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Common Overuse Injuries - Pt 2

01 July 2010

The following article is the second in a two part series highlighting the most common chronic or overuse injuries associated with mountain biking. As in the prior article it provides a brief overview of the injury, and the prevention and management thereof.

Recent research lists the most common anatomical sites for overuse injuries associated with cycling as; neck (48.8%), knee (41.7 %), buttock (36.1%), hands (31.1%) and lower back (30.3%).

When managing chronic injuries it is always vital to precisely identify the anatomical structure at fault and also to identify any risk factors that predispose one to the injury. Risk factors will be intrinsic (cyclist- any postural problems, muscle imbalances etc.) and extrinsic (bicycle set up/ bicycle frame and environment factors). Treatment is therefore always two fold; reducing the symptoms (physiotherapy, medication etc.) and addressing the underlying causes for the injury (bike set up, correcting the cyclists muscle imbalances, correct training errors etc).

KNEE PAIN

Knee pain can be anterior (front of the knee), lateral (at the outside of the knee), or medial (at the inside area of the knee).  In this article anterior knee pain will be discussed as it is the most common, we will discuss other types of knee pain, including ITB syndrome in future articles.
Anterior knee pain is commonly referred to as Patellofemoral pain syndrome and causes symptoms under and around the knee cap (patella). The repetitive flexion (bending) and extension (straightening) of the knee during cycling places strain on the knee joint and on the structures surrounding the patella.

Predisposing factors:

• Incorrect training (rapid increase in training volume, incorrect use of bicycle gearing, and excessive hill training)
• Incorrect pedal or foot interface (cycling shoes /cleats)
• Incorrect bike set up (incorrect frame size, poor saddle height, saddle too far forward)
• Muscle imbalances (weak quadriceps, pedaling asymmetry, poor hip and knee stabilisation during riding)
• Anatomical abnormalities in the cyclist (small knee cap, knock knees)
• Abnormal linear pattern of movement during downstroke of cycling (this can be corrected by altering cleats or saddle position)

Management

• Pain relief through physiotherapy techniques and or medication
• Correct training errors
• Correct bicycle set up

BUTTOCK PAIN

Sustained time in the saddle can cause muscle spasm within the gluteal or buttock muscles.  Commonly known as Piriformis syndrome the pain is described as a deep ache and may radiate down the outside of the lower leg into the calf and sometimes down to the ankle.

Predisposing factors:

• Sustained long periods on a hard saddle
• Pedalling asymmetry as a result of muscle imbalances
• Poor bicycle set up

Management:

• Localised physiotherapy treatment; trigger point release and massage
• Stretching of the gluteal muscles
• Correct bicycle set up
• Strengthening to correct muscle imbalances to ensure symmetrical pedalling

NUMBNESS AT THE HAND

Tingling and chronic numbness in the ring and little finger and even weakness at the hand may occur as a result of compression of the ulnar nerve. This is due to the constant pressure and vibration exerted on the extended wrist whilst holding the handlebars.

Prevention:

• Wear cycling gloves
• Adjust handlebar position
• Padding on the handlebars
• Alter hand position regularly when cycling
• Reduce body weight on the handlebars

Management:

• Rest from cycling until the numbness and tingling has subsided
• Physiotherapy treatment can help reduce the chemical irritation of the ulnar nerve
• Ensure the above prevention measures are taken

Early intervention is always vital so should you be experiencing any of the above symptoms please consult your local physiotherapist.

When it comes to overuse injuries the best intervention is EARLY INTERVENTION or if you can: prevention! Please consult your physiotherapists should you be experiencing any of the above complaints.  You can find us at www.centreforsportsmedicine.co.za

www.centreforsportsmedicine.co.za

Tarryn Graham BSc Physiotherapy (Stell)
Physiotherapist
Centre for Sports Medicine, Umhlanga

031 5605557 or info@centreforsportsmedicine.co.za