Pain on the Outside of the Knee When Cycling: IT Band

Rather than guessing, measure your actual position with your own camera.

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What the IT band is

The iliotibial band is a thick strip of connective tissue that runs down the outside of the thigh, from the hip to just below the knee. As your knee bends and straightens, the band slides over a bony bump on the outside of the knee joint. Thousands of times per ride.

If the band is under too much tension, or the knee is tracking at an angle, that repeated sliding irritates the tissue. The result is a sharp, burning or aching pain on the outer knee, typically starting after a predictable number of minutes and getting worse until you stop.

The tell-tale pattern

IT band pain has a signature that separates it from other knee complaints:

• It sits on the outside of the knee, not the front or back.
• It often starts at the same point in a ride, twenty minutes, forty minutes, rather than from the first pedal stroke.
• It frequently affects one side only.
• It can feel sharp when the knee is bent around 30 degrees, which is exactly the angle where the band crosses the bony bump.

Pain at the front of the knee is the kneecap and points at a low saddle. Pain at the back points at a high saddle and the hamstrings. Outer-knee pain is this.

The two bike causes

Saddle too high. When the leg over-extends at the bottom of the stroke, the IT band is pulled tight on every revolution and the hip rocks to compensate. Both increase the friction over the outer knee. This is the most common cause, and the first thing to check.

Cleats angled wrong. If the cleat forces your foot to point in a direction it does not naturally take, the knee compensates by twisting, and the band is dragged across the joint at an angle. This is why IT band pain so often affects one side: one cleat is off, the other is fine.

A narrow stance width, feet closer together than your hips want, can contribute for the same reason.

What to change, in order

1. Check saddle height first. If your hips rock or your toes point at the bottom of the stroke, lower the saddle by 5 mm and ride for a week. 2. Then check cleat rotation. Sit with your legs dangling and note where your feet naturally point. Adjust the cleat on the painful side to allow that angle. Loosen slightly toward more float if your pedals allow it. 3. Check stance width. Move the cleat slightly inward on the shoe (which moves the foot outward) if your knees track inward. 4. One change at a time, and expect two to three weeks before judging.

Off the bike

Foam-rolling the outer thigh and strengthening the hip abductors, the muscles on the outside of the hip that control how the knee tracks, can help. Weak hip muscles let the knee drift inward, which is precisely the movement that irritates the band. Side-lying leg raises and clamshells, two or three times a week, are the standard exercises.

When to stop and get it looked at

IT band irritation responds well to position changes and rest. Pain that persists after correcting saddle height and cleats, or that comes with swelling, clicking or instability, should be assessed by a physiotherapist, those are signs of something other than the band.

Measuring it

The main bike cause, saddle height, is directly measurable. A BikeFit/LAB analysis reports your knee extension at the bottom of the stroke and how much your hips rock, the signature of a saddle that is too high, so you can see whether the saddle is the cause before you start moving cleats.

Rather than guessing, measure your actual position with your own camera.

€5 for one fit, or 10 fits for €25. See pricing →