Article

Changes in Sports Injuries Incidence over Time in World-class Road Cyclists

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Abstract

This is a descriptive epidemiologic survey on all traumatic and overuse injuries which occurred in 2 groups of male elite road cyclists based on retrospective clinical interviews and physical examinations. The historical group consisted of 65 professional road cyclists surveyed from 1983 to 1995. The contemporary group included 65 elite racers still active and reporting injuries from 2003 to 2009. Injury/cyclist ratio was 1.32 in the historical group and 2.13 in those still active. Traumatic injuries increased from 39.5% (historical) to 53.9% (contemporary) (p<0.05). Severe traumatic lesions decreased from 49.9% in the historical group to 10.5% in the contemporary group (p<0.01). Patellofemoral pain decreased from 28.8% (historical) to 6.1% (contemporary) (p<0.01). Muscle injuries substantially increased from 13.4% to 44.9% (p<0.01). In the historical racers, the rates of risk for traumatic injury were 0.104 per year per cyclist, and 0.003 per 1 000 km of training and competition. These figures increased to 0.287 and 0.009 respectively in the contemporary group. In summary, contemporary professional road cyclists are exposed to double the risk of traumatic injuries than those competing in the 80s and early 90s. However, these lesions have less severity. Overuse injuries had a completely different clinical pattern, with the currently active cyclist exhibiting more muscle injuries and less tendinous lesions.

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... The variability between non-competition road events, mountain events, and competitive road events limits generalizability of information across disciplines. The literature examining injuries in competitive road cycling is limited to small-scale descriptive studies that surveyed professional male cyclists about injuries throughout their career and do not provide information specific to the risks of road cycling competitions (Barrios et al. 2015). Little is known about the nature of injuries suffered by cyclists participating in road cycling competitions. ...
... The lower extremity was the second most frequently reported injured body part in our data set, at about 32%. This is consistent with reports of injuries in professional cyclists where traumatic injuries occurred in the lower extremity in 26% (Bernardo et al. 2012) and 17.1-23.5% of cases (Barrios et al. 2015). The lower extremity appears to be involved in a much higher proportion, 67%, of overuse injuries (Bernardo et al. 2012) when compared to other body regions. ...
... In our study, males accounted for 84.8% of the injury report forms collected. Males account for the majority of participants in non-competitive cycling events ranging from 65% (Boeke et al. 2010) to 68% (Emond et al. 1999) of total participants, and much of what we know about cycling has focused on male cyclists (Barrios et al. 2015;Bernardo et al. 2012;Clarsen et al. 2010). Males and females differed somewhat on disposition categories. ...
Article
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Background Competition in road cycling events is common, yet little is known about the nature and disposition of injuries sustained in these events. The purpose of this study is to describe injured body regions and the disposition of injuries sustained by cyclists during competitive road cycling events. Methods Data regarding body region injured and injury disposition were retrospectively analyzed from a convenience sample of 1053 injury reports (male: n = 650 [61.7%], age = 33.4 ± 13.6 years; female: n = 116 [11.0%], age = 33.3 ± 13.9 years; missing: n = 284 [27.0%]) completed during the 2016 competitive season. Results A total of 1808 injuries were reported. Injured body regions included upper extremity (46.5%, n = 841), lower extremity (32.2%, n = 583), head/neck (10.4%, n = 189), torso/back (5.2%, n = 95), face (4%, n = 87), and internal/other (0.7%, n = 13). There were 1.37 ± 0.81 injuries recorded per report. Dispositions following injury were medical attention (34.1%, n = 316), ambulance/EMS (19.3%, n = 179), report only (15% n = 139), referred (13.0% n = 121), released to parent/personal vehicle (12.1% n = 112), refused care (4.1% n = 38), and continued riding (2.5% n = 23). Males (34.0%, n = 212) received medical attention more frequently than females (23.3%), p < 0.05. Females received EMS transport (29.1%, n = 30) more frequently than males (16.8%, n = 105), p < 0.05. Conclusions Upper extremity is the most injured body region in this data set. Following injury, racers often receive medical attention and a substantial percentage require transport by EMS. Clinical relevance Anticipating the nature of injuries sustained by cyclists may promote positive health outcomes by ensuring medical teams are prepared for the immediate medical needs of cyclists.
... Cycling was the seventh high risk sport out of the 35 sports. The high incidence shows that to maintaining a healthy and physically active population it is important to prevent these crash related injuries [4] [5]. Several studies have found that injuries to the upper extremities are the most common [7][4][3] [5]. ...
... The high incidence shows that to maintaining a healthy and physically active population it is important to prevent these crash related injuries [4] [5]. Several studies have found that injuries to the upper extremities are the most common [7][4][3] [5]. In the present study, 9.4 % of all injurie resulted in PMI where the cyclist will have lifelong complications. ...
... The falling mechanisms in road cycling is often caused by that the shoulder is the first contact point with the ground [13]. Barrios et al [5] found that professional cyclists have a high occurrence of traumatic injuries at the shoulder and the upper extremities. These injuries could be prevented and to reduce these injuries it is recommended to develop and implement protection for the upper extremity [14]. ...
Conference Paper
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Few previous studies have examined acute injuries in competitive cycling or training as compared to other sports. By using nationwide insurance data including all injured cyclist registered in the Swedish Cycling Federation and all reported injuries during exercise race in Sweden, the objective was to examine acute injuries during competitive cycling or training for different types of cyclists. The injury incidence and injuries leading to permanent medical impairment were examined. All cyclists that were injured during 2008-2017 were included (n=1937). Among the 2666 licensed cyclists the incidence of cyclists injured during training or competition was 44 per 1000 licensed cyclists per year. Focusing on participants in exercise races, the incidence was annually 1.5 injured cyclists per 1000 participants per year. The most commonly injured body region was the upper extremity (41%), followed by head and neck (18%). In total 9.4% of all injured cyclists sustained a permanent medical impairment. Given an injury, non-licensed participants in exercise races were slightly older, and the proportion of females were higher (30% vs. 16%), than among licensed cyclists. The injury incidence among the cyclists was high, and to maintain a healthy and physically active population it is important to make efforts to prevent injuries.
... Cycling is also a weight sensitive sport and the use of protective gear is still limited to only a helmet to protect the head from greater impact. Previous studies were able to show the existence of severe and life-threatening injuries and a high occurrence of injured athletes [9,12,13]. This underlines the importance of understanding patterns and injury mechanisms of professional road cycling athletes in order to be able to introduce adequate preventive measures and focused medical care [14,15]. ...
... Several studies used retrospective interviews, risking a bias of overestimation in recollection of severe injuries and negligence of minor injuries such as soft tissue injuries. It is therefore not surprising that these studies came to the conclusion that fractures pose the most common type of injury [2,12,23]. Ueblacker et al. [5] showed an injury event incidence in the elite level of 10.0/ 100.000 km, covering a single one-day race of the 2008 UCI WorldTour equivalent, which approximates the 15,26/100.000 km found in this study. ...
... Athletes observed by Becker et al. who were cycling at a competitive level reported an average amount of 13.1 h per month of performance, whereas the monthly average of competition time for athletes of this study is about 30% higher with 19,3 h per month, showing road cycling to have a further increased overall risk of injury per season when comparing different disciplines. Analysis of all road cycling studies showed the upper extremities including the shoulder to be the most affected body region [2][3][4][5]9,12,23]. The finding of hematoma/ contusion/bruising to be the most common type of injury followed by lacerations and fractures is supported by Decock et. ...
Article
Objectives: To measure and evaluate the extent and characteristics of accidents and injuries in professional cycling competitions at the elite level (UCI WorldTour 2019) during one complete season. Methods: 54 male athletes from two different teams were involved. Accidents and injuries were recorded immediately after the incident by a team physician present at every race. Exposure, location, type and cause of injury have been recorded. Incidence was calculated. Severity was measured as a cumulative severity score and burden depicted in a risk matrix. Results: Total time of exposure was 12537 hours over 3524 athlete days and 544002 kilometers of racing. 98 accidents were recorded, with 83 leading to injury. The total number of recorded injuries was 193. Injury incidence for all injuries was 54,8 (±SD 47,7-62,8) /1000 athlete days, 15,4 (±SD 13,4-17,7) /1000 athlete hours and 35,5 (±SD 30,8-40,8) /100.000 km raced. By far the most frequent types of injury were hematomas, contusions and bruising (n=141, 73%) followed by lacerations (n=22; 11,4%). Most injuries affected the arm and elbow (n=34, 17,6%) followed by the shoulder and clavicle (n=28, 14,5%) and occurred with contact (79%). Fractures pose a high injury burden due to long time loss, whereas hematomas, contusions and bruising showed the highest incidence numbers but comparably less time loss. Conclusion: Road cyclists' injuries have been underestimated in previous studies. Hematomas, contusions and bruising pose the highest number of injuries with a broad degree of severity and range of injury burden. Fractures are less common but show the highest injury burden. The upper extremities are involved the most.
... This predisposes cyclists to different types of injuries that change in pattern and distribution over time. [1] During bicycling, there is a high demand on the lower extremities to rotate the crank and produce speed, which puts a heavy load on the legs, thus contributing to overuse injuries. [2] As reported by De Bernardo et al., [3] overuse injuries accounts for 53% of the injuries of top-level cyclist, and overuse injuries of the lower limbs constituted 68.5%. ...
... Three epidemiological studies that evaluated the prevalence of Achilles tendon overuse injuries in professional cyclists, gave a prevalence range from 6.4% to 15%. [1,3,4] The distribution in recreational cyclists was slightly lower. [5] In triathletes, the distribution was close to that for recreational cyclists. ...
... The data were collected using a structured, self-administered questionnaire designed by the researchers after reviewing the literature and similar studies based on the objectives of the study. [1,3] T h e q u e s t i o n n a i r e c o n s i s t e d o f f o u r parts: (1) sociodemographic data: age, gender, nationality, level of education, marital status and club name; (2) sport participation: goal, experience, frequency, duration, warm up, stretching exercises, strengthening exercises, and rest days; (3) type of bicycle used, bicycle fitting and clip-less pedal; (4) Achilles tendon pain in the preceding 12 months, frequency, precipitating event, and management. ...
Article
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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. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.
... This predisposes cyclists to different types of injuries that change in pattern and distribution over time. [1] During bicycling, there is a high demand on the lower extremities to rotate the crank and produce speed, which puts a heavy load on the legs, thus contributing to overuse injuries. [2] As reported by De Bernardo et al., [3] overuse injuries accounts for 53% of the injuries of top-level cyclist, and overuse injuries of the lower limbs constituted 68.5%. ...
... Three epidemiological studies that evaluated the prevalence of Achilles tendon overuse injuries in professional cyclists, gave a prevalence range from 6.4% to 15%. [1,3,4] The distribution in recreational cyclists was slightly lower. [5] In triathletes, the distribution was close to that for recreational cyclists. ...
... The data were collected using a structured, self-administered questionnaire designed by the researchers after reviewing the literature and similar studies based on the objectives of the study. [1,3] T h e q u e s t i o n n a i r e c o n s i s t e d o f f o u r parts: (1) sociodemographic data: age, gender, nationality, level of education, marital status and club name; (2) sport participation: goal, experience, frequency, duration, warm up, stretching exercises, strengthening exercises, and rest days; (3) type of bicycle used, bicycle fitting and clip-less pedal; (4) Achilles tendon pain in the preceding 12 months, frequency, precipitating event, and management. ...
Article
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.
... Cycling is a popular sport worldwide [1,2] that has been found to not only improve fitness and health, but also assist rehabilitation regimes due to its lower impact on the joints in comparison to other activities such as walking and running [3,4]. Despite these benefits, cycling may also result in overuse/fatigue and acute injuries [2,5,6]. Decock et al. (2016) examined cycling competitions in 2012 and found that 15.8% of the cyclists sustained an injury. ...
... Decock et al. (2016) examined cycling competitions in 2012 and found that 15.8% of the cyclists sustained an injury. Barrios et al. (2015) found that 54% and 46% of injuries among professional cyclists are related to acute and overuse injuries, respectively. ...
... While previous research has reported the frequency and type of cycling-related cycling [2,[5][6][7], there less research related to the associated risk factors and prevention factors, both of which are fundamental the development of prevention programs that aim to reduce the incidence and severity of injuries [8]. Although studies have hypothesized that risk factors for cycling injuries include sex [2,9] and age [2], modifiable factors such as cycling profile or bicycle equipment [10][11][12] are also worth examining. ...
Article
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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.
... All these things together allow one to assume that these athletes are exposed to a high risk of traumatic injuries. 3 Despite the ever-increasing popularity of bicycle racing, the high perceived risk of acute injuries and the recent media attention, studies of acute injuries in road cyclists are rather scarce. [3][4][5] Most studies describe injury incidence in school groups, urban population or recreational cycling. ...
... 3 Despite the ever-increasing popularity of bicycle racing, the high perceived risk of acute injuries and the recent media attention, studies of acute injuries in road cyclists are rather scarce. [3][4][5] Most studies describe injury incidence in school groups, urban population or recreational cycling. [6][7][8][9] The goal of this study is to evaluate the incidence, aetiology and patterns of acute injuries in non-professional competitive road cyclists during cycling races in Flanders in 2002 and 2012. ...
... Only three studies described acute injuries in road cyclists with Barrios as a common author. [3][4][5] The first study was published in 1997 and evaluated data of all injuries, both overuse and traumatic injuries, of road cyclists of 2 different professional cycling teams (65 riders) during a period of 13 years (1983-1995). Also, De Bernardo et al researched traumatic injuries in professional road cyclists. ...
Article
Introduction Despite the ever-increasing popularity of bicycle racing, the high perceived risk of acute injuries and the recent media attention, studies of acute injuries in road cyclists are rather scarce. The goal of this study is to evaluate the incidence, aetiology and patterns of acute injuries in non-professional competitive road cyclists during cycling races in Flanders. Material and methods All acute injuries that occurred during competition in Flanders in 2002 and 2012, collected in the injury registry, were analysed. The incidence, injury rate, diagnosis, circumstances and level of performance were evaluated. Results A total of 777 documented reports of accidents (1230 injuries) were retrieved for the years 2002 and 2012. There was no significant difference between incidence and injury rate between 2002 and 2012. There was a strong significant difference in the incidence between the different levels of performance in both seasons. Severe injuries were seen in 29.5% in 2002 and in 30.1% in 2012. The most common location of a severe injury was the hand. Collision with another rider was the most common cause of injury. Conclusions Almost 1 out of 6 non-professional competitive road cyclists had an accident during cycling races in 2002 and 2012 in Flanders and collision with other riders was the most important cause of a crash. The most common lesion was abrasion, but almost one out of three riders had a severe injury.
... Overuse injuries are common in cycling (Barrios, Bernardo, Vera, & Hadala, 2015;Callaghan, 2005;Clarsen et al., 2010;Silberman, 2013) and imbalanced aBMD and LM may increase the risk of these unilateral injuries. (Clarsen et al., 2010) Longterm FAs and asymmetrical strain on structural anatomy may describe the injury mechanism for unilateral overuse injuries. ...
... (Callaghan, 2005) Overuse injuries in cycling are most commonly found at the knee and low back. (Barrios et al., 2015;Clarsen et al., 2010;Silberman, 2013) Not specific to cycling, low back pain is often associated with FAs and muscle imbalances. (Barrios et al., 2015;Childs et al., 2003;Nadler et al., 2001) Due to the high asymmetry levels and consistency of greater LM on the pelvis dominant side, we speculate that the LM asymmetries seen in the pelvis of the cyclists could be a factor in these overuse injuries and chronic pain. ...
... (Barrios et al., 2015;Clarsen et al., 2010;Silberman, 2013) Not specific to cycling, low back pain is often associated with FAs and muscle imbalances. (Barrios et al., 2015;Childs et al., 2003;Nadler et al., 2001) Due to the high asymmetry levels and consistency of greater LM on the pelvis dominant side, we speculate that the LM asymmetries seen in the pelvis of the cyclists could be a factor in these overuse injuries and chronic pain. Low back pain is also associated with reduced lumbar spine aBMD which can be common in cyclists. ...
Article
Cyclists may be at greater risk of developing asymmetrical force and motion patterns than other ground-based athletes. However, functional asymmetries during cycling tend to be highly variable, making them difficult to assess. Dual-energy x-ray absorptiometry (DXA) measurements of areal bone mineral density (aBMD) and lean mass (LM) in the lower limbs may be a more sensitive and consistent method to identify asymmetries in cyclists. The goal of this study was to determine if competitive cyclists have greater levels of asymmetries in the lower body compared to non-cyclists using DXA. A secondary aim was to determine if aBMD and LM asymmetries change over the road cycling season. 17 competitive cyclists and 21 non-cyclist, healthy controls underwent DXA scans. Lower-body asymmetries were greater in cyclists compared to non-cyclists in aBMD and LM for all lower limb segments. However, these asymmetries did not tend to consistently favour a particular side, except for the pelvis having more LM on the dominant side. The were no longitudinal changes in aBMD or LM in the cyclists. Asymmetry analysis via DXA provides evidence that although functional asymmetries during cycling are variable, cyclists have increased lower body LM and aBMD asymmetries compared to non-cyclists.
... Although the epidemiology of GOIs has been studied (Barrios et al., 2015;Clarsen et al., 2010;Dahlquist et al., 2015), there are substantial methodological differences between studies making comparisons between studies difficult. Methodological differences include: differences in terminology and the definition of gradual onset injuries (Dahlquist et al., 2015;Van der Walt et al., 2014;Wilber et al., 1995), defining and reporting the exposure (annual incidence, incidence during single-day or multi-day staged races), small sample sizes (Dahlquist et al., 2015;Wilber et al., 1995), lowresponse rates with possible selection bias (Van der Walt et al., 2014; Wilber et al., 1995), differences in the populations studied (ranging from professional cyclists to multistage cycling events) (Barrios et al., 1997(Barrios et al., , 2015Clarsen et al., 2010;De Bernardo et al., 2012), and use of self-reported data with differences in timing and content of questionnaire administration (Dahlquist et al., 2015;Van der Walt et al., 2014;Wilber et al., 1995). ...
... Although the epidemiology of GOIs has been studied (Barrios et al., 2015;Clarsen et al., 2010;Dahlquist et al., 2015), there are substantial methodological differences between studies making comparisons between studies difficult. Methodological differences include: differences in terminology and the definition of gradual onset injuries (Dahlquist et al., 2015;Van der Walt et al., 2014;Wilber et al., 1995), defining and reporting the exposure (annual incidence, incidence during single-day or multi-day staged races), small sample sizes (Dahlquist et al., 2015;Wilber et al., 1995), lowresponse rates with possible selection bias (Van der Walt et al., 2014; Wilber et al., 1995), differences in the populations studied (ranging from professional cyclists to multistage cycling events) (Barrios et al., 1997(Barrios et al., , 2015Clarsen et al., 2010;De Bernardo et al., 2012), and use of self-reported data with differences in timing and content of questionnaire administration (Dahlquist et al., 2015;Van der Walt et al., 2014;Wilber et al., 1995). ...
... The reported annual incidence of GOIs varies between 17 and 88% (De Bernardo et al., 2012;Van der Walt et al., 2014). However, in most studies, only elite cyclists were studied where the reported annual incidence of GOIs is between 17 and 58% (Barrios et al., 1997(Barrios et al., , 2015Clarsen et al., 2010;De Bernardo et al., 2012). In two studies in recreational cyclists, an annual incidence of 85e88% 13 11 has been reported, and we note that this is substantially higher than the annual incidence we report in our population (2.5%). ...
Article
Objectives Prevalence, clinical characteristics and severity of gradual onset injuries (GOIs) in cyclists are poorly documented. We determine the prevalence, anatomical regions/sites affected and severity of GOIs among entrants in a community-based mass participation event. Design Cross-sectional study; Setting Cape Town Cycle Tour; Participants Race entrants Main Outcome Measures Of 35914 entrants, 27349 completed pre-race medical questionnaires. We studied 21824 consenting cyclists (60.8% of entrants). Crude lifetime prevalence, retrospective annual incidence, anatomical region/sites, specific GOI, tissue type and GOI severity is reported. Results The lifetime prevalence of GOIs was 2.8%, with an annual incidence of 2.5%. More common anatomical regions affected by GOIs were lower limb (43.4%), upper limb (19.8%), and lower back (11.5%). The knee (26.3%), shoulder (13%), and lower back (11.5%) regions were mostly affected. The most common GOI was anterior knee pain (14.2%). Of the GOIs, 55% were in soft tissue. 50% of cyclists reported symptom duration >12 months, and 37.3% of GOIs were severe enough to reduce/prevent cycling. Conclusion 2.5% recreational cyclists report a GOI annually. >50% of GOIs affect the knee, lower back and shoulder. GOIs negatively affect cycling. Risk factors related to GOIs in cyclists need to be determined to develop and implement prevention programs.
... In cycling, both trauma and overuse injuries have a similar prevalence (De Bernardo et al., 2012). In this regard, through a descriptive epidemiologic survey in male elite road cyclists, Barrios et al. (2015) found a prevalence of 46.7% in traumatic lesions and 53.3% of overuse injuries. Pommering et al. (2017) reported that the most prevalent injury in a two-year period was trauma, accounting for ~52% of injuries. ...
... However, the risks to the integrity and health of the vertebral structures of cyclists are speculative since no longitudinal studies have been found that affirm such injuries in cyclists. However, studies have been found thar low back pain is one of the most frequent injuries in cyclists (Barrios et al., 2015;Clarsen et al., 2010;Wilber et al., 1995). ...
Article
The aim was to know if cycling affects spinal morphology in postures off the bicycle, such as adapting the spinal curvatures on the bicycle depending on the handlebar type and position on the handlebars. A systematic review was conducted following the PRISMA guidelines. The studies selected met the following criteria: a) the study design was cross-sectional or longitudinal (experimental or cohorts); b) the study evaluated the sagittal morphology of the spine on the bicycle; c) the study included healthy and trained participants without injuries or cyclists reporting low back pain. Fifteen studies reported that a greater pelvic tilt was observed that when the handlebar was in a lower position. Sixteen studies found that lumbar kyphosis was greater when the handlebar grip was lower and farther from the saddle. Twelve studies reported that a tendency towards greater thoracic flexion as the time spent pedalling on the bicycle increased. In conclusion, the practice of cycling produces adaptations in the morphology of the spine of the cyclist compared to non-cyclists, such as an increase in pelvic tilt and a greater capacity for lumbar flexion in trunk flexion positions, and a greater thoracic kyphosis in the standing position.
... 3 The rate of traumatic injuries in elite cyclists nearly doubled from the 1980s and early 1990s to the period 2003-2009. 2 Injuries due to overuse in professional cyclists most commonly affected the lower back, knee, and lower leg. 4 The prevalence of injuries and treatment strategies of injuries among amateur cyclists have been examined in several studies. ...
... In previous studies, the annual injury rate among professional cyclists ranged from 10% to 29% among 65 and 93 cyclists between 1983-1995 and 2009-2010, respectively. 2,3 Our analysis showed that the most common injuries sustained by cyclists requiring withdrawal from the Tour de France were traumatic fractures (n ¼ 67), lacerations or contusions (n ¼ 17), multiple injuries (n ¼ 8), and muscle sprains or strains (n ¼ 7). These results are similar to those described by Barrios et al, 3 with the most common injuries from 1983 to 1995 being fractures, lacerations, and sprains. ...
Article
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Background Cycling injuries are increasing, particularly among elite athletes during major events such as the Tour de France. Many athletes miss considerable time from sport and require surgical intervention. Little is known about the epidemiology of injuries to guide practice participation strategies, return-to-competition expectations, and injury prevention protocols. Purpose To evaluate the injury epidemiology, operative incidence, and return-to-competition timeline among all elite cyclists participating in the 21-stage Tour de France race over a span of 8 years. Study Design Descriptive epidemiological study. Methods All injuries sustained during 1584 unique rides by cyclists participating in the Tour de France from 2010 to 2017 were evaluated. In the absence of an established Tour de France injury database, demographic, injury, surgical, and return-to-competition details from all athletes who withdrew because of a traumatic injury were retrospectively compiled using publicly available data, which were cross-referenced for validity. The inclusion criterion consisted of any cyclist who withdrew from the Tour de France because of an injury; cyclists who withdrew for noninjury reasons were excluded. Independent variables included injury demographics, missed days, and whether the injury required surgery. Injury prevalence, relative frequency distributions, and sample proportions were dependent metrics for this investigation. Results Among the 1584 cycling entries evaluated over the 8-year study period, there were 259 cyclists (16%) who withdrew (17 cyclists/year). A total of 138 withdrawals were caused by acute trauma, 49% of which were fractures (n = 67), which represented the most common reason for withdrawal. A total of 29 (43%) cyclists with fractures underwent surgery. The most commonly fractured bones were the clavicle (n = 21), followed by the wrist (n = 6), hand (n = 5), femur (n = 5), humerus (n = 5), and ribs (n = 5). Cyclists who underwent operative fracture fixation had a longer time between the injury and their next race compared with those who did not undergo surgery (77 vs 44 days, respectively; P = .065). Conclusion The most common injury leading to withdrawal from the Tour de France over the study period was acute fracture, comprising 49% of all injuries. Almost half of the cyclists with fractures underwent surgery. The clavicle was the most commonly fractured bone. For cyclists who underwent operative treatment of their fractures, return to competition was more than 1 month longer than for those who did not. A prospective database is warranted to catalog injuries among these elite cyclists.
... Cycling is a popular sport that promotes fitness and cardiovascular benefits (Oja et al., 2011). However, there is a potential risk of overuse and traumatic injury among cyclists (Barrios, Bernardo, Vera, Laíz, & Hadala, 2015;De Bernardo, Barrios, Vera, Laíz, & Hadala, 2012;Decock, Wilde, Bossche, Steyaert, & Tongel, 2016). Compared to traumatic injuries, overuse injuries comprise a larger proportion of injuries in cycling (52-62% vs. 28-49%); also, overuse injuries are more commonly prevalent in the lower extremity whereas traumatic injuries are more commonly prevalent in the upper extremity (De Bernardo et al., 2012;Silberman, 2013). ...
... In addition, although we created the survey in four languages to acquire a more diverse sample, participation may have been biased in favor of those countries in which those languages are commonly spoken. We had considered methodologies used in other studies (Barrios et al., 2015;Clarsen, Krosshaug, & Bahr, 2010), such as a prospective study design and data collection via interviews. However, in order to achieve a large sample that spanned across multiple regions and countries, we opted for a web-based questionnaire that assessed current cycling characteristics. ...
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Although bike fitting is recommended to help reduce injury risk, little empirical evidence exists to indicate an association between bike fitting and injury incidence. The aim of the study was to determine the effect of bike fitting on self-reported injury, comfort, and pain while cycling from a worldwide survey of cyclists. A total of 849 cyclists completed an online questionnaire between February and October 2016. Questionnaire collected data on respondent demographics, cycling profile, bike fitting, comfort and pain while cycling, and injury history. The main predictor variable was bike fitting (yes, by the respondent, i.e. user bike fitting; yes, by a professional service; or no). Covariates included demographic and cycling profile characteristics. Logistic regression models estimated the odds of injury within the last 12 months, reporting a comfortable body posture while cycling, and not reporting pain while cycling. Odds ratios (OR) with 95% confidence intervals (CI) were reported. User bike fitting was associated with increased odds of reporting a comfortable posture (OR = 2.28, 95%CI: 1.06, 4.68). User (OR = 2.35; 95%CI: 1.48, 3.84) and professional bike fitting (OR = 2.35; 95%CI: 1.42, 3.98) were both associated with increased odds of not reporting pain while cycling. No associations were found between bike fitting and injury within the last 12 months. In conclusion, we found an association between bike fitting and reported comfort and pain while cycling. We recommend integrating bike fitting into cycling maintenance. However, further studies with longer follow-up are necessary to determine the presence of an association between bike fitting and injury.
... It has been proposed that regular participation in activities which require prolonged postures and repeated movements can increase tissue stress and microtrauma, and eventually develop movement impairment syndromes (kinesiopathological model) (5). Despite the higher prevalence of LBP from prolonged postures or repeated movements in athletes, there are relatively little research literature to investigate this type of LBP (6,7). ...
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Background: The majority of low back pain (LBP) problems in athletes are the result of stress induced by prolonged postures or repeated movements. Cycling is a sport that needs prolonged trunk flexion during the activity. Objective: To compare sagittal lumbar spine and sagittal pelvic tilt range of motion (ROM) between athletes with CLBP (chronic low back pain) who regularly ride bicycles and healthy controls without regular bicycle riding. Methods: Nineteen cyclists with CLBP and 20 asymptomatic non-cyclist athletes participated in the study, (mean age: 26.00±8.67 years). Sagittal lumbar spine and sagittal pelvic tilt range of motion (ROM) were measured during forward bending and backward return clinical tests using a three-dimen¬sional motion capture system. Results: During forward bending, cyclists with CLBP demonstrated a limited anterior pelvic tilt angle (p = 0.03), compared to non-cyclists athletes. No sig¬nificant differences were found in lumbar flexion angle between the groups during the test. During Backward return, cyclists with CLBP exhibited a limited posterior pelvic tilt angle (p = 0.02) and lumbar extension range (p = 0.05), compared to non-cyclist athletes. Conclusions: A regular sitting position on the bicycle for a prolonged period may result in adaptations in sagittal lumbar and pelvic ROM which may contrib¬ute to the development of LBP.
... Das Gleiche gilt für den Profiradrennsport. Eine aktuelle Untersuchung zeigte eine Verletzungshäufigkeit von 0,009 Fahrer/1000 km in einem 6-jährigen Untersuchungszeitraum [9]. Zu ähnlichen Ergebnissen kommen De Bernardo et al. [10], die von einer Verletzungsrate von 0,007 pro Fahrer und 1000 km berichten. ...
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Despite a high probability of being involved in accidents, road cycling remains a popular leisure and recreational activity. In 2016 more than 200 professional or semi-professional teams were registered. The amateur sector also has a high number of members and an estimated 6 million inhabitants of Germany participate in road cycling on a regular basis; nevertheless, only very few investigations have been carried out on injuries in professional cycling. The most frequent injuries are abrasions, contusions and sprains. More serious injuries, such as fractures and dislocations predominantly involve the shoulders and upper extremities; however, multiple injuries up to polytrauma also regularly occur in cycling. The most frequent cause of fatal trauma are severe head injuries. Often cited reasons for cycling injuries are rider errors, such as loss of control, inappropriate speed and weather conditions. At the competitive level mass collisions are a particular cause of injuries. A smaller number of injuries happen during training, mainly after collisions with other road users. Overuse injuries are less common but regularly occur in professional road cycling and are recurrent reasons for non-participation in training and competitions. Preventive measures for avoidance of serious accidents must be undertaken by the rider, the team and the organizers of cycling events.
... During one competitive racing season 59.9% of the participants reported injury. This is lower than expedition length adventure races 3,9,10 but is similar to that of triathlete studies 4,6,11 . 237 injuries in total were reported from which an injury incidence of 0.92 injuries per athlete was calculated, representative of injuries occurring in and out of competition. ...
Article
Introduction Sprint‐distance adventure racing is a multisport activity that has seen exponential growth over the past decade. Despite this, there is no published descriptive epidemiology of injury data available. Our research aims to describe the demographics, anthropometrics and epidemiology of injury of this athletic cohort. Methods This study describes the findings of 257 completed athlete profiles. The study retrospectively details training habits, competitive history, injury records and injury rates, occurring both in and out of competition during one complete season. Results Of the entire group 59.9% reported injury. Injury incidence was 0.92 injuries per athlete. Injury rate was 2.75 injuries per 1000 hours of training while race injury rate was 23 injuries per 1000 hours of competition. 70% of injuries occurred during training. 74% of injuries affected the lower limb. 58.6% of all injuries were chronic in nature. Conclusion Injury rates are high in sprint‐distance adventure racing. The injuries sustained occur in a predictable fashion and are associated with significant disability. The lower limb accounts for the majority of reported injuries. Injury is itself an independent risk factor for subsequent musculoskeletal insult in beginner and intermediate level athletes. Injuries occur more frequently in competition than during training. Larger prospective studies are needed to explore these findings in greater detail. This article is protected by copyright. All rights reserved.
... Cycling is a popular form of transportation, recreation, fitness and sporting activity amongst people of all ages (Dahlquist et al., 2015;De Bernardo et al., 2012;Kotler et al., 2016). However, there is also a risk of acute traumatic and gradual onset injuries (GOIs) in both amateur and professional cyclists (Barrios et al., 2015;Decalzi et al., 2013;Roi & Tinti, 2014). ...
Article
Objectives: Risk factors related to Gradual onset injuries (GOIs) in cyclists need to be identified to enable effective injury prevention strategies. We aim to determine risk factors related to GOIs in cyclists participating in mass community-based events. Design: Cross-sectional study. Setting: Cape Town Cycle Tour. Participants: Race entrants (n = 35,914) MAIN OUTCOME MEASURES: Completion of pre-race medical questionnaires. 21,824 consenting cyclists (60.8%) were studied. 617 cyclists reported GOIs. Selected risk factors associated with GOIs: demographics, training/racing history, chronic disease history, and medication use, were explored using multi-variate analyses. Results: Prevalence ratio (PR) of GOIs was similar in males and females, but higher in older age categories [>50 yrs vs. categories: ≤30yrs (PR = 1.6); 31 to ≤40yrs (PR = 1.5); 41 to <50yrs (PR = 1.4)] (p < 0.0001). Intrinsic risk factors associated with GOIs (adjusted for gender and age) were: 1) increased weekly training/racing frequency (PR = 1.1, p = 0.0003), 2) chronic disease history [cardiovascular disease symptoms (PR = 2.3, p = 0.0026), respiratory disease (PR = 1.6, p < 0.0001), nervous system/psychiatric disease (PR = 1.5, p = 0.0082)], and 3) history of analgesic/anti-inflammatory medication (AAIM) used before/during racing (PR = 5.1, p < 0.0001). Conclusion: Increased training frequency, chronic disease and AAIM use are risk factors associated with GOIs in cyclists. A novel finding is that in recreational cyclists, chronic disease history could be considered when managing GOIs and implementing prevention programs.
... Few studies have examined competitive cycling, particularly with reference to SRC and the sporting cultural narratives associated with it in cycling. However, research interest in cycling related concussion has developed over recent years, though is still in its infancy (Elliott et Research in Mountain Biking and BMX reported that these athletes may be at risk of sub-concussive brain trauma due to the external loads experienced from the demands of the terrain and excessive head movements, which are then compounded by frequent crashes (Hurst et al., 2018 Barrios et al., 2014), with increasing concern around concussions in this discipline . ...
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The purpose of this study was to explore the cycling community’s online interactions with sports-related concussion within competitive cycling. Through an analysis of twitter data (n=196), this study examined the limited discourse related to the problem of concussion in cycling. The results found overall engagement and awareness of concussion in cycling was low but has been increasing year on year from 2008 to 2019. Thematic analysis of the data found three main themes within the online cycling community on Twitter: 1) Increasing awareness of concussion as a problem for the sport 2) A narrative of apathy in policy by governing bodies and 3) The need for better education as a result of misperceptions of concussion. Overall, these findings contribute to the limited research in the field of concussion in competitive cycling and outline the utility of social media as a platform to disseminate educational resources around the safe management of concussion in the sport.
... Cycling is a popular form of transportation, recreation, fitness and sporting activity amongst people of all ages (Dahlquist et al., 2015;De Bernardo et al., 2012;Kotler et al., 2016). However, there is also a risk of acute traumatic and gradual onset injuries (GOIs) in both amateur and professional cyclists (Barrios et al., 2015;Decalzi et al., 2013;Roi & Tinti, 2014). ...
Article
Objectives Risk factors related to Gradual onset injuries (GOIs) in cyclists need to be identified to enable effective injury prevention strategies. We aim to determine risk factors related to GOIs in cyclists participating in mass community-based events. Design Cross-sectional study. Setting Cape Town Cycle Tour Participants Race entrants (n=35914) Main Outcome Measures Completion of pre-race medical questionnaires. 21824 consenting cyclists (60.8%) were studied. 617 cyclists reported GOIs. Selected risk factors associated with GOIs: demographics, training/racing history, chronic disease history, and medication use, were explored using multi-variate analyses. Results Prevalence ratio (PR) of GOIs was similar in males and females, but higher in older age categories [>50 yrs vs. categories: <30yrs (PR=1.6); 31 to <40yrs (PR=1.5); 41 to <50yrs (PR=1.4)] (p<0.0001). Intrinsic risk factors associated with GOIs (adjusted for gender and age) were: 1) increased weekly training/racing frequency (PR=1.1, p=0.0003), 2) chronic disease history [cardiovascular disease symptoms (PR=2.3, p=0.0026), respiratory disease (PR=1.6, p<0.0001), nervous system/psychiatric disease (PR=1.5, p=0.0082)], and 3) history of analgesic/anti-inflammatory medication (AAIM) used before/during racing (PR=5.1, p<0.0001). Conclusion Increased training frequency, chronic disease and AAIM use are risk factors associated with GOIs in cyclists. A novel finding is that in recreational cyclists, chronic disease history could be considered when managing GOIs and implementing prevention programs.
... They theorise this to be due to the external loads experienced from the demands of the terrain and excessive head movements. Road cycling is also recognised as having high rates of traumatic injury (De Bernardo et al. 2012; Barrios et al. 2014) and we are seeing increasing concern with concussion in this discipline also (Heron et al. 2019) The field of concussion in competitive cycling is in its infancy; as such, there is limited data on the incidence rates of concussion. Work from Rice and colleagues (2020) found from a sample of 780 recreational and competitive cyclists in the USA, 408 suffered a crash over a two-year period and 77 of these sustained a concussion described through experiencing 17 of the 22 symptoms on the Sport Concussion Assessment Tool 3 symptom checklist. ...
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The purpose of this study was to examine the concussion knowledge and attitudes of UK competitive road cyclists to identify gaps in knowledge and assess attitudes. This was a cross-sectional study using 118 UK competitive cyclists, spanning a range of ages and abilities. An adapted Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS) was administered to the participants. The RoCKAS contained separate knowledge and attitude sections (possible scores ranged from 0-33 and 15-75, respectively). A cohort analysis was conducted to examine for differences in attitudes amongst the participants. The mean score for concussion knowledge was 26.4 ± 4.12 and 63.1 ± 6.4 for concussion attitude. Statistically significant differences were found in attitudes between the 49-58 age group and the 19-28 age group (p=0.013). Significant differences were also found between competitive cyclists and recreational cyclists who trained but did not race. The results of this study suggest that UK competitive cyclists have moderate concussion knowledge and good concussion symptom recognition. A cohort analysis shows that youth are less concerned about concussion than older participants and higher ability groups were associated with more dangerous attitudes. These findings can help inform targeted educational interventions in cycling to improve concussion awareness, reporting behaviors, and concussion management behaviors.
... Relacionado con las lesiones, en el ciclismo se pueden diferenciar, en función de su origen, dos tipos. Las lesiones por sobreuso, producidas como consecuencia de un patrón de movimiento repetitivo incorrecto, y que representan aproximadamente la mitad de las lesiones (46-52% del total), y las lesiones traumáticas, que son aquellas sufridas en un evento traumático puntual, como una caída, y que representan aproximadamente la otra mitad (48-54% restante) (Barrios et al., 2014;de Bernardo et al., 2012). ...
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Llevar una postura correcta sobre la bicicleta durante la práctica de ciclismo de carretera es muy importante para prevenir lesiones y mejorar el confort, el rendimiento y la seguridad. Una revisión de la literatura revela que un gran porcentaje de ciclistas sufre molestias ocasionadas por un incorrecto ajuste de la bicicleta o tipo de sillín utilizado. Entre las más comunes caben mencionarse el entumecimiento en la zona perineal, la excoriación o la hematuria. Específicamente en mujeres se ha detectado que tanto los diferentes modelos como los métodos de ajuste del sillín utilizados no son verdaderamente útiles, siendo las molestias en la zona perineal más frecuentes que en hombres. A la vista de estos problemas, en los últimos años se han desarrollado modelos de sillín específicos para mujer. Sin embargo, sólo unos pocos estudios han analizado el efecto de éstos sobre el confort en las mujeres durante el pedaleo.
... All these highlighted aspects could have an impact on endurance sports since the change in foot posture, caused by a decrease in the height of the medial longitudinal arch, can be considered a risk factor for patellar tendon injury or patellofemoral pain (Burns et al., 2005;Cowley & Marsden, 2013;Fukano et al., 2018). Similarly, anterior knee is an anatomical region with one of the highest incidences of injury (40-60%) in cycling (Barrios et al., 2014;Clarsen et al., 2010;de Bernardo et al., 2012). Knee pain has shown high perceived pain rates during cycling (15.6; 95%IC [12.9-18.2%]) ...
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Previous studies have focussed on the relation between foot structure and function, revealing that 3D scanning is the measurement tool with higher precision and accuracy. However, to date only non-studies have investigated the test–retest reliability and potential of a smartphone 3D application for measuring foot morphology. The purpose of the present study was to assess the intra-rater reliability of the Avatar3D application in analysing the foot structure of cyclists. Thirty-five female road cyclists assessed her own foot through the Avatar3D application on two occasions separated by 10 minutes. Instep girth, foot length, ball girth, and ball width were registered in sitting and standing positions during the test and retest. The reliability of the measurements was evaluated using intraclass correlation coefficient (ICC), coefficient of variation (CV’s) and Bland–Altman plots. All dependent variables showed ICC range values from moderate to very high with low CV’s (<6%), evidencing no significant changes in any variable. This thesis was reinforced by Bland–Altman plots and one sample t-tests (p > 0.05). The Avatar3D application is a reliable and easy-to-use tool for assessing the foot structure in female cyclists in sitting and standing positions.
... In road cyclists, LBP accounts for 15% to 50% of reported injuries (Dettori & Norvell, 2006). Even though 24% to 60% of elite road cyclists report LBP (Barrios et al., 2015;MJ Callaghan & Jarvis, 1996;Clarsen et al., 2010), only a few studies have explored the mechanism associated with LBP in road cyclists (Balasubramanian et al., 2014;Balasubramanian & Surface, 2009;Burnett et al., 2004;Srinivasan & Balasubramanian, 2007;Van Hoof et al., 2012). ...
Article
This study was designed to identify neuromuscular adaptations of low back pain (LBP) cyclists , and the impact of a cycling effort on spinal shrinkage. Forty-eight trained cyclists rode their road bike on a smart trainer for 1-hour. Surface electromyography (EMG) recorded muscle activity of the lumbar erector spinae (LES), 3D motion analysis system recorded kinematic of the trunk, and stadiometry measured spinal height. Statistical comparisons were made using repeated measure ANOVAs. The LBP group presented increase in pain levels throughout the effort (p < 0.001). A significant group difference was only observed for the thoracic angle (p = 0.03), which was less flexed for LBP. The one-hour cycling effort (time effect) significantly increased the trunk flexion (p < 0.001) and thoracic flexion (p < 0.001) for both groups. Significant lower LES activation (35% less) was observed at the end of the effort as well as a decrease in spinal height (p = 0.01) for both groups. Neuromuscular adaptations to cycling effort is identified by a decrease in LES EMG amplitude and an increase flexion of the trunk. Adaptation to pain is seen by an increase in thoracic flexion. Despite these adaptations, LBP cyclists could not ride their bike pain-free.
... It is the goal of each trainer and coach to ensure that their athletes are light and lean to perform; however, it must be a balance, as decreased BMD in turn increases the risk of injury (37). Second to overuse injuries, falls are the most common major injury to competitive cyclists, and specifically falls that result in humerus and clavicle factures are very common (1,11,37). ...
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Competitive cycling has been associated with low bone mineral density (BMD); however, BMD is a multifaceted issue. The purpose of this study was to investigate how age (18-49 years), sex, USA Cycling Category (elite-4) and racing type (road and multiple bikes), influenced body composition across a season in competitive cyclists. February marked the preseason, where 42 participants (22 males, 20 females) completed a health history and cycling questionnaire, four day dietary log and a Dual-energy X-ray absorptiometry (DXA) scan and repeated the measures 180±11 days later. Preseason BMD and Z-Scores were within healthy ranges and similar between sexes, age groups, competition levels and racing type groups (p≥0.053). Age was significantly correlated with whole group BMD (r=0.309; p=0.047). Postseason analysis revealed very encouraging findings as no significant changes in BMD or Z-Score were observed in any group (p≥0.067). A significant main effect for time was found in all groups as Lean Mass decreased and Fat Mass increased across the season (p≤0.001). Additional analysis showed a significant time*group interaction as Cat. 1 riders decreased Body Mass and BMI while Cat. 4 riders responded in the opposite direction (p≤0.037). Postseason correlations highlighted significant positive relationships between BMD and age, Lean Mass, and Kcal ingested (r≥0.309; p≤0.047). The only significant negative correlate of BMD was percent Body Fat (r=-0.359; p=0.020). Armed with this information cyclists and coaches should aim to prioritize balance between body mass and caloric intake while meeting the demands of training to minimize risk of cycling related low bone mass.
Article
Introduction Despite the ever-increasing popularity of bicycle racing, the high perceived risk of acute injuries and the recent media attention, studies of acute injuries in road cyclists are rather scarce. The goal of this study is to evaluate the incidence, aetiology and patterns of acute injuries in non-professional competitive road cyclists during cycling races in Flanders. Material and methods All acute injuries that occurred during competition in Flanders in 2002 and 2012, collected in the injury registry, were analysed. The incidence, injury rate, diagnosis, circumstances and level of performance were evaluated. Results A total of 777 documented reports of accidents (1230 injuries) were retrieved for the years 2002 and 2012. There was no significant difference between incidence and injury rate between 2002 and 2012. There was a strong significant difference in the incidence between the different levels of performance in both seasons. Severe injuries were seen in 29.5% in 2002 and in 30.1% in 2012. The most common location of a severe injury was the hand. Collision with another rider was the most common cause of injury. Conclusions Almost 1 out of 6 non-professional competitive road cyclists had an accident during cycling races in 2002 and 2012 in Flanders and collision with other riders was the most important cause of a crash. The most common lesion was abrasion, but almost one out of three riders had a severe injury.
Article
Objectives: Although road bicycle races have been held for more than a century, injury and illness patterns during multi-day bicycle events have not been widely studied. The aim of this study was to determine the incidence of injury and illness among riders and describe the medical care interventions provided to participants of cycling road races. Methods: A prospective observational study was conducted on the Presidential Cycling Tour of Turkey, which was held between April 26 and May 3, 2015. The race lasted 8 days and covered 1258 km of road. There were 166 elite cycling athletes representing 21 teams from various countries. Data collected pertaining to incidents involving injury or illness included the following: type of injury; anatomical location of injury; details of the medical encounter; location of the intervention; treatment provided; medication administered and disposition of the rider. An injury was defined as a physical complaint or observable damage to the body produced by the transfer of energy of the rider. An illness was defined as a physical complaint or presentation not related to injury. Results: The overall incidence (injury and illness) was 5.83 per 1000 cycling hours. (Injury incidence was 2.82 vs illness incidence of 3.01 per 1000 hours cycling). A total of 31 incidents occurred. Of these, 15 were injuries, while 16 were complaints of a non-traumatic nature. A total of 43 interventions were made in the 15 cases of injury. The most commonly injured body regions were limbs; the majority of injuries involved the skin and soft tissue. The most common medical intervention was wound care (64% of all interventions). Two riders had to withdraw from the race, and one was hospitalized due to a traumatic pneumothorax. None of the non-traumatic cases resulted in withdrawal from the race. Conclusions: A broad spectrum of illness and injury occurs during elite multi-day road races, ranging from simple skin injuries to serious injuries requiring hospital admission. Most injuries and illnesses are minor; however, medical teams must be prepared to treat life-threatening trauma.
Chapter
Cycling is popular among recreational and competitive athletes of many different ages. Despite being a low-impact, noncontact sport, cycling puts athletes at risk of injury – both traumatic and chronic overuse. Traumatic injuries usually result from falls or collisions, and the most common injuries include “road rash,” closed head injuries, and fractures of the upper extremity (clavicle, wrist, and forearm). Cyclists who spend long hours in the saddle during training and competition are also vulnerable to characteristic overuse injuries. The team physician should have a working knowledge of proper bicycle fitting and should be able to identify anatomic variants and errors in bicycle fit that can contribute to injury. The most common overuse injuries include neck/back pain, upper extremity nerve compression, saddle sores, knee pain, and foot/ankle pain. These injuries usually improve with adequate rest and alteration of bike fitting and/or technique.
Article
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.
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Background Patellofemoral pain is considered one of the most common forms of knee pain, affecting adults, adolescents, and physically active populations. Inconsistencies in reported incidence and prevalence exist and in relation to the allocation of healthcare and research funding, there is a clear need to accurately understand the epidemiology of patellofemoral pain. Methods An electronic database search was conducted, as well as grey literature databases, from inception to June 2017. Two authors independently selected studies, extracted data and appraised methodological quality. If heterogeneous, data were analysed descriptively. Where studies were homogeneous, data were pooled through a meta-analysis. Results 23 studies were included. Annual prevalence for patellofemoral pain in the general population was reported as 22.7%, and adolescents as 28.9%. Incidence rates in military recruits ranged from 9.7–571.4/1,000 person-years, amateur runners in the general population at 1080.5/1,000 person-years and adolescents amateur athletes 5.1%–14.9% over 1 season. One study reported point prevalence within military populations as 13.5%. The pooled estimate for point prevalence in adolescents was 7.2% (95% Confidence Interval: 6.3%–8.3%), and in female only adolescent athletes was 22.7% (95% Confidence Interval 17.4%–28.0%). Conclusion This review demonstrates high incidence and prevalence levels for patellofemoral pain. Within the context of this, and poor long term prognosis and high disability levels, PFP should be an urgent research priority. PROSPERO registration CRD42016038870
Article
Both lower extremities and lower back are common sources of injury for cyclists. For providers to optimize care within this area of sports medicine, they need to understand the most common sources of injury in this population. Cycling presents a unique challenge: treating both the athlete and the complex relationship between rider and bicycle. Physicians should not replace the role of a professional bike fitter and should view these individuals as integral members of the team to alleviate current and prevent future injury. This article explores common lower extremity and lumbar back overuse injuries in cyclists and their medical management.
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Ter gelegenheid van de start van de Tour de France is dit artikel geschreven. We duiken hierin wat dieper in de wetenschap achter 'La grande Boucle'.
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All overuse and traumatic lesions which occurred in 65 professional cyclists were studied from 1983 to 1995. The mean age of the study participant was 25 years (range 21-32). Out of 56 cyclists, 86 injuries had occurred, 33 (38%) due to falls. Only nine cyclists (14%) were free from injury. There were 21 fractures that occurred at different locations, the clavicle being the most frequently affected bone (9 cases; 43%). Overuse lesions occurred in 37 cases (53 lesions). The severity of traumatic injuries, calculated according to the Abbreviated Injury Scale score, was classified as minor and moderate in 16 cases, severe in 16 cases and critical in one case. Among overuse injuries, 96% were considered minor and moderate lesions and 4% severe, As for the overall absence from competition, 26% were regarded as major injuries, 58% moderate and 15% minor. Injury rates calculated were 0.54 per racer over the 5-year follow-up, 0.11 per year, 0.003 per 1000 km and 0.001 per day of competition for traumatic injuries, and 0.86 per racer, 0.17 per year, 0.005 per 1000 km and 0.002 per day of competition for overuse. Our results disclose a different pattern of lesions and a higher injury exposure risk in elite racers than in other populations.
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This review presents information that is useful to athletes, coaches and exercise scientists in the adoption of exercise protocols, prescription of training regimens and creation of research designs. Part 2 focuses on the factors that affect cycling performance. Among those factors, aerodynamic resistance is the major resistance force the racing cyclist must overcome. This challenge can be dealt with through equipment technological modifications and body position configuration adjustments. To successfully achieve efficient transfer of power from the body to the drive train of the bicycle the major concern is bicycle configuration and cycling body position. Peak power output appears to be highly correlated with cycling success. Likewise, gear ratio and pedalling cadence directly influence cycling economy/efficiency. Knowledge of muscle recruitment throughout the crank cycle has important implications for training and body position adjustments while climbing. A review of pacing models suggests that while there appears to be some evidence in favour of one technique over another, there remains the need for further field research to validate the findings. Nevertheless, performance modelling has important implications for the establishment of performance standards and consequent recommendations for training.
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The aim of this review is to provide greater insight and understanding regarding the scientific nature of cycling. Research findings are presented in a practical manner for their direct application to cycling. The two parts of this review provide information that is useful to athletes, coaches and exercise scientists in the prescription of training regimens, adoption of exercise protocols and creation of research designs. Here for the first time, we present rationale to dispute prevailing myths linked to erroneous concepts and terminology surrounding the sport of cycling. In some studies, a review of the cycling literature revealed incomplete characterisation of athletic performance, lack of appropriate controls and small subject numbers, thereby complicating the understanding of the cycling research. Moreover, a mixture of cycling testing equipment coupled with a multitude of exercise protocols stresses the reliability and validity of the findings. Our scrutiny of the literature revealed key cycling performance-determining variables and their training-induced metabolic responses. The review of training strategies provides guidelines that will assist in the design of aerobic and anaerobic training protocols. Paradoxically, while maximal oxygen uptake (VO2max) is generally not considered a valid indicator of cycling performance when it is coupled with other markers of exercise performance (e.g. blood lactate, power output, metabolic thresholds and efficiency/economy), it is found to gain predictive credibility. The positive facets of lactate metabolism dispel the ‘lactic acid myth’. Lactate is shown to lower hydrogen ion concentrations rather than raise them, thereby retarding acidosis. Every aspect of lactate production is shown to be advantageous to cycling performance. To minimise the effects of muscle fatigue, the efficacy of employing a combination of different high cycling cadences is evident. The subconscious fatigue avoidance mechanism ‘teleoanticipation’ system serves to set the tolerable upper limits of competitive effort in order to assure the athlete completion of the physical challenge. Physiological markers found to be predictive of cycling performance include: (i) power output at the lactate threshold (LT2); (ii) peak power output (Wpeak) indicating a power/weight ratio of ≥5.5 W/kg; (iii) the percentage of type I fibres in the vastus lateralis; (iv) maximal lactate steady-state, representing the highest exercise intensity at which blood lactate concentration remains stable; (v) Wpeak at LT2; and (vi) Wpeak during a maximal cycling test. Furthermore, the unique breathing pattern, characterised by a lack of tachypnoeic shift, found in professional cyclists may enhance the efficiency and metabolic cost of breathing. The training impulse is useful to characterise exercise intensity and load during training and competition. It serves to enable the cyclist or coach to evaluate the effects of training strategies and may well serve to predict the cyclist’s performance. Findings indicate that peripheral adaptations in working muscles play a more important role for enhanced submaximal cycling capacity than central adaptations. Clearly, relatively brief but intense sprint training can enhance both glycolytic and oxidative enzyme activity, maximum short-term power output and VO2max. To that end, it is suggested to replace ~15% of normal training with one of the interval exercise protocols. Tapering, through reduction in duration of training sessions or the frequency of sessions per week while maintaining intensity, is extremely effective for improvement of cycling time-trial performance. Overuse and over-training disabilities common to the competitive cyclist, if untreated, can lead to delayed recovery.
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The purpose was to investigate the effect of 25 weeks heavy strength training in young elite cyclists. Nine cyclists performed endurance training and heavy strength training (ES) while seven cyclists performed endurance training only (E). ES, but not E, resulted in increases in isometric half squat performance, lean lower body mass, peak power output during Wingate test, peak aerobic power output (Wmax), power output at 4 mmol L−1 [la−], mean power output during 40-min all-out trial, and earlier occurrence of peak torque during the pedal stroke (P < 0.05). ES achieved superior improvements in Wmax and mean power output during 40-min all-out trial compared with E (P < 0.05). The improvement in 40-min all-out performance was associated with the change toward achieving peak torque earlier in the pedal stroke (r = 0.66, P < 0.01). Neither of the groups displayed alterations in VO2max or cycling economy. In conclusion, heavy strength training leads to improved cycling performance in elite cyclists as evidenced by a superior effect size of ES training vs E training on relative improvements in power output at 4 mmol L−1 [la−], peak power output during 30-s Wingate test, Wmax, and mean power output during 40-min all-out trial.
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Patellofemoral pain (PFP) is a common overuse injury in cycling, but its etiology in cycling is not well understood. It is associated with poor patellar alignment during knee movement from flexion to extension. Biomechanical factors associated with patellar malalignment include poor quadriceps function, vastus medialis obliquus insufficiency, extensive subtalar-joint pronation, and poor muscle flexibility. Factors in the biomechanics of PFP in cyclists include abnormal lower-limb biomechanics, incorrect bicycle and equipment setting, and incorrect training methods. Abnormal forefoot and rear-foot alignment are associated with patellar maltracking. There is anecdotal evidence that leg-length discrepancies and varus or valgus knee malalignment are implicated in PFP in cyclists. Incorrect equipment settings include saddle height, incorrect cleat position, and the type of cleat and shoe. Training factors associated with PFP in cyclists are hill training, cycling with high gears at a low cadence , and a sudden increase in training volume. The article reviews the etiology, biomechanics, clinical diagnosis, and management of PFP in cyclists.
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Little epidemiological information exists on overuse injuries in elite road cyclists. Anecdotal reports indicate anterior knee pain and lower back pain may be common problems. This study was conducted to register overuse injuries among professional road cyclists with special focus on anterior knee and lower back pain. Descriptive epidemiology study. We attended training camps of 7 professional teams and interviewed 109 of 116 cyclists (94%) on overuse injuries they had experienced in the previous 12 months. Injuries that required attention from medical personnel or involved time loss from cycling were registered. Additional information on anterior knee pain and lower back pain was collected using specific questionnaires. A total of 94 injuries were registered; 45% were in the lower back and 23% in the knee. Twenty-three time-loss injuries were registered-57% in the knee, 22% in the lower back, and 13% in the lower leg. Fifty-eight percent of all cyclists had experienced lower back pain in the previous 12 months, and 41% of all cyclists had sought medical attention for it. Thirty-six percent had experienced anterior knee pain and 19% had sought medical attention for it. Few cyclists had missed competitions because of pain in the lower back (6%) or anterior knee (9%). Lower back pain and anterior knee pain were the most prevalent overuse injuries, with knee injuries most likely to cause time loss and lower back pain causing the highest rates of functional impairment and medical attention. Future efforts to prevent overuse injuries in competitive cyclists should focus on lower back pain and anterior knee pain.
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Most mathematical models of athletic training require the quantification of training intensity and quantity or ‘dose’. We aim to summarize both the methods available for such quantification, particularly in relation to cycle sport, and the mathematical techniques that may be used to model the relationship between training and performance. Endurance athletes have used training volume (kilometres per week and/or hours per week) as an index of training dose with some success. However, such methods usually fail to accommodate the potentially important influence of training intensity. The scientific literature has provided some support for alternative methods such as the session rating of perceived exertion, which provides a subjective quantification of the intensity of exercise; and the heart rate-derived training impulse (TRIMP) method, which quantifies the training stimulus as a composite of external loading and physiological response, multiplying the training load (stress) by the training intensity (strain). Other methods described in the scientific literature include ‘ordinal categorization’ and a heart rate-based excess post-exercise oxygen consumption method. In cycle sport, mobile cycle ergometers (e.g. SRM™ and PowerTap™) are now widely available. These devices allow the continuous measurement of the cyclists’ work rate (power output) when riding their own bicycles during training and competition. However, the inherent variability in power output when cycling poses several challenges in attempting to evaluate the exact nature of a session. Such variability means that average power output is incommensurate with the cyclist’s physiological strain. A useful alternative may be the use of an exponentially weighted averaging process to represent the data as a ‘normalized power’. Several research groups have applied systems theory to analyse the responses to physical training. Impulse-response models aim to relate training loads to performance, taking into account the dynamic and temporal characteristics of training and, therefore, the effects of load sequences over time. Despite the successes of this approach it has some significant limitations, e.g. an excessive number of performance tests to determine model parameters. Non-linear artificial neural networks may provide a more accurate description of the complex non-linear biological adaptation process. However, such models may also be constrained by the large number of datasets required to ‘train’ the model. A number of alternative mathematical approaches such as the Performance- Potential-Metamodel (PerPot), mixed linear modelling, cluster analysis and chaos theory display conceptual richness. However, much further research is required before such approaches can be considered as viable alternatives to traditional impulse-response models. Some of these methods may not provide useful information about the relationship between training and performance. However, they may help describe the complex physiological training response phenomenon.
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To determine if there is evidence that equipment use reduces sport concussion risk and/or severity. 12 electronic databases were searched using a combination of Medical Subject Headings and text words to identify relevant articles. Review Specific inclusion and exclusion criteria were used to select studies for review. Data extracted included design, study population, exposure/outcome measures and results. The quality of evidence was assessed based on epidemiologic criteria regarding internal and external validity (ie, strength of design, sample size/power calculation, selection bias, misclassification bias, control of potential confounding and effect modification). In total, 51 studies were selected for review. A comparison between studies was difficult due to the variability in research designs, definition of concussion, mouthguard/helmet/headgear/face shield types, measurements used to assess exposure and outcomes, and variety of sports assessed. The majority of studies were observational, with 23 analytical epidemiologic designs related to the subject area. Selection bias was a concern in the reviewed studies, as was the lack of measurement and control for potentially confounding variables. There is evidence that helmet use reduces head injury risk in skiing, snowboarding and bicycling, but the effect on concussion risk is inconclusive. No strong evidence exists for the use of mouthguards or face shields to reduce concussion risk. Evidence is provided to suggest that full facial protection in ice hockey may reduce concussion severity, as measured by time loss from competition.
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External iliac stenosis due to endofibrosis is a rare condition that predominantly affects top level cyclists. Short term symptomatic relief is reported in an Olympian after percutaneous transluminal angioplasty, which was performed to allow the patient to return to training without delay.
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In England the use of bicycle helmets remains low as debate continues about their effectiveness. Time trend studies have previously shown an inverse association between helmet wearing rates and hospital admissions for head injury, but data on helmet wearing are often sparse and admission rates vary for numerous reasons. For the period of this study comprehensive data on helmet wearing are available, and pedestrians are used as a control to monitor trends in admission. Among cyclists admitted to hospital, the percentage with head injury reduced from 27.9% (n = 3070) to 20.4% (n = 2154), as helmet wearing rose from 16.0% to 21.8%. Pedestrian head injury admissions also declined but by a significantly smaller amount. The wearing of a cycle helmet is estimated to prevent 60% of head injuries.
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Approximately one in five top-level cyclists will develop sports-related flow limitations in the iliac arteries. These flow limitations may be caused by a vascular lumen narrowing due to endofibrotic thickening of the intima and/or by kinking of the vessels. In some athletes, extreme vessel length contributes to this kinking. Endofibrotic thickening is a result of a repetitive vessel damage due to haemodynamic and mechanical stress. Atherosclerotic intimal thickening is seldom encountered in these young athletes. This type of sports-related flow limitation shows no relationship with the classical risk factors for atherosclerosis like smoking, hypercholesterolaemia or family predisposition for arterial diseases. The patient's history is paramount for diagnosis. If an athlete reports typical claudication-like complaints in a leg at maximal effort, which disappear quickly at rest, approximately two out of three will have a flow limitation in the iliac artery. In current (sports) medical practice, this diagnosis is often missed, since a vascular cause is not expected in this healthy athletic population. Even if suspected, the routinely available diagnostic tests often appear insufficient. Definite diagnosis can be made by a combination of the patient's history and special designed tests consisting of a maximal cycle ergometer test with ankle blood pressure measurements and/or an echo-Doppler examination with provocative manoeuvres like hip flexion and exercise. Conservative treatment consists of diminishing or even completely stopping the provocative sports activity. If conservative treatment is insufficient or deemed unacceptable, surgical treatment might be considered. As surgery needs to be tailored to the underlying lesions, a detailed analysis before surgery is necessary. Standard clinical tests, used for visualising atherosclerotic diseases, are inadequate to identify and quantify the causes of flow limitations. Echo-Doppler examination and magnetic resonance angiography with both flexed and extended hips have been proven to be adequate tools. In particular, overprojection and eccentric location of the lesions seriously limit the usefulness of a two-dimensional technique like digital subtraction angiography. In the early stages, when kinking has not yet led to intimal thickening or excessive lengthening, simple surgical release of the iliac artery is effective. However, for patients with excessive vessel lengths or extensive endofibrotic thickening, a vascular reconstruction may be necessary. A major drawback of these interventions is that long-term effects and complications are unknown. As both the diagnostic methods and the treatments for this type of flow limitation differ substantially from routine vascular procedures, these patients should be examined in specialised research centres with appropriate diagnostic tools and medical experience.
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This review presents information that is useful to athletes, coaches and exercise scientists in the adoption of exercise protocols, prescription of training regimens and creation of research designs. Part 2 focuses on the factors that affect cycling performance. Among those factors, aerodynamic resistance is the major resistance force the racing cyclist must overcome. This challenge can be dealt with through equipment technological modifications and body position configuration adjustments. To successfully achieve efficient transfer of power from the body to the drive train of the bicycle the major concern is bicycle configuration and cycling body position. Peak power output appears to be highly correlated with cycling success. Likewise, gear ratio and pedalling cadence directly influence cycling economy/efficiency. Knowledge of muscle recruitment throughout the crank cycle has important implications for training and body position adjustments while climbing. A review of pacing models suggests that while there appears to be some evidence in favour of one technique over another, there remains the need for further field research to validate the findings. Nevertheless, performance modelling has important implications for the establishment of performance standards and consequent recommendations for training.
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The aim of this review is to provide greater insight and understanding regarding the scientific nature of cycling. Research findings are presented in a practical manner for their direct application to cycling. The two parts of this review provide information that is useful to athletes, coaches and exercise scientists in the prescription of training regimens, adoption of exercise protocols and creation of research designs. Here for the first time, we present rationale to dispute prevailing myths linked to erroneous concepts and terminology surrounding the sport of cycling. In some studies, a review of the cycling literature revealed incomplete characterisation of athletic performance, lack of appropriate controls and small subject numbers, thereby complicating the understanding of the cycling research. Moreover, a mixture of cycling testing equipment coupled with a multitude of exercise protocols stresses the reliability and validity of the findings. Our scrutiny of the literature revealed key cycling performance-determining variables and their training-induced metabolic responses. The review of training strategies provides guidelines that will assist in the design of aerobic and anaerobic training protocols. Paradoxically, while maximal oxygen uptake (V-O(2max)) is generally not considered a valid indicator of cycling performance when it is coupled with other markers of exercise performance (e.g. blood lactate, power output, metabolic thresholds and efficiency/economy), it is found to gain predictive credibility. The positive facets of lactate metabolism dispel the 'lactic acid myth'. Lactate is shown to lower hydrogen ion concentrations rather than raise them, thereby retarding acidosis. Every aspect of lactate production is shown to be advantageous to cycling performance. To minimise the effects of muscle fatigue, the efficacy of employing a combination of different high cycling cadences is evident. The subconscious fatigue avoidance mechanism 'teleoanticipation' system serves to set the tolerable upper limits of competitive effort in order to assure the athlete completion of the physical challenge. Physiological markers found to be predictive of cycling performance include: (i) power output at the lactate threshold (LT2); (ii) peak power output (W(peak)) indicating a power/weight ratio of > or =5.5 W/kg; (iii) the percentage of type I fibres in the vastus lateralis; (iv) maximal lactate steady-state, representing the highest exercise intensity at which blood lactate concentration remains stable; (v) W(peak) at LT2; and (vi) W(peak) during a maximal cycling test. Furthermore, the unique breathing pattern, characterised by a lack of tachypnoeic shift, found in professional cyclists may enhance the efficiency and metabolic cost of breathing. The training impulse is useful to characterise exercise intensity and load during training and competition. It serves to enable the cyclist or coach to evaluate the effects of training strategies and may well serve to predict the cyclist's performance. Findings indicate that peripheral adaptations in working muscles play a more important role for enhanced submaximal cycling capacity than central adaptations. Clearly, relatively brief but intense sprint training can enhance both glycolytic and oxidative enzyme activity, maximum short-term power output and V-O(2max). To that end, it is suggested to replace approximately 15% of normal training with one of the interval exercise protocols. Tapering, through reduction in duration of training sessions or the frequency of sessions per week while maintaining intensity, is extremely effective for improvement of cycling time-trial performance. Overuse and over-training disabilities common to the competitive cyclist, if untreated, can lead to delayed recovery.
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In several recent studies, athletes experienced substantial gains in sprint and endurance performance when explosive training or high-intensity interval training was added in the noncompetitive phase of a season. Here we report the effect of combining these 2 types of training on performance in the competitive phase. We randomized 18 road cyclists to an experimental (n = 9) or control (n = 9) group for 4-5 weeks of training. The experimental group replaced part of their usual training with twelve 30-minute sessions consisting of 3 sets of explosive single-leg jumps (20 for each leg) alternating with 3 sets of high-resistance cycling sprints (5 x 30 seconds at 60-70 min(-1) with 30-second recoveries between repetitions). Performance measures, obtained over 2-3 days on a cycle ergometer before and after the intervention, were mean power in a 1- and 4-km time trial, peak power in an incremental test, and lactate-profile power and oxygen cost determined from 2 fixed submaximal workloads. The control group showed little mean change in performance. Power output sampled in the training sprints of the experimental group indicated a plateau in the training effect after 8-12 sessions. Relative to the control group, the mean changes (+/-90% confidence limits) in the experimental group were: 1-km power, 8.7% (+/-2.5%); 4-km power, 8.1% (+/-4.1%); peak power, 6.8% (+/-3.6); lactate-profile power, 3.7% (+/-4.8%); and oxygen cost, -3.0% (+/-2.6%). Individual responses to the training were apparent only for 4-km and lactate-profile power (standard deviations of 2.5% and 2.8%, respectively). The addition of explosive training and high-resistance interval training to the programs of already well-trained cyclists produces major gains in sprint and endurance performance, partly through improvements in exercise efficiency and anaerobic threshold.
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Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football injuries; this has made inter-study comparisons difficult. An Injury Consensus Group was established under the auspices of FIFA Medical Assessment and Research Centre. Using a nominal group consensus model approach, a working document that identified the key issues related to definitions, methodology and implementation was discussed by members of the group during a 2-day meeting. Following this meeting, iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis and causation are proposed. Proforma for recording players' baseline information, injuries and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented. The definitions and methodology proposed in the consensus statement will ensure that consistent and comparable results will be obtained from studies of football injuries.
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Wide variations in the definitions and methodologies used for studies of injuries in rugby union have created inconsistencies in reported data and made interstudy comparisons of results difficult. The International Rugby Board established a Rugby Injury Consensus Group (RICG) to reach an agreement on the appropriate definitions and methodologies to standardise the recording of injuries and reporting of studies in rugby union. The RICG reviewed the consensus definitions and methodologies previously published for football (soccer) at a meeting in Dublin in order to assess their suitability for and application to rugby union. Following this meeting, iterative draft statements were prepared and circulated to members of the RICG for comment; a follow-up meeting was arranged in Dublin, at which time all definitions and procedures were finalised. At this stage, all authors confirmed their agreement with the consensus statement. The agreed document was presented to and approved by the International Rugby Board Council. Agreement was reached on definitions for injury, recurrent injury, non-fatal catastrophic injury, and training and match exposures, together with criteria for classifying injuries in terms of severity, location, type, diagnosis and causation. The definitions and methodology presented in this consensus statement for rugby union are similar to those proposed for football. Adoption of the proposals presented in this consensus statement should ensure that more consistent and comparable results will be obtained from studies of injuries within rugby union.
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Wide variations in the definitions and methodologies used for studies of injuries in rugby union have created inconsistencies in reported data and made interstudy comparisons of results difficult. The International Rugby Board established a Rugby Injury Consensus Group (RICG) to agree on appropriate definitions and methodologies to standardize the recording of injuries and reporting of studies in rugby union. The RICG reviewed the consensus definitions and methodologies previously published for football (soccer) at a meeting in Dublin to assess their suitability for and application to rugby union. Following this meeting, iterative draft statements were prepared and circulated to members of the RICG for comment; a follow-up meeting was arranged in Dublin at which time all definitions and procedures were finalized. At this stage, all authors confirmed their agreement with the consensus statement. The agreed-on document was presented to and approved by the International Rugby Board Council. Agreement was reached on definitions for injury, recurrent injury, nonfatal catastrophic injury, and training and match exposures together with criteria for classifying injuries in terms of severity, location, type, diagnosis, and causation. The definitions and methodology presented in this consensus statement for rugby union are similar to those proposed for football. Adoption of the proposals presented in this consensus statement should ensure that more consistent and comparable results will be obtained from studies of injuries within rugby union.
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The protection of athletes' health by preventing injuries is an important task for international sports federations. Standardised injury surveillance provides not only important epidemiological information, but also directions for injury prevention, and the opportunity for monitoring long-term changes in the frequency and circumstances of injury. Numerous studies have evaluated sports injuries during the season, but few have focused on injuries during major sport events such as World Championships, World Cups or the Olympic Games. To provide an injury surveillance system for multi-sports tournaments, using the 2008 Olympic Games in Beijing as an example. A group of experienced researchers reviewed existing injury report systems and developed a scientific sound and concise injury surveillance system for large multi-sport events. The injury report system for multi-sport events is based on an established system for team sports tournaments and has proved feasible for individual sports during the International Association of Athletics Federations World Championships in Athletics 2007. The most important principles and advantages of the system are comprehensive definition of injury, injury report by the physician responsible for the athlete, a single-page report of all injuries, and daily report irrespective of whether or not an injury occurred. Implementation of the injury surveillance system, all definitions, the report form, and the analysis of data are described in detail to enable other researchers to implement the injury surveillance system in any sports tournament. The injury surveillance system has been accepted by experienced team physicians and shown to be feasible for single-sport and multi-sport events. It can be modified depending on the specific objectives of a certain sport or research question; however, a standardised use of injury definition, report forms and methodology will ensure the comparability of results.
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Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries, making interstudy comparisons difficult. Therefore an Injury Consensus Group was established under the auspices of Fédération Internationale de Football Association Medical Assessment and Research Centre. A nominal group consensus model approach was used. A working document on definitions, methodology, and implementation was discussed by the group. Iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity, and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players’ baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented.
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The scientific evidence that bicycle helmets protect against head, brain and facial injuries has been well established by 5 well designed case-control studies. Additional evidence of helmet effectiveness has been provided from time series studies in Australia and the US. Bicycle helmets of all types that meet various national and international standards provide substantial protection for cyclists of all ages who are involved in a bicycle crash. This protection extends to crashes from a variety of causes (such as falls and collisions with fixed and moving objects) and includes crashes involving motor vehicles. Helmet use reduces the risk of head injury by 85%, brain injury by 88% and severe brain injury by at least 75%. Helmets should be worn by all riders whether the cyclist is a recreational rider or a serious competitor engaged in training or race competition. The International Cycling Federation (ICF) should make the use of helmets compulsory in all sanctioned races.
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The increasing participation in the athletic forms of bicycling warrants expanded physician attention to the traumatic and overuse injuries experienced by cyclists. The modern bicycle consists of a frame with various components, including handlebars, brakes, wheels, pedals, and gears, in various configurations for the various modes of cycling. For high performance cycling the proper fit of the bicycle is critical. The most efficient method to provide an accurate fit is the Fitkit, but proper frame selection and adjustment can be made by following simple guidelines for frame size, seat height, fore and aft saddle position, saddle angle, reach and handlebar height. The human body functions most effectively in a narrow range of pedal resistance to effort. Riding at too much pedal resistance is a major cause of overuse problems in cyclists. Overuse injuries are lower using lower gear ratios at a higher cadence. Cycling injuries account for 500 000 visits per year to emergency rooms in the US. Over half the accidents involve motor vehicles, and road surface and mechanical problems with the bicycle are also common causes of accidents. Head injuries are common in cyclists and account for most of the fatal accidents. Despite good evidence of their effectiveness, victims with head injuries have rarely worn helmets. Contusions, sprains and fractures may occur throughout the body, most commonly to the hand, wrist, lower arm, shoulder, ankle and lower leg. The handlebar and seat have been implicated in a wide variety of abdominal and genital injuries. Abrasions, lacerations and bruises of the skin are the most common traumatic injuries. Trauma may be prevented or reduced by proper protective safety equipment and keeping the bike in top mechanical condition. Anticipation of the errors of others and practising and adopting specific riding strategies also help to prevent traumatic injuries. Management of overuse injuries in cycling generally involves mechanical adjustment as well as medical management. Neck and back pain are extremely common in cyclists, occurring in up to 60% of riders. Ulnar neuropathy, characterised by tingling, numbness and weakness in the hands is common in serious cyclists after several days of riding. Managing saddle-related injuries or irritations may also involve adjusting seat height, angle and fore and aft position in addition to changing the saddle. Padding in the saddle and shorts play an important part in saddle problems. Saddle-related problems include chafing, perineal folliculitis and furuncles, subcutaneous perineal nodules, pudendal neuropathy, male impotence, traumatic urethritis and a variety of vulva trauma. Improper fit of the bicycle may also lead to problems such as trochanteric bursitis, iliopsoas tendinitis, and ‘biker’s knee’ (patellofemoral pain syndrome). Foot paraesthesias, metatarsalgia and occasionally Achilles tendinitis and plantar fasciitis have also been reported in cyclists. Cyclists should take proper precautions against sun and heat injuries, especially dehyration. Cyclists may benefit from a variety of protective clothing and equipment, such as helmets, mirrors, eyewear, lights and reflective clothing and footwear.
Article
Previous case-control studies on bicycle helmet efficacy are mostly Anglo-Saxon, and based on data from the early 1990s when hard-shell helmets were common. In France, the Rhône county (1.6 million inhabitants) is covered by a road trauma registry that includes emergency department visits, hospital admissions, and fatalities. Over the 1998-2008 period, 13,797 cyclist casualties were identified. The injuries sustained were coded using the Abbreviated Injury Scale (AIS) for injuries to the head (AIS1+ and AIS3+), face (AIS1+), or neck (AIS1+). The study uses a case-control design where the control group includes cyclists injured below the neck-that is, not injured in the region associated with the helmet. We first adjusted for age, gender, and type of crash, as in a previously published Cochrane review. Then we adjusted for injury severity based on non-head, face, or neck injury, and when relevant, for crash location: type of road, urban/rural area. The fully adjusted ORs of helmeted versus unhelmeted cyclists are: for AIS1+ head injuries, 0.69 (95% CI 0.59 to 0.81); for AIS3+ head injuries sustained in urban areas, 0.34 (95% CI 0.15 to 0.65), those sustained in rural areas, 0.07 (95% CI 0.02 to 0.23); for AIS1+ facial injuries, 0.72 (95% CI 0.62 to 0.83); and for AIS1+ neck injuries, 1.18 (95% CI 0.94 to 1.47). This study confirms the protective effect for head and facial injuries, even though soft-shell helmets have now become more common. The reduction of risk is greater for serious head injuries. The study is inconclusive about the risk for neck injuries.
Article
Background Asymptomatic musculoskeletal function, normal range of joint motion and normal muscle strength are considered not adequate star points to design a prevention injury program. Objective To assess core muscle balance and control in the lumbar spine using simple functional tests during low load activity and high load dynamic movements. Design Cross-sectional descriptive study. Setting Professional road cyclists. Patients 51 elite road cyclists were functionally evaluated at the beginning of the 2010 season. All injuries affecting racers during previous seasons were recorded throughout a clinical oriented interview. Interventions Specific assessment of the site (lower back and pelvis) and direction of uncontrolled movement, under low and high loading within functionally orientated tasks. Main outcome measurements Three tests were conducted in the crook laying position: (1) double leg lift and lower, (2) single leg extension, (3) bridge+single leg extension. In two first tests the 'stabilizer' pressure biofeedback unit was used to measure the influence of the global muscle system on trunk stability. Muscle functional extensibility of iliopsoas, tensor fasciae late, anterior rectus femoris and hamstrings were also evaluated. Results Uncontrolled movements in lower back in low load test were found in flexion (57% of cyclist) and extension test (67%). Passive and active restriction of hamstrings while sitting showed significant correlation with impaired low back movements in flexion test (p<0.05). Weakness of the gluteus maximus correlated with uncontrolled movement in low back extension at high loading. Impaired movements in pelvic girdle (70%) showed a statistically significant relationship with asymmetrical passive restriction of rectus anterior muscle (p<0.03). Conclusion Muscle imbalance between hamstrings and hip flexors together with weak hip extensors provoke uncontrolled movements in the low back of cyclists, predisposing them to more overuse injuries. A specific preventive program should be desirable.
Article
Injuries in triathletes are common and are mostly overuse injuries. Rotator cuff tendinitis is the most common complaint from swimming, but the incidence of tendinopathy and rotator cuff tears on magnetic resonance imaging is comparable in triathletes without and with shoulder pain. Cycling injuries are mainly to the knee, including patellar tendinosis, iliotibial band syndrome, and patellofemoral stress syndrome, and to the Achilles tendon and the cervical and lumbar spine. Running is associated with most injuries in triathletes, during both training and racing, causing the athlete to discontinue the triathlon. In addition to knee injuries from running, triathletes may also develop foot and ankle, lower leg, and hip injuries similar to single-sport distance runners. Some injuries in triathletes may be mainly symptomatic during one of the three sports but are exacerbated by one or both of the other disciplines.
Article
Crank torque (CT) application and rate of CT development (RCTD) are important considerations in sprint cycling. The stiffness of the musculotendinous unit is related to the isometric rate of torque development (RTD); however, this relationship has yet to be examined in sprint cycling. Maximal isometric torque (MIT) and isometric RTD of the quadriceps were assessed in 21 trained male cyclists (28.7 +/- 9.5 yr, 1.74 +/- 0.08 m, and 67.5 +/- 7.2 kg). Unilateral musculoarticular (MA) stiffness of the quadriceps was quantified using an oscillation test. Further, the participants performed a maximal 6-s sprint to assess peak power output (POpeak), peak CT (CTpeak), peak RCTD (RCTDpeak), and the crank angles associated with CTpeak and RCTDpeak. Participants were ranked on MA stiffness properties and were divided into a relatively stiff group (SG) and a relatively compliant group (CG). The SG displayed a significantly higher MA stiffness than the CG (P < 0.05). Furthermore, the SG reported significantly elevated MIT (27%), RTD (26%), and RCTDpeak (16%) when compared with the CG (P < 0.05), along with trends for increased POpeak (7%) and CTpeak (8%). The angles at CTpeak and RCTDpeak were 7% and 12% lower for the SG, respectively (P < 0.05). MA stiffness was significantly correlated with RCTDpeak, MIT, RTD, and POpeak. Higher stiffness is related to superior RCTDpeak in trained cyclists during a single sprint. A significant proportion of the variance in RCTDpeak was attributed to MA stiffness (37%), which was of greater magnitude than the relationship between RCTDpeak and MIT. Furthermore, the lower CTpeak angle and RCTDpeak angle may contribute to a more rapid development of CT. Accordingly, MA stiffness seems to be an important consideration for sprint cycling.
Article
The increasing participation in the athletic forms of bicycling warrants expanded physician attention to the traumatic and overuse injuries experienced by cyclists. The modern bicycle consists of a frame with various components, including handlebars, brakes, wheels, pedals, and gears, in various configurations for the various modes of cycling. For high performance cycling the proper fit of the bicycle is critical. The most efficient method to provide an accurate fit is the Fitkit, but proper frame selection and adjustment can be made by following simple guidelines for frame size, seat height, fore and aft saddle position, saddle angle, reach and handlebar height. The human body functions most effectively in a narrow range of pedal resistance to effort. Riding at too much pedal resistance is a major cause of overuse problems in cyclists. Overuse injuries are lower using lower gear ratios at a higher cadence. Cycling injuries account for 500,000 visits per year to emergency rooms in the US. Over half the accidents involve motor vehicles, and road surface and mechanical problems with the bicycle are also common causes of accidents. Head injuries are common in cyclists and account for most of the fatal accidents. Despite good evidence of their effectiveness, victims with head injuries have rarely worn helmets. Contusions, sprains and fractures may occur throughout the body, most commonly to the hand, wrist, lower arm, shoulder, ankle and lower leg. The handlebar and seat have been implicated in a wide variety of abdominal and genital injuries. Abrasions, lacerations and bruises of the skin are the most common traumatic injuries. Trauma may be prevented or reduced by proper protective safety equipment and keeping the bike in top mechanical condition. Anticipation of the errors of others and practising and adopting specific riding strategies also help to prevent traumatic injuries. Management of overuse injuries in cycling generally involves mechanical adjustment as well as medical management. Neck and back pain are extremely common in cyclists, occurring in up to 60% of riders. Ulnar neuropathy, characterised by tingling, numbness and weakness in the hands is common in serious cyclists after several days of riding. Managing saddle-related injuries or irritations may also involve adjusting seat height, angle and fore and aft position in addition to changing the saddle. Padding in the saddle and shorts play an important part in saddle problems. Saddle-related problems include chafing, perineal folliculitis and furuncles, subcutaneous perineal nodules, pudendal neuropathy, male impotence, traumatic urethritis and a variety of vulva trauma.(ABSTRACT TRUNCATED AT 400 WORDS)
Article
This investigation determined the accuracy of self-reports of physical activity compared to observations obtained surreptitiously. Subjects were 44 adults engaged in 1 h of their preferred physical activity while actual activity levels were surreptitiously obtained and compared to immediate self-reported estimates of physical activity. Results indicated that subjects were moderately accurate in recalling their physical activity levels (R = 0.62) but underestimated sedentary activities and overestimated aerobic activities by over 300%. Males overestimated their activity relative to females, and obese subjects underestimated their activity levels compared to normal-weight subjects. Finally, a number of two-way interactions that moderated the accuracy of those subjects engaging in high chronic levels of physical activity were observed.
Article
In order to study the incidence and mechanisms of injury in soccer and to recommend prophylactic measures, 180 players in a senior male soccer division were followed prospectively for 1 yr. Attendance records for games and practice sessions were kept, and all injuries were examined and treated by the same orthopaedic surgeon. One hundred twenty-four players incurred 256 injuries, mostly sprains and strains of the lower extremities. Of these, 62% were considered minor with ankle sprains being the most common (17%), while 11% were considered major with knee ligament sprains being the most frequent (32%). Overuse injuries were most frequent in the preseason training period. Traumatic leg injuries involved players with inadequate or no shin guards. Of the traumatic knee injuries, 11 of 18 (61%) occurred during a collision; non-contact knee injuries were frequently seen in those players with a history of knee injury and existing instability. Study of injury sequence disclosed that a minor injury was often followed within two months by a major one. In addition, with severe injuries incurred during fouls, the individual causing the penalty was injured. This prospective study suggested that those with knee instability and those allowed to resume play with poorly rehabilitated or clinically unhealed injuries are more apt to sustain further injury. Some injuries can be avoided by using better equipment and by observance of the rules.
Article
Overuse problems in cycling can be attributed to several factors. First, the symmetric design of the bicycle matched against the asymmetric variants of the human body produce, on occasion, abnormally directed stress loads on tendons and muscles. Second, cycling involves a high number of repetitions compared with other sports, often as high as 5000 revolutions per hour. Last, with the advent of advanced pedal systems, the cyclist has become more "fixed" to the bicycle. It is critically important that these factors be understood and addressed when treating overuse injuries in cyclists. Standard modalities and therapies are essential components of the treatment plan for cycling-related overuse injuries that should not be overlooked. Surgical intervention should only be considered after prolonged nonoperative measures have failed to relieve symptoms.
Article
Back and neck problems in bicyclists should be managed by a combination of bicycle adjustment or modification, technique change, and medical treatment. The bicycle should be checked for proper fit. Often it is necessary to relieve the rider's extended position by using handlebars with less drop, using a stem with a shorter extension, raising the stem, or moving the seat forward. Changing hand positions on the handlebars frequently, riding with the elbows "unlocked," varying head position, using padded gloves and handlebars, and riding on wider tires all reduce the effects of road shock. Initial medical management includes ice, massage stretching, and nonsteroidal anti-inflammatory drugs or acetaminophen. Definitive treatment is neck and back rehabilitation based on dynamic muscular stabilization. It involves three progressive and overlapping parts: (1) establishing range of motion, (2) finding and stabilizing the neutral position, and (3) adapting the neutral position to exercise.
Article
Iliotibial band syndrome is an overuse injury caused by repetitive friction of the iliotibial band across the lateral femoral epicondyle. Once considered an injury indigenous to runners, it is now frequently being seen in cyclists. The purpose of this paper is to identify iliotibial band syndrome as a significant problem in cyclists and to propose both operative and nonoperative measures for treating cyclists. Nonoperative measures specific to cyclists consist of bicycle adjustments and training modifications. These are adjunctive therapies to stretching, icing, rest, and oral nonsteroidal antiinflammatory drugs. For cyclists requiring operative intervention, a new surgical technique for excising or releasing the distal iliotibial band is presented. This technique, used by the senior author (JCH) since 1984, involves excision of an elliptical piece of the distal posterior band off the lateral femoral epicondyle.
Article
To examine the risk of injury to the head and the effect of wearing helmets in bicycle accidents among children. Case-control study by questionnaire completed by the children and their carers. Two large children's hospitals in Brisbane, Australia. 445 children presenting with bicycle related injuries during 15 April 1991 to 30 June 1992. The cases comprised 102 children who had sustained injury to the upper head including the skull, forehead and scalp or loss of consciousness. The controls were 278 cyclists presenting with injuries other than to the head or face. A further 65 children with injuries to the face were considered as an extra comparison group. Cause and type of injury, wearing of helmet. Most children (230) were injured after losing control and falling from their bicycle. Only 31 had contact with another moving vehicle. Children with head injury were significantly more likely to have made contact with a moving vehicle than control children (19 (19%) v 12 (4%), P < 0.001). Head injuries were more likely to occur on paved surfaces than on grass, gravel, or dirt. Wearing a helmet reduced the risk of head injury by 63% (95% confidence interval 34% to 80%) and of loss of consciousness by 86% (62% to 95%). The risk of head injury in bicycle accidents is reduced among children wearing a helmet. Current helmet design maximises protection in the type of accident most commonly occurring in this study. Legislation enforcing helmet use among children should be considered.
Article
The scientific evidence that bicycle helmets protect against head, brain and facial injuries has been well established by 5 well designed case-control studies. Additional evidence of helmet effectiveness has been provided from time series studies in Australia and the US. Bicycle helmets of all types that meet various national and international standards provide substantial protection for cyclists of all ages who are involved in a bicycle crash. This protection extends to crashes from a variety of causes (such as falls and collisions with fixed and moving objects) and includes crashes involving motor vehicles. Helmet use reduces the risk of head injury by 85%, brain injury by 88% and severe brain injury by at least 75%. Helmets should be worn by all riders whether the cyclist is a recreational rider or a serious competitor engaged in training or race competition. The International Cycling Federation (ICF) should make the use of helmets compulsory in all sanctioned races.
Article
Professional cycle racing is one of the most demanding of all sports combining extremes of exercise duration, intensity and frequency. Riders are required to perform on a variety of surfaces (track, road, cross-country, mountain), terrains (level, uphill and downhill) and race situations (criterions, sprints, time trials, mass-start road races) in events ranging in duration from 10 s to 3 wk stage races covering 200 m to 4,000 km. Furthermore, professional road cyclists typically have approximately 100 race d/yr. Because of the diversity of cycle races, there are vastly different physiological demands associated with the various events. Until recently there was little information on the demands of professional cycling during training or competition. However, with the advent of reliable, valid bicycle crank dynanometers, it is now possible to quantify real-time power output, cadence and speed during a variety of track and road cycling races. This article provides novel data on the physiological demands of professional and world-class amateur cyclists and characterises some of the physiological attributes necessary for success in cycling at the élite level.
Article
Male professional road cycling competitions last between 1 hour (e.g. the time trial in the World Championships) and 100 hours (e.g. the Tour de France). Although the final overall standings of a race are individual, it is undoubtedly a team sport. Professional road cyclists present with variable anthropometric values, but display impressive aerobic capacities [maximal power output 370 to 570 W, maximal oxygen uptake 4.4 to 6.4 L/min and power output at the onset of blood lactate accumulation (OBLA) 300 to 500 W]. Because of the variable anthropometric characteristics, 'specialists' have evolved within teams whose job is to perform in different terrain and racing conditions. In this respect, power outputs relative to mass exponents of 0.32 and 1 seem to be the best predictors of level ground and uphill cycling ability, respectively. However, time trial specialists have been shown to meet requirements to be top competitors in all terrain (level and uphill) and cycling conditions (individually and in a group). Based on competition heart rate measurements, time trials are raced under steady-state conditions, the shorter time trials being raced at average intensities close to OBLA (approximately 400 to 420 W), with the longer ones close to the individual lactate threshold (LT, approximately 370 to 390 W). Mass-start stages, on the other hand, are raced at low mean intensities (approximately 210 W for the flat stages, approximately 270 W for the high mountain stages), but are characterised by their intermittent nature, with cyclists spending on average 30 to 100 minutes at, and above LT, and 5 to 20 minutes at, and above OBLA.
Article
It was claimed that the bicycle helmet law in New Zealand reduced head injuries to adult cyclists by 28% (Povey, L.J., Frith, W.J., Graham, P.G., 1999. Cycle helmet effectiveness in New Zealand. Accident Analysis and Prevention 31, 763-770). However, the pre-law increase in adults wearing helmets (from 30% in 1990 to 43% in 1993) was accompanied by a fall of 45 head injuries per 100 limb injuries (i.e. -3.47 for every 1% increase in helmet wearing) compared with a fall of 11 when wearing increased from 43 to 93% with the law (-0.23 for every 1% increase in wearing). Unless voluntary wearing is 15 times more effective in reducing head injuries, it seems likely that the apparent effects (as described by Povey et al., 1999) were an artefact caused by failure to fit time trends in their model. Such inconsistency of effects over periods of substantial change compared with periods of little change in helmet wearing may be a useful indicator of the presence of trends. Because the large increases in wearing with helmet laws have not resulted in any obvious change over and above existing trends, helmet laws and major helmet promotion campaigns are likely to prove less beneficial and less cost effective than proven road-safety measures, such as enforcement of speed limits and drink-driving laws, education of motorists and cyclists and treatment of accident black spots and known hazards for cyclists.
Article
Each year, in the United states, approximately 900 persons die from injuries due to bicycle crashes and over 500,000 persons are treated in emergency departments. Head injury is by far the greatest risk posed to bicyclists, comprising one-third of emergency department visits, two-thirds of hospital admissions, and three-fourths of deaths. Facial injuries to cyclists occur at a rate nearly identical to that of head injuries. Although it makes inherent sense that helmets would be protective against head injury, establishing the real-world effectiveness of helmets is important. A number of case-control studies have been conducted demonstrating the effectiveness of bicycle helmets. Because of the magnitude of the problem and the potential effectiveness of bicycle helmets, the objective of this review is to determine whether bicycle helmets reduce head, brain and facial injury for bicyclists of all ages involved in a bicycle crash or fall. To determine whether bicycle helmets reduce head, brain and facial injury for bicyclists of all ages involved in a bicycle crash or fall. We searched The Cochrane Controlled Trials Register, MEDLINE, EMBASE, Sport, ERIC, NTIS, Expanded Academic Index, CINAHL, PsycINFO, Occupational Safety and Health, and Dissertations Abstracts. We checked reference lists of past reviews and review articles, studies from government agencies in the United States, Europe and Australia, and contacted colleagues from the International Society for Child and Adolescent Injury Prevention, World Injury Network, CDC funded Injury Control and Research Centers, and staff in injury research agencies around the world. Controlled studies that evaluated the effect of helmet use in a population of bicyclists who had experienced a crash. We required that studies have complete outcome ascertainment, accurate exposure measurement, appropriate selection of the comparison group and elimination or control of factors such as selection bias, observation bias and confounding. Five published studies met the selection criteria. Two abstractors using a standard abstraction form independently abstracted data. Odds ratios with 95% CI were calculated for the protective effect of helmet for head and facial injuries. Study results are presented individually. Head and brain injury results were also summarized using meta-analysis techniques. No randomized controlled trials were found. This review identified five well conducted case control studies which met our selection criteria. Helmets provide a 63%-88% reduction in the risk of head, brain and severe brain injury for all ages of bicyclists. Helmets provide equal levels of protection for crashes involving motor vehicles (69%) and crashes from all other causes (68%). Injuries to the upper and mid facial areas are reduced 65%. Helmets reduce bicycle-related head and facial injuries for bicyclists of all ages involved in all types of crashes including those involving motor vehicles.
Article
This study examined force and repetition during simulated distance cycling with regard to how they may possibly influence the on-set of the overuse injury at the knee called iliotibial band friction syndrome (ITBFS). A 3D motion analysis system was used to track lower limb kinematics during cycling. Forces between the pedal and foot were collected using a pressure-instrumented insole that slipped into the shoe. Ten recreational athletes (30.6+/-5.5 years) with no known history of ITBFS participated in the study. Foot-pedal force, knee flexion angle and crank angle were examined as they relate to the causes of ITBFS. Specifically, foot-pedal force, repetition and impingement time were calculated and compared with the same during running. A minimum knee flexion angle of approximately 33 degrees occurred at a crank angle of 170 degrees. The foot-pedal force at this point was 231 N. This minimum knee flexion angle falls near the edge of the impingement zone of the iliotibial band (ITB) and the femoral epicondyle, and is the point at which ITBFS is aggravated causing pain at the knee. The foot-pedal forces during cycling are only 18% of those occurring during running while the ITB is in the impingement zone. Thus, repetition of the knee in the impingement zone during cycling appears to play a more prominent role than force in the on-set of ITBFS. The results also suggest that ITBFS may be further aggravated by improper seat position (seat too high), anatomical differences, and training errors while cycling.
Article
Exercise-induced arterial endofibrosis (EIAE) is now a 20-year-old concept. Initially observed in highly trained cyclists, it has been found in many other male and female endurance athletes. Most stenoses are located on the first centimetres of the external iliac artery but other localisation may be found. The disease is defined by specific histological findings showing fibrosis of the intimal and medial wall of the artery. Ankle pressure measurement plays a key role in the diagnosis of EIAE provided that the exercise tests reproduce symptoms and are performed with the subject being highly trained, and that pressure measurements are performed early following exercise. Various cut-off values have been proposed in the literature. Magnetic resonance imaging or arteriography or ultrasound imaging should be performed by trained operators only. Surgical ‘endofibrosectomy’ is preferable in young cyclists generally associated with a saphenous enlargement patch. We do not recommend angioplasty. Athletes are generally allowed to return to competition within 3–4 months following surgery. Many unanswered questions remain, specifically about the pathophysiology of this disease. Mechanical and pressure strain play a central role in the development of EIEA, but nutritional and haemorrheological factors, hormonal changes and a genetic predisposition are likely to contribute. New techniques could facilitate the diagnosis of EIAE.
Article
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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