Iliotibial Band Syndrome and Cycling

Iliotibial band syndrome (ITB) is a form of inflammation commonly felt by cyclists on the outside of their knees.

Why do cyclists get it?

The Iliotibial band is a ligament that runs from the top of the hip to the outside of the knee. This ligament keeps the knee stable.  ITB is caused by the Iliotibial band rubbing against a bony part of your knee.

What are the symptoms?  The main symptom of ITB is a sharp, burning pain along the side of your knee during or after cycling.  The outside of your knee may also get tender or swollen, and the pain may prevent you from continuing to ride.

Think you have ITB?  Check 3 things on your bike:

1) Seat Height: Try setting your saddle to equal 40 degrees knee flexion at bottom of the pedal stroke.   ITB sufferers most often get pain around 30 degrees of knee flexion, the so-called “impingement zone.” Keeping the saddle to a maximum knee extension of around 40 degrees often avoids this zone.

2) Saddle Position: Saddles set too far back cause the cyclist to reach to far forward for the pedal and stretch the IT band with resultant knee pain. Saddle position can be evaluated with the “plumb bob technique”. Seated with the pedal in the 3 o’clock position, a “plumb” hung from the most forward portion of the knee, should intersect the ball of the foot and the axle of the pedal.

3) Shoe Position: If your knee falls in towards the toptube, then your cleats may be canted too far inward.  This often pulls the IT Band across the outside of the knee.  Cleats should be positioned so that the ball of your feet is directly over the axles of the pedals to keep knees aligned over them.

For more information, come visit us at the CPMC Sports & Wellness Center.

Tel: 415.600.5860 or



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