IT Band Tendonitis

[indyrider]

Greetings,

Last May I injured my knee on the return ride of a weekend double century. My right knee was sore after the first 100 and I awoke at night in extreme pain on the outside of my right knee. An MRI showed nothing but tissue inflammation but I disagreed. A sports DR. diagnosed it as IT band tendonitis.

Fast forward to present and I still have pain in my knee :mad: :mad: . I read a cycling medicine book which also describes my injury as tendonitis. It recommends to move my cleat position so that my foots points a little outwards and also stretching.....

Is it typical to still be in pain so long after the injury(I've been on the road a little here and there) and can you recommend any healing procedures or little tweaks to the machine which might help aleviate this problem???

thanks in advance, josh

[Fixed]

bro a change in shoes and cleats are what most bros do my friend went from time to the c.s.c. speedplays that worked for him .hope you feel better soon bro cheers :beer:

[cs124]

been there, done that...

visited a physiotherapist

program of stretches and strength exercises

new cycling shoes

adjusted cleats

knees good as gold

[Ray]

I used to get IT band pain a lot in the first few years I was riding, particularly early season. It could be VERY painful, but never lasted more than a day or two before I could get back on the bike. I never rode a century when my knee was already sore though, so you could have damaged it more from that. Your's also sounds kind of different though - mine always started hurting while I was riding rather than after I'd stopped. Stopping always helped. A couple of times the pain was bad enough that I had to stop before completing the ride. So you may have done something different. But based on my experience, yeah, 8-9 months is a LONG time to still be in pain from an IT band incident.

-Ray

[cinelli]

Because my left foot naturally angles outward,
I developed IT tendonitis several years ago
with the introduction of clipless pedals. My foot
could not angle out far enough causing the IT
band to become inflamed. Rest would help
along with ice and aspirin. The pain persisted.

Floating pedals came along and the tendonitis
diminished somewhat, but did not disappear.
Finally, I found a good orthopedic doc who
gave me some stretching exercises to try
before every ride. This along with a severe
angle to my left cleat has kept me going.
I still get minor flare-ups, but a little ice
immediately afterward ususally takes care of it.

[RABikes2]

Add to the other suggestions...see a Massage Therapist for regular appointments (and stretch)!

Feel better Josh. :beer:
RA

[Too Tall]

No it should not last that long and you need to focus on diagnosis and rehab until you find answers that make sense.

For now consider using platform pedals with toe straps. Use ice, LOTS of ice immed. after exercise. 2 lb bags of frozen peas work.

Buy "the stick" from www.thestick.com. Get the "origional stick" with blue handles and use that to roll your IT from insertion to origin. Don't go deep, just seek to keep it loose. Self help is a good thing.

Find the best sports med. doc you can and quit listening to intenet advice ;)

Good Luck.

[RABikes2]

Use ice, LOTS of ice immed. after exercise. 2 lb bags of frozen peas work.

Buy "the stick" from www.thestick.com. Get the "origional stick" with blue handles and use that to roll your IT from insertion to origin. Don't go deep, just seek to keep it loose. Self help is a good thing.
Good advice. Frozen peas are excellent for icing. I've been using "the stick" for years; a good piece of equipment to work on yourself with.

[EnduroFit]

Make sure you stretch your calves really good too! When tight, your foot likes to invert and rotate(pointing down and in), thus causing your hip to internally rotate placing unwanted tension on the IT Band! The same thing has/is happening to me and stretching thoroughly before, stopping during a ride and lightly stretching, as well as after is important. Just dont' stretch the IT to the point of pain, nice light stretch seems to work best. I also use the "Stick" 2-3 times a day for relief and find it the most effective means thus far. Talk to a good SMed Doc and get some exercises to compliment your stretching routine. Good luck :)

[billrick]

Ditto on what everyone has said already - focus on getting it diagnosed and rehabbing. 8 months is a long time and I'd guess you are still out of whack biomechanically. Find a good physiotherapist and maybe a bike fitter. Be diligent about the prescribed stretches and strength exercises. Be prepared for orthotics, new shoes, new pedals, and maybe even a new bike.

When I was running marathons, I had IT band tendonitis to the point that one side slightly hemorraged. Doc said he had never seen that before. Suffered through the last race and then went to a physiotherapist and a podiatrist. Orthotics and stretching fixed me, but I am still prone to pain when I get lazy about the stretching.

Good luck with a speedy recovery!

:)

[andy mac]

TT, would using foam rollers help him too??

cheers,

andy.

[shaq-d]

what caused the IT band tendonitis? isn't it because the saddle's too high? did you lower the saddle?

sd

[david]

stretch, stretch, stretch.
but not just before and after a ride.
i stretch every night before bed as i watch tv.
it really works.

[Too Tall]

Andy, you betcha bosco! Thanks for saying it, they are much more effective for deep work and less painful because of the broad surface. He will need initial instruction how to keep his vastus slack when doing the work or it will just end up being a nice side lying ab transverse ab crunch :rolleyes: Just what the world needs..not. To hit the IT origin use a 2kg red weight ball and do what comes unnaturally....roll circles slowly with the ball just lateral to sits bones...that'll hurt in a good way.

[andy mac]

plenty of good questions/reading on cycling news:

http://www.cyclingnews.com/fitness/?id=default#qa


an answer to an ITB queston at:

http://www.cyclingnews.com/fitness/?id=2005/letters11-07

ITB question

I am a 35 year old amateur road racer and have the following question. I have always had iliotibial band pain on only my left side. It was so painful from running that it forced me into the sport of cycling and while it was always present I was able to manage it through stretching and the like. It has become very painful recently for no apparent reason, i.e. new equipment, position change, etc. The pain shows up in two specific places-on the outside of the knee and on the outside of my glutes. Therefore, I have read about leg length discrepencies and their role in ITB pain. I wondered if I chronically only have pain on my left side what might this be indicative of? Does the longer or shorter leg usually have the pain? Any thoughts or ideas are welcome including positions or equipment that might be helpful. Thanks.

John S

Detroit, Michigan, USA

Steve Hogg replies

John,

Has anyone structurally assessed you thoroughly? By that I mean stripped you to your underwear, made you bend and stretch etc to determine how you function. If not, it is a good idea as you may get some insight into how you function and what level of asymmetries you have between left and right sides.

You may have a left side problem leading to loading of the left ITB. Equally, you may have a right side problem that you protect [common occurrence] and compensate on the left side and pay a physical price for that.

Knowledge is power. Find out your own particular structural and functional state of play by finding a good physio or similar. Once you are armed with that info, then some suggestions can be made.


and another question/reply at:

http://www.cyclingnews.com/fitness/?id=2005/letters09-05


ITB problem

I am a 58 year old avid, recreational road cyclist. Last year my mileage almost tripled (1200 to 3400 miles) I began having ITB pain, but not at the knee. My pain came from the hip area. My ortho doctor said that the band was snapping around some area near my hip. His x-ray showed no arthritis or other problem. A cortisone shot cleared up the problem. That was at the end of last season. Now that I've exceeded 2000 miles this year, the problem has returned.

Obviously there's a fit problem with my bike. I have a leg length difference. The longer right leg has the pain issue. My leg difference is almost 1/2 inch. What about the fact that my position on the bike could be causing such a problem? Should the seat be raised, lowered? I have also noticed that, as I pedal, my right knee (the problem side) tends to travel left and right instead of straight up and down, especially during strenuous, seated climbing.

Rik Gagnon

Massachusetts

Steve Hogg replies

Rik,

My experience is that most [not all] cyclists with a longer right leg favour that side in the sense of twisting further forward to that side while pedalling. This is a result of the greater torque exerted at the hip of the longer leg over a lifetime, causing the iliac crest on that side to move forward which in turn means that the hip has to move up and back, though a lesser distance. This leaves you with a situation where you stand with the right hip behind the left.

Anatomically, you will do whatever you have to to align your hips. Usually this means that the right side will twist forward, bringing the hips into square but leaving the pelvis with an anterior right iliac crest and a posterior right sit bone. Additionally, they often have a notable varus forefoot to a degree not present on the left.

The shorter explanation is that both of these things are usually the fallout of spending a life with different length limbs. What all of this adds up to, and what maybe occurring in your case, is a longer right leg with compromised function around the hip reaching a lesser distance to the pedals than the shorter left leg. If no steps have been taken to accommodate the leg length difference in terms of shims under the short leg or whatever, and you make no mention of that, often the rider sets the seat height so as to be comfortable for the shorter left leg that is reaching further anyway, because of the propensity to twist towards the right side.

Where this leaves you is with right side hip flexors that are being cramped up and restricted in their movement, which may be the basic problem that you have. Do you have anyone available to you with experience in positioning people with noticeable asymmetries? It would be worth asking around and seeing who has a good reputation.

If this option isn't open to you, I would confirm what I have said above or otherwise by having someone look at you from above and behind while you pedal on an indoor trainer with your shirt off. If as I suspect, you are twisting forwards on the right side, then the seat will probably need to go up, the seat nose will need to point to the right a few degrees and a shim of whatever size is appropriate will need to go under the left foot and I would play around with some Lemond wedges under the right foot too with the thick side towards the crank.

[Kahuna]

Don't dispair. This is a very treatable and common ailament. I had ilio tibial band friction syndrom (ITBFS) bad enough that I thought it would ruin my ability to ride a bicycle. At its worst point, I couldn't ride more than 10 miles without pain forcing me to stop.

What worked was a combination of several things. Four weeks off the bike while undergoing physical therapy prescribed by an orthopedist.

The PT consisted of 1) stretching, 2) leg strength training with particular focus on the hip muscles, 3) balancing excerises because it helps strengthen all kinds of supporting structures. 4) ultrasound with topical cortisone, 5) myofacial release (deep tissue massage), and 6) ice (very important).

It sounds like a lot but all this involved was 1 - 1.5 hours, three times a week at a local Healthsouth facility and self-rehab at home on the weekends. Certainly not any more time involved than riding. I was lucky because the PT was covered by my medical insurance.

Knock on wood but after only 3 weeks of that, the dreaded ITBFS never bothered me again. I actually think I came out faster and stronger than before the injury.

Good luck and let us know how it goes.


Greetings,

Last May I injured my knee on the return ride of a weekend double century. My right knee was sore after the first 100 and I awoke at night in extreme pain on the outside of my right knee. An MRI showed nothing but tissue inflammation but I disagreed. A sports DR. diagnosed it as IT band tendonitis.

Fast forward to present and I still have pain in my knee :mad: :mad: . I read a cycling medicine book which also describes my injury as tendonitis. It recommends to move my cleat position so that my foots points a little outwards and also stretching.....

Is it typical to still be in pain so long after the injury(I've been on the road a little here and there) and can you recommend any healing procedures or little tweaks to the machine which might help aleviate this problem???

thanks in advance, josh

[Kevin]

What Kahuna said, ditto.

Kevin