If you love cycling and don’t want to see your orthopaedic surgeon…

During 2020’s first lockdown in Melbourne, Andrew dusted off his bike and started riding in to our rooms in East Melbourne. Within weeks, he had lost weight, increased muscle mass, his already high energy levels were even higher and he just felt better. He was soon chatting to patients about cycling and to just about everyone he saw! Here began the journey from Orthopaedic surgeon discussing the benefits of cycling with patients, to seeing the benefits himself.

After many mornings of Andrew coming into the rooms, super excited about cutting 2 minutes of his cycling trip, hitting a higher average speed and what he did on Zwift the night before, we decided that he should put his thoughts on paper (virtual paper) and let us know about the benefits of cycling and how it can help you from having to see him!

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Benefits of Cycling

While there are many benefits to cycling, Andrew wanted to focus on the benefits that keep cyclist from having to see him.

• Cycling is a low-impact exercise. This means that cycling limits impact stress on weight-bearing joints, like your hips and knees.
• Adjustable intensity: Bicycling can be done at a wide range of intensities. If you tend to go a little slower, you can coast once in a while, or use the lower gears to ease the burden on your legs. Research has shown in people with knee osteoarthritis, low-intensity cycling is as effective as high-intensity cycling in improving function and gait, decreasing pain, and boosting aerobic fitness.
• Muscle strengthening: When the bike’s pedal resistance is moderate, it not only promotes range of motion at the hip and knee, but also strengthens your quadricep muscles (on the front of your thighs). Pedaling works your glutes and hamstrings (on the back of your thigh), to a lesser degree. Strong muscles help support and protect your joints.
• Weight control: Excess weight can exacerbate inflammatory arthritis, as well as put increased pressure on your joints, particularly your knees.

Some things to be aware of

Pain – If you experience ongoing pain, the common-sense answer to any ongoing pain is to stop what you’re doing and seek professional advice.

There are two main types of cycling injury, other than the obvious flesh wounds and breakages caused by the trauma of falling off. They’re the less impressive ( “believe me” says Andrew who has found himself off his bike a number of times)— but sometimes no less painful — strains and pains caused by overtraining, and injuries resulting from biomechanical stress caused by muscle imbalances or incorrect bike set-up.

Hip pain

Probable cause: Piriformis syndrome. Also known as wallet syndrome, because of where it hurts, this is often caused by overtraining and specifically by overworking the gluteus maximus muscles in your buttocks.

The piriformis itself is a small muscle that rotates the leg outwards. As this isn’t a movement that cyclists need to do much, the muscle can shorten and weaken. If overstressed, it can build in size to the point of putting pressure on the sciatic nerve, causing pain or numbness down the leg or in the hip — which is why it’s a common cause of sciatica.

Treatment: If this injury has been caused by an imbalance between muscles, where the underused piriformis becomes weak, the solution is fairly simple. By strengthening it, the tightness will ease off and often the pain will disappear too. Your allied health professional (eg. physio, chiro, osteo, myotherapist) is the best person to assist with this.

Knee pain

Probable cause: Although knee pain is one of the most common areas of complaint from cyclists — followed by back and then neck — it can be difficult to diagnose.

One of the most common cyclist knee complaints is pain in the kneecap. “This is likely to be the overuse injury, patellofemoral pain syndrome or chondromalacia patellae,” says Andrew, “where the under surface of the patella becomes inflamed, usually because tightness or weakness in associated muscles moves the kneecap in a way it shouldn’t as you pedal.” If the kneecap rubs on the bones behind it, this can irritate and inflame the cartilage at the back of the cap.

The same problem can be caused by your iliotibial band over-tightening and pulling the kneecap out of line — again causing it to rub against underlying bones.

One of the most common fundamental causes of lower body and knee pain in cyclists is actually a small muscle on the outside of the hip called the posterior gluteus medius. This muscle is quite important for stabilising your hip and preventing your knees rolling inwards, and when weakened by an over-tight IT band can be the cause of many painful problems, including medial knee pain, anterior knee pain and even lower back pain.

In runners this is one of the biggest causes of patellar tendonitis or Achilles tendon injuries.

Treatment: If the knee pain is acute, the first course of action is to apply what the experts call RICE — Rest, Ice, Compression and Elevation — and then see your allied health professional. The aim is to treat the swelling of the knee and release the IT band, but most importantly get to the cause of the tightness that caused the problem so that it doesn’t recur.

Things that can help

• Ride the right bike for the right purpose. If you’re riding on rough terrain, you need a mountain bike with bigger tires that will absorb the consistent shock of the ground.
• Make adjustments for your body type. It is imperative that proper body mechanics are used in physical sport. When you purchase a bicycle, have it adjusted for your body before leaving the shop.
• Learn how to pedal. Yes, this is a real thing. The salesperson who sells you a bicycle should be able to discuss or even demonstrate a proper pedaling technique.
• When riding, learn how to distribute your weight from the back to the arms and back again, so no muscles are forced to support the body at all times.

As always, if you would like to discuss how cycling can help, or if it is causing your problems, please contact our rooms, we are here to help.