Iliotibial (IT) Band Syndrome In Cyclists

This is a submission from Paul Glodzik, DC
An injury that often plagues cyclists as well as long distance runners is IT band syndrome. The symptom most commonly reported is severe pain just above the lateral aspect (outside) of the knee. This usually occurs when there is a sudden increase in training volume or improper bike fit. To fully understand how this occurs I will need to explain the anatomy and the biomechanics of the knee. The IT band is a tough thickened piece of fascia that starts at the lateral aspect of the iliac crest of the hip and extends down to the patella (knee cap), tibia (shin bone) and biceps femoris tendon (part of the hamstrings). Fascia is a type of connective tissue that surrounds muscles and tendons and allows the muscles to glide over each other more easily.
The IT band functions to stabilize the lateral aspect of the knee. It was believed that the IT band would rub against the lateral condyle of the femur (outside edge of the thigh bone) or a bursa (fluid filled sac) and cause pain. Newer research has shown that this is not the case. Most individuals do not actually have a bursa at this location.(1) There is a highly vascular fat pad that is located beneath the IT band at this location. When the knee is flexed (bent) the tibia rotates internally (inward) if there is no compensating external rotation of the femur (hip bone) the IT band increases compressive forces on the lateral aspect of the knee. The increased compressive forces prevent blood flow from passing through the above mentioned fat pad. With the decreased blood flow inflammation occurs within the fat pad causing pain. The pain is usually at its highest intensity when the knee is flexed at 30 degrees.
IT band syndrome is usually treated conservatively with rest, ice, anti-inflammatories (try Bromelain it is a proteolytic enzyme that has the same effect as aspirin or ibuprofen without the side effects of gastric bleeding and increased stress on your liver), stretching and rehabilitative exercise. In a small percentage of patients that have recurrent IT band syndrome surgery is performed to release the posterior aspect of the band.
If you notice that you are starting to experience pain in your knee that is similar to this the best thing to do is to take time off your bike. Now I understand that is not something most cyclists want to hear. It however may be a necessary step to reduce the pain. To aid in the reduction of pain stretching and rehabilitative exercises need to be completed. A recent study on IT Band problems suggests this stretch. Start by standing on the right leg and place your left leg behind and across the right leg. Make sure that you are close to a wall for balance with the right side closer to the wall. Now lean your left hip away from the wall and reach toward the left foot. You should feel a stretch in the outside of your left leg and hip. It is also important to have proper therapy performed on the IT band. There are soft tissue techniques, such as ART (Active Release Techniques) and Graston Technique, which are designed to help break up any adhesions that are present in the IT band.
More important than stretching is dealing with the cause in most cases. The gluteus medius (one of the deep buttocks muscles) is usually very weak in patients that have this syndrome. The gluteus medius is one of the external rotators of the hip and the muscle that is most active when attempting to stabilize the pelvis on one leg.. When your hip is flexed to 90 degrees the gluteus medius helps externally rotate your femur (thigh bone). When you are at the top of your pedal stroke both your hip and knee are flexed. This means that the femur should be externally rotated with the tibia internally rotated. With a weakened gluteus medius the femur stays internally rotated. This causes the fat pad at the lateral aspect of the knee to be exposed to the increased compressive forces from the IT band. The gluteus medius can be strengthened by performing exercises on one leg. By performing these activities the majority of patients who suffer from IT band syndrome receive relief of their symptoms. A good exercise to strengthen your gluteus medius is a one leg step down. Start with your right leg on the edge of a step and the left leg off of it. Now begin to lower yourself onto your left foot (make sure to land on your heel and not the toes). This is accomplished by sitting back and bending your right knee until the left heel touches the ground. Once you have touched the ground push back up. Do not let your right knee collapsing inward. Make sure to keep your knee over your foot. If you have any questions contact painfree123@gmail.com.
1) Khaund, R and Flynn, S Iliotibial Band Syndrome: A Common Source of Knee Pain American Family Physician 2005 Apr 15;71(8):1545-50