Every Athlete needs an Amie – Physio and Cycling

Words: #CountryRunner / #CountryCyclist Ian Macleod

I did have one more secret weapon as #CountryCyclist: Amie Collins, my physiotherapist. Every cyclist should have an Amie!

Being new to the sport, I ran a major risk of creating or worsening an injury. I brought several chronic problems from years of running. I also needed to prepare my body for a more extreme four months of training than I had ever experienced and then nine days of mountain biking at an averageof 100km per day. I couldn’t have done it without Amie.

Barro-Physio-logoA keen athlete herself, Amie works out of Barrow Physiotherapy at the Netcare Waterfall Hospital, north of Joburg. Currently planning her Masters in sports Physio (probably after her wedding), her special interests are sports injuries and general orthopaedics.

Amie took me through a complete assessment to determine find my strengths and (mostly) weaknesses. From there developed a comprehensive training plan. We’re not talking your usual push-ups and squats, though. Amie had me performing the most extraordinary activities to strengthen muscles you’ll ordinarily barely engage. Some of her contortions (like the ‘alternate Superman in four-point, kneeling) were as much of a mental riddle as they were muscle burners. But that’s the point. These often ignored muscles are the ones you injure if you don’t prepare them. And if you do, they make you fitter and faster, too.

680-Ian-Jump-17-April

For starters, here’s Amie’s list of the 6 most common cycling injuries. Later I’ll move on to her assessment of my condition ahead of joBerg2c and how we went about improving that.

The Most Common Injuries seen Clinically

  1. Neck Pain
  2. Back Pain
  3. ITBS
  4. Patello-femoral Knee Pain
  5. Achilles Tendinopathy
  6. Sciatica or Piriformis Syndrome

(1) Neck Pain:

Possible Cause: Due to repeated and prolonged positions of the spine held, usually in extension, while cycling resulting in fatigue, overuse and stiffness of the tissue involved.

Prevention:

  1. Keep back of neck lengthened to obtain a more neutral neck position, but ensure that you can still see where you are going!
  2. Have your bike set up checked and corrected in order to prevent being in the overreach or very upright position, both of which encourage neck hyperextension.
  3. Make sure you also stretch your neck down to your chest regularly so that you are not in a sustained position for more than 20min.
  4. Stretch your neck before and after cycling
  5. Strengthen the deep neck flexors, neck extensors, scapular stabilizers and retractors with your physiotherapist.

603e071baecaa1973a6f2593f499b457_DSC_9866(2) Lower back Pain:

Cause: Due to prolonged positions of the spine held in a non neutral position resulting in overuse and fatigue of the tissues involved.

Prevention:

  1. Have bike set up correctly to help maintain a neutral spine and avoid over hunching or over reaching
  2. Work on flexibility in the lower quarter as well as core strength around the pelvis in order to help maintain a neutral spine.
  3. Ensure a good warm up Move out of the sustained position at least every 20min

(3) Iliotibial Band Syndrome:

  • Pain over the lateral aspect of the knee where it inserts onto the tibia. The ITB is a thick fascial band running from the lateral aspect of the pelvis down to the lateral knee.
  • Cause: The repetitive action of cycling can cause irritation of the insertion or origin usually as a result of poor biomechanics, which can be as the result of poor bike set up or incorrect knee and hip alignment as a result of weak gluts and core. Toeing in will increase the stress in the ITB as well as knee overextension as a result of a saddle that is too high or knee overflexion as a result of a saddle that is too low all of which will increase the stress placed through the ITB.

Prevention:

  1. ITB, and Piriformis flexibility and rolling
  2. Glut and Core Strength
  3. Biomechanic retraining and correction
  4. Bike set-up correction

(4) Patellofemoral Pain Syndrome:

  • Pain behind or around the kneecap due to joint irritation. Can lead to degeneration of the undersurface of the kneecap (patella).
  • Cause: Due to poor biomechanical control and abnormal muscle imbalance resulting in maltracking of the patella in the femoral groove which leads to excessive patellofemoral joint pressure
  • Treatment includes correction of muscle imbalance in the quadriceps (Including the VMO) to ensure good patella tracking. Stretching of tight lateral structures (ITB, Vastus lateralis and lateral retinaculum) as well as biomechanic correction on the bike

(5) Achillies Tendinopathy

  • Is an overuse injury to the Achilles tendon resulting in microtears, blood vessel infiltration and scarring and mal-alignment of the tendon fibres. It can be due to too much to soon, muscle imbalances (Tight hamstings and calf muscles), poor eccentric strength, poor foot ware, flat and overpronated feet or high arched feet with tight Achilles tendons.
Achilles tendinopathy was to hit me hard during the race, but Adventure Physios were there to help.
Achilles tendinopathy was to hit me hard during the race, but Adventure Physios were there to help. They operate on most of our major bike tours and work some real magic on tired and broken bodies.

Prevention/Treatment:

  1. Correct imbalance strength and flexibility imbalances
  2. Correct bike set up
  3. Correct training amount/intensity
  4. Correct cycling and pedaling technique and biomechanics
  5. Strapping and eccentric exercises

(6) Piriformis Syndrome:

  • The sciatic nerve is compressed or irritated by the piriformis muscle which causes pain usually in one buttock which can refer down the back of the leg resulting in sciatica
  • Cause: Due to weakness of the core and stability muscles of the pelvis and hip, excessive pressure of the saddle and overpronating feet.

Treatment:

  1.  Includes DN, massage and stretching of tight piriformis and associated muscle inflexibilities
  2. Joint and ST mobilistion of spine, hip and pelvis
  3. Address core strength of hip and pelvis
  4. Correct biomechanics of foot
  5. Correct bike set up

Barrow Physiotherapywww.barrowphysiotherapy.co.za and [email protected]

Adventure Physioswww.adventurephysio.co.za and [email protected]

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