Cycling InjuriesATAF Spring Conference - 2013Stephen A. Black, DSc, M.Ed., PT, ATC/L, NSCA-CPTRockyMountain Human Performance, Inc.Florida Gulf Coast University

Statistical Overview

• Recent Statistics (2012) – total reported ~19,000+

– Killed – 107– Seriously injured – 3,085 (hospital admission)– Slightly injured – 16,023 (non-hospital admission– 25% of total were children– 25% of those killed had significant head trauma

NHTSA - 2012

Statistics Cont.• Orthopaedic Overview

– Back / Neck Px– Knee Px– Patellar / quad tendon tendonitis / tendonopathy– ITB– Hip – Medial Tibial Stress Syndrome– Foot pain / numbness– Pelvic Girdle Pain (PGP) Syndrome– others

Cycling vs. RunningWhat do you call an injured runner?

• Non-impact– Fewer stress fractures

• Eccentric muscle action not as important– Fewer muscle strains / tears• Hours spent in saddle

– Less overuse problems than running?• Overtraining or staleness is more common

A cyclist!Why

Cycling Injurieshttp://www.youtube.com/watch?v=mYPDAry-A-s&feature=player_embedded

Macro-Trauma

OVERUSE INJURIES

Micro-Trauma

Contact Overuse

Saddle Sore

Neuroma

Neuropathy

Neuroma• Impingement of nerves• Chronic inflammatory mass• Burning pain• See riders shaking foot out of pedals• Between 3rd and 4th metatarsal classically

Neuroma On the Bike Treatment

• Adjust cleat position, usually further back• Check inside shoe for cleat bolts• Change shoes to wider toe box• Shoe inserts may help

NeuromaMedical Treatment

• Biomechanics• STM / IASTM• Nerve Glide• Functional Ex• Guided Injection• NSAID• Surgery

Saddle Sores• Moisture + Pressure + Friction• Chafing• Ulceration• Folliculitis• Abscess• Subcutaneous nodules

Saddle Sores On the Bike Treatment

• Change saddle• Check saddle height and tilt• Clean chamois, no seams, keep dry• Don’t sit around in your kit after riding• Emollients

Saddle SoresMedical Treatment

• Prevention– Keep dry, clean, chamois, avoid shaving high

• Medical Treatment– Warm soaks– Topical cortisone, anti-fungal, anti-bacterial– Oral antibiotics– Surgical incision and drainage

Hand Neuropathy

• Cyclist’s Palsy (Ulnar Neuropathy)• Carpal Tunnel Syndrome• Worse after long rides• Worse on rough terrain• May become permanent

Hand NeuropathyOn the Bike Treatment

• Relieve pressure• Pad bars• New gloves (Specialized)• Reposition often• Bars

– too far forward– Too low– Too much tilt

Hand NeuropathyMedical Treatment

• STM / IASTM• Kinesiotape• Nerve Glide• Guided Injection• NSAIDs• Night splint• Strengthen upper extremity• Surgery

Bursitis

Pre-patella and

MCL bursa

Greater Troch

Ischial Tuberosity

Ischial Tuberosity Bursitis• ‘Sits Bones’ sore• Cold weather, early season, time trialing• Modalities – relative rest• On the Bike:

– Change saddle– Check saddle height and tilt– New chamois

Greater Trochanteric Bursitis• Proximal ITB Syndrome• Pain with lying on side at night• Manual Modalities• Foam Roller / Stick• Kinesiotape• Guided Injection• On the bike:

– Check saddle height– Check cycling form

More Common Issues

ITB

Patella Femoral

Patella Tendon

Patella Femoral Pain Syndrome

• Pain under the patella from excessive load– Hill climb– Wind– Big gear– Time trialing– Resistance training

Patella Femoral Pain Syndrome

• Tender patella facets• Tender patella compression• Unable to do one legged squat• No effusion

Patella Femoral Pain SyndromeTreatment

• Off the Bike– Soft Tissue Techniques– Modalities– SFMA / FMS– Surgery i.e. removal of medial plica

• On the Bike– Bike Fit

• Check if saddle is too low or forward• Check if cranks are too long• Cadence / Gear Ratio

Knee Pain and Adjustment

Location Cause Solution

Anterior Saddle too low Raise saddleSaddle too far forward Move saddle

back Cranks too long Shorten cranksPosterior Saddle too high Lower saddle

Saddle too far back Move forwardMedial Toes point out Point in

Feet too far apart Move closerTight pedal tension Lower tension

Lateral Toes point in Point outFeet too close Move apart

Arnie Baker 1998 Bicycle Medicine

Training Mistakes

Training Stimulus

Performance

Training Volume/Intensity

Overtraining• Cyclists are notorious• Clinical history is most important• Many blood tests, not very helpful• Exclude organic disease• Profile of Mood States• Performance Testing Decrement

– VO2, Lactate, HR, Watts, EPOC, RPE relationship

Laws of Training1. The race is won in the off season2. Train frequently, all year round3. Start gradually and gently4. Build a big base5. Go hard on the hard days, easy on the easy days6. Do not overtrain7. Avoid monotony8. Train with others9. Keep a logbook10. Take a break at the end of a season, stay active

Adapted from Tim Noakes in the Lore of Running