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Cycling Injuries. ATAF Spring Conference - 2013 Stephen A. Black, DSc, M.Ed., PT, ATC/L, NSCA-CPT RockyMountain Human Performance, Inc. Florida Gulf Coast University. Statistical Overview. Recent Statistics (2012) – total reported ~19,000+ Killed – 107
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Cycling Injuries ATAF Spring Conference - 2013 Stephen A. Black, DSc, M.Ed., PT, ATC/L, NSCA-CPT RockyMountain Human Performance, Inc. Florida Gulf Coast University
Statistical Overview • Recent Statistics (2012) – total reported ~19,000+ • Killed – 107 • Seriously injured – 3,085 (hospital admission) • Slightly injured – 16,023 (non-hospital admission • 25% of total were children • 25% of those killed had significant head trauma NHTSA - 2012
Statistics Cont. • Orthopaedic Overview • Back / Neck Px • Knee Px • Patellar / quad tendon tendonitis / tendonopathy • ITB • Hip • Medial Tibial Stress Syndrome • Foot pain / numbness • Pelvic Girdle Pain (PGP) Syndrome • others
Cycling vs. Running What do you call an injured runner? A cyclist! • Non-impact • Fewer stress fractures • Eccentric muscle action not as important • Fewer muscle strains / tears • Hours spent in saddle • Less overuse problems than running? • Overtraining or staleness is more common Why
http://www.youtube.com/watch?v=mYPDAry-A-s&feature=player_embeddedhttp://www.youtube.com/watch?v=mYPDAry-A-s&feature=player_embedded Cycling Injuries
Micro-Trauma OVERUSE INJURIES
Contact Overuse Saddle Sore Neuropathy Neuroma
Neuroma • Impingement of nerves • Chronic inflammatory mass • Burning pain • See riders shaking foot out of pedals • Between 3rd and 4th metatarsal classically
Neuroma On the Bike Treatment • Adjust cleat position, usually further back • Check inside shoe for cleat bolts • Change shoes to wider toe box • Shoe inserts may help
NeuromaMedical Treatment • Biomechanics • STM / IASTM • Nerve Glide • Functional Ex • Guided Injection • NSAID • Surgery
Saddle Sores • Moisture + Pressure + Friction • Chafing • Ulceration • Folliculitis • Abscess • Subcutaneous nodules
Saddle Sores On the Bike Treatment • Change saddle • Check saddle height and tilt • Clean chamois, no seams, keep dry • Don’t sit around in your kit after riding • Emollients
Saddle SoresMedical Treatment • Prevention • Keep dry, clean, chamois, avoid shaving high • Medical Treatment • Warm soaks • Topical cortisone, anti-fungal, anti-bacterial • Oral antibiotics • Surgical incision and drainage
Hand Neuropathy • Cyclist’s Palsy (Ulnar Neuropathy) • Carpal Tunnel Syndrome • Worse after long rides • Worse on rough terrain • May become permanent
Hand NeuropathyOn the Bike Treatment • Relieve pressure • Pad bars • New gloves (Specialized) • Reposition often • Bars • too far forward • Too low • Too much tilt
Hand NeuropathyMedical Treatment • STM / IASTM • Kinesiotape • Nerve Glide • Guided Injection • NSAIDs • Night splint • Strengthen upper extremity • Surgery
Bursitis Greater Troch Pre-patella and MCL bursa Ischial Tuberosity
Ischial Tuberosity Bursitis • ‘Sits Bones’ sore • Cold weather, early season, time trialing • Modalities – relative rest • On the Bike: • Change saddle • Check saddle height and tilt • New chamois
Greater Trochanteric Bursitis • Proximal ITB Syndrome • Pain with lying on side at night • Manual Modalities • Foam Roller / Stick • Kinesiotape • Guided Injection • On the bike: • Check saddle height • Check cycling form
More Common Issues Patella Femoral ITB Patella Tendon
Patella Femoral Pain Syndrome • Pain under the patella from excessive load • Hill climb • Wind • Big gear • Time trialing • Resistance training
Patella Femoral Pain Syndrome • Tender patella facets • Tender patella compression • Unable to do one legged squat • No effusion
Patella Femoral Pain SyndromeTreatment • Off the Bike • Soft Tissue Techniques • Modalities • SFMA / FMS • Surgery i.e. removal of medial plica • On the Bike • Bike Fit • Check if saddle is too low or forward • Check if cranks are too long • Cadence / Gear Ratio
Knee Pain and Adjustment Location Cause Solution Anterior Saddle too low Raise saddle Saddle too far forward Move saddle back Cranks too long Shorten cranks Posterior Saddle too high Lower saddle Saddle too far back Move forward Medial Toes point out Point in Feet too far apart Move closer Tight pedal tension Lower tension Lateral Toes point in Point out Feet too close Move apart Arnie Baker 1998 Bicycle Medicine
Training Stimulus Performance Training Volume/Intensity
Overtraining • Cyclists are notorious • Clinical history is most important • Many blood tests, not very helpful • Exclude organic disease • Profile of Mood States • Performance Testing Decrement • VO2, Lactate, HR, Watts, EPOC, RPE relationship
Laws of Training • The race is won in the off season • Train frequently, all year round • Start gradually and gently • Build a big base • Go hard on the hard days, easy on the easy days • Do not overtrain • Avoid monotony • Train with others • Keep a logbook • Take a break at the end of a season, stay active Adapted from Tim Noakes in the Lore of Running