Understanding the body-mechanics of a cyclist
Massage has a long and proud association with the sport of cycling, with the soigneur (pronounced ‘swan-year’) being an integral member of the professional cycling team. As a recreational sport, cycling is experiencing rapid growth, with an ever increasing number of people taking up the sport, both on-road and off-road (in the form of mountain biking). This has been partly due to the extensive media coverage given to events like the Tour de France (especially with the phenomenal success of Lance Armstrong). The other reason is that, being non-weight bearing, it has allowed many people who otherwise may have struggled to take part in regular exercise, to do so with little risk of injury. However, injuries do occur, and therapeutic massage therapy can be a valuable tool in ensuring that these injuries are kept to a minimum.
When one considers the high speeds that are attainable on a bicycle, as well as the added danger of motor cars, pedestrians and other obstacles, it is easy to see that by far the most significant injuries are of a traumatic nature. These range from skin abrasions and lacerations, through fractures and sprains, to the more serious head injuries.
For these reasons, any massage therapist that is involved with a cycling team needs to be highly competent with basic first aid techniques, and to ensure that the first aid kit is adequately stocked. Furthermore it is important that the massage therapist is also aware of past accidents, as these may have resulted in altered biomechanics, as well as possibly being the source of the presenting symptom e.g. headaches and/or muscle spasm due to whiplash.
However, for most massage therapists the problems that the cyclist brings into our practice is of a more chronic nature. These can be sub-divided into complaints that are due to the specific posture associated with cycling, and those that are due to overuse of particular musculo-tendonous units. In order to better understand these injury patterns we need to understand the biomechanics of cycling.
The legs
The power required to propel a bicycle forward is generated primarily by the gluteus maximus and quadriceps muscles, with added power coming from the hamstrings, gastrocnemius and soleus myscles, as well as the iliopsoas.
It is worth noting that whilst recreational cyclists rely on a downward push on the pedals, the elite cyclist also pulls the pedal back up, thereby substantially increasing the total power output. Unfortunately, this also means that there is little chance of recovery for the muscles.
Because of the cyclist’s position on the bicycle, the leg muscles are unable to work through their full range of motion, and are forced to operate mainly in their middle and inner range. As a result, these muscles tend to be short and strong, with an increased tendency towards the development of myofascial trigger points.
The repetitive actions of the leg muscles result in changes in the connective tissue, predisposing the cyclist to fascial tightness, trigger points and associated pain.
Furthermore, when one considers that the cyclist’s knee joint is required to flex and extend more than 4000 times per hour, any deviation from normal alignment can quickly become problematic, e.g. iliotibial band syndrome, patellofemoral pain, and tendonitis. These problems are usually best treated in collaboration with a physiotherapist, as the use of electro-therapy modalities assists in the control of the inflammation. (See Mandy Eagar ’s article specific injuries on page 9)
The trunk
The cyclist’s position on a bicycle results in the lower half of the spine being held in sustained flexion, with the upper thoracic and cervical spine in hyper-extension.
This posture can be held for up to seven hours by the serious cyclist, putting the vertebral joint structures under extreme stress. It is little wonder then that the vast majority of problems reported by cyclists involves the back and neck region.
This is aggravated by the position of the hips (flexed) and shoulders (flexed and protracted), which increases the neural tension, resulting in pain (especially the trapezius) as well as headaches. It is very common, therefore, to find splinting of the quadratus lumborum, trapezius and levator scapula muscles.
Whilst the massage therapist is perfectly equipped to deal with the soft tissue dysfunction, it is recommended that the cyclist is treated regularly by a physiotherapist or chiropractor to ensure that correct spinal alignment and function is maintained.
Core stability
Optimal usage of the power generated by the leg muscles is dependant on the efficient transfer of the energy from the cyclist’s body, through the bicycle, to the road. This is best achieved through a closed kinetic chain, with the load transfer occurring at the sacro-iliac joint. This in turn is dependant on the cyclist having good core stability, ensuring that there is no energy lost in unnecessary lateral movements. This kind of energy loss is easily observed with the side-to-side movement of the recreational cyclist, often accompanied by the bicycle itself wobbling from side to side!
It is, therefore, imperative that the massage therapist encourages the cyclist to do some form of core stability exercises such as Pilates. This will not only improve performance, but will also reduce the likelihood of sacro-iliac joint pain, and the associated tightness of the piriformis and gluteus minimus muscles.
Bike set-up
There is little doubt that by far the most important component in preventing chronic injuries is by ensuring that the bicycle is set up correctly.
If the bike is too small, or the saddle too low, the increased strain on the lower back and knees is a recipe for disaster. Likewise, a bike that is too big, or a saddle that is set too high, will result in upper back / neck and or hip problems.
When the massage therapist suspects that the presenting problems may be due to the bike set up, it is best to refer the cyclist to an expert for the necessary advice.
Feet
Last, but not least, the feet. In order to ensure that the feet are not pulled out of the shoes on the up-stroke (especially when sprinting) the shoes have to be tightened far more than normal. Added to which, the feet tend to swell from the heat and exertion, resulting in them being squashed. The presenting symptoms may vary from pins-and-needles, to pain, to tendonitis. All of these are easily treated with ice and massage.
To summarise, whilst the cyclist is frequently a complex and demanding patient, they are also often the most rewarding people to work with; not only because there presenting problems are so challenging, but also because they are so appreciative of the massage therapists efforts.