TMBRA - Rider Board

[LENO9]

Hey Doc,

I've been having problems with what I think is ITBS syndrome? I've been having the problem for approximately 8 months now. When I run I have this pain on the outside of my hip right where the hip bone protrudes. Usually the pain occurs after the run like a gradual ache. I have been to two Orothopedic doctors who both say it's ITBS and possible bursitis. They have taken x-rays which came back normal. I took a one month prescription of anti-inflammitories from the first doctor with little to no help and did not run for 6 weeks as instructed. I then started to gradually run and the pain came back. I went back to the same Ortho and he gave me a coritsone injection which seemed to help for a short time, but the pain came back. This went on for about 7 months until I finally went to another Ortho and he told me it was probably ITBS. He sent me to PT(going on 3 weeks now) but all they do is show me different stretching techniques that don't seem to be helping. All the doctors tell me is "don't run for 3 months."

My hip doesn't hurt when I ride but sometimes feels tight. I've been stretching regularly for most of the 8 months and all but stopped running. It doesn't hurt to walk but sometimes I can feel something rubbing over the outside of my hip bone almost like a taught rubber band would feel. If I lay on my right side(left hip is the bad one) on the edge of a table and drop my outstretched left leg behind my outstretched right leg as if off the table there is no pain. But, when I raise my outstretched left leg back up and roll my left leg the taught rubber band feel multiplies by about 10 and you can almost hear it roll over the bone. It will then begin to ache after doing this several times.

I know this probably sounds extremely confusing but it's the only description I can come up with. I'm beginning to think I'll never be able to run again. Please help, any suggestions would be greatly appreciated. Thanks.

[Anonymous]

Does it hurt when you drive? When you lift your leg out of the car?

[The Bike Doc]

LENO9:


Your symptoms and description of the pain and sensation are consistent with greater trochanter bursitis. The greater trochanter is the prominence of the femur at the hip on the upper outer aspect of the thigh. It can be aggravated by the iliotibial band which is a fibrous sheath that covers the muscles of the thigh and runs from the lower pelvis (the ileum to the top of the lower leg bone the tibia thus the name the ileotibial band. In iliotibial band syndrome (ITBS) the pain is typically located over the lower outer aspect of the thigh and outer knee. A tight ileotibial band can aggravate either greater trochanter bursitis, ileotibial band syndrome or both simultaneously, thus the stretching exercises to help loosen up the ileotibial band can be beneficial. The Physical Therapist often employs deep massages and myofacial release maneuvers to try to loosen up the tight ileotibial band.

Other possible causes of your hip pain include a strain of the muscle that anchors to the greater trochanter. Gluteus medius tendonitis can also have similar type of pain. These type of injuries are more likely due to a chronic strain or repetitive injury rather than an acute injury. Rarely the gluteus medius muscle can pull away part of the bone causing an avulsion fracture but this is less likely in your case as you have had two negative sets of hip X-Rays.

Treatment for all of the above possibilities includes resting, icing, physical therapy and tincture of time. For severe persisting bursitis due to an excessively tight ileotibial band that does not respond to conservative therapy, steroid injections and physical therapy, then orthopedic surgery to release the ileotibial band is a possible option.

Visit with your orthopedic doctor about your options and discuss long term treatment and recovery plans. Also explore with your doctor exercise options that you may pursue to help maintain your fitness while you are recovering, swimming is one activity that comes to mind.
_________________
Paul K. Nolan, MD
AKA: The Bike Doc

[LENO9]

Weegz,

No, it doesn't seem to hurt when I drive. Once I sit down or drive for a while and then start to walk, it seems stiff and then loosens up.

[LENO9]

Doc,

Thanks for the help. I went to PT again today and this therapist performed some deep tissue massage. She said my IT Band was extremely tight and had what felt like knots in it. She also said the hamstring on that same leg was tight. She recommended more deep tissue massages. I think I'll see a massage therapist for a deep tissue massage and then see the Ortho doctor in another week. I appreciate your help. Do you recommend staying off the bike as well as not running?

[The Bike Doc]

LENO9:

Lay off the bike for awhile because if you have an associated bursitis or tendonitis, it may well be aggrivated. Give it a two week rest and talk with your orthopedic doctor regarding when to step up your exercise again.

Thanks,
_________________
Paul K. Nolan, MD
AKA: The Bike Doc

[LENO9]

Thank you. Your the only doctor who gives me a straight answer.