IT-Band woes ??

[bfloyd6969]

Hello all. I've been experiencing some pain on the sides of my knees which I think may be the IT-bands. It is right on the outside next to the knee caps. From looking at pics of IT-band inflamation online, it looks to be it. I have tried the stretches recommended but the pain still persists. I wouldn't label it a dying pain, but more of a nuisance really. Mostly noticed when clothing rubs against it - and on the bike of course.

The pain started when I wanted to improve my spin. I have always been more of a masher and recently got a single speed and wanted to see what gearing I was going to use with it. So, I have been using my geared road bike and trying different gear ratios. I live in a hilly area so I wanted a gear that would get me up the climbs and have a decent spin on the flats. However, once I get my spin up to approx. 95 rpm's the pain begins. IMO, 95 rpm's should be no problem... for most people. Now, I can get the pain to stop when I shift up a gear and bring my rpm's down to about 80 - what I am used to. However, once I shift back down and spin faster, the pain comes back. I have always read that higher rpm's / lower gear ratios are better on the knees, but I'm not finding this to be true

Do IT-band troubles and higher rpm's go hand in hand at times? I know 95 isn't considered a high rpm, but coming from an average of 80 rpm's like myself, it is new to me. I don't know if perhaps I am changing my leg angle when spinning higher? - perhaps my heel is dropping or rising causing the pain? I know the best thing to do is see a doctor about this, and I do plan to, but I wanted to check in here first to see if anyone else has experienced anything similar to this and perhaps I could share that information with the doctor.

Thanks.

[Carbonfiberboy]

I'm fighting a case of this right now, just in one leg. It's called iliotibial band syndrome (ITBS). Google. My PT says it's most frequently a symptom of something else being wrong. Stretching is not particularly effective. Strengthening, especially the hips, is much more effective. In your case, it's possible that it's being triggered by your foot angle on the pedal, either toe angle or whole foot angle. It that's it, a bike fit specialist might be able to help with wedges, insoles, cleat angle, etc.

In my case, I think it's being triggered by some muscle imbalance, possibly causing my kneecap to track wrong, which is causing the knee to swell, which is causing the ITBS. It's in the knee which has previously had medial meniscus surgery. I'm doing this: stretching three times a day, just in case. Lying on my side, knees well bent, holding feet together, lifting the up knee as far as possible and holding briefly. 30 reps each side. Straight leg high kicks, sets of 15. At the gym, the regular workout, 30 reps: squats, leg sled, seated rows, hyperextensions or back machine, pushups, plus the ordinary core and upper body stuff. I'm also going to work the stepmill for 45 minutes a crack. The idea being to strengthen the muscles which attach to the kneecap and leg muscles in general, and possibly correct any muscle imbalances resulting from concentrating too much on just the bike. I'll only ride once/week until this gets better. If it doesn't get better, time for an MRI.

Doctors by and large are completely useless at resolving these sorts of problems. This is possibly because most doctors have no clue about athletic injuries and possibly that diagnosis of these things by inspection is so difficult. These two factors are mutually reinforcing.

High cadence doesn't normally cause ITBS. You're right that high cadence is easier on the knees. However that tendon flipping back and forth under the band will flip more times with higher cadence. Try pedaling knees in. Try different foot angles: toe in, toe out, heel down, heel up, push on the outside, push on the inside. Some cases of ITBS yield only to rest.

[bfloyd6969]

Thanks for the info and tips, CFB. I think a visit to the lbs for a pedal/cleat fit is in need.... I'll try the other mentioned as well.

Last case scenario, I too will seek out an MRI.

[Tundra_Man]

Been struggling with IT band issues for the last year myself. It is generally an over-use injury. Perhaps spinning in-and-of-itself didn't cause the problem, but the increase in the number of rotations may have accelerated how fast you noticed it.

In my case it was caused by the number of running miles I was logging in preparation for a half-marathon. I saw a sports therapist who checked me over and determined that my quads were super strong but my hamstrings and glutes were weak. Because of this imbalance I had poor running form which aggrevated my IT band.

My solution was a couple months rest from cycling and six months of rest from running, along with weight training specifically targeting my weak muscles. So far I've been advancing without a recurrance of the issue.

[bfloyd6969]

Everyone, please tell me if you think I'm on the wrong track here -

My cycling shoe cleats are set up to have a straight line front to back. It has been like this for as long as I've ridden clipless and has never caused me any troubles with the lower cadence. Now, I notice when I walk my feet are toe'd out just a bit. So, this morning's ride I though I would do a bit of trial and error. I adjusted my cleats so that I would be a bit toe'd out, not as much as when I walk, but a noticeable amount nonetheless. During the hour long ride, there was very little pain, if any. However, as I type this the pain is still noticeable as before, but during the ride no. Is it possible that I need to match my cycling position to my natural walking foot position? Is it possible that in time riding like this that things might improve? Opinions please....

[Carbonfiberboy]

Everyone, please tell me if you think I'm on the wrong track here -

My cycling shoe cleats are set up to have a straight line front to back. It has been like this for as long as I've ridden clipless and has never caused me any troubles with the lower cadence. Now, I notice when I walk my feet are toe'd out just a bit. So, this morning's ride I though I would do a bit of trial and error. I adjusted my cleats so that I would be a bit toe'd out, not as much as when I walk, but a noticeable amount nonetheless. During the hour long ride, there was very little pain, if any. However, as I type this the pain is still noticeable as before, but during the ride no. Is it possible that I need to match my cycling position to my natural walking foot position? Is it possible that in time riding like this that things might improve? Opinions please....

It's generally thought to be a good idea to do so. I use SPD pedals with a 5°-7° float. I position the center of the float in about the position my feet seem to naturally assume on the pedals, then let them move as they will.

[Carbonfiberboy]

Fixed my ITBS. Only took 2 weeks. Gym, stretching, and cross-training, very little biking. Leg sled, seated rows, back machine, squats, pushups, calf raises, Roman chair, lat pull-downs, 30 of each. 45 minutes at a time on the step-mill, zone 2, and hiking, zone 1.

[bfloyd6969]

Congrats, CFB! Are you going to start to ease cycling back in now - very low intensity?

[Carbonfiberboy]

I've been doing a relatively hard ride once/week. Week before last, I had to finish 60 miles with one leg. This week, I had a little discomfort a couple of times in 50 miles, but it got better not worse, and was never pain. Today I'll do some one-legged pedaling on my rollers, but that's all the biking I'll do before this Saturday's ride. I'll do more weights and stepmill instead. Next week I'll sub some midweek biking miles for the stepmill if all goes well.

For me, it's all about full body conditioning and good pedaling mechanics. If everything is working the way it's supposed to, I don't have problems. I just screwed up by getting lazy and overconfident.

[jim p]

I have not experience this problem. I am riding cleats which have about 6 degrees of float. My feet want to sit with the heels in a little when I pedal. I set my cleats up so that they hit their limit when my feet are pointing straight ahead. I often practice riding with my feet straight and my cleats sitting against the limit. I also like to practice pulling my knees toward my chin as I pedal. I don't know if any of this is helpful but it is fun to try different things just to see how it feels.

Someone mentioned that muscle imbalance might be causing the problem. I wonder if pulling on the upstroke might help with the muscle imbalance. I really like the ability to pull on the upstroke.

[bfloyd6969]

Thanks for the tips. I will be the first to admit that my spin is far from circular. Just lately I have been concentrating on lower rpm's while working on a complete circular spin, both down push and up pull.

[Carbonfiberboy]

The one-legged pedaling went very well. I was trying to get the best muscular workout from the fewest pedal revolutions. Surprisingly, both legs were about the same. Pedaling with legs together, I don't pull up on the backstroke unless I'm doing a short acceleration. Rather I unweight the up pedal. The object of the game is to put a constant torque on the bottom bracket. This just means that one foot has to be pushing all the time, not that each foot must do that. Riding rollers or a trainer, one hears a constant humm. Doing OLP strengthens the up muscles and more importantly, teaches them when to fire.

[vic303]

Sage Rountree's book The Athlete's Guide to Recovery has some good instruction on IT band self massage.

[bfloyd6969]

Thanks for the tip on the book, vic303!

I tried doing some one-legged drills on the trainer last winter. I was really experimenting with them but plan to do them more seriously. Now, still being kind of early season, is a good time to try them again...

[mjsocal]

I've had IT band problems in the past. Strengthening, stretching, and using my foam roller generally helps. This syndrome can show up in many places along the leg hip area. Just to be sure...are you positive it's not a hamstring tendon issue? I'm only mentioning this because the pain from mine is in the same exact place. Those are tricky. I'm dealing with this now and it's much harder for me to treat. I think I'll have to go the ART and massage route.

[bfloyd6969]

Just to be sure...are you positive it's not a hamstring tendon issue? I'm only mentioning this because the pain from mine is in the same exact place. Those are tricky. I'm dealing with this now and it's much harder for me to treat. I think I'll have to go the ART and massage route.

I'm assuming that it is the IT band due to it's location, exactly on the outside of the knee. I assumed this from reading up online and seeing pics. How did you pinpoint that yours was hamstring related?

[Carbonfiberboy]

I've had IT band problems in the past. Strengthening, stretching, and using my foam roller generally helps. This syndrome can show up in many places along the leg hip area. Just to be sure...are you positive it's not a hamstring tendon issue? I'm only mentioning this because the pain from mine is in the same exact place. Those are tricky. I'm dealing with this now and it's much harder for me to treat. I think I'll have to go the ART and massage route.

You make a good point. It's very difficult to diagnose the origin of the IT band problem. There are many different things that can cause a knee to swell and cause ITBS symptoms. A swollen hamstring tendon sheath could certainly contribute. People will say that their knee is sore. Yup. My approach is to take a shotgun to it. Do everything that might work.

OTOH if the knee is popping and is especially painful going down stairs, right in the center or on the inside, there's decent chance it's a torn meniscus. MRI is the only way to diagnose that.

[mjsocal]

I'm assuming that it is the IT band due to it's location, exactly on the outside of the knee. I assumed this from reading up online and seeing pics. How did you pinpoint that yours was hamstring related?

Mine was diagnosed by an exam, but I was already starting to hone in on the right diagnosis online by the way it felt. If you've figured out it's your IT band, it probably is. My pain is not directly on the outside...it's a bit posterior and lateral (behind and to the outside) from the knee. Tendonitis in this area is wicked because there is not enough blood supply for quick healing. It's very difficult to do a full knee flex with it. I mentioned this just in case.