The iliotibial band (ITB) is a tendonous and fascial band that originates on the hipbone (iliac crest) inserts on the outside (lateral aspect) of the tibia, just below the knee. The band also attaches to the gluteal muscles (your rump) and the tensor fascia latae (TFL - the muscle on the outside of your hip that assists in moving the leg outward). As the ITB descends toward the knee, it narrows considerably, before attaching to the outside of the tibial plateau (the top of lower leg bone), fibres also extend over to the knee cap (patella).

The primary functions of the Iliotibial Band are to:

Provide static stability to the lateral (outer) aspect of the knee.
Control adduction (inward motion).
Assist in controlling knee flexion, notably deceleration of the thigh.
Assists the tensor fascia latae & the gluteus maximus to support the extension of the knee while standing, walking, running & cycling

All of the above are significant as they contribute to the maintenance of an effective cycling action.

The demands placed on the ITB during cycling are actually significant and continuous and because of the repetitive nature of the pedalling action allied to the frequency and duration of training rides, many people experience issues which if not rectified can lead to a development of a common but significant over use injury – namely: Iliotibial Band (ITB) Syndrome.

Overuse injuries, otherwise known as cumulative trauma disorders, are described as tissue damage that results from repetitive demand over the course of time.

As stated Iliotibial Tibial Band Syndrome (ITBS) is a common overuse injury that not only affects cyclists but triathletes and runners alike.

It presents as:

  • A sharp or burning pain on the lateral aspect of the knee.

  •  Pain radiating up the side of the hip or thigh

Many factors can contribute to the development of this problematic condition; Anatomical abnormalities (e.g. varus knee – bow legged, leg length discrepancy), muscular imbalances (e.g. weak gluteal muscles) or bike malalignment (improper bike fit).

Many keen cyclists, who might be forced due to lifestyle constraints to cram their 7 to 11 hours of training into 2 /3 rides per week (1mid week & 2 at the weekend) run a high risk of developing ITBS should any of the above issues exist. This should not come as a surprise if one considers the involvement of the ITB in the physical actions involved in the sport.

Cycling at a moderate pedalling cadence of 90 rpm, results in 180 activity cycles per minute, therefore on a two-hour ride, the ITB is active 21,600 times.

There are two theories as to the cause of the syndrome; the most commonly stated cause of ITB irritation results from repetitive friction of the ITB across the lateral femoral (a bony projection on the lower extremity of the femur – thigh bone) flexion and extension as with each pedal stroke the ITB is pulled forward on the down stroke and backwards on the up stroke. The second suggests that a weakness of the gluteal and core muscles cause tension to develop in the iliotibial band as the muscles inserting into it have to also assist to keep the hips level. This action creates muscular imbalances which result in unnatural levels of tension leading to significant inflammation in the fibrous band.

Regardless of the cause a cyclist with ITB will complain of a sharp stabbing pain on the outside of the knee and a loss of power. If the resultant irritation is not alleviated early enough chronic inflammation and fibrosis occurs

As stated above the development of ITBS can be attributed to a number of factors but in the majority of cases the trigger tends to be a combination of physical issues (imbalances / weaknesses), the actual act of cycling and the basic cycling position. The latter two feed any underlying imbalances thereby contributing significantly to its development. In essence the smallest amount of malalignment between the cyclist and the bike, whether anatomical or equipment related (bike set up / cleat alignment) places significant stress on the distal (area closest to the knee) ITB which can lead, particularly in periods of heavy training / competition to the development of this painful and debilitating condition.

Regardless of the factors which contribute to the problem ITB pain should be addressed as quickly as possible to avoid the development of a chronic debilitating injury which would probably require time off the bike and in the worst case scenario surgery. In the first instance

Temporary decrease or stopping training.
An intensive stretching routine.
Strengthening of the hip abductors (gluteal muscles esp. the gluteus medius).
Gentle foam rolling.
Addressing any malalignment issues.

If the above do not help relieve the issues then, ice, non-steroidal anti-inflammatories and treatment by a qualified practitioner may be necessary. ITB pain is certainly preventable and can be quickly eliminated if treated early.

A follow up article will look at issues of; anatomical abnormalities, malalignment and their correction.

 

Hopefully you have found this article of interest & value to you. Should you require further information on this subject or wish to find out how we at Cyclissimo can help you realise your cycling aspirations please contact us at enquiries@gocyclissimo.com or via the contact section found on our website: www.gocyclissimo.com

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