Been having itb tighteness and slight pain on the outside of my knee.
I have a leg length discrepancy and it’s on my longer leg.
I have also been riding more miles on the road with spds.
I have been using a foam roller and stretching.
Have had a bike fit which fixed my lld with a shimmed cleat.

It’s not bad pain but niggling.. not getting worse maybe got a bit better with stretching and rolling.
How have others worked through it?
Obviously there’s something not spot on with my riding position and or muscle weakness / imbalance.
Any tips?

It’s only usually a problem for me when running and then the foam roller does work. Just keep up with the roller and stretching every day. It’s only ever gone once on the bike which meant around 10 miles of pedaling one legged, I couldn’t even leave my foot on the pedal and not use that leg.

Try moving the saddle forward an inch. I had ITB for years on the bike, till a coach suggested moving my saddle forward. ITB problems vanished overnight!

I raised my seatpost a bit and my ITB-type pain disappeared in no time.

Might be the knees getting cold.
Even in this sun the knee warmers are on. The wind chill tightens it all up.
Agree too with a bit forward and down with the saddle.

I also have odd sized/length legs. have all sorts of pain. Strange thing is though, I can thrash myself riding fixed with 165mm cranks and never have much bother.
So ended up going fairly low saddle hieght on other bikes and gone down to 170mm on all now.

Roll on summer, when the warm takes all the aches away.

There’s an exercise to do – it’s often a muscle imbalance.

(I think it’s lying on your side and lifting the upper leg up and down slowly but IANAPhysio)

ITB niggles usually come about because the knee is too extended (straight) at the point of greatest knee extension (straightest point) in combination with overuse. Tight hamstrings and poor pedalling form also don’t help. Cleats too internally rotated also irritates the lateral (outside) knee. There isn’t one fix and often one change as others describe above intended to address one thing has an unintended effect of helping several other aspects which lets the irritation settle down. The complex interaction of the various joints and supporting structures of the lower limb is where a really decent bike fit should help as it is hard to suggest just one or two changes in isolation.

The usual advice without knowing more details is to lower the saddle a touch, even a few mm initially and reduce the volume of riding- complete rest too in some cases.

Some things to think about:
– Are you sure the ITB is getting irritated, how has this been diagnosed and have other sources of irritation been ruled out?
– Are you currently having physiotherapy?
– How did you have a leg length discrepancy diagnosed? Very often their is a functional but not actual leg length discrepancy arising from imbalances around the pelvis which can be worked on rather than anatomical differences. Using a shim may mask a functional imbalance that would be better treated in the long run rather than compensated for in the short term.
– How have you ensured the SPD’s are set up correctly? Are you new to SPD’s or the shoes or pedals?
– What crank length do you run? Is it the same on all bikes?
– What has been the progression in “more road miles”? Sudden jump?
– Do you warm up properly and keep your knees religiously warm? 🙂
– Where and what type of bike fit did you have?
– Do you plan to revisit the bike fitter as a matter of course (bike fitting is an ongoing and evolutionary process)?
– What stretching do you do and how frequently?
– How do you use the foam roller and how frequently? A lot of people don’t use them properly!

My opinion would be that it isn’t going to be caused or cured by one thing but you need someone to really dig in to the cause of the irritation. Sometimes it is simply a case of the body needing to adjust to a higher volume of riding and taking the time to rest rather than stubbornly push on with things. A combined bike fit and physiotherapy appointment is probably the best place to get the right help although there aren’t too many people around with that expertise or interest unfortunately. For me, it was taking the time to understand my body and my niggles with the help of a really keen and knowledgeable physio that cracked it

Also, a lazy and poorly co-coordinated vastus medialis is a common thing which can cause grief…

Im pretty sure its my ITB just the way it niggles with my leg bent at 45deg and where i poke in with my fingers i can feel it tender.

I think theres probably alot of things im doing wrong..
combined with being new to spds, more mileage, tight hamstrings, aching glutes, not warming up properly.

Any good links for ITB rolling pain? So far the stretches ive been doing seem to be helping. LLD was identified during my bike fit and ive also been to a physio for concurred that it seemed my left femur was longer.

Leg length (as in anatomical) is really hard to measure, and even with a full leg x-ray the measurement error is within the usual leg length discrepancy expected for most people. Chances are it is a functional length difference but it may be a true difference.

Weak glutes is another good one to work on and an area cyclists seem quite poor at controlling/ coordinating with the rest of the lower limbs. Single leg glute toe touches (can add a dumbell later) are something that personally helped me a lot. The standing leg should be slightly bent but not bend throughout the movement- only the hip should move. Most physios will also look at your form throughout a single leg squat to get an very, very initial idea of glute and quads coordination. I found more benefit to trying to be more balanced overall than doing lots of very specific things which aim to target the ITB but have little evidence for actually working.

For targeted ITB stretches, there is a lot of debate and most likely you can’t effectively stretch the ITB itself. Certainly, the stretches I was given by the physio made no difference at all. The most effective single stretch I found doesn’t necessarily target the ITB specifically but is great for loosening out everything in lateral calf, thigh and hip. I can’t find any pictures though! With an almost straight standing leg, cross the other leg over in front of the standing foot so the toes of both feet are close together and your non-standing foot is roughly at 45 degrees. You can take some weight on the “non-standing” foot and align your body with this foot and touch your toes. The standing leg is straight and the “non-standing” leg is bent. As you are touching you toes push your hips out laterally to the standing leg so push right for the right leg and vice versa. As I said, not a ITB specific stretch but something I found very useful and easy to control.

Foam rolling is again something there isn’t really any good evidence for but seems to relive pain. I like to give attention to all major muscles in the thigh in addition to the ITB area which gives a feeling of everything being looser and more pain relief than just aiming for the ITB. Most likely it doesn’t do anything in reality but it does seem to relieve symptoms by some mechanism. There are a lot of videos out there although your physio is the best person to ask for advice.

If you haven’t seen one recently, go and see a physio/osteo to get it checked. Mine tends to pull my hips and pelvis out of line and aggravate a lower back issue, so might be worth getting all possibilities checked out. I found accupuncture helped my ITB problems when it flaired up.

If it is a real problem see if anyone on here can recommend a local bike fit expert or a physio with specific cycling experience to check out your position. Life is too short to have pain when you are riding.

My issues are much the same as MoreCashThanDash, gradually affecting my hips and lower back more and more, rather than pain just around the knee. Nothing is isolated in the body which is where a decent physio becomes invaluable. I’ve had a few bike fits and someone like Scott Cornish at BikeScience Bristol has the right experience and background to help (I really enjoyed my fit with him and got a lot out of it).

I went and got mine professionally unmangled… Was quite funny the first time, “So I’m going to work on your legs and lower back today and probably the neck and shoulders too, should have time… Oh! No, forget all that, I’m going to spend an hour working on this one leg”

Difference was ridiculous, to the extent I couldn’t sleep normally for a couple of days- I’d got so used to the leg acting up, I’d forgotten it was even doing it, so having it more or less back to normal felt too bizarre.

YMMV of course but no amount of stretching or other home remedies had made any real difference. Mine is mostly a result of old injury and surgery so it’s maybe not typical.

A few things you can try – single leg squats but the focus being on keeping the knee, foot, hips in line and maintaining good form.

‘Clam’ – similar to what Cynic-al recommends.

Dan… Thanks for such a detailed response.. that stretch seems to help.

No worries! Hope it clears up soon 😀

Mine’s been giving me grief since December, but over the last couple of months I seem to have got it more or less under control, to the point where these days it just feels a bit tighter than ideal when I’ve been overdoing it on the exercise front.

I’ve been visiting the physio most weeks, with deep (and painful) massages on my leg. I’ve also been religiously stretching – the one I’ve been doing most (and which I never used to do) is stretching my glutes:

It’s a bit of a weird stretch, but by lacing your hands through your legs and pulling back on your knee you can stretch your glutes.

I’ve been using a roller a bit, but not regularly enough for it to have made much difference.

Whatever you do, make sure you do get it fixed – my knee was like yours initially, just a bit tight. And then it flared up, to the point where it would be painful enough to wake me up at night. Thankfully that’s now a thing of the past!