The majority of cycling injuries are caused by repetitive loading of the tissues which is influenced by a combination of poor biomechanics, increased training load, muscle imbalance, joint instability and muscle weakness.
A typical cycling injury is pain to the outside of the knee. This is due to repetitive friction of the illiotibial band at the outside of the knee. The iliotibial band is a tight fascia which runs from the pelvis down the outside of the upper leg to the knee. If a cyclist has weak trunk and gluteal muscles their knees will tend to move closer to the frame when they begin to fatigue. This change in posture causes repetitive friction between the illiotibial band and a bony prominence on the outside of the knee, causing the tissue to become irritated and painful.
When cycling your biomechanics are affected by your bike setup, as well as your flexibility, strength and technique. With abnormal biomechanics, excessive stresses are put on certain parts of the body leading to a break down of certain tissues, inflammation and then pain. When addressing the underlying causes of a cycling injury your physiotherapist will help you ascertain whether the cause of your problem is you, the bike or both.
Cyclists commonly report injuries after a change in their training load. This may be a result of increased weekly mileage or an introduction of intervals or hill sessions. In this situation the injury has occurred because the tissues are not resilient enough to cope with the increased training load.
Knee pain in cyclists occurs most commonly at the patellofemoral joint (between the knee cap and the knee). A lot of stress is placed on the patellofemoral joint during cycling and as a very mobile joint it is susceptible to the effects of poor biomechanics. As a result, this form of knee pain can be caused by cleat position, saddle height, reach distance, tightness in the hips, quadriceps or hamstring muscles or weakness in the pelvis and trunk (core muscles).
Your physiotherapist will be able to provide manual therapy to help reduce pain and may tape the knee cap to enable increased pain free activity and a return to training. Your treatment program also may include an exercise program to address the biomechanical causes of the problem and you may need to have a biomechanical bike fit assessment.
Back pain in cycling is multifactoral. It can be apparent in both your lower (Lumbar spine) and upper back (thoracic spine). It is a result of deficits in your joint range of movement, muscle weakness, joint instability, poor position on your bike and an inability to cope with a sustained period of time in the cycling position. With prolonged and repetitive bending forwards at the spine when cycling it causes the back of the spine to become weak, predisposing it to lumbar disc injuries. The upper back (thoracic spine) can become extremely stiff and painful with cycling because of poor positioning on the bike (handle bars too low, reach length too great) and poor trunk stability. This can predispose the cyclist to thoracic spine dysfunction which may also cause problems with the neck.
After a thorough assessment, your physiotherapist will be able to provide manual therapy to help reduced pain, and then provide an exercise programme to restore your joint range of movement and improve your core stability. This will improve the body's ability to cope with being in the static cycling position. They will then be able to address any biomechanical causes of the problem such as tight hamstrings or stiff hips which will reduce the stresses on your lower back. In addition the physiotherapist can assist in altering your bike setup to enable an optimal position on the bike.
If you would like to discuss your problem before booking an appointment please give our physiotherapy team a call, we will do our best to help.