By Christopher Cudworth
Last Thursday I asked readers of this blog to tell me what vexes them in a piece titled “So tell me, what’s wrong with you.” If you’d like to submit your issue to We Run and Ride after reading this post, please do. We’ll crowdsource some replies and see if we can help.
My first three respondents are receiving a poster (as promised) that I designed…once I get their addresses.
What we’d like to do from here is to “crowdsource” responses to each of their problems. Some of you may have had similar issues. Others may actually be physicians or others with experience dealing with the problems they express.
Like the Car Talk Guys
I’m going to provide some baseline perspective on each issue. Mine is not a professional opinion other than my experience as a runner of 40 years and a cyclist for about a decade. I’ve also illustrated and helped edit a book on running biomechanics and worked in a running shop for a couple years. Our goal here is to provide a little consensus on the issue described and perhaps give our fellow reader enough information to re-approach their problem and perhaps find a cure. In the meantime, you can view my feedback much like Click and Clack on Car Talk. All advice is suspect until proven ridiculous. But if if works, who’s to complain?
Brenda Beason, an MBA who works in Real Estate for Weichart Hometown First in Florida. She responded through LinkedIn:
Brenda says: I’m training for my first marathon and I trained up to 19 miles and got an injury to what I think is my IT Band and an MRI done only to find out I have a medial meniscus tear and in the posterior horn as well. No marathon for me. This IT band has been 2 months of agony ? Put a cortisone shot in there; however, at times it still hurts. Running aggravates it. I have been biking a little not wanting to over do anything but trying to get my physical fitness maintained. Just feeling frustrated. Biking is not the same if you are a runner but it’s something. I’m afraid the IT band issue will be chronic. I am wondering if there is a correlation between the tear and the IT band because it’s in the same leg.
We Run and Ride answers:
Brenda: It sounds like there are a few things going on at once. First, the injury sounds like it had time to build, so it likely wasn’t the result of a tear resulting from a ballistic motion as would be the case with a torn ACL. IT Band injuries are generally (and often) the result of a biomechanical problem either farther down the leg or up the side of the leg to hip drawing on muscular imbalances or weaknesses in the supporting tissues or main muscles attached to the IT band. In other words, you’re out of whack.
Opposites do not prove attractive
What you’re dealing with is a tension and weakness issue. Something strong is pulling or torquing your iliotibial (IT) out of optimal position, resulting in the stressed IT band and possibly also the meniscus tear inside your knee.
Those conditions can occur several ways. First, if you increase your mileage quickly the IT band is often forced to deal with fatigued or overstressed muscles. That can lead to stress or tightness from hip to toe. If you also have pronounced pronation in the foot of that leg or even the opposite leg, your body is trying to compensate all the time. The longer you run, the more you stress the outside of your leg. Same holds true for cyclists. If you “grind” early in the season on the big ring before your legs are accustomed to riding hard and long, you can develop serious knee problems. Progress is related to acceptable levels of increased stress. Injuries most often occur when we exceed our body’s capacity for adaptation to stress.
I deal with weak hip flexors and have taken up yoga to help me strengthen those connective tissues, better align the pelvis and make up for 35 years of running without much stretching. I used to play a lot of sports like basketball and soccer, which greatly helped prevent injuries because it was great training for balance, etc.
Having torn my ACL twice, I can no longer do those sports, which means yoga is a great alternative. You are never in a position where you can’t control your actions. The stress you put on your body is by choice, not circumstance. That would be a great starting point for dealing with your IT band problems.
A tear of the meniscus is a sign of something deeper in the joint that is out of line. Either you jolted your knee at some point causing a tear in the cartilage inside your knee or else it is worn down from constant bio-mechanical stress. Among women, that can occur because the angle of your upper leg from your hip is wider. That can result in an inward rotation of the leg from the hip. Sometimes you see this in gals whose legs flip out from the knee on one side or the other, or both.
If you have never had anyone assess your running form, now is the time. If you have been running a long time, the meniscus tear may be a warning sign that you need to address the biomechanics of your hips, knees and ankles. A good running shop can help you with this, because other than by video, it can’t be diagnosed.
I use a pedorthist, who confirmed I have a leg-length discrepancy. Okay, cut the jokes about the male anatomy for a minute and focus on the issue at hand, so to speak. What a varied leg length might mean is that my body is essentially twisted and tilted from 40,000 miles of running with slightly different length legs.
For anyone this is a problem, and issues like these can grind down the inside of your knee cartilage if you do not diagnose and address them. I suspect your meniscus tear is the result of both a high mileage increase and a bio-mechanical issue. Is may go away temporarily with rest and time, but if you don’t fix the problem it will likely come back, especially at marathon distances.
Rotating your tires
The best analogy is why you rotate your car tires. If you driving them forever in the same position, they develop wear patterns from making the same turns, etc. Rotate your tires and things become more balanced and the tires wear longer.
The human analogy is that you must increase your muscular balance and strength while determining if your bi0-mechanics are disrupting the health of your stride. If they are, you may need to consider orthotics in one or both feet.
Physical therapy is also a great tool for rehabilitation of chronic injuries. A PT can usually do a few tests and see quite clearly where your problems start.
Dr. Cudworth may not be right
What do other readers think? That’s my take but it may not be right. What would you recommend for Brenda to fix both her IT band problem and torn meniscus? Stretching? Weight work? Surgery?
Please make your comments in the response below or send them to firstname.lastname@example.org