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“My knee hurts” is such a common phrase to hear come out of a cyclist’s mouth that you probably wouldn’t even think twice if someone uttered it on a ride. As a Board Certified Athletic Trainer, I’m a firm believer that pain isn’t an essential part of exercise.
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While there are many structures and culprits of knee pain, IT Band Friction Syndrome (“ITBS”) has repeatedly proven itself to be a common cause. In fact, I’ve dealt with ITBS as a high school runner and a few years later, again, as a collegiate runner.
Then, once I was qualified to prevent, evaluate, and rehabilitate injuries as a degreed and certified athletic trainer, I began to see more cases of ITBS in endurance athletes than almost any other injury. It’s estimated that ITBS accounts for 22 percent of lower-extremity injuries. ITBS makes up 15 percent of overuse injuries in the knee region for cyclists specifically.1 It made me think: If ITBS is this common then why aren’t more people talking about it?
What is IT Band Friction Syndrome
The IT band (iliotibial band) is a long fibrous band that runs down the side of the leg. It is a continuation of the tensor fasciae latae (TFL) muscle which is a small muscle in the hip. The IT band runs from the TFL, down the side of the leg, and attaches at a bony landmark called Gerdy’s tuberacle near the side of the knee.
When the knee is flexed to 30 degrees, the IT band shifts backward and passes over the lateral femoral epicondyle. In other words, when you bend your knee, the IT band will pass over a small bony protuberance. Over time, the IT band and/or surrounding structures may become inflamed when the IT band is continually moving over this protuberance and causing friction.
Since cycling is characterized by repeated flexing and extending of the knee, it only makes sense that cyclists would be prime candidates to experience this overuse injury.
Signs and symptoms of ITBS
If you are experiencing ITBS you will likely feel pain or a burning sensation at the side of the knee that radiates down toward the foot. It may hurt to touch, walk down stairs or downhill, when fully straighten the leg, when the knee passes through 30 degrees of being bent, or when the knee is at 30 degrees in your pedal stroke.
Prevention and rehabilitation of ITBS
The main goal of prevention and rehabilitation of ITBS is reducing inflammation and tension in the IT band.
Increase training volume gradually: Since ITBS is an overuse injury, one of the best ways to prevent it is to gradually increase your training volume. Be sure to listen to your body, include appropriate rest in your training, and only increase your training volume by approximately 10 percent per week.
Ice: Ice decreases cell metabolism and therefore can help to minimize inflammation. Consider icing your IT band for approximately 20 minutes after exercise.
Strengthen the hips: The attachment of the IT band originates from the hip muscles; therefore, hip strengthening exercises are often the primary rehabilitation and prevention exercise recommended for ITBS. A few hip-strengthening exercises to add to your routine should include:
Fire hydrants: Assume the quadruped position, on your hands and knees. Lift your leg out to the side, slow and controlled.
Clamshells: Lay on your side. Bend your knees to 90 degrees and angle your hips slightly forward. With your feet together, separate your knees, by lifting the knee on top. To make this exercise more challenging, consider adding a resistance band around your legs.
Glute bridges: Lay on your back with your knees bent to 90 degrees and your feet flat on the floor. Push up to lift your glutes off of the ground. Start with normal glute bridges and then progress to single-leg glute bridges.
Lateral walks: With a resistance band around your ankles, sidestep. As cyclists, we spend so much time going forward that it’s important to also work the muscles that help to move us side to side.
IT band stretches: When the IT band is too tight, it can be pulled too taut as it passes across the bony protuberance. Keeping your IT band fibers loose can help to prevent or rehabilitate ITBS by reducing friction. Try the side-lying IT band stretch or the standing IT band stretch.
Foam roll: Finally, foam rolling can help to keep the IT band supple. When you foam roll, lay with the foam roller on your IT band. Move slowly, only one to two inches at a time. Pause and breathe deeply any time you feel a tender spot.
Play it safe
Remember to always listen to your body and to seek medical attention if pain persists. Riding bikes should be fun and I think it should be pain-free!
1. Lavine, Ronald. “Iliotibial Band Friction Syndrome.” Current Reviews in Musculoskeletal Medicine, Humana Press Inc, 20 July 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2941581/.