clip out at least one of your feet (if not both) and when you start up you will have to clip in again. Trust me — this will take a fair amount of practice before it becomes second nature.

3. Falling: This is not meant to scare you but EVERYONE (myself included) will eventually tip over and fall while learning to use clipless pedals, at least once! Yup, I did it! I did it the firs time out on my brand new bicycle, while standing still with only one foot clipped in!  You should practice with your new pedals in areas with as little hazards as possible — and do not use them in a bike race until you are comfortable with them because if you are not comfortable using them you could literally seriously injury or kill yourself or someone else.

Now that you have a little bit of information on bicycling and the weather has gotten nice — make sure you get outdoors and give biking a try!