2011
12.15

Question:

Hi David

I run and cycle; having been doing so for years….more of a recreational person…aims to complete not compete…

in the last Standard Charter marathon…i had extreme pain on the outer part of my leg. And it would go away when i walked and then when i jogged it would come back after about 100 meters and i did that for the last 10km of the marathon…pain came at about 26km

I did a run a few days later…because i felt fine…..was fine for first few km and then pain came back after about 3km…

so i thought i would ride…did a round island on Sunday, great pain but only at the 110km mark…both knees this time, same place …outer medial part of knee…i could not even pedal…i have been riding for years, mtb and road never ever experienced this…

had no problems whilst riding until last Sunday…prior to that i did a Tour de Bintan (1st day / stage 150km, next day / 2nd stage 73 km and afternoon 3rd stage 38km…Never did such a grueling ride…had no pain during or after the event.

all said i am wondering whether you know what it could be, based on info provided…..oh yah…during the ride i had great pain only at my lower back or upper part of my butt….thought it could be my riding style because the tour de Bintan was damn hilly, nothing but up and down the whole course….and during my ride last Sunday…no hills, hardly, but still that butt / lower back pain…

Please advise thanks

Clinton

Answer :

I believe your troubles stem from an overuse issue in your gluteus, causing a lack of force partnership support to the Tensor fascia lata (TFL). As the TFL contracts it pulls on the Iliotibial track of cartilage that inserts on the lateral side of the knee.

During you efforts to complete the marathon you were slowly depleting your applied neurological muscular engagement pattern with each step. Unfortunately your gluts may not be fully part of your existing kinetic physiology and or were somewhat pre-exhausted from the demands required in Bintan. Thus when the system in use got to the point of failure, your gluts were forcibly fully recruited and engaged to help propel you.  If this is the case they were not accustom to doing this much work and have become depleted in their ability to provide future support until they are fully recovered.

How does this affect your ITB you may ask?

The answer is in several ways:

As the Gluts work they slowly contract, please note that the gluts actually connect to the Iliotibial track at the base of its insertion point onto the pelvic cradle. So when they fully contracted from extensive unfamiliar  forced recruitment, the result was a pull on the iliotibial track that inserts into the lateral side of the knee. The pull is what causes the pain at its insertion since the force is starting from the origin and connection point to the Gluteus Maximus. The continued pain you now feel in the upper part  of your buttocks  and lower back is due to the fact that these muscles, the gluteus medius and the Quadratus Lumborumare are now being asked to provide extra work to support the already failed gluteus maximus. And since these muscles are not accustom to this additional taxation, they too are failing and suffering from over usage as well.

The Tensor fascia lata (TFL) is in fact the direct muscle connecting to the iliotibial track and the main root of your discomfort.  Once again as it contracts from overuse and due to lack of support from its force partner gluteus Maximus. It has an intense effect on the IT band, as it has a direct connection and relationship with this track of cartilage.

As a whole, cycling does in fact demand the full engagement of the TFL. It is merely intensify with the “aggressive” nature of the position. The more “aggressive” the position is, the more work the TFL is required to perform and thus greater demands are required by its force partner, Gluteus Maximus

Please note that all muscles have a direct force partner in which it relies on to help protect it. As one fails, the other one is then forced to work harder which has its own negative effect on our systems. Forced partnership is one of the topics that I explain and additionally help to tutor my fit clients to create equality of engagement, maximization of muscles recruitment and methods of perhaps to help prevent future injuries such as the one you are experiencing now.

I have attached several photos for your review to help you visualize the cause and effects of your issues. Short term I would suggest that you let your body fully recover by ceasing all exercises and strenuous activities. Enjoy sleeping in and generally take it easy for a few weeks then start back slowly with light riding. Long term, a bicycle fitting and continued education are vital for a long lasting and enjoyable athletic vocation.

Additionally, the position required for peak performance on a hilly ride such as Bintan, is very different to that of the flat terrain of SG.  This I why I always invite our clients to return for a fit adjustment prophylactically as their, goals, frequency, duration and or the terrain to be ridden changes so we can make the appropriate adjustments to ensure the riders comfort, sustainability, power and safety are all at the pinnacle of consideration

I hope this helps you to understand the sensations you are feeling.  Please feel free to reply with any and all additional questions you may have in the future.


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