After dealing with IT band pain for about six weeks and listening to Rob tell me I should go see a doctor about it for just about as long, I finally decided he was right. It wasn’t worth risking a $700+ investment to try to save $100 dollars by not seeing a professional.
So I did a quick search of my tri club’s Facebook page for a good physical therapist and saw something interesting. A physical therapist right near my work offered free running analyses to members of my triathlon club. Free?! That’s only my favorite word! I quickly called and made an appointment for 6:30am the next morning.
Because I needed to get in my strength routine before the running analysis, it was an early, early morning for me. I was up at 4:35am, which would have been more doable had it not been just a few days after the time change. But I managed to wake up and make it to my office’s gym in time to do my workout there and make it to my appointment on time. David, the physical therapist, was very personable, and I felt at ease right away. I tend to feel pretty uncomfortable and awkward around people, so the fact that I felt at ease in this new situation speaks to his bedside manner (is it still called that if someone is a physical therapist and not a medical doctor?).
He asked me a few basic questions, and I told him about the IT band pain I’d had recently. Because it was early and I wasn’t functioning all that well, though, I told him it was on the left side when it was on the right side. I’m really not good with rights and lefts, and I must have just gotten confused and turned around. The test itself was simple enough. I jumped on a treadmill and set it to 7.6 mph. David measured my cadence and took some videos of me running, both from the back and from the side. I ended up running for about four minutes, and then we discussed the data. It was surprisingly simple, and he e-mailed me the still shots of me running afterwards so I can even include them here for reference.
We went over two shots from the back—one of my left foot striking and one of my right foot striking. We discussed the following measurements on each side: the angle that my opposite hip dropped when striking the ground, the position of my knee in relation to a straight line between my hip and heel, and the position of my foot in relation to the midline.
My right side actually looks pretty solid on most of those points. The angle of the hip drop should be less than 10° and my foot hits right on the midline where it should be hitting. As you can see, though, my knee turns in a bit instead of staying in a straight line. David said this could be part of what is causing the IT band pain.
My left side looks a little worse, despite the fact that I haven’t struggled much with pain on the left side. Especially after looking at the shots from the side, I suspect I may have been unconsciously compensating for pain. I tried to run normally, but that’s easier said than done. On the left side, you can see my hip drop angle is right at the 10° mark that it shouldn’t go over. No real problem there, but it’s not quite as good as my right side. On this side, my knee is in line with the rest of my leg, but my foot crosses over the midline too much.
We also went over how bouncy I am when I run, or how much up-down movement there is for each stride. As you can see, I’m moving up and down about 12.5cm every stride. I wish I could recall exactly how much I should be moving, but I recall I was over the ideal. David didn’t seem all too concerned about it, though, and said that my bouncing up and down as much as I was wasn’t as much of a problem as it would be if I were shorter.
The video from the side is where my main problem with my stride appeared. Again, my left foot strike is worse than my right foot strike, quite possibly because I was subconsciously changing my stride with my right foot due to my recent pain. With my left foot, you can see that the angle at which my heel first hits the ground is 14°. That’s too much. What that reveals is that my foot is probably too far forward and my leg is probably too straight when it hits. You can see that the angle of my bent knee is around 8°. It should be around 20°. A straighter leg causes a more jarring impact and also forces your knee to absorb that impact instead of your quads. (Oh, I’m also standing up too straight and don’t have much of a forward lean.)
My right side is better. My foot is at an 8° angle when my heel hits the treadmill which results in my knee having a much better (though still a little sub-par) angle of 15°. Again, I do not have enough of a forward lean, which is something I’ve heard since high school.
As we discussed my running mechanics, David also noted that my cadence was a little slow. The nebulous “they” say running cadence should be 180 steps per minute. David said his opinion was that the metric is a little restrictive. Apparently, that study was originally done on elite marathoners, and he noted that we are not all elite marathoners. Still, my cadence was 172 steps per minute which he thought was a little slow. So he suggested I try upping it to 178 steps per minute.
He had me hop on the treadmill to try it out. We set the pace back to 7.6 mph and he turned on a metronome at 178bpm and had me match it with my pace. Lo and behold, my over-exaggerated heel strike was fixed! Basically, when I sped up my cadence, I shortened my stride which caused my foot to strike closer to my body and which transformed me into a mid-foot striker. Magic! While it didn’t fix everything with my stride (my lack of a forward lean is just as prominent as ever), most of the more troublesome aspects looked much better.
So, with a little advice and some encouragement, he sent me out the door. I asked him when I should come in for more IT band help if this advice and my strength training didn’t clear it up, and he suggested I give it two weeks. If, after stretching, strength work, and form improvement, I was not seeing any improvement in two weeks, I should come back in. I still wanted to take that week of training very easy in regards to running. After the longer run the previous weekend, I felt my IT band could use a little rest. A couple of days later, I did a 15 minute run on the treadmill using a metronome. I could feel the difference in my stride, and my knee held up really well. I was feeling positive, like there was a light at the end of the injury tunnel.
Then, over the weekend, I went for a long bike ride. I didn’t feel my IT band at all during the ride, which isn’t surprising because I’ve never felt it on a bike, even at its worst. The next day, I headed out for a maybe-hour-long run with the intent of stopping early if I felt pain. Much to my surprise, even with a quicker tempo, I started feeling pain literally two minutes into the run. After five, I realized it was going to keep getting worse, so I just stopped and walked back home. I was at a loss after this. Since this was the worst pain I’d had in weeks, it made sense to suspect that my long bike ride had something to do with it (correlation is not causation, but it is cause for suspicion). However, since cycling didn’t seem to hurt, or even irritate, my IT band. My only guess (which could be completely wrong) is that my legs were fatigued enough on Sunday from my long ride the day before that it caused my form to disintegrate faster than usual. So, since I was told to wait two weeks anyway, I decided to avoid doing my runs on days after a long or hard bike ride.
Despite this last-ditch tactic, I get the feeling I’ll be calling up the physical therapist on Friday and scheduling an appointment for early next week.