A Runner’s Knee Injury Opens Door to Alternative Healing

[The following is a guest post by Linda Tobia that chronicles her long, winding, and surprising road back from a knee injury.]

I ran sixteen miles today. It wasn’t particularly fast or effortless, but every time I run this far, it feels like a small victory. I am so grateful to be able to run. Eight years ago I developed a nagging pain on the outside of my knee that would not go away. I was ultimately diagnosed with iliotibial band syndrome (ITBS). The journey to heal my knee has been painfully slow, but brought with it insight and some powerful lessons about life.

When I was first injured I began with basic symptom treatment: icing, then over the counter anti-inflammatory medicine, followed by a doctor’s visit. My doctor’s advice, “You aren’t a candidate for surgery. Take anti-inflammatories. Rest. Maybe you should stop running altogether.”

Anti-inflammatories did reduce the inflammation while I was taking them but as soon as I stopped the pain returned. I started to look for other alternatives to traditional doctors. I asked my doctor for a referral to physical therapy, and on my own started massage therapy.

About six months after my initial injury, my massage therapist recommended seeing a chiropractor. I was very nervous about it given the narrow, negative view I had of this profession, but I was ready to try almost anything to be able to run again. Visiting the chiropractor was my first step toward opening the door of alternative medicine. After that, acupuncture and other alternative treatments did not seem outlandish.

Persistence turned out to be the key to my success. You learn something new from each practitioner you visit and that some doctors are better than others. I ended up seeing three physical therapists, four chiropractors, and two orthopedic surgeons. If I had given up on physical therapy or chiropractic treatment after my first experience, I would not be running today.

Persistence was also required to get to the root cause of my problem which turned out to be my low back. I have a couple of compressed discs. I’ve learned that sitting for long periods of time is the most aggravating activity, not running.

I also found that sharing my problem with others generated many great ideas and referrals; new perspectives gave me more alternatives to try and I found a great podiatrist, physical therapist, and chiropractor through personal referrals.

I’ve become skeptical of any practitioner who believes his “one” treatment will “cure” me. I believe it’s a combination of several therapies that have been so powerful in my success. The most successful treatments for my ITBS have been chiropractic care for my back, coupled with daily core strengthening and posture exercises, stretching and yoga, custom orthotics, supplements to support my joints, and improved running form. I continue to look for new options to support my ability to run. Most recently I’ve added myofascial release to my therapy regime. I’m seeing very good results. It seems to be the most effective way to relax my IT band.

Finally, the last lesson I want to share with you: it can require self-discipline, attention to detail, and a positive attitude to overcome a difficult injury. As runners, we have already developed these abilities. We rise before sunrise to get in a run before work. We set goals for ourselves to cover greater distances or to breakthrough to a PR. Through sheer bull-headed optimism, we can coax our bodies to run farther or faster than we previously thought possible. We can call on these same abilities to heal our injuries.

Addendum:
My journey to great running health continues to go down paths I didn’t expect. When I wrote the above article in 2009, I thought I had the perfect formula in place. I stayed open to new ideas, but I didn’t think I was going to need to tweak anything.

Well, I started having problems with a nodule on the instep of my foot, along the length of the plantar fascia. Running in my orthotics aggravated the nodule. When it first happened, I went back to my trusty podiatrist, who adjusted my orthotics and eventually gave me a cortisone shot. That worked for a while, but it flared up again a few months later. In frustration, I pulled out a pair of Vibram Five Fingers that I had purchased on a whim a couple of years before and I ran five minutes in them. I figured if I had to take a rest from my regular running, why not experiment with VFFs. While I rested my foot from regular running shoes, I started a very gradual build up with the VFFs. I liked the way it felt to run in them, and it just seemed like a good idea to use a more natural shoe. I want to run for the rest of my life, and I sensed that VFFs might be a worthy experiment in that quest.

Over the course of a year, I shifted a good portion of my running to VFFs and I’m doing the rest in neutral, cushioned, minimalist shoes. Right now, I’m in New Balance 101s for long trail runs and Newton’s for road running. I have stopped wearing orthotics and I changed my non-running footwear completely to shoes with hard soles, no arch support and a nice wide toe box. (My local shoe store loves me.) The nodule on the instep of my foot has shrunk to almost nothing. It never bothers me.

The experience with the VFFs just reinforces that I need to continue to be open to new ideas and try new things, while being careful to listen to my body and not throw away my tried and true approaches to healthy running.  Next, I’m thinking of going completely barefoot.  I’ll be the crazy lady you see on the trail without shoes.  Hopefully you’ll notice my joy in running, not just my lack of footwear.

Call for Comments (from Bryon)

  • Have you got a story of a long and winding path from running injury to health? If so, please share.
  • Ever find healing in an alternative therapy to which you were initially skeptical?

There are 20 comments

  1. Bartman

    Bryon,

    Thanks for posting Linda's story. What a truly remarkable journey back to health and running. I have heard it before some several sources that sitting for long periods injures more runners than running does.

    Eight years ago, because of a plantar problem my wife was dealing with we got involved with ChiRunning. Her injury was a real blessing for both of us. In Eve's case the results were nothing short of miraculous and we have both been avid "chirunners" since. Because of a ruptured disc in my lower back I would probably not be running today if were not for Danny Dryer's instructions and an excellent PT. It is often a team effort of key players that keep us moving. RFP, right Bryon!

    Good luck Linda with your continued journey and best of health to you.

  2. Chris

    Linda,

    Thanks for sharing! I too have had long term (over a year) IT issues. Like you, I've also noticed improvements with minimal type shoes: I did a head to head test of 4 shoes, and the best result was with the Inov-8 F-lite 195. (But it'll take a while to get used to the small cushioning…) Also Chi Running helped some, massage, and a 2 mm extra sole on the left shoe. But we do it because we love it!

    Did you ever get into the hip adductor/gluteus medius strengthen routines?

  3. Jeff

    I've found that I need to constantly tweak my regimin. As soon as I think I have running figured out, something pops up and I need to adjust my training, equipment or fuel. Great article Linda!

  4. Matt Smith

    With running injuries, the obvious assumption is that they are related to a specific weakness, the wrong gear, bad technique, etc.

    But sometimes, chronic pain has a psychological root cause. This is not to say that the pain or injury is not real, but rather that the mind (particularly the subconscious) has a significant influence over bodily mechanics and muscular tension, which can lead to several well-known 'syndromes', such as myofascial pain syndrome and fibromyalgia.

    Dr Sarno's books on the topic are renowned in some circles, especially The Mindbody Prescription. I personally overcame long-standing, severe neck pain without any medical intervention by using the techniques outlined by Dr Sarno.

    I suspect that some long term running injuries, particularly those that move from one part of the body to another (first knees, then hips, then Plantar fascia) have nothing to do with the 'wrong' shoes or over-training, but rather are related to some underlying psychological tension that is manifesting itself physically.

    Just something to consider when we talk about being open to alternate therapies to help cure our ills and keep us on the trail.

    1. Ric Moxley

      Matt – I thoroughly concur, and based on personal experience. Using the advice presented in Sarno's books, I've been able to work through, and even eliminate, pains that had previously prevented me from running. in retrospect, i am certain that at least two previous surgeries I've had were unnecessary, had i known the mind-body stuff.

      That said, I've also learned the hard way that pain can be a genuine indicator of a physical malady that has no psychological recourse. Using the mind-body connection theories that have worked for me in the past couple of years, i tried to resolve a growing pain in my forefoot metatarsal region … until i was reduced to a hobbling walk. The podiatrist at first thought i may have fractured a bone, but it turned out to be a massive bone spur growing off my 2nd metatarsal that was literally crashing into my 3rd metatarsal bone! Although I'm just a week beyond the surgery to remove the spur, and i'm still recuperating, the pain is clearly gone and I'm dying to get back into running again in a couple more weeks.

      So pain must be dealt with. And hopefully without surgery! But not always without. :)

  5. mtnrunner2

    I went through a similar knee trouble > minimalist shift, and am benefiting from it greatly. In my case is was knee tendinitis that wouldn't go away.

    I've found that the strictures of minimalist footwear shapes up my running form and keeps the knees running true. The quick cadence reduces all kinds of other pains and issues as well. I'm not as fast (yet) but I never really was fast to begin with! At least I can keep running.

  6. Dan

    A little over a year ago I also developed a pretty bad case of ITBS. I self massaged with "the stick" several times a day but it never seemed to get better. After fighting the injury for about 10 months, I switched to a more traditional foam roller. Miraculously, the foam roller cured my ITBS in a matter of only a few weeks. Rolling the outside of my upper legs hurt like hell at first, but now I can roll back and forth with all of my body weight on it virtually pain free.

    Sometimes a small adjustment can make a huge difference.

  7. Brad

    I've struggled a lot with ITB pain, Plantar Fasciitis, and stress fractures within the last 2 years in my Ironman training (haven't been brave enough to step up to Ultra-marathons yet). I've found that it all traces back to the start of my first office job about 2 1/2 years ago. Foam rollers and natural shoes have helped some, but my speed had been dropping like a rock, and I couldn't figure out why. Then I stumbled upon Foundation training. Its a posterior chain strengthening program, and it has worked a miracle in me. All the muscle wasting and posture degradation that has occurred from sitting 9 hours a day in front of a computer were the real culprit. After about 4 weeks of Foundation, I'm as fast as I've ever been, and my ability to absorb training is higher than its ever been. I'm projecting taking nearly an hour off of my next IM, based on projections from past experience. I would highly recommend it to anyone. It has really revamped my training, and my life as a whole. I've never felt so good! All it takes to overcome pain is an open mind, and a little hard work!

  8. Linda Tobia

    Chris,

    I have a whole core strengthening routine that I do regularly. It's a combination of exercises from two physical therapists. It does include a lot of hip adductor and glut work.

  9. Dave F

    Loved to run – I used to run 5Ks in the 90s and did only one 10K.

    I finally had to give it up due to a bad sacroiliac injury that would always reoccur after sustained running.

    8 years later…….

    October 2010, my buddy blindly buys me a copy of Born to Run. In reading it, I start thinking maybe if I tweaked my foot strikes to mid/forefoot, changed my cadence etc perhaps I could try running again. I slowly gave it a shot.

    I started getting regular miles in – bought a pair of FREEs, started going with more lightweight, less supportive shoes (room in the toe box to let my forefoot spread out)….. now I am known at work as the 'psycho running guy'. Run during lunch at work at least 3/4 times a week with a few other running pals – long run on the weekends. Bunch of 5Ks and 10Ks in the can, 3 half marathons and my first full marathon down. March 24th I am doing my first 50K and am totally stoked.

    For a guy who never thought he would want to run long distance and never actually thought he would be able to RUN again period……. I am pretty damn happy.

  10. Jeff

    I've battled ITBS for decades and have tried all the standard remedies: icing, NSAIDs, stretching, foam rolling, hip adductor/abductor work. After a video running analysis, I'm convinced that most of my problems are related to form, especially moderate heel-striking. I've upped my cadence, shortened my stride, and focused more on mid/forefoot striking. I do some of my work in Brooks Pure Grits, which help strengthen my lower legs and teach me to be more economical, but I also use my old PI Syncrofuel XCs for long runs, which eases the transition to minimal footwear. The problem has miraculously resolved itself after decades of problems. I think the single most important thing I did was to increase my cadence to 185-190. I have also been doing a simple kettebell swing routine, which has done wonders for chronic lower back pain I've had for years.

  11. George Harris

    Great stories of injury and recovery. In 2001 I had an issue was my IT band and was not able to run. At the suggestion by a friend I went to a chiropractor for treatment and was introduced to active release technique (ART) and was back to running after just three treatments. I have continued ART treatments weekly and I am convinced that I would not be running without it.

  12. chalky

    This post is very timely since it sounds very similar to what recently happened to me. My ITBS flared up after my 12 hour race at the end of December and put a big damper on my training. I knew my doctor would tell me "to rest, ice and take Advil" so I started using a foam roller daily to help release the tension and loosen my muscles. Low and behold, that seemed to work and my massage therapist recommended I see her friend — a sports chiropractor — for some more help to improve my core and alignment.

    A week later, the pain has subsided — more or less — and I have a better routine to strengthen my core. During my evaluation, it became quite apparent that my legs were about 10x stronger than everything else. I was always hesitant to see a chiropractor and deviate from solely running — I love it — but like Linda, I want to run until the end of time. It's amazing what a little bit of experimentation and an open mind can do.

  13. Brad

    It focuses on your posterior chain, and on opening up your hips. Due to lifestyle (ie sitting far too much) our joints that are designed to be mobile like the hips and mid back tighten up, so some of our motion has to come from areas that are designed to be stable (ie low back). Foundation strengthens the parts that are supposed to be stable, and loosens up the parts that are supposed to be mobile. It definitely makes sense in my book, and the results have spoken for themselves. Its done wonders for me and all of my family. Even my father who was facing back surgery is largely pain free, and they keep pushing his surgery back. They think he may not even need it anymore. I'd recommend it to anyone!

  14. Phill

    Thanks for the great post Linda. I always enjoy reading about how people have dealt with lingering injuries as like you said not all doctors are the same : )

    So many ITBS injuries! Everyone seems to agree that the foam roller is as effective as it is painful! When I got into running last year I managed to catch ITBS but two solid weeks of roller and hip abductor lifts with my duvet (We all have to improvise!) and it was gone. Couldn't believe it. 1 year later and not even a niggle!

    Best of luck with the running.

  15. marco

    Yes the foam roller is a must have if you are a runner. It has cured me of ITBS a few times before. Now I just do it for prevention. Also the forefoot running helped me enjoy more my running, or should I say the post run is not as painful as before. Now it's just tired muscles. Most of the runners I talk to that have suffered from ITBS all agree that the root problem is in the lower back or hip abductors. So I do a lot of preventive stretch and foam roller exercises and it seems to do the trick for me. Thank you for sharing your story.

  16. Dano

    Yes, another foam roller supporter here! I went through a couple years of on again off again ITBS and would go to physical therapy, strengthen and get better only to have it rear its ugly head again. A friend told me to get the foam roller that it had worked for him so I did. It was the best $20 I have ever spent. I use it daily after my runs and have had no ITBS since. I still do core and hip exercises, which no doubt help as well. Thanks for sharing!

  17. Maria

    Thank you, I needed to read that, remember that running already has provided me with the (mental) tools to heal. I need to have my old positive and open minded attitude about this road to recovery.

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