How to avoid and treat overuse injuries
By Erik Moen
Most cyclists have experienced a few aches and pains along the way. Most of the time, it just comes with the territory and a little bit of rest is all you need. Sometimes, though, the aches and pains can grow into something more serious: overuse injuries.
Overuse injuries are prolonged rubs, grinds and tears of soft tissue that cause pain and limit riding. As the name implies, they occur over time and are caused by irregular or excessive forces applied to a soft tissue such as cartilage or tendons.
Overuse injuries may also occur as a result of an improperly rested acute injury. Common overuse injuries include tendinitis, cartilage degeneration, pain syndromes, peripheral nerve irritation and muscle tears.
These injuries often creep up slowly and their effects on performance are progressive. But while the pain may seem innocent at first, dysfunction related to an overuse injury often comes to a dramatic crescendo, leaving the athlete in a state of depression.
Bicycling-related pain syndromes do not have to occur, but a “ride through the pain” attitude will only make things worse. By observing a few precautions, you should be able to enjoy the sport relatively pain-free for years to come.
Why do they occur?
If you think about the mechanics involved in cycling, it’s almost surprising that there aren’t more overuse injuries in the sport. The bicycle is supposedly a symmetrical object, which your maybe-symmetrical, hopefully flexible body is supposed to fit onto. Then, you pedal with force for hours upon hours. At 80–90 revolutions per minute, that’s about 15,000 pedal turns over the course of a three-hour ride. It’s a recipe for overuse.
So what are the main culprits in overuse injuries, and how can you prevent them? Common mechanisms of injury include training errors, musculoskeletal anomalies and bike-fit irregularities. Training errors are a large part of overuse injuries. These errors can fall into two categories: physiological errors, and pedagogy or technique errors.
Physiological errors usually involve excessive increases in volume (miles or hours of training) and intensity (heart rate) without proper recovery: a guaranteed route to injury. Hard work is a necessary part of our sport, but care must be taken when advancing training variables. The general rule with regards to intensity and volume is to decrease one while increasing the other.
The act of pedaling a bicycle is part of bicycling pedagogy. Pedaling techniques are important, as pedaling is a high-force and highly repetitive motion. Common pedaling errors include quad bias pedaling (a.k.a. mashing the pedals or pedaling squares) and prolonged low cadence (less than 80 rpm). Ideal cadence for endurance riding is 80–100 rpm.
Musculoskeletal anomalies are imperfections or challenges of our muscles, tendons, bones and joints. Anomalies limit our ability to ride a symmetrical bicycle with force over time. They fall into three groups: flexibility, weakness and asymmetries.
Flexibility is one of the most over-looked training methods in the sport of bicycling. Good flexibility of the legs and spine allow for pedaling with few motion compensations. Motion compensations frequently become evident in rotations of the leg asthe foot passes through the dead-bottom-center of the pedal stroke. This is why cleats with float are necessary for some
riders. Cyclists are most commonly inflexible in the hamstrings.
Weakness or imbalance of muscle groups can also be a stimulus for injury. The most common weaknesses are of the hamstrings relative to the quadriceps, the gluteus medius (lateral hip muscle), and the lumbar extensors. A well-balanced hamstring group helps stabilize the knee joint under forceful extension of the leg (pedaling), and then helps clear the leg across the back of the pedal stroke.
The role of the gluteus medius is to help guide femoral direction and stability in pedaling. It helps prevent the knee from drifting to the inside during the pedal stroke, otherwise known as a valgus moment at the knee. The lumbar extensors are the base of support in cycling. They serve to anchor the torsion of a somewhat upright posture, and they are responsible for providing a base of support for the production of leg force and the transfer of that force to the pedals. Weakness
of trunk musculature allows for greater irregular joint-loading and extremity/spine motion
Musculoskeletal asymmetries provide challenges to a person attempting to fit on a symmetrical bicycle. Common body asymmetries arise from such things as flexibility differences, strength imbalance and structural differences. Body asymmetries often cause one-sided injuries. Leg-length differences are a common form of body asymmetries, and can arise from differences in tibial length, femoral length or from pelvic dysfunction.
The most common bike-fit errors include improper saddle height, improper handlebar reach, and misalignments of pedal and shoe. A good bike fit should consider individual musculoskeletal challenges and features. Once your bike is fit to you properly, write down the specific measurments so you can dial in your position after disassembling your bike for traveling, making repairs, or putting on new components.
The treatment of an overuse injury depends on the individual case. The sooner you identify an overuse injury and the sooner you start to fix it, the sooner you will be back to pain-free cycling. It’s like being a detective. How did you develop the injury in the first place? This information will allow you to tailor your rehabilitation plan to the specific needs of the injury.
Recovery and treatment require modified rest. Effective treatment will include aspects of flexibility, anti-inflammation, strength, biomechanics and nutrition. The re-training of pedaling skills should be included. Possible intervals should include one-legged pedaling and fast pedaling. Controlling variables such as gearing, heart rate, cadence, and terrain can help, too. Consider making a healthy habit of having a complete physical at the completion of a competitive season. This physical should include physiological markers, cycling biomechanics, and musculoskeletal examination. Attention to observed deficits in your seasonal training plan will allow for greater performance gains over the following season.
The key to injury-free performance is the athlete’s ability to discern and report irregular pain and dysfunction. The body is adaptable to a certain point. Attempts to push the body past the point of adaptation will lead to injury and/or pain-induced performance reduction.
Be safe, be smart, train right!
Erik Moen PT, CSCS is a coach with Carmichael Training Systems. Erik is
the clinic director of Physiotherapy Associates – Northgate in Seattle, WA, an outpatient orthopedic and sports physical therapy practice. Erik can be reached through CTS at www.trainright.com
What are common overuse injuries?
Anterior knee pain, ilio-tibial band tendinitis, spinal pain (neck and lower back), hamstring tendinitis, and extremity (hand and foot) numbness/pain are among the most common overuse injuries. Here are some of the reasons why they occur:
Anterior knee pain >> Low saddle, low cadence, quad bias pedaling, misaligned cleat, and muscle imbalance (strong quads, weak hamstrings).
Ilio-tibial band tendinitis >> High saddle, leg-length difference, and misaligned cleat.
Neck pain >> Long/low handlebars, short-reach handlebars, and downward tilt of saddle.
Low back pain >> Inflexible hamstrings, low cadence, quad bias pedaling, poor back strength, and long/low handlebars.
Hamstring tendinitis >> Inflexible hamstrings, high saddle, misaligned cleat, and poor hamstring strength.
Hand numbness/pain >> Short-reach handlebars, poorly placed brake levers and downward tilt of saddle.
Foot numbness/pain >> Quad bias pedaling, low cadence, faulty foot mechanics, and poor cleat placement.