The biomechanical and fit issues that accompany these tendinopathies are similar to that of the patellofemoral syndrome.Inthe case of an acute flare of tendon pain, activity and loads should be modified to decrease possible risk of chronic injury. Similarly, abnormalities in patellar tracking, hip abduction strength, and bicycle fit also can contribute to distal ITB pain, resulting from friction of the ITB across the lateral femoral epicondyle. In full extension, the ITB lies anterior to the lateral femoral epicondyle; however, with flexion, it glides posteriorly, contacting the lateral femoral condyle in an ‘‘impingement zone’’ at less than 30- of knee flexion. During pedaling, the ITB is pulled anteriorly on the downstroke and posteriorly on the upstroke (25). The minimum knee flexion angle at the bottom of a pedal stroke is close to the impingement zone of the ITB; therefore, conditions of increased knee extension such as excessive saddle height or improper cleat position can contribute to a distal ITB friction syndrome, resulting in pain over the superolateral knee, sometimes radiating up into the lateral thigh (22).