The Cyclists Guide To Treating Iliotibial Band (IT) Syndrome

Cyclists IT Band Syndrome

Aside from your screaming lungs and thighs on that last hill you just climbed, cycling should be painless. You shouldn't have lingering knee pain when you get off your bike.

Knee pain is one of the more common complaints cyclists have.

Pain on the outer edge of your knee is less common than anterior or posterior knee pain. However, it occurs quite commonly in runners and is surprisingly common among cyclists as well.

This outer knee pain originates as a result of irritation of the iliotibial band.

IT band location

The iliotibial band (IT band) is a ligament running from the pelvis to the shin. This ligament provides critical stability to your knee and leg.

On its way to the shin, the IT band runs across the later epicondyle on your femur (bony protrusion at the knee), and it is at this point of contact the irritation occurs.

Once irritated, the pain is surprisingly persistent and can set your training back by months. It haunts you throughout the day and forces you to find creative ways to stay in shape while not doing cardio.

Quickly identifying the root cause and aggressively rehab of the ligaments on the outside of your leg is essential.

Most riders only experience IT band pain as a result of overuse. If you have just finished a century ride and are experiencing IT band syndrome, then it might only be that you've inflamed the IT band from the long effort. Take some aspirin, ice it, and give it a week off → 13 Ways to Get Rid of Muscle Soreness

Keep in mind ITB syndrome will often allow you to continue to ride with minimal pain. However, after the ride, the pain will likely flare again and remain persistent while at rest.

If the pain continues, it is necessary to take aggressive action towards getting relief.

Identify Underlying Causes

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There is an unlimited number of causes behind an IT band inflammation. Typically, it stems from a muscle imbalance or tight ligaments. However, you can often live pain-free with that imbalance for years until something new causes it to flare.

That trigger item could be something as simple as a new pair of running shoes. Or new pedals or cleats. Or a long road ride on your new bike that hasn't been properly adjusted to you, yet (or, worse, is the wrong size).

Here are 4 of the most common suspects to examine. You'll notice many of them will potentially require the help of a professional bike fitter to identify and resolve.

1. Leg Length Discrepancy

This is a less common cause of ITB syndrome. If one foot is shorter than the other, it creates excessive pressure on the iliotibial band. To compensate, shims should be added to the cleat of the shorter leg, to create an equal and even basis for pedaling.

In some cases, cyclists may fight lower back pain their entire lives, before eventually discovering -- thanks to an ITB flare -- that they have a leg length discrepancy.

2. Improper Q Factor

The width between the pedals is called the Q factor. The Q factor does not vary much between the different bicycle brands. Until recently, there has been very little research done on the biomechanical effect these different pedal spacings have on your body's performance.

Q factor is one of the newer suspects when it comes to knee pain. However, it makes plenty of sense. If you are riding a bike with a narrow Q Factor, this forces your foot to angle inwards, placing greater pressure on your shin and increasing the likelihood the epicondyle will press on the ligament.

An easy action step is to adjust your cleats so your foot points slightly outwards. It might also help to move the cleats as far to the inside of the shoe as is possible (moving the cleat towards the inside of the shoe, pushes your foot outwards).

3. Forefoot Pronation

The angle your foot connects to the pedal at is one of the ways to help account for a narrow Q Factor. For several decades, plastic wedges have been available.

These wedges work well when installed under your cleats to account for forefoot pronation and create a healthier angle for your foot, which then translates into less pressure on your knee.

4. Weak Supporting Leg Muscles Or Tight Ligaments

If the above three fitting solutions don't resolve the problem, it might be worthwhile to look more deeply at muscular imbalances.

Cycling creates massive quadriceps while neglecting many of the smaller supporting muscles. This imbalance can create instability in the knee and cause the leg to "wobble" or "wander" on longer rides as the cyclist gets tired. This wobble can create intermittent stress on the IT band, resulting in a flare.

Conscious care should be used to always pedal in a smooth, up-and-down motion with no side-to-side movement. Slow-motion video can be used to watch the cyclist pedal on a trainer and can sometimes capture the issue.

Targeting these weak portions in your leg with a few daily exercises, can greatly speed your recovery and prevent relapse.

Glute Strengthening

Since cycling is heavily focused on strengthening the Quadriceps, you need to counter them by exercising the opposing muscle. Strengthening the gluteus with butt bridges is an excellent place to start ↓


The key here is to perform several lunge variations in order to capture all of the stabilizing muscles.

Wall Squats

This is one that also works the quads but seems effective at strengthening all of the muscles connecting to the knee and provides fast relief to a variety of knee problems ↓

Shoot for three minutes of wall squats a day and break it up as you need to in order to reach that goal. Many athletes have reported seeing an improvement in their symptoms once they work up to consistent, minute-and-a-half-long wall squats.

Foam Roller

If your IT band is tight, and you must help loosen it. A foam roller session after every cardio workout is a must ↓

Lay your outer thigh on the roller and work up and down. Most folks who suffer from IT band pain invest in a foam roller and use it religiously.

Balance Practice

As you progress, standing and squatting on a wobble board can help increase your muscle control and activation ↓

Don't load yourself with weights. Instead, work with bodyweight only, and allow your body to build healthy connections.

An IT band flare can feel hopeless at times. However, consistent treatment over a month or two can yield significant rewards.

As always, if you have symptoms that concern you, consult your doctor or physiotherapist. Surgical relief is required in some situations, and you should pursue every option available to you.

Here's a wish that your years is full of many pain-free moments on your bike!

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