Exactly one year ago I underwent a surgical procedure to alleviate a long standing and rather severe case of Iliotibial Band Syndrome, or runners knee. This is a very common injury involving a pathologic tightening of the iliotibial Band (ITB) causing sharp pain in the outside of the effected knee, likely due to a hip weakness. The uncommon part of my particular injury was its lack of progress with physical therapy. 95-97% of ITB related problems can be solved by conservative measures (skilled physical therapy and/or injections). Being a PT myself, the lack of progress was particularly distressing and preventing me from doing the one thing I moved to Durango to do, which was run on the beautiful mountain trails. After nearly 4.5yrs of hard work I opted to have a procedure called a Z-plasty performed by one of our local Orthopedic Surgeons.
Initially after surgery my knee was very stiff and painful, but I was able to walk the next day with only the support of one crutch. Within four days I returned to work at the clinic with onle a slight limp, icing between patients and staying late to do my own rehabilitation.
Rehabilitation for this type of procedure is fairly straight forward. In the beginning days/weeks a priority is placed on knee range of motion (ROM), especially for straightening. From there, making sure the muscles of the quadriceps are firing correctly and improving my wallking form were emphasized. Shortly there after (2-4 weeks) gentle hip strengthening began with the focus being placed on the Gluteus Medius.
The Gluteus Medius is responsible for abducting the leg, or swinging the leg out sideways. Also, when standing on one leg, it is the muscle responsible for keeping your pelvis level over the standing leg, preventing the hip from kicking out sideways. If this muscle does not work correctly, or is weak for some reason, there is an assortment of injuries that can result. Some research has linked this muscle to injuries of the ankle, knee, hip, and even lumbar spine (low back). It was going to be essential for me to get my gluteus medius as strong as possible if I was going to be able to run again pain free.
By 6 weeks I was permitted to begin jogging again, which was incredibly encouraging for me. It was by no means pain free, but I never had the stabbing pain in the outside of my knee that I had become so accustomed to after 2-3 miles.
With the nearly constant help of Dave Rakita PT, Ellen Tomsic PT, and my wife who is also a PT, I made good progress. The greatest challenge, as it is with our patients, is in fact being patient. The body has specific healing times that must be respected in the rehabilitation process. Knowing the appropriate timing and progression during recovery can mean the difference between running for fun a few miles a week and being able to compete at a high level again. It was with the guidance of other therapists who have the advantage of perspective (It is very difficult to be realistic in expectations when it is your own body in recovery. Even for a PT).
I spent much of the winter and spring of 2013 in the clinic and Durango Recreation Center weight room strengthening my legs, and most specifically my glutes. By the time June came around I was running pain free and with improved form. I continued to work hard on my therapy even though I was 7months post op. All of my hard work began to pay off in big ways. Not only was I running pain free, but I was able to challenge my self again. Running my first marathon, then a week later doing the Pikes Peak Ascent and setting a PR. However these were only stepping stones to my ultimate goal that I have had for nearly 10 years.
On September 28, nearly 11months after my surgery, I finished my first Ultra-Marathon. Not only did I finish the Devil Mountain 50K, but beat my goal time and in the process finished 5th overall, which was a completely unexpected result.
It was only with a tremendous amount of hard work and good guided therapy that I was able to finally achieve a goal that I had nearly given up on a year prior. Through this experience I have grown an even greater appreciation for the efforts that our patients give towards their own rehabilitation and training. These are scary times after surgery, but with hard work and the advice of trusted clinicians a 110% recovery truly is possible.
Stephen Stockhausen, PT, DPT