Who especially needs to watch out for cycling injuries?

According to research, about 62% of injuries in professional riders are chronic overuse injuries, while recreational cyclists tend to have a higher proportion of acute traumatic injuries. Those who ride long distances, use poor riding posture, or have an ill-fitting bike setup are more likely to develop discomfort in the neck, knees, back, or groin.

What are common ways to manage cycling injuries?

Chronic injuries from overuse may be eased through bike fitting adjustments, such as changing saddle height, handlebar position, and training methods. Depending on the individual, pain may also improve with massage, physical therapy, injection treatment, and training modifications.

What signs mean you should get a medical evaluation?

After a fall, if you suspect a fracture of the clavicle, wrist, ribs, or other areas, or if you have persistent knee, neck, or back pain, or numbness, tingling, or weakness in the elbow or wrist, it is advisable to seek a medical evaluation to distinguish nerve compression from other causes and to arrange appropriate management.

Cycling Injuries: Acute Trauma and Chronic Overuse

Cycling injuries can be divided into acute traumatic injuries and chronic overuse injuries. Acute injuries are mostly accident-related: muscle tears, soft-tissue strains, concussion, and clavicle, wrist, or pelvic fractures caused by a fall. Chronic injuries are cumulative damage from overuse, affecting the neck, knees, groin, wrists, or back.

According to research, about 38% of injuries in professional riders are acute and traumatic while roughly 62% are chronic overuse injuries. More than two-thirds of the traumatic injuries occur in the upper limbs, and two-thirds of the overuse injuries occur in the lower limbs. Among recreational cyclists, the proportion of acute traumatic injuries is relatively higher.

Acute Trauma

The most common fracture is of the clavicle, followed by the wrist, ribs, and elbow; fractures of the lower limbs and pelvis are rare, and the chance of injury is higher in mountain biking than in road cycling. Most clavicle fractures do not require surgery unless there is significant displacement or malalignment. With non-surgical treatment, there is a chance of starting to ride again within 2 to 3 weeks. A clavicle fracture should also prompt checking the sternoclavicular joint and the acromioclavicular joint. When surgery is not needed, there is a chance of returning to competition in about 4 to 6 weeks.

Chronic Overuse Injuries

Chronic overuse injuries are related to fatigue monitoring. Through training-load management, it should be possible to reduce sports injuries, and a systematic plan can help manage training intensity, distance, and frequency effectively.

Upper Body

Neck pain has some relationship with long-distance riding and riding posture, causing muscle tightness, abnormal neck fascia tension, restricted range of motion, and cervical facet arthritis. Besides riding distance, a helmet that is too heavy, handlebars set too low, or poor suspension in the saddle or system can all be contributing factors.

Also, if the elbows and wrists stay in a fixed position for long periods while riding, the ulnar nerve at the elbow or the median nerve at the wrist can sometimes be compressed, producing local numbness, tingling, or weakness that needs to be distinguished from neck problems. Changing position from time to time, using gloves, and adjusting saddle or handlebar height can help reduce the chance of compression.

Lower Body

Knee pain is one of the common problems in cycling injuries. There are many causes of knee pain, including patellar tendinitis, patellofemoral pain syndrome, medial plica syndrome, medial and lateral ligament strains, and iliotibial band syndrome. Each condition has a different mechanical mechanism and may be related to congenital tibial rotation, a wider pelvis, bow legs or knock knees, or an overly tight iliotibial band.

Certain bike adjustments can help reduce the chance of injury, for example raising the saddle so that the knee flexion angle is less than 25 to 30 degrees, emphasizing cadence rather than large gears, and using a cadence above 85 rpm. In addition, patellar tracking problems caused by lower-limb muscle imbalance may all be causes of knee pain.

Back pain has some external causes, such as an uneven road surface, riding for too long, handlebars set too low, needing to produce greater force output, or an inappropriate saddle height, all of which place stress on the lower back. Some causes are internal, such as insufficient flexibility, scoliosis, leg-length discrepancy, spinal degeneration, or a herniated disc.

External factors can be improved through bike fitting, for example lowering the saddle height and adjusting training methods; internal factors require changing one’s own posture or strength to improve the muscles and spinal stability of the back.

Riding for long periods compresses the groin, which can cause chafing or a burning sensation, and adequate rest usually relieves it. Groin pain can also be related to pudendal nerve injury or to compression that restricts blood supply. A wider, padded saddle, changing the saddle tilt angle, or using padded cycling shorts may help relieve it. One study reported that among recreational cyclists riding more than 400 km per week, 24% had erectile dysfunction.

Summary

Most cycling injuries are caused by overuse. Overuse conditions occur mainly at the knee, and traumatic lesions occur mainly in the region around the shoulder. Other less common problems include Achilles tendinitis and iliac artery kinking or fibrosis. Chronic overuse injuries can be eased through bike adjustments, and the pain they cause may also improve with massage, physical therapy, injection treatment, and training modifications.

References

OVERUSE INJURIES IN CYCLING- Aspetar
Bicycling injuries. Curr Sports Med Rep. 2013 Sep-Oct;12(5):337-45.