Repetitive Strain: the IT Band Saga

Before I begin I just want to make clear that I am not an exercise scientist, sports medicine doctor, orthopedic surgeon, physical therapist, or any other kind of expert in sports injuries. If you’re experiencing unusual pain while cycling or during any other physical activity, seek advice from a qualified medical professional. This will mostly be a rant about injury and a description of my own continued experience with recovery. 

My understanding of repetitive strain (or overuse) injuries is that as a category, they primarily affect the soft, connective tissues (tendons, bursa, fascia). This is a bummer. Unlike sore muscles which can heal in days, or broken bones which—as long as they aren’t complicated and require surgery—typically heal in a month or two, repetitive strain injuries can take a very long time to heal and often require constant maintenance to prevent reinjury. 

In my case, we’re talking about a large tendinous fascia that connects to the exterior of the knee, and runs the outside length of the femur to connect somewhere around the hip. Yep, the iliotibial (IT) band. From what I’ve researched, the IT band and IT band injury are maybe not the most well understood. I could be encountering crackpot internet theorists, but there isn’t exactly unanimous consensus on the causes and treatments. It’s thought that overuse in particular conditions—running up hills and on uneven surfaces seem to be a commonly referenced set of circumstances—can lead to inflammation that is continually aggravated as the tendon passes bony protrusions around the knee during activities such as walking, running, hiking, climbing, cycling, etc. (but even sitting can exacerbate inflammation as it did for me). Furthermore, muscle imbalances, particularly quad-dominance and a complimentary relative glute-feebleness —often found in runners (though perhaps the great scourge of the modern sedentary lifestyle)— is thought to play a role.

Well, guess who’s got a weak ass? After a few big hill training days I started to notice radiating pain from what felt like the top of the lower leg, or the lower part of the outside of the knee. It seemed like an odd location for IT pain, but apparently this is kind of one of the places the IT band anchors, or the pain is complicated by interweaving nerves. I don’t know. At first I was worried that I had torn some ligament at the proximal tibio-fibular joint, the joint between the two bones in the lower leg because the pain also coincided with riding clipless again after a six year hiatus, and a subsequent spill or three. This is what I get for being a worry-wart-amatuer-internet-slueth. 

But by and large the circumstances and symptoms of IT band syndrome do align with my experience. Initial injury coincided with hill training, more climbing than I’ve ever done before, for a 60 mile ride with 5200 feet of climbing mostly packed into two brutal climbs, one at the start and one right at the end. Worse, I was doing this training on relatively new equipment (new bike, new clipless). I probably hadn’t taken enough time to properly acclimate to the new gear, and possibly identify and make appropriate adjustments for my physical needs. And of course I never stretch, or cross train, or do anything like healthy maintenance. Compounding mistakes. 

So of course one of the more common recommendations for treatment for weak-asses (such as myself) is working on those muscle imbalances. Improving glute strength and activation during physical strain is one way to do that. And the exercise I’ve seen recommended most is probably the glute bridge, or some variation—also squats and lunges (if your symptoms allow), calm shells, and planks. This makes sense to me. With the glute bridge it’s possible to target the glutes, hamstrings, adductors, low back, etc. while minimizing movement in the knee itself, movement that could cause more discomfort. I’ve been doing sets of single leg glute bridges on a somewhat regular basis, often in the mornings and right before bike rides. 

Also stretching and deep tissue massage of the IT band itself are thought to help alleviate symptoms. I like to get up in the morning and foam roll the old IT and hip fascia. Nothing wakes me up faster than excruciating pain! The foam roller hurts (so good?)! And of course RICE is always one of the recommendations. 

Obviously physical therapy is a good option for expert guidance in the types of exercises and stretches and all the proper techniques for treating IT band syndrome. From what I’ve read, surgery is never mentioned as a possibility (hey, a silver lining!). Again let me reiterate: seek qualified professional advice if you’re experiencing any unusual pain. Knee pain in particular could be any number of other conditions that might require vastly different treatments.

TL;DR: Shit sucks. 

I’ve been dealing with this IT thing for over six months. I started noticing symptoms right around the time the COVID-19 lockdown started. Granted, I’ve definitely noticed improvements. Early on I couldn’t ride more than about 20 miles without pain. Now I don’t notice much irritation until after 30 or 40 miles depending on the amount of climbing. But I’m also afraid to push too hard. I’m not keen to risk reinjury. And if I’m being honest, I haven’t been nearly consistent enough with the exercises and stretches and foam rolling. This is shaping up to be a very long road to recovery.

OK. Big take away time.

Don’t: be like me.

Don’t: skip stretches.

Don’t: over do it.

Do: train smart. 

Do: pay attention and be mindful of pain.

Do: work on muscle imbalances before they become injuries.

Do: seek professional medical advice for any consistent unusual pain.

And who am I? That’s something you’ll never take away. 

XOXO

Gravel Guy