Iliotibial Band Syndrome (ITB) is a common sporting injury, especially among cyclists. Team GB Triathlete Nick Busca, who is a patient at The Putney Clinic of Physical Therapy, sustained this type of injury earlier in the season and it worsened after competing at the World Championships in the summer. In this article he tells us how a combination of massage, osteopathy and physiotherapy have helped him on the road to recovery from injury.


Everything was proceeding smoothly. I was very consistent with my training blocks and had been able to avoid both massive tightness in my muscles and, more importantly, any injuries. I was in the shape of my life and looking forward to racing the Long Distance Triathlon World Championships in full force.

But in sports, as in life, the road is never smooth. At the end of a descent, there’s always another mountain to climb and, after a positive period, there can always be another setback. In my case, my nemesis for the 2018 season was the ITB. Here are 6 things I learned while battling it:


Before I knew its name, ITB was only a feeling… A sharp and painful feeling running deep inside my quads and in between the quads and the hamstrings. The most acute area was around the right knee-cap, located externally. Even the lightest touch felt like I was pricking my knee with a needle. The pain activated a very specific alarm that ran back into my brain and reported: “this is not good”. Even walking up and down the stairs was becoming increasingly harder, let alone running.

In order to combat this, I decided to book a massage session with Toby and an osteopathy session with Adrian as soon as possible. I needed to act quickly to make sure I was back on track for the Worlds in the middle of July. It was only the middle of June and I thought I had time.


Then I did what we all do when we panic: I asked “Uncle Google” for advice. “ITB,” he said, adding a sterile and scientific description: “ITB is a thick fibrous structure or band of fascia which originates from the Tensor Fascia Lata and Gluteus Maximus muscles on the outside of the pelvis, travels over the hip and knee and inserts just below the knee on the lateral condyle of the Tibia, known as ‘Gerdy’s Tubercle’”.

That sounded about right; my pain was also running from the glutes down to the knee and it was there that it expressed its worst side. But what could I do to reduce it? Uncle Google led me to a famous running magazine website. “Oh look, I’m not alone!”, I thought. What better place to learn how to treat ITB pain than a running magazine? I was still convinced that ITB problems were caused by running and believed – as did the magazine – that the only thing I could do was to not run, reduce the inflammation with rest, ice the spot, take anti-inflammatories, have a massage and stretch. “Good, I’m on the right path,” I thought.


Little did I know back then that my ITB issues were actually caused by cycling and not actually by running. More specifically, it was caused by a lot of climbing at low cadence and on steep mountains. My coach was right when he told me that perhaps it was actually the bike and not the run that was the real cause of the pain. Running brought the pain to the surface due to the higher impact on the body. However, the real cause was in fact an old cycling cleat wobbling left and right in the wrong direction (and the additional burden of climbing big mountains on a saddle).

The sessions with Toby to reduce the tightness on my quads were pure agony. I have never experienced so much pain during a massage! But they were effective and they helped. I felt like I was getting better, but the tightness in my quads was so severe that, at that time, there was not much I could have done to really make it better. Not forgetting to mention the weakness in my glutes, which, up until that time, I had not really focused on.


After a few massage and osteopathy sessions, some rest and some kinesio tape here and there, I thought I was back on track and ready to race the World Championships on full gas. It all went well up until the end of the bike section. I was in the top ten of my age group, and even the first part of the run was going well. Then, at the 7-kilometre mark, the skeleton jumped out the closet.

The pain was getting more and more acute with each kilometre and, by the 15-km mark, it had become so intense that I was no longer able to run and, eventually, I was forced to walk to the finish line (a further 15 km). By this time, even walking had become difficult and I was a bit scared that there was something really wrong afoot. However, I knew that it was the same problem that I had experienced a few weeks earlier, just at a higher level.


Back in London after the race, I decided to see Dermot, one of the physiotherapists at The Putney Clinic of Physical Therapy, to get more advice about what to do with my ITB. On top of the massage and osteopathy (which helped reduce the tightness in my muscles and restore a correct balance in my posture), Dermot gave me a protocol to reinforce my glutes (in particular my right glute), as this was probably one of the causes of my ITB pain.

I had to do a few exercises with resistance bands after running and cycling sessions (my keenness drove me to also do them after swimming sessions). This re-awoke a part of my body that had been in hibernation. During the previous months, I had “forgotten” my focus on core and strength sessions due to a hectic work and training schedule. As a result, my glutes had become completely weakened. Cycling and running in the wrong way for long periods of time (and at higher intensities), I started to overcompensate, which – in turn – contributed to making my injury worse.


Finally, after two months of worrying, being in a lot of pain, taking anti-inflammatories, having some very painful massages and some more relaxing osteopathy sessions, reading up online and beyond (I highly suggest Anatomy for Runners by Jay Dicharry), starting a lot of fun and useful exercises to reinforce some specific areas for running, experiencing some more pain, embarking on a new coaching routine and mindset, etc… I feel that my ITB problem has now almost gone 100%. I still feel that it can be like a skeleton in the closet, particularly if you do the wrong things over and over. However, I have definitely learnt a lot over this period and I will try to make the most out of this setback. After all, we learn from our mistakes.


The most important lesson to remember is that, as soon as you feel pain (that pain telling our brain something is not right), to book a session with a professional. Uncle Google may not be the most reliable way to finding out what to do.


If you are suffering from ITB or are looking to take up cycling and would like an examination to rule out any existing injuries, you can book an appointment with our team of Osteopaths and Physiotherapists. Book online or by calling us on 020 8789 3881. We also offer sports and therapeutic massage in 30, 45 and 60 minute time slots, all of which can be booked online. Consult our treatment fees page for prices.


Nick Busca is a freelance journalist based in London, focusing on sports (particularly cycling, triathlons and skiing), travel and foreign affairs. His work has been published in a variety of publications, including The Guardian, BBC Travel and CNN , and other sport themed websites.

Nick is also a Level 2 Triathlon Coach and has been regularly competing in triathlons since 2012 and has represented Team GB. In addition to this, he is a ski instructor.