The long road back from an ITB injury

I wrote this piece in 2010, eight days post op and into rehab on my ITB. I often have people asking me about my injury and what I did to fix the issue. If you’ve had knee problems I hope this can help you.

After a long, hard 2009 season I took three weeks off to rest and recover. On the 20th December I started my training program and made the mistake of being super motivated for the year ahead and did a hard four-hour ride on my first day back. The following few days I did between thee and four hours and on then fifth day of training, toward the end of the ride, I felt a sudden weakening/ loss of power in my left leg from the hip down. This weak feeling was not associated with any type of pain while riding and I thought nothing of it until I stopped to have a drink and then when I stood up I experienced an excruciatingly painful stabbing feeling on the outside of my left knee. I called my girlfriend to pick me up in her car as I did not want to do further damage by riding home. I took two days off and iced my knee hoping this would sort it out. Two days later I decided to get back on the bike and see how it went. I was on the bike for 45 minutes pain free and then suddenly I was struck with severe pain and, was once again stranded on the side of the road. This time I could hardly walk or bend my knee without pain.

Two days before I began my training for the season I was chatting with one of our team sponsors, Anthony Nash and he had asked me if I had ever suffered from ITB syndrome (inflammation of the iliotibial band) and I thought to myself he was just another guy moaning about nothing. One week later there I was limping around with knee pain! I found myself in a huge panic as I had a big year planned with my team (then Medscheme) and the opportunity to race abroad with the SA National Team in Langkawi. So the pressure was on to get this fixed in a hurry!

The first thing I did was email Dr Jeroen Swart at the Sports Science Institute in Cape Town. Burry Stander pulled out of the ABSA Cape Epic in 2008 with severe ITB Syndrome and it was Dr Jeroen Swart that sorted it out. I needed his professional advice immediately. His questions to me were: is your bike set-up correct? Have you recently changed shoes? Have you fitted new cleats? Have you changed saddle?

I made a few changes to my cleats (turned the ankle slightly inward) and put my old saddle back on as I had changed my saddle to a newer one. However after a week or two I could still not ride any longer that 15-minutes without terrible pain. Dr Jeroen Swart suggested I come and see him for a bike set-up and a full individual anatomy analysis.

In the end I did not go to Jeroen and instead decided to see our team massage therapist, Hannes Van Der Walt, hoping to sort the problem out by simply loosening my gluteus and lower back muscles. Often ITB knee pain is caused by a tightening in these muscles which then creates added friction and greater pressure on the femoral condyle (boney prominence on the outside of the knee).

I also had intense physiotherapy everyday with my physiotherapist, Anna Theron. We did acupuncture, interferential current, TENS, ultrasound, Bemer (Bio-Electro-Magnetic-Energy-Regulation) and basically threw the textbook at it. After one solid month of rehab I was back on my bike riding 20-hours a week with very little pain but it would still come and go now and again and this is when I started panicking. I decided without my physiotherapist or massage therapists consent to see another health care professional nearby to where I live hoping he would sort me out even though I was well on my way to being fixed.

This was the worst thing I could have done. He ended putting aggressive cross friction on the ITB where it rubs over the bone to break scar tissue down that he felt had developed. I ended up limping out of his rooms and was told to train three- to four-hours per day and if I had pain not to worry as it was good to get the blood circulation going. I would continue each day riding with pain and would call him each day to ask if he was sure about me riding through the pain and he would say “trust me”!

Anyway I ended up doing a race that weekend and ended the race in such bad pain I could not drive home as I couldn’t even push in the clutch. This particular “Doctor” ended up putting me off my bike for another two months! This “Doctor” would book patients every 15-minutes, did absolutely no background checkups and asked no questions on the history of my injury, he just ploughed straight into my knee and damaged it further. I was just another patient swiping my card, it seems this guy was more interested in making money and not interested in helping people.

I was furious about how this guy handled and treated my injury, it was totally unprofessional. There are so many specialists out there that would rather make a quick Rand than help cure your problem with patience, so who do we trust to help us when we are desperate? The lesson is, do not panic and go looking for other people to help fix the problem. It is really easy to become desperate but injuries certainly require patience and time to heal otherwise you are going nowhere.

At this stage I really felt like I was living in my own world, people were telling me what “could” have started the injury but we still could not pin point what caused my sudden problems. I did not know when I would be able to race my bike again with my team and win races. Just shows you how quickly things can go wrong but I am a firm believer that things happen for a reason even when you can’t see it immediately.

Finally I did get on the plane to Cape Town to see Dr Jeroen Swart as my injury had now worsened as a result of incorrect therapy as I spoke about and it required a corticosteroid injection. I needed to get right to the bottom of this once and for all. The following is a list of what he did with me.

• Full Ergo fit bike set-up including cleats
• Measurements to see if I have a leg length discrepancy in either leg (femur, tibia)
• Flexibility test. Hamstrings, hip flexors and quadriceps.
• Confirmed ITB syndrome

However everything looked good, no obvious problems with my bike set-up. Leg lengths were equal but we did find a slight difference in the length of my femur left and right by one-centimetre however the overall lengths of my legs were equal and balanced out by the lower part of the leg on each side. This caused my hips to rotate on the saddle, adding tightness to my left ITB. We sorted this problem out by moving the cleat one-centimetre forward on my right shoe to compensate. The corticosteroid injection was used to reduce the inflammation under and around the ITB. This helped for two weeks and then the pain returned.

Dr Jeroen then sent me to Dr Gavin Shang at the Centre for Sports Medicine & Orthopedics as I was back in JHB and needed immediate attention. Gavin gave me a second corticosteroid injection to try and further reduce inflammation, but again two weeks down the line I was back to square one with lateral knee pain. I chose to have an MRI scan done to rule out any possible structural damage to the knee but the MRI scan showed a very healthy knee joint, but did confirm chronic inflammation around the ITB. It was at this stage that we decided conservative treatment was no longer an option as I am a professional cyclist and so I decided together with Jeroen, Anna and Hannes to go for surgery (lateral release of the ITB). On the 12 March I had my operation done down in Cape Town at the Life Sport Science Orthopaedic Surgical Day Centre by Orthopaedic surgeon, Dr Brendan Dower.