IT band - SOLVED!!

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superdx
Posts: 524
Joined: Sun Jun 29, 2014 1:27 pm

by superdx

I just got back from a knee surgeon, and he said the pain I was experiencing (only when cycling) was from the IT band. He suggested a few training things I could do for about 3-4 weeks to recover. There was no medication prescribed, I'm not in any pain. I'm curious as to whether this is going to become a permanent thing. It would suck as I really enjoy long rides, and rides with lots of climbs.
Last edited by superdx on Sat May 02, 2015 2:46 am, edited 1 time in total.

scott91
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by scott91

IT bands vary a lot person-to-person.

Some people will get better with some rest, ice, and then a more gradual progression back into distance being ridden. Suggest working with a physiotherapist for that part. Bike fit can also play a huge part - has anyone fit you?

Others will require surgery.

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11.4
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by 11.4

IT band therapy is changing these days. The standard used to be to have you do a lot of foam roller work, but data have shown that this simply increases adhesions to the ITB. Physical manipulation helps, both leg manipulation and localized massage, but it has to be done right and most physical therapists aren't up to date. If you want to address it yourself, a few thoughts:

1. It's hard to stretch the ITB effectively. One can do better with someone manipulating your leg, but even so, stretching tendons isn't the real idea here. It's an unusual piece of tissue because when you stretch your achilles tendon, you are actually stretching the gastroc that's attached to it. Tendons just aren't intended to stretch that much. ITB pain is more about pressure on the muscles underneath (or pressure as the muscles hypertrophy with use) and about both irritation and adhesions that develop. However, your ITB can also get dislocated by uneven muscular hypertrophy caused by heavy exercise, and then it starts colliding with parts of the knee or hip joint in ways it wasn't intended to. That's where you get sharp snapping pain or just a popping feeling near the joints. Rehabilitative strength training to even out your leg musculature is what helps best here.

2. In cycling, wedging the cleat or the foot directly is often the easiest most immediate solution so you can keep riding, but you shouldn't depend on it entirely or the pain is likely to return. I haven't found many fitters who really can address this problem, so you might work on it yourself unless you're lucky enough to be around someone really qualified.

3. Try changing saddle height slightly. It isn't a long-term solution, but it can change the line of your ITB slightly as you apply pressure to pedals and can sometimes avoid the snapping and the pain. It gives you time to fix the problem and then adjust your saddle back to what was presumably your ideal saddle height.

4. Lots of general stretching and time in a sauna or hot tub help a lot.

5. If you are wearing tights or knickers at this point, and they have high compression, they can actually move your patella slightly so it interferes more with your ITB. Just keep an eye on it. And if you are riding in cold or wet weather, it changes your pedaling stroke somewhat, which is why you see so many extra ITB cases in the late fall.

Miele
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by Miele

Its a good suggestion above to check your bike fit. My pain was actually caused by having bars too level to the saddle on my cross bike which caused me to lean back when climbing having my pedal stroke 'strained' as it were. On my road bike, with low bars and weight much more forward the pain was never there.
Also spin over grinding if you like to climb - this is taking my years to get used too as I used to style my riding after Merckx when I was a kid. Take a look at old videos of him in the tour.

jeffy
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by jeffy

1) google MobilityWOD

2) invest time in your functionality (see 1)

RimClencher
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by RimClencher

Recovery time can depend on how badly you hurt it. It also may never go away without certain lasting changes in riding position or riding style if it's chronic damage. With my IT band injury the main things that help me in descending order of usefulness:

Push less on the affected leg
Do not ride through the pain (when you feel that stabbing pain it's best to stop asap)
Lower the saddle height (pain usually occurs when knee passes through at 30° angle - lowering the saddle prevents your knee going through that angle so much)
Spinning not grinding (puts less strain on the IT Band - I bought myself a 12-30t cassette to go with my compact)
Rolling the IT Band (I found it helps, but only after changing from a foam roller to PVC water piping - a foam roller was just too soft to do much)
Keeping the peddling stroke straight (moving the leg around while peddling can cause the IT Band to rub, and movement occurs more readily when pushing hard)
Ride in the saddle (including at traffic lights and when climbing - riding out the saddle moves your legs around and can cause your IT Band to rub when it's most stressed)
Push through the ball of the foot (try some one-legged squats and feel which leg muscles you use - push through the ball of your foot only to try and get used to not using the IT Band to help support your leg through the peddling stroke)
Adjust leg length (not surgically of course, but check if your leg with the IT Band pain is physically longer than the other leg - if so try putting some cleat shims or an extra insole in the other side to balance them out and so the other leg does a bit more of the work)
Massage the area of pain (this helps for me and my pain, might help for you - be vigorous)
Ice + Ibuprofen after exercise (may help, probably won't hurt)

I'm planning to try plasma rich platelet (PRP) therapy to see if that helps my chronic injury. It's not really a medically proven thing but it's very, very low risk.

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Mr.Gib
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by Mr.Gib

Try all the conservative therapies but it it keeps coming back have the surgery.

The surgery is very effective and easy to recover from. I had epic bilateral IT band syndrome. I have had both knees done. The results are perfect. The surgeons I have spoken with have yet to see an unsuccessful case using current surgical techniques - triangular resection of the IT band near the femoral epicondile and excision of the bursa like tissue beneath. A surgeon in Belgium did a sample of 32 athletes with the excision only with 100% success. This suggests that removing the inflamed tissue underneath the band is the key. One idea is that the removal of this tissue simply removes the source of the pain.

My sports med is a surgery as a last option kind of guy but with ITB syndrome he is losing faith in conservative therapy and going to surgery more quickly with his athletes. My only regret was wasting time and money on a lot of physio etc.
wheelsONfire wrote: When we ride disc brakes the whole deal of braking is just like a leaving a fart. It happens and then it's over. Nothing planned and nothing to get nervous for.

superdx
Posts: 524
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by superdx

It's been a couple months so I figured I'd post an update.

Late November
I tried a lot of things including twice daily hip strengthening, stretching, foam rolling etc. and for the month of December. At this point it's been almost 3 weeks off my bike. Can't do 9km without feeling serious pain in my left knee. Decided to try physiotherapy. Found a centre that seems to focus on sports injuries.

Early December
First 2-3 weeks of sessions of muscle release, strengthening and new stretches seemed to be working. Can do 30-35km rides but still lots of pain at the end. Apparently all my muscles were really tight because I do zero stretching. 2 years of this accumulated into the IT band problem.

Late December
Moving on to acupuncture. Did a 35km ride with almost no pain. Things are looking better. But on a 2nd ride in the same week, the pain was back.

Physiologist found something new. Left calf muscles had a lot of pain when pressure was applied to them. Did a muscle release in that area + acupuncture and... SUCCESS! I was able to do not only a 39km ride with no pain, but it was with hills as well. 8-9% grades, lots of effort needed. My front derailleur also got screwed up mid-ride and ended up on a big chain going up those hills. Wasn't ideal and felt a bit of pain at the end of the ride.

January - present
Seems like the problem is in my calves, surprising that it would affect the IT band. Doing calf specific stretches is helping and the physiotherapy will continue there as well. It's definitely looking better every day and can't wait to get back to normal riding. But a lot of muscle work needs to be done to ensure that the injury stays away.

Will update in a month or so, but definitely very happy in the start of 2015 so far. Can see the light at the end of the tunnel.

superdx
Posts: 524
Joined: Sun Jun 29, 2014 1:27 pm

by superdx

Further update, aside from my seat height possibly being too high, the cleat position was also too far forward, which meant that most of the strength was coming from my calves instead of quads and glutes.

Using the coin/washer trick from CyclingTips, I found that the current cleat position was 5mm forward of the coin, instead of the recommended 5mm backwards from the coin. I've adjusted it now (thankfully had some speedplay screws to spare) and hopefully this makes a difference. Physiotherapist recommends a 50km ride with some 8-10% climbs to see if the pain still stays away.

jpanspac
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by jpanspac

Link to CyclingTips article, please.
My favorite components are the ones I never have to think about.


mr4fox
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Joined: Sat May 15, 2010 2:01 pm

by mr4fox

A lot of good info here already.
Sounds like a fascial restriction/tightness in addition to muscle problem. I'd be stretching the glutes and mobilising the hips t-o-n-s too. Parts of the glutes attach to the ITB. I'd also be looking at the feet. If you're over pronating when walking you may be irritating that calf and tightening the muscles and the fascia there. Tightness in the hips will also effect loading at the knee while on the bike.

I've had good success with patients using orthotic innersoles, kenisiotaping, joint mobilisation, stretching, dry needling (acupuncture), pelvic manipulations, Granston Technique (I'd definitely be doing this!!!) In addition to retraining/cross training and self mobilisation and stretching of every thing from the waist down.

As mentioned above Kelly starrett from mobilitywad has lits of good food self help stretches and self mobilisations for these things.

And from personal experience...a good bike fit can be worth its weight in gold and save time and money in the long run.

Hope its still improving and good luck

RyanH
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by RyanH

I'm in the same boat as the OP. Although I caused my issue back in January by forcing my cleats into too narrow of a position. An 80 mile ride on Saturday like that and then a 40 mile, very strenuous ride on Sunday has left me basically crippled on the bike. I rested for two weeks then tried two 30 mile rides, which I think caused more damage since I barely made it home both times.

I've been doing lunges daily, as well as stretching. I've been off the bike for three straight weeks, as well as on and off the bike for most of Jan/Feb, but I've seen no improvement. 6 miles into my ride today the pain began to flare up. The suggestion of looking at other muscles might be what I need to do next.

A few questions for everyone:

Is there any benefit to going to an Orthopedic surgeon and getting an MRI? I'll be paying cash for this, so would prefer to avoid the cost if they are going to provide the same advice as above.

Not on the bike, but while going about day to day, I've noticed some minor pain on the opposite side of the knee (around the vastus medialus or Medial retinaculum) and also in my lower leg area, it feels like a tendon but is probably the peroneus longus (it's very sore when massaged). Any suggestions for those?

Regarding saddle height, my saddle height is at 71.5cm while my inseam is 79.5cm. No set back. Should I go lower?

Lastly, since I've moved my pedal stance back out, is it possible to be too wide and cause a problem with the ITB?

mr4fox
Posts: 276
Joined: Sat May 15, 2010 2:01 pm

by mr4fox

So we're the cleats set too narrow or were your feet too narrow?

I don't think a surgeon should be your first port of call. I'd suggest a sports physio/chiro that treats these types of injuries. Ime surgeons are good at surgery not rehabilitation. They use other physical therapists for that.

I'm wondering if you are pronating more on the affected side. Over pronation at the foot can change angles at the knee and stress tendons muscles and fascia. One hypothesis would be that the initial cleat position change may have exaggerated this and lead to the overload which caused your problem. Too high a saddle may have caused more muscle recruitment and stress in the lower leg to compensate for sub optimal glut positioning (another theory).
If it were me I would try to find some sort of physical therapist (their specific degree doesn't matter so much as their experience) who has had success with this type of thing and who knows something about the foot. The other option would be a proper bike fit by a bike fitting specialist. Many bike fitters will see this stuff pretty often and if they can't fix it they will likely know a therapist in the area that's had some success with these problems.

To me it sounds like there are some changes that have occurred that aren't fixing themselves so treatment may be necessary in addition to a bike fit.

I don't know if this helps any and I wish I could help more. I know how much it sux to have a problem like this which stops you doing what you love to do. Good luck with it!!

by Weenie


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superdx
Posts: 524
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by superdx

I don't think an MRI or even an ultrasound is going to reveal anything. All these injuries are muscle/ligaments which don't show up really well in those kinds of scans.

Update on my own condition, my ITBS migrated from my left knee to right!!! It hurts even more on the right side. I've given up and now fully committed to a 4-6 week core / hip / lower back strengthening routine. There have been several studies that showed athletes with ITBS becoming pain-free in about a month if they go full into core strengthening. Hopefully this works out for me. Physio has only helped mitigate the pain, I think to solve it really requires effort on the patient. I'll update in a few weeks time and see what the results are.

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