Overview of Cycling
Sports Medicine Considerations
Tad Leusch, MS, LAT
Matt Doyle, MS, LAT
Kim Eppen, MA, MPT, PT
Rationale for Discussion
Popularity of the sport in our community
RAGBRAI and Tour de France
An improved understanding of the sport, equipment, and culture of cycling
may assist us in diagnosing, treating, managing, and preventing cycling related
injuries.
Cyclists: A unique breed of individuals
Overview of Bikes and Equipment
Bikes
Road
Off-road
Saddles
Helmets
Clothing
Shoes, Cleats, and Pedals
Bikes
Road vs. off-road
Geared vs. single speed
Fixed gear
Types of Racing
On road
Road racing
Criterium racing
Time trials
Off road
Cyclocross
Mountain bike cross-country
Saddles
Helmets
Clothing
Tight, bright clothing serves a function.
Shoes
Cleats and Pedals
Training
Different injuries may result from different
types of training.
Periodization or phases of training
Off-season:
recovery
core, strengthening, cross training
Early pre-season:
base training (high volume, low intensity)
Pre-season:
intensity and race specific training
Season: racing/peak performance.
Intermittent tapers for big races
Adaptations to Training
The body will learn to adapt to or break down from the stresses that it
repetitively incurs.
Physiologic and physical adaptations
Improved aerobic capacity of muscles
Flexibility
Strength
Posture
Bone density
Neuromuscular
Adaptations to training and body positioning
Considerations for attaining body balance
and optimizing performance
on and off the bike:
Balance and symmetry with strength and flexibility
Core stabilization: active vs. passive
Medicine & Science in Sports &
Exercise: Vol 37(5) Supplement May, 2005, p S121-S122.
Exercise Considerations
Strengthening (dynamic)
Core
Dynamic integrative core exercises
Squats and lunges
Dumbbell bench press with a straight arm press
Serratus anterior
Rows
Know your local resources
Local bike shops
Geoffs Bike and Ski
Local cycling clubs
Iowa City Cycling Club (ICCC)
Bicyclists of Iowa City (BIC)
Professional bike fitting experts
Cronometro: Madison, WI
Cycling Injury
Overuse
Poor bike fit
Badly designed training programs
Aging
Crashes and trauma
Bike Fit
Variations for tri-athletes, tourists, mountain bikers (off road),
competitive cyclists, etc.
Due to comfort, ability to produce power, aerodynamics, control,
stability, and handling
Bike Fit
Provides fit window for starting point
not 100 % accurate
Dynamic fit better than static
Individualized: consider goals
comfort vs. getting aero
Comfortable for extended time, good breathing, produce power, no numbness
or pain, weight distribution for handling/control
Bike Fit for Road Bike
Find the optimum position of the body on the bicycle to meet your most
common cycling goals. The bike is easier to adjust than the body.
Chris Carmichael
Bike Fit for Road Bike
Three contact points: pedal, saddle, handlebars
Variables to adjust:
Position of foot on pedal
Position of saddle and handlebars
seat height, seat setback, handlebar reach, and handlebar height
Foot/Cleat Position
1st MTP to 3rd MTP over pedal axle
Shims for LLI
Cleat position for femur LLI
Saddle Position
Most important fit variable
Height
Setback
Tilt
Saddle Height
Seat too high
Posterior knee and Achilles tension increased
Patellar position poor, no fulcrum
Pelvis rocking
Seat too low
PF compression and shear force increased
Saddle Height
Option #1
Heel on pedal
Option #2
Formula
Option #3
Goniometry
25-35 degrees
Lower saddle for poor flexibility
Seat Setback
Related to length of femur
Position anterior knee directly over pedal at 3 oclock
Positions hips over bottom bracket
Changing setback changes height
Seat Tilt
Should be level
If not, indicates other parts of bike fit are incorrect
Nose down puts pressure forward
Nose up tilts pelvis posteriorly
Handlebar Position
Reach and height
Determines angle of torso
Personal choice based on goals, body limits, comfort
Handlebar Reach
Option #1
Forearm/finger length
Option #2
Weight distribution
Handlebar Height
Option #1
Measure fist
Option #2
Goniometry
20-35 deg competitive
MTB 45 deg
Option #3
Differential chart
Common Cycling Pain Syndromes and Their
Pathomechanics
Anterior Knee Pain Conditions
Patellar Tendinosis
Spring Knee
Chondromalacia
Causes of Anterior Knee Pain
Poor Quadriceps flexibility
Regular, Proper stretching
Poor cleat alignment
Define and align cleat to neutral
Low saddle height
Increase saddle height
Forward saddle position
Knee over pedal spindle
Excessive quadriceps use in pedaling
Increase cadence and use proper technique
Prolonged low cadence
Increase cadence
Posterior Knee Pain Conditions
Pes Anserine Bursitis/Tendinosis
Biceps Femoris/Popliteus Tendinosis
Posterior Knee Pain
Poor cleat alignment
Define and align cleat to neutral
Excessive saddle height
Lower saddle height
Saddle too far back
Saddle forward, knee over spindle
Excessive cleat float
Limit float to 3 degrees per side
Lateral Knee Pain Conditions
IT Band Syndrome
Plica Syndrome
Lateral Knee Pain
Poor hamstring flexibility
Regular, proper stretching
Poor cleat alignment-toes point in
Define and align cleat to neutral
Extreme height of saddle
Lower and normalize saddle height
Low saddle height
Raise and normalize saddle height
Narrow stance-width on pedals
Widen and normalize stand with of pedals
Medial Knee Pain Conditions
Inflammation of medial patellar femoral ligament
Plica syndrome
Medial Knee Pain
Weak lateral hip muscles
Strengthen core and lateral hip muscles
Poor cleat alignment-toes point out
Define and align cleat to neutral
Excessive stance-width on pedals
Narrow and normalize stance-width on pedals
Neck and Shoulder Pain
Improper tilt of saddle
Normalize/neutralize saddle tilt
Excessive reach to handlebar
Shorten stem length
Limited reach to handlebar
Increase stem length
Handlebar too low
Raise level of handlebars
Lower-Back Pain
Poor hamstring and gluteal flexibility
Regular, proper stretching
Excessive reach to handlebars either in reach or depth
Shorten stem or raise handlebars
Improper tilt of saddle
Normalize/neutralize saddle tilt
Poor core strength
Stomach and back strength and conditioning
Numb/Painful Hands
Low saddle tilt
Normalize/neutralize saddle tilt
Excessive reach to handlebar
Shorten stem length
Limited reach to handlebar
Increase stem length
Single hand position
Change hand position frequently
Numb/Painful Feet
Forward cleat position
Cleat under ball of foot
Mechanical dysfunction of foot
Proper orthotic
Shoe too small
Proper fitting shoe
Excessive quadriceps use in pedaling
Increase cadence and use proper technique
Prolonged low cadence
Increase cadence
Acute Cycling Related Injuries
Wrist Fracture
Clavicle Fracture
AC Sprain
Lacerations
Abrasions also called road rash
Hip fracture resulting in avascular necrosis
Traumatic Crashes
Upper Extremity Fractures and sprains
AC Sprain
Concussion
Road Rash wounds
Summary
Questions?