By Ricardo Colberg, M.D.
The weather is gorgeous. The bike is running like a dream. The road is open and there’s nothing standing between you and a long ride. That is, until the pain sets in. But you’re in peak shape; you’ve been riding all summer. Your legs are strong. Your lungs are full. What could be the problem?
It’s not at all uncommon for even the most seasoned rider to experience muscle, joint and nerve fatigue as the summer miles add up. The most common mid- to late-season injuries among riders from recreational to the professional ranks are in the hands, back and knees.
The good news is that most of these are just a few tweaks and stretches away from being relieved, keeping you on the road through the rest of the summer and into the fall. I’ll provide some practical advice for how to avoid and alleviate the pain we’re all prone to suffer from time to time in our hands, lower back and knees, what to do in the off-season to help avoid suffering from these maladies during the riding season and, finally, a general rule of thumb to know when it might be time to seek medical assistance to deal with a particularly troublesome issue.
Hands: Our Most Important Tool on the Bike
Think about it: Our hands are perhaps the most important tool we have on a bike. They’re our steering, braking and gear-shifting mechanism. So when they go numb, we lose much more than feeling.
Cyclists’ palsy is a condition where the ulnar nerve, which runs from the outside of the wrist to the pinky finger, becomes pinched and irritated due to excessive pressure being placed on the hand. Mild symptoms of cyclists’ palsy range from temporary numbness and tingling while riding to lingering numbness after the ride that may take a few hours to resolve. Severe symptoms include significant hand weakness and permanent numbness.
While typically an ailment faced by beginners, riders of any experience level can be at risk if they are riding an ill-fitted bike or they do not have proper back and core strength.
A properly fitted bike is key to ensuring that a rider’s center of gravity is balanced. If the center of gravity is off and the body is pitched forward, too much pressure will be put on the hands and the ulnar nerve. Enlisting the advice of a professional fitter – an expert who knows the mechanics of both the bike and the body – is highly recommended to ensure that you and your bike are one.
A handlebar and tape job that provide a wider and thicker platform can also help take pressure off the ulnar nerve. Additionally, moving your hands to different positions on the bar throughout a ride can help change the pressure points.
Strengthening your back will also help relieve the pressure put on your hands. When you’re leaning over the handlebars, if your back muscles are too weak, you break posture and transfer pressure to your hands. A strong back will allow you to support your weight, keeping your center of gravity properly balanced over the saddle, pedals and handlebar, and not placing too much pressure on your hands.
When you do suffer from cyclists’ palsy, it is important to address the condition as soon as possible. Nerves are very delicate and take time to heal. If the tingling and numbness do not resolve within 24 hours, seek medical advice. Once the condition reaches a more severe stage, it can take a year or more to heal, which can lead to permanent muscle atrophy and weakness.
Back: Biomechanics More Important than Fit
Among the most common injuries for cyclists to suffer at the height of riding season are those that occur in the back. When the body is in a sitting position and leaning forward, increased pressure is placed on the back, particularly the lower back and lumbar area.
This increased pressure can result in lumbar muscle strains or more serious conditions, including degenerative injuries of the lower disks like herniation and pinched nerves.
While a properly fitting bike helps support proper alignment and alleviates some back pain, biomechanics can play an even bigger role.
Building proper core and lower back strength with weight and strength training is very important. Deadlifts, good mornings, sit-ups, superman and swimmer exercises are all great for strengthening this area. Additionally, it is imperative your legs are properly stretched, as tight hamstrings and hip flexors in your pelvis can cause restriction and put added pressure on your lower back.
Before and in between rides, do regular hamstring and hip flexor stretches, like seated and standing toe touches, and pigeon and spider-man stretches. Using a foam roller is another good way to keep these muscles stretched and loose.
Knees: Three Forms of Pain Possible
The last of the common in-season afflictions is knee pain, which mostly presents in three forms: front, inside and outside (referred to as anterior, medial and lateral, respectively).
Anterior knee pain is typically caused by a seat that is too low, resulting in added pressure on the knee. It is an injury seen more in those who ride lower for the type of activity they are doing (e.g., mountain biking, BMX and freestyle biking), but an ill-fitted road bike can be a culprit, as well.
Like the other injuries, if not addressed, anterior knee pain can progress into much more serious conditions like patellar chondromalacia, where the under-side of the knee deteriorates and develops arthritis. Again, make sure your bike is fitted properly, paying special attention to the seat height.
If the pain is on the outside of the knee, it is likely caused by tightness in the IT band, hip flexors and/or hamstrings in the lateral aspect of the knee. Daily stretching routines, like those listed above, in addition to cross-foot toe touches, clamshell and band walk exercises will help loosen these areas and alleviate the pain.
Finally, pain on the inside of the knee is most often the result of poor positioning of the feet at the cleat-pedal interface. Rotating the foot too much to the inside can put strain on the medial collateral ligament and joint capsule. Correcting that alignment so the pressure is put more on the center of the knee will be the best solution.
Off-Season Conditioning: Best Means to Avoid In-Season Problems
In much of the U.S., and around the world, it’s difficult to ride year-round, which presents some unique challenges for keeping our bodies in top performance shape. Making a habit of regular exercise throughout the week during the off season will benefit riders once the weather warms up.
Weekend warriors – those that sit at a desk for eight hours a day and then go for long rides on the weekend – are at a much higher risk for injury than those that stay active throughout the week. So, building in time for exercise throughout the week is critical to staying conditioned in the off-season, and also to avoiding injuries during the riding season.
Following the American Heart Association’s recommendations of getting 30 minutes of exercise at least five days a week is a great way to stay in good physical shape.
But for cyclists, it’s important to vary the exercises you are doing, focusing on both aerobic and strength training. In addition to riding the trainer, and possibly working out on an elliptical or treadmill, weight and strength training on your core, legs and back are key. Also, flexibility exercises, like yoga and Pilates, are a great way to maintain and increase range of motion.
Working on the things detailed above that can help alleviate pain during the season are among the best conditioning elements to focus on in the off-season, too. Doing so can help you avoid those common in-season injuries altogether.
Know When to Seek Medical Assistance
To be sure, minor aches and pains come with virtually any prolonged physical activity – no matter how much work we’ve put in to try to prevent or avoid them.
We cyclists typically know our bodies pretty well, but we can be an obstinate group in terms of trying to ride through the pain and not take days off or see a medical professional until things have reached a crisis point.
In short, it’s important to know when these types of injuries have gone from general soreness to something that requires more attention. And to seek that attention sooner rather than later in the process.
Here’s a general rule of thumb to follow: When you have moderate to severe pain (think five or more out of 10 on a pain scale) or when symptoms persist for more than three days, it is best to seek medical assistance from a board-certified sports medicine physician, physiatrist (physician specialized in musculoskeletal and nerve injuries), or orthopedic surgeon.
Ricardo E. Colberg, M.D., is a sports medicine and non-operative orthopaedic physician at the Andrews Sports Medicine and Orthopaedic Center in Birmingham, Alabama. He is medical director for the Jacksonville State University Gamecocks, and head team physician for the Birmingham Blaze semi-pro football team and the Birmingham Hammers semi-pro soccer team, among other teams. He has also worked as team physician for the U.S.A. Paralympic Team. An avid cyclist, Colberg is a member of the International Bicycling Association (IMBA, BUMP).