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.