Date:    Thu, 25 Nov 1999 22:21:41 -0800

> I missed discussion earlier regarding Iliotibial Band Syndrome.  I have been
> having leg pain lately & the doc. told me this could be causing it.  What
> can other cyclists tell me about this ie, symptoms, causes, cure, avoidance
> in the future?

Illiotibial Band Syndrome is caused by the bike fit all right. But it is
an overuse injury and your bike fit may not be the direct cause, but
instead be a factor contributing to retaining the injury.

The people most in danger of contracting this RARELY serious but painful
problem are short women with wide hips. However, there have been reports
from both sexes and all sizes upon occasion.

It is caused when the illiotibial band is stretched across the bony
ridge on the outside of the knee joint. Bend your knee and feel the
outside edge of your leg at the knee and that is where the pain should
be if it is am illiotibial band problem.

Another problem in the immediate area is patelar tendonitis. The pain
for this is associated more with the knee cap (patelar) than the side of
the leg/knee. PT pain is usually more towards the center of the kneecap
though mine was to the outside top of the knee cap.

Normally people who contract IBS from bike fit simply have the seat down
too low. This is also the cause of much Patelar Tendonitis.

Both problems are usually associated with a major jump in the amount of
riding or the level of riding that you have performed.

The cure for either is pretty much the same regiment:

1) As long as you have the pain do not ride hard. It is usually
recommended that you stay in the small ring. But many people can strain
just as hard in the little ring as the big. The main thing is to ride,
but to ride easy.

2) Start your ride easy and ride for about 15-20 minutes then stop and
stretch. Stretching is normally something like holding your left foot in
your right hand for 30 seconds, releasing and resting for about a minute
then repeating three times. If you can feel ANYTHING stretching you are
pulling too hard. Proper stretching is designed to return tendons to
their NORMAL length not pull them over your shoulder. Do both sides
regardless that only one is bothered. The other side will be carrying
more load than usual because you will favor the painful side.

3) Directly after your ride you must again stretch. Don't put it off
till later. There is no later in stretching. You must stretch when your
muscles are warmed up and the tendons are ready for it.

4) Immediately after you get back from your ride ice the painful area. I
just put a few ice cubes into a zip-lock plastic bag, sat down and
watched a 1/2 hour TV show. You need at least 20 minutes of icing. Some
people are sensitive to ice and then need to use a regular ice back or
wrap the plastic bag in a face cloth or some such. As long as you aren't
burning your skin, more icing is better than less.

5) As an OPTION but one I recommend, you can take over-the-counter
anti-inflammatories such as aspirin or ibuprophen. NEVER MIX pain
relievers. NEVER, NEVER mix them with Tylenol or other acetylmenophen
mixtures. Kidney failures have been known to happen when mixing these
things at package dosages. People, even doctors, are often pretty
cavalier about aspirin and the like but you should always follow the
package directions for maximum dosage and you should always consume a
lot of water when using these things. These things are dangerous to your
health if mishandled.

6) If you don't stretch you will not get better. If you don't ice you
may not get better. The important thing in fit is to get the seat height
and the handlebar reach appropriate for your body. There are other
factors in a fit that can lead to problems but you need to know
something about bike fit and this isn't the appropriate forum. Remember
that it's easier to hurt yourself stretching than just about any other
way so always use care when stretching.

7) Finally, I said that this rarely becomes serious -- but sometimes it
does. If you allow this pain to persist for a very long time it can
cause scarring of the tendon on the tibial ridge area and fixing this
can require surgery. This is not the sort of pain the you can 'ride off'
such as when you're hardening up your sit bones for longer rides. Or
when your neck hurts from bending it up in a tight aero tuck. This pain
requires you to do something about it. IF IT PERSISTS DEFINITELY GO TO A
DOCTOR SPECIALIZING IN SPORTS INJURIES OF THIS NATURE.

8) Bike fit to prevent the problem in the first place. Stretch as a
preventative measure if you are in the most likely group -- short, wide
hipped women. Stretch, ice and ani-inflammatory to rid yourself of the
problem. Ride easy until the pain is gone.

In some people the pain goes away in a week while in others it takes
months of hard work. And remember that in 99.99% of the cases the
simplest measures are the most effective.