If you have never heard of the iliotibial band (ITB), consider yourself lucky. For many cyclists (and runners), their first introduction to their ITB is when they suddenly notice a dull or sometimes sharp pain on the outside of their knee.
After a long ride or through overuse, friction of the iliotibial band (ITB) against the outer part of your knee joint can occur, resulting in pain that can also be accompanied by stiffness and swelling. This is commonly known as ITB syndrome.
In best case scenarios, rest, icing and ITB-specific stretching and exercises can prevent the pain from reoccurring. In worst case scenarios, cycling short distances may become very difficult and your ITB may become chronic.
So What Is Your ITB?
The ITB is a tendinous connective tissue tract that originates on the iliac crest (hip bone), where gluteus maximus (the largest gluteal muscle) and tensor fascia latae (a small hip flexor) muscles insert into the tract. The IT band is continuous with the lateral intermuscular septum beneath it, which is one of the areas to focus on when trying to resolve the condition.
With pedaling, the band crosses over the epicondyle repeatedly and this can irritate the tissue.
Common Causes of ITB Syndrome
Sometimes there is no apparent reason for getting ITB friction syndrome apart from simple overuse, but more often than not there is an underlying cause or combination of causes.
- Muscle Imbalance: A muscle imbalance, where some muscle groups (hip flexors, quadriceps) have become too tight, while others (hip abductors and extensors) have become too weak or fatigued.
- Improper Bike Fit: An incorrect bike set up, such as a saddle that is too high or at the wrong incline or cleats that are too close together, can also be a contributing factor (and can cause the previously mentioned muscle imbalance).
- Leg/Pelvis Discrepancies: Differences in leg length or incorrect alignment of the pelvis.
- Foot/Ankle Pronation: Excessive ankle/forefoot pronation can significantly stress the shin and outer thigh, despite the foot arch being supported in a fixed position.
As previously mentioned, rest is one of the most important things you can do if you experience ITB pain. Anyone who has experienced ITB problems will tell you that you simply can not work through ITB pain and it is not smart to try because you could make it chronic. And while you are resting, consider getting a professional bike fitting; ensuring a proper fit be worth every penny when it comes to injury prevention.
Self Help: Exercises
There are ITB-specific stretches and strengthening exercies that specifically target your ITB, such as hip flexor stretches or rolling your ITB along a foam roller. Click here to view exercises.
Physical Therapists can use various other techniques that can help to reduce symptoms and manage the condition. Therapies such as dry needling, soft tissue massage (e.g. Graston Technique®), trigger point release as well as other modalities like laser and ultrasound can be used to help reduce soft tissue tension/swelling around the ITB. A physical therapist can also create an individualized exercise program to diagnose and address biomechanical dysfunction that may be causing the problem. Learn more about Physical Therapy at CVMC.