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.

Ensuring The Best Size Fit For Bicycles

   The frame size is the single most important aspect of the bicycle and the proper size is vital to safety, performance and injury-free biking. Correct frame size is determined by straddling the bike in a standing position. Lift the entire bike off the floor until the top tube is pressing against the crotch. The distance between the bottom of the bike’s tires and the floor should be 1 to 2 inches for a road bike and 3 to 6 inches for a mountain bike.

   Correctly positioning the saddle will help maximize power and stability while minimizing the risk of lower extremity pain. To set the saddle height, the cyclist should sit on the bike in a normal riding position with the crank arms straight up and down. With the ball of the foot on the pedal in the 6 o’clock position, the biker should bend the knee at an angle of 25 to 30 degrees. Some mountain bikers prefer a lower seat to improve off-road stability and maneuverability.

   To set the saddle fore and aft position, one should drop a plumb line from the front of the cyclist’s patella while he or she is sitting on the bike with the crank arms horizontal. Adjust the saddle forward or backward until the kneecap of the front leg is directly over the pedal axle. Some mountain bikers prefer to have the saddle about one-half inch back from this position in order to improve rear wheel traction while climbing. The biker may then adjust the saddle for tilt. The saddle should be level or slightly upward for men and level or slightly downward for women.

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