Support road.cc

Like this site? Help us to make it better.

ITB Syndrome

Since I have changed to my winter bike a couple of weeks ago I have been having knee trouble. It shows itself as tenderness on the outer edge of both knees. I did have a similar problem earlier this year when I went from winter to summer bike, and that sorted itself out after a few weeks. Since then I have bought a saddle for the winter bike to match that on the summer bike. I have also adjusted the seat height and fore/aft (relative to BB spindle) to be the same, so thought I would be OK. The effective top tube lengths are within 5 mm of each other for the two bikes, and both stems are the same length. The saddle height on the winter bike was perhaps a 2 or 3 mm too high when I first rode it a couple of weeks ago, but I have adjusted it down now. Could those few millimetres be the cause of my problem? Does ITB syndrome need prompt action, or can I keep riding? I already do quad, hamstring, hip flexor, upper and lower ITB stretches and use a foam roller after each ride, and have been applying an ice pack (frozen peas!). I am in my mid fifties and have ridden 3300 miles this year so far, compared to 3000 last year. Can anyone offer advice based on personal experience?

If you're new please join in and if you have questions pop them below and the forum regulars will answer as best we can.

Add new comment

13 comments

Avatar
physio_scott | 9 years ago
0 likes

Hi,
Did you get a full functional assessment as part of your bikefit? Something we always do as it is an essential part of the process. The fitter needs to understand you as a rider first, i.e. flexibility, range of joint motion, stability, esp around the pelvis. Only then can you tell where you should be within the suggested ranges, if indeed you fit within the ranges.

Can I also debunk the myth that you can alter the length of your ITB. You cannot. A foam roller isn't going to make structural changes. It is a tendon as has been said so cannot be treated like a muscle. Rolling up and down it with a foam roller will do nothing for it apart from cause you a lot of pain! You have to look at why it is overworking. Look at strength of the gluteal group of muscles. Are your adductors overly tight? Is there any pelvic or femoral torsion? A fitter has a qualification in the area of human function should be able to advise on this at the time of the fit or post fit if the issue develops.

Avatar
pcaley replied to physio_scott | 9 years ago
0 likes

Yes I did get a full functional assessment when I had the bike fit done, what will be 2 years ago now. I did go back earlier this year and have a position 'fine tune' to make sure that my position is the same on both of my bikes.
I think I will pay him another visit and see if he can offer any assistance now. Interestingly I rode 58 miles yesterday with my saddle slightly lowered and the problem seems to have eased considerably.
I have previously done exercises for gluteus medius from the following article, which I found very informative.
http://www.bikeradar.com/gear/article/take-care-of-your-knees-part-2-17445/
This was also useful
http://www.cyclingweekly.co.uk/fitness/training/injury-prevention-thigh-...

Avatar
pedalpowerDC | 9 years ago
0 likes

As previously mentioned, dropping your saddle to what may feel like absurdly low can be another fix. The rubbing of the ITB on the knee joint happens as you extend your knee to straight. If your saddle is low enough that you don't extend your knee so much that your ITB doesn't rub past the inflamed joint, then you avoid the motion that causes the inflammation.

I had a re-fit done (with a fitter with a masters degree in kinesiology) in light of the ITBS, and my saddle went from the top of an appropriate saddle height range to the bottom of it. It felt very, very low compared to what I was used to. I used it for a while, but did end up moving it up 5-10mm and into the middle of the range.

Avatar
pedalpowerDC | 9 years ago
0 likes

I would strongly suggest getting a proper diagnosis from an orthopedic surgeon who specializes in sports injury and has experience working with cyclists.

As for "pushing through" the pain, if it is ITB Syndrome, that could only make the problem worse. I encountered ITBS when I started back to training from a month break in the winter. In the time I was not cycling, my ITBs tightened up. The motion of cycling was keeping them stretched out. I ended up spending 3 months off the bike. I had to change docs because the first one didn't know anything about cyclists; he mainly dealt with college sports athlete injuries and old people needing joint replacement. I stayed off my bike and avoided leading with the bad knee up stairs (for 6 weeks) and, by the time I got a consult with the right doc, the swelling had gone down and pain had mostly subsided. I started physical therapy the next day working on strengthening the joint, further reducing inflammation, and stretching the ITB to avoid reinjury.

One way you could start working on a fix at home is using a foam roller to stretch out your ITBs. Alignment issues and tightness in the tendon are causes of the syndrome. Your ITB goes all the way from your butt to below your knee joint. Roll the whole thing with the foam roller.

Avatar
Paul J | 9 years ago
0 likes

So, on the advice to "push through" knee pain - I'm not entirely sure this is good advice. Knees (mine anyway) take ages to heal. The more you go on, the more damage you risk doing and it'll take even longer to recover. I find it better to take a break for recovery sooner rather than later if I get a knee pain.

Also, on frozen peas. I think you actually want to do exactly the opposite.

Cold is good for stopping swelling of injuries, by reducing blood flow to the area. It can also numb pain. It's good for the immediate aftermath of a *tissue* injury. However, once you're past the swelling stage, cold is bad for healing, because it reduces blood flow to the area.

To promote healing, I think you actually want heat, not cold. This increases blood flow to the area, which hopefully helps healing processes a little. I had a knee niggle recently and rested my knee on a hot water bottle when I could (e.g. in bed before going asleep). Note: your knee's surface temp shouldn't go above 40° - it shouldn't be scorching hot, just hot enough to get the blood going through there.

Avatar
ch | 9 years ago
0 likes

My knees become more sensitive in the cold weather.

Avatar
Jimmy Ray Will | 9 years ago
0 likes

And you mentioned that you now use the same saddle between bikes, is that right?

Reference the IT Band, I'd be happy to put a fiver on you being right, that it is the cause of the knee pain, and the patellar tracking problems of old.

The question has to be what causes it... if its the feet then what can be done, but have you explored how well your hips/femurs are tracking?

Avatar
pcaley | 9 years ago
0 likes

It's much worse on the left knee than the right. I don't think there is a fundamental problem with the set up as I have paid good money for a full bike fit including orthotic insoles. I use the same shoes cleats and pedals on both bikes. I started using the foam roller earlier this year at the same time as I started doing hip flexors. I think they got me over my problem back then. Whether it was the roller or the hip flexors which did the trick I guess I will never know! 7 years ago I suffered a patellar tracking problem on my left knee, so it seems to be a 'weakness' (or is it tightness) I have on that leg. I understand that both problems are caused by a tight ITB. I think I will increase the frequency and number of ITB stretches and foam rollering and see how it goes!

Avatar
sergius replied to pcaley | 9 years ago
0 likes
pcaley wrote:

It's much worse on the left knee than the right. I don't think there is a fundamental problem with the set up as I have paid good money for a full bike fit including orthotic insoles. I use the same shoes cleats and pedals on both bikes. I started using the foam roller earlier this year at the same time as I started doing hip flexors. I think they got me over my problem back then. Whether it was the roller or the hip flexors which did the trick I guess I will never know! 7 years ago I suffered a patellar tracking problem on my left knee, so it seems to be a 'weakness' (or is it tightness) I have on that leg. I understand that both problems are caused by a tight ITB. I think I will increase the frequency and number of ITB stretches and foam rollering and see how it goes!

When I had a bike fit done it actually made things worse for me, I guess adjusting things to be "correct" (by the measure of the averages that bike fits by necessity rely upon, everyone is different) whether or not that is what my body wanted. I ended up spending a few weeks (I only get to ride on weekends) iterating making lots of small adjustments to my cleats before I could ride pain free.

I have to say I was narked no end that an expensive bike fit process made things worse. It's not something I will ever pay for again.

Avatar
fukawitribe replied to sergius | 9 years ago
0 likes
sergius wrote:

I have to say I was narked no end that an expensive bike fit process made things worse. It's not something I will ever pay for again.

What did they say when you told them about the pain in your knees ?

Avatar
sergius replied to fukawitribe | 9 years ago
0 likes
fukawitribe wrote:
sergius wrote:

I have to say I was narked no end that an expensive bike fit process made things worse. It's not something I will ever pay for again.

What did they say when you told them about the pain in your knees ?

The chap spent a fair amount of time looking at Q angles and the like, but (to me at least) it felt like he was more interested in what the "ideal" position was.

In the interests of full disclosure, my knees would always be fine for the first ~20 miles or so (and were during the ~45 minutes I was on the turbo with the chap). It was only after the distance started going beyond that that i started experiencing serious pain.

For me, lots of internet research (Steve Hogg has a *lot* of info on his site) and numerous iterations of micro adjustments were required to get comfortable again. I spent a Saturday afternoon just doing loops of a simple 7 mile circuit by my house, making lots of small tweaks.

Avatar
Jimmy Ray Will | 9 years ago
0 likes

If its both knees then its something fairly fundamental with set up differences.

If you have addressed these now, you should find symptoms will go away over time, so push through. If not then its probably worth getting professional help with regards to bike set up and recovery.

How does the foam rolling of the IT band work for you? There are opposing arguments for doing so (I can't decide personally), but if the rollings not helping, try stopping for a bit and seeing if it helps.

Avatar
Tintow | 9 years ago
0 likes

In short - yes those few mm can cause it. I had exactly the same problem earlier this year although I only had pain on the outside of my left knee. I would be ok for about 20-25 miles but then the pain would start building over the rest of the ride. Dropped the seat by less than 5mm and the pain has gone away.
Another thing worth checking, if you wear different shoes on each bike, is that the cleat position is correct - cleats being to far forward or incorrectly angled can cause the same symptoms but if yours is on both knees with the bike being the only difference then it sounds like seat height.
Good luck.

Latest Comments