Cycling injuries of the lower extremity

Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA.
The Journal of the American Academy of Orthopaedic Surgeons (Impact Factor: 2.53). 01/2008; 15(12):748-56.
Source: PubMed


Cycling is an increasingly popular recreational and competitive activity, and cycling-related injuries are becoming more common. Many common cycling injuries of the lower extremity are preventable. These include knee pain, patellar quadriceps tendinitis, iliotibial band syndrome, hip pain, medial tibial stress syndrome, stress fracture, compartment syndrome, numbness of the foot, and metatarsalgia. Injury is caused by a combination of inadequate preparation, inappropriate equipment, poor technique, and overuse. Nonsurgical management may include rest, nonsteroidal anti-inflammatory drugs, corticosteroid injection, ice, a reduction in training intensity, orthotics, night splints, and physical therapy. Injury prevention should be the focus, with particular attention to bicycle fit and alignment, appropriate equipment, proper rider position and pedaling mechanics, and appropriate training.

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    • "Furthermore, anecdotal evidence from patients in our lab has suggested a lack of desire to participate in cycling because it is painful for the knees. These findings are not unreasonable considering knee injuries are the leading complaint in cycling (Dettori and Norvell, 2006; Kennedy et al., 2007). Due to the lack of literature regarding cycling with OA, it is unclear if people with knee OA present the same cycling patterns as healthy Clinical Biomechanics 30 (2015) 276–282 ⁎ Corresponding author at: Biomechanics/Sports Medicine Lab, The University of Tennessee, 1914 Andy Holt Ave., Knoxville, TN 37996. "
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    ABSTRACT: Background: Cycling is commonly prescribed for knee osteoarthritis, but previous literature on biomechanics during cycling and the effects of acute intervention on osteoarthritis patients does not exist. Due to their altered knee kinematics, osteoarthritis patients may be at greater risk of osteoarthritis progression or other knee injuries during cycling. This study investigated the effects of reduced foot progression (toe-in) angles on knee joint biomechanics in subjects with medial compartment knee osteoarthritis. Methods: Thirteen osteoarthritis and 11 healthy subjects participated in this study. A motion analysis system and custom instrumented pedal was used to collect 5 pedal cycles of kinematic and kinetic data in 1 neutral and 2 toe-in conditions (5° and 10°) at 60 RPM and 80W. Findings: For peak knee adduction angle, there was a 61% (2.7°) and a 73% (3.2°) decrease in the 5° and 10° toe-in conditions compared to neutral in the osteoarthritis group and a 77% (1.7°) and 109% (2.4°) decrease in the healthy group for the 5° and 10° conditions, respectively. This finding was not accompanied by a decrease in pain or peak knee abduction moment. A simple linear regression showed a positive correlation between Kelgren-Lawrence score and both peak knee adduction angle and abduction moment. Interpretation: For individuals who cycle with increased knee adduction angles, decreasing the foot progression angle may be beneficial for reducing the risk of overuse knee injuries during cycling by resulting in a frontal plane knee alignment closer to a neutral position.
    Clinical Biomechanics 01/2015; 30(3). DOI:10.1016/j.clinbiomech.2015.01.003 · 1.97 Impact Factor
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    • "Foot orthoses and in-shoe wedges have been advocated and used by cyclists to achieve a variety of goals [2,4]. Some of these goals include increasing comfort levels [2], injury prevention [5-7] and increasing power production [2,4,7]. The mechanism of action proposed to achieve these goals generally encompasses an improvement in the biomechanical alignment of the lower limb and foot, by seeking a more linear cycling motion [2,8,9]. "
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    ABSTRACT: Background The use of foot orthoses and in-shoe wedges in cycling are largely based on theoretical benefits and anecdotal evidence. This review aimed to systematically collect all published research on this topic, critically evaluate the methods and summarise the findings. Methods Study inclusion criteria were: all empirical studies that evaluated the effects of foot orthoses or in-shoe wedges on cycling; outcome measures that investigated physiological parameters, kinematics and kinetics of the lower limb, and power; and, published in English. Studies were located by data-base searching (Medline, CINAHL, Embase and SPORTDiscus) and hand-searching in February 2014. Selected studies were assessed for methodological quality using a modified Quality Index. Data were synthesised descriptively. Meta-analysis was not performed as the included studies were not sufficiently homogeneous to provide a meaningful summary. Results Six studies were identified as meeting the eligibility criteria. All studies were laboratory-based and used a repeated measures design. The quality of the studies varied, with Quality Index scores ranging from 7 to 10 out of 14. Five studies investigated foot orthoses and one studied in-shoe wedges. Foot orthoses were found to increase contact area in the midfoot, peak pressures under the hallux and were perceived to provide better arch support, compared to a control. With respect to physiological parameters, contrasting findings have been reported regarding the effect foot orthoses have on oxygen consumption. Further, foot orthoses have been shown to not provide effects on lower limb kinematics and perceived comfort. Both foot orthoses and in-shoe wedges have been shown to provide no effect on power. Conclusion In general, there is limited high-quality research on the effects foot orthoses and in-shoe wedges provide during cycling. At present, there is some evidence that during cycling foot orthoses: increase contact area under the foot and increase plantar pressures under the hallux, but provide no gains in power. Based on available evidence, no definitive conclusions can be made about the effects foot orthoses have on lower limb kinematics and oxygen consumption, and the effect in-shoe wedges have on power during cycling. Future well-designed studies on this topic are warranted.
    Journal of Foot and Ankle Research 05/2014; 7(1):31. DOI:10.1186/1757-1146-7-31 · 1.46 Impact Factor
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    • "Aspects which are considered to increase the performance in top level cycling include targeted training, talent, nutrition, the optimal position on the bike, as well as innovations concerning the bike frame, wheel sets, handlebars, and clipless pedals. Lately, individual bike fittings and cycling specific insoles have been used for better performance and at the same time for the prevention of overuse injuries (Burke 2003; Dettori and Norvell 2006; Jeukendrup and Martin 2001; Schmidt et al. 2011; Wanich et al. 2007). The biomechanical , anthropometric optimal position of the athlete on the bike is a key factor for the power output (Bini et al. 2011; Bini et al. 2013; Burke and Pruitt 2003; Silberman et al. 2005) and is set with the three contact points handlebar, saddle and pedals. "
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    ABSTRACT: The usage of innovative technologies in high performance cycling is essential. Special insole devices made of carbon are expected to have an impact on the anatomical and biomechanical structures of the foot. They aim to prevent cycling-specific overuse injuries, as well to increase output power. Therefore, the effects of a cycling-specific carbon insole were evaluated with respect to its impact on the output power in a Wingate Test (WAnT). 18 male cyclists and triathletes (age: 26.3 ± 5.6 years, height: 181.9 ± 4.7 cm, mass: 76.7 ± 4.4 kg, foot length 28.2 ± 0.8 cm) on at least a national level were tested for peak and mean power during three WAnT with randomized and blind application of a standard insole or the cycling-specific carbon insole. The mean power of the standard insole (790.6 ± 50.3 W) was in overall trials 0.6 % higher than with the carbon insole (786.0 ± 45.0 W). The peak power with the standard insole (891.7 ± 74.6 W) was 1.5 % higher than with the carbon insole (878.4 ± 64.9 W). Neither for mean power (P = 0.76) nor for peak power (P = 0.53) the difference was significant. The usage of the cycling-specific carbon insole thus shows similar output power values as standard devices.
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