INJURY PREVENTION AND TREATMENT By Warren Hutson, MSc, DO

Cycling has been described as balancing the body on an unstable system, while simultaneously providing motive forces combined with speed and direction.

The two major components are the machine (cycle) and the human body, the former is adjustable but not adaptable, while the latter is adaptable, but only to compensate within certain limits. If one goes outside those limits then injuries, traumatic or overuse, will almost certain- ly occur in the athlete's cycling career.

The human body makes contact with the bike at three points; hands (handlebars), pelvis (saddle) and the feet (pedals). If these three points of contact are disre- garded and set up incorrectly then almost certainly overuse and traumatic injuries will occur. One can try to adjust the bike to the person but one cannot adjust the person to the bike without a great deal of difficulty.

OVERUSE INJURIES These type of injuries occur in most sport- ing activities and can be treated with similar treatment

regimes, but when

treating cycling injuries one must take into consideration the forces applied to a structure over a period of time. In cycling this can apply to an increase in mileage or the intensity of the training regime (hill work or big gears), these are the most common cause of overuse injury. Once again one has to look at the set up of the bike and its components ie. leg length discrepancy or misaligned cleats.

Overuse injuries can be graded according to pain or persistence of pain: Grade 1 Pain only after activity Grade 2 Pain starts during activity Grade 3 Pain persists the next day Grade 4 Pain is constant

Treatment principles Cycling is no exception, applying general principles which are common to most sports should prevent overuse injuries. Allow the body sufficient time to adapt to the increase in activity. Levels of activity should be increased gradually with allowance for rest, heavy and light train- ing regimes, with time for a warm up, cool down and with stretching incorporated into the training. Track cyclists tend to

www.sportex.net CYCLING

INJURIES – PREVENTION AND TREATMENT

spend more time in the above routines then their road or off-road colleagues.

General treatment principles ■ Adjust activity to allow healing, reduced activity maybe preferable to complete rest

■ Reduce any inflammation using ice, oral non-steroidal anti-inflammatory drugs (NSAIDs), cortisone injections and manual (physical) therapy includ- ing ultrasound, contrast baths and massage

■ Adjust if needed the biomechanical stress or external factors in cycling. Check and alter the bike if needed, cleat position. The bike must fit the rider not the other way round

INTERACTIVE 1

‘Saddle up: Fitting Body to Bike’ - Article in sportEX health issue 9 - detailed information on

how to achieve the correct biomechanical set up of a bike

General injury types ■ Tendinitis - inflammation or irritation of a tendon can be caused by different reasons ie. ill-fitting shoe or cleat posi- tion. 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 move- ment over each other. When one of those surfaces is also tendon then it is difficult to distinguish between ten- dinitis and bursitis. This is of little rel- evance because the treatment regime is the same for both.

■ Compression neuropathy - an abnor- mality 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 abnor- mal function of the pudendal nerve.

■ Stress fracture - an overuse injury of bone which are relatively uncommon in cycling.

SPECIFIC INJURIES Knee injuries The most common area for injuries in cyclists is the knee, from possible overuse, trauma and the cycling position. Overuse injuries in and around the knee are due to the repeated and constant stresses of riding a bike and represent the most common problem that cyclists seek medical advice for. The common overuse injuries are chondromalacia patellae, patellar, quadriceps, anserine, tibialis anterior tendinitis, and prepatellar bursi- tis, plica (patellofemoral ligament inflam-

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