I’m a Cyclist and Physical Therapist, and When I Identified This Pain On the Outside of My Knee, I Did This

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.

  1. Do you experience sharp pain on the outside of your knee below the joint where the boney bump sticks out when you ride?
  2. If you press the boney spot while bending your knee back and forth, does it cause the same pain you feel when cycling?
  3. Does the pain worsen and travel to your thigh or calf the more you ride?
  4. Do you feel tightness and lack of flexibility on the outside of your thigh and front of your hips?
  5. Has it been a long time since you had a proper bike fit?
  6. Did you recently have a sudden increase in mileage or intensity?
  7. Are you an aggressive pedaler or primarily use a low cadence?
  8. 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.

diagram of leg muscles and knee bones

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.

anatomical diagram showing knee tendinitis

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:

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