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"Tri set-ups cause ITB" - Physio's opinion

 

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mv2005

Feb 19, 09 14:22

Post #1 of 31 (4322 views)
"Tri set-ups cause ITB" - Physio's opinion Quote | Reply

Following from my other posts on ITB pain, I went back to see a physio I had seen previously for a bike setup (over a year ago) to see what muscle imbalances I may have had. This was the final piece in the puzzle having got several deep tissue massages and had a cortizone shot prior to my A race (IMNZ).

Anyway he asked me if I still had my bike setup he did before. A year ago I went to see him with a traditional forward setup, 90 degree arms etc. He said I needed to get the glutes firing and tri setups don't allow this. He moved me back and got more weight over the saddle. He also raised me up both front and back. The feet went pidgeon-toed a bit as he claimed it was a stronger position for pushing down (could generate more force). It should be noted that I went injury free during that IMNZ buildup but rode a little slower than Busso 12 weeks earlier (5:08 vs 4:48, 65o/a vs 50th of thereabouts).

8 months ago I got a new road bike and a few weeks later started developing quad pain. Having fixed (red shimano) cleats I ended up straightening out the cleats (no heel out toe it posture) and reverting back to yellow cleats to give the leg a bit more freedom.

For this current prep I had switched coaches and went back to a typical tri setup. The physio shook his head in frustration and said it is tri setups that cause ITB because they don't allow the glutes to fire and then the TFL ends up pulling the ITB unbalanced. He tried telling me it's never the runners that come in to see him with ITB but triathletes. He also said we should be riding at least 80% of the time on our road bikes in traditional road setup to utilise and work the glutes.

I told him I don't get the ITB pain on the bike and he said I wouldn't because the knee doesn't reach the required degree of extension. When I then go to run I don't have the glute strength to hold the band in place and whammo.

Interested in hearing comments on this.

Mike


gamebofh

Feb 19, 09 14:25

Post #2 of 31 (4314 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [mv2005] [In reply to] Quote | Reply

I had ITB well before I ever did triathlon, only ran.

My only bike is a triathlon bike.

What he is saying runs contrary to my experience.

-Jot


D!

Feb 19, 09 14:33

Post #3 of 31 (4289 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [mv2005] [In reply to] Quote | Reply

+1 to the contrary. My ITB pain was 100% caused by running.


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dgunthert

Feb 19, 09 15:00

Post #4 of 31 (4244 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [mv2005] [In reply to] Quote | Reply

Don't know why Runner's World would have several articles dealing with ITB, including ones that state it's very common in runners.


fatbastardtris

Feb 19, 09 15:02

Post #5 of 31 (4238 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [mv2005] [In reply to] Quote | Reply

Feedback on this will likely be distorted I would imagine. Plenty of people in that "tri" position will not have ITB pain and will therefore discount what your physio said. Perhaps what your physio should have said is that those with weak glutes who utilize the "tri" position without also doing something to strengthen the glutes will be more susceptible to ITB pain.


gbot

Feb 19, 09 15:03

Post #6 of 31 (4238 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [D!] [In reply to] Quote | Reply

+2. Had ITB multiple times when I was primarily a runner, haven't had it since I got into tri's.


LMT

Feb 19, 09 15:07

Post #7 of 31 (4226 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [mv2005] [In reply to] Quote | Reply

Sorry to hear about your pain. I am a sports massage therapist and work on a lot of athletes, runners and triathletes with ITB syndrome. There are a lot of things that can cause ITB pain. One of the common occurrences I see are weak hip abductors and hip rotators. These muscle groups are under utilized with biking and running compared to major muscles that perform hip flexion and extension (ie, glute max, hams, quads). The ITB needs to be free of pain first, then the weak abductors and rotators need to be strengthened, thus stabilizing the ITB better.


j-hud

Feb 19, 09 15:13

Post #8 of 31 (4212 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [LMT] [In reply to] Quote | Reply

Any recomendations on strengthening exercises for those? I am healthy now and would like to stay that way this season.


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maximuscrates

Feb 19, 09 15:22

Post #9 of 31 (4190 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [j-hud] [In reply to] Quote | Reply

I also got it before I had a triathlon bike setup. pose running got rid of my ITB syndrome. I think the main concept of pose curing the ITB was the bent knees. With knee's slightly bent there is a little less tension on the ITB so it does not rub quite as hard on the outer knee. pose can create problems of its own though (mortons neuroma & turf toe).


Slowman

Feb 19, 09 15:30

Post #10 of 31 (4174 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [mv2005] [In reply to] Quote | Reply

in my experience, ITB on a bike is most likely caused by saddles too tall, or cleats too far forward. forward positions on the bike don't alter muscle firing patterns very much. changing the angularity of the body, relative to itself, does. in other words, if you move the saddle forward but don't lower the front end of the bike, you've changed the rider's position relative to itself. if you rotate the body forward, the angles of the body don't change. it's like riding a wind trainer in the road position and then just jacking up the back of the trainer. the body isn't changing relative to itself, tho the body's CG is changing. so, it's changing relative to gravity, and to the horizon. firing patterns, leverage, mechanical advantage, kinematics, none of that changes much.

perhaps drop your physio an email with a link to this thread. as you might know, i fit a lot of people and train about a hundred fitters and retailers per year on the process. ITB problems are not associated with steeper seat angles per se, they're associated with taller saddles and too-forward cleats, whether on steep seat angles or shallow.


Dan Empfield
aka Slowman


LMT

Feb 19, 09 15:36

Post #11 of 31 (4162 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [j-hud] [In reply to] Quote | Reply

Lateral walks with mini bands are real simple but very effective. Check out this video for more ideas:

http://www.performbetter.com/...ercisebandinstrvideo


gamebofh

Feb 19, 09 15:40

Post #12 of 31 (4154 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [LMT] [In reply to] Quote | Reply

Those are very effective. Damn how I hate them. :)

-Jot


cyclenutnz

Feb 19, 09 15:42

Post #13 of 31 (4144 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [mv2005] [In reply to] Quote | Reply

Your physio should go to a FIST course. Your glutes don't care what their orientation relative to gravity is, which is all that changes when you go forward.

It was probably him putting up your saddle that caused your problems.


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cerveloguy

Feb 19, 09 15:53

Post #14 of 31 (4128 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [mv2005] [In reply to] Quote | Reply

Steep causes more neck pain and more pressure on the taint and there is no getting away from this since you hold your neck in more extension and roll forward on the saddle. I always thought cycling ITB pain was often a function of seat height.


jackmott

Feb 19, 09 16:27

Post #15 of 31 (4089 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [LMT] [In reply to] Quote | Reply

How are you measuring the strength of peoples hip abductors and hip rotators to conclude that they are weaker than normal and thus the cause of ITB pain?

In Reply To:
Sorry to hear about your pain. I am a sports massage therapist and work on a lot of athletes, runners and triathletes with ITB syndrome. There are a lot of things that can cause ITB pain. One of the common occurrences I see are weak hip abductors and hip rotators. These muscle groups are under utilized with biking and running compared to major muscles that perform hip flexion and extension (ie, glute max, hams, quads). The ITB needs to be free of pain first, then the weak abductors and rotators need to be strengthened, thus stabilizing the ITB better.



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LMT

Feb 19, 09 16:50

Post #16 of 31 (4066 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [jackmott] [In reply to] Quote | Reply

I test using muscle tests isolating those muscle groups while applying resistance. After working on the muscles, I can re-test to determine if they fire stronger.


Tom Demerly

Feb 19, 09 17:04

Post #17 of 31 (4052 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [mv2005] [In reply to] Quote | Reply

Interesting. Most importantly I wish you luck on your recovery.

I am not a physcian obviously so I can't make as qualified a diagnosis as a physician or a trained physical therapist.

I would be interested to know what (combined?) role saddle height may have played here. I might suggest this is more a function of linear proximity from the greater trocanter to the center of the bottom bracket (just one way to measure it) than its angular relationship to the bottom bracket.

The reason I suggest this is that the old tests done for Daedelaus (however you spell it) project, the pedal powered HPV aircraft, tested power output from prone to supine recumbent and nearly everywhere in between. They found that there wasn't much difference in relative seat angle in terms of power output but there was changes when saddle to bottom bracket proximity (i.e., "saddle height") were changed. In simple terms: seat height mattered more than seat angle in power output on the bike.

Now, it pays to revisit the two predominant reasons a steep cycling posture is favored among triathletes:

1. Some studies (Hodges, et al) suggest we run better off a steeper seat angle. (some do not produce this finding).
2. a more aerodynamic posture may be induced by rotating the entire posture forward around the axis of the bottom bracket reducing frontal area and, thusly, drag.

It isn't about power output. It is about posture and running off the bike.

I wonder if seat angle isn;t the smoking gun but, in the time-honored Slowtwitch.com tradition, perhaps your seat is too high.


Tom Demerly
The Tri Shop.com


Flying Wombat

Feb 19, 09 17:23

Post #18 of 31 (4034 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [Slowman] [In reply to] Quote | Reply

As long as you rotate the rider forward and downward around the BB to maintain the hip angle I dont see why gluteal recruitment should be reduced in a forward position. I run my saddle 3.5cm in front of the bottom bracket and I know I feel my glutes when going hard.
I concur with Slowman that going forward without dropping the front end it what causes the issues. I found this out in the mid 90's when I moved the saddle way forwards on my Softride without making any other adjustments and it resulted in too much stress on my quads and major quad cramps when running off the bike.

Kevin


tonyoh

Feb 19, 09 18:20

Post #19 of 31 (3976 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [mv2005] [In reply to] Quote | Reply

I dont disagree with your physio - in most parts - and I have certainly seen the same issue a number of times. I dont have any issue with the "go forward and lower at the front" philosophy either. One thing I do see, particularly in those that are in a forward position from an early stage in their cycling, is a propensity to sit on the nose of the saddle. I think this is something that does cause lower back and also probably ITB issues longer term. Sitting on the nose of the saddle is a less stable position that being supported on the seat bones toward the rear of the saddle. I don't think the issue is as bad in those that have spent a few years (or more) riding a more traditional roadie position. So it maybe less of the actual position and more of the execution of the position. That said, roadie set-up is an easier way to "learn" to sit properly on the saddle.
On the issue of cause and effect, I also believe that cycling does aggravate the ITB, but the symptoms are generally felt running. I personally have this issue when I ride the TT bike more.


nickag

Feb 19, 09 19:39

Post #20 of 31 (3927 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [tonyoh] [In reply to] Quote | Reply

my experience with 2x ITB injuries (different legs) was that having the saddle led the injury but only became apparent when I was running. I think it was to do with the relative hip angle between biking & running - the upright running posture causing the ITB to rub over the hip/knee bone that didn't happen on the bike ie. tight ITB caused by biking but injury caused when running. In hindsight my saddle was way too high, but solution was also a regular stretching regime.


Tai

Feb 20, 09 2:36

Post #21 of 31 (3825 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [Slowman] [In reply to] Quote | Reply

Hey Dan, can you elaborate on the causation from cleats being to far forward? I've been having a few IT issues, well more TF issues which end up pulling the IT tight. It's pretty recent though and seems to flare up from running more than cycling but as I run my cleats slammed forward as far as they'll go I was just curious to what you had to say. Thank god for my TP therapy rollers...

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seebritri

Feb 20, 09 3:22

Post #22 of 31 (3804 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [mv2005] [In reply to] Quote | Reply

"Tri set-ups cause ITB"

Precede with "incorrect" and insert "without proper sport-complementing functional strength training" and you have a true statement.


Brian Grasky
Grasky Endurance: World Championship Triathlon Coaching; Professional Training Camps
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rickystheme

Feb 20, 09 11:51

Post #23 of 31 (3677 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [mv2005] [In reply to] Quote | Reply

Mike

As an experienced PT and a triathlete.....I have experienced and fixed all levels of athltes with IT band syndrome. I also complete professional bike fitting.

While most posts here are good, your physio had a good point. And here is a fact. 99% of all my itb patients have tight quads, hip flexors, and weak glute meds and max. You can roll all day on a foam roll, but you need to correct for the muscle imbalance. It should be done with stretchig FIRST then immediately strengthening the opposing muscles. This is not the sexy, fast way to treat like with a cortizone injection, but it works.

As for bike fit....I get people into between 9 and 13 degrees of knee extension. And have never had an itb problem once set up properly. If your seat is too low, you will be using more hip flexor and quads, and not getting much hamstring and glute max firing. So your strengthening of these already tight muscles will only lead to increased problems.

Do not go to a bike shop for a fitting.....they do not know the boimechanics of the body. They can get you close, but if you ride ironman distances, close is not good enough. Call your local physical therapy clinics, and see if they have people who do bike fitting. You will be surprised as to what you learn, and it is completely worth the time and money.

But in over 5 years of orhopedic specialization, I have never seen an ITB patient from a triathlete set up, but hundreds of weak glute runners who cant stretch.

Good Luck.


fulla

Feb 20, 09 11:55

Post #24 of 31 (3668 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [mv2005] [In reply to] Quote | Reply

I would have thought toes in whilst cycling would put much more pressure on the IT band?


fatbastardtris

Feb 20, 09 12:15

Post #25 of 31 (3654 views)
Re: "Tri set-ups cause ITB" - Physio's opinion [rickystheme] [In reply to] Quote | Reply

While most posts here are good, your physio had a good point. And here is a fact. 99% of all my itb patients have tight quads, hip flexors, and weak glute meds and max. You can roll all day on a foam roll, but you need to correct for the muscle imbalance. It should be done with stretchig FIRST then immediately strengthening the opposing muscles.

Could you post a good workout routine to address these typical weaknesses? I have been gathering exercises from here and there but not sure I have a good complimentary routine. One thing I have noticed is that it takes very little strengthening of these areas to see noticable results. I just don't do them often enough with everything else to train.

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