ITBS Sufferers - Advice needed

A bit of background on my knee injury -

I first hurt my knee when I swerved suddenly on my uni on a curve. I heard a click but there wasn’t any pain or swelling. When I got off I realised I couldn’t walk and I couldn’t straighten my leg. It got better a day or two later.

A month after, I ran a marathon, suppressing the pain with heat rub for the last half of it. I couldn’t walk at the end of the run and couldn’t walk for the days after.

In between, I’ve rested for almost 2 months before getting back to light running and cycling. I ran 10k at a very very leisurely pace recently but felt slight twinges about midway. I unicycled about 30k today, moderately fast with sprints in between. I stopped because I can’t walk anymore and I still can’t walk now.

The pain has been consistant - a dull pull on the outer side-to back of my knee that hurts more when I bend my knees or squat. On a regular day, squatting hurts. I’ve seen a sports doctor, had MRIs done and was told that there was nothing wrong with my knee, he can’t isolate the source of my pain and that I could run/cycle more until the pain comes back and he can find out where the pain is at and inject some Cortisone in me. It sounds rather dubious imo.

I’ve googled a bit and read about the different kinds of knee injuries. The same doctor had initially suggested a possible meniscus tear (disproved by the MRI) but ITBS seems a more likely fit. I’m seeing the same doctor again tomorrow (unless insurance qualifies me for a second opinion) but I’d like to know my options before talking to him. So now the questions.

  • Does physio help much in ITBS? I know stretching helps but it doesn’t seem to be a permanent solution.

  • Any experience with cortisone? I’m reading that effects last only a few weeks.

  • I think today’s onset is due to the fact that I like my seat low and when the seat’s slightly higher, I feel my knee destabilizing on the down-pedals which is scary. What’s better for the knee?

  • Anyone recovered from it fully and could share some pointers?

Sorry to hear about your knee being injured, hope your knee improves quickly. (I don’t have a clue about knee problems, but can bump this message to the top.)

I’ve had ITBS. It took me more than 2 months to recover. Take it easy for as long as it takes to recover to the point that it won’t be coming back on the next long ride. That means no riding, no running, for 2, 3, 4 months.

Stretch regularly using the various stretching techniques you’ll find on ITBS web sites. Some stretches get more near the butt and other stretches get more down towards the knee. You need to do a variety of stretches to get the whole ITB stretched.

I also wore a PattStrap during the day, and later on when I started riding again.

At first after getting back to riding I had to worry about the pain and symptoms coming back. I’d feel it starting sometimes and I’d stop, stretch, and take it easy. That went on for a year or two or more. Now I haven’t had a twinge or any kind of a recurrence. I still remember to stretch the ITB before and after rides, but it seems to be OK. It’s been about 10 years or so.

For riding fit I think one important factor is to have the knees go straight up and down. If someone watches you from the front the knees should be moving up and down with no wobble or circular motion. That is easiest on the knee joint. Experiment with different foot positions on the pedals. Think about lifting your knees up with your upper legs. Put your hands straight out in front of you and think about trying to get your knees to hit your hands. That will get you to pedal in better circles and reduce backpedaling pressure on the knee which I believe contributes to ITB problems.

Thanks a lot for that. It’s very comforting to know it’s not terminal. It’s been exactly 4 months since the initial injury and I have to say I’m incredibly frustrated by the fact that I can’t do more without killing my knee.

How serious was your ITBS at its worst?

The first onset happened after a muni ride. I finished the ride without pain. Soon after the knee got painful and I could barely bend it. Walking was a challenge. I don’t recall how long it was before I was able to walk normally again. That was the only time I had it so bad that I couldn’t walk.

It was a while after that before I was able to walk up and down stairs without pain or any twinge. I don’t recall how long it took.

I was careful after that to never let it get so severe that walking became a problem. I had many minor reoccurrences after that, but never so bad that walking was significantly hampered. When I felt it coming on I stopped the activity and took it easy.

No long rides after that. And it was several years until I was confident that I’d be able to do a long ride and finish it. But after that it’s been all good.

Oh, I should add that I don’t run or jog. The only activity to aggravate the ITB was unicycling. Running and jogging is probably more harmful that cycling.

I’ve been recovering from knee problems lately, but not ITBS specifically. The key for me has been training my leg muscles without the unicycle.

At least for me, the problem with unicycling only without other training is that my leg muscles became imbalanced, and that allowed my knees to track incorrectly when I unicycled. I’ve read that it’s common for cyclists in general to overtrain their quads and neglect their hamstrings and glutes, and a friend who would know recommended hamstring curls to me. So I’ve been doing exercises like hamstring curls to strengthen my hamstrings, and it has seemed to help.

I don’t know if I had ITBS but like you, I was a bit over-zealous with my running and did a marathon without too much training. And I wrecked my knees in the process. I don’t run anymore.

Around that time, I used to get a bit of pain on the lateral side of my knee/thighs (presumably a tight ITB), when I used to unicycle on the 24". Nothing major coz it always went away.

I’d recommend a break from all sports and do lots of daily stretching. Get back to unicycling slowly. Take a longer break from running. If you do get back to running, build up really slow. After my marathon, I trained my sister over 2 years to run one too. Over the 2 years, there were times when the mileage increase was almost negligible but she’s been running daily for 4 years now and has never had injuries. Also, try to run on earth/mud, rather than tarmac. Concrete is a no-no!

These days, I get a pain in my knee from unicycling that I think is a mixture of muscle imbalance and not having a brake. My route has a lot of undulations and braking on a downhill puts a lot of stress on one’s knees. I will be getting a brake soon.

Get your seat height right. At the bottom-most position of the pedals, if you have your heel on the pedals, your leg should be straight. That means if you have your balls of the feet on the pedals at that seat height, your legs should be almost straight, at the bottom-most position. Play with it.

I always thought cortisone was not a solution but just a way to mask the pain. I could be wrong.


I dont run anymore as it caused too many overuse injuries. But my one piece of advice, unless you have no other choice, dont do cortisone. It masks the pain but does not help it heal and weakens the tendons/ligaments. Hope you feel better! I had a partial menisectomy. Thats OK but get pain below the knee on the top of the shin now at times. I think its just tendonitis from my leg losing strength. The pains are slowly going away…

Sid - I think this pretty much rules out joining you for any amount of days for 3 Oceans :frowning:

So the doc confirmed an ITB problem and tells me to rest for a week before starting out light again. I’m supposed to head to a physio next week and get my uni fitted to me. I’ll share what goes on at that session after. Uni-fitting sounds really exciting.

I developed ITBS after training/running my first ultramarathon. It was certainly due to undertraining as I had a long training run of fourteen miles, then ran a fifty miler :astonished:

It continued to bother me even with some downtime, for about six months, so I went to see a physical therapist. He told me that my hips were tight, showed me some stretches, etc…, I found the Piriformis stretch to help the most. Essentially the ITB is a tendon that runs along the outside of your knee. It gets a lot of abuse, and if you get some swelling it will begin to rub, this makes the swelling worse, which brings on the pain.

I would start doing stretches for ITBS, add in NSAIDs before and after exercise (running/riding), other than that it’s a matter of grin and bear until it goes away.

Oh, and I stopped all that excessive running, so it doesn’t really bother me anymore :slight_smile:

How old are you? We aren’t getting any younger, are we?

I’m 24.

I did something quite similar to you. I decided to do a marathon in August, got injured in Nov and eventually ran a marathon in December. Prior to June, my mileage was 0-10km/month.

Somehow, I suspect that the ITB came as a consequence of another injury. I feel very distinct pains in 2 areas of my knee - the outside (ITB) and the inner back. The marathon injury and the one I’m talking about in this post is most certainly an ITB but I’m quite certain ITB injuries don’t get started on short rides on flatland when you turn a corner and hear a click in your knee.

That is the stretch that I found most helpful as well. I do it as demonstrated here: Piriformis stretch position.

Interesting. Because my knee hurts when I do that.

For the past few months I’ve found riding hard muni over about 5 miles irritates my left outer knee. After doing some research online and mentioning it to me chiropractor, I’m convinced I’m dealing with ITBS.

I’m even more convinced because the pirformis stretches gives me relief. I also do one where I sit on a hard chair, bad leg crossed over good knee, sit straight and lean my chest forward. I did this one sitting on a boulder when I had pain during a ride and gave myself several more miles of painless riding.

I also find my pain is much worse later. I raced hard muni yesterday for about 2.5 hours. Within a few hours, I could hardly walk. Within a few days with stretching and no riding, I expect to be back to normal. But I need to get rid of this altogether.

According to, there are many possible causes. The one that stands out for me is:
"Muscle imbalances - particularly quads versus hamstrings "
Since my only exercise is riding muni about twice a week this makes the most sense to me.

So I’m guessing my quads would be stronger from riding muni, and I should stengthen my hamstrings more?

fluxusmaximus, have you solved your itbs problems at this point?