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Cycling – Injury Prevention

With the FedUni Road Nationals on in Ballarat this week it is the perfect time to talk cycling with many of us inspired to jump on the bike ourselves. For those of us however that perform cycling as a competitive sport, injuries can always be a worry that is at the back of your mind. As cycling is a very repetitive sport by nature, overuse injuries are unfortunately all too common. These types of injuries are generally far less debilitating than the acute injuries that can occur, however they can still affect training and ultimately race day performance. Broadly speaking, overuse injuries in cyclists have two common causes; bike positioning alongside lack of strength in certain areas. Let’s have a look at what some of the most common overuse injuries are in cycling and what we can do to prevent them. 

Neck Injuries

Neck injuries account for the biggest proportion of overuse injuries in cycling as often a cyclist’s neck can be placed into excessive hyperflexion for extended period. It is therefore important that we take note of a few things including handlebar and seat positioning. We can then also look at strengthening through the upper back, not only the strength but the conditioning of these muscles to hold this position for long periods of time too. There are a few upper back exercises we can do to help reduce the risk of this including: 

  • Ring row
  • Banded pull apart 
  • Dumbbell bent over row
  • Cat Camel stretch

Knee Injuries

The next most commonly injured area is that of the knee with an array of different overuse injuries that can occur, however the main ones being patellofemoral pain (PFP) and iliotibial band syndrome (ITB syndrome). Due to the high demand that is placed on the quadriceps during the downstroke of cycling (where the knee is extending), this leads to a large amount of force being translated to the patellofemoral joint. This reaction is said to be the cause of PFP, while ITB syndrome can be better accounted for through the repetitive nature of the sport. As with the non-specific neck injuries that cyclists can have, the set up of the bike is a large contributing factor to the occurrence of these injuries. Other factors include a rapid increase in training volume and an increase in hill work performed. It is therefore important that we be mindful of this as a cycling community and prepare our bodies appropriately to be able to withstand the increase in load. It is important that our increase in load is no more than 10% per week and we are not increasing both volume and hill work at the same time. It is also then important that we strengthen our bodies to withstand this added volume. For this it is important that we improve the strength in our glutes and stabilizing muscles through the hip. A few key exercises that we can use to aid in this include:

  • Banded glute bridge 
  • Side lay leg lift 
  • Split squat

Lower Back Injuries

The last injury we will talk about is that of chronic lower back pain. This type of non-specific pain is generally caused by the prolonged flexed position that the athletes are placed in, resulting in a flexion/relaxation inhibition or fatigue of the erector spinae (lower back) muscles. Again, preventing this type of injury can be attributed to making sure that the athlete has the correct set up of their bike. It is also important however that we look to improve our lower abdominal and general core strength, to offset any weakness through the erector spinae muscles. There are a few key exercises that we can use to help target these areas. 

  • Dead bug 
  • Swiss ball crunch 
  • Bretzel

Summing it up…

In summary, if you are a keen cyclist there are a few very important things that you will need to take note of in preventing any chronic overuse injuries from occurring. Firstly, making sure that the bike is fitted correctly to you, correct seat type and position and correct handlebar position. It is then important that we don’t increase the amount of training that we are doing too quickly (10% at a time) and only in one form at a time whether that be increasing volume or hill work. Lastly it is important that we perform some strength work to off set any injuries that could occur. 

Happy cycling 😊

References

  1. Schwellnus, M,P. & Derman, E,W. Common injuries in cycling: Prevention, diagnosis and management. South African Family Practice. 47(7): 14-19. 2005.
  2. Visentini, P. & Clarsen, B. Overuse injuries in cycling: The wheel is turning towards evidence-based practice. Aspetar Sports Medicine Journal. 8: 486-492. 2019.
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Injury Prevention for Rowers

With rowing pre-season schedules starting to heat up it is important that we acknowledge the potential increased injury risk that athletes may have. With the increased workload and the repetitive nature of the sport there are some common overuse injuries that can occur. To understand the injuries we first need to understand the sport. As with many sports technique in rowing is paramount to not only performance but also to the prevention of potential overuse injuries. We must also note that there are two types of rowing; sweep whereby each person has one oar and sculling where each person has two oars (pictured below). There are four phases of the rowing stroke (3), comprised of: 

  • The catch; the start of the stroke where the rower’s legs and back are fully flexed and the oar is square. 
  • The drive phase; where the legs extend first followed by the back beginning to extend, this is where the most power is produced for the stroke. 
  • The release; where the elbows draw the blade through the water as the handle lightly brushes the abdomen, the blade is then feathered across the water. 
  • The recovery; where the drive phase is reversed until the arms are fully extended to prepare for the next catch phase. 

Now that we understand the basics of rowing, let’s have a look at the common overuse injuries that can occur and what we can do to help prevent them. 

Back Injuries

Firstly non-specific lower back injuries account for 15 to 25% of injuries in rowers, with it more common among females due to hip muscle imbalance, and those starting training prior to the age of 16 (3). These injuries are generally chronic by nature and are caused by excessive hyperflexion and/or excessive twisting forces applied on the lumbar region (3). This is generally exacerbated at the catch position as the lower back muscles (erector spinae) can be relatively relaxed, whilst having great loads (up to 4 times body weight) placed on them during the drive phase (3). Other causes include fatigue and breakdown of technique due to increased volume and intensity, as well as varying training methods, compounding the muscle fibre contractility (3). However there are ways we can manage this as training volume starts to increase, including:

  • Improving hip flexor strength whilst improving hamstring length.
  • Improving endurance in the lumbar extensor muscles. 
  • Improving abdominal and gluteal strength. 
  • Maintaining length in the gluteal muscles. 

Exercise we can do to help reduce this risk include (1):

  1. Back extension
  2. Good morning
  3. Crunch
  4. Hip thrust 
  5. Hip flexor stretch
  6. Inch worm (dynamic hamstring stretch)

The Ribs

The next common over use injury for rowers is rib stress fractures, a less commonly expected injury however due to the excessive repetitive force that is exerted by the muscles around the ribs (serratus anterior and external obliques) with every stroke, it can lead to a weakness in the bones (2). This loss of strength in the bones can lead to a decreased shock absorption ability and increase the stress placed on the ribs at selected focal points (2). The incidence of this injury is up to 22% higher in female athletes due to often decreased bone density (2). One of the key factors that we can target in the gym to help reduce the risk of this occurring is working to reduce the imbalance between the serratus anterior muscles and the external obliques (2). Some exercises targeted towards reducing this risk include (1):

  • Push ups 
  • Bench press 
  • Push up plus

Shoulder Pain

The last two injuries that we will speak about are a little less common however are still very important to consider when looking at injury prevention. Non-specific shoulder pain can be caused by many factors however the most common includes overuse, poor technique and tension through the upper body (3). To reduce the risk of this injury occurring we can improve strength through the lower traps, serratus anterior, and shoulder girdle (3) by implementing exercises such as (1):

  • High cable row
  • Shoulder Y, T, W 

ITB Friction Syndrome

Finally, Iliotibial band friction syndrome is an overuse injury felt as a pain on the lateral side of the knee, commonly as a result of the full knee compression that occurs in the catch position (3). It is associated with tightness in the Iliotibial band (ITB) and weakness through the hip abductors (3), therefore it is important that we work to improve hip abductor strength as well as stretch and lengthen the ITB – this might involve (1):

  • ITB stretch 
  • Banded clam 
  • Cable abduction

Summary

So there you have it – the repetitive and demanding nature of rowing results in high risk of injuries, however, with some critical planning and programming including strength training and mobility we can help to reduce the risk of these injuries occurring. 

References

  1. Gee, T. I. Olsen, P. D. Berger, N. J. Golby, J. & Thompson, K. G. Strength and Conditioning practices in rowing. Journal of Strength and Conditioning Research. 25: 668-682. 2011. 
  2. McDonnell, L. K. Hume, P. A. & Nolte, V. Rib stress fractures among rowers. Journal of Sports Medicine. 41: 883-901. 2011. 
  3. Rumball, J. S. Lebrun, C. M. Di Ciacca, S. R. & Orlando, K. Rowing Injuries. Journal of Sports Medicine. 35: 537-555. 2005. 
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Travelling Athlete Tips

Want to travel as an athlete?

As a young athlete today the lure of travel can be quite compelling when finishing school or university; the excitement of discovering the world that is around you, meeting new people, and breaking that potentially dull routine. You may be reluctant to take that jump as an athlete because you are worried about your training and how it may be affected while you are away; feelings that are common among athletes, particularly when their world revolves around their sport and performance. There is however no reason to worry – overseas travel does not mean that the training and hard work has to stop.

As a keen runner and strength and conditioning coach it was definitely a concern of mine when deciding to travel overseas this year. I may not be an elite athlete but training, competing and staying in shape are engrained into me so it was difficult to think that I may not be able to maintain these. Too strong though was the lure of discovering the world around me while I was still young, thus I decided to take that metaphorical leap. Being a runner made maintaining my training a little easier given that all I needed was a pair of runners and a map… don’t want to get lost in a foreign city. Strength training would prove a little more difficult to adhere to, but given my work as a coach this was something I wanted to maintain as best as I could whilst away. With a little imagination and a keen eye there was no need to worry at all. Creativity is imperative on occasions when a gym is unavailable, however resistance bands, a bench, stairs or any other structure can serve as an able replacement.

Resistance bands are a fantastic tool for adding difficulty to an exercise when conventional weights are not available, while they are also super light weight and easy to pack. Further, many fantastic body weight exercises are effective at building strength and should be staples even when you have an abundance of equipment.

An example program is outlined below:

Warm-up (2 sets only)
1. Banded lateral walk/monster walk x10 each way
2. Banded fire hydrant x 10 e/s

Workout (3 sets ea.)
A1. S/L Squat x 10 e/s
A2. Push ups x 10
A3. SL hamstring bridge off bench x 10 e/s

(3 sets ea.)
B1. Reverse lunge x 10 e/s
B2. Banded rows x 10
B3. SL calf raises x 15 e/s

(2 sets only)
C1. Side plank x 45sec e/s
C2. Banded dead bug x 10 e/s



Keep in mind this is just an example which you can change depending on your sport/injuries/ability and what facilities you have around you. What else can I do? Bikes are in abundance around the world and are a fantastic cross training tool, while serving as an inexpensive way to see a city that you may be in. Pools are also universally available and generally quite affordable, again offering a cross training option with low impact which is ideal when away from your routine.

Flexibility is key when on holidays – be creative with your routine, and be open to change, i.e. planning training around activities. Diet structure may provide additional concerns when travelling; again look to be creative and cook yourself, or alternatively head out for a meal, researching establishments that sell freshly made dishes with an abundance of nutrients, although this may cost a little more. The occasional treat will not affect your training as long as a consistent diet is maintained, so go out and indulge in that local delicacy you’ve been eyeing off, and the mental benefits that come from this will likely outweigh the negative of the potentially poor nutritional value. Personally, I struggled thinking that if I tried too many of the unhealthy local dishes, my training would be impacted. With a little persuasion at the start of my trip and a conscious effort not to have too much, I have managed to try different foods from the countries that I have visited, all without it impacting my training.

If you are an athlete finishing school or university and dreaming of a big adventure overseas, but are a little anxious about how it may impact your training – prepare, be creative, have an open mind and you will manage to smash your training. When you are young with few commitments it is the perfect time to take that leap, so my advice is go out and explore, learn and develop, and most of all enjoy yourself!