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Inflammation of the iliotibial (IT) band is a common cause of knee pain in cyclists, but the IT band is also one of the most commonly misunderstood parts of the body.
The IT band is a thick, fibrous collection of fascia, a type of connective tissue, that extends from the tensor fascia latae (TFL) and gluteus maximus at the hip down along the outer portion of the thigh to the knee. The IT band connects at the iliac crest at the pelvis to the tibia, just below the knee.
If you have pain along the outside of your thigh, hip, or knee, you may have IT band syndrome (ITBS), a condition caused by irritation of the IT band. IT band pain is highly prevalent in endurance athletes, such as cyclists and runners, with more than 15 percent of cyclists and 22 percent of runners experiencing it.
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Cyclists and runners try to do IT band stretches, typically by crossing one leg behind the other and driving the hip out to the side, but because the IT band is connective tissue and not a muscle, it can’t stretch, Bridget Dungan Twedt, D.P.T. and triathlete explains to Bicycling. That move does stretch the TFL which may give you some sense of relief, but the root of the issue isn’t tightness—it’s poor body mechanics, Dungan says, that result in friction or compression of the IT band and underlying tissue where it connects to the hip or the knee.
Therefore, if you have symptoms that include sharp or burning pain along the outer part of the knee and/or soreness and pain along the outer thigh, you may have IT band syndrome. Pain can stay localized or radiate up or down. If the sensation is more painful than average tightness and the feeling isn’t relieved with stretching (which would be associated with muscles, not your IT band), then your IT band may be aggravated.
How Riding Can Aggravate Your IT Band
Dungan says that excessive internal rotation of the hip and knee adduction (when the knee knocks inward) while cycling can cause irritation of the IT band or the fat pad that lies beneath it. This can occur as a result of weak glutes and/or poor neuromuscular control at the hip and/or ankle. She suggests that targeted strengthening and movement retraining with a movement specialist, such as a physical therapist, can help to correct these mechanics.
Foam rolling the IT band may help a little, but you’ll need to adjust your position on your bike or your body mechanics to permanently fix the problem, explains Jason Twedt, professional bike fitting specialist and owner of Bethel Cycle Works in Bethel, Connecticut. Because the IT band is active throughout the entire pedal stroke, cyclists tend to get IT band issues from friction or the “snapping” of the IT band over the knee joint.
“At the top of the pedal stroke, the IT band is active with the tensor fascia latae,” he says. “When the hip is extended to drive the pedals through the effective part of the pedal stroke, the IT band is active with the gluteus maximus.” In other words, this band is working as hard as you to push the pedals. Like most injuries, ITBS is an overuse syndrome that is usually exacerbated by poor pedaling mechanics and a bad bike fit.
So what can you do if you’re experiencing pain along the IT band before, during, or after a ride? Here are some suggestions from the experts.
IT Band Stretches (That Don’t Specifically Target the IT Band)
There is a place for stretching in treating ITB tightness—but it’s not stretching the unstretchable. Tightness may also result from stiffness of the connective tissue, which can be alleviated by self myofascial release in the form of massage or foam rolling.
To stretch the muscles of the hip and thigh, try the following stretches:
Figure 4 Stretch
Lie faceup with knees bent and cross left ankle over right thigh. Place hands around the backside of right thigh and draw right knee in toward chest while keeping left knee pressed away from you, lower back against the floor. Hold for at least 30 seconds. Repeat on other leg. Perform this stretch daily.
Lying Hip Stretch With Strap
Lie faceup with right foot extended up toward ceiling and left leg resting on mat. Loop a yoga strap or belt around right foot and perform a hamstring stretch by gently pulling the leg toward forehead using the strap. Then draw the right leg out to the left side, keeping it straight. Hold in this position for at least 30 seconds. Repeat on left leg.
Glute Exercises to Address IT Band Issues
According to research performed at Stanford University, strengthening the gluteus medius and maximus is the most important step in avoiding ITBS-related pain.
Clamshell
Place a resistance band loop around legs just above knee. Lie on left side with knees bent, and ankles, knees, and hips stacked. Rest head on left hand to avoid straining neck and rest right hand on mat in front of you. Keeping heels together, rotate right knee up toward ceiling as much as possible. Return to starting position. Repeat. Do 15 reps. Then switch sides.
Side-Lying Leg Lift
Lie on left side with legs extended out straight. Prop yourself up on left forearm and rest right hand in front of you on floor. Lift right leg up while keeping hips steady and facing forward (do not rotate backward). Lower down and repeat. Do 15 reps. Then switch sides. For an added challenge, wear an ankle weight or place a resistance band around ankles.
Glute Bridge
Lie faceup on the mat with a resistance band loop around legs just above knees and knees bent, heels close to butt, arms at sides. Contract glutes, and press into heels to lift hips up toward ceiling so body forms a straight line from shoulders to knees as you simultaneously press knees out to keep them in line with hips and maintain tension on the band. Pause, then lower. Repeat. Do 10 to 15 reps.
Hip Hike
Stand with left foot on a step, box, or bench at least four inches high with right foot hanging off the edge. Keep both hips squared forward and shoulders level. Place hands on hips for an extra visual aid and balance. Keeping left leg straight, no bend in knee, raise right hip directly upward and then use hip and core to lower right foot below the step. Repeat. Do 15 reps. Then switch sides.
Adjust Your Bike Fit
Twedt reminds riders that you have three contact points on the bike: your feet, your sit bones, and your hands. Everything in fit starts at the feet. This includes the cleats, soles of the shoes, and foot beds. If any of these are not properly adjusted, it will cause a knock-knee effect up the kinetic chain and contribute to IT band pain. Bike fitting is not a simple process so he suggests seeing a professional to make sure your bike is set up just right for you.
Foam Roll Your Muscles
Though the research on the effectiveness of foam rolling is not conclusive, it sure does feel good to experience that “hurts-so-good” pain. Instead of focusing on the IT band, though, try focusing your foam rolling on the quadriceps, glutes, and hamstrings to help your muscles warm up and cool down before and after rides.
4 Foam Rollers We Love
Amazon Basics Amazon Basics High-Density Round Foam Roller
Brazyn Brazyn Morph Foam Roller
Rest
If you are experiencing pain before, during, or after a ride, along with walking or performing daily activities such as going up stairs or standing, you may need to take a little break. By continuously performing the same repetitive motions that cause your pain without addressing the actual root of the issue (potentially weak hips or poor bike fit), you will only continue the cycle of more pain and inflammation.
