The strength of osteopathy is its ability to combine detailed analysis of the specifics of an injury with the overall biomechanics of the patient in the clinic. I regularly analyse both cycling and running videos supplied by patients to work out what’s right and what’s going wrong. Often a small series of functional adjustments makes all the difference.
Below are some typical problems I see in cyclists, followed by some top tips for staying out of trouble.
Low back pain
This is often caused by sustained lumbar flexion without rotation. When your lumbar spine is flexed there is much more pressure on the intervertebral discs and this can lead to problems such as numbness and pain radiating down through the leg. Even when you’re working hard there is little twisting in the low back and generally the body prefers movements to be combined – that’s when it functions best. The key here is to improve lumbar rotation, which leads to improvements in both cycling speed and duration due to increased efficiency of movement.
Neck and shoulder pain
Some cyclists exhibit pronounced lower body dominance with relatively underpowered shoulders. The shoulders are usually slightly rounded to the front and the neck is hyperextended. That is all addressed with exercises and education, and with thoracic spine mobilisation too. Once the balance is restored, the body works better and the first thing I get told is that breathing is easier on longer rides as the lungs have more room to expand.
The knees are usually damaged via overuse and overextension as a cyclist works to get every available pound per square inch of muscle power to the cycling drivetrain. Perhaps surprisingly knee problems often arise as a consequence of ankle and hip problems; inadequate mobility at these joints the knees requires more work from the knees, so the osteopathic approach is to make sure that all the joints in the biomechanical chain are functioning optimally through mobilisation, exercise prescription and so forth.
This is usually a simple problem but can be reluctant to settle. When holding the handlebars the wrists are extended, which is not a natural position for them at all. We have got used to that wrist position through mouse use, but it can lead to a painful synovitis which requires treatment, rest and sometimes splinting to resolve.
Finally, there is pain in the hand at the Tunnel of Guyon. This is a lesser known but highly problematic type of repetitive strain injury (RSI). Continual pressure from the handlebars can compress and inflame the ulnar nerve as it passes under a ligament which lies between two bones – the hamate and the pisiform. Some riders can go a lifetime without ever experiencing it, while others suffer endlessly. Anatomical education is the main thing here, and an explanation of what is getting compressed and where, then rest, gentle traction and ulnar glide stretches. Problem solved.
Top tips for staying out of trouble
- Get your riding position right. It’s not a static thing and varies enormously depending on the terrain, how tired you are, how flexible your shoulders are and so on, so keep adjusting and don’t settle on something that was right when you bought the bike but isn’t actually working out.
- If your low back is sore, raise your handlebars a tad. The little that you will lose in aerodynamics will be more than made up for by improved stamina and potentially power to the pedal too.
- Keep your upper back and neck moving, both on and off the bike. There is a lovely tai chi exercise that I teach to stop the upper back flexing forwards and the shoulders rounding. Cycling is thought of as low impact, but it’s generally low on spinal movement too, so keep those spinal rotations going.
- Check your saddle position, height and angle to take any pressure off your knees. Ask an expert to look again at the distance between the handlebars and the saddle – if it’s too far, there will be excessive pressure on the front of your knees leading to pain at the front of the knee (patellofemoral pain syndrome or PFPS). Make sure cleats are in the right position to optimise balance as you put power through the knees.
- Look out for pain in the wrist and hand when it starts and try to adjust your positioning. Different grips are available, and sometimes a vertical grip solves wrist pain instantly. If it doesn’t settle, get it looked at.
A version of this post appeared in Cycling Weekly in January 2018