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I have had IT band tendinitis for the last year and haven't been able to train at all. Has anyone recovered from this? Is my racing career over? Looking for any inspiration to keep biking.

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    Did you have a bike fit? Did some sport doctor evaluate your gate? Do you have any irregularities such as duck feet, foot turned outside or inside? Did you try to move your cleats and change their orientation according to such observations? For me that can change a lot, I wasn't able to cure it, but bu moving the cleats wrongly I can easily make it worse. At first it originated with flat pedals, though... – Vladimir F Oct 4 '19 at 12:00
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Unfortunately there are a large number of factors that could lead to IT band issues. If your only exercise is biking, you can easily build up muscle imbalances which can lead to problems such as chronic pain. Furthermore, if you also have flexibility issues you can be compensating without knowing it, which can lead to muscle imbalances, which can lead to pain. Incorrect bike fit and position can also cause compensatory patterns that lead to IT Band. Finally IT band issues may also be a symptom of structural issues.

Common causes of 
ITB syndrome

Many factors can contribute towards this problem. Sometimes there is no apparent reason for getting ITB friction syndrome apart from simple overuse. Often ITB syndrome is caused by a muscle imbalance, where some muscle groups (hip flexors, quadriceps) have become too tight, while others (hip abductors and extensors) have become too weak or fatigued. Therefore, it often helps to strengthen these weaker hip muscles (extensors, abductors and external rotators).

These muscle imbalances 
may be accentuated by an incorrect cycling position; for example, a saddle set too high or at too steep an incline. Cleats may be too close together for the width of the pelvis, causing excessive adduction (inward rotation of the knee joint) — note, Specialized now supplies pedal axle extenders that can increase cleat width by 4cm.

Leg length discrepancies or a mal-aligned pelvis are two of the biggest causes of chronic ITB problems; these structural asymmetries increase the frictional forces through the tract even with the correct recovery stretches and strengthening exercises. Excessive ankle/forefoot pronation significantly stresses the shin and outer thigh, despite the foot arch being supported in a fixed position. In severe cases, cyclists may need customised shoe orthotics placed in their cycling shoes.

Injury prevention: Thigh and knee 
Iliotibial band (ITB) syndrome

As you can see IT issues can stem from a large range of possible causes (including any combination of factors mentioned above). It is impossible to diagnose someone over the internet. If you are not functional, which appears to be the case from your description, you need to get professional help. A physiotherapist can be a good first step, but I find they tend to be better at acute rather than chronic issues. A good kinesiologist or someone who has an expertise in functional movement, may be a better fit. Some physiotherapist also have these expertise (e.g., sports physiotherapists) so shop around.

Anecdotal Experience - Hip Issues

When I first started cycling more intensively (about 20 years ago) I had a lot of IT band issues, which I resolved originally by reducing cycling and doing other activities that didn't bother my IT band. I believe the other physical activities ended up restoring my function.

About 18 years later I was getting flare ups again, but this time I took more time to understand the mechanism of the flare up related to my hip stability. Cyclists can often develop hip and glute weakness, as well as having quads that are too tight.

What worked for me (again I am not you) was the following triad:

  1. getting good at self-massage (quads and glutes)
  2. working on stretching (hips especially)
  3. building strength and endurance in hip stabilizer muscles (e.g., medial glute exercises)

Self-massage is an art form in of itself as you have to relax into the sensation, if you register it as pain, stop, because our body's response to "pain" is to contract muscles, which will work against any massage benefit. Overly tight muscles can change how you use joints and therefore muscles and ligaments in those joints. This can lead to overuse injuries such as IT band flareups.

For quad releases I have had very good results with the 5 inch Orb Massage Ball. I found that foam rollers did not provide deep enough release as they distribute the force over a wide area. The 5 inch ball was great at providing deep tissue release, but it can be a very intense experience. I methodically roll my quads until I cannot find any tight spots or adhesions in the entire quad. When its bad I will release daily.

For the glute releases I use a smaller 2.5 inch triggerpoint massage ball and make sure to get up high in the hips as the medial glute is a common problem in cyclists.

Finally for exercises there is a good program from Princeton for strengthening and stabilizing your hips. Also remember to stay on top of hydration, if you are dehydrated, this can affect connective tissue such as fascia, which can exacerbate issues such as IT band flare ups.

These programs take time and consistency to work. I haven't found any easy solutions for IT band issues, as well for me at least it has always been an indicator of a larger set of issues.

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  • How long did you do strength training before returning to the bike? – user2879934 Oct 4 '19 at 21:17
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    @user2879934 you never stop strength training or your likely re-encounter your problems. Also Soft tissue injuries can take a long time (e.g., 3-6 months) to recover from especially if there is a lot of inflammation. – Rider_X Oct 4 '19 at 21:36
  • Specialized no longer sells those extenders after they caused several crashes. I understand those were mainly broken cranks. Other manufacturers supply them, including cheep Asian online shops. – Vladimir F Oct 7 '19 at 11:25
  • I want to reinforce the "never stop strength training" point; not only will it help prevent recurrence of the problem, ongoing strength training will make you a stronger cyclist in general. – DavidW Oct 7 '19 at 16:48
  • foam rollers did not provide deep enough release I found I had to use the hardest foam rollers available. it can be a very intense experience That's an understatement. When I first started rolling my ITBs, it HURT. – Andrew Henle Oct 7 '19 at 19:44
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These issues van often be caused by irregularities of your legs or feet. Even a small one can case issues after tens of thousands of revolutions. It is a pity that you did not reply to my comment with questions.

Unless these issues are large obvious, they may not be that apparent. It is highly recommended to have a bike fit. Make sure that your saddle position is correct (both height and forward-backward). Make sure that your Q-factor is correct. Make sure that you are not forcing the foot to be in a wrong angle by incorrect cleat orientation.

Cleats/pedals with some float can help. Moving cleats outward (increasing the Q-factor made a huge difference to me). Some report success with pedal extenders, but be aware that some pedals are not compatible with them and the could overstress the cranks. Maybe just a spacer or two would be enough (there are limits of what can be applied safely). Some pedal manufacturers offer longer and shorter axles. Some also report success with cleat wedges.

Do leg stretches before and after the ride and even when you stop midway and have some time. Do strength exercises to fix any muscle imbalance, best under the supervision of a physioterapist.

Be aware that what worked for one person may not work for another person. The causes are often different.

The biggest change for me was probably doing regular strength exercises in a cross-country skiing clubs. Completely not-cycling related strengthening of the whole body but it helped a lot also with my common outer hip pain (the same side as my ITB pain).

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