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ITB + Cortisone=Boston?

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Schuey
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ITB + Cortisone=Boston? Empty ITB + Cortisone=Boston?

Post  wendy_miller Tue Apr 10, 2012 11:43 am

I've been gone for a while, but I've still been running. Leave it to me to make my reappearance in the injury forum.

So I ran my first ultra this past March--a 60K--and both the training and the race went really well. Zero injuries running high mileage, including 30 mile long runs. Ran a really good time at the race, finished third, all happy, etc.

The next time I ran after that race, I felt some pain in my left ITB. It was a short run, like three miles, so I just finished it. The ITB came and went for about a week after, then finally went away. UNTIL...two weeks ago I did a really hilly 20 miler. ITB pain the day after like a mofo during my 5 miler. It's been there ever since. I've hardly been running, been foam rolling, grastoning, all the normal stuff. If it weren't for the fact that I'm signed up for Boston, I'd just rest and let it go away.

However, I am signed up and have paid all my money. Though I'm not planning to "race" (legs too shot from ultra and I've not run much at all in the past month), I really want to go and run the race because my whole running group is going and we're running together. So my doctor gave me a cortisone shot to the ITB bursa (went in with the needle to my femur, withdrew a bit, then injected..ouch) yesterday.

I know you can't tell if cortisone has worked for a couple of days, and I haven't tried to run since the injection, but I guess what I'm getting at is--have any of you had this done? Did it work? How long did it take? I'm running out of time in terms of making a decision about getting on that airplane and of course all I do is sit around and needlessly/fruitlessly obsess about what I'm going to do. Yep, same old Wendy.
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Post  Michele "1L" Keane Tue Apr 10, 2012 12:22 pm

My bet is that with all the excitement and adrenaline of Boston, you won't feel a thing over at least 21-23 of those miles, and then well, you can tough it out for the rest.

I have had cortizone only in my heel once for PF, it worked, and I was running on it pain free in a few days. I did; however, defer Boston that year because of it. Could I have run - absolutely. Would it have hurt - absolutely. But then again I've got 20 yrs on you Wendy, so it takes a lot longer to heal.

I say if you run my pace Wink you'll be fine during the race, and then owe yourself the time off that you need.
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Post  Schuey Tue Apr 10, 2012 12:27 pm

Well first off all can say is that is bummer! Really when you invest the time and effort into something you wanted and waited for such a long time and then to have this come up.

I have had a couple of bouts with ITB and in one word it really sucks. The one good thing that I do know about ITB from research, experience and speaking with my sports doctor is that the ITB can not be injured anymore (another words you can't tear or pull it like a muscle) since it is one big tendon. The problem and the issue with it is that once that sucker gets inflamed it is tough to get it healed.

I have also found that the cause of ITB is normally caused by another area in the body. For me I have had being caused by piriformis muscle and lower back. Once I was able to loosen up those muscles then the ITB inflammation cleared up and I was good. Just recently after running JFK (which somehow I ended up putting the wrong lift in my shoe 1/4 instead of the 1/8 I ended up with a good case of ITB in my left leg! All because of that lift which tossed my left hip out of whack and ended up taking me 3 months of exercise, trigger point, etc. to finally get it to relieve. All the while I had to really cutback on my running due to not like the discomfort of running everyday twice a day with not having a whole lot of fun.

As for the cortisone shot I have never done it and to be honest I personally try to stay a way that type of stuff due to the other damage I feel it can do. I my outlook is that if I'm in pain running and it is stopping me from running I want to heal it 100% and not hurt myself more. Now the good thing for you is that it is the ITB and again from my understanding once it is inflame there is not any more damage you can do to it. Which then would mean it all comes down to how much pain can and how long you want to endure that pain? I guess for me it is one thing to deal with that pain for a 8-10 mile run vs. dealing with something like that for 26.2 to 50 miles. Also I think it depends how bad the ITB problem is. I can remember when mind was flared up at it is worst point it would stop from running and then there were times were yes it hurt but hey I can endure this pain and run through it.


So as to the question of running Boston or not really is a tough question and not something I would find to be a fun decision I would want to make. So good luck on that one, we are all different in making the choice on whether it is worth it or not worth. Again all I can say is that it sucks and trust me I have had my doubts about Boston myself this year. If it wasn't for the fact that I have finished 5 in a row and I want number 6 and would like to keep my streak alive it would be a tough choice for myself on whether I would be making the trip to bean town this year. So my choice has been one of running Boston as a training run to get ready for my two 50 milers that I'm running later this year and Chicago.

Good luck with you choice and I really hope you feel better!
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Post  Admin Tue Apr 10, 2012 12:28 pm

I'm sure you know that cortisone can weaken tendons. While rare, tendon ruptures have occured after a cortisone injection (particularly in the achilles tendon). I tend to believe that if you couldn't run it without the injection, then you shouldn't run it. Cortisone doesn't *heal* anything, it just stops the body's reaction that causes the inflammation. Whatever was wrong to cause the inflammation, is likely still wrong. Is Boston worth the risk of additional/prolonged injury?

All that said, if it were me would I run it anyway? Maybe...

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Post  Schuey Tue Apr 10, 2012 12:30 pm

Mr MattM wrote:I'm sure you know that cortisone can weaken tendons. While rare, tendon ruptures have occured after a cortisone injection (particularly in the achilles tendon). I tend to believe that if you couldn't run it without the injection, then you shouldn't run it. Cortisone doesn't *heal* anything, it just stops the body's reaction that causes the inflammation. Whatever was wrong to cause the inflammation, is likely still wrong. Is Boston worth the risk of additional/prolonged injury?

All that said, if it were me would I run it anyway? Maybe...

Wow thanks for the info Matt, I have always known that cortisone is not a great choice and that is why I do it. But I didn't realize even with the ITB that it could rupture that tendon due to it being such a big tendon. Thanks for the education lesson today! So when one opens their mind to others it's amazing what one can learn.
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Post  wendy_miller Tue Apr 10, 2012 12:31 pm

I would never, ever get a cortisone shot in a tendon. But the IT band is not a tendon, it's a fibrous band, more like fascia, and I got the BURSA sac injected, not the actual band. So I'm not worried about anything tearing or ripping since the medicine went into the bursa.

I am fully aware that the cortisone isn't going to "heal" it, and if I hadn't invested all this money into the trip and have time for some rest afterward, I would not consider it. I just don't want to go and DNF. So my question was about whether the shot is effective at covering up the inflammation.
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Post  wendy_miller Tue Apr 10, 2012 12:32 pm

Schuey wrote:
Mr MattM wrote:I'm sure you know that cortisone can weaken tendons. While rare, tendon ruptures have occured after a cortisone injection (particularly in the achilles tendon). I tend to believe that if you couldn't run it without the injection, then you shouldn't run it. Cortisone doesn't *heal* anything, it just stops the body's reaction that causes the inflammation. Whatever was wrong to cause the inflammation, is likely still wrong. Is Boston worth the risk of additional/prolonged injury?

All that said, if it were me would I run it anyway? Maybe...

Wow thanks for the info Matt, I have always known that cortisone is not a great choice and that is why I do it. But I didn't realize even with the ITB that it could rupture that tendon due to it being such a big tendon. Thanks for the education lesson today! So when one opens their mind to others it's amazing what one can learn.



The ITB is not a tendon, and the injection does not go into it. It goes into the bursa that lies beneath it. The ITB is not the source of pain--it's the sac underneath it that gets irritated.
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Post  Schuey Tue Apr 10, 2012 12:37 pm

wendy_miller wrote:
Schuey wrote:
Mr MattM wrote:I'm sure you know that cortisone can weaken tendons. While rare, tendon ruptures have occured after a cortisone injection (particularly in the achilles tendon). I tend to believe that if you couldn't run it without the injection, then you shouldn't run it. Cortisone doesn't *heal* anything, it just stops the body's reaction that causes the inflammation. Whatever was wrong to cause the inflammation, is likely still wrong. Is Boston worth the risk of additional/prolonged injury?

All that said, if it were me would I run it anyway? Maybe...

Wow thanks for the info Matt, I have always known that cortisone is not a great choice and that is why I do it. But I didn't realize even with the ITB that it could rupture that tendon due to it being such a big tendon. Thanks for the education lesson today! So when one opens their mind to others it's amazing what one can learn.



The ITB is not a tendon, and the injection does not go into it. It goes into the bursa that lies beneath it. The ITB is not the source of pain--it's the sac underneath it that gets irritated.


Not to be a smart ass or act dumb because I'm not I guess now I would like to know because from talking with my sports doctor and the below are you saying this is incorrect?


Anatomy

What is the ITB, and what does it do?

The ITB is actually a long tendon. (Tendons connect muscles to bone.) It attaches to a short muscle at the top of the pelvis called the tensor fascia lata. The ITB runs down the side of the thigh and connects to the outside edge of the tibia (shinbone) just below the middle of the knee joint. You can feel the tendon on the outside of your thigh when you tighten your leg muscles. The ITB crosses over the side of the knee joint, giving added stability to the knee.

The lower end of the ITB passes over the outer edge of the lateral femoral condyle, the area where the lower part of the femur (thighbone) bulges out above the knee joint. When the knee is bent and straightened, the tendon glides across the edge of the femoral condyle.

A bursa is a fluid-filled sac that cushions body tissues from friction. These sacs are present where muscles or tendons glide against one another. A bursa rests between the femoral condyle and the ITB.

Normally, this bursa lets the tendon glide smoothly back and forth over the edge of the femoral condyle as the knee bends and straightens.
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Post  wendy_miller Tue Apr 10, 2012 12:41 pm

No problem, Schuey. Yes, that is incorrect. But it is a very common misconception. It actually has properties of both a ligament (bone to bone) and tendon (muscle to bone), but it is neither. It is actually a stationary band, and the only thing that moves is the knee (specifically the lateral epicondyle of the femur). When the knee flexes, this moves to the front and back of the IT band, which causes the pain when an inflamed bursa lies beneath.

The IT band is commonly called the "iliotibial tract" because it is so unique. It's not called the IT tendon because it is not a tendon.



Here's the official definition: The iliotibial tract or iliotibial band (a.k.a. Maissiat's band, IT Band) is a longitudinal fibrous reinforcement of the fascia lata. It is attached to the anterolateral iliac tubercle portion of the external lip of the iliac crest and to the lateral condyle of the tibia.

But you are totally correct that people (including physicians) often refer to it as a tendon.
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Post  Randy E Wed Apr 11, 2012 3:09 pm

Hi Wendy, sorry to see you are having this problem. I spoke with someone a long time ago about this malady and this Dr. told me that many times a problem with the ITB can be caused, not by a tight ITB, but by a tight tensor fasciae latae. So, try rolling the tensor fasciae latae or loosening it up with one of your creative methods. That may help. Good luck.
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Post  Jeff F Wed Apr 11, 2012 3:54 pm

Randy E wrote:Hi Wendy, sorry to see you are having this problem. I spoke with someone a long time ago about this malady and this Dr. told me that many times a problem with the ITB can be caused, not by a tight ITB, but by a tight tensor fasciae latae. So, try rolling the tensor fasciae latae or loosening it up with one of your creative methods. That may help. Good luck.

+1 That is exactly what causes my ITB issues.
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Post  Jerry Wed Apr 11, 2012 5:09 pm

Wendy,

In case you are running, just a reminder, you only need 3:39:11 to beat Jerry's Boston time. Very Happy
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