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Old 05-09-12, 03:24 PM   #1
PauseTheMoment
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Anybody experience horrible knee pain while touring?

I just started my first tour and after doing 4 straight days of riding (220 mi) my knees started to get terribly sore. Yesterday was 50 miles of long hills out on Rt. 30 in Oregon heading out towards Astoria. That certainly didn't help one bit. We finally arrived in Astoria yesterday evening and I was experiencing horrible pain in both knees, but more specifically my left knee. The outer (IT band?) is killing me to the point that walking is a slight issue, using my legs in a pedaling motion, walking up stairs, etc is a nightmare.

Today is my first rest day and I'm going to have to take another day tomorrow at the least. Have you experienced outer and inner knee pain on tour? If so, how did you treat it?
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Old 05-09-12, 03:39 PM   #2
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have you got your bike position set correctly? try adjusting the saddle height up or down to the point where you feel no pain.
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Old 05-09-12, 03:40 PM   #3
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You might check this thread: http://www.bikeforums.net/showthread...with-bad-knees
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Old 05-09-12, 03:53 PM   #4
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It could be bike fit, it could be your riding style, it could be you have bad knees, it could be too much too soon. If your bike fit is good, focus on using a lower gear and spinning faster especially when climbing.

I like to keep my cadence at around 80 pedal revolutions per minute on the flats, but it's hard to spin that quickly when climbing. If you're really mashing hard on the pedals, your knees are going to hurt. Try using an easier gear and spinning faster.
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Old 05-09-12, 04:26 PM   #5
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You need to stretch your IT band.It has tightened with intense use. Sit on the ground or pad with your legs straight out in front of you. Then bend your left knee until you can grab your ankle. Pull the left bent portion over the right leg and toward your torso. You will feel resistance. Gently pull the leg towards your torso gradually for several minutes stopping as needed. This should relax the IT band to eventually stop the irritation caused by the tight band getting irritated by movement over the boney area on the outside of the knee. Repeat regularly and use an anti inflammatory as the band recovers. Knee pain usually diminishes quickly as the swollen It B sheath heals.If you have other knee pain caused by bike position and saddle height investigate the suggestions mentiooned in this forum. Good Luck!
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Old 05-09-12, 05:08 PM   #6
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Have you experienced outer and inner knee pain on tour? If so, how did you treat it?
Yep. Several years ago on tour, left knee, IT band I guess. Off bike overnight, ibuprofen, gone next day. No idea why it happened. Hasn't happened again. Severe enough I did hitch to my campsite.
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Old 05-09-12, 05:17 PM   #7
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About four years ago. IT-band. Orthopedist put me off the bike for six weeks. My first day back, immediate pain.

Two days later, I went to my LBS and got my bike adjusted (he raised my saddle almost an inch and told me to make sure I kept my knee in line with my hip, while pedaling - I tended to pull my knee in, toward the top tube when I got tired). I have not had a problem since.

Your mileage may vary, but bike fit is quite important on long rides.
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Old 05-09-12, 05:29 PM   #8
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Another opinion:
Almost no one on the proffered Touring forum thread knows what they are talking about.

You do have iliotibial band syndrome (ITBS). Google. It is usually a symptom of another problem. You cannot stretch an IT band. You can stretch the iliotibial tendon which runs beneath the ITB, but stretching that tendon is of doubtful utility. The reason most people get ITBS is that their knee joint swells due to some other cause. This makes the joint sore where the trapped iliotibial tendon rubs against the lateral femoral condyle. NSAIDs don't really touch it. They may help a little, but do more damage by causing you to ignore the problem, which then gets worse.

I don't know what to tell you as far as your tour is concerned. Most advice is about what you should have done earlier. Now is too late. So: Take the ibuprofen, and don't ride, and walk as little as possible, Mostly you want to lie down. When you aren't lying down, stretch 3 times/day as follows, and be gentle: ordinary seated toe-touch/hamstring stretch 3 X 20 seconds. Still seated, pull one foot into your groin while trying to put that knee on the ground and leaning forward as far as is comfortable. Next the hurdler's stretch. Then the tailor's stretch, feet together and pulled into your groin, knees to the floor or as far as is comfortable. Then the pulling-your-leg-to-chest stretch described in a previous comment. Then stand and do the quad stretch, then the calf stretch with knee locked and then with knee bent.

Next do high kicks: leg held straight, kick as high as you can, 15 reps each leg. When your knee pain eases off due to rest, try doing wall sitting, with knees bent at 90. Then unweighted squats, just down to where your thigh is horizontal, no further. If that goes well, you can try one-legged squats with one foot on a chair, one hand against the wall. This might work over a period of a week.

You can also drop your saddle 1/4", but this may not do anything.

This is all about restoring normal leg function which has gotten all screwed up because of poor cycling technique. On the bike, you need to pedal at a high cadence, 90 on the flat, 80 climbing, or as best you can with the gears you have. IOW, climb in the lowest gear that works for you. Try to pedal circles. Pull back and the bottom, push forward at the top, and lift your leg, but not the pedal, on the backstroke.

If and when you can ride again, take frequent breaks during the day. Keep your daily mileage as low as you can, and spread out the cycling over as much of the day as is practical. Get an early start. Take it easy.

You may have to bail, so prepare a bailout plan. Notify who you have to notify. Stay where you are as long as you can, then try riding. Bail if it doesn't work. ITBS only gets worse once it starts. You won't be able to ride through the pain.

When you do try to ride again, pedal knees in, as close to the top tube as you reasonably can. Relax your ankles and orient your feet as closely to your normal walking position as you can.

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Old 05-09-12, 05:43 PM   #9
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About four years ago. IT-band. Orthopedist put me off the bike for six weeks. My first day back, immediate pain.

Two days later, I went to my LBS and got my bike adjusted (he raised my saddle almost an inch and told me to make sure I kept my knee in line with my hip, while pedaling - I tended to pull my knee in, toward the top tube when I got tired). I have not had a problem since.

Your mileage may vary, but bike fit is quite important on long rides.
Also worth trying. Sitting normally on your saddle and holding yourself upright against a post or wall, put your heel on a pedal. If your saddle height is correct, your knee should be completely locked out. In fact, you may not be able to quite touch your pedal with your heel. If your knee is bent doing this test, raise your saddle until it is as described. Too low a saddle would cause chondromalacia, swelling the knee joint and bringing on the ITBS. You might let us know how that saddle height test goes.
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Old 05-09-12, 06:47 PM   #10
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I had ITBS and it took neary a year for it to go away completely. If you have clipless pedals, it maybe time to go platform. Whenever you have feet or leg problems, the clipless pedals could very well be the problem. As Carbonfiberboy stated, you were pedaling too hard and can no longer do that. There are exercises you can Google the net to find them but again, this is a long recovery.
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Old 05-09-12, 07:50 PM   #11
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There's three suspects, as I see it. Fit, gearing and cadence, and fitness. All three would have optimally been addressed before you began your tour.

For fit, you might find a decent bike shop that can check how the bike fits you.

Gearing and cadence: as mtnbud noted, a cadence of 80 is pretty good. I'll drop to 70 on steep (>5%) climbs, shift down as necessary. Don't forget gear zero: get off and walk. In your case, it might be a good idea to check the bike shop (that you're going to for a fitting!) and see if they can fit lower gears, and get a cyclocomputer with cadence.

Fitness: were you ready to do four consecutive 55-mile days when you started? (Rhetorical question, it's clear the answer is "no.") At the point, the best you can do is back off. When you resume, do a couple of 20-25 mile days, then maybe a couple more 30-35, then a week's worth of 40 mile days. Back off when it gets hilly. By the time you hit Kansas, if you can make it that far, you can probably do 75 miles in a day. Almost any halfway serious cyclist can go out and ride 50 miles a day. The problem comes when you try to do it day after day after day... So back off, relax, enjoy the museums, parks, tourist traps, and libraries for a while.
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Old 05-09-12, 08:46 PM   #12
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You need to stretch your IT band.It has tightened with intense use. Sit on the ground or pad with your legs straight out in front of you. Then bend your left knee until you can grab your ankle. Pull the left bent portion over the right leg and toward your torso. You will feel resistance. Gently pull the leg towards your torso gradually for several minutes stopping as needed. This should relax the IT band to eventually stop the irritation caused by the tight band getting irritated by movement over the boney area on the outside of the knee. Repeat regularly and use an anti inflammatory as the band recovers. Knee pain usually diminishes quickly as the swollen It B sheath heals.If you have other knee pain caused by bike position and saddle height investigate the suggestions mentiooned in this forum. Good Luck!
Thanks for the stretching tips. I will give those a shot. I tried some IT band stretches I found on YouTube and my left leg is feeling so much better than it was this morning. I'm working on stretching my right now. I'm using ibuprofren and bengay on my knees as we speak. Icing/heating as well.

For those who asked about pedals, I'm riding platforms.

@pdlamb - Fitness: You're most likely spot on. Too much too soon. Thanks for the help. I'm going to see how I feel in the morning and try an extremely short ride.

Thanks a lot guys...
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Old 05-09-12, 11:07 PM   #13
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Actually, clipless pedals go a long way toward preventing this problem, far from causing it. The OP can only push down, which is essentially what the problem is: overuse of a few muscles, and the muscular imbalance created by same.
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Old 05-10-12, 02:39 AM   #14
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@pdlamb - Fitness: You're most likely spot on. Too much too soon. Thanks for the help. I'm going to see how I feel in the morning and try an extremely short ride.

Thanks a lot guys...
I haven't experienced the pain you are describing as all of my long distance cycling was an incremental increase of what I did a few weeks before. It was an extension of what I was doing already. Be good to yourself, as much as this changes your trip and expectations it is the trip. When the pain is relieved LOWER the power output and experiment with pedaling technique. One of the things I learned on my old Schwinn five speed riding around Los Angeles as a teenager was feeling light on the pedals, knees in line with feet, feet in line on the pedals, knees floating. Hard pedaling on platforms can end up being like climbing stairs which no one wants to do for hours on ends. Easy spinning is the technique. From that power can be developed but easy spinning is the cycling equivalent of walking, you have to walk before you can run.
Wishing you recovery and strength.
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Old 05-10-12, 04:44 AM   #15
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The best treatment for ITBS is to roll or massage the IT band. You can't stretch it because it is not a muscle. I use a trigger point foam roller. If you catch it early you can roll it out a few times for several minutes and be good to go the next day. YMMV I have used a frozen water bottle in the middle of a ride to get me home and a round smooth small log found by the side of the road. I have also used the palm of my hand to massage it while on descents when I sense it coming on to keep it from getting bad. If I roll it for a couple minutes every day I never have a problem but I sometimes get complacent when it doesn't bother me for awhile. My left leg is stronger than my right and my right knee is the one affected but I roll both to be safe. Amazing how much it can hurt and how quickly it can go away when rolled out. You are rolling out the knots, not stretching.
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Old 05-10-12, 05:05 AM   #16
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Actually, clipless pedals go a long way toward preventing this problem, far from causing it. The OP can only push down, which is essentially what the problem is: overuse of a few muscles, and the muscular imbalance created by same.
Not sure I agree with all of that but I do believe that 99.9% of folks will not have knee problems from properly adjusted clipless systems. I'll add that the vast majority do not need a lot of float. If the angle of your foot normally changes during a pedal revolution you either have some really weird bio-mechanics or something is wrong with your form.

That said you really need to get the adjustment right, especially the angle of the cleats, and this may take some trial and error.
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Old 05-10-12, 05:12 AM   #17
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I did have some knee issues on a recent tour. Something just suddenly went snap and I was in pain. I took a lot of walk breaks and generally took it easy, while still doing fairly long mileage with only one short (33 mile day). I knew that there were a couple major passes coming up and I just babied the knee as best I could. That meant a good bit walking on climbs. Despite coming close to abandoning and flying home, I was fine in less than a week and finished the tour. I was actually fine by the time I got to the pass that I was dreading most.

That said, knee pain can have many causes.
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Old 05-10-12, 06:20 AM   #18
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A long while back I joined a couple of friends for a weekend trip despite not having been on a bicycle in something over a year (living in a city which was just not friendly to cycling). The plan was to do 50km on Day One, and another 50 on the next two days before heading home. But Day One turned out to be 75km, not 50, and by the end of the day I could hardly move my leg. I bought cream and painkillers, but by the next morning it was clear that it wasn't going to work, so bailed at the next town. My trip back took one bus and then three trains, and the ride back from the station was also very, very painful. I worried about that knee for almost a year before I strengthened it back up again.

Lesson: be prepared, and take things easy until you are.
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Old 05-10-12, 11:37 AM   #19
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I will echo the pedals issue. Are you on platforms without toe clips? I had issues with toe clips because of the angle they positioned my feet; I walk a bit duck-footed, and my ideal pedaling form follows. Well-adjusted clipless pedals have gone a long way toward minimizing (or eliminating) ITBS for me.
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Old 05-10-12, 04:50 PM   #20
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About 10% of tourings cyclists appear to have serious knee pain - peerhaps resulting from clipless pedals.
If you are riding with clipless consider doing two things.

1. Rest
2. Switch out to cage pedals and ordinary shoes.

Despite what people say about float and settings -
It seems that some cyclists get repetitive motion stress in the knees.
When using ordinary pedals - you have a much wider range of motion.
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Old 05-10-12, 05:02 PM   #21
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I just started my first tour and after doing 4 straight days of riding (220 mi) my knees started to get terribly sore. Yesterday was 50 miles of long hills out on Rt. 30 in Oregon heading out towards Astoria. That certainly didn't help one bit. We finally arrived in Astoria yesterday evening and I was experiencing horrible pain in both knees, but more specifically my left knee. The outer (IT band?) is killing me to the point that walking is a slight issue, using my legs in a pedaling motion, walking up stairs, etc is a nightmare.

Today is my first rest day and I'm going to have to take another day tomorrow at the least. Have you experienced outer and inner knee pain on tour? If so, how did you treat it?
Where do you sit on your saddle when you are climbing a hill or riding on flats?
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Old 05-10-12, 05:17 PM   #22
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About 10% of tourings cyclists appear to have serious knee pain - peerhaps resulting from clipless pedals.
If you are riding with clipless consider doing two things.

1. Rest
2. Switch out to cage pedals and ordinary shoes.

Despite what people say about float and settings -
It seems that some cyclists get repetitive motion stress in the knees.
When using ordinary pedals - you have a much wider range of motion.
Actually, clipless pedal systems help reduce knee issues if they are correctly fitted and installed by a professional bike fitter. A professional bike fitter when coming to fit a person with clipless pedals works almost the same way as a professional shoe fitter in a pro running shop. Usually, a fitter determine the foot gait by looking at how the person walks -- toe out and toe in and is the person pronating or supinating and does he or she need orthotic wedge to keep the knees tracking straight without excessive buckling. Not everyone has a perfect feet as demonstrated that some people need orthotics to help correct imperfect feet. There are spacers you can add to the SPD cleats to compensate a person's pronation or supination issues or to compensate for unequal length of the person feet which then causes the pelvis to rock side to side too!

However, if these countermeasures were addressed in the bike fitting and the rider still suffers from knee issues, it is most likely coming from under developed lower core strength usually to help stabilize the pelvis from the down stroke. This is not as critically necessary if your ichium bones are solidly planted on the saddle, but the tendency of a person would be to shift the riding position upfront towards the nose while climbing and then if your core is weak, your butt tends to look like it's rocking up and down and treating the knees and ankles as a muscle group causing some muscle imbalance and buckling happens on the joint area (knees are joints not muscles to power your pedals). If you move from the hip and only from the hip with the core engaged, you can see the person's leg coming down like pistons and knees and ankles will act only as joints as they should be when viewed from behind even if the person is riding on the nose of the saddle which is what triathletes do on their tri-bikes.

Btw, I do have spacers and an orthotic wedge on my Specialized shoes that took the fitter 2.5hrs just for the shoes alone minus bike fit (one foot pronate and the other supinate). I used to have knee issues, but is now solved. Proper SPD cleat setup helped a bunch!

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Old 05-10-12, 06:40 PM   #23
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On my first extra-long tour, I had to catch a Ferry about 55 miles from home and I mis-judged the time needed so pushed hard for the last 20 miles. I developed sharp pain in one knee toward the end of the ride to the Ferry. About a 1/2 hour into the ride the next morning, it came back. Fortunately, another cyclist stopped by for a chat while I was resting, and after I commented about the knee, he checked out my position on the saddle, and the distance to the pedals. Both were wrong, and after making adjustments, we both were on our way. Not only did the pedaling seem easier, the pain subsided as the day wore on. I was very fortunate that I met that fellow when I did, before really damaging the knee or having to abort the trip. That fellow seemed very experienced, and he further explained how to monitor my energy output level (using the gears rather than maximum power) and take frequent breaks so as not to over-exert, burn out, or damage myself. That trip was 1400+ miles of country/wilderness riding, and I averaged 85 miles a day without any further physical problems other than a bit of a sore butt, mostly due to using a cheap saddle.
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Old 05-12-12, 02:37 PM   #24
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Good advice on the stretching and foam roller, according to my gf who is a Physical Therapist. According to her, you *can* "stretch" the IT band, although "stretch" might be the word that is causing some confusion here. I've done stretches she's suggested which have helped immediately. But it is not the same as stretching a muscle, because what you're really doing is breaking up adhesions that develop due to strain or overuse. Normally the fibers that make up the IT band grow laterally along its length, but they can become damaged due to overuse and strain, and when the damage repairs itself the resulting adhesions can grow in unpredictable directions, causing knots, for lack of a better term. The result is a shortening or tightening of the band, which puts tension on your knees. When you massage the band as RayfromTX stated, it helps to break up those adhesions, in effect increasing its length, which takes tension off of your knees. It's the tension on the knee that is causing the pain there. So do those "stretches," and attached are a few more that might help, courtesy of my gf. Oh, and she says ice is good, but heat might not be the best thing because it could increase inflammation in the knee area.

Of the stretches depicted below, the photo of the woman is one I have found quite effective against IT band issues. When doing that one I hang my arms down until I eventually stretch down far enough to touch my toes (I'm not the most flexible person). To get both legs, reverse feet and repeat.




The ibuprofen is good too, if you have no stomach issues with it. I once had tour-related knee issues (patellar tendonitis)and was told by a PT to use a heavy dose (600mg at a time, four times per day) over a ten day period to get the inflammation down. I'm not saying you should do that, just what was suggested for me in my situation. I never tour without ibuprofen.
Attached Images
File Type: jpg hudlers stretch.jpg (5.7 KB, 3 views)
File Type: jpg IT band stretch 1.jpg (6.8 KB, 7 views)
File Type: jpg IT band stretch 2.jpg (5.2 KB, 2 views)
File Type: jpg quad stretch.jpg (5.4 KB, 2 views)
File Type: jpg Standing Hamstring Stretch.jpg (3.4 KB, 2 views)
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Old 05-12-12, 02:54 PM   #25
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Originally Posted by Carbonfiberboy View Post
Another opinion:
Almost no one on the proffered Touring forum thread knows what they are talking about.

You do have iliotibial band syndrome (ITBS). Google. It is usually a symptom of another problem. You cannot stretch an IT band. You can stretch the iliotibial tendon which runs beneath the ITB, but stretching that tendon is of doubtful utility. The reason most people get ITBS is that their knee joint swells due to some other cause. This makes the joint sore where the trapped iliotibial tendon rubs against the lateral femoral condyle. NSAIDs don't really touch it. They may help a little, but do more damage by causing you to ignore the problem, which then gets worse.

I don't know what to tell you as far as your tour is concerned. Most advice is about what you should have done earlier. Now is too late. So: Take the ibuprofen, and don't ride, and walk as little as possible, Mostly you want to lie down. When you aren't lying down, stretch 3 times/day as follows, and be gentle: ordinary seated toe-touch/hamstring stretch 3 X 20 seconds. Still seated, pull one foot into your groin while trying to put that knee on the ground and leaning forward as far as is comfortable. Next the hurdler's stretch. Then the tailor's stretch, feet together and pulled into your groin, knees to the floor or as far as is comfortable. Then the pulling-your-leg-to-chest stretch described in a previous comment. Then stand and do the quad stretch, then the calf stretch with knee locked and then with knee bent.

Next do high kicks: leg held straight, kick as high as you can, 15 reps each leg. When your knee pain eases off due to rest, try doing wall sitting, with knees bent at 90. Then unweighted squats, just down to where your thigh is horizontal, no further. If that goes well, you can try one-legged squats with one foot on a chair, one hand against the wall. This might work over a period of a week.

You can also drop your saddle 1/4", but this may not do anything.

This is all about restoring normal leg function which has gotten all screwed up because of poor cycling technique. On the bike, you need to pedal at a high cadence, 90 on the flat, 80 climbing, or as best you can with the gears you have. IOW, climb in the lowest gear that works for you. Try to pedal circles. Pull back and the bottom, push forward at the top, and lift your leg, but not the pedal, on the backstroke.

If and when you can ride again, take frequent breaks during the day. Keep your daily mileage as low as you can, and spread out the cycling over as much of the day as is practical. Get an early start. Take it easy.

You may have to bail, so prepare a bailout plan. Notify who you have to notify. Stay where you are as long as you can, then try riding. Bail if it doesn't work. ITBS only gets worse once it starts. You won't be able to ride through the pain.

When you do try to ride again, pedal knees in, as close to the top tube as you reasonably can. Relax your ankles and orient your feet as closely to your normal walking position as you can.
Excellent post, thanks.
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