ITB injuries in Cyclists
Iliotibial Band (ITB) Syndrome can be
a serious overuse injury in cyclists that requires
prompt treatment. The ITB is a thick fibrous band
that runs along the outside of the leg from the
hip to the knee. ITB irritation results from repetitive
friction of the ITB across the lateral femoral
condyle on the outside of the knee. With each
pedal stroke the ITB is pulled forward on the
downstroke and backwards on the upstroke. If irritation
is not alleviated early enough chronic inflammation
and fibrosis will occur. A cyclist with ITB will
complain of a sharp stabbing pain on the outside
of the knee and a loss of power.
The development of ITB can be attributed to a
number of factors.
Training Errors as a result of a marked
increase in mileage and intensity without an adequate
training base can lead to injury. Excessive hill
work and pedaling at too low a cadence can also
increase stress on the ITB.
The most common cause of ITB is the smallest amount
of Malalignment between the cyclist and
the bike. Whether anatomical or equipment related,
malalignment will place significant stress on
the distal ITB.
Anatomical Abnormalities include a Varus
Knee (bow legged) which will increase the
stretch along the outside of the knee. Spacers
placed between the pedals and the crankarm can
reduce stress by widening the cyclist's stance
on the bike. Excessive Pronation will also
increase the stretch on the ITB by internally
rotating the lower leg. Over the counter foot
beds such as superfeet; or custom made orthotics
can correct this. Cycling orthotics differ from
running orthotics in that they are longer, providing
additional support under the metatarsals and are
made of a stiffer lighter material such as carbonfiber.
A Leg Length Discrepancy will cause excess
ITB stretch on the shorter leg. Shims can be placed
between the cleats and the pedals to correct a
true leg length discrepancy. Minor inequalities
can be alleviated by setting the cleat of the
shorter leg forwards and the longer leg backwards.
Functional leg length differences often due to
muscle imbalances should not be corrected in a
bike fit. A Tight ITB can cause excessive
friction across the outside of the knee. An aggressive
ITB stretching routine should become an essential
part of training.
Malalignment caused by an Improper Bike Fit
can increase friction and stretch on the ITB.
This can be caused by a Saddle position
that is too high or too far back. A Cleat
position that is excessively internally rotated
(toe in) will also increase stress. Cleats should
be aligned to reflect the cyclist's natural anatomic
alignment or can be slightly externally rotated
to reduce stretch on the ITB. Pedals with float
allow the natural rotation and lateral movement
of the lower leg to occur. Pedals with free float
and no stopper however can cause excess strain
as the lower leg fights to stop the movement.
In summary ITB pain should be addressed ASAP to
avoid a chronic debilitating injury requiring
time off the bike and the possibility of surgery.
Treatment may simply require backing off on your
training, addressing any malalignment issues and
starting an aggressive stretching routine. If
this is not sufficient, ice, rest, non-steroidal
anti-inflammatories and modalities may be necessary.
ITB pain is certainly preventable and can be quickly
eliminated if treated early.