IT Band injuries and cycling: what you need to know
How to prevent and treat Iliotibial Band pain
Over the past couple of weeks, I’ve dedicated a lot of time to find out just what the web has to say about the IT Band and why it’s so problematic.
Here’s a glimpse of what I’ve found regarding discomfort of the IT Band: stretch the IT Band; stretching the IT Band is impossible; use ice; use heat; foam roll; don’t foam roll; use anti-inflammatory meds; don’t use anti-inflammatory drugs; strengthen the IT Band; and the list goes on.
But if you’re searching Google for “painful IT Band”, you’ve already exacerbated your situation. Why? Because you’ll be inundated with thousands of pages of information that typically stem from a singular perspective.
Or said differently, you’re reading somebody’s opinion or possibly even getting a glimpse of his or her financial interests.
The idea with this piece is to start with some simple facts and stay clear of making contentious commentary.
Once a baseline knowledge is in place we’ll explore what we can do for ourselves as cyclists to get back on the bike free of pain — with you knowing which route is most appropriate.
What is the IT Band?
As per its name, the Iliotibial Band starts at the top of the pelvis on a big bony ridge just above your belt line (the ilium) and runs all the way down the outside of the thigh, connecting just below the knee joint (lateral aspect of the tibia). Simple enough.
From the more basic perspective, the IT Band is a dense fibrous connective tissue.
A really cool aspect of these tissues is that they can respond to increased stress — the higher the stress, the more dense the tissue becomes. This can work in our favor or sometimes it can work against us.
What does the IT Band do?
The IT Band is typically labeled a ‘stabilizer’ of the lateral leg and often toted as a major contributor to our ability to walk or run. But what does this mean? And is the term ‘stabilizer’ accurate?
The physiological role is to prevent elongation (stretch). So for that reason it is called a stabilizer — it can, all things being equal, stabilize the knee or the pelvis, or both.
But for cyclists trying to understand why they have so much discomfort, I feel this is an overly simplistic view.
If we were just standing all day long, I’d consider the ‘stabilizer’ descriptor appropriate. But given that cycling is our passion, we’re creatures of a highly repetitious motion, I consider the IT Band an ‘anchor’.
It helps facilitate the function of the true hip stabilizers and prime movers by providing something for them to attach to, at least partially.
For the purposes of evaluating the cyclist’s body and acknowledging the IT Band as an anchor, the question becomes: what does it anchor and how does that influence you as a cyclist?
The IT Band anchors two important muscles of the hip: the gluteus maximus (other attachments as well) and the tensor fascia latae.
To keep things simple, know that when you flex your hip, as you would to bring your pedal to the top of the stroke, the IT Band is influenced via the tensor fascia latae (TFL).
And when you extend your hip, driving force to the pedals through the effective part of the pedal stroke, the IT Band is again influenced via the gluteus maximus.
In short, if you pedal a bike, your IT Band is being affected throughout the entire pedal stroke. It is literally being pulled a little forward and a little backward with every pedal stroke.
For the cyclist, there really is no ‘stabilizing’ taking place, at least not the same way as when standing still, walking or running.
In fact, by nature of the pedaling motion and the knee and hip angles, the IT Band could be considered relatively lax in comparison to its running counterpart.
So, for the cyclist, the muscular component of the system is very commonly the root of the problem.
When things go wrong
The most common IT Band symptom for cyclists is an isolated painful tissue that tends to manifest on the outside of the leg.
The most common problem is friction between the IT Band and either other connective tissue, underlying muscle tissue, bony landmarks, or other knee features (like inflamed bursa sacs). In the case of the cyclist, this is highly repetitious friction.
If the IT Band and tissue interactions are anything less than optimal, then problems arise.
If sub-optimal mechanics is the most common culprit (which is almost always the case with overuse injuries), what leads to less-than-optimal mechanics? In most simple form, muscle dysfunction, lack of muscle function, or scarred tissues.
As you already know, the gluteus maximus and tensor fascia latae interact with the IT Band and therefore can be looked upon as the most likely sources of your troubles, muscularly speaking.
There are other IT Band issues that can manifest as a result of faulty mechanics. Sometimes IT Band associated pain is much higher in the leg, near the hip — if this is the case, find a professional to help identify the root of the problem.
In my experience, there is usually something more complex going on and attempting to alleviate your situation without guidance could lead to more significant challenges.
Where do we go from here?
Without accurate knowledge of the structure and function of the IT Band, how can you expect to find relief?
Should you just do what your friend did to rid their IT pain? Should you foam roll? Should you stretch? Drop your saddle a few millimeters? Scrap your bike fit and start all over? Wedges or insoles in the shoes? Maybe anti-inflammatory drugs are the ticket? Or just rest and ice? What exercises can help?
For some exercises that can help to alleviate IT Band pain, take a look at the gallery at the top of the page.
Finding relief — the ‘system’ approach to your IT Band
Before jumping straight in to the million-dollar question of “how do I cure my problem?” please acknowledge a simple fact: you’ve executed thousands, or hundreds of thousands, or millions of pedal strokes to create this situation.
To think there will be a quick or easy solution to the pain you’re experiencing is a fallacy. A commitment to pedaling created your condition and only an equally powerful commitment to treatment will allow you to pedal free of pain.
The treatment possibilities
Treatment for cyclists, in my experience, should begin with a simple concept — once upon a time, your IT Band wasn’t bothering you, but now it is. What could have happened to cause such a scenario?
Here are some valuable questions you can ask yourself to help find a starting place:
- Have you recently made significant increases in volume or intensity on the bike?
- Have you changed the position of any of the contact points on your bike (saddle model/shape, saddle height, saddle fore/aft, saddle tilt, shoes, cleats, pedals, insoles, new bike)?
- Are any of the contact points aged beyond their intended use (saddle that no longer has its original shape due to bent rails or twisted shell, insoles that no longer provide sufficient support, cleats that no longer provide consistent contact)?
- Have you recently engaged in other non-cycling activity (running, hiking, resistance training, etc.)?
- How much time per day do you spend in a seated position (driving, flights, or just in a chair)? Has this changed recently?
- Are you going through any treatments that may affect your hip musculature or the way your hips behave (physical therapy, bodywork, chiropractic, etc.)?
Key influencers: bike fit and hip health
Your position on the bike is obviously a key player in the manner in which the IT Band, gluteus maximus and tensor fascia latae operate.
In my experience as a bike fitter, the list of culprits is long and below is a brief summary.
Please note, these aren’t things I’m recommending you start tinkering with, but rather key influencers that you should know about when having bike fit conversations.
1. Pedals
Pedals affect stance width, which is the distance between your feet when engaged in the pedals. Not all pedals come with the same spindle length, and this is something you and your bike fitter should be considering because it can promote or deteriorate proper mechanics.
Cleats for each of the various pedal systems can allow, or prevent, rotational movement. Because the knee is not a simple hinge, for most riders a bit of rotation at the foot is necessary to prevent issues. Choosing the right system with the right amount of float for your type of riding is critical.
Additionally, the rotational component of mounted cleats is far too often a result of the manufacturer’s markers located on the bottom of the shoe.
Cleats should be mounted in a position that allows a rider to maintain some sort of natural foot deviation.
The manufacturer’s labels have nothing to do with this, so there is no rationale behind aligning the cleat with any of these markers, unless using them to mimic a previous mounting location!
Cleats for pedals are considered a “wear item” (some more than others). If you think you may have aged hardware, you can engage the shoe by hand and see how much axial movement is possible.
Is the cleat rocking side-to-side? If so, was it meant to do this right out of the box?
2. Shoes
For the most part, the shoes themselves are usually not the culprit. However, everything inside and outside of them can have an influence on your IT Band.
Insoles, or lack thereof, can play a role in IT Band problems. The philosophy of insoles is to aid in potential instability of the ankle complex. However, their direct action on the foot creates a series of indirect actions further up the leg.
In short, an unsupported arch can lead to a rotation of the thigh as well. This puts stress on the lateral aspect of the hip, the IT Band, for instance, and that stress can lead to problems.
Some insoles are better than others at preventing this scenario, but regardless of brand, I’m yet to come across a ‘lifetime’ insole. They break down over time, and if yours are tired and worn out, they’re no longer serving you.
When warranted, forefoot wedges are another bike fit tool that could be a positive influence on IT Band symptoms.
Similar to how a collapsed arch can create medial rotation up the leg, so can a lack of support in the forefoot. However, they should be used cautiously and the presence of forefoot angulation is not itself grounds for filling the shoes with gadgets.
It’s also important to know that at least one brand, Specialized, is building forefoot wedging in to the sole of the shoe – for some riders this requires correction to eliminate this canted feature.
Much like forefoot wedging, heel wedging, when warranted, can provide support to the IT Band system. Fortunately, heel wedging is not as common as forefoot wedging. I say fortunately because I firmly believe heel wedging can lead to larger impacts on the body, but the scope and explanation is beyond that of this article.
External wedging between the sole of the shoe and the pedal cleat can also influence mechanics. Again, the explanation is somewhat similar to that of insoles and wedging, but for different reasons. Internal and external wedging are not the same thing, and should not be treated the same.
3. Saddles
The scope of this article is far too narrow to bring forth the question of saddle comfort.
But what is manageable is a simple question: are you able to sit squarely on the saddle that’s currently mounted on your bike? And, are you able to position your spine in a ‘neutral’ position?
If you cannot or are not sitting squarely on the saddle, this can have an impact on the development of IT Band symptoms.
From my experience, any time a rider does not have good support under the sit bones they will do one of three things: shift laterally to favor one sit bone, rotate the pelvis (from a top-down view) in search of support, or rotate the pelvis posteriorly (from a side view). Any of these events will lead to unbalanced demands on the IT Band and its related musculature.
Also, in regards to saddles, is effective saddle height. There’s a regular comment I see from forums: if you have IT Band issues, lower your saddle.
Perhaps lowering the saddle alleviates tension of the IT band, leading to a decrease in friction, inflammation and pain. However, before lowering your saddle, document the saddle height you start with, and document the changes you make moving forward.
If new symptoms arise from your new position, you’ll at least be able to communicate to your bike fitter what you’ve done and when.
4. Hip health
It’s common in the world of cycling to see unhealthy hips, at least in my experience.
What I mean by this is that the manner in which we move and function today is not in line with the way our bodies were designed to operate.
Muscles meant to perform certain motions no longer can without compromise. The synergies between muscles to coordinate complicated movements lose their ability to talk to each other clearly.
There are far too many causes of dysfunctional joints to name within the bounds of this article, but the most common symptom I see among cyclists is the lack of a quality neurological signal to the gluteus maximus (and medius and minimus). Which is to say that we simply ‘forget’ how to use these muscles.
Have you ever heard that early gains associated with resistance training progression are due to neurological adaptation? Said simply, getting the muscle and the brain to communicate is enough to get things rolling in the right direction.
The proper exercises, done in the proper order, with the proper load and frequency, and in ideal form can quickly lead to improved muscle function.
Squats and lunges, and any of their variations, can lead to significant increases in function. Seek out exercise specialists with clinical or orthopedic specializations to help you recognize how to get good neurological signals going.
Stretching and foam rolling
For whatever reason, the topics of stretching and foam rolling are where I notice the most back and forth in forums.
Disclaimer: I am a dedicated stretcher and user of the foam roller. I believe proper stretching and use of a foam roller can bring significant benefits, especially to cyclists. But much like resistance training, there are correct and incorrect ways to stretch and use a foam roller and if done improperly, can leave you in a worse condition than you started.
As for the foam roller, there are lots of different schools of thought, but prior to their mass commercialization the idea was that foam rollers allow individuals to perform self-guided ‘trigger point’ work.
But the physiological mechanism involved lies within muscle, not connective tissue. So, if you want to use a foam roller as a potential way to alleviate IT Band discomfort, which muscles should you target? The gluteus maximus and the tensor fascia latae.
Should you foam roll the entire length of the IT Band? Personally, I think it’s painful, but not because of ‘making gains’. It’s painful because the femur is incredibly exposed along the side of the leg, and bones don’t like being smashed — that pain is the femur telling you politely to do something different.
Conversely, I find that foam roller on a muscle belly is incredibly relaxing… funny how that works.
Anti-inflammatory options
First and foremost, I am not a medical professional. It would be unethical for me to say whether or not you should engage in non-steroidal-anti-inflammatory drugs (NSAID).
However, what I will communicate is a piece of advice that came from a medical professional that knows far more than I about the topic.
His advice goes something like this: NSAIDs provide relief from mild pain and decrease inflammation, allowing cyclists to continue to perform their training workouts. He continued by asking, is this a good thing or a bad thing? If you eliminate your body’s message to you that something is wrong, is that good or bad? How will you know if things are getting better or worse? This question raises an important topic for conversation between you and your healthcare provider.
Aside from NSAIDs, there’s always the option of ice, which is another means of reducing inflammation.
There seems to be an abundance of information for how long and how frequent to cycle treatments, but the most consistent information I read is that it should not be uncomfortable.
Don’t allow skin tissues to come in to direct contact with ice — a wet cloth is a great means of protecting the skin and transmitting the cold.
And last but not least, rest. Yes, it can be just that simple. Just don’t give the IT Band a reason to get inflamed and you’re already pointed in the right direction.
Get back to riding
The complexity of the hip and the IT Band is immense, as you now know. And like I mentioned early on, if it’s taken you a lot of work to create an injury, there’s going to be a lot of work involved in alleviating your situation.
Rider positioning, equipment choices, muscular function (or dysfunction) and continuous self-care are all part of the healing equation. But fear not, I am a former IT Band pain sufferer and have used all of the above information myself to find relief.
Here are my final critical reminders:
- Breathe. Always be breathing. Funny enough, but if you can’t breathe properly it’s a clear indicator you’re doing too much. Too much weight, too much stretch, too much foam rolling. Always be breathing.
- Exercises should be done using a load and rep count that enables good form. Once good form is gone, stop.
- Stretching should be a 2–3 / 10 on a ‘pain’ scale, which is to say it should not be painful at all. Overdoing it will actually work against you — it is not a competition.
- Foam rolling should feel good. If it doesn’t, you’re doing something wrong. Try a softer roller or move your body around to try to reduce the amount of pressure.
- Be patient. There is no ‘free lunch’.
