Sports Medicine: Just the Facts

Lateral

• Iliotibial(IT) band friction syndrome/tendintitis


• Causes:(1) Bicycle-fit problems (improper cleat place-
  ment, seat too high or too posterior). (2) Anatomic
  (hyperpronation, genu varum, tight IT band, leg length
  discrepancy).


• Treatment:(1) Adjust cleats, lower seat, move saddle
  forward. (2) Consider cycling orthotics. (3) IT band
  stretching. (4) Rehabilitation and knee strengthening.

Posterior

• Biceps femoris tendinitis, semimembranous tendinitis,
  posterior capsule strain


• Causes:(1) Improper training (too aggressive, too
  much riding out of saddle. (2) Bicycle fit (saddle too
  high, too far anterior, cleats improperly set).


• Treatment:(1) Review and adjust training plan. (2)
  Move seat up and/or back, adjust cleats. (3) Rehabi-
  litation and knee strengthening.

SHOULDER
•Weight is borne through shoulder joint

1. Subacromial bursitis


2. Rotator cuff tendinitits

NECK

• Common in up to 60% of riders (Mellion, 1994)
  
  
  1. Most commonly caused by increased load on the
     arms and shoulders necessary to support the rider
     and the hyperextension of the neck in the horizon-
     tal riding position.
  
  
  2. Bicyclists may develop myofascial trigger points
     in neck (levator scapula, splenius capitis, trapezius,
     sternocleidomastoid, infraspinatous, supraspina-
     tous, and rhomboid muscles).
  
  
  3. May treat by raising handlebars or shortening the
     stem extension to reduce the amount of hyperex-
     tension of the neck. Strength and flexibility exer-
     cises may also be used.
  
  
  
  

BACK

• The low back muscles are primarily what a cyclist uses
  for control and generation of power. Chronic fatigue
  and pain may develop due to position on bike. In older
  cyclists, may also be a component of degenerative disk
  changes. Must also consider leg length discrepancy, de-
  conditioning, and other conditions that increase muscle
  tension (stress, anxiety, depression) (Mellion, 1994).
  1.Management: Strengthening, flexibility, and/or
  weight loss and posture improvement
  2. On-bike: Change positions, push lower gears, use
  higher cadence, rise from saddle on climbs.
  3. Review bicycle fit. Move saddle forward—if effec-
  tive top tube length is too great, extension will
  exaggerate a lordotic lumbar posture.

HANDS

• Ulnar neuropathy: Ulnar nerve is compressed in
  Guyon’s canal. Pain, numbness, tingling lateral 4th
  and 5th fingers secondary to compression of the
  ulnar nerve on the handlebars. May be acute or
  chronic with sensory changes most often occurring
  first.


• May be treated with padded gloves, increased handlebar
  padding, change hand position frequently while riding.


• Carpal tunnel syndrome: Numbness and tingling in
  thumb, index, middle, and ring fingers caused by
  median nerve compression.
  •Tenosynovitis: Tendons of the extensor pollicis
  brevis and abductor pollicis longus (De Quervain’s).
  Usually caused in mountain bikers by tight gripping
  of the handlebars on difficult terrain (Richmond,
  1994).

FOOT/ANKLE

•Paresthesias: Numbness and tingling in feet

1. Cause: Tight shoe straps and increased pressure on
   pedals


2. Course: Usually self limited
   3.Management: Loosen straps, ride at higher
   cadence to reduce pedal pressure
   •Metatarsalgia: Pain over metatarsal heads


3. Cause: Poor foot position, increased pedal pressure.
   May be caused by pes planus or hyperpronation.


4. Management: Adjust cleats or consider cycling
   orthotics.

• Achilles tendonitits
  •Plantar fasciitis

HIP

•Trochanteric bursitis: Caused by repetitive sliding of

fascia lata over greater trochanter.

• Iliopsoas tendinitis: Pain in medial proximal thigh
  
  
  1. Usually because seat is too high.
  
  
  2. Lower seat height, evaluate frame size.
  
  
  
  

GROIN

• Saddle sores: Caused by friction, pressure then infec-
  tion may be prevented with chamois cream.
  •Crotchitis (tinea cruris): More common in women
  secondary to warmth and wetness.


• Ischial tuberosity tenderness: Eases with continued
  riding.


• Pudendal neuropathy: Compression of dorsal branch of
  pudendal nerve between bike seat and pubic symph-
  ysis.
  
  
  1. May last several minutes to several hours.
  
  
  2. May be prevented by adjusting seated position
     every 5–10 min on the ride or by tilting saddle
     slightly downward.
  
  
  
  

484 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS