Overloading of my Knee - illiotibial band syndrome

[Mikeys]

Hi, anyone who has any advice would be much appreciated.

I was regulary completing 50mile rides comfortbly in readiness for the Forest of Dean Spring Classic in April 2007; which my bro told me was 70 miles!! Turned up at the startline and realised that it was a seriously tough 85 miles which felt like the majority were climbing!!

I've never had a problem with my knee when road or mountain biking before however about an hour into the ride I had a twinge in my right knee. I thought it was a niggle so pushed on going through the various pain barriers (and enjoyign it). When I finished my knee was hurting quite a bit but didnt think much of it.

I had a few days rest and went for a ride. As soon as I hit the smallest incline i had a sharp shooting pain through my knee which progressively got worse the more I pushed.

For the last 3 years I have never been able to ride without my right knee causing me pain. I've tried everything i can think of, new pedals with more float, checked seat hight, MRI scan on knee to check all is well, private sports physio and still I can't go out for a ride without holding back. After reading up on the net I believe I'm overloading my knee, illiotibial band syndrome as it's referred to.

I've now sold my beautiful Bianchi road bike because every ride I ended up frustrated, I just plod around mountain biking which is just as frustrating but at least something!!

Please can anyone with any advice or ideas help?

Please feel free to email me at mike.stitt@yahoo.com

 

[sandmonstersandy]

Hi Mike,

I had a similarly frustrating experience but only for 3 months- It felt like my knee was giving way whenever I pushed hard. I did so many core exercises but only a few were effective

I finally found the best remedy to be:
1. Single leg squats- keeping the knee cap tracking straight- check in the mirror, and keeping the pelvis stable
2. Cleat wedges

By doing these for 2 weeks it improved dramatically, it still hasn't gone away completely, but I hope it will with a bit more time

Regards

Sandy

 

[fatandfast]

Cross train. Jump rope. Buy a computer. Make sure your mass index is in line with norms for your age,height and weight. Never figure anything out on the bike if it hurts stop.You should have a log that shows through consistent traing that you can make the mileage and conditions. Train at 110% of your event/race mileage and effort. Wake up do 85 miles of hard climbs could equal long lasting injuries.

 

[mherm79]

if the pain has yet to go away after 3 years I'd go immediately to a physio and get scans done to see what it going on.
I'd also stop any form of exercise that causes the pain. If spinning on a trainer is pain free, then stick to that.

long rides + hills will expose any form / set-up issues that can be hidden on shorter easier riders.

don't waste time - go and see one or more professionals.

 

[Tapeworm]

The pain that you describe can usually be attributed to a fit issue. Forces on the knees in cycling (even at 60rpm) are quite low. If you are getting pain it mean something isn't working properly. A good fitter will examine leg length, foot size, hip rotation, leg extension etc etc. You can do all the core exercises you like but if you still don't fit correctly to your bike you probably will get recurring issues. Retul fits can be quite good as they can identify the very small irregularities which can't be judged by sight alone.

Look at the some of the posts by Steve Hogg on cyclingnews, he's something of an authority on all this stuff.

 

[brianf7]

I can take a guess and say its comming from your hips write to Steve Hogg on the Fittness forum of look up some of his posts on previouse isues.

My Orthopedic surgeon told me I have ostiophites on the Pattela tendon he said he could clean it up but it would take 5 years before I race again.

 

[ravens]

Hi, anyone who has any advice would be much appreciated.

I was regulary completing 50mile rides comfortbly in readiness for the Forest of Dean Spring Classic in April 2007; which my bro told me was 70 miles!! Turned up at the startline and realised that it was a seriously tough 85 miles which felt like the majority were climbing!!

I've never had a problem with my knee when road or mountain biking before however about an hour into the ride I had a twinge in my right knee. I thought it was a niggle so pushed on going through the various pain barriers (and enjoyign it). When I finished my knee was hurting quite a bit but didnt think much of it.

I had a few days rest and went for a ride. As soon as I hit the smallest incline i had a sharp shooting pain through my knee which progressively got worse the more I pushed.

For the last 3 years I have never been able to ride without my right knee causing me pain. I've tried everything i can think of, new pedals with more float, checked seat hight, MRI scan on knee to check all is well, private sports physio and still I can't go out for a ride without holding back. After reading up on the net I believe I'm overloading my knee, illiotibial band syndrome as it's referred to.

I've now sold my beautiful Bianchi road bike because every ride I ended up frustrated, I just plod around mountain biking which is just as frustrating but at least something!!

Please can anyone with any advice or ideas help?

Please feel free to email me at mike.stitt@yahoo.com

I am not even going to bother outlining all the crap I have been through with my knees. After all that, I find the thing that makes me feel the least pain both during and after exertion is a simple $10-15 brace at any drug store at walmart. Open patella but make sure it has the side stabilizers.

Other suggestions, stretching before and after, stretch right and don't cut any corners or abbreviate the duration. LIGHT weight lifting such as leg press may help. a phys therapist may have better exercises.

Ice afterwards.

1. Brace(s)
2. Stretching - especially post rides.
3. Ice.
4. Stop the pain cycle before doing anything else that hurts.

 

[inzinyathi]

re ITB

Hi Mike
I saw your post a week ago and wasn't going to reply, I have had similar problems for the last year and have been at my wits end with my left ITB.
It stopped me mid-race in Costa Rica in November and cost me a lot of money.
I am a Dr myself but its extremely difficult to treat yourself!
What i did do though was research ITB in cyclists thoroughly and finally things are starting to come right, I had my first pain free 30 mile hilly cycle in a year this weekend so thought I would reply!

There are two components to most common cycling injuries- the first is overuse and the second is biomechanics.
In ITB overuse usually refers to too much too soon, excessive hill riding, excessive use of big gears or a combination of all three.
On top of this there is usually a biomechanical problem either just on one side (as with me) or bilaterally.
ITB is a friction syndrome which is difficult to treat because contrary to what some physio's will tell you the ITB is almost impossible to stretch- its like a band of high tensile steel.
My approach would be
1) Correct training errors, decrease hill work, use easier gearing- I have gone to a triple with 170mm cranks and I don't give a **** what people think.
2) Biomechanics-
a) fit- get fitted up professionally looking at seat post position and cleat position- for ITB you want cleats with lots of float as far out as you can set then
b) assess for leg length discrepancy-this is my main problem my R leg is 2cm shorter than the left.
c) assess for muscle strength imbalance between the two sides at hip and knee.
d) flexibility esp hamstrings.
Things you can start doing straight away, REALLY work on hamstring flexibility and hip abductor strength-i.e. **** muscles- they, together with the muscle attaching to the ITB are key stabilizers.
A good physio will be crucial for all of this, contact your local racing club and ask who they use, like Dr's physio's are becoming more specialized- worth finding a good cycling one.
I hope this helps

 

[Richard S]

Hi Mikey,

I agree with a lot of the advice that has been given above. I am sure that you will be able to get back riding pain free with a little concerted effort.

Be careful about just slamming your cleats as far out as possible or other blanket measures. The key thing to remember is that everyone is different, therefore I would highly recommend seeing a good fitter or a physio with experience dealing with cylcists. Pushing your cleats out wide, whilst it will offload the ITB in the short term, if you have deeper biomechanical issues such as leg length discrepancies and/or sacroilliac joint disfunction, then eventually your ITB will simply get tighter still untill the problem returns.

Without looking closely at your body and Hip/Knee/Ankle alignment it's difficult to say what is causing the problem, but I would lay money on there being a mechanical cause, which once addressed will allow you to significanlty reduce the load through the patella and stop the ITB frictioning on the lateral epicondyle of your femur (which is the end result whatever the cause). Get someone who knows to get to the bottom of what is happening and you should be able to fix that root cause.

As I said, everyone is different, and one person with a leg length difference could display very similar symptoms to someone with a lack of Gluteal strength allowing the knee to track inwards during pedalling.

If you are in the UK (I am located in the Manchester area) ,drop me a line and I would be happy to take a look and see what we can do, I am sure that with the right setup and exercise program for buiding back up to distance riding we could get you pain free soon.

All the best, and good luck with it.

Richard

 

[Kennf1]

Just to add to what everyone else has said, stretch that IT band, every day. Not the easiest thing to stretch, but it can be done. And use a foam roller on the outside of your quad. Painful, but effective. If your knee is diving inward on the downstroke, you probably have a strength deficit with you hip external rotators. Also, ITB inflammation will never, ever, go away if you keep it inflamed. As soon as you feel a twinge, stop.

 

[Martin318is]

my solution

hi,
I had a serious case of ITB syndrome last year. I have raced on and off for about 20 years and had come back to the bike after a nearly 2 year lay-off. Because i was away from home, I had my position set up by a local respected bike shop owner. everything seemed fine but after 2 months of training I started to have serious issues. From October through to January, I was unable to get in or out of a chair using my legs alone. I had to put hands down to take the lowering and lifting load in my arms because the pain was too great in my knees and hips. (my muscles at the time were Very strong on the bike etc but the pain when getting down to 90 degree leg bends was extreme).

I took 2 months off the bike completely and went to find an old friend who has always managed my bike position. He immediately saw that I was sitting 'back' on the bike and moved my saddle forward by over 1 full cm. I immediately noticed that I was now pushing straight down on the pedals and not 'reaching out' to them the way I had been. I have been training on this setup for 1 month and have zero pain and considerably more power.

Please note, i am NOT NOT NOT suggesting that the solution to ITB is to move your saddle forward a bunch.

What I am saying is that there is almost certainly a position related issue going on here and getting yourself assessed by a REAL professional fitter (not just a guy at the local shop) will quite likley save you years of issues.

Whatever you do, don't overtrain either!

 

[DrVrides]

IT band insight

Mikey and others,
The Iliotibial band gets tight and weak when there is intestinal dysfunction. With proper digestive correction, I could virtually guarantee that your pain would cease. The challenge is finding the right correction. It might be probiotic's, best taken at bed time and high dosages initially. It might be digestive enzymes, more likely if there is associated patellar pain involved. Interestingly, digestive enzymes are also wonderful anti-inflammitory agents. It could be a food like wheat or corn causing the IT band irritation. From the food perspective you could do an elimination diet trying to correlate diet changes with symptom relief or go to http://www.ICAKUSA.com to locate a qualified Applied Kinesiologist to shorten the pursuit. Let me know if you have further questions.
Best wishes in your recovery,
Dr. V

 

[Anonymous]

Knee Trauma

I smashed one of my knees in a motorcycle accident in 1971. I don't know what was damaged but ever since I have various degrees of discomfort to pain. Maybe 10 years ago I started taking various combinations of glucosamine, chondroitin, MSM which are essential for healthy joints. When I don't take them I have serious pain after an hour on the bike. When I do take them (large doses for a long time) I can easily do 4 to 5 hours.

You might investigate these supplements. Good luck.

 

[Grandspb]

Just wanted to warn you guyes not to buy blindly suppplements that are flooding the net now, it's always better ask your GP - they at least know what's junk and what's not.

 

[James Johnson]

IT Problems

Man, I have had the same problem which sidelined me for over a year. I did all the stretching, strengthening etc. But the breakthrough for me was a bike fit which included pedal spacers. These pedal spacers provide about an inch of extension, placing the pedals in a wider position which for me straightened out the pedal stroke and almost overnite cured the problem. We also have done some wedging to account for a slight leg discrepancy. My bike fit PT learned about spacers about 6 months ago and has now used them with 7 other folks, to great effect. I pedaled my commuter bike which didnt have the spacers, and instantly felt that old painful feeling. for me, these spacers are the key. I think they are called knee savers, you can purchase on line, but use with a bike fit specialist. Best of luck, JJ

 

[WC Roadie]

Just to add to what everyone else has said, stretch that IT band, every day. Not the easiest thing to stretch, but it can be done. And use a foam roller on the outside of your quad. Painful, but effective. If your knee is diving inward on the downstroke, you probably have a strength deficit with you hip external rotators. Also, ITB inflammation will never, ever, go away if you keep it inflamed. As soon as you feel a twinge, stop.

If you are definitely suffering from IT Band pain, Kennf1 is dead on here. It's an overuse injury and you need time off, going easy will not help. I suffered from ITBS for a few years, mine also gets inflamed every so often. I stretch daily and use a foam roller as well as "The Stick" to loosen up the IT Band.

Good luck.

 

[waccampbell]

Would something like this count for a feeling like your hamstring is going to cramp? That's the only way I can describe it really and led me to the point where I do not have any confidence in my left leg.

I've been to a physio and I think this is what he was talking about and gave me a stretch where you move your head and feet at the same time and stretch out your hamstring (hard to explain)

I was never properly fitted to my bike, infact I was quite disappointed with how the bike shop went about it. It feels comfortable but I'm 99% sure that something could be moved to make life easier on the saddle.

 

[Martin318is]

Whilst I am no expert, that doesnt really sound like ITB syndrome to me. THe ITB connects to the upper end of the tibia and passes up the outside of your leg to eventually connect up near the hip. THe pain is usually first presented near the outside of the knee as the inflamation occurs due to the band continually rubbing over a slight bone protrusion on the knee itself. Once this starts, the pain and discomfort can radiate from the outer knee, right up to the hip - but its generally feels like its on the outide of the leg.

What you are describing does sound like a positioning issue and I wonder whether it will be more to do with your saddle fore/aft position relative to your bottom bracket. Rather than guess my way through this, I would really recommend you get yourself to a local fitter. Most bike clubs will know who all the local riders go to.

 

[Martin318is]

Incidentally, mine is back - worse and I have been off the bike being treated for about 2 months. Really really getting sick of this - not to mention FAT!

 

[waccampbell]

Is there any good fitting places in Melbourne that could do a fit, its only up the road.

I'm off to work for 3 weeks on Monday and won't be riding for that time, hopefully my leg can settle down between then and when I get back I will go and get properly fitted.

As lazy as I am, I always seem to want to ride alot more when I can't haha maybe it's because I have a good excuse not to, who knows. It certainly does suck being off the saddle though.

 

[Martin318is]

Is there any good fitting places in Melbourne that could do a fit, its only up the road.

Go and see Derek White at Vuelta cycles on the corner of Inkermann street and st Kilda road. He is the best I know in Melbourne and has an excellent reputation.

 

[durianrider]

Many say that Steve Hogg at http://www.cyclingfitcentre.com in Sydney is the best in the world. I agree. I dont know anyone that has fitted up as many pro's, amputee's, punters etc and all with a money back guarantee.

Ask Steve to show you his 'superman pushup..'

In the meantime, make sure your cleats are positioned so your heals are rubbing/almost rubbing your cranks. Sit on the edge of a bench and let you feet hang naturally..if heels go in, do the above. If they stay out, do the opposite.