Pain In Cyclists Research Articles

The effect of cleat position on foot pain in cyclists.

Amateur or non-competitive cycling is one of the most popular and growing sports, and the repetitive nature of this sport, combined with a cleat position that is too far forward, often leads to peripheral ischemia or pressure, which can cause pain at the metatarsal level due to the nerve and vascular structures present at this level, according to several authors. This clinical series describes the work done to reduce pain in 21 cyclists who reported foot pain/discomfort exclusively during pedaling. To exclude different causes of pain, other than the position of the cleat, the cyclists received biomechanical assessments using an indoor bike smart trainer and a 2D motion capture system. The pain was found to be associated with the incorrect positioning of the shoe cleats, which were generally positioned at the level of the phalanges and, according to our hypothesis, in a significantly forward position. Our intervention was to move the cleat back under the metatarsal head in all the cyclists examined. After five cycling sessions, feedback showed significant improvements. The authors were aware of some limitations, such as the small number of subjects studied, the different types of cleats used by different cyclists, and the lack of information on cadence. However, the overall data collected during the study showed a significant improvement of 5 points on the Numeric Pain Rating Scale (NPRS) after treatment. This clinical series supports the hypothesis that cleat retraction improves foot pain in cyclists, but further studies are needed to better characterize and understand the mechanism underlying the development of pain. More methodologically sound studies are needed. The current clinical series is the first of its kind to describe an initial method of reducing metatarsal pain in cyclists.

Effects of Cycling on Spine: A Case-Control Study Using a 3D Scanning Method.

Few studies have investigated the effects of adopting a specific and prolonged posture on cyclists. This study aimed to evaluate the upright spine in a sample of recreational cyclists and compare it with a sample of non-cyclists, though still athletes, through a 3D scanning method. Forty-eight participants were enrolled in this observational study. The sample consisted of 25 cyclists for the cycling group and 23 non-cyclist athletes for the control group. The Spine3D device (Sensor Medica, Guidonia Montecelio, Rome, Italy) was used to evaluate the spine of the participants in both groups. The results showed significantly greater spine inclination in the cycling group compared to the control group (p < 0.01). Furthermore, there was a significant decrease in lumbar lordosis in the cycling group compared to the control group (p < 0.01). This case-control study raises the possibility that the onset of lower back pain in cyclists may be due to a reduction in lumbar lordosis. Furthermore, this study demonstrated that the Spine3D device can be used in sports to monitor the spine of athletes to prevent and reduce musculoskeletal deficits.

Association of Cycling Kinematics With Anterior Knee Pain in Mountain Bike Cyclists.

Comfort and pain in cyclists are often discussed as a result of the posture on the bike, and bike fit, including motion analysis, is advocated as a strategy to minimize these conditions. The relationship between cycling kinematics, comfort, and pain is still debatable. To investigate the association of ankle, knee, and trunk kinematics with the occurrence of anterior knee pain (AKP) in mountain bike cyclists. Cross-sectional study. Fifty cross-country mountain bike cyclists (26 with AKP and 24 without AKP) had their pedaling kinematics assessed. Linear and angular data from trunk, hip, knee, ankle, and foot from cyclists with and without AKP were recorded using Retül motion analysis system. The binary logistic regression model showed that kinematic variables such as peak ankle plantar flexion, peak knee flexion, and forward trunk lean were significant predictors of AKP. Both larger peak plantar flexion and knee flexion decreased the probability of reporting AKP. On the other hand, larger forward trunk lean increased the probability of reporting AKP. Ankle, knee, and trunk sagittal kinematics may predict AKP in cross-country mountain bike cyclists, whereas hip, knee, and ankle alignment in the frontal plane showed no association with occurrence of AKP. In other words, cyclists with larger ankle plantar flexion and knee flexion are less likely to have AKP, whereas those with increased trunk forward lean are more likely to have AKP.

Factors associated with Achilles tendon pain in cyclists in eastern province of Saudi Arabia.

BACKGROUND:Cyclists are predisposed to different types of injuries whose patterns and distribution change over time. During bicycling, the high demand on lower extremities to produce speed places high load on the legs resulting in overuse injuries of which pain in the Achilles tendon is one. This study assessed Achilles tendon pain in cyclists in the eastern province of Saudi Arabia.MATERIALS AND METHODS:This was a cross-sectional study of active cyclists in the eastern province of Saudi Arabia. Data were collected using validated and pretested web-based self-administered questionnaire. Of the 511 cyclists invited, 311 completed the questionnaire yielding 60.62% response rate. SPSS was used for data entry and analysis. Descriptive statistics included calculation of frequencies and percentages for categorical variables, and median, mean and standard deviation for continuous variables. Chi-square test measured the associations between Achilles pain and various risk factors. Student's t-test, or Mann–Whitney test as appropriate, was used to compare continuous variables.RESULTS:Ten percent of mature and 9.1% professional cyclists reported that they had Achilles tendon pain. The pain was reported by significantly higher proportion of cyclists who raced (25%) and cyclists who rode mountain bicycles off-road (60.0%); average duration of the Achilles tendon pain was 7 days. Of the cyclists who had Achilles tendon pain, 32.1% reported that the pain increased when they were in running load and 28.6% reported increased pain in cycling load. Most cyclists described the pain as mild (67.9%) and moderate (32.1%). Overweight and underweight cyclists reported significantly higher rates of Achilles tendon pain (60% and 12.5%) compared to other body mass index classes.CONCLUSION:Achilles tendon pain commonly affects both amateur and professional cyclists. The study underpins the importance of a gradual increase in the training load, proper conditioning, bike fitting, and the maintenance of ideal body weight of cyclists to prevent Achilles tendon pain.

Nyeri Punggung Bawah Akibat Posisi Duduk yang Salah Pada Pesepeda

Background: Lower back pain still occurs in many cyclists. The sitting position is considered to be one of the factors causing complaints of low back pain. This study was conducted to determine the correlation between sitting position and complaints of low back pain in cyclists. Methods: This study employed the narrative review method by collecting ten research articles from the Google Scholar and PubMed databases, identifying keywords using the PEOs format, so that the keywords "Cyclist", "Sitting Position", "Lower Back Pain", and "All Study Design" were used. Results: All articles used were articles published starting in 2010. Seven articles stated that lower back pain occurred more frequently in a sitting position with large lumbar flexion. Six articles stated that the sitting position of a cyclist was affected by the position of the handlebars. Five articles stated that sitting with the lower handlebars resulted in greater lumbar flexion and anterior pelvic tilt. Five articles stated that prolonged lumbar flexion and anterior pelvic tilt resulted in a lower crossed syndrome. Four articles found that lower crossed syndrome contributes to lower back pain. Conclusion: There is a correlation between sitting position and complaints of low back pain in cyclists. However, there are limitations to the article which states that the statistical closeness of the correlation between sitting position and complaints of low back pain in cyclists.

A retrospective international study on factors associated with injury, discomfort and pain perception among cyclists

Although cycling has been associated with overuse/fatigue and acute injuries, there is lack of information regarding associated risk factors and prevention factors. The objective of the study was to determine the factors associated with injury, and perceptions of discomfort and pain in cyclists. A total of 739 cyclists completed an online questionnaire between February and October 2016. The questionnaire acquired information on participant demographics, characteristics related to cycling profile and fitness training, bike components and cycling posture, self-reported perceptions of comfort and pain, and injuries sustained in the last 12 months. Logistic regression models estimated odds ratios (OR) and 95% confidence intervals (95%CI) that examined factors associated with reporting overuse/fatigue injury, acute injury, body discomfort, saddle discomfort, and pain while cycling. Odds of reporting an overuse/fatigue injury increased when the cyclists complemented training with running (OR = 1.74; 95%CI = 1.03–2.91) or swimming (OR = 2.17; 95%CI = 1.19–3.88), and with reported pain while cycling (OR = 1.17; 95%CI = 1.05–3.69) and not cycling (OR = 1.76; 95%CI = 1.07–2.90). Odds of reporting an acute injury increased when biking to work (OR = 1.79; 95%CI = 1.07–2.86), and decreased with increased average cycling speed (1-km/h decrease OR = 0.93; 95%CI = 0.88–0.97), and compared to low-end bike, with the use of mid-range (OR = 0.25; 95%CI = 0.09–0.72) and high-end bike (OR = 0.34; 95%CI = 0.13–0.96). Although body discomfort was only associated with saddle discomfort and the presence of pain during cycling, saddle discomfort was also associated with biking to work (OR = 0.46; 95%CI = 0.22–0.88). Finally, pain perception was associated with a number of factors such as ride to work, core training, cycling experience, saddle discomfort, pain while not cycling. Numerous factors are associated with injury, and perceptions of discomfort and pain in cyclists. Such factors should be considered when developing training routines, bicycle maintenance best practices, and injury prevention programs.

Beneficial Intervertebral Disc and Muscle Adaptations in High-Volume Road Cyclists.

Cycling is widely practiced as a mode of transportation, a leisurely pursuit, and a competitive sport. Approximately half of cyclists experience low back pain. Yet, there has been limited study of spine tissue adaptations due to cycling. To investigate potential risk factors for spinal pain, we compared 18 high-volume cyclists (>150 km·wk for ≥5 yr) to 18 height-matched nonsporting referents. Participants had no history of spinal pathology. Magnetic resonance imaging was used to quantify intervertebral disc (IVD) morphology and hydration, and psoas, erector spinae, quadratus lumborum, and multifidus muscle size and fat content. Endurance of trunk muscles (flexors and extensors) was measured, and physical activity levels were assessed objectively using accelerometry. Cyclists' IVD showed prolonged T2 time (+10.0% ± 17.3%; P = 0.021), implying better IVD hydration and glycosaminoglycan content, compared with referents. Lower thoracic and upper lumbar IVD T2 time were longer in cyclists (P ≤ 0.029) but not at the lower lumbar spine. T2 time differences were larger in the nucleus pulposus compared with the annulus fibrosus. Cyclists showed larger psoas muscles with less fat content compared with referents. Cyclists also exhibited longer isometric trunk endurance times (P ≤ 0.036) and higher physical activity levels (osteogenic index, P = 0.038). Despite previous studies reporting higher than average prevalence of back pain in cyclists, the high-volume road cyclists in our cohort showed no anatomical or functional deficiency in spinal structures. By contrast, we found evidence for beneficial adaptations to the IVD and psoas muscles in high-volume cyclists compared with referents. These data support the notion that cycling is not detrimental to the spine, rather, by contrast, may be associated with beneficial changes at the spine.

Effects of a prophylactic knee bracing on patellofemoral loading during cycling

The aim of the current investigation was to utilize a musculoskeletal simulation approach to examine the effects of prophylactic knee bracing on patellofemoral joint loading during the pedal cycle. Twenty-four (12 male and 12 female) healthy recreational cyclists rode a stationary cycle ergometer at fixed cadences of 70, 80 and 90 RPM in two different conditions (brace and no-brace). Patellofemoral loading was explored using a musculoskeletal simulation approach and participants were also asked to subjectively rate their perceived stability and comfort whilst wearing the brace. The results showed that the integral of the patellofemoral joint stress was significantly lower in the brace condition (male: 70 RPM = 8.89, 80 RPM = 9.76, and 90 RPM = 12.30 KPa/kg s and female: 70 RPM = 11.59, 80 RPM = 13.07 and 90 RPM = 14.14 KPa/kg s) compared to no-brace (male: 70 RPM = 10.23, 80 RPM = 10.96 and 90 RPM = 13.20 and female: 70 RPM = 12.43, 80 RPM = 14.04 and 90 RPM = 15.45 KPa/kg s). In addition, it was also revealed that participants rated that the knee brace significantly improved perceived knee joint stability. The findings from the current investigation, therefore, indicate that prophylactic knee bracing may have the potential to attenuate the risk from the biomechanical parameters linked to the aetiology of patellofemoral pain in cyclists. Future, longitudinal analyses are required to confirm the efficacy of prophylactic knee braces for the attenuation of patellofemoral pain symptoms in cyclists.

Potential factors associated with knee pain in cyclists: a systematic review.

The potential factors associated with overuse injuries and pain in cyclists that are supported by evidence remain unclear. Our study aimed at assessing, using a systematic search of the most updated evidence, the main factors related to overuse knee-related pain and/or injuries in cyclists. The search assessed any potential mechanism related to knee pain or injury that could be used in the clinical practice. Databases were searched (i.e., PubMed, Scopus, Web of Science, and EBSCO). Studies were included if they presented results from original studies. They had to include, preferably but not limited to, recreational and/or competitive cyclists with or without knee pain. Quality of articles was assessed. Eleven articles were deemed eligible for full text appraisal. Studies involved generally the assessment of biomechanical outcomes associated with knee pain in cyclists. Overall, studies showed that cyclists with knee pain present larger knee adduction and larger ankle dorsiflexion and differences in activation for hamstrings and quadriceps muscles. Unclear results were observed for knee moments and no differences were observed for knee flexion angle, tibiofemoral and patellofemoral forces. It is important to state that varied types of knee pain were mixed in most studies, with 2 focused on anterior-related pain. Cyclists with overuse-related pain or injuries on their knees presented an increased medial projection of their knees and an altered activation of the Vastus Medialis and Vastus Lateralis muscles. However, this limited evidence is based on retrospective studies comparing cyclists with and without pain, which limits the conclusion on how cyclists develop knee pain and what are the main options for treatment of knee pain.

Factors associated with lumbo-pelvic pain in recreational cyclists

Background: Overuse injuries in cyclists are as high as 85%, with lower back and pelvis pain (LBPP) being common. The lower back and pelvis are pivotal to powering and controlling the bicycle and essential for optimal functioning, comfort and performance. Cyclists spend long, continuous hours in sustained forward flexion, which is regarded as a main contributor to LBPP. Cyclists with LBPP assume greater lumbar flexion but the reason has not yet been established. Objectives: To identify intrinsic and bicycle set-up factors associated with lumbo-pelvic pain in cyclists. Methods: This study was cross-sectional and descriptive. One hundred and twenty-one cyclists in Gauteng, South Africa, participated in this study. The factors proposed to be associated with LBPP were determined to be namely: lumbar curvature on the bicycle in all three handlebar positions, strength of the gluteus maximus (Gmax) and medius (Gmed), extensibility of the hamstrings, control of lumbar movement in the direction of flexion, neurodynamics, active straight leg raise, one leg stance test for lateral pelvic shift, leg length discrepancy and bicycle set-up (saddle height, set-back and angle, handlebar height, forward reach, cleat position). Results: Only the lumbar curvature in the brake lever position (p=0.03) and weakness of the Gmed (p=0.05) were related to LBPP in cyclists. Conclusion: This study was the first to assess the relationship between the multiple factors described above and LBPP in cyclists. Understanding the relationship between increased lumber flexion in the brake lever position and the weakness of the Gmed and LBPP may lead to the development of strategies to reduce LBPP occurrence.

Lower extremity and spine pain in cyclists.

The number of cyclists increases each year. Some people treat cycling as a passion and practice it at every possible occasion, while for others it is a mean of transport or a form of relaxation at the weekend. However, very few people realize that cycling can also have a negative impact on their health. To assess the prevalence of lower extremity and spine pain in cyclists, and evaluate the influence of various factors causing it. The study was performed on 167 subjects during amateur cycling competitions in the Greater Poland and Kuyavian-Pomeranian Provinces. A specially prepared questionnaire was used in the study. The questions related to the pain caused by cycling, the character and the localization of the pain, and the presence of warm-up and stretching. Knee pain was reported in 40% of the study subjects (mostly anterior pain - 26%). Spine pain was reported in 41% of the studied athletes, where 26% was related with the lumbar spine. Variables, such as age, weight, age, BMI, training experience and number of hours devoted to training per week had no influence on the incidence and the localization of leg pain, but it had influence in the case of spine pain. Stretching after cycling was the factor which significantly distinguished the studied groups with regard to the incidence of knee pain. The most common type of leg pain was knee pain (anterior knee pain) whereas spine pain was most commonly reported in the lumbar spine. Statistical analysis showed that spine pain is more often reported by people who are older, have higher weight, and people who spend more time training per week. Warm-up and stretching after cycling are recommended to cyclists who experience pain.

Kinematic Measures Of The Knee While Cycling

Factors contributing to knee pain in cyclists include deviations from optimal pedaling patterns and poor bike fit. Accurate measurement of kinematics is essential to obtain optimal positioning, but motion analysis equipment cost is an obstacle for many clinicians. PURPOSE: To compare the Retül 3D motion capture system to the Vicon 3D system. A lack of significant difference between devices would support a low-cost option for clinicians working with cyclists. METHODS: Cycling kinematics were captured from eleven competitive female cyclists using a 10-camera Vicon MX system and compared with a cycling-specific motion analysis system, Retül, while pedaling at 70% peak power output on a Velotron cycle ergometer. RESULTS: MANOVA demonstrated no significant difference between systems for knee range of motion (ROM) (mean difference (MD)=0.12°, p=0.96), knee extension (MD=0.12°, p=0.10), knee frontal plane knee angles (MD=2.7°, p=0.15), ankle dorsiflexion (DF) (MD=1.45°, p=0.46) and plantarflexion (PF) (MD=4.51°). However, knee flexion (MD=1.42°, p=0.02), hip flexion (MD=32.83°, p<0.001), hip ROM (MD=3.8°, p<0.001), ankle ROM (MD=3.7°, p<0.001) and measurement of the mean knee distance from bicycle centerline (MD=11.13 mm, p<0.001) were significantly different between systems. ICC indicated moderate agreement between systems for knee flexion (ICC(2,5)=0.52, p<0.001). Linear regression of difference scores on mean scores demonstrate a significant relationship for knee flexion, hip ROM and ankle DF (p=0.66, p=0.10, p=0.38, respectively). CONCLUSION: In general, these data support Retül for use in comparison with Vicon for the measurement of knee extension, ankle DF and ankle PF, which are most relevant measurements for obtaining correct fit on a bicycle. Keywords: Bike-fit, kinematics, agreement

Relationship Between Body Positioning, Muscle Activity, and Spinal Kinematics in Cyclists With and Without Low Back Pain: A Systematic Review.

Context:Low back pain is reported by more than half of cyclists. The pathomechanics and association of risk factors of lumbar spine overuse injuries in cycling are not clearly understood.Objective:To determine whether relationships exist between body positioning, spinal kinematics, and muscle activity in active cyclists with nontraumatic low back pain.Data Sources:In August of 2015 and April of 2016, a comprehensive search of the PubMed, CINAHL, Ovid MEDLINE, and Scopus databases was performed independently by 5 reviewers.Study Selection:Included articles consisted of biomechanical studies examining factors relating to low back pain in cyclists as agreed upon by group consensus.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:Five reviewers appraised by consensus each article using the Downs and Black checklist.Results:Eight studies met criteria for this review. There is evidence that cyclists with lower handlebar heights displayed increased lumbosacral flexion angles during cycling. Core muscle activation imbalances, back extensor endurance deficits, and increased lumbar flexion while cycling were found to be present in cyclists with low back pain.Conclusion:Spinal and core muscle activation imbalances in a prolonged flexed posture associated with cycling may lead to maladaptive spinal kinematics and increased spinal stresses contributing to overuse low back pain.

Cyclists Have Greater Chondromalacia Index Than Age-Matched Controls at the Time of Hip Arthroscopy

To evaluate the clinical symptoms and intraoperative pathology associated with hip pain in the cyclist compared with a matched hip arthroscopy surgical group. In an institutional review board-approved study, we retrospectively reviewed a prospective database of 1,200 consecutive hip arthroscopy patients from 2008 to 2015. Adult patients were identified who reported cycling as a major component of their activity. Patients were age, gender, and body mass index matched to a control, noncycling group. Pain symptoms, preoperative examinations, radiographic and operative findings were compared. Primary outcome variables included the femoral and acetabular Outerbridge chondromalacia grade. Additional outcome measurements included the involved area and the chondromalacia index (CMI; the product of the Outerbridge chondromalacia grade and surface area [mm2× severity]). A total of 167 noncyclists were matched to the cycling group (n= 16). Cyclists had significantly greater femoral head chondromalacia grade (2.0 [95% confidence interval (CI), 1.5-2.5] v 1.4 [95% CI, 1.3-1.6], P= .043), femoral head chondromalacia area (242 mm2 [95% CI, 191-293 mm2] v 128 mm2 [95% CI, 113-141 mm2], P < .001), and femoral head CMI (486 [95% CI, 358-615] v 247 [95% CI, 208-286], P= .001) assessed intraoperatively. Hip pain in cyclists positively correlated with an increased acetabular center-edge angle (R= 0.261, P < .001) and an increased Tonnis grade (R= 0.305, P < .001). Cyclists were also more likely to have a coxalgic gait on physical examination (R= 0.250, P= .006). Cyclists had a greater degree of femoral chondromalacia than a matched group of noncyclists. Cycling activity positively correlated with the presence of femoral chondromalacia with clinically significant gait alterations. These data support the hypothesis that cyclists with hip pain have more chondral pathology than a similar group of other patients with hip pain. Ultimately, cyclists with hip pain should be identified as higher risk for more advanced chondral damage. Level III, case-control study, therapeutic.

Muscle Activation Patterns and Patellofemoral Pain in Cyclists

Patellofemoral pain syndrome (PFPS) is pervasive and debilitating in the sport of cycling. Currently, little is known about the underlying mechanism causing patellofemoral pain in cyclists. The purpose of this study was to determine whether temporal differences in the muscle activity of the vastus medialis (VM), vastus lateralis (VL), semitendinosus (ST), and biceps femoris (BF) were correlated to patellofemoral pain in cycling. Ten healthy cyclists (six women and four men, height = 1.74 ± 0.10 cm, weight = 71.9 ± 16.5 kg, cycling experience = 199.5 ± 82 miles · wk(-1)) and seven cyclists with PFPS (one woman and six men, height = 1.84 ± 0.08 cm, weight = 89.8 ± 9.4 kg, cycling experience = 228 ± 51 miles · wk(-1)) volunteered to participate in this study. Each participant completed a 10-min cycling trial during which surface EMG was recorded for the VM, VL, ST, and BF muscles. Sagittal plane knee kinematic data were recorded using an electrogoniometer. An ANOVA revealed no significant difference between groups for the differences in onset times of the VM and VL (P = 0.805). There were significant differences between groups for the differences in offset time of the VM and VL (P = 0.032), the differences in onset time of BF and ST (P < 0.001), and the differences in offset time of the ST and BF (P = 0.024). Root mean square values for BF activity were significantly higher in the PFPS group compared with the control (CTL) group (P < 0.01), and ST values were significantly lower in the PFPS group compared with the CTL group (P < 0.01). Root mean square values for BF were significantly greater than ST activity in the PFPS group (P < 0.01) but not in the CTL group (P > 0.05). The results of this study indicate that trained cyclists with PFPS exhibit altered temporal characteristics in muscle activation patterns compared with trained cyclists without PFPS.

Revisão etiológica da lombalgia em ciclistas

ABSTRACT: Low back pain is a common disorder in cyclists and it’s occurrence has long been related mainly to a lack of flexibility. The aim of this study was to review the etiologic factors of low back pain in cyclists cited by articles from SciELO, PubMed and Scopus, published from 1965 to 2011, indicated, when appropriate, by books cited in these articles. The results indi-cated that excessive trunk flexion, leg length discrepancy, frame size and/or other components of inappropriate length, poor bike fit or improper bike fit, lumbopelvic muscle weakness, poor flexibility and postural deviations may compromise performance and comfort of the cyclist on the bike, especially during long distance riding and may lead to the development of low back pain. Therefore, the cyclist with back pain should be evaluated based on different variables described in literature with the purpose of identifying the etiologic factors may trigger lumbar dysfunction to make the necessary corrections.KEYWORDS: Etiology; low back pain; cycling; long distance.

Commentary on “Low back pain associated with internal snapping hip syndrome in a competitive cyclistLow back pain associated with internal snapping hip syndrome in a competitive cyclist”

Low back pain is a common problem among people who cycle. This article draws attention to a source of low back pain in cyclists that was not noted previously in...

Effect of changing the saddle angle on the incidence of low back pain in recreational bicyclists.

OBJECTIVE: According to the literature, 30-70% of cyclists suffer from cervical, dorsal, or lumbar back pain. This study was conducted to evaluate one of the possible causes of low back...