Cycling – Lower Limb Problems

This session included presentations on: Bike fit – theory and angles; Conditioning for cycling; Pudendal nerve problems and other saddle-related issues; Knee pain in cyclists; Thigh pain in cycling; Hip trauma from cycling; and Kinematics and the link to lower limb pathology.

Good bike fit is crucial and needs to be individualised to the cyclist depending on their MSK profile and medical history; checking bike fit is one of the first things to do for many of the issues that cyclist face. All the interfaces (foot/pedal/ handlebars/ saddle) need to be considered and the different events (road/track/MTB/triathlon/commuter) have different bike fit requirements. Efficient force production in cycling involves concentric hip and knee extension (hip extensors, gluteals and quadriceps), plantar flexion of the ankle, with the trunk/upper body providing stability and effective force transfer to the pedal. Useful exercises for generating hip extension in a flexed position include bench bridges and hip extension, squat and lunge, single-leg deadlifts. Exercises for the core stability, lower abdominals and pelvic control contribute to upper body strength required. Kinematics (the branch of biomechanics concerned with the study of movement from a geometrical point of view) also helps to understand muscle activation and co-ordination patterns, which will help in reducing fatigue and developing cycling specific training and rehabilitation programmes. Pudendal health issues affect almost all professional cyclists but it is something that is not discussed and is very much an unmet need. Pressure from the saddle causes skin and subcutaneous tissue issues as well as compression of blood vessels and nerves. Can be helped with good personal care, suitable saddle choice as well as a number of medical interventions but, as always, prevention is better than cure. Overuse anterior knee pain is common in cyclists and can be helped with checking bike fit and physiotherapy. Anterolateral pain can be managed as lateral patellar overload syndrome, but beware of anteromedial pain. External iliac artery endofibrosis is a possible cause of thigh pain, which can be managed conservatively. Surgery requires a specialist and is very invasive but can be very effective. Hip trauma among cyclists is usually the result of high-energy impact, and can involve injury/fracture of the pelvic ring, acetabulum, proximal femur as well as multiple injury. Early expert opinion is need to determine treatment options and early rehab aids outcome. Beware of the risk of DVT and post-traumatic OA. Recovery can take up to a year.