One of the most interesting aspects of my occupation is injury prevention. I have always believed that identification of the underlying cause of injury to be one of the most important factors in an effective rehabilitation. Often what may appear to be a simple rolled ankle or other common injury may have been caused by muscle imbalances, a slight dysfunction in running stride or incorrect support from footwear to name but a few.
Being a keen cyclist I have a special interest in cycling injuries. However, the repetitive nature of any sport such as cycling, running or even golf can highlight weakness or bring a niggling injury to the surface. For example, in cycling a simple but often poorly understood area is saddle height. There are many theories and many people have studied the area at length (including myself during my first degree) however I still believe that there is no standard method.
An example of saddle height being too low can increase pressure through the knee joint itself. Having the saddle too low may also reduce the recruitment and availability of muscle fibres as there is an optimal length at which muscles contract. The body is able to adapt surprisingly well to most situations. However it is finding the balance and allowing the body to function efficiently and economically. Often the most economical (least oxygen consumed) is not the most efficient position for power output. This can be a juggling act for not just the competitive cyclist but also the weekend warrior trying to beat his friend in the sprint down beach road. Therefore a cyclist may adopt an uncomfortable position because they feel they can ride faster in that position. It is important that this position does not cause undue stress on the body, which may cause the rider to fatigue earlier.
Common injuries from cycling
1) Anterior Knee
a) Patellar tendonitis
Inflammation of the patella tendon originating from the tibia, usually due to overuse. With repeated irritation thus inflammation scarring and tearing can occur. Pain is usually centred on the lower tip (inferior pole) where it connects to the tendon. If the tendonitis is severe you may get localised swelling – Bump or lump just below your knee. Pain is felt in the front of the knee below the patella, when you pedal or walk upstairs, but it will probably be worse descending the stairs. It will also hurt when you palpate or press on the tendon itself.
b) Patellafemoral syndrome / Chondromalacia patella:
Chondromalacia is irritation of the cartlidge behind the knee. Pain is often felt in the front of the knee when the knee joint is bent or flexed. It can often be caused by mal-tracking patella, poor foot mechanics or musculature problems. It is more common in women due to their wider pelvis.
Generally caused by pushing big gears- cadence to low, Saddle too low or too far forward, Foot to far forward on pedal, Crank arms too long
2) Hamstrings / Gastroc (muscles at the back of the knee)
Leading to excessive tension and tightness in the muscles and is caused by Saddle being to high or too far back, Too much pedal float, Leg length discrepancy.
3) Inside of the knee (Medial collateral ligaments or medial meniscus)
Leading to repetitive strain to cartilage and ligaments. Caused by the Cleat position to wide so the foot is held externally rotated, Excessive knee frontal plane motion, Too little pedal float
4) outside of the knee (Iliotibial band, Lateral collateral ligaments, Lateral meniscus)
Leading to the common ITB syndrome and is caused by Cleat position to narrow- foot is held inwards, Too little pedal float.
For the most effective rehabilitation there should be a clear understanding by both health practitioner and patient as to how both can help each other. As an Osteopath I may see someone once a week during rehabilitation, however, this is only a short period of time and it’s crucial for the patient to take responsibility for his or her rehabilitation and work in tandem.
Every person is different and will have a different optimum. By working together with a health professional who is able to objectively assess not only position but also the patients musculoskeletal system there is a greater chance for an effective and healthy position on the bicycle. I have written here about cycling but these principles can extend to any person in any situation. Even someone who sits at the computer all day, when was the last time you used your left hand to navigate your mouse? Repetitive movements can be hazardous to your health but simple measures can greatly reduce the risk of injury.
I look forward to helping you with your injury rehabilitation and most importantly prevention in the future.
Article Source: by Dr Drew Blatchford
