Therapeutic massage for common cycling injuries
Cycling season is around the corner again and league rides are taking place on the weekends, attracting keen cyclists from all over. For these people training is a means of attaining new personal best times in the next Argus Cycle Tour, or simply to shed the extra kilo’s they gained during the winter months. This means these cyclists will be pushing their bodies to the limit, often resulting in muscles strains and injuries.
Among these cyclists are a fair number of people who regularly visit therapeutic massage therapists. This article investigates common cycling injuries, the causes thereof and the role therapeutic massage therapists can play in treating it. The list of injuries include:
· Patella femoral pain,
· Achilles tendonitis and,
· Neck and shoulder pain.
Cycling is a low impact sport, resulting in rapid recovery as there is less stress and strain placed on the joints and muscles. Most injuries are due to poor bike set-up or improper riding techniques and biomechanics. The biomechanics of cycling involves two phases, a power phase and a recovery phase.
The power phase occurs when the pedals move between 12 o’clock and 6 o’clock and the recovery phase between the 6 o’clock and the 12 o’clock position. The power phase delivers the most force and generates the momentum. This force is produced via the extension of the lower limb. When pedaling, the largest force produced acts through the knee up to between 4 000 and 5 000 times an hour therefore the slightest incorrect distribution will result in a knee injury. It is important to understand the actions of the upper and lower muscles to understand the role they play during the power phase to effectively support the cyclist.
The rectus femoris is one of the quadriceps femoris group of muscles and is responsible for flexion of the hip and extension of the knee. The gluteus maximus is also responsible for extension of the hip, as well as external rotation of the hip and some of the lower fibers assist with adduction.
Posteriorly situated, the biceps femoris, one of the three hamstring muscles play a role in hip extension, as well as knee flexion and external rotation of the knee and hip. The other two hamstrings, the semitendinosus and semimembranosus have the same actions namely extension of the hip, flexion of the knee and internal rotation of the hip and knee. The gastrocnemius and the soleus are responsible for plantar flexion of the ankle. Because the gastrocnemius also attaches above the knee joint, it assists with flexion of the knee.
The recovery phase contributes to the overall power delivery by the upward pull of the attached shoes via the flexors, hip flexors, hamstrings and anterior tibialis. During the power phase, the knee will drift medially due to the normal valgas orientation of the femoral condyle. The foot pronates during the power phase impacting an internally rotating force to the knee therefore increasing the stress on the medial side of the knee. The opposite happens during the recovery phase.
Patella femoral pain
Pain is usually experienced behind the patella and it is usually caused by gluteal muscle dysfunction, vastus medialis oblique weakness, a tight iliotibial tract, tensor fascia latae muscles and rectus femoris.
Pain at the knee is caused by a tight lateral retinaculum, shortened hamstrings and gastrocnemius, lateral tibial torsion and increased pronation. This causes an excessive medial drift of the knee during the power phase. It can be caused by the seat being too low causing excessive patellofemoral loading throughout the pedal cycle the knee functions in hyperflexion, increasing compression of the patella on the femur.
Activating the gluteus maximus and vastus medialis will help prevent the knee drifting too far medially.
Chondromalacia patellae refers to the degeneration of the underside of the patella. Symptoms include:
· A dull pain felt behind or around the patella that usually worsens after exercising and particularly after doing hill work.
· Pain that gets worse when walking up or down stairs.
· A sense of the knee "giving way"
· The knee swelling or "water on the knee".
The patella degeneration is usually due to overuse, poor alignment of the knee joint or muscle imbalances. Strengthening upper leg and hip muscles and avoiding activities or bandages that compress the kneecap can avoid it.
Pain is generally experienced on the lateral side of the knee. It is caused by excessive pressure on the iliotibial band (ITB) as it passes over the lateral femoral condyle. Excessive tibial internal rotation causes increased pressure between the femoral condyle and the ITB.
A cyclist may develop the ITB syndrome when the saddle is set to high or too far back. This puts the ITB on a stretch. It can also be the result of a leg-length difference causing the ITB of the shorter leg to be stretched.
Biceps Femoris Tendonitis
Biceps femoris tendonitis refers to an inflammation to the hamstring tendon insertion at the ischeal tuberosity. Symptoms of this condition include:
· Tenderness and swelling over the area where the tendon inserts onto the bone (tendonitis).
· Pain when you try to bend the knee against resistance.
· Stiffness after exercise.
It can also be the result of the saddle that is set too high or too far back, putting the hamstring on a stretch.
It is clear that adjusting the bike’s saddle position can go a long way to improving problems related to postural imbalances as it alleviates the strain and resulting pain the patient is feeling. Once the muscle can freely contract and relax the range of motion also improves.
Therapeutic massage therapists can support the patient by effecting soft tissue release, with trigger point work and doing general stretching to all the muscles involved.
The Achilles tendon is another culprit often causing a cyclist a lot of discomfort. The gastrocnemius and soleus muscles attach to the calcaneus via the Achilles tendon. The gastrocnemius crosses over the ankle and the kneejoint while the soleus only crosses over the ankle joint. The Achilles tendon is strong but not very flexible. Most problems occur here as people ignore the warning signs and push through the pain. As the muscles become increasingly fatigued, more stress and strain is put on the Achilles tendon. Pain in the Achilles usually occurs due to:
· Over training,
· Under- or over-stretching,
· Increases in amount of training, hill work or speed work.
To alleviate the pain the therapeutic massage therapist can apply friction and passive stretching to the gastrocnemius. The best way to self-stretch the tendon is to stand on a step with the heel off the back of the edge of the step and then to drop the heel down. The soleus is stretched by taking the same position but with the knee slightly bent. In order to isolate the muscle, the knee has to be bent, as the soleus does not cross over the knee joint.
Neck and shoulder pain
Cyclists often complain of pain in the neck and shoulder area, the reason being that their backs are constantly in state of flexion in the lumbar region and extension in the cervical region. This results in muscle fatigue.
Over time a cyclist gets used to spending hours in this position and may slowly build up the muscle strength needed to complete a race pain-free but the therapeutic massage therapist plays an important supporting role. The therapist will need to release the muscles in the neck and upper back region to alleviate some of the pain and discomfort. Target the upper trapezius, rhomboids, and levator scapular as well as the sub occipital muscles in the nape of the neck. Also work on the rectus capitis posterior major and minor and capitis oblique superior and inferior.
Besides massaging the affected areas, the therapist can:
· Show the patient how to stretch their necks by dropping the chin onto the chest, rolling the head from one side to the other etc.
· Educate their patients on the importance of making sure that the bike is set up correctly for their body type.
· Encourage them to include activities that involve extension of the back like swimming backstroke or lying on their backs on the floor.
1. Cash, M. (2000). Pocket atlas of the moving body. London : Edbury Press
2. Fyfe, S Sports Injury Bulletin http://www.sportsinjurybulletin.com/archive/cycly-injury.htm
3. Marquis, R. Bicycke Source.com. http://www.bicyclesource.com
4. Quin, E. About.com Sports Medicine http://sportsmedicine.about.com/cs/leg_injuries/a/leg4.htm
5. Quin, E. About.com Sports Medicine http://sportsmedicine.about.com/od/bicyclinginjuries/a/bikeinjury.htm