Physiotherapy for the Cyclist

This article is by Zak Buttle the physiotherapist at the Angel Sports Injury and Physiotherapy Clinic.

Cycling iinjuries can come from a manor of different circumstances. Some would think back to large scales collisions and crashes that can range from flesh wounds to multiple fractures and worse. However, to the keen cyclist, it is often the aches and pains that develop over a number of rides that cause you the most grief.

Many patients that I have treated with cycling related repetitive trauma injuries I have advised that they seek a bike fit - a professional intervention to ensure that your bike is set up to match your own dimensions. However, these unfortunately vary in their quality, and regularly place the importance of power over injury avoidance.

Keen athletes have come into our clinic having had a bike fit recently, but the damage to themselves had been done already - the repeated actions of your legs on the pedals, or the sustained position of your back when on the saddle.

Even as an individual who obsesses over the human body and its mechanics, I struggle to find a part of the human musculoskeletal system that is not used in cycling. Common cycling injuries can include but are certainly not limited to:

• Achilles’ tendinopathies
• Calf strains
• Patellofemoral joint syndrome
• Hip flexor strains
• Mechanical lower back pain
• Postural thoracic pain

But as we look elsewhere in the human body, the acromioclavicular joint, connecting the shoulder to the collar bone, can be compressed, or distracted, depending on your cycling style, causing undue overload and resulting in injury.

An athlete with a wide cycling stance can overly rely upon hip abductors as opposed to his hip flexors and strain the iliotibial band (ITB) – a common injury in, but not exclusive to, runners.

Other patients have suffered problems while on the bike because of a range of causes that originate away from the bike. Postural deficiencies that cause no problem during work and resting time, can be then be altered so drastically by the position that we sit on the saddle that it is only then that we feel symptomatic.

All injuries result from overload. From a huge impact to the clavicle or tibia bones in a crash, to a steep increase in the amount we use our calves while cycling, or a prolonged time we spend with our spine flexed.

Once assessed and the problems are identified, treatment for the variety of injuries will normally always contain of a home-based exercise routine that requires an active involvement from our patients. This may include:

o strengthen the structures that were not ready to be overloaded, or
o stretching regime to take pressure away from the symptomatic region, or
o proprioception/balance programme to avoid a loss of control within isolated parts of each limb, preventing undue stresses and strains.

The large majority of problems will also benefit from some form of hands-on therapy to compliment these, such as soft tissue release and massage, joint mobilisation, or passive stretching. These will always be discussed and offered to the patient.

Physiotherapists are well equipped to treat the ailing cyclist; all of the aforementioned injuries have been treated successfully by my colleagues and I over the years. Chronicity (duration of a current symptom) plays a large role in the prognosis – the ability/time to recover, and the sooner a problem is treated, the less time the human body has to create long-term adaptations that a re harder to treat, hindering a prognosis.

Therefore, I strongly encourage any cyclists with nagging aches and pains to act upon this and seek a resolution as soon as possible!

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