07/26/2019
Cycling injuries can seem fickle and arbitrary. One minute, you might be enjoying a brisk ride along a beautiful country road. The next, your pain is unbearable. As a sports medicine physician, I see lots of injuries that are specific to certain sports or activities, and cycling is no exception. Here are a few of the most common injuries for cyclists, what to do if you think you might have them, and how they might be prevented:
Hot Foot
A burning sensation on the underside of the foot is often referred to as hot foot. The pain comes from the pressure on the nerves running near the bottom of the feet. For hot foot, preventing and treating it is the same. You can try wearing looser fitting shoes like Shimano or Bont, wearing thinner socks or making sure your cleat placement allows for the pressure you are applying to the pedals to be spread across your foot.
Pain on the outside of the foot can mean the insole of the shoe is not supporting your foot properly. Plantar fasciitis may present similarly from a pain standpoint, so it could be investigated if the circumstances regarding the start of your pain indicate the possibility. Either of these issues, if mild, can typically be treated effectively with custom insoles.
Saddle Sores
While derriere pain is a common source for jokes after a long ride, it can become severe enough to force pro cyclists out of races. Trying to avoid saddle sores by altering your body positioning also makes you more vulnerable to other injuries.
Unfortunately, rest is the best way to tame this beast. You’ll also want to clean the sores with warm soap and water. Also, wear loose clothing to allow them to breathe. Watch for signs of secondary infection such as spreading redness, increasing drainage, or warmth. If these appear, I recommend you seek medical care.
Preventing saddles sores is all about your bike saddle and lower body wear. Cycling weekly offers a men’s guide and women’s guide for the saddles, and cycling shorts should fit well. For extra measure, chamois cream can also be used to minimize friction.
Low Back Pain
Most often in cyclists, low back pain results from a sore piriformis muscle or lower cross syndrome. For piriformis syndrome, direct pressure on the muscle, which runs from the tailbone to the lateral thighbone, can lead to irritation similar to tendonitis. Alternately, the irritation can affect the nearby sciatic nerve, causing sciatic pain. The best home remedies are rest, stretching and using a foam roller, but beyond that, I recommend you see the provider of your choice to treat the symptoms. Lower cross syndrome occurs from a muscle imbalance due to the aggressive position of most cyclists. The hip flexors often become dominant in this position and the glutes become inactivated and can’t contract at the right time. This causes muscles of the low back to compensate, leading to overuse of these muscles and pain. This imbalance can be corrected with a custom program of counter exercises designed to stretch and improve your range of motion for the hip flexors, as well as strengthening and activating the glute muscles. If you struggle to improve on your own, guidance from a physical therapist can help.
Knee Cap Pain
While all types of knee pain are possible, it’s usually pain in the knee cap that that occurs with cycling. The official diagnoses of patellofemoral syndrome and patellar tendonitis are typically caused by overuse, improper seat or pedal positioning, or ramping up your cycling activity too quickly.
Long-time cyclists may also develop a muscular imbalance, where the outside quadriceps muscle becomes much stronger than the inside muscle. This overpowering can lead to the kneecap being pulled to the outside, wearing your cartilage and causing pain.
Glute strengthening, IT band stretching and other muscle-strengthening exercises can help prevent further cartilage damages and decrease symptoms. If left untreated wear of the cartilage over time leads to osteoarthritis and may progress to the need for surgery.
Hip Impingement
Hip impingement, or femoralacetabular impingement (FAI) – as it is now more now widely known as – is a mechanical pinching of the cartilage of the ball and socket of the hip joint. The hip joint contains thick cartilage called the labrum. It that fits like a gasket ring around the ball and socket. In FAI, the labrum gets pinched by the thighbone and hip socket. If left untreated, it can progress to degeneration or tearing of this cartilage. Cycling is typically a great exercise, but with untreated FAI the repetitive nature of the activity then becomes damaging.
For prevention and treatment, the correct bike fit is important and there are also exercises we can teach you to alleviate symptoms and develop your flexibility, strength and conditioning, both before and after riding. Unfortunately, many people with this condition will end up needing a Hip Scope at some point.
Do you need an expert diagnosis for your cycling injuries or pain? Call (402) 609-3000 to make an appointment with me or one of our other sports medicine specialists.
