Cycling Injury Prevention

During the summer I was asked to present to a local GranFondo Training Clinic on cycling injury prevention.  Personally, I am not a cyclist more a runner however, my expertise lies in my in depth knowledge of anatomy and movement dysfunctions.  Here’s a brief synopsis of what I presented.

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How Cycling Injuries Occur
Cycling injuries are reported to be caused by a combination of inadequate preparation, inappropriate equipment, poor technique and overuse.  It is recommended that injury prevention should be the focus, with particular attention to bicycle fit and alignment, appropriate equipment, proper rider position and pedaling mechanics, and appropriate training.

Your body is an adaptable and usually asymmetrical unit sitting on a fixed symmetrical apparatus, the
bicycle. Therefore the more symmetrical your body can function the less your chances of getting an overuse injury. Overuse injuries can be caused by your body’s reaction/adaptation to inappropriate positioning on the bicycle and/or your body’s existing dysfunction or imbalance trying to adapt to the demands of cycling.  For example, decreased flexibility on one hip will create a functionally shorter leg and the pelvis will tilt toward that side thereby affecting your ankle, knee, hip, pelvis, torso, and extension of arms between the sides.

Common Areas of Cycling Injuries
Knee pain 
Ironically cycling is the most commonly prescribed activity for rehabilitation of knee injuries, yet knee pain is the most common injury resulting from cycling.  This is because cycling related knee pain is rarely intrinsic.  It is usually the result of an issue with the opposite foot/ankle or hips/low back. The knee joint is a hinge type joint and therefore cannot adapt to multi-planar movements like the hip and ankle can tolerate.  For example, a seat being too low can cause the patella to track incorrectly (anterior knee pain) or an existing hip dysfunction can pull on the opposite knee (lateral knee pain).

Low back and hip pain
Low back pain is the next most common cycling complaint.  This is usually the result of incorrect seat position, overly long reach to the bars and/or poor core stability.  Core strength is needed to stabilize your low back and pelvis while applying force through your legs.  Also, too much flexion through the Lumbar spine will eventually become symptomatic as posterior structures lengthen and weaken.  It is better to try to flex or bend forward at the hips, which requires hip flexibility and lengthened hamstrings.

Upper back, neck and hand pain
These pains are usually connected.  Generally asymmetric pain is due to a pelvic malalignment. 
Your shoulder, arm, hand and upper back of the side of the forward pelvis will brace to counteract this motion.  Whereas, with symmetric pain, the bar and or seat position is usually at fault.  For example, if the bars are too low, the rider has to extend the neck more to see forward.  Tension builds in the arms, shoulders and upper back to maintain stability and causes pain.  Try not to be at your end of your available neck range of motion when looking forward with hands on the drop bars.  Also, your shoulders should sit naturally and not thrust forward with your hands on the brake hoods.

Sore or numb feet
The main causes of painful feet are poorly fitting shoes and the cleat position being too far forward.  Cycling shoes should fit a little more snugly than walking or athletic shoes but too much lateral compression compresses your Metatarsophalangeal joints and the nerves between them (Metatarsalgia).  Cleat position too far forward stresses your plantar fascia (tendon from heel to MTPs) and can cause Plantar Fasciitis.

Injury Prevention:  So what you can do?

1. Get a professional bike fit to ensure that the bike fits your individual biomechanics. 
2. Book a thorough musculoskeletal assessment by a physiotherapist to establish a baseline of joint movement, muscle strength and muscle length.
3. Maintain good posture.  Working on your posture enhances your natural curves in your spine and strengthens the core muscles to hold you there.
4. Work on core and hip strengthening, specifically your Transversus Abdominis, Multifidus and Gluteus Medius and Minimus.  Exercises like bridging, plank and hip abduction are good.
5. Stretch the large muscle groups used in cycling including Hamstrings, Gluteals, Quadriceps, Low Back and Hip Flexors.  Focus on dynamic stretching pre-cycle and static stretching post cycle.  A foam roller is a great way to roll out and loosen hard to stretch areas like your Iliotibial Band.
6. Don’t forget to rest and recover especially after long rides, including proper hydration.

References 

1. Hogg, S.  The five most common cycling injuries.  Bicycling Australia.  Jan/Feb. 2013.
2. Sanner, W & O’Halloran, W.  The biomechanics, etiology, and treatment of cycling injuries.  Journal of the American Podiatric Medical Association.  2000; 90(7): 354-376. 
3. Wanich, T et al.  Cycling Injuries of the Lower Extremity.  Journal of the American Academy of Orthopaedic Surgeons.  2007; 15: 748-256.