from Fit Magazine March 2006

Chris Watts is the founder and CEO of Stretch Ltd which specializes in postural realignment using a technique known as Active Isolated Stretching. He gives us the low down on how to avoid ITB and other cycling injuries

The most common injury suffered by bike riders and many runners is known as Illiotibial Band Syndrome (ITB). Basically, the tendon (Stabilizer of the upper leg) on the outside of the thigh, which runs alongside the knee joint, becomes inflamed and painful.

If a cyclist is suffering from ITB syndrome it’s usually due to poor mechanics at the hip level, with a weak gluteus Medius and too much external rotation at the hip causing the knee joint to overload and continuing down to the forefoot where foot pronation is common. Over-training without proper stretching can also lead to ITB syndrome. There are 29 muscles which have origins and insertions into the hip and all should be flexible enough to prevent this type of injury and soreness.

Cyclists should ensure the bike saddle isn’t too low. If it is, excessive use of quadriceps and knee flexion could contribute to ITB. When sitting on the bike, with feet on the ground, there should be a slight bend in the knee. When in motion 40 percent of body weight should be on the handlebar and 60 percent on the rear half of the bike. Don’t increase distance, or change cycling style too quickly. When cycling, your knees should point straight ahead. Bikes fitted with shock absorbers are recommended. And, avoid high gears.

Runners can also experience this injury. In this case it will be a dull ache a couple of kilometers into a run which only goes when the runner stops running. It’s usually worse downhill or on cambered surfaces. ITB can be caused by wearing incorrect running shoes, or worn soles, excessive hill running, overtraining, overpronation (feet rotate too far inward on impact) and/or lack of proper stretching in the deep hip rotators.

For runners, the first thing to do if suffering from this injury is to stop running! If pain is mild, a reduction of the training load and intensity, avoiding any hills or cambered surfaces and increased rest periods should be sufficient. Checking that correct shoes are worn is vital. Motion control shoes with good shock absorbsion and orthotics are advised.

For both cyclists and runners, if pain persists a course of non steroidal, anti-inflammatory drugs could help (check with your doctor first and only used as directed). Apply ice to the knee for about 10 minutes every couple of hours to reduce inflammation. Self massage with arnica cream or an anti-inflammatory gel will help, taking care NOT to massage where pain is felt as this will aggravate the friction. If the injury does not respond to treatment within two to three weeks physiotherapy may be required. If physiotherapy fails to alleviate the pain in rare cases cortisone injections or even surgery may be necessary.

To help prevent Illiotibial Band Syndrome remember to warm up, and cool down properly, and to stretch. Inadequate flexibility in the calf muscles, quadriceps, gluteal muscles and hamstrings, and tightness and restriction of the lumbar spine will all contribute to ITB.

Treat your injuries immediately they occur, not doing so will reduce muscle power and efficiency.

Useful stretches to aid in ITB syndrome

Hip abductor stretch
Internal rotator stretch
Upper thigh stretch
Quad stretch

If lacking a strap, a dressing gown belt will do just as well.