Secrets To Treating Bicycling Injuries

By Mark A. Caselli, DPM, Edward C. Rzonca, DPM and John J. Rainieri, DPM

   The sport of cycling has grown in popularity in recent years. Spurred on by Lance Armstrong’s successes in the Tour de France and the increasing popularity of mountain biking (the first Olympic mountain bike race was held at the 1996 summer games in Atlanta), participation in bicycling is second only to swimming.    The Bureau of Transportation Statistics at the U.S. Department of Transportation estimates that more than 49 million Americans ride bicycles at least monthly, with over 5 million people riding at least 20 days per month. Cycling creates a tremendous demand on the lower extremities since they are responsible for producing a majority of the energy imparted to the bike. The high reactive forces created between the foot and the pedal produce loads that often adversely affect the joints and muscles of the legs and feet, leading to overuse injuries.    The incidence of lower extremity injury in cycling is high. One study of over 500 recreational cyclists reported 85 percent of the cyclists experienced one or more overuse injuries, 36 percent of which required medical treatment.    The main causes of overuse injuries in cyclists include a poorly fitting bicycle, musculoskeletal imbalances and training errors. Cycling is very repetitive. During one hour of cycling, a rider may average up to 5,000 pedal revolutions. The smallest amount of malalignment, whether it is anatomic or equipment-related, can lead to dysfunction, impaired performance and injury. In order to evaluate and treat a cycling athlete properly, the clinician needs a basic understanding of bicycle fitting, the proper selection of cycling shoes and foot orthoses (if indicated), and how anatomic factors and training errors contribute to these overuse injuries.

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