As a bit of background, I’ve been managing IT band issues in my left leg for the 18 months or so; swimming and cycling are absolutely fine, it only gives me trouble when I’m running. Some periods it’s fine (at the start of this season I was regularly running long runs of 20-30+km without major issues but could still feel some tenderness), other periods it flares up bad (now I’m fine running 10-12km but longer than this and it comes on pretty quickly). I’ve been to a couple of physios over the last 12 months and tried a lot of different exercise and stretching regimes (including the popular gluteus medius targeted exercises) and nothing has really helped to actively treat it.
I visited a physio yesterday and she diagnosed the root cause as a dominance of the lateral muscles in both the upper and lower leg (tfl, vastus lateralis, peroneal muscles, lateral gastrocnemius etc etc etc) this makes a lot of sense because after a long run I often feel tightness all the way down the outside my left leg and across the top of the foot. She advised that the usual gluteus medius strengthening exercises probably aren’t going to help that much and, if anything are probably feeding into that tightness and lateral dominance. Instead, she prescribed a few exercises and stretches (e.g. squats and lunges) aimed at getting the medial leg muscles to contribute more. That sounds sensible, but I’ve tried the exercises and stretches a few times already and sure it’s easy to get those muscles working in say a squat, but I can’t see that they’re going to do that much to address the issue out on the road.
My question is, has anyone else experienced this kind of imbalance and what did you do to correct it? How can I encourage the medial muscles of my upper and lower legs to stop being lazy and start contributing more! And crucially, how can I do transfer this to my running stride to prevent the IT band knee pain flaring up on long runs?
I’ve found that single leg exercises(single leg squat, lunge, deadlift, bridge, side clam, hip tilts) and lateral walks with resistance band work best. Mine was solved by strengthening hips. It all started because of bad form: my left leg was landing too close to center line of body.
I’ve been fighting chronic ITBS for over a year. I even broke my other leg during all this and it still came back when I got to running MONTHS later.
I’ve tried all the hip / glute strengthening / stretching / rolling. 2 PT’s. I’ve had a surgeon look at my knee to confirm it’s ITBS and not something else. Slow motion run gate analysis. Fits on both Tri and TT bike. Nobody can find anything wrong!
I feel that same tightness outside at times. It’s my left leg and I tend to lean right a bit riding my bike.
I’ve done MANY hours of research and my findings are that the latest and greatest say they don’t really know what causes ITBS. They also don’t really know for sure how to fix it. But I never had it this bad before I started biking a lot. So for me I think something to do with riding is the cause, but it doesn’t flare badly unless I run. I just did an IM where it never flared badly until about 15 miles. Then believe it or not the other flared a couple miles later and I’ve never had both flare! So I’m simply going to take a few months off running assuming it’s going to come right back when I start back up!
I’ve found that single leg exercises(single leg squat, lunge, deadlift, bridge, side clam, hip tilts) and lateral walks with resistance band work best. Mine was solved by strengthening hips. It all started because of bad form: my left leg was landing too close to center line of body.** **
This is interesting. I have slightly bowed lower legs, which causes my feet to naturally land slightly more toward the centre-line of my body and if I over-exaggerate this (like a catwalk-model walk) I can really feel the stress all the way down the outside side of my leg. I’m well accustomed with those exercises, but I’ve tried glute medius targeted strength work A LOT and if anything it just seems to add to the stress on the IT band-knee region. I’m inclined to agree with my physio at the moment, that hip strength isn’t the major issue and that’s only feeding in to the lateral dominance and tightness in my outer leg muscles.
With respect to your left leg drawing inwards, did you try to actively correct your gait and make your foot land further out? I know a lot of people say that consciously trying to modify your gait is a bad idea.
Thanks for the reply, I remember your original posts about your IT band issues because I was going through the same thing; I was impressed to read your IMWI race report given your fairly catastrophic injury last year!
The most frustrating thing that I find is that the more I try to actively address it, the worse it seems to get. I was fine for the first half of this year, running 40+ mpw, set a new half marathon and 70.3 PBs but now I’m right back where I was 12 months ago. I’m signed up for Ironman UK next year and *really *want to get on top of it before training starts in earnest.
I’d like to clarify that you are saying the outter leg muscles are dominant. That’s correct right?
I have yet another fitting scheduled. I still am confident I have a pedal / cleat / fit issue with my left leg. It may be a natural thing.
Funny thing is I believe my ITBS leg tends to track inward…or my knee tends to collapse inward. This did not show up on either 2 retul fits, but maybe it wouldn’t. I’m not sure if retul tracks the knees.
I’ve ridden about 6-8 times now post IM. I never get pain in the knee while riding, but I can feel it…already!
I am overpronator, so getting shoes with support helped to alleviate the IT band issue. Previously I would try to land on the outside of my foot to compensate, which drew my foot closer to my center line. Now I land on the ball of my foot and haven’t had issues since. I do the strength and foam rolling to maintain.
Now to try and figure out why I get PF in my right foot =( I do negative calf raises, stretching, and roll my foot on a lacrosse ball. I guess I have weak feet.
I’d like to clarify that you are saying the outter leg muscles are dominant. That’s correct right?
Yep, that’s right. I went to see a physio earlier this week and after watching me walk, run, squat, lunge, stand on tip-toes and a whole bunch of prodding and poking that was her diagnosis. Basically the outer (lateral) leg muscles that I mentioned above were getting overworked and the inner (medial) muscles were just chilling out doing nothing!
It makes a lot of sense because the outside is where I feel a lot of tightness after hard or long run sessions and foam rolling the peroneal muscles on the outside of the lower leg is agony on my left, ITBS-affected leg, but not that bad at all on my right leg. My TFL muscle is noticeably bigger on the left side too, so obviously something is causing that whole chain of muscles to get overworked, tighten up and cause the friction and pain at the knee. The only relief I’ve found is really stretching the TFL, which can alleviate the tightness and discomfort, but if I try this during a run it just tightens up immediately again and I get nowhere.
Have any of your fits looked at Q-factor on the bike? I suspect in my case, a too narrow Q-factor might be contributing to the tightness and outer leg muscle dominance, but it’s only with all the extra eccentric movements associated with running that it really tightens up and causes pain. Having said that, I paid close attention to this when I was on the bike yesterday and it seems as though my medial muscles are actually doing some work in the pedal stroke and I’m reluctant to start fiddling with my bike position seeing as it doesn’t cause me any issues there at the moment, although I’m aware it still might be contributing to my issues on the run. Very frustrating.
I’m having Chris Balzer do my fit. As far as I know he’s done about as many fits as anyone. Yes we will talk q-factor. I have not had that addressed in other fits.
I do believe Q-factor may be an issue yes. Now which way it needs to go I don’t know! The way it sounds maybe bigger is better.
For what it’s worth I just built a fat bike from scratch. The Q-facor on that bike is 223mm! LOL. Compare that to a road bike with 150mm and it’s an entirely different beast. 3.5 cm wider per side! I’m well tuned in to that fact that we’ll see if that makes any sort of difference.
I’m also planning to do even more strengthening this winter.
Yeah, I’m thinking wider Q-factor might be better. When I ride my commuter road bike with flat pedals I notice that my feet naturally fall well to the outside of the platforms, so it feels that my “natural” Q-factor might be wider than I’m using on my proper road bikes.
Well let me know if you ever find a solution because it sounds as though we’re suffering from very similar problems!