ITBS Questions

[Guest ThatGuy]

I've been jogging for the past 13 years of my 14 year career in the AF. When I was enlisted in the AF, we took the bike test. But I decided to switch over to the officer side and I jogged about 6 days a week in college. Just so I could get a pilot slot and be the fastest guy in my AFROTC detachment. Jogging 6 days a week made me unstoppable on the track.

I don't even say running, I call it jogging because my dog is normally by my side. I say jog so I get out there and do it at a leisurely pace. You think you are going at a leisurely pace but its pretty fast to everyone else.

I developed Iliotibial band syndrome (ITBS) so I listened to the doctors and I've been taking it easy. This past year the flight doctors said running (jogging) six days a week was too much and my body needs time to recover after a jog. Its something I've done since college.

I was actually in a lot of pain after attending physical therapy at my home base. I'm currently TDY and I attended physical therapy while at my TDY location which hasn't helped at all. I did some research and found many runners have resolved ITBS by attending ASTYM and ART treatments. After returning to my home base for the Christmas break I saw a physical therapist who practices ASTYM. Basically she rakes plastic tools over your injured ares to help regenerate new tissue and to help break up scar tissue which typically occurs with ITBS. I was only able to see her twice during my one week break.

I wanted to try ASTYM and ART because I believe I may have some scar tissue that has built up. But my TDY location does not have any therapists who offer the treatment. Closest place is 3 hours away. I will have to wait until I return back to my home base in a month to attend ASTYM/ART treatment sessions. The therapist I saw at home and who practices ASTYM mentioned glute strengthening and gave me some at home exercises to perform. After the exercises didn't help my pain I started to use the machines at the gym to help strengthen my hip abductor muscles and glutes. I also started just doing basic stretches for running. My hip pain has subsided and the flight doctors at my home base told me they will need to do an MRI to determine whether scar tissue has built up around the hip area and around the knee. To stay in perfect shape I have been riding the exercise bike and lifting weights to maintain my physique. Trying to jog 1.5 miles again in the past have resulted in my leg hurting the next day. I haven't tried since the pain has subsided but I am weary of pushing my luck.

I have never failed a fitness test in my active duty career (9 years as an officer). For my next test I will have to do push-ups/sit-ups only. I have 6 years remaining before I can officially retire and I do not want to retire at 15 years. Additionally, I am a major select now. I want to know with my ITBS will the AF still allow me to make it to 20 years, even if they can't get me back to my jogging form again? My last run time for my fitness test as a 35 year old last year was 9 mins 58 secs. Will the AF give me a waiver from jogging for 6 years if I can't be fixed? I know if ASTYM/ART can't help my next option may have to be surgery. I really miss jogging. I would rather jog 2.5 miles for 19 minutes than sit on a bike and ride for 45 minutes.

Edited February 17, 2015 by slick999

[Danny Noonin]

...Just so I could get a pilot slot and be the fastest guy in my AFROTC detachment. Jogging 6 days a week made me unstoppable on the track.

...To stay in perfect shape I have been riding the exercise bike and lifting weights to maintain my physique.

Slick. what the fuck.

[Warrior]

Try yoga. Seriously.

I had IT band issues, though not as serious as it sounds like yours. On a deployment I started doing yoga in addition to running and lifting. Haven't had any problems since. But I used to not stretch much either.

[deaddebate]

words

I think you actually have three questions:

How do I get better?

Can I keep flying?

Can I stay in the Air Force?

I'll ask JediDoc or JCJ to advise on the actual treatment options and care. Your other concerns of whether the Air Force will "keep" you is probably over-blown, and I hope I can put you at ease. Starting at the beginning, recognize that retention and continued flying are separate standards.

So, to focus of retention first, realize there is no such thing a multi-year PT test waiver (profile/DLC/AF 469/AF 422). All PT exemptions have a maximum of 365 days (the regulation says they can be extended to 455 days, but the ASIMS program doesn't actually support that very easily, so nobody does it).

You may hear stories about folks that are retained on ALC with "permanent waivers," but that is not the actual coding. The "waiver" must be re-evaluated every year, and renewed with whatever recommendations are appropriate at that time, as the condition improves or worsens. And this is a real possibility for you--if your knee concerns are significant enough to prevent deployment for a year continuously, you will likely undergo IRILO (aka MEB) consideration. Now, MEB's are not as big and scary as people think they are, and there is a small gray area where the PT test requirements are slightly higher than the deployment and AFSC requirements, so conceivably you could get annual "waivers" without ever actually getting an IRILO, but that is statistically uncommon.

Regarding your continue flying, it also depends on how your FS interprets the injury and your ability to perform your duties, then contrasting that with the AF Medical Standards Directory (MSD) and the waiver guide. Realistically, musculoskeletal (MSK) waivers are pretty darn common and usually easy to process.

Finally, none of these questions will get definite answers now. You should continue to focus on your recovery in the immediate future. Waivers and IRILO isn't really pushed until after 9 months or so of fitness limitations in most cases.

[jcj]

I don't know as much about this diagnosis (I'm a general surgeon, not orthopedics) but the attached article looks like it's a really good resource. It's evidence-based & from a very reputable source. If you have any option to see a provider (either a PT, Family Med doc or Orthopedist) with additional training in sports medicine I think that'll be a bonus. If you happen to be @ LRF, there is a sports medicine fellowship trained family medicine doc (civilian AME) who is working there as a contract doc in the Med Group on base. He's a personal friend & really good - PM me & I'll give you his name.

Everyone I know who does yoga swears by it. I think it's for real. I keep promising myself I will start one day.

ITBS article.zip

Edited February 20, 2015 by jcj

[deaddebate]

I don't know as much about this diagnosis (I'm a general surgeon, not orthopedics)

"I'm a doctor, not a milkmaid!"

You got most everyone else beat, though. Thanks for posting.

Everyone I know who does yoga swears by it. I think it's for real. I keep promising myself I will start one day.

I tried it recently, with a routine that focused on weight loss/flexibility. That shit is no joke--it's a workout but with low impact. The biggest downside is it takes much longer. 20 minutes of normal calisthenics becomes an hour of yoga.

[Guest ThatGuy]

I think you actually have three questions:

How do I get better?

Can I keep flying?

Can I stay in the Air Force?

I'll ask JediDoc or JCJ to advise on the actual treatment options and care. Your other concerns of whether the Air Force will "keep" you is probably over-blown, and I hope I can put you at ease. Starting at the beginning, recognize that retention and continued flying are separate standards.

So, to focus of retention first, realize there is no such thing a multi-year PT test waiver (profile/DLC/AF 469/AF 422). All PT exemptions have a maximum of 365 days (the regulation says they can be extended to 455 days, but the ASIMS program doesn't actually support that very easily, so nobody does it).

You may hear stories about folks that are retained on ALC with "permanent waivers," but that is not the actual coding. The "waiver" must be re-evaluated every year, and renewed with whatever recommendations are appropriate at that time, as the condition improves or worsens. And this is a real possibility for you--if your knee concerns are significant enough to prevent deployment for a year continuously, you will likely undergo IRILO (aka MEB) consideration. Now, MEB's are not as big and scary as people think they are, and there is a small gray area where the PT test requirements are slightly higher than the deployment and AFSC requirements, so conceivably you could get annual "waivers" without ever actually getting an IRILO, but that is statistically uncommon.

Regarding your continue flying, it also depends on how your FS interprets the injury and your ability to perform your duties, then contrasting that with the AF Medical Standards Directory (MSD) and the waiver guide. Realistically, musculoskeletal (MSK) waivers are pretty darn common and usually easy to process.

Finally, none of these questions will get definite answers now. You should continue to focus on your recovery in the immediate future. Waivers and IRILO isn't really pushed until after 9 months or so of fitness limitations in most cases.

I am for certain I can deploy. My leg won't keep me from doing that at all. I just know running makes it worse or standing for long periods of time for some odd reason. I wouldn't have to do any of those things while deployed or as an aviator. When this happened the flight doctor was like we are NOT going to say you cannot deploy because of this condition.

[ISRNSTR]

Similar problem here. I am already a pilot for the USAF and have deployed already and flown with this issue (doc already knew before signing me off for deployment) so I can prove I can do my primary duties of flying. However, I have bad ITBS which stops me from running the 1.5 mile run the last couple of times. ITBS only happens from running, totally fine outside of that. I complete the remainder of the test with no issues and am in good physical shape. Is this a type of issue that would DQ me from continued flying if I keep getting waivers for it for the run? Is there such thing as a long term waiver for this or do I just need to keep going back every 6 months? I have done physical therapy in the past but to no permanent solution as this issue keeps coming back. I do not want to keep pushing through the injury since I have read that ITBS can get pretty serious if you push it too far. 

BLUF: I have ITBS which makes it so I can't do the 1.5 mile of the PT test, was wondering if this issue and or waiver will keep me from flying (I know there are different standards for active pilots). Any regulation guidance would be helpful. Can PM more details if needed.