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Ever felt a pain on the outside of your knee while running down a hill? Or felt like there was a vice grip squeezing your knee during the power phase of the pedal stroke?
Written by: Nathan Koch, P.T., A.T.C.
You may be experiencing the dreaded ITB friction or compressive syndrome, the second-leading cause of knee pain in runners and most common cause of lateral knee pain. The ITB, or iliotibial band or tract, is a dense thickening of fascia tissue that originates from hip muscles and extends down the outside of the thigh, crossing the knee joint and attaching to the top portion of the lower leg (tibia). Excessive compression or friction forces at this lower attachment results in tenderness and pain when bending the knee under load.
On the bike, ITB syndrome can be caused by bike position (narrow stance, mal-aligned cleat position, saddle too high, etc.). With running it can be caused by training on uneven or canted surfaces, shoe selection, running downhill or running the same direction around the track. Typically, there are also biomechanical issues within the athlete, such as leg-length discrepancy, asymmetrical hip/lower extremity flexibility, hip muscular imbalance, foot and ankle mechanics or anatomical conditions (“bowlegs”).
Resolving ITB syndrome can range from self-treatment to surgical intervention. Identifying the cause is critical for complete resolution and prevention, and may require a thorough assessment of bike position and/or run gait.
On your own, start with:
1. Foam rolling on the ITB, from hip to knee
2. Hip/LE stretching (dynamic stretches before activity and static after)
3. Lateral and rotational hip strengthening using bands or cable machines
4. Ice after a ride or run
Treat early and often to prevent downtime!