Cycling injuries are either overuse injuries which develop gradually over time because of repeated movement patterns or pressures, or acute, traumatic injuries due to a fall! These are extremely variable and so not really covered here.
The most common gradual onset cycling injuries tend to be knee injuries. But wrist and elbow pain can also occur.
IT band syndrome
IT band syndrome or runners knee as it is sometimes called is a gradual onset injury causing pain on the outside of the knee. Over time the pain gets progressively worse until the player must stop. Typically they will rest for a period of time until symptoms go only for it to return again as soon as they go back to playing tennis or running. Treatment is based around reducing the pain and inflammation along with stretching, foam roller use and strengthening exercises. Read more about IT band syndrome treatment.
Patellofemoral Pain Syndrome
Patellofemoral pain syndrome (PFPS) also known as runners knee, chondromalacia patellae is a generic term used to describe kneecap pain at the front of the knee. Symptoms include an aching pain in the knee joint, particularly at the front of the knee around and under the patella. Treatment includes rest, applying ice or cold therapy to reduce pain and inflammation along with a full rehabilitation program of specific exercises along with knee taping. Read more on treatment for patella pain.
Lower back pain
Back pain can be acute (sudden onset back pain) or chronic back pain (gradual onset or persistent). It can be difficult to diagnose due to the complexity and the number of structures and tissues in the lower back that can cause pain. Pain radiating down the leg is known as Sciatica.
Handlebar palsy is a condition caused by compression of the ulnar nerve at the wrist against the handlebar. Symptoms include numbness, tingling and weakness over the outside of the hand, little finger and outer half of the ring finger. Read more on the causes and treatment for handlebar palsy.
A wrist strain is a general term used to describe pain in the wrist. This may be due to a sudden force causing an acute injury, or due to overuse, causing a repetitive strain injury. Symptoms of a wrist strain include pain in the wrist which may develop gradually or suddenly. There may be a specific area which feels tender to touch and swelling may develop. Pain is likely to be reproduced when moving the wrist against resistance. Read more on the treatment for wrist strain.
Sudden onset injuries from a fall often occur to the shoulder as the cyclist falls onto an outstretched arm.
AC joint sprain
AC joint separation or AC joint sprain is an injury to the ligament that holds the acromioclavicular joint together at the top of the shoulder. It is usually caused by fall onto an outstretched arm. A grade 1 sprain is very mild and a grade 6 injury would be very severe. Getting early treatment and support through taping is important to avoid long-term problems or shoulder deformity. The Symptoms include pain right at the end of the collarbone on the top of the shoulder. Initially the pain may be widespread throughout the shoulder but become more localized to a bony point on the top of the shoulder later on AC joint sprain treatment and rehabilitation.
Rotator cuff tear
A Rotator cuff strain is a tear to any of the four rotator cuff muscles in the shoulder and is common in throwing and racket sports. They are so called because their job is to rotate the arm at the shoulder and provide a supportive cuff around the joint. Treatment consists of reducing pain and inflammation followed by a full rehabilitation program consisting of mobility, strengthening and sports specific exercises. Read more on the causes and treatment of a rotator cuff strain.
Should I seek professional treatment?
If you have any of the following symptoms you should seek further medical assistance.
- Severe pain, especially on walking
- Severe swelling (oedema)
- Altered sensation in the foot – such as a feeling of “pins and needles” (paresthesia) or a “loss of feeling” (anaesthesia).
- Unable to complete normal daily activities after the initial 72 hours.
Further medical assistance can be sought through either your local GP or a private clinician such as a podiatrist, physiotherapist, sports therapist, osteopath or chiropractor. If you have followed the P.R.I.C.E. principles (see below) and are still unable to walk after 72 hours or still have severe pain that is not subsiding after the first 72 hours you should visit your local A&E department for further assessment.
Secondly, if you have applied for P.R.I.C.E. principles and still have weakness that lasts a long time (more than 2 weeks) or have ongoing discomfort in your foot or heel, you are highly recommended to seek advice from a specialist expert - such as a podiatrist or physiotherapist, osteopath, or chiropractor - who can provide you with advice and an appropriate and effective recovery and rehabilitation program.
Immediate first aid for acute injuries
The PRICE principles are the gold standard set for treating acute sports injuries. The acronym stands for Protection, Rest, Ice, Compression and Elevation and should be applied as early as possible and continued for at least the first 24-72 hours.
Protection of the damaged tissue is vital to prevent further damage and enable the healing process to start efficiently and effectively. There are a number of ways to protect the injured area all with the same aim of limiting further movement and use of the joint/muscle/ligament/tendon. One way this can be achieved is by using a support or splint.
In the early stages, rest is one of the most important components of the P.R.I.C.E principle but is often neglected or ignored. It does not only refer to the prolonged period of time that the athlete will be out of action but also to the immediate period after the injury.
An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer.
If an injury is sustained during sporting activity some athletes have a tendency to 'run it off'. This implies that by continuing to participate in the exercise, the injury will simply go away. In fact, in the majority of cases, this is not true and is not advisable.
Ice therapy, also known as cryotherapy, is one of the most widely known and used treatment modalities for acute sports injuries. It is cheap, easy to use and requires very little time to or expertise to prepare.
The application of ice to an injury, in the acute phase, can substantially decrease the extent of the damage. It achieves this in a number of different ways:
Decreases the amount of bleeding by closing down the blood vessels (called vasoconstriction).
Reduces pain (pain gate theory)
Reduces muscle spasm
Reduces the risk of cell death (also called necrosis) by decreasing the rate of metabolism
Ice is usually applied to the injured site by means of a bag filled with crushed ice which is wrapped in a damp towel. The damp towel is essential as it forms a barrier between the bag of ice and the skin and reduces the risk of an “ice burn”. DO NOT leave the ice on for more than 15 minutes as you could cause an “ice burn”.
There are a small number of areas that you should not apply ice to which include the neck, the outside bone of the elbow, the collarbone (upper end), the front of the hip (bony part) and the outer bone of the knee. The reason for this is there is a superficial nerve just below the skin in these areas that can be damaged by applying ice to it. Always check for contraindications.
Applying compression to an injured area minimises the amount of swelling that forms after an injury in two ways and should be applied for the first 24 to 72 hours from the onset of injury. Compression can be applied through a number of methods. The most effective of these is by using a compression bandage which is an elasticated bandage that simply fits around the affected limb.
Elevation of the injured limb is the final principle of PRICE but is equally as important as the other 4. Elevation allows gravity to drain the fluid away from the injured site. This aids in decreasing the swelling which in turn may decrease the pain associated with the oedema (swelling).
Read more on PRICE principles
Cycling Injury Prevention
Many cycling injuries can be prevented, as the vast majority of acute injuries are due to a fall from the bike. Others such as the overuse injuries listed above are often due to incorrect bike set-up, improper training techniques or postural issues.
Warming up is often overlooked but should be part of your injury prevention routine. A good warm will:
- Increase the temperature of muscles - they work better at a temperature of 40 degrees.
- Increase blood flow and oxygen to muscles.
- Increase the speed of nerve impulses - making you faster.
- Increase range of motion at joints reducing the risk of tearing muscles and ligaments
Warm up will not only help avoid injury but will also improve performance.
A warm-up should consist of:
- A gentle pulse raiser for 5-10 minutes to circulate blood and oxygen supplying the muscles with more energy to work with. Ideally, this should be performed off the bike in the form of a jog or skipping for example.
- Stretching to increase the range of motion at joints. Emphasis should be placed on stretching the muscles of the legs and lower back, although do not neglect the upper body completely!
This is also often overlooked in favor of sitting down and resting! However, it can help avoid injuries and boost performance. The aim of the cooldown is to:
- Gradually lower heart rate.
- Circulate blood and oxygen to muscles, restoring them to the condition they were in before exercise.
- Remove waste products such as lactic acid.
- Reduce the risk of muscle soreness.
The cooldown should consist of a period of very easily cycling a the end of the work-out, lasting 5-10 minutes, followed by light stretching.
Protective equipment can literally save a cyclists life, especially for road cyclists. The most important of all cycling equipment is, of course, the Helmut. The Helmut should meet with certain safety standards and must be fitted to properly fit the individual. Helmut's should be replaced in the event of an impact, or within 3 years of purchase due to deterioration of the expanded polystyrene foam that many are made from.
Other protective gear such as gloves, knee and elbow pads can be worn, and are particularly advisable for those involved in cycling such as BMX.
Getting a regular sports massage can flush the muscles of waste products and release tight knots, lumps, and bumps in muscles that if left may cause strains and tears. It is possible for a good sports massage therapist to identify potential trouble spots long before they become injuries.
Nutrition, Hydration & Injury
Proper nutrition is important. A bad diet will prevent you from recovering from training sessions making you more prone to injury. A balanced diet is what you should aim for:
- Carbohydrate is important for refueling muscles.
- Protein rebuilds muscles.
- If you become dehydrated then less blood will flow through muscles. The muscles will be more prone to injury.
- Vitamins and minerals are required for a number of reasons related to recovery.
Much of what is discussed above should be part of your sporting routine. A biomechanical analysis can help identify possible injury risks. Assessment from a sports therapist or specialist can identify weak areas and possible injury risks. A course of exercises specific to your needs can give you the best chance of avoiding injury.
TrainingNot allowing your body to recover properly from training will eventually result in injury. Your body needs time to rebuild itself stronger before the next training session. Remember - you are not training when you are training, you are training when you recover! Sleep is also an important part of your training. If you are not getting enough, get it sorted</