Medicine of Cycling Research Library

As cycling is a ‘low impact’ sport, it is assumed the injury rate is low. Cycling is a very symmetrical activity that when combined with asymmetric variants of human body will result in abnormally directed loads.

In addition to the general approach to overuse injuries – need to consider the following additional factors in cyclists: Shoe/cleat alignment
Seat height
Seat fore-aft position
Seat angle
Handle bar/stem height
Pedalling technique

Proper “fit” of bicycle is essential component of injury prevention, injury management and performance – measurement systems are available to ensure this. A reliable cycle retailer can do this. A factor in injury could also be an insufficient time to adapt to a new configuration/position of the cycle. Many of the injuries in cycling are from crashes (eg head injury, concussion, laceration, and abrasion).

Knee pathology:
Most common overuse injury in cyclists – usually patellofemoral pain syndrome, iliotibial band syndrome or patellar tendonitis - as well as anatomic malalignment, problems with bike fit include a seat that is too low or too far forward. A foot that is too internally or externally rotated on the pedal may also be a problem.

Leg length discrepancies:
Adjust bicycle to suit long leg – under-correct for short leg by placing lift between shoe and cleat – most cyclists will adapt by increased dorsiflexion/plantarflexion while pedaling.

Foot pathologies:
• paraesthesia in foot are common in long distances. May be due to tight shoes. Usually self-limiting.
• metatarsalgia/Morton’s neuroma type problems are common due to pressure on pedal
• achilles tendonitis and plantar fasciitis are reported as being more common in those with a lower seat  due to increased ankle dorsiflexion

Cycling shoes:
Shoes are rigid for power transfer and attachment to pedal. Several different types of shoes and mechanisms for affixing shoe to pedal mechanism – cleated, clipless, mountain bike and touring. The old style toe clip and straps are not used much today for competition, but are widely used for recreational cycling.
Some pedal systems allow transverse plane rotation – others are fixed  these may have implications for load transmissions

Foot orthoses:
Very little room in cycling shoes for orthoses, as cyclists prefer a very tight fit. Lack of ‘heel contact’ makes standard functional foot orthoses less effective.
Forefoot wedging between shoe and pedal to alter alignment may be useful for overuse injury, but need to consider its effect on the midtarsal joint, before it can affect STJ – may be less of a factor in very rigid sole shoes.
After anatomical variations are detected and accommodated  check bike fit and riding position.
Use felt padding in cycling shoe prior to prescription of orthoses.
If use orthoses – need to be thin with higher medial arch height with forefoot extension
Forefoot wedging may increase stress on first MPJ.

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