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.
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.
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.
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).
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.
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.
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.
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?
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.
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.
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:
Some studies (Hodges, et al) suggest we run better off a steeper seat angle. (some do not produce this finding).
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.
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.
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.
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.
