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Hiking with ITB: Illiotibial Band Syndrome

The main symptom of Iliotibial band syndrome is pain that starts outside of your knee and radiates up the side of the thigh. I had a case of it last year when I was section hiking the Long Trail. The ligament on the outside of your knee feels like a rubber band snapping against your knee bone, making it quite painful to walk.

I managed the condition using an ITB compression strap, which you wrap around your leg, just above the knee. This video shows exactly how the strap works. It let me hike without pain and helped me to complete the Long Trail and several long sections of the AT last year.

After that, I got back into the gym and strengthened my quadriceps by riding literally thousands of miles (I calculate 4,000 miles) on an upright stationary bike. That and losing some weight have helped prevent a recurrence this year.

My advice is not to lose hope. Get a strap and keep hiking. Try a bunch of different techniques to strength, stretch, and heal the muscles that cause ITB. It will go away if you keep at it or find a good physical therapist (not a doctor) who understands how to treat this condition.

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  1. Ironically, I developed ITB *from* riding a bunch of miles on a stationary bike. I got new spinning shoes and after a few weeks developed intense pain. Adjusting the cleats (and staying off the bike for a couple weeks) cleared the problem right up.

  2. ITB is also a common problem for bikers and runners. Pronation is often the culprit. Sounds like that's what you had.

  3. What a coincidence, my girlfriend and I did a 14 mile day hike yesterday and we both experienced the exact same pain that you described in your original post. Also I've always had pain near my patella so maybe I can look into a strap or brace that target both. Thanks a lot for your post and this awesome blog, I really appreciate it.

  4. regarding bicycling and ITB:


    1 – started riding a bicycle basically everywhere over a year ago

    2 – some time after changing to this biking-heavy lifestyle, i developed down-hill hiking associated iliotibial band syndrome (as confirmed by physiotherapist, MRI, and orthopedics)

    3 – when attempted a jog, could not go for more than 10 minutes without pain

    4 – got some alleviation from liberal *foam roller* usage (even carried a knifed off edge of it hiking once)

    5 – stopped bicycling 2.5 months ago, havent felt pain since, and test jog was succesful without any pein

    conclusion: my ITB was brought on either by bicycling (although i was quite conscious of seat height, which i kept at good level), or possibly the LACK of walking. because i used bike to get door to door at work, and to meet people socially, i was under the impression that the lack of action my legs/knees were playing contributed to my ITB. just wanted to throw that out there, in case anyone else came across this weird bicycle/ITB connection that i think was my issue…

  5. I know people who've had the same experience. Ironically, I have just the opposite. If I stop riding a stationary bike, I develop a tight ITB. I think the issue is one of muscle balance in the end, and of varying your workouts so that one muscle group doesn't dominate another. Funny how, we can put a man in space, but we still don't really know how to the body works.

  6. hi Earlylite.

    Question: from the people who had the same bicycle-induced ITB, did you get the sense it was from the bicycle doing harm, or rather the lack of walking that was doing the harm?

    good to talk about this stuff here, as i had heard no such hypothesis when i was going through months of ITB…hopefully others will be able to find this when googling now.

    your case is interesting as well…that goes more along with what my physio recommended: basically lots of stretching and strengthening exercises (that clearly didnt help MY case). he seemed to think the bicycling would only help me stay strong. and when he put me on my regimen, it was I who asked if i should stop biking to test, and he said "sure, if you can get around otherwise" but didnt really push the idea.

    i totally agree with you though. in retrospect, it must have been the imbalanced muscle usage i was doing with the new and heavily increased bike/walk ratio i had switched to in my daily routine.

  7. I have had ITB soreness, my wife has, my sister has, and after all doing heeps of physio with little results.
    the answer we all found was easy………
    Walk down hills on the balls of your feet don’t land with your heels first on steep descents, keep the heel strike down on steeper descents.

    Try it. thank me latter. I hope it works for someone else to.
    We did TOUR DU MONT BLANC. 220 klms in 11 days, climbed and descended over 12,000 mtrs not one sore knee or twinge.
    Good luck.

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