One of my favorite populations to treat are the lifelong athletes, especially those who share a love of one of my favorite sports: cycling. Cycling has been a huge part of my life for the last 10 years! Between commuting around Atlanta, riding mountain bike trails and gravel roads, and road biking, I’ve spent a lot of time on a bicycle and really enjoy it.
During PT school I was commuting longer distances around Atlanta and then riding for fun during my free time. I experienced a variety of different aches and pains including, neck and shoulder pain, IT band tightness, anterior knee pain, and various hand and wrist issues. The most frustrating part of being injured was how little fun cycling became with pain joining me on and off the ride.
Whether someone is just getting started riding or trying to compete at a high level, I think they would benefit from physical therapy and a mobility/strengthening plan for pain relief or improved performance. Regardless of an individual’s goals within cycling, my hope is that they always keep riding! To paraphrase Confucius, “It does not matter how slowly or quickly you go as long as you do not stop.”
When it comes to working with cyclists, I think two things must be considered when trying to understand cycling-related injuries in physical therapy: the bike and the technique. We know some great bike fitters around Atlanta that we can direct you to if bike fit is the issue, but technique often comes down to posture on the bike, gear shifting strategies, and other factors the rider can adjust...which we can help with!
Beyond the cycling specific factors, the diagram below illustrates how I like to approach any athlete’s plan of care in the PT setting. Since most of us out there riding bikes have much more happening in our life aside from riding, it often helps to consider some other things that may be contributing to the problem beyond just the bike.
I’m a big fan of massage and foam rollers and other things like that for addressing pain, however, I find in the clinic with more chronic or stubborn injuries that it’s often beneficial to zoom out and consider other factors. One’s training program can help prevent injury and lead to long term pain reduction.
There’s strong evidence1-2 that strength training in addition to cycling improves performance. Strength training has also been shown to reduce back, neck, and shoulder pain in the long term. A good program that focuses on core and posterior chain strengthening can only benefit someone who spends a lot of time riding their bike.
Sleep and diet are very important in recovery and creating an environment where your nervous system can handle the stress placed upon it from life and miles spent riding a bike. This idea of stress on the nervous system or strain can be measured with devices such as the Whoop. The whoop can be a great way to monitor your sleep and check the quality of sleep you may be getting. This device measures heart rate variability which lets you know whether you are in a period of sympathetic (low HRV) or parasympathetic (high HRV) activity. They have found that low HRV can lead to increased pain with higher levels of activity.4 Getting enough sleep and eating well will improve a cyclist's ability to recover from longer training rides. Check out this blog our team wrote on everyday ways to improve your sleep and nutrition. If you have any specific nutrition questions, we work with Allyson Balzuweit, MPH, RDN/LD who is a great resource for nutrition and athletic performance.
Finally, the mobility tools are the icing on the cake that are great for addressing pain and discomfort that naturally come with cycling. I do some of this in the clinic through manual therapy and then I like to show my client how they can get similar results at home with different mobility tools.
While sound nutrition, good sleep habits, and a solid strengthening and mobility program would benefit anyone’s health, the extent to which one needs to follow this pyramid should go with their goals. For example, if you enjoy riding the Path or the Beltline 2-3x/week at 1-10 miles at a time you probably do not need as comprehensive of a training program as someone who’s trying to be competitive above the Cat 3 level and compete in regional to national level races. My goal for any cyclist who comes in is to meet them where they’re at, resolve any pain or dysfunction, and show them how they can best manage their injuries or pain so they can ride longer while feeling strong and healthy.
If you are a cyclist and injuries and pain are stopping you from riding, give us a call. At Functionize, we believe that everybody has an inner athlete, whether they enjoy cross-country riding or cross-stitching. Just like every athlete performs at a high level, so should you. No matter what stage of life you’re in, our goal is to help you remain active so you can thrive and enjoy the best years ahead.
Thanks for reading!
Tyler Balfour, PT, DPT
Tyler and his family currently live in Decatur where he enjoys rock climbing, cycling, running, golf, and playing yard games in his free time. Being outside and moving energizes him and he seeks to use the highest quality of care to help his patients overcome physical impairments so they too can get outside and move.
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Sources:
Vikmoen O, Rønnestad BR, Ellefsen S, Raastad T. Heavy strength training improves running and cycling performance following prolonged submaximal work in well-trained female athletes. Physiol Rep. 2017;5(5):e13149.
Vikmoen O, Rønnestad BR, Ellefsen S, Raastad T. Heavy strength training improves running and cycling performance following prolonged submaximal work in well-trained female athletes. Physiol Rep. 2017;5(5):e13149.
Pyramid - Institute of Clinical Excellence Course
Williams et al 2017. Heart Rate Variability is a Moderating Factor in the Workload-Injury Relationship of Competitive CrossFit™ Athletes