Workshop on sports injuries & prevention

Dr Sushal Shanthakumar MS Orthopaedics

What s cooking …

Stretching

Getting the right fit

Common problems/injuries

The knee – an enigma to cyclists

Why physiotherapy ?

Question time !

Stretches

U gotta stretch yo ! ! !

Why do we need to stretch ? ?

“ just not merely a stretch of imagination ”

To improve the flexibility

To prepare for an imminent increase in activity

Anatomy of stretching

What is static & dynamic stretching

What is best for us ???

anatomy & physiology of stretch

All muscles at rest – contracted

Cross bridges – less widely separated in rest

Optimum stretch – max pre load

Total tension = passive tension + active tension

Stretches for the upper limb

DELTOID :

stand with feet apart

Keep shoulders square

Pull arm across the body perpendicular to the ground

TRICEPS :

Stand with shoulder flexed till ears

Bend elbow so the hand rests b/w the shoulder blade

Apply pressure on the opp. elbow with other hand

LEVATOR SCAPULAE:

Sit/stand with shoulders square

Look down towards opposite arm pit

Apply slight pressure with the near hand

Stretches for the lower limb

LOWER BACK STRETCH :

LOWER BACK contd ..

GLUTEAL STRETCH :

Sit on the floor

Bend the knee you are stretching and place it across over the opposite thigh

Pull bent knee to your chest while keeping both buttocks on ground

HIP FLEXOR ADDUCTOR STRETCH

IT BAND STRETCH:

cross your right foot over in front of the left

most of your weight should be on your left foot

reach your right hand overhead, and lean as far as you can to your left

push your hips out while you are reaching overhead

QUADRICEPS HAMSTRINGS CALF STRETCH

Remember ….

‘feel’ the stretch

slow & gradual stretch

hold for 10-15 secs

do not bounce or jerk

repeat atleast once

Getting on the bike

Get a good fit

Be meticulous on choosing the bike

Don’t go by opinions

Every individual is different and so will his bike

Why is it important to get the right fit

• EFFICIENCY – Aerodynamics 80% effort required to overcome air resistance at 25mph – Power Cannot let the legs do the pedaling if you’re not relaxed• COMFORT – Neck ache (bars too low) – Over-reaching to handlebars (neck/shoulder/elbow pain) – Pain Knee (saddle too low or too high) Perineum (saddle too high, too forward/back, tilted up/down) Lower back (saddle too high)• AVOID INJURY – Knee injury (damage to ligaments) – Tendinitis (neck/shoulder/elbow) – Male impotence (perineal nerve damage)

The right fit

A myth or reality ?

Anatomical or mechanical ?

Common problems & injuries

Back pain

Knee pain

Hand & shoulder syndromes

Foot pain

Low back pain

Back – considered as the weak link for cyclists

Any force directed into the pedals also goes up into the torso

If the torso is weak, that force DOESN'T go into the pedals but is dissipated in flexing of the torso

CAUSES -

80% of low back pain arises because of poor posture

Muscle spasms - inflexibility

Medical problems

TIPS-

Strengthening of abdomen n back

Stretching

If nothing helps see a doc

Knee pain

Most common problem – 90% have exp some kind of knee pain

Irony ! ! ! Cycling is one of the better exercises for knee

Anatomy

Stability – rather instability ! ! !

Bones are incongruent

More emphasis on muscles & ligaments

Multitude of causes …

ANATOMICAL

- leg length discrepancy

- wider pelvis

- flat foot

- muscle weakness

BIKE FIT

- saddle too high

- saddle too low

- saddle too far forward

- saddle too far back

- internally rotated cleats

- externally rotated cleats

TRAINING

- rapid increase in activity ( 10% rule )

- faulty techniques

- early return to sports following repair

Variety of conditions ..

Patello-femoral pain syndrome

IT band syndrome

Chondromalacia

Tendinitis

Bursitis

Ligament & meniscal tears

Cruciates & Menisci

CRUCIATE LIG

- ACL & PCL

- injury – how?

- is surgery essential

- if so when ?

- results ?

‘an ACL deficient knee is the beginning of the end’

Meniscus

Medial & lateral

Avascular structures

Functions

Injury

Is surgery essential ?

Results ???

Menisci contd ..

Rehabilitation

Extremely essential

Tailor made to individual case

Basic points

- achieve full ROM within 2 weeks

- strengthening hamstrings & quadriceps

- earliest return to sports – 6 months

- criteria ---

quads & hams strength at least 80% of the normal leg

no swelling

good stability

ability to complete a running program

Foot & ankle

FOOT :

Numbness or burning – compression of nerves

Due to tight shoes / road vibration

Flat feet

- is it congenital or acquired

- flexible or rigid

- all flat feet don’t require Rx

- effect on cycling - ?

- symptomatic – insoles , custom made shoes

ANKLE :

Most often results from ‘ankling’

Cleats are wrongly positioned

ACHILLES TENDINITIS:

• Tendon on back of the foot • Indicates problem with pedaling

technique• Ankling / cleats too far forward /

saddle too high – toe pedaling

Hands neck & shoulder

HANDS:

Entrapment neuropathies – ulnar & median nerves

Pressure of handlebars / overuse of wrist/ fractures of small bones of hand

Numbness & tingling in hands

Rx – padding , gloves , wrist splints , change of position , lowering the saddle

NECK:

- neck pain - common due to riding position

- overuse injuries

- reassess your posture (saddle ht position distance)

- r/o medical conditions

- tips – stretches , freq change of hand position , relaxing elbows , varying head position

‘try not to ride with your neck in the same position for long periods of time’

Thank you & happy cycling