| Condition | ITB tendinopathy, left knee |
| Prior Treatment | 2 years of PT — stimulation, heat, stretching, standard exercises |
| Prior Recommendation | Stop running |
| How He Found Us | Online research after refusing to accept “stop running” |
| Root Cause Discovered | Old ankle injury affecting kinetic chain |
| Treatment Protocol | F-ESWT + radial shockwave + Anatomy in Motion + chiropractic + targeted strengthening |
| Outcome | Pain-free, running 12+ miles |
The Presenting Complaint
A 26-year-old male runner came to us with left knee pain that had plagued him for two years. He’d tried standard physical therapy — stimulation, heat, stretching, generic exercises — but none of it worked. His doctor’s recommendation was clear: stop running.
He refused to accept this answer. Running wasn’t just exercise for him — it was his passion, part of his identity as a young athlete. He wasn’t ready to give it up. So he did his research, found CityIR, and came in seeking a real answer: what was actually causing his knee pain, and could it be fixed?
Treatment Approach
The Evaluation: Finding What Others Missed
Our deep evaluation revealed the key: an old ankle injury that had never fully healed. This wasn’t causing obvious problems in isolation, but it was disrupting his entire kinetic chain. The ankle instability was forcing compensatory patterns up through his knee, overloading structures that weren’t designed to carry that burden.
The diagnosis was ITB tendinopathy — inflammation and degeneration of the iliotibial band where it inserts at the knee. But this wasn’t a knee problem. It was a symptom of a broken system below it. The IT band was being overloaded because the ankle and foot weren’t functioning properly, which threw off hip mechanics, which rippled up through the kinetic chain.
Shockwave Therapy: Focused and Radial
We performed four sessions of focused extracorporeal shockwave therapy (F-ESWT) targeting the distal ITB tendon insertion — the exact point where pain was originating. This focused energy breaks down scar tissue and stimulates healing at the tendon attachment.
Alongside this, four sessions of radial shockwave addressed the broader fascial tension throughout the IT band itself. Where focused waves hit a precise point, radial waves disperse energy across a wider area, treating the band’s overall tension and inflammation. Together, they addressed both the localized tendinopathy and the broader tissue dysfunction.
Learn more about our shockwave therapy protocols.
Rehabilitation: From the Ankle Up
But shockwave therapy alone wouldn’t fix the root cause. We had to rebuild the foundation.
We started with targeted ankle stability work on his previously injured ankle — retraining proprioception and strengthening the small muscles that had atrophied during two years of compensation. Chiropractic adjustments addressed joint restrictions that had developed. We applied Anatomy in Motion principles to restore proper gait mechanics, teaching his body how to move correctly again.
Finally, we implemented targeted strengthening of his hip and pelvic musculature — the muscles that stabilize the entire lower chain. These had never been addressed in his prior PT, even though they were critical to his recovery. By fixing the ankle, restoring movement patterns, and strengthening supporting muscles, we eliminated the compensatory stress on his knee.
See how chiropractic care integrates with our rehabilitation protocols.
Recovery Timeline
| Weeks 1–2 | Shockwave protocol initiated. Ankle stability work began. Pain during running started noticeably decreasing. |
| Weeks 3–4 | Continued shockwave sessions. Hip and pelvic strengthening introduced. Able to run with significantly less pain — approaching baseline capability. |
| Weeks 5–6 | Treatment phases completed. Movement patterns corrected. Running completely pain-free for the first time in two years. |
| Week 8+ | Back to 12+ mile runs with zero pain. Maintains strength and movement pattern work to prevent recurrence. |
The Outcome
A young runner told to stop running was back to 12+ mile pain-free runs in under two months — because we found and treated the root cause that two years of standard physical therapy never identified.
Why This Approach Works
Standard physical therapy often treats the symptom at the site of pain. When a patient has knee pain, PT focuses on the knee. But knee pain in a runner frequently originates elsewhere — in the ankle, hip, or foot mechanics.
This case demonstrates exactly why a comprehensive, whole-body evaluation is essential. We didn’t just look at the ITB and the knee. We traced back through the kinetic chain, found the dysfunction at the ankle, and addressed it from the ground up. The ankle injury was the root cause. The ITB tendinopathy was the consequence.
By fixing the cause instead of just treating the symptom, we didn’t just mask pain — we solved the problem.
Disclaimer: This case study represents one patient’s experience and does not guarantee individual results. Outcomes vary based on individual factors including injury severity, adherence to treatment protocols, and baseline health status. Always consult with a healthcare provider before beginning any new treatment program.