ExpertSpeak

Cycling Orthopedic

Dr hirag Thonse

Dr Chirag Thonse

Dr. Chirag Thonse (MBBS, M.S (Ortho), F.SICOT (Germany), Fellow Arthroscopy Sports Med) is a Consultant Orthopedic & Arthroscopy Surgeon and he specializes in sports injury surgeries, Arthroscopy (key hole) surgeries and ligament reconstructions. CRANK caught up with him to discuss some of the most common injuries a cyclists may face due to overuse or bad posture or accident and their prevention and cure.

Cyclists may encounter various injuries of the foot, ankle, hip, knee, shoulder and back. Most of them are overuse injuries, which are developed over a period of time due to repetitive strain. Acute injuries are usually due to fall or sudden unconditioned activity, which could result in either a fracture of bone, dislocation of a joint or rupture of tendon.

Common Injuries are 

• Patellofemoral pain (anterior knee pain) – a dull aching pain in the front of the knee, which aggravates on exertion of the knee. There could be tenderness around the kneecap and occasional swelling which usually subsides on rest. There could be a clicking or cracking sound which could be noticed at times during knee bending and in case the pain is persisting for a long duration, one could notice a visible wasting of quadriceps muscle

The initial cause of the patellofemoral pain syndrome could be overuse like a sudden increase in the duration and speed of cycling or excess uphill cycling. Immediate treatment for the pain would be rest, local icing, anti-inflammatory medicines and activity modification. Patella taping may be required in severe conditions.  A mal-tracking of the patella (knee cap) is an important preexisting cause for the pain hence it should be recognized and treated accordingly

• Iliotibial band syndrome – is inflammation of the iliotibial band (a long tendon of the Tensor fascia latae muscle which runs down the outside of the thigh to the knee). Symptoms could be pain in the outer aspect of the knee, thigh or hip, which aggravates on exertion and usually subsides on rest. This pain could be triggered by knee bending, downhill cycling. Persons with a tight iliotibial band or weak hip muscles (gluteus medius) are more susceptible to this injury. The initial treatment of this syndrome would aim at reducing pain and inflammation, once the inflammation has subsided ITB stretches and strengthening of the hip muscles is suggested

• Tendo Achilles tendinitis – inflammation of the tendoachilles tendon usually caused by overuse, poor bike fit or improper footwear. Stretching of calf muscles before cycling would help in preventing this injury, also lowering the bicycle seat would allow adequate dorsiflexion of the foot and relax the tendoachilles tendon

• Hamstring tendon and calf (muscle) strain- tightness of the calf muscle and hamstring tendon makes it prone for injury, hence it is advisable to stretch the calf and hamstrings before cycling a foam roller would be a helpful device

• Neck and back pain–cyclists riding for too long often suffer from neck and upper back pain, this could be due to the posture or because of muscle fatigue. A low handlebar may strain the shoulders and upper back. Neck extension exercises, shoulder shrugs and core muscle strengthening would prevent such injuries

A fall from the bicycle would result in acute injuries like a wrist or clavicle (collar bone) fracture, rotator cuff tear or dislocation of shoulder, AC joint injuries, head injury  such injuries warrant an  immediate evaluation by a doctor further management.

Pre cycling muscle stretches, proper strength and conditioning training, hydration, nutrition and adequate rest to the body are the key to injury prevention in a cyclist.

In conclusion head injuries due to fall may be the most morbid injury one could encounter, which could result in substantial disability, hence wearing a helmet during cycling is a must.

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