photo: Abe Morrison

Saturday, February 19, 2011

Iliotibial band lengthening surgery recovery

Runners all deal with nagging and complaining body parts on occasion. My one issue has always been my IT bands. It first started in ~2003 while trying to ramp up my running mileage. I've cross trained in a lot of ways and very much enjoy hiking, cycling, climbing, etc. but I always return to running. I really only enjoy running on trails often with significant elevation changes. However, with any regular running comes a flare up in less than a month in either leg. The symptoms are classic with fairly intense pain right on the outside of the knee that practically goes away when I stop running. It has never bothered me while cycling.

After running a few ultra marathons, and not being able to do consistent training runs, I decided 2010 was the time to visit Jeremy Rodgers and figure out why I can't shake this syndrome. After several visits and a severely horrible year resulting (in my opinion) from an adverse reaction in both legs to cortisone shots into the bursa under the site of pain, I decided to undergo surgery to lengthen my iliotibial bands by Dave Grauer at Avista in Louisville, CO. I scoured the web for info on surgeries like this and found surprisingly little. I inquired running professionals such as coaches and massage therapists and posted on some forums and got the whole spectrum of advice. I'd tried everything from constant icing (frostbite scars to prove it), not running for months, consulting with massage therapists, physical therapists, and coaches, and completed long periods of directed strengthening, stretching, and foam rolling exercises. However I could not find any satisfactory personal experiences

The surgery involves making a ~1.5 inch incision just above the knee and making many small nicks into band as if you had a taut rope and continued to poke at it with a knife until it lengthened just a little bit. I had both knees done at the same time since they've both been problematic in the past.

Recovery wasn't too bad all things considered.
First 3-4 days: I couldn't really walk around but could get to the bathroom, etc. on my own without crutches. Although I was not allowed to shower or get the wound wet, or even remove the bandage for more than a week.
Next 2 weeks: Basically I had to teach myself how to walk again. It didn't just happen. I had to command my quad to pick up my foot, move it forward, place it down, shift the weight onto that foot and repeat. Foot placement was weird and painful. At the end of this period, I could walk 3-4 city blocks without too much problems. Although stairs presented a pretty big problem, and my knee caps were sore from the swelling.
Next month: Everything continued to heal well, but I was not allowed to run, hike, ski, etc. I think I rode my bike a few times just around town. I started physical therapy at Peak Form going about once a week. I had a pretty good vibe from PT although was a bit disappointed that only 1 of the therapists I'd seen over 5-6 visits was a runner, and got comments like "maybe you weren't made to run".

So after 6 weeks of recovery, my incisions were healed aside from a decent amount of scar tissue that I can't seem to work smooth (comment added a year later, small amount of scar tissue, but not an issue. If I squeeze it, it feels a little more solid than the rest of nearby flesh), and I was able to begin running again. I started with 0.5 mi jogs. In my 4th week of running, I ran 3x during the week (1-2 mi) with a longer hike (5 mi) on the weekend. If you read later posts, I chronicle the recovery with charts of weekly mileage.

My right leg with the scar visible at the bottom of the photo. The left leg scar is even more difficult to see.

I've noticed that I seem to feel looser if I run more often, so have been running consistently running 5 days a week, taking one day off during the week and another on the weekends. I slowly increased to 15 miles a week (1-3 mi, 4x during the week, 2 on a treadmill) and (6-8 mi on Saturday) with Sundays doing something else like cycling.

It's now mid February, and I've run 80 miles cumulatively in 2011 over about 30 runs. This is the most consistent I've even been, mostly because I haven't ever tried running such short runs of 1 mi, for example. I've drastically reduced my running speed on purpose, and work very hard on my form. Most runs are at 11 min/mi pace.

So far, my legs don't feel perfect, but I also haven't had any real cases of IT band pain or anything similar. I have some random aches around the knee areas like still some pain below the patella, and a little pain around the incision site. All things considered, I feel like my knees are mostly fixed and I look forward to a great future of running.

(Another note added about a year later, I often have some small annoyances which go away if I take a week off. I have ghost IT band pain after a run, it feels somewhat like it did in the past, but the next day I can run again and it never hurts during runs. This has mostly taped off throughout the year, and I've been able to mostly quit the stretches, PT exercises etc and run comfortably.)

6 comments:

  1. Dear Mr. Luther,

    How is it now another 1yr + after your post? I've got a similar story as you and am approaching 7 months of all conservative therapy that works in spurts but ultimately fails. I have a century ride scheduled in 1.5 weeks and after that I'm really thinking about the surgery.

    Thanks for sharing your story.

    Chris Andersen
    Orange County California

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    Replies
    1. Running better than ever right now. Try all other options first, look into dry needling/acupuncture if conventional PT can't get it tamed.

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  2. Hi, I am having extreme ITBS after an osteotomy to correct a deformity in my lower leg. The leg is straighter now and apparently, the stretch is too much for the ITB. I can barely walk at all on most days and nothing is working after 8 months of PT. Can you tell me how much that surgery costs?

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  3. I have been dealing with IT band issues for two years now. I have trouble sitting, standing, walking, ellipticaling, biking, running, everything! It is constant pain. I have been quite unimpressed with the level of care I have received treating this. I have seen 6 doctors, 2 P.T.s and a chiropractor, all of which cannot figure this out and don't understand why it hurts all the time. I have had 2 x-rays, an MRI, hip analysis, hip x-rays, and a gait analysis. I have been doing research on my own to try and get this problem underway. I have foam rolled, stretched, taken time off (1.5 years), massage therapy, astym, 2 cortisone shots, steroid pill pack, physical therapy, I swear I have done everything but seen a witch doctor in Africa/Samoa. I have been reading into the IT band surgery, but I would really love to speak with someone who has had this procedure done. Would you be willing to chat about this? I would like to know more about it, and schedule to have surgery in May (I am a teacher). I have lots of questions about the surgery, the recovery, and how you are doing now.
    My email is stephaniejensen08@gmail.com

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  4. Great to hear your experience with the surgery; thanks for sharing!

    I had a similar story though only one knee was affected. I'm 1 week post-op and have been looking for what to expect after the surgery. This is very good and detailed info on your recovery which is something I'll likely try to mimic (ability dependent) as I continue in my recovery. And yes, oh holy, sore knee cap! I'm also experiencing foot pain. If I could ask one question it would be, how did your range of motion progress? I could only bend my knee a couple inches from straight the first day and I now a week later maybe 6-8 inches. I'm assuming a lot of the limitation is from the swelling.

    Either way, thanks again, your experience was a great read.

    Hoping to get back to running,

    Healing in MN

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  5. Greetings!

    I appreciate everyone's dialogue on this issue as I have not found many blogs pertaining to the IT band surgery and the only blogs I do find typically comes from folks bashing the surgery who have not had the surgery.

    I also just had the IT Band surgery 12 days ago after suffering from EXCRUCIATING pain in both legs to the point that I ended up in the ER just from the intense pain. I couldn't walk and the sharp shooting pains got so intense that I had to crawl just to get to the bathroom at one point. Any weight I put on either leg was like a death wish. The 5 months prior I had moderate IT band pain before they turned into tight-ropes as well as super tight burning hips (TFL muscles).

    Prior to the surgery I had exhausted ALL other options including aggressive PT at two locations, chiropractors, acupuncture, foam rolling 5+ times a day, stretching until my eyes turned blue, pilates, yoga, Graston, ultrasound, cortisone shots, dozens of creams, supplements galore, myofacial release, doc appointments with 3 orthopedic surgeons, red light therapy, hundreds of dollars expended on professional massages... all to no avail. I used to miss running but now I just miss WALKING! Running became something like an addiction and I knew I was asking for trouble when I continued on my 10 mile per day excursions for 6 months. I just couldn't stop and now I am paying the price...

    Anyway, I finally found a doctor who actually seems to give a dam about his patients and cares about me finding relief. Other doctors continued to tell me just to return to all of the things that were not working. This time I told the doc that I wanted the surgery and it was my only option left. He said he would do it on one leg to make sure that it works and then we can decide about the other.

    Immediately after the operation I woke up (granted still on anesthesia) and felt overwhelming RELIEF! It was as if I had a brand new leg and that tight rope was gone. The only pain I could feel on my entire body was the tightness and pain in the other leg that had not been operated on (my right leg). I have been completely bed ridden since the procedure and have been really making sure it heals and is well rested. However, it has been 12 days now and I am starting to get a little nervous and anxious to see the results. I am able to walk but there is definitely a lot of soreness, swelling, slight sting here and there and some tension near the incision site (at the knee). The IT band itself seems to be improved but everything still feels a little tight and I am just hoping that everything is ok. I have been doing acupuncture and now my other leg is improving either from that or from the rest. Still, I am sure it will tighten up the minute I start getting active again (as ALWAYS) so I am likely going to get the other leg done if the results are effective on this one.

    My question is what is the timeline for your recovery? Have you noticed any abnormalities or glitches? I walked a good 6 blocks with a cane the other day and I think that is a good sign although I was limping along...

    I am just feeling so depressed and worried about everything and just hope it all works out!

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