Originally Posted by cyclezen

My caveat: This is the internet and I'm not an MD...
I have a tendency for very 'hard' muscles, meaning they're always very hard feeling and not very pliable...
This has a tendency, when the muscles get really stiff to put pressure on the IT (among other things) and consequently cause mis-alignment in the knee.
The IT band is the Largest Ligament'Facia in the Body. It DOES NOT Stretch... It can get irritated at the connection to the hip or knee.
Inflammation at the connections is a more difficult issue to address.
But if the problem is mostly in the underlying muscles being too hard (which is usually my issue...) getting them to relax and become less inflamed will help.
What works for me...
Self-massage of the legs - I do this regularly, even when I don;t have any issues. There are some good resources on learning this on the web - but also some really bad/wrong resources. - more on that later.
I do use a 'roller' - I prefer Hand-held not one you lie down on. mine is not foam, but is spaced,nubbed disks rotating on a handle - really is up to what you like for giving the needed pressure.
I Tolerate Ibuprofen well - so I have a use routine for it. Discuss with your MD as to it's suitability and use.
I do quite a bit of stretching - AFTER a ride or any heavier or extended exercise period - I also have/do some basic yoga routines which help a lot with the overall stretching.
As noted - key is the cleat alignment in 'rotation'/yaw .
Even if you haven't changed your 'position', your body does change over time. If you haven't ridden for some time and now riding more frequently and harder, your overall flexibility may have changed. AS noted by others, a change in saddle height might help... often lowering just a bit helps. MAKE CHANGES IN V-SMALL INCREMENTS and keep it there for some time/rides before making additional changes! A saddle height adjustment is 3 to 5 mm is quite a bit. Might also need some change in fore/aft - 2-3mm is reasonable...
CONCERNS/CONSIDERATIONS about any massage or 'pressure' methods (like rollering)
The Larger veins in the body have one-way valves, which keep the blood from backing up and only allow blood flow TOWARDS the heart. You never want to cause such back pressure as to cause rupturing of these valves. SO, heavy massage or pressure should always be done in a direction towards the heart - meaning UP the length of leg, not down towards the feet.
Think about what happens when you 'roller' your leg muscles... Especially an issue where you have large veins close to the body surface - like the lower leg.
Pressure across the muscle is not a problem, percussive pressure/therapy or soft kneading of muscle are usually not a problem.
Do everything in 'increments', soft easy stretching to start, then let the body slowly soften into further stretches, same for massage.
If you're gonna ride, ride easy, lower gears, comfortable cadence, no big gears, no heavy spinning, no big mileage, until you feel the problem has eased enough.
Then, Every thing in INCREMENTS!
Hope it all gets better for you.
Ride On
Yuri