IT BAND SYNDROME – OUCH!!!
Commonly known as “runner’s knee,” IT band friction syndrome also plagues cyclists. Symptoms include pain on the outside of the knee, tenderness and sometimes swelling. Pain can be dull to ice picky, oh my ___ make it stop shooting pain.
I know the drill – I had the incredibly painful ice pick in the outer knee IT band friction syndrome. It hurts! Luckily, I had successful IT band surgery back in 1990 after experiencing quick onset of that acute, debilitating pain. I was racing on the prestigious and phenomenal 7-Eleven cycling team and shattered my collarbone (four pieces, compound, through the skin…2 surgeries…but that is another story in itself) and as I worked to regain fitness being off the bike, I incorporated some running into my training. The hard trail running on uneven surfaces, coupled with a lot of trainer riding, put my IT band in a tizzy. Thankfully, I had the best in the world in the form of Boulder’s famous Andy Pruitt. He and a small team of docs got me in and out – cut the inflammed IT band out – and I healed quickly and have not experience pain since – even with four marathons and lots of cycling training later.
If you’ve been riding and/or running for a while, chances are you’ve experienced it. Here is a breakdown of what IT band friction syndrome is and how to address it problem.
IT pain is typically associated with prolonged, repetitive activity – however, the advanced cases may cause pain when simply walking or going up and down stairs. You may feel stiff or tight after periods of inactivity and especially after prolonged sitting.
The iliotibial band (ITB) is a tendonous and fascial band that originates on the iliac crest (hipbone). It also attaches to the gluteal muscles (your bum) and the tensor fascia latae (TFL). The TFL is the muscle on the outside of your hip that moves your leg outward.
As the ITB travels toward the knee, it narrows and attaches to the outside of the tibial plateau (the top of your lower leg bone) with fibers also extending over to the patella. The band often feels palpably tight and can almost be strummed with your fingers on the outside of the knee.
The syndrome occurs as the band slides across the lateral femoral epicondyle, a bony bump on the outside of the femur – a little bony bump just below the outside of your knee (ask me to show you my scar there some time…!) As your knee flexes and extends repeatedly, the band can become inflamed. During a pedal stroke, the band crosses the epicondyle once on the down stroke and again as the knee flexes back to the top of the stroke. This pic from Athletes Treating Athletes shows where it typically hurts:
If you consider a cyclist pedaling at a cadence of 90 rpm, that would equate to 180 slides per minute. On a two-hour ride, the ITB will cross the knee 21,600 times..wowza.
Many factors can contribute to the problem. One is muscle imbalance, where some muscle groups are tight and others are weak or fatigued. The basic cycling position can feed these imbalances.
Tightness, or a loss in flexibility, can occur in the hip flexors, hip abductors and internal rotators. Correspondingly, it often helps to strengthen the hip extensors, abductors and external rotators. And, little known fact that week glute muscles (glutes are considered part of the core) can also be a big contributor.
Other things that can cause IT band syndrome are alignment and bike fit. Even with good saddle height and position, problems can arise from misalignment of your feet and ankles. People who tend to be bowlegged are often more at risk. However, a more common issue is the person who tends to be a pronator, or flat footed.
In cycling there is a nearly constant downward force on the pedals. Although there isn’t the impact associated with running, there is still a tremendous amount of room for joint movement in the ankle, hind foot and mid foot.
As downward force is exerted on the pedal, the foot pronates, resulting in associated internal rotation and abduction of the hip and knee. This creates increased tension on the ITB and a higher degree of friction.
If foot and/or ankle misalignment is an issue, the problem can often be addressed with a good set of shoe inserts. In severe cases, custom orthotics may be necessary. It is also important to ensure proper cleat placement so the knee tracks properly over the foot and pedal.
FIX IT HOW?
Treatment of IT band syndrome includes stretching, massage and frequent icing. Although flexibility of the ITB complex isn’t typically an issue, stretching can be beneficial (especially during the healing process). Massage promotes blood flow to the affected area and can minimize scar tissue formation. This can be done by a professional or self massage or using a foam roll or massage stick. Sometimes, however stretching and rest is not enough and active release techniques (A.R.T.) is required.
The good news is that, often, you don’t have to stop riding completely. Exercise can promote blood flow and be beneficial to the healing process. However, you probably should curb the intensity and duration until the inflammation goes away. If the stress on the affected tissues can be reduced and the pain subsides, begin to increase your riding time and intensity.
If your symptoms don’t improve, get more help from docs. Lateral meniscus tears, articular cartilage lesions or arthritic changes can mimic ITB problems. However, it is always best to catch and address the problem early. Better yet, get on a program to reduce your risk and address any factors you know may contribute to the problem.
For example, if you know you are a pronator, get inserts in your shoes now—not when the pain starts. The best prevention is by ensuring proper alignment and fit as well as being consistent with a yoga program and ensuring core strength is solid.
This pose below – one knee bent, one straight – is a great example of an IT band stretch targeting primarily the upper (hip) end of the band. More stretches can be found in my other blog posts.