Before I even left college, I was being introduced to the world of international road cycling races as one of my colleagues and patients at college was an international-level competitor.  In helping him with his training, I learned a lot, especially about the problems that can be caused by even the slightest imbalance in the muscles.

Ever since the Olympics there has been a huge increase in the popularity of cycling.  I do a lot of driving between practices, home and my horse, and scarcely a journey goes by without me seeing at least one person clad in their sponsor-laden Lycra, pedalling away with great enthusiasm in the name of fitness and transport.  But with this increase in cycling popularity, there has also been a corresponding increase in the number of health problems related to cycling being seen in my Clinic.

The main problem is position.  It is a really good idea to get your bike professionally fitted to you by a local specialist, as this cuts down on the chances of injuries occurring.  However, it is not uncommon for cyclists to go out for an hour or two at the time, or longer, and throughout that period they are maintaining more or less the same position.  All well and good if that position is a strong one, and they have the muscles to support it, but not so good for John Smith who bought his bike at the weekend off Amazon and is out for his first trip.  The most common area for problems in the early days is in the lower back, and I have put my incredible artistic skill to the test to try and explain why this might be the case.  So here goes.  First we have the posture adopted by people who see Chris Hoy powering around the track and want to be just like him.  So the handle bars are set way down, the saddle almost on a level with them.  And this is what we end up with:

Now, it’s not so much the height of the handlebars compared with the saddle causing the issue here, as the fact our cyclist is using his back to achieve the forward flexion needed to reach the handlebars.  This means that your spine – which isn’t a massive fan of bending at the best of times – spends several hours at a time scrunching forward with no help at all from the fact you are powering up and down hills.  So how can it be corrected? Try this:

Here, the handle bars are still at the same height as the seat, but the forward bend is all coming from this rider’s hips, keeping his back straight and strong in a position it can maintain for the hours required.  An added bonus of this posture is that it allows your gluteal muscles in your buttocks to really get in on the action, and they are the true powerhouses behind straightening your leg from your hip.  More power from the muscles means more power through to the pedals resulting in more speed on the road.

So much for the back, but you are also putting all that force onto the pedals through your legs, and that means your knees are getting involved.  Now, if it is being done properly, cycling is a perfectly good form of exercise in terms of the strain on your knees.  It is low impact, unlike running, and you aren’t likely to be hit from the side as you are in rugby, and you also aren’t expected to do sudden turns with your foot planted as you are in football.  But there are a few areas which, if left unattended, can cause quite significant pain in the knees.

Primarily, the problem comes when the knee joints are allowed to collapse in towards the bike, instead of staying out so that if you were to look straight down they are travelling over your second toe.  This puts a great deal of pressure the outer half of the joint, and also risks straining the ligaments down the inside as they are expected to stretch to accommodate the angle.  This is particularly a problem for women, but is also seen in men.  Strangely, the problem actually has nothing to do with your knees – it’s all about the buttocks.  Well, the muscles that form your buttocks, at least.  The gluteus medius in particular is responsible for taking your leg out to the side, and this translates as being responsible for holding your thigh in a straight line and therefore keeping your knee straight, rather than falling in to the bike.  If this muscle simply doesn’t have the strength to perform this function, then it is highly likely the first symptom you as the cyclist will notice will be pain at the knee.  Besides, cycling in a knock-kneed posture looks a little odd, and we all want to avoid that!

So, as far as road-cycling is concerned, posture and correct muscle strength is key.  Faults with either of these factors can be easily corrected, and injury avoided.

Mountain biking is a whole different kettle of fish.  No nice smooth surfaces to race along for these guys.  Not surprisingly, the most common event which causes a mountain-biker to rock up at the door of my clinic is falling off.   And they do it a lot.  So primarily, my role as a Chiropractor for anyone who enjoys flinging themselves off daft places with only a bit of metal framework, two wheels and a crash helmet is picking up the pieces when it didn’t quite go as planned!

Muscle strains, ligament tears and broken bones are all common sights after a day of extreme biking, but for those who are a little more safety conscious and prefer just going off-track rather than down mountains by the shortest route possible, there are still a number of considerations.

Posture is still important for off-road cycling, and the knees can often take even more of a hammering as when you stand up in your saddle to ease the jarring of a rough track on your back, it is your knees which have to flex and bend to keep your body as still as possible and your feet in contact with the pedals.  A problem which is more often seen in mountain bikers than road cyclists is injury to the nerve which supplies the hand.  If you are using straight handle bars, and imagine where the bar sits across your palm, it quite often ends up sitting right where one of the main nerves into your hand passes through a bony passage.  The constant pressure and occasional shocks it receives as you bounce around on a dirt track can lead to compression and inflammation, resulting in pain and numbness or tingling into your hand which takes longer to ease off the more often it happens.  Unfortunately, the only real way to address this is to change where the handle bars are sitting on your hand, either by using a different style of handle bar, or changing your grip.  If it doesn’t happen very often, it may be sufficient to simply wear padded gloves to minimise the compression.

Finally, we come to the form of cycling where it is more of a mode of transport than anything else.  None of this Lycra obsession, and certainly no rocks and boulders in sight.  Again, posture is important, but the best posture is now focussed on minimising the stress to your back and shoulders, even at the expense of a little of the power and speed.  So rather than having the handlebars low, the saddle high and having to lean forward, you are much better off adopting a high handlebar, low saddle ratio which allows you to sit up straight on the bike.  Imagine your typical cyclist in the Netherlands, or possibly one of those black and white photos of a Victorian person on their bike, and you get the idea.  It may not be as fashionable (although I am pleased to say I seem to be seeing more and more people opting for this posture) but it is by far the best idea for protecting your spine and staying pain-free!