Overuse injuries occur due to repetitive stress or microtrauma that becomes overwhelming to a specific tissue, joint or bony area, leading to macrotrauma in the form of a specific injury.
Though a fun and ideal way to stay in shape, mountain biking is repetitive in nature, which puts cyclists at risk for this type of injury. But don’t feel like you have to give up your favorite past-time activity just yet.
Jill Murphy, DPT, LAT, CSCS, physical therapist/owner at MotionWorks Physical Therapy in Neenah, WI, and Alexis Colvin, MD, orthopaedic surgeon at The Icahn School of Medicine at Mount Sinai in New York City about treatment and prevention options for overuse injuries in cyclists.
About.com: Why do overuse injuries occur?
Dr. Murphy: Overuse injuries occur due to training errors (doing too much too soon), lack of variety in a work-out program (i.e., always running or always cycling without any cross training), and or a lack of rest/recovery days in the weekly training routine. Overuse injuries also tend to occur due to muscle imbalances that create changes from healthy, normal movement patterns to unhealthy movement patterns that preferentially utilize or compensate with certain muscles/tendons leading to injury. Overuse injuries such as stress fractures can occur in part due to training errors, but also due to changes in hormones if a woman has stopped ovulating and lack of calcium and Vitamin D intake.
Dr. Colvin: Overtraining or too much of the same activity.
About.com: What are some overuse injuries common to cycling?
- Nerve compression/irritation/entrapment in the hand: ulnar neuropathy can cause numbness and tingling as well as weakness in the hands due to prolonged pressure on the Guyon canal, the place in the hand where the nerve passes in the palm when due to the precarious superficial position of the ulnar nerve at this particular location.
- Saddle injuries: a variety of injuries down under conditions such as perineal skin issues, pudendal neuropathy (numbness/tingling), and male impotence among others; all are related to poor seat position, height, angle, or design, inadequate biking shorts, and lack of frequent changing position when riding
- Neck pain and back pain: these issues can arise due to poor positioning on the bike; typically an insult to the back or neck off the bike instigates pain and lack of trunk stability for the endurance required to maintain a safe and stable spine position when biking for long distances.
Dr. Colvin: Iliotibial band tendonitis, patellar tendonitis
About.com: What factors cause overuse injuries in cyclists?
Dr. Murphy: What I mentioned above, as well as:
- Cycling at a higher gear ratios at a lower cadence;
- Not being professionally bike fit;
- Doing a group cycle or race you are not prepared for; keep distance gains from one bike ride to the next to 10% to reduce the risk of injury.
Dr. Colvin: The constant flexion and extention of the knee.
About.com: How is an overuse injury diagnosed?
Dr. Murphy: Most cyclists will know they have a problem when the pain is not improving or improves very slowly after a week, limiting their ability to ride as well as perform functional activities in daily life. Most overuse injuries are diagnosed by family or sports medicine physicians, orthopedic surgeons, licensed athletic trainers, physical therapists, or chiropractors.
Dr. Colvin: Usually by physical exam. Occasionally, further imaging such as an X-ray or MRI is needed.
About.com: What are some possible treatment options and prevention techniques for overuse injuries in cyclists?
Dr. Murphy: Good first steps are to check your bike fit and overall set-up, check for training plan errors, and check your riding posture- are you changing position frequently for your seat as well as your hand placement to reduce the pressure on just one area. Are you flexing at your hips versus all at your spine for sustained periods of time? Also, icing, resting, and modifying your activity level to only pain-free activities are a good first step. Don’t wait more than 1-2 weeks to seek professional help if you are not getting better, as this will only lead to more missed mileage on the bike in the long run.
Dr. Colvin: Rest, anti-inflammatories, physical therapy, stretching, icing, cross-training. Prevention techniques include proper form, cross-training, strengthening and stretching all muscle groups, especially the ones that aren’t worked as much during cycling.