by
Nina Patterson, PT
Don’t give up yet.
Common injuries I have recently treated in cyclists include neck pain, low back pain, hamstring strains, and calf or Achilles tendon strains. Each injury has been a result of over stressing one area and under-use of another, combined with specific areas of weakness. These imbalances are amplified with an increase in miles, climbing, or speed. In each case, the injury has been a result of cumulative trauma. Repetitive motion tends to tighten muscles. A tight muscle that remains tight tends to weaken. A weak muscle tends to tighten, and the cumulative trauma cycle continues. Tight and weak muscles are also vulnerable to internal frictions, pressures, or tensions that may cause an acute inflammation even without a specific injury. This leads us to “I didn’t do anything, it just started to hurt” phase. Inflammation cues the body to repair itself, which can result in the formation of fibrosis or scar tissue between tissues. Over time, fibrotic tissue is no longer capable of the same blood flow or circulation and the downward cycle is perpetuated.
NECK PAIN
The road cyclist’s seated position is with the low and mid-back flexed forward with arms reaching forward to grasp the handlebars. The neck is extended and the head is then raised to allow the cyclist to see out from under the helmet and down the road. As a result, a hinge is created between the upper back and the lower neck. This “hinge” is over-stressed while the upper and mid-back remain stiff and weak. Cyclists often have a posture even off the bike with slightly rounded shoulders, flexed upper back and forward head.
Treatment of this type of problem consists of loosening (using A.R.T. and spinal mobilization) and strengthening the spine and muscles of the mid-back and shoulder blades. Postural corrections on and off the bike are also suggested.
LOW BACK PAIN
Chronic low back pain in cyclists is often aggravated with pushing a big gear or with lots of climbing. More often than not, these folks have tight and weak gluteals, hamstrings, and hip flexors (psoas) and poor core stability.
Ideally, the low back (lumbar spine) is supported by the deep abdominal muscles (transverse abdominus) and deep back muscles (multifidi) in a fairly static or still position as the legs move steadily around, providing power to the pedals. The power muscles for time trials and long hill climbs are the quadriceps to extend the knee and the gluteals and hamstrings to extend the hip. If the power muscles are tight and weak and the lumbar or core stabilizers insufficient, extra movement either flexion-extension, side bending or shearing can occur in the lumbar spine. This extra friction, pressure, or tension on the lumbar structures can cause pain, inflammation, and eventually cumulative trauma.
Treatment includes A.R.T. to the lumbar spine, hip, hamstrings to regain normal movement and an extensive dynamic stabilization strength program to eliminate unwanted motion in the lumbar spine.
HAMSTRING STRAINS
Cyclists are proud of their well-defined quadriceps and ability to squat or leg press Volkswagen Bugs, yet the same pride and attention does not seem to fall on the hamstrings. Cyclists have come to me with complaints of hamstring pain just below the gluteal fold (just below the buttocks). Symptoms are worse, generally, with climbing and aggressive stretching to the hamstrings. The much-used, and admired quadriceps and hip flexors can become quite tight on cyclists, limiting not only the motion but also the muscle firing of the hip extensors. Strength tests often result in the hamstrings and the hip muscles as being 50-60% of sufficient strength.
The hamstrings may be the area of pain, yet the entire core and lower extremity must be treated to regain full mobility and functional strength. With hamstring strains or tears, it is imperative that the athlete not returns too soon to the hard efforts.
CALF / ACHILLES TENDON STRAINS
I group the calf and Achilles tendon strains together as one often leads to the other. The “calf” is made up of the gastrocnemius and the soleus, which combine and attach to the heel via the Achilles tendon. Abnormal tightness or friction on the gastroc-soleus or Achilles can all lead to Achilles strains or tendonitis. Deep to these structures lies the tibialis posterior, otherwise known as “the muscle that gives us an arch in our foot”. As it turns out, the latter is extremely important in walking and running but not seem as much of a problem in cycling. The soleus is extremely important in providing power while climbing and accelerating in a standing position._ The gastrocnemius assists the hamstring to bend the knee. Thus if the hamstrings are weak, the gastroc can be overstressed and sustain injury.
Treatment of these conditions includes A.R.T. to the muscles of the hip, thigh, and lower leg to restore normal range of motion, and specific strength exercises for the hip and hamstrings to relieve the stress from the calf muscles.
Keep the rubber side down…
Nina Patterson has been a cyclist for 25 years and has raced in California and Oregon.
REFERENCES
*Active Release Techniques® is a federally protected Trademark. Members of the Active Release Techniques College of Providers are the only ones permitted to use the term “Active Release Techniques treatment.”
_ Krause M. Kinematic comparative analysis of pedaling in seated versus standing cycling. http://www.acay.com.au/~mkrause/Cyclingkinematics.htm