What the IT Band Is1 of 7
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 rump) 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. 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.
If you consider a cyclist pedaling at a moderate 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!
What Causes Tightness2 of 7
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.
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.
Cycling isn't considered a closed kinetic chain activity. (Closed chain activities are weight-bearing exercises or activities where the foot is in contact with the ground.) However, 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.
How to Fix It3 of 7
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 by self-massage using a foam roll or massage stick.
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 abates. 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, seek further evaluation. Lateral meniscus tears, articular cartilage lesions or arthritic changes can mimic ITB problems or may be concomitant issues. 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 stretching and core-strengthening program.
Bridging March4 of 7
Lying on your back, lift your hips to a full bridging position. Lift one foot off the mat while maintaining the bridging position. Do not allow your hips to drop. Return to start position. Now, lift other foot. Continue by repeating exercise.
Sidelying Clam5 of 7
Lie on your side with elastic band around your thighs just above your knees. Keeping your feet together, lift the upper leg off the lower leg. Lift only as high as is comfortable and do not allow your back to rotate. You should keep your spine stable throughout the exercise and isolate the motion to the hip.
Sidelying Hip Abduction6 of 7
Lying on your side, lift the upper leg again, isolating motion to the hip. Don't lift too high and keep the spine stable. You want to focus on keeping your leg in line with your trunk and your foot parallel to the ground.