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Grounded Runner Gets Back on Her Feet and Beats Her Best Time

Ultrasound-guided cortisone injection relieved a common running injury once it was diagnosed

NEW YORK—June 11, 2008

In 2006, 32-year-old Gayle White ran the Chicago marathon in two hours and 53 minutes, which was a record for the eight-time marathoner. Immediately after the run, however, she began feeling extreme pain in her left hip.

The pain, often felt in the thigh, hip and/or knee after running, was caused by a common injury in runners called iliotibial band syndrome. Usually referred to as the IT band, the iliotibial band is a thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee.

"My injury came on very suddenly and less than two weeks after the Chicago Marathon, I went out for a recovery run, and couldn't straighten my leg all the way," said Gayle. "I had to hobble home and had significant weakness and soreness in the entire left leg, mainly centering in and around my left hip, including my hamstring, glutes, and IT band. As with many running injuries, it was hard to pinpoint what was causing the pain and so I decided to seek treatment."

At the onset of pain Gayle immediately made an appointment to meet with Jordan D. Metzl, M.D., a primary care sports medicine specialist at Hospital for Special Surgery in Manhattan. As an avid runner and triathlete, having completed the Boston Marathon five years in a row, Dr. Metzl was familiar with Gayle’s pain.

“IT band syndrome is one of the leading causes of lateral knee, thigh and hip pain in runners,” said Dr. Metzl. “We recommend that the patient immediately begin a course of rest, anti-inflammatory medication and physical therapy. If the pain does not subside, which was the case with Gayle, we prescribe an imaging study, usually an MRI, to further investigate what is causing the pain and what is the best course of action.”

“Gayle’s MRI revealed abnormality to the IT band as well as within the left side of the hip where the trochanteric bursa, a fluid-filled sac that acts as a cushion between tendons and bones, is located. We commonly see these conditions in runners,” said Gregory Saboeiro, M.D., chief, Division of Interventional Radiology and CT, Hospital for Special Surgery.

“In collaboration with Dr. Metzl, we both determined that the best treatment plan would be an ultrasound-guided cortisone injection along the iliotibial band and into the trochanteric bursa to help reduce her pain. Ultrasound-guided injections using dedicated high-resolution ultrasound equipment are very precise and allow a radiologist to target the injections directly into the areas of abnormality, thus maximizing the therapeutic outcome of the injections. Also, direct real-time ultrasound during the procedure allows visualization of adjacent neurovascular structures and minimizes the risk of complications.”

"Gayle's pain in her hip was not only keeping her from training, but also completing her much needed physical therapy," said Robert Maschi, P.T., M.S., DPT, CSCS, advanced clinician, Sports Rehabilitation and Performance Center, Hospital for Special Surgery. "The guided injection played a very important role in Gayle's recovery and allowed her to continue a physical therapy regimen that was focused on seeing that she was not only able to run again, but also improve her overall performance."

"About a week after the injection I was back on my feet, completing physical therapy and also training again, which is pretty amazing given that I had not been running in over ten months," said Gayle. "I recently ran the Myrtle Beach marathon and beat my best time ever by finishing in two hours, 49 minutes and two seconds. I also finished first, which was an amazing accomplishment after what I had been through."

In addition to running marathons, Gayle is also participating in the JP Morgan Chase Corporate Challenge® as a team leader for Hospital for Special Surgery. The 32nd annual JPMorgan Chase Corporate Challenge® in New York is scheduled for Wednesday, June 18, and Thursday, June 19, in Central Park. The 3.5 mile run attracts thousands of participants each and every year. Gayle is also a member of New York Road Runners and will be running the New York City marathon in the fall.

According to Dr. Metzl, the following training habits can cause IT band syndrome:

  • Running on a banked surface (such as the shoulder of a road or an indoor track) bends the downhill leg slightly inward and causes extreme stretching of the band against the femur
  • Inadequate warm-up or cool-down
  • Increasing distance too quickly or excessive downhill running
  • In cycling, having the feet "toed-in" to an excessive angle
  • Running up and down stairs

Dr. Metzl recommends that runners always warm up before a run, monitor aches and pains and consult with a sports medicine specialist when experiencing pain before, during or after a run.

About Hospital for Special Surgery Department of Radiology and Imaging

Hospital for Special Surgery (HSS) Department of Radiology and Imaging has the largest and most experienced academic musculoskeletal radiology faculty in the world, each with academic appointments at Weill Cornell Medical College. HSS radiologists are board certified by the American Board of Radiology and have received numerous awards by professional and honor societies, including the Consumer's Research Council of America Guide to America's Top Radiologists. The Department's focus is diagnosis of musculoskeletal conditions and diseases and their treatment utilizing image guidance. More than 200,000 musculoskeletal examinations are performed annually, of which approximately 150,000 exams are conventional radiography, 24,000 are Magnetic Resonance (MR), and 12,000 are Ultrasound (US) examinations. Other modalities include Computed Tomography (CT), Nuclear Medicine (NM), and Teleradiology. All images are acquired digitally and transferred to the referring physicians via PACS.

HSS Radiologists are committed to excellence and under the direction of Dr. Helene Pavlov, radiologist-in-chief, emphasize that diagnosis depends on quality image acquisition and expert interpretations and that “all images and imaging are not created equal." For more information on the Department of Radiology and Imaging at Hospital for Special Surgery, contact 212.606.1132.



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