Consistency & patience.
practiced in the context of ITBS
Lately, my training mileage has been reduced. You may have read my recent race report and noticed that one of the obstacles that surfaced in that 50k was some IT band pain.
Ah, the dreaded iliotibial band syndrome—ITBS. Like many ailments, the black hole of on-line intel just may send ITBS sufferers spiraling downhill faster than their inflamed knee can safely carry them.
I’m not in a lot of pain at the moment, and it’s not constant. But as I’ve noticed it pop up, I’m taking notes, and working hard to address it *before* it gets intolerable. I’m getting quite adept at noticing the pre-pain signals.
First, a disclaimer: I’m dealing with ITBS in the best way I can discern how—with the help of the people I trust to guide me—in my ultra-running journey. No one I’m working with has promised me the moon, and I am not certain of how this story ends either. So please take all of my notes and links with a healthy dose of salt (or electrolyte solution of your choice), and know that my research and treatment plan represents only a small sliver of the ITBS information that is out there. It’s a big, confusing, and inconclusive injury.
For me, ITBS pain presents on the outside of my left knee. The pain at its worst is pretty intolerable—a highly inflamed throbbing with each plant of the affected leg. The pre-pain signal feels like someone is lightly pressing on that same part of my knee while running—I often describe it as “stress” on the outside of my knee.
After Bandera 100k last January, this pain first popped up after my recovery period. It began as that throbbing feeling, on and off throughout short runs, until it progressed over a week or so to the point of, “nope, I’m not running on that.”
When it was at its worst, I spent a weekend as a spectator at one of my kid’s basketball tournaments wishing for crutches to get me to and from court to car. It was incredibly tender. Walking was laborious, and running was out of the question. Coach Jenny and I handled this with lots of rest, and lots of ITBS-specific strength . . . and it worked! Within a week I was back to “ running-lite,” and within three weeks I was on my way back to usual volume and intensity.
I continued with the exercises a few times a week for several months, then eventually let them go. I didn’t deal with IT band pain for months of hard training. I figured I was getting all of the strength support I needed from my regular strength programming.
And then the 50k.
For context, I trained for and ran a 5k in April, a 12-miler in May, and a 20k in August—all without any knee pain.
It wasn’t until the 50k—in October—that I experienced ITBS again.
And though it’s not nearly to the degree that I encountered after my 100k recovery, it is surfacing now as I’m coming out of my 50k recovery.
This is super informative.
You can find many suspected triggers for ITBS on-line, and among them is the belief that this particular kind of knee pain “usually starts with a bigger-than-usual workout run, hike, or walk, especially if there’s a lot of descent (stairs, hills, mountains). The classic onset scenario is going down a big hill when you’re already tired.” (Source.)
Ah, yes, sounds like this could be related to those longer distances that I train for . . . given my experience thus far, I’m buying this.
The cause? Again, the reasons that a runner or other athlete may be a candidate for ITBS are varied, and frankly, inconclusive. But one hypothesis is that it originates from weak hip and/or glute muscles.
When I run over the marathon distance, I’m asking my body for a great deal of muscular endurance. And when I push past a traditional limit, I’m discovering things about my body that may never have become a problem if I weren’t pushing it to this degree. For the purpose of competing at the ultra distances, I’m asking these muscles to be stronger than they currently are.
In this targeted strengthening process, I’m also discovering—with the help of a PT assessment—that I have imbalances in my left and right mobility. Again, nothing distressing. But addressing the ways that my left side is not as flexible or strong as my right side may just unlock the root of my ITBS. As Coach Jenny said in my log last week when discussing our discoveries and plans going forward, “...mobilizing the right spots can work wonders.”
I like this wisdom. It is certainly worth a try!
I experimented with a longer run a couple of Fridays ago. The original goal was 16 miles, but the modified assignment was to adjust for IT band pain. I took a resistance band along, and whenever the tell-tale “stress” popped up, I stopped, did some glute and hip activations, and ran some more. On that Friday, I stopped at 4.5 miles, 8 miles, 10 or 11 miles, and then finally at 14.4 miles into my run to perform these exercises.
The first three times it worked wonders. By paying attention to the precursors, I was able to avoid pain for quite a few miles!
But at the 14.4 stop, when I did the activations, my glutes—and particularly hips—felt extra fatigued. And it turns out that they weren’t all that willing to be re-engaged. When I went back to running after *that* stop, the stress on my knee was not gone, and after light jogging for not even another half mile, the “stress” progressed to pain. Time to tap out. 14.8 miles, though. Not bad!
This particular experiment gaves me great hope that I can further increase the distances that my hips can hold in there by continuing to strengthen them.
After that run, we rested the irritation that had already surfaced, and focused on strength. I executed my PT routine, and decreased mileage. Then this week, we continued PT and slightly increased mileage. And yesterday, on a “kinda’ long” run, I hit the pain point again.
Darn.
Strengthening is going to take time. Consistency is key.
And in the meantime, I’ve got to respect the inflammation with rest, not further aggravation. Patience is also key.
I knew when I started the assigned PT exercises, that’s it’s going to need to be a consistent part of my routine. At the moment, I’ve got three ITBS-specific supersets on the docket, three times a week.
Consistency may not be easy, but this I can do. If I can make time for eight trail miles on a regular training day, I can make time for an extra 30 minute PT session.
Especially if I’m spending less time on the trail, right?
Yes, right. This strength work is what will get me back out onto the trail; I’m all in.
But when that running time gets reduced even further, that’s when I wonder if my consistency even matters . . . I struggle more with patience.
Oxford Languages defines patience this way:
“The capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset.”
After yesterday’s flare up, instead of a back-to-back, I’m resting today: exercising that patience muscle.
Though I do enjoy a regularly scheduled rest day, truth be told, I’d rather be running. In the context of injury—forced rest—I’m not all that great at (emotionally) putting my feet up.
Literally, in this moment of writing, my feet are indeed up. It’s my spirit that doesn’t feel at rest. My internal dialog is definitely upset.
How long will this bout of ITBS persist? . . . How many miles can we increase my long run this week? . . . How many miles can I handle next week? . . . Are ultra-distances still an option for me?
It’s hard to trust the process when the process doesn’t look or feel like progress all the time. Sigh. I wish this process were a little more linear.
But my consistency won’t matter if I am not patient.
Honoring the strength building process means that I not only consistently perform the required PT, but that I also patiently take a day off running when my ITBS inflammation requires rest.
Does anyone else find it ironic that running is often the easy part of this ultra-running equation?
Here’s to hoping that the progress part evidences itself again soon—that my patience is rewarded—that the consistency-&-patience-training-approach builds my trust in the process . . .
. . . that in the meantime I can put my emotional feet up and really rest today.
I’m sorry about the set backs and I hear you about injury and frustration. Hope you can get the real rest you need.