Friday, February 1, 2013

Cycling Injury & Prevention

On Saturday February 9th, TOCA Physical Therapist Christine Phillips will be participating in the Sun Devil Classic (Strada Racing Club & ASU Cycling) road cycling event in Tempe from 7am to 5pm. (Click here to read more about this event). I deemed that this would be a good opportunity to talk about cycling and common injuries. Whether you ride a road, mountain, commuter or cruiser bike, cyclists are susceptible to a wide variety of injuries. These injuries can be related to many factors including muscle weakness, muscle tightness, improper fitting to your bike, poor pedaling mechanics or improper training. Many of these injuries can be avoided by adding several simple exercises and stretches to your weekly routine.

Today, there are about 80 million cyclists in the United States. Studies estimate that large numbers of these cyclists experience physical problems: 48 percent in their necks, 42 percent in their knees, 36 percent in the groin and buttocks, 31 percent in their hands, and 30 percent in the back.

Knee Pain
The knee is the most common site for overuse injuries in cycling. Patellofemoral syndrome (cyclist's knee), patella and quadricep tendinitis, medial plica syndrome, and iliotibial band friction syndrome are a few of the more common knee overuse injuries. The first four injuries mentioned involve pain around the kneecap, while the last condition results in outer knee pain. Shoe implants, wedges beneath the shoes, and cleat positions may help prevent some overuse injuries.

Head Injuries
One of the most common injuries suffered by cyclists is a head injury, which can be anything from a cut on the cheek to traumatic brain injury. Wearing a helmet may reduce the risk for head injury by 85 percent. The majority of states have no laws governing the use of helmets while riding a bicycle, but helmets are readily available for purchase and typically low in cost.

Neck/Back Pain
Cyclists most likely experience pain in the neck when they stay in one riding position for too long. An easy way to avoid this pain is by doing shoulder shrugs and neck stretches that help relieve neck tension. Improper form also leads to injuries. If the handlebars are too low, cyclists may have to round their backs, thus putting strain on the neck and back. Tight hamstrings and/or hip flexor muscles can also cause cyclists to round or arch the back, which causes the neck to hyperextend. Stretching these muscles on a regular basis will create flexibility and make it easier to maintain proper form. Changing the grip on the handlebars takes the stress off of over-used muscles and redistributes pressure to different nerves.

Wrist/Forearm Pain or Numbness
Cyclists should ride with their elbows slightly bent (never with their arms locked or straight). When they hit bumps in the road, bent elbows will act as shock absorbers. This is also where changing hand positions will help reduce pain or numbness. Two common wrist overuse injuries, Cyclist's Palsy and Carpal Tunnel Syndrome, can be prevented by alternating the pressure from the inside to the outsides of the palms and making sure wrists do not drop below the handlebars. In addition, padded gloves and stretching the hands and wrists before riding will help.

Foot Numbness and Tingling
Foot numbness and tingling are common complaints, and shoes that are too tight or narrow are often the cause. In addition, foot numbness can be due to exertional compartment syndrome. This arises from increased pressure in the lower leg and resulting compression of nerves. The diagnosis is made by pressure measurements and is treated with surgical release.

General injury types
  • Tendinitis - inflammation or irritation of a tendon can be caused by different reasons ie. ill-fitting shoe or cleat position. Falls may also cause bruising to tendons and overuse or extra or sudden forces may cause strains. Pain can arise from nerve irritation within the tendon and must be taken as a warning that something is wrong, the tendon maybe swollen or stretched or small tears may have occurred. Many overuse injuries around the knee are overuse tendon injuries.
  • Bursitis - irritation or inflammation of the fluid filled cystic structures found between surfaces that facilitate movement over each other. When one of those surfaces is also tendon then it is difficult to distinguish between tendinitis and bursitis. This is of little relevance because the treatment regime is the same for both.
  • Compression neuropathy - an abnormality of nerve function often caused by pressure on a nerve or the blood vessels that supply it. The common cycling neuropathies are cyclist's palsy (ulnar nerve) and penile numbness, a common problem related to the abnormal function of the pudendal nerve.
  • Stress fracture - an overuse injury of bone which are relatively uncommon in cycling.

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