By Christoper Schwenker (courtesy of The Zommunique)
Editor’s note: Christopher, a friend of 303Endurance and podcast guest (EPISODE HERE) has ridden tens of thousands of miles on Zwift and has built an amazing community of Zwifters, be sure to check his website for wonderful content and follow him indoors on rides.
The majority of cycling-related injuries are overuse injuries. They’re overuse injuries because tissue damage occurs from repetitive stress over time, unlike acute injury resulting from an accident or crash. Studies show that knee-related overuse is most likely to cause professional cyclists to take time out of the saddle.
It explains why the pain I experience on the outside of my knee comes and goes—directly related to periods of increased training intensity and volume. Recently, when the pain became too much to ride through, I had to get to the bottom of it.
Ask yourself the following questions.
- Do you experience sharp pain on the outside of your knee below the joint where the boney bump sticks out when you ride?
- If you press the boney spot while bending your knee back and forth, does it cause the same pain you feel when cycling?
- Does the pain worsen and travel to your thigh or calf the more you ride?
- Do you feel tightness and lack of flexibility on the outside of your thigh and front of your hips?
- Has it been a long time since you had a proper bike fit?
- Did you recently have a sudden increase in mileage or intensity?
- Are you an aggressive pedaler or primarily use a low cadence?
- Do you enjoy other sports that make your knee bend repetitively, like running and hiking?
If you answered “yes” to five or more of these questions, you might be suffering from a cycling-related overuse injury known as Iliotibial Band Friction Syndrome (ITBS). It is called “Runner’s Knee,” but it is almost as common in cyclists, especially this one.
The iliotibial band is the strong connective tissue that runs along your outer thigh. It extends from your pelvis to just below the knee and inserts on that boney bump (the lateral femoral condyle) I mentioned earlier.
Friction occurs in that area as you bend your knee (most significant between 0 and 30 degrees) repetitively and intensely when riding, leading to inflammation and pain. The ITB rubs against the lateral femoral condyle, or vice versa, which causes irritation.
A 2017 systematic review published in the International Journal of Sports Physical Therapy determined ITBS was the most common cause of lateral knee pain in cyclists. The underlying reasons noted include:
- Tightness of the ITB.
- Toeing in of your foot on the pedals.
- If your saddle position is too high.
- Excessive hip adduction occurs when your foot is too close to the crank.
- A rapid increase in mileage
Here are a few tips, tricks, and suggestions I offer my patients and cycling friends and have used myself.
Tip #1 – ITBS Self Test
In my clinic, I sometimes use Noble’s Compression Test to diagnose ITBS. Ideally meant to be performed by a clinician on a patient, but you can do it to yourself to get an idea if ITBS is your problem.
Grab the back of your knee and place your thumb on the boney bump where you experience pain. Apply firm pressure with your thumb as you bend your knee between 0 and 45 degrees. If you feel localized pain (most significant at 30 degrees), snapping, or rubbing, it just may be your ITB.
Tip #3 – Roll Your ITB and Hip Flexors
Tip #4 – Strengthen Those Glutes
There are many glute strengthening movements you can do at home, like the ones found in The ZOM article entitled “Dead Butt Syndrome—A Real Pain in the Cyclist’s A–.” However, nothing beats getting in the gym to do some squats, lunges, or hitting the leg press.
Tip #5 – Basic Bike Fit and Pedaling Recommendations
A proper bike fit by a certified specialist is always a good idea, but you can give this a try until then.
- Lowering your saddle height (or decreasing crank length) will ease the friction of excessive flexion and give your knee time to heal, but it won’t solve the problem. A proper fit will.
- Adjust your cleat inward to move your foot out on the pedal.
- Avoid toeing in of your foot on the pedal.
- Address any leg length differences with shims.
- Focus on pedaling technique and avoid low cadence and high torque.
Click here for a written description of the things we discussed.
Pain on the outside of your knee is common, but you will see. These tips will help you as much as they did me.
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