Health is important in our lives. As with all competitive sports, there is also a risk for injury in competitive bicycling. The patterns of injury in bicycling are unique since exposure includes high speed, obstacles like cyclists, pedestrian and motor vehicles, and unpredictable road, environment and weather condition. As a result, we should know more about cycling health, including epidemiology of cycling injury, managing common cycling injuries, cycling fatigue and overtraining, and cycling recover interventions.
Epidemiology of cycling injuries
Bicyclists often avoid many external troubles and injuries with wearing a helmet. There is a risk of both acute traumatic injuries and overuse injuries. And it is important to understand the pattern and epidemiology of injuries suffered by competitive bicyclists in order to implement appropriate injury prevention and treatment strategies.
The usual outcome measures that injury studies try to quantify include the incidence, rate, location, severity and type of traumatic and overuse injuries. The findings of bicycling injury studies to date can be difficult to compare because definitions of injury, calculations of injury incidence and rates, and descriptors of location, severity and type of injury are not consistent.
Studies vary in how specific body locations were described and/or grouped, with some studies grouping location of injury as upper or lower extremities or just extremities. The majority of bicycling injuries occur in the knees and the low back, accounting for 26 to 64% and 15 to 60%, respectively, of all traumatic and overuse injuries.
This finding is perhaps not surprising, given the body positioning and how biomechanical forces are exerted through the lower extremity in bicycling. Researchers have found that knee and back injuries together caused 73.9% of overuse injuries resulting in time loss from training and competition.
More recently, using a novel study design to monitor over-use injuries, the prevalence of knee, lower back, shoulder, and anterior thigh overuse problems was 23, 16, 7, and 8 percent of semi-professional and junior level competitive bicyclists. Chondromalacia patella, patellar tendinitis, quadriceps tendinitis, and ilio-tibial band syndrome are the most common knee injury diagnoses in competitive cyclists.
In competitive road bicycling, fracture and dislocations of the upper extremity are the most common type of traumatic injury followed by contusions, abrasions, hematomas and lacerations. The most common site of fractures and abradions has been reported to be of the clavicle and the hip/elbow, respectively.
External iliac artery end fibrosis (EIAE) is a condition that is somewhat unique to bicycling although it is also reported in other endurance athletes. During a bicycle race it can be very difficult to properly assess a cyclist for a concussion injury since the determination of whether a bicyclist can continue riding must be made quickly and under sub-optimal conditions. Nonetheless, much better adherence to the current recommendations for assessment and management of concussion, such as the most recent Consensus Statement on Concussion in Sport, has been strongly recommended.
The majority of traumatic injuries are caused by falls. It suggested that at high speeds, cyclists generally position their shoulder forward and then try to roll while falling, which probably explains the high incidence of clavicle fractures experienced by competitive bicyclists. Some reports said that most common causes of bicycle accidents were flat tire and collision with other bicyclists. Data results found that mechanical failures caused two injuries while other injuries were caused by falls within the peloton or fast downhill riding. In off-road bicycling races, falls over the handle bars and falls during down-hill descents lead to more serious injuries.
The cause of over-use injuries are multi-factorial, with risk factors possibly including age, gender, equipment set-up (namely, bike and riding shoes), years racing experience, dryland training, and training volume and intensity. Risk factors for overuse injury in competitive cycling have not been well studied but scientists reported that in recreational cyclists, the risk factors for male back, groin and buttock injuries were high weekly riding mileage, lower number of bike gears, and less years of cycling. The risk factors for female groin and buttock injuries were more non-competitive events/year and less pre-cycling stretching.
In summary, the knee and low back are the most frequently injury body locations and usually over-use type injuries. Falls cause the most upper extremity fractures and dislocations.
Managing common cycling injuries
Here, I am going to take you through some of the most common cycling injuries, how they come about, and what you can do to treat and avoid them.
Let's start from the ground up. Most road cyclists 'clip in' to their bike, fastening their feet to the pedals via cleats that sit on the bottom of their shoes. The problem here is that if your cleats are not properly positioned at the correct angle, you will end up with shooting pains in your knees that will simply continue to grow until corrected. The easy fix is to correctly set up those cleats. There are a lot of guides online to show you how to do this. A happy side effect of well-aligned cleats is that they will help you to generate more power with each pedal stroke.
As for the bum, saddle sore is the main thing to watch out for. It's caused by friction between your skin, clothing and the saddle, and can result in sore buttocks and/or a pretty nasty rash. Decent padded shorts can make a massive difference (cheaper ones less so). Just to be clear: cyclists go commando, so no boxer shorts under your cycling gear.
And finally, the hands. By holding the handlebar in the same position for a long period of time, gripping it too tightly, or leaning too far over the front wheel, you run the risk of compressing the ulnar nerve, which runs all the way from the little finger up through the elbow and into the upper arm. It's the largest unprotected nerve in the body, so it's easy to damage.
There are manly technical ways to resolve problems with the ulnar nerve, but honestly the simplest preventive measure is to make sure that you move your hands around the handlebar a bit. Try not to get stuck in one position on long rides. Road bikes are specifically designed to allow riders to grip the handlebars in different places - on the sides, above, or down below on the drops - so just make sure to alter your position as you ride. If you start to feel pins and needles or discomfort in your hands and fingers while riding, that's your body telling you that you're not shifting position frequently enough.
Amateurs probably aren't lucky enough to be able to call upon a team masseuse, however. A DIY trick to keeping your quads in shape is to use kinesiology tape (applied before starting), which can promote muscle endurance and aid recovery. Another good idea is to alternate between pedaling in and out of the saddle. This will spread the load among other muscles and avoid overloading the quads.
Muscle tightness. You’d better have quite tight hamstrings and calves. The tightness doesn't always manifest itself when you're on the bike because the body adapts to the rhythm of the pedal stroke, but try a non-cycling movement pattern like running and you soon notice that your legs aren't right. The problem also gets exacerbated by cycling longer distances than you're used to, when tightness in a calf or hamstring can lead to muscular tearing. Not a fun experience.
The simple answer is to make sure that you warm up before exercise and cool down afterwards. Stretch your calves out so the muscle fibres retain their elasticity. A foam roller used at the end of a ride can also do a huge dollop of help: it's painful, but using them to smooth out your muscles will reduce any lasting tightness.
Back and neck pains. 21st Century Man is a sedentary creature who spends long periods of time sitting down, often at computers. As a result, our posture is far from good, and many of us have pains in our back that niggle away. Cycling can bring these to the fore - especially among those who own aerodynamic road bikes that see them pitched forwards in the saddle.
Ideally, cyclists ride with their back muscles in neutral, but this often isn't possible when the bike you're riding isn't set up to your exact size. The best answer is to get a professional bike fit done. It will set you back £100 or so, but you'd be amazed how much difference small tweaks can make. Once you've found that perfect riding position, those aches and pains in your back disappear pretty quickly.
Another option is to use kinesiology tape on the lower back area. It will help stimulate the skin in the area, promoting muscle function and decreasing pain.
One last thing, gashes may not be that common among sensible amateur cyclists, but if you want to avoid injury there's one bit of advice that should never be ignored: always wear a helmet!
Cycling fatigue and overtraining
The symptoms of the overtraining syndrome are difficult to define since there can be many and they are seldom exactly the same in any two overtrained athletes. Physiologically, the only ones that are common are poor performance and fatigue. But since these can occur even when an athlete is not overtrained, overtraining remains a bit of mystery in sports science.
Fatigue may be the better indicator. Every athlete experiences fatigue since physical stress is necessary to produce improved fitness. This is referred to as overreaching and is a necessary part of any training program. When an athlete ignores the fatigue of overreaching and continues to train with high stress and without rest or recovery then the possibility of overtraining greatly increases. For younger athletes this has been shown to require several weeks of such dedicated and exhaustive training. Older athletes and those who are relatively new to the sport may produce overtraining in fewer than three weeks.
While overreaching, an athlete can shed the fatigue by resting or training very easily for a few days. After that he or she can return to high stress training. But once the overtraining syndrome has occurred the fatigue will not go away easily. The athlete can become listless, grumpy, and unmotivated. These psychological symptoms are usually best identified by a spouse and close friends. The overtrained athlete may continue in this state for weeks or months. The relentless fatigue is with them as a constant companion.
The symptoms are much like chronic fatigue syndrome, Lyme disease or mononucleosis. In fact, an athlete who experiences such deep and lingering fatigue should see a physician to be tested for these and other similar medical conditions. The best way to avoid overtraining is to monitor fatigue and test frequently.
Excessive training, which is common among serious athletes, has the potential to produce overtraining. Frequent recovery for a few days is necessary to prevent it. How often and how long the recovery period should last is an individual matter which can only be determined through trial and error. If unsure of how often and much you should rest I would recommend erring on the side of too much rather than too little. I'd rather see an athlete undertrained but motivated than highly trained but unenthusiastic about life in general and competition in particular.
Also, know that a single bad day does not mean you’re over-trained. In fact, cycling coach Matt McNamara, of Sunnyvale, California, says it’s actually pretty hard to end up over-trained if you’re riding less than 15 hours a week. Still, it’s possible—especially if you’re going out and hammering every single day. “Most athletes, when left to their own devices, ride too hard,” says McNamara.
Avoid at all costs the “I only have 90 minutes to ride, so I better go all out” trap. That workout, when done over and over again, will only leave you exhausted and mentally bored, McNamara says. To make things interestin1g, add in intervals of different lengths and intensities. “I try really hard to keep things varied for my athletes,” he says, adding that he also allows athletes to make tweaks to any workout if they’re just not feeling it. “I tell my athletes that if they just don’t feel they can do the workout, to err on the side of caution,” rather than pushing through it.
Which is probably for the best? If you’ve truly reached the point of fatigue and overtraining, it can take a surprisingly long time to work your way out of it. Traditional wisdom is that you’ll need at least as many weeks of rest as you’ve spent with those bad symptoms, but that has not been shown in research and because we’re such a diverse species, it’s very difficult to say this will work the same for everyone.
The more know about cycling health, the more you enjoy riding. Health is a big treasure, and with the right guides, cyclists can ride faster, go further. Good luck!