Since most of the 2020 season was wiped for everyone, opportunities to catch up and write race reports have been slim. But, even as orienteering and running races come back online, I still find myself on the sidelines. I’ve sadly been injured since December 2019 and I haven’t been able to solve the problem that first appeared a week after Kepler Challenge almost 1 year ago.
After placing 3rd at Kepler in 2019 – my 3rd attempt at the 60km race and my 2nd time on the podium – I went directly to Orienteering NZ’s Under 23 Squad training camp as a coach. I ended up taking part in a few high intensity sessions while still carrying fatigue from Kepler. Additionally, I had started on some dietary interventions to investigate my ongoing gut issues and had commenced a 3 month trial of a low carb high fat diet (LCHF) that week. I was definitely feeling fatigued that fateful week, but it’s hard to know which factors contributed most, and whether the damage was initiated at Kepler or just at the training camp.
I recognised the injury instantly, Iliotibial band syndrome (ITBS), and never ran through any pain. Then I had a week completely off, and began to reintroduce low intensity running and cycling. The injury was clearly lingering as the dull ache in the side of my right knee would emerge during even a 30 minute jog and progress up to 3/10 pain before I’d make it home.
I spent most of January on the bike. It’s great to have road cycling to fall back on both for aerobic training and a sense of adventure, in times when running has been problematic, and this strategy has been frequently employed over the years. It was also great to have a chance to test the benefits and drawbacks of the LCHF diet, and I was often doing 3 hour rides before breakfast with no sign of running out of energy. I also used a 5 day water only fast to super charge some of these fat burning adaptations and I’ll get into that in my next post.
January was still a satisfactory month with a structured approach to training, featuring long endurance rides, easy recovery rides, and also some tempo rides to test glycogen stores and learn more about how my body was responding to the new diet. But my physio and I decided we needed to give my leg a proper test. We were hovering in a no-mans-land where I wasn’t showing any symptoms of the injury on the bike, and nothing had been revealed in our biomechanics assessments, but I was too scared to run and risk further aggravating the injury. So I raced Sprint the Bay. Well, 4 out of 6 races at least, before my knee was too sore to continue. I then did a long run up Roy’s Peak in Wanaka a week later. When in Wanaka… That was very bad for my knee, but at least we knew that we had not made any progress with the interventions so far and so had to start looking elsewhere for solutions.
This was a turning point for the injury, but one of those turning points where the trajectory goes from almost recovered to very bad. The bad kind of turning point. I could feel the ITB on the side of my right knee flicking forward and backward with each step while running or riding the bike. Clunk clunk clunk clunk, with every cycle of my knee. I could only handle 5 minutes before the pain would hit 3/10. I became a walker, doing 75 minutes walks every day. My ITB would not clunk while walking, as the clunking was only at a certain point when the knee crossed through 60 degrees. The knee remains straight enough that there was no clunking and no pain. It was a this point that the world locked down and all sporting calendars were wiped clean.
The remainder of the year to date has been uneventful. Together with help from Sports Lab, we’ve made minimal progress. I’ve got my running back up to 2 hours a week a number of times, but had to reduce it again as the clunking and pain returned. Ultrasound and MRI scans have shown a thickening of the joint capsule (the tissue underneath the ITB). This is consistent with the flicking of the ITB over some structure as I bend my knee past 60 degrees, but it’s not clear whether this thickening has been driving the injury all along or whether this was a response from the abuse I gave it at Sprint the Bay and while romping in Wanaka.
I’ve also had a cortisone injection into the joint capsule in an effort to promote some healing and remodelling, but I’ve yet to come to a conclusion about that.
So it’s sad times for me, although I enjoy walking and listening to podcasts. I don’t know when I’ll be running again, but all my bets are off. I’m not in great pain, but the threshold of running training I can handle is just so low that pushing this 2 hours per week limit doesn’t achieve any longer term goals and is definitely not worth the emotional stress of knowing that you might be doing further damage. More updates to come including how I’ve managed to maintain reasonable fitness with such a long standing injury.
Hi Gene, this sounds rather familiar, and I know the frustration. I’ve been attempting to manage ITB issues in my right knee for about 15 years (and I’m ~30 years older than you.. ) brought on through a year or so of intense half and full marathon training and racing. I spent quite a while working with physios, doing various “recommended” strengthening and stretching routines and getting nowhere with it. Walking was ok, cycling on its own was ok but like you if I had stirred it up by running it would also complain when cycling. There is some permanent numbness externally and it’s not perfect, but it is now a LOT better. It sounds like you have been getting good professional help, but what worked for me was getting help (in my case Claire Aitkin-Smith, Applied Movement) to understand how I move… and more to the point, how I should move. Alignment of feet and arms while running, general posture etc. Which seems trivial, but I learnt a lot and it really helped me to be thinking about how I am running. Even now if the ITB starts to complain just thinking about where my feet are pointing can help. The other aspect was the expected core stability, but less about strength than engagement. Some really basic lunge drills (forwards and backwards) are key to this for me, along with some basic gym based core work. If I get lazy and stop doing them, the ITB flares up again. Anyway, you probably know all this much better than me, but I thought that I’d share my experiences. By the way, I’ve never found cortisone very helpful for overuse injuries, you have to sort the problem not the symptom. My other comment from too many years of various running injuries: to be in it for the long haul sometimes you just have to accept that a season has gone, and try and sort things out for the next one 🙂
Nice to hear your experience. It’s great you could share, not just for me but for other readers. I think Claire Aiken-Smith (appliedmovement.co.nz) is great!
It’s good that you have found the tricks for you. I’ve found the tricks for many of the other issues over the years, but this one still evades me despite trying all the typical things including those that you have mentioned. More posts to come.