Virtual Case Study: Pain on the Outside of the Knee While Cycling

Eliminate and prevent the pain on the outside of your knee when cycling by following these simple tips!

Patient Presentation: History, Background, and Complaints

Brodie B. presented to my office when the pain on the outside of his knee when cycling made it difficult to continue randonneuring through the sequoias, and caused a hitch in his step when he stopped to have his brevet stamped at the summit of the Titans Grove KOM.

It was obvious that Brodie was having a bad day when he could be overheard saying, “I forgot my cycling shoes on the way to the ‘control’ and had to borrow a pair.”  He wondered if this had anything to do with it.  It was 1,000K ago.

Brodie complained of the following symptoms:

Physical Examination

While Brodie’s lower body strength appeared good, he did demonstrate weakness when attempting to rotate his hip outward.  Most significant, however, was the extreme tightness he displayed on the outside of his hip and thigh, which when stretched while he bent his knee produced clicking and pain on the outer portion of his knee.

Diagram of leg muscles and bones

Diagnosis: What is it Called?

Iliotibial Band Friction Syndrome

Describes symptoms caused by inflammation of the iliotibial band (or IT band).  The IT band is a connective tissue structure which travels along the outside of the thigh from the hip to the knee, whereupon it becomes thickened at its attachment.  With tightness of the IT band, that fibrous attachment creates inflammation-causing friction as it rubs excessively against the bone or bursa resulting in swelling and discomfort.  

Etiology: What Causes It?


Irritation due to the repetitive nature of the pedal stroke if performed improperly or if problematic, especially if improper positioning causes abnormal stress to the outer portion of the knee.

Muscle Imbalance or Weakness

Stiffness or shortening of the IT band due to prolonged repetitive exercise while improperly positioned or if a congenital musculoskeletal predisposition exists.  Or weakness of the external hip rotator muscles and glutes which when fatigued allow the leg to turn inward.

Core Weakness

Without strong back and abdominal muscles there is no foundation for strength production by the legs and an inconsistent and improper pedal stroke can result.


The residual effects of prior trauma or recent injury can cause significant and limiting knee pain.

Bike Fit

Improper positioning on the bike causes repetitive stress-causing inflammation and pain in the affected area.

Treatment: What Can You Do About It?

Description of the benefits of foam rolling when you have pain on the outside of your knee when cycling
Pain on the outside of your knee when cycling exercise program

Referral: When is it Time to Ask For Help?

Green bike avatar

The Expected Outcome: Conclusion

Pain on the outside of the knee, often the result of excessive tightness of the musculoskeletal structures on the outer thigh, can be chronic and negatively affect cycling performance and enjoyment.  The good news is that Iliotibial Band Friction Syndrome is effectively treated and even avoided by following the simple tips outlined above.  


Brodie B., convinced that by following a consistent stretching and recovery plan he would be able to once again ride pain free, had this to say as he set off without a hitch, “Now off to collect my Brevet d’Audax.”

Next appointment

In the next instalment in this series, learn what may be causing the pain on the back of your knee and what you can do to keep riding without performance limiting discomfort.

What about you?

Have you suffered from IT Band syndrome?  If yes, let your fellow virtual cyclists know what worked best for you. 

Learn more about your cycling-related aches and pain by visiting the Virtual Case Study page of The ZOM.

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1 year ago

Should have read this six months ago… Started to have this problem since my vEveresting mid-March and made the error to ignore the pain and soldier on for two more months to win our ZRL S3 division. Been off cycling for three months since, countless sports physician and physiotherapist visits and still no significant improvement. A recent ultrasound showed the IT band is swollen and there’s a bursitis as well (after three months without any serious strain on the tendon). My sports physician switched to anti-inflammatory medication now. Hoping that helps and these exercises might put me on the right track afterwards!


[…] For a deeper dive into other possible causes, treatment, and prevention of lateral knee pain, check out the ZOM virtual case study entitled “Pain on the Outside of the Knee While Cycling.“ […]

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