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Physiotherapy


Cycling Injuries

Introduction 

Cycling is a great, low impact Exercise and Sport to maintain fitness. Cycling involves risk of pain and injury.
Cycling pain is mostly due to Poor bike fitting, Improper technique while cycling, Overtraining syndrome etc.

pCauses of cycling injuries 

• Due to faulty and improper saddle height.
• Seat more backward or forwards leading shoulder and neck pains.
• Pushing excessively with high gears.
• Leg muscles strains.
• Improper cycling position and technique.
• Injuries may also occur due to high-speed collisions with the competitors, trees, rocks and other objects.

Common Cycling Injuries

Head Injuries

    They occur due to fall without helmet and are common while cycling.

Clavicle Fracture

    This occurs due fall on the shoulder breaking partial/total break of bone along with clavicle.

Upper Limb Injuries

    Carpel tunnel syndrome due to incorrect cycle fitting affecting the median nerves of the wrist.
    Ulna neuropathy/Handlebar palsy – Tingling and Numbness may occur in the ring and little fingers due to pressure on the hands placed on the handlebars for prolonged time.
    Mountain cycling athlete absorbs great force by their bodies and hands through the handle bars vibration leading to strain injuries of wrist and shoulder muscles.

Back injuries

    Low back pain
    Sciatica may occur due to improper sitting while riding.

Knee Injuries

   - Knee pain is also common as cycling causes excessive strain on the joint mainly while cycling in hill areas.
   - Cyclists with flat feet are mostly prone to excessive Pronation/Internal rotation of the lower leg which causes stress on the IT band at knee.
   - Patellar tendinitis, Patellofemoral syndrome.

       Injury may happen due to pushing big gears, low saddle, and saddle is too far from the handle bars, improper pedaling, and leg length discrepancy with seat due to short legs.   

       Prevention

        a.Ride at 75 rotations/pedaling per minute.
        b.Move the seat back or raise the seat length.
        c.Check the length of the leg and adjust the seat.

  - Hamstrings and calf muscle strain

      This may happen due to high/Too far saddle, increased pedal float, and leg length discrepancy
      Move seat forward or lower the seat length till needed range.

  - Osteoarthritis of knee also occurs in athletes. It is degenerative disease with stiffness and pain of joints in morning.

Leg injuries

  - Plantar fasciitis

    It causes pain and swelling at the bottom of the heel. This may lead to Heel spur.

  - Over Pronation injury

    Pronation movement is moving the foot inwards to the body. Excessive pronation movement may lead to pain in the foot.
    Wearing shoes which limit over motion/Pronation of foot may help.

  - Arch pain

    Inflammation and Burning sensation in the arch of foot area. Shoes which support the arch area reduce the arch pain.

  - Heel spur

    Over growth of bone at the bottom of the heel causes pain while walking.

  - Calf muscle pull/strain or Achilles tendinitis
    This occurs when lower leg muscles (Gastrocnemius and Soleus) are pulled from Achilles tendon. Pain in the back of the leg region.

Muscle cramps

    Cramp is a sudden intense pain in the muscle which contracts involuntarily and forcibly which does not relax.

Skin abrasions and wounds

    They occur due to fall while cycling causing outer layers of skin to rub off.

Sprains and Strains

    These are acute injuries causing Pain, Swelling, Bruising and Movement loss in the joint.

External Iliac Arteriopathy

    This is uncommon and is due to arteries damage of the pelvis/groin/lower leg due to cycling.

Overtraining syndrome

    This occurs due to repeated training and overuse of the same muscles beyond their limit and capacity during competition/work-out lead to over training syndrome.

Blisters

    Fluid filled sacs on the skin surface of the feet due to Improper shoes, Cycling on bare feet, Cycling for longer periods etc

Physical Therapy Treatment

Diet

    Proper nutrition should be taken. Improper diet prevents from early recovery. A balanced diet includes:

        Carbohydrate intake which help in refueling muscles
        Proteins to rebuild muscles
        Drink plenty of water to keep hydrated.
        Vitamins and Minerals

Shoulder Exercises

    Rest to the injured limb
    Ice therapy
    Compression bandage
    Elevation of the injured part if needed
    Medicines like pain killers
    Modalities like heat, straps, and supports.
    Seated row exercises
    Lateral pull downs
    Military press/Shoulder press
    Side raises and external rotation with dumbbells
    Medicinal ball exercises
    Rotator cuff muscle strengthening stabilizes the shoulder joint and decrease hyper mobility.

Lower body strengthening and stretching exercises are more useful. Glutei muscles and IT band is to be stretched.

Leg Injuries Treatment

   - Rest for few days depending on the severity. Slow, Gentle movements. Then strengthening exercises of ankle.
   - If the sprain is more severe, then surgery may be needed to repair the ligament. Physiotherapy treatment done after surgery.
  
            Rest for some time.
            Isometric and strengthening exercises for quadriceps muscle.
            Stretching exercises, Range of motion exercises of the knee.
            Soft tissue massage – Stroking technique is used from upper thigh region to the knee. This stretches the muscle fibers and improves muscle contraction.
            Pain relievers like aspirin also help.
            Avoid full leg extensions with knee bent as this may rupture the kneecap making the condition worse.

Knee Injuries Treatment

    Rest the part. Slow, Gentle Passive and Active movements of the joint. Later Stretching and Strengthening exercises of the knee.
    Knees kept strong by leg lifts, strengthening exercises by machines.
    Wearing Ace bandage on knee help in preventing the injury to get worse.
    Quadriceps exercises
    Squats
    Leg press
    Cycling
    Lunges
    Leg extensions
    Leg raises for adductors and abductors along with stretches.
 
Hip Injury Treatment
   
Exercises

Wrist Extensors

    Sit in a chair and place injured hand on the edge of the table with palm downwards. Hold a light-weight object/dumbbell and raise the hand till pain-free range.
    Hold for 5 sec and relax.
    Repeat it daily for 3-4 times till pain-free range. Increase resistance as you feel better.
    This helps in strengthening of the extensor muscles.

Wrist Flexors

    Sit in a chair and place injured hand on the edge of the table with palm upwards facing the ceiling. Hold a light-weight object/dumbbell and raise the hand till pain-free range.
    Hold for 5 sec and relax.
    Repeat it daily for 3-4 times till pain-free range. Increase resistance as you feel better.
    This helps in strengthening of the flexor muscles.

Prevention

Injury prevention methods are similar to all most all the sports but slight variations regarding protective equipments and conditioning exercises should be taken care of.

Warm-up Program

    It should consist of 5 min Cardio/Pulse raising exercises like Jogging, Cycling, and Skipping etc.
    Stretching exercises
    Jogging

    Benefits

      - Increasing temperature of muscles.
      - Increases blood circulation and oxygen to muscles.
      - Increase the speed of nerve impulses making the muscle action faster.
      - Increase the range of motions of the joints.
      - Improves the performance of the joint action.

Stretching Exercises

    All muscles and joints stretching to be done. This helps in preventing injuries.
    Good stretching program for upper and lower limb muscles is to be done.
    Stretches should be static without any bounce and held for at least 30 sec.

Cool-down Program

    It consists of gentle jogging followed by light stretching.

    Benefits

     - Gradually lower your heart rate
     - Restoration of blood and oxygen to muscles as they were before exercise program
     - Removes toxic and waste products
     - Reduces muscle soreness present after activity.

First Aid Kit

    Adhesive bandages, Adhesive tape, Ace bandages
    Ice packs
    Pain killers
    Sterile gauze pads,
    First aid cream/Disinfections cream/Analgesic cream
    Scissors
    Cloth swatches for making slings in case of emergency.

Sports Massage

    Regular sports massage help in flushing of toxic and waste products.
    Relaxes the muscle stress.
    Releases tight lumps and bumps in the muscles.
    Give more importance to Lower limbs.

Dress Appropriately

   - Proper fitted equipments should be worn. They include
      Proper Shoes - Good sneakers/Shoes with skid resistant soles. Always examine the shoe soles and if smooth areas are seen replace them as soon as possible.
        a. Wear comfortable and appropriate shoes which absorb the force impact during pedaling in hard and uneven surfaces.
        b. Shoes should also have ankle support. Over Pronation may lead to Achilles tendinitis.
        c. Shoes should have good cushioning effect and should provide support and stability to the arch of the foot.
        d. Ankle support reduce ankle sprains

      Proper socks are also needed. The sock should not allow the foot to slide more inside the shoe and on the pedal.
        a. Cotton socks absorb perspiration and add support to the foot.

    Knee pads

    Padded shorts are worn to prevent skin abrasions and wounds, if the person falls.

    Braces and Supports help in stabilizing the injured area improving movement.

    Knee cap/Ankle brace gives support to the injured part relieving stress and inducing healing.

    Helmet is needed for safety to prevent head injuries. The helmet should be comfortable and must fit properly to the individual. It should be replaced within certain duration.

    Other protective equipments like Gloves, Knee pads and Elbow pads are to be worn.

• Practice using correct biomechanics of cycling.

• Be cautious to have a complete fit cycle.

• Choose cycles with gear which allow a cadence/speed of 75-90 rpm.

• Gradually increase your training program instead of sudden changes in training sessions.

• Minor injury should also be treated as early as possible as this may lead to severe injury in later stage.

• Good fitness training and trainer are also necessary. During practice also wear good and protective shoes.

• Use a sunscreen lotion in summer and moisturizer in winter season while clycling to protect the skin.

• Low resistance pedaling with speed of 80-90 rpm is to be done which helps body to adjust to road riding.

• Leg length discrepancy in every one is common but more than 1/8 or 3mm may affect during cycling.

• Cycling injuries can be prevented by good body alignment and good cycling techniques.

Cycle Adjustments to Prevent Strains and Injuries

Handlebar adjustment

    Handlebars should be adjusted at needed distance in the reach of hands without stretching the hands and neck. This reduces strain on the neck and shoulder.
    Handlebars should be at right distance away from the saddle and at right height which helps in proper cycling technique.

Saddle adjustment

    Getting correct adjustment of length and angle of the stem and saddle create perfect cycling position.
    While cycling, our upper and lower back should be kept straight without stretching.
    If seat is too low, knee joint and front muscles of leg get affected.
    If seat is too high, muscles behind the leg are affected.

Lever position

    Place levers high on the handlebars which help in upright cycling position. It should not be so high because reaching the brake levers from the bottom of the handlebars may become difficult.
    Shallow/Compact drop bars can be used. These help in reducing the upper bar distance to the lower part helping the cycler to use many different hand positions and prolonged cycling.

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