Dealing with Common Cycling Injuries

by Fred Matheny

With warm weather’s greater riding volume, the risk of injury and illness increases. Hard training can suppress the immune system, making you more susceptible to colds and other respiratory infections.

Below is quick primer on common injuries and health problems that plague riders as they begin their seasons in earnest.

Colds and Flu

Nearly everyone catches a cold now and then. It’s especially frustrating in the spring when you’re eager to boost training. Follow these rules if you start getting the sniffles.

• REST. Couch time gives your body extra energy to fight infection. Cut back on work hours, take a sick day or procrastinate on home chores to buy more down time.

• PUMP FLUIDS. Use them to wash down a few hundred extra milligrams of vitamin C at each meal.

• USE COLD REMEDIES WITH CAUTION. Many contain ingredients to treat all possible cold symptoms, several of which you may not have. Alka Seltzer Plus cold medicine is a basic formula that seems to work well for standard head colds.
  
  If you’re a racer, beware of over-the-counter cold remedies that contain pseudoephedrine (most do). This is a stimulant and a banned substance. You’ll probably test positive for drug use. For the rest of us, a cold medicine makes the activities of daily life considerably more comfortable.

Some riders pride themselves on “training through” a cold. I know—it’s hard to stop training just when the weather is improving and you’re making real progress toward your goals. But don’t force it, especially in the first couple of days when you don’t know the extent of the illness. A hard ride could turn an average cold into something worse. Or instead of a cold it could be the flu, a severe illness you can’t afford to play with.

Certainly, if you don’t feel like riding, stay home. You’ll be farther ahead if you devote several days to recovery. If you try to train through, you could lengthen the cold, slow your recovery and take much longer to return to form.

TIP! Use the above-the-neck rule. When cold symptoms are from the neck up (sneezing, stuffy nose), it’s usually OK to exercise lightly. But when symptoms are also below the neck (coughing, chest congestion, muscle aches), don’t train. Once you’re feeling better again, do at least one week easy for each week you were off the bike.

Don’t forget to get a flu shot each fall. It can prevent lots of physical misery as well as the mental anguish of seeing a month of your season go to waste.

Knee Pain

Spring is the season for sore knees. In fact, one common version of inflamed knee tendons (tendinitis) is known as “spring knee.”

When your hinges start hurting, here’s a general rule from Andy Pruitt, EdD:

If the pain is in the front of the knee, your saddle may be too low. If the pain is in the back of the knee, the saddle is probably too high.

In spring, however, the cause of bum knees is often overuse rather than improper saddle height. If you’re still in the weight room doing squats or leg presses, your knees may protest when you add longer or harder rides. Another cause is using big gears before your tendons and ligaments are ready for the 53-tooth chainring. Not covering your knees when it’s cooler than 65F degrees can inflame tendons, too.

Knee tendinitis usually takes one of 2 forms.

• PATELLAR TENDINITIS. Pain develops in the front of the knee, below the kneecap (photo). It hurts while riding, perhaps when you walk up stairs, or merely when you touch the ten- don. There may be swelling. Your knee might squeak when bent, indicating that the tendon’s lubrication is lacking.
• SPRING KNEE. This is marked by sharp pain at the top of the kneecap. The kneecap is triangle-shaped with one point at the bottom. The pain of spring knee is usually felt on the right or left points on top.

Knee Treatment

1. APPLY ICE (in a plastic food storage bag) 1-3 times a day for 15-20 minutes each time. Protect your skin with a washcloth. Place the ice bag on the injured area and hold it in place with an elastic bandage. Remove the ice for at least 30 minutes before another session.

2. TAKE A NSAID (non-steroidal anti-inflammatory drug) with food. Ibuprofen works well for many riders.

CAUTION! NSAIDs can be dangerous. Excessive doses combined with dehydration can cause kidney problems. Never exceed the manufacturer’s recommended dose. This is especially important on a tour or during periods of heavy training when you might become dehydrated.

3. APPLY A COUNTER-IRRITANT. When you get back on the bike, consider using a heat rub that encourages more blood flow to the area. Check with a pharmacist to see what’s available over the counter. Then shield the injured knee from cool wind with a light coating of petroleum jelly. Always wear knee-protecting knickers, leg warmers or tights if the temperature is below 65F degrees. You’d be wise to raise this to 70 if you’re already hurting. Use low gears and a high cadence. It often helps to raise your saddle 3-4 mm.

If you’re still having problems, revise your training plan to increase mileage more gradually. Get a professional bike fit from a USA Cycling coach, reputable bike shop or a sports medi- cine facility with knowledge of cycling. Make sure this includes cleat positioning. As a last resort, see a physical therapist.

ILIO-TIBIAL BAND FRICTION SYNDROME. This knee injury is named after the wide sheath of fibrous material that extends along the outside the thigh from the crest of the hip bone to slightly below the knee. The lower end crosses a bony protuberance on the side of the knee (photo). This is the area that’s irritated.

Symptoms are a sharp, stabbing pain around the bony bump. It can feel like someone is stabbing you with an ice pick, especially at the top of the pedal stroke.

IT band problems are usually caused by an overly narrow stance on the bike, badly adjusted cleats or a saddle set too high. Bowlegged riders and those with flat feet are susceptible too.

To treat this injury, apply ice and take NSAIDs as mentioned above. Widen your stance on the bike by moving your cleats as far to the inside of the shoe soles as possible. Pedals that allow feet some free rotation usually help. Lower your saddle about 6 mm. (IT band friction syndrome is one of the few knee problems where the saddle should be lowered rather than raised.) Over-the-counter arch supports or custom orthotics usually help.

If these fixes don’t relieve the pain in one day, stop riding. Once this injury gets established, it’s hard to correct.

While you’re off the bike, see a physical therapist for instruction on stretches designed to treat the problem. In advanced cases, surgery may be necessary.

Upper-Body Discomfort

Soreness between the shoulder blades, low-back pain, neck strain and aching triceps often accompany hard, hilly or long rides in spring.

Remedies:

1. CHECK BIKE FIT. Your reach to the handlebar is a crucial dimension. Stretch out too far and your triceps and low back will ache. So will your neck as you strain to see up the road. As you lean far forward, the saddle nose can press into you uncomfortably.

Conversely, a reach that’s too short causes you to hunch, putting stress on upper-back and shoulders. You sit excessively upright, putting too much weight on your crotch.

The rule for reach: When you’re riding comfortably with hands on the brake lever hood and elbows slightly bent, the handlebar should block your view of the front hub.

This is a guideline, of course, and doesn’t work for all riders. If in doubt, get a professional bike fit for additional self-help information.

2. STRENGTHEN MUSCLES. A basic upper-body weight training program, such as the one in chapter 3, will help prevent muscle soreness on long rides.

3. MOVE AROUND. Locking your body into one position for long periods is a sure way to make muscles seize. Stand up, sit down, move forward and back on the saddle. Change hand positions frequently.

Saddle Sores

It rarely fails. Just when spring training is going well, your crotch becomes tender, abraded or even invaded by an open wound or boil. Suddenly you’re riding in pain—or not riding at all.

Most medical experts think that boils are caused by skin bacteria that invade surface abrasions. Remedies have come a long way since riders put a slab of raw steak in their shorts to cushion the abraded area. Of course, avoiding saddle sores is better than curing them.

Here’s how:

• CHECK BIKE FIT. If your saddle is too high, your hips will rock and rub soft tissue on each pedal stroke. If the saddle is too far to the rear, you’ll slide forward onto the narrow nose where your crotch bears the weight that your sit bones should be supporting.
  
  If you suffer from chronic saddle sores, have your position checked by a USA Cycling- certified coach or knowledgeable bike shop personnel.
  
• CHANGE POSITION. When sitting, slide to a different part of the saddle every few minutes. Stand as frequently to take pressure off your crotch. Get out of the saddle on short hills or while accelerating away from stop signs. At the back of the paceline, stand and stretch. If the saddle isn’t touching your crotch, it can’t irritate it.

• WEAR HIGH-QUALITY SHORTS. The liner should be large, soft, lightly padded and have no seams or at least flat ones. You’ll probably need to buy different brands to find that one that your anatomy really likes. Women often do better with shorts cut for the female anatomy. If the liner isn’t one piece, it should be sewn with a curved “baseball” pattern to avoid a center seam.

• FIND A SUPPORTIVE SADDLE. Saddle choice is crucial, of course. Don’t be fooled by large, cushy seats. Excessive width will rub your inner thighs. Too much padding lets your sit bones sink deep, putting pressure in the center where you don’t want it.
  
  Depending on your anatomy, some narrow saddles won’t support you on your sit bones. They put too much weight on soft tissue that soon becomes irritated. Trying different saddles can be- come expensive, so trade with other riders or find a bike shop that has a demo program.

• LUBE YOUR CHAMOIS. To reduce friction between the shorts liner and your skin, use Chamois Butt’r or a similar lubricant. Rub a dab into your crotch before you put on the shorts. Water washes away most lubes, so break out the petroleum jelly on a rainy day. It’s greasy and stays on your skin and shorts in soggy conditions.
  
• CLEAN UP. Always ride in clean shorts. If you’re prone to problems, wash your crotch with mild soap and warm water, then dry well and lube up before donning your shorts.
  
• CAUTION! Avoid hanging around in sweaty shorts after a ride. Bacteria love a damp and dirty environment. Shower as soon as possible after riding and put on loose, well-ventilated clothing. If you’re at an event and can’t wash, at least change out of your shorts and wipe down. Moist towelettes that pop out like tissues work well. Get an antibacterial brand.
  
• TIP! Ask your physician about a prescription for a topical antibiotic called erythromycin (Emgel). After each ride, rub a dab on any irritated “hot” spots. Ed Pavelka turned me on to this medicine before our transcontinental PAC Tour. We rode 3,400 miles in 24 days and neither of us developed a saddle sore.

Sometimes you will still develop a saddle sore, despite your best preventative efforts. A couple of days off the bike will help it heal. But if you’re in a situation where you must continue riding, try these fixes:

• SWITCH SHORTS OR SADDLES. Your problems are probably isolated to one small area—a boil or abrasion—so changing your saddle or shorts can change the pressure. Some people on sagged multi-day tours take a spare saddle mounted on a seatpost. They switch every couple of days to avoid concentrated irritation.
  
• USE A HEAVIER LUBRICANT. If you’re getting abraded, try a more viscous lube. A favorite of long-distance riders is Bag Balm, designed for sore cow udders but available in most pharmacies. It has healing properties, too.

These tips will hopefully keep you injury free this spring, or at least help you recover faster.