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Injury prevention & Maximal performance in cycling

Chris Carpino, MPT

Cross Country EducationLeading the Way in Continuing Education and Professional Development.

www.CrossCountryEducation.com

To comply with professional boards/associations standards:• I declare that I or my family do not have any financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved do not have any financial relationship.•Requirements for successful completion are attendance for the full session along with a completed session evaluation form.•Cross Country Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity.

injury prevention & Maximal performance in cycling

Chris Carpino, MPT

Table of contents

• I. Fitting Principles

• II. Cycling Injuries

• III. Performance Optimization

• IV. Anatomical Modification

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Common cycling injuries

• Low back pain

• Neck pain

• Shoulder pain

• Anterior knee injuries

Risk factors for injuries

• Inadequate preparation

• Overuse

• Improper Equipment

fitting principles

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fitting principles

• Introduction

• Who is your rider?

• Injury history

• Skill Level

• Frequency of rides

• Duration of rides

• BE COMFORTABLE

fitting principles• Gait Analysis

• Varus/valgus stresses

• Femeral anterversion/retroversion

• Tibial rotation

• Determines cleat position

fitting principles

• Shoes

• Size in relation to pedal axle

• Navicular tuberosity drop can help determine cleat angle

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fitting principles

• Float in foot should be same distance as crank arm

• Modified with cleat adjustment

fitting principles• Saddle Height

• Knee flexion angle should be approximately 10-20∘flexion when pedal is fully down

• Use plumb line to decipher any valgus or varus stresses

• Knee is a common area for injury (non-traumatic/overuse)

fitting principles• Saddle Fore/Aft Position

• Plumb line should fall from patella to pedal axle

• Modify via seat position forward or backward

• modify clip for toe in/out as appropriatecomfortable

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Fitting principles

• Shoulder and upper extremity alignment

• 90∘shoulder flexion

• Vision of front wheel axle should be blocked by crossbar

• Adjust with handlebar tilt and stem length

Fitting principles• Spine

• Minimum of 20∘cervical extension

• Flat thoracic and lumbar spine

• Trunk 45∘from parallel

• Can be affected by saddle height, hand position

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Fitting principles

• Hand position

• Lower hand position increases hamstring activation

• Hands on tops, hoods or drops

• Level depends on rider type (casual, racer, touring)

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Fitting principles

• Handlebar Width

• Should equal shoulder width

injuries

The most common cycling injury

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injuries• Neck and Back

• Typically postural and/or musculoskeletal

• Low back pain prone to overuse as well as knee injuries

• Trunk flexion can reduce perineal pressure in holed saddle design

• Good response to therapeutic treatment

injuries

• Shoulder

• Injuries are positional

• Correctable with modification in upper extremity position

• Modify stem height, seat fore/aft

injuries

• Elbow and Wrist

• Positional habits

• Elbows and wrists typically locked in extension

• Modification can reduce injuries in wrist, elbow, shoulder and cervical spine

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injuries

• Hip and Ankle

• Usually due to weakness, instability, or tightness

• Can be affected by saddle height

performance optimization

performance optimization• Saddle Height

• Significant effect on knee injuries

• Raising saddle height increases ankle joint kinematics

• Lowering saddle height places greater demand on knee contribution

• Force effectiveness and gross efficiency are found not to be influenced by seat height

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performance optimization• Saddle

• Tilt of saddle (tube angle) has minimal effect of muscle power, more influenced by pelvic orientation (rectus femoris)

• Adjusted saddle position can offset muscle activation changes with uphill climbing

• Handlebar position lower than saddle position has been shown to increase perineal compression

performance optimization

• Stem Length

• Modified for experienced riders

• Longer stem places rider in more aerodynamic position

performance optimization

• Crank

• Minimize dead spot position

• Longer crank arms can improve force generation

• Improved workload demonstrated with crank arms not parallel to ground at dead spot

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performance optimization

• Cadence

• Shown to affect gross efficiency and force effectiveness of pedaling

• Improves energy expenditure

Anatomical modification

Anatomical Modification

• Hand Position

• Lower hand position increases hamstring activation

• Padded gloves and changing position minimizes Cyclist Palsy

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Anatomical Modification

• Saddle Height

• Affects stresses on spine, upper extremity, knees/hips

Anatomical Modification

• Body Position

• Upright/Uphill

• Down/Downhill

Remember

• A bicycle is adjustable

• A cyclist must be adaptable

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