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Q. Why does my hip and knee hurt every time I ride my bike?

-Tom




A. When cycling (as well as running) the most common culprit with regards to knee and hip pain is a piece of tissue called the Iliotibial Band or “IT Band”. The IT band contains the muscles that help you to flex and rotate your hip outwards as well as the ligaments and tendons that stabilize the hip and knee joints. When this band becomes tight it can rub and “snap” over the bony prominences of the hip and knee and cause pain and clicking noises. This time of year I see a lot of IT band problems as people come out of hibernation and begin to get active again. Thankfully ITB problems can usually be mitigated with some planning and therapy.

The first thing to keep in mind is to ramp up your training schedule slowly so as not to overuse muscles that have been dormant for most of the winter. For the first few weeks gradually increase your distance and intensity to longer rides/runs.

Make sure to stretch your glutes and ITB before and after you exercise. The best solo IT band stretch involves standing and crossing (for example) your right leg behind the left and leaning towards the left side. In this case you should feel the stretch in the right hip and knee. Hold 15 seconds, relax, and repeat 3 times. After you finish one side make sure you stretch the other. To stretch the glutes extend one leg while sitting and then cross your body with the other leg (your foot should end up at about mid thigh on the floor at the outside of your thigh). Take hold of the knee that you crossed in front and hug it towards you. Again hold 15 seconds, do it three times and then switch sides.

Many times the ITB will have some degree of what is called “fascial dysfunction.” Fascia is like a sweater for your muscles. When you have an injury or repetitive aggravation the sweater can get “snagged” and cause the muscles underneath to not work properly. The solution for this is to untangle the fascia which can sometimes be accomplished with a foam roller or a rolling pin-like “stick.” Sometimes if the fascia is particularly stubborn you will need to have a professional perform soft tissue mobilization with an instrument to straighten out the fascia and allow your leg to resume it's full range of motion without pain. Any fascial therapy whether performed at home or in an office is tender, but reducing long-term pain and preventing further injuries down the road are worth the temporary discomfort.

Additionally you should visit a bike shop and have them evaluate your bike to make sure that it is adjusted properly for your body type. Something as simple as your saddle being too high or too low can cause knee strain and lead to pain and injury. Please do not ignore nagging knee or hip issues. Knees and hips are far and away the most commonly replaced joints for a reason.