Knee Pain While Cycling: IT Band Friction Syndrome

“My knee hurts.” It’s such a common phase to hear come out of an athlete’s mouth. While there any many structures and culprits of knee pain that can hinder one’s ability to enjoy riding, IT Band Friction Syndrome has repeatedly proven itself to be a common cause.

I, myself, dealt with IT Band Friction Syndrome off and on as a runner in high school and then again in college. As I began my career as an athletic trainer I quickly found I was no where close to being alone. In fact, to date, IT Band Friction Syndrome might be one of the most common injuries I’ve worked with athletes to prevent, rehabilitate, and ultimately overcome.

So what is this sneaky overuse injury, why do so many cyclists and runners have it, and how can we prevent/rehabilitate the condition?

What is IT Band Friction Syndrome?

The IT Band (iliotibial band) runs along the side of the upper leg. It originates from the Tensor Fascia Latae muscle in the hip and inserts at the knee. It is a dense, fibrous band of tissue, but not a muscle in its own right.

When the knee flexes and extends, the IT Band passes over the a bony protuberance of the femur (thigh bone) at 30 degrees of knee flexion. If the IT Band is pulled very tight or other various factors are present, the IT Band or the structures around it will become inflamed due to the repetitive friction.

Signs and Symptoms:

IT Band Friction Syndrome may present itself as a “burning” pain over the outside of the knee. It might hurt to touch or hurt if pressure it applied while the knee is moving. You may experience pain when riding, running, running downhill, or walking downstairs.

Why is it common in cyclists?

In cycling, we have very repetitive flexion and extension of the knee. We are constantly requiring the IT Band to move back and forth across the femur. Furthermore, we often have weak glute medius muscles which can exasperate the issue.

Prevention/Rehabilitation:

The focus of IT Band Friction Syndrome prevention and rehabilitation is through soft tissue mobilization and hip strengthening exercises. Since the IT Band attaches at the hip, a tight or weak hip muscle may pull on the IT Band thus making it more taunt. Follow these exercises to help with IT Band Friction Syndrome!

Clam Shells

Clam Shell

Clam Shells will work on your glute medius muscle and help to strengthen all hip muscles that pull your leg away from your body. Lay on your side with your knees bent and your legs stacked on top of each other. With or without a resistance band, pull your knees apart to feel the activation.

Fire Hydrants

Fire Hydrant

In a quadruped position, lift one leg from the floor directly out to the side. This exercise might feel awkward, but you’ll definitely feel the burn.

Glute Bridges

Glute Bridges

An oldie but goodie. You can complete this exercise with both legs on the floor or with just one leg to make it more challenging. Make sure you are keeping your pelvis neutral and your back flat during the exercises.

Lateral Walks/Monster Walks

Assume an athletic position (with you knees slightly bent). Using a resistance band and keeping your feet spread apart walk side to side. As cyclists we usually only move forward. It’s important to stay well rounded and also move side to side. For monster walks, use the same stance but walk forward/backward while still keeping your feet apart and the band on a stretch.

IT Band Stretches

Finally, don’t forget to stretch the IT Band. While it isn’t a muscle, you can still help to loosen the fibers. Pictured here are my two favorite IT Band Stretches.

Foam Rolling

Foam Roll

Foam rolling is also a great way to make the IT band more supple. Move slowly and stop on a tender spot and breath into it.

You Got This!

IT Band Friction Syndrome is definitely an injury you can overcome even though it is so painful in the moment. As with any injury, pain is your body’s way of telling you something isn’t right. If you experience pain during exercise or during the exercises listed here do not complete them. Build slowly and listen to your body.


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