Monday Medical: Don’t let pain end your cycling season early
August 16, 2015
While many in Steamboat are currently experiencing short-term cycling fever, others have been fully immersed in the sport since a warm spring enticed them off the slopes and onto the roads back in March.
For these avid cyclists, late summer can be associated with a plateau, where injuries and pain make the thought of logging more miles much less appealing than earlier in the year.
Steamboat Springs orthopaedic surgeon Alex Meininger is a self-described, fanatical road and mountain biker who competes in the pro division of the Steamboat Town Challenge and records more than 20 hours a week in the saddle. He is all too familiar with seeing pain and injuries associated with cycling.
"There is evidence suggesting there are problems when we stay focused on one activity for a long period of time,” Meininger said. “Since spring, a lot of people have just been plowing ahead putting hours on the bike, and it's not surprising they end up with pain."
Pain for cyclists often comes from three categories — over use, improper fit (ergonomics) and acute injuries (usually from falling).
Meininger explained that overuse injuries usually involve the lower extremities but are also associated with neck pain, back pain and finger numbness. In many cases, the pain arises from unconditioned supporting muscles.
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"We work our quads and hamstrings because everybody thinks the pedal stroke is so important, but it's often the supportive muscles that we don't have good use of," Meininger said. "If those fatigue early, it can contribute to poor form on a micro level."
One important supporting muscle group is the abductors, which function to spread the legs, help the hips with rotation and provide balance to the pelvis. When the abductors fatigue, knee and hip pain often sets in with overuse.
The core muscles are also important, as they serve to keep the upper body erect. With poor core strength, riders often place too much pressure on their hands, leading to hand and finger numbness. A fatigued core also forces the neck and back to carry more of the load in maintaining proper body position, which leads to pain.
Muscle fatigue is only worsened by poor bike fit.
"If you have some sort of poor fit, including your pedal cleat being in the wrong place, or your seat height is improper, it exacerbates problems, because you're asking the body to do something out of its perfect mechanics," Meininger said.
Meininger said it's not uncommon to see a seat too far back, which causes the foot to be in front of the knee through the pedal stroke. This, in turn, puts too much pressure on the kneecap or patellar tendon and can lead to pain.
For cyclists who push the limits, acute injuries from falling can also end a season pretty quickly. Yet Meininger warned it's not uncommon to see injuries from a simple spin on the Core Trail.
Wrist, elbow, shoulder and collarbone injuries are the most common from falling on an outstretched arm, however hip injuries are also seen with falling.
"The preventable part is usually in the decision-making, where people are over their ability level, at too high of speeds," Meininger said. "The scary part is just the speed and force relationship. We can see injuries comparable to those from a car accident."
Treatment for cycling pain and injuries can be as simple as resting, icing and stretching. Other treatment may include massage, topical creams and gels, anti-inflammatory medication or corticosteroid injections. Surgical options are also considered for injuries that do not heal, as well as acute issues involving falls.
Adjusting training regimens and proper physical therapy can train the supporting muscles for longer hours on the bike. Education about bike fit is important, and most riders will benefit from getting their bikes professionally fitted.
Meininger also emphasized the importance of adding variety to your cycling routine.
"Mix up the training regimen to get the muscles going in a different fashion. Adding new exercises to a gym routine or even something new like CrossFit with help," Meininger said. "Switching bike rides, so maybe going from long rides to intervals, or high intensity rides to change things up physically, is important."
Nick Esares is a marketing and communications specialist for Yampa Valley Medical Center