I have recently met with a number of cyclists that have been complaining about knee and hip pain. One of the most common causes of knee and hip pain in cyclists is iliotibial band (IT band) syndrome.

The IT band is a fibrous band of tissue, which is located on the outside of the leg from the hip to the knee. Generally, the pain is caused when the band becomes tight and rubs over the bony bulges of the hip (greater trochanter) as well as the knee (lateral epicondyle). Depending on the severity of IT band syndrome, stretching, physical therapy, and proper bike fit maybe all that is needed to reduce pain and avoid injury.

In addition to tight muscles in the lower extremities, knee and hip pain can be caused by a faulty bike fit, pushing a large gear, using long crank arms, and poor cleat alignment. As I listened to the rider's complaints about their pain, and analyzed their pedal strokes, I realized they all had poor feet and leg alignment while riding.

The foundation of a good bike fit is proper foot and leg alignment. The foot should be well supported while cycling. It is like building a sound structure and it should be built from the foundation for greater stability. Aligning the foot is a very important first step towards achieving an efficient, powerful and durable cycling position. Many riders' knees either track towards the outside or inside at the top of the pedal stroke in a quick snap-like motion and are not tracking vertically. The lateral and medial motion is often caused by a lack of alignment of the lower leg and foot. Misalignment not only compromises power, strength, endurance and aerodynamics, but may cause pain and/or injury. There are many techniques and products available that can accommodate proper knee and leg alignment for a safe, strong and more aerodynamic position.

The first thing I like to look at is how the cyclist's feet provide natural shock absorption in the joints and soft tissue during impact of weighted motion. The shock absorption is accomplished by rolling and collapsing of the foot inwards (pronation) or a rolling of the foot outwards (supination). While riding the bike, the force being applied to the pedals is absorbed by the foot's side-to-side motion instead of going directly to the pedal. The most common occurrence is over-pronation where excessive strain is placed on the tendons, ligaments and joints. In a 1988 study published in the Journal of Orthopedic and Sports Physical Therapy showed that 95 percent over-pronate or supinate. Fortunately, science and technology has provided us with supportive devices in the form of custom orthotics, footbeds and cant wedges.

The use of custom cycling orthotics and/or footbeds is the most effective method to correct foot and leg misalignment. In general, custom cycling orthotics can be more difficult to find and may require you to travel to a qualified podiatrist. A custom footbed is somewhat similar to a medical orthotic (but far less expensive). Custom foot beds will support your entire foot from the heel to the arch and forefoot. The footbed should mirror the shape of your foot in a strong neutral position. The cost for footbeds can range from $50 to $250.

The use of cant wedges fit between the cleat and the shoe and can also help improve alignment and tracking. However, unlike the comprehensive nature of a footbed, cant wedges address forefoot alignment only. Cant wedges can be used separately, but most often they should be used in conjunction with custom footbeds to ensure the entire foot is supported, unless you are one of the 5 percent that do not over-pronate or supinate.

If you are having discomfort in your knees or hips, do a little research and find the right footbed for you.

Greg Combs is a cyclist and coach for more than 30 years and is considered an expert in bicycling fit and rider positioning. He is also the Director of the Sport Management Program at Methodist University in Fayetteville, NC. For more information browse: www.velosmart.com or email him at gcombs@methodist.edu.