When it comes to triathlon training, running gets most of the blame for repetitive use injuries, and this is justified most of the time. Our bodies take a lot of stress with every foot strike on the pavement. Although it has been difficult to accurately measure, we put approximately 3.6 times our body weight across our joints just with jogging. However, if you consider how much we as triathletes cycle in relation to swimming and running it is not a surprise that injuries can and do occur from cycling.
Pedaling at an average cadence of 90 revolutions per minute is equal to 5,400 pedal revolutions per hour. If you ride 5,000 miles per year that is equal to 1.5 million pedal strokes. Even though cycling is not a full weight bearing sport and is less stressful on our joints as compared to running, this is a great amount of repetitive motion on the ligaments, tendons and muscles of our lower extremities. Not to mention our days off from cycling are not always spent with our feet up, but spent stressing our bodies with other sports.
It is never easy to find the exact root cause of an injury when you practice multiple disciplines. To complicate matters more, many factors both intrinsic and extrinsic contribute to injuries. Some intrinsic examples are muscle imbalances, poor flexibility, changes in technique or form, and sudden changes in volume of intensity. Extrinsic examples include new or different equipment, changes in bike cleats or position, and change in position. Therefore, some lower extremity injuries might be caused from running alone and be aggravated with cycling or vice versa. Either way the injury needs to be addressed, fixed and prevented as we continue to train.
As you can see, it can be well worth your time to seek out a practitioner who understands what we as triathletes do to help guide you in your treatment. Below we will discuss common lower extremity injuries and how they can be treated and prevented in relation to our fit on the bike.
Patellar tendinitis presents as pain just below the kneecap and at the top of the shinbone, which is worsened with activity. Risk factors include climbing in a big gear and hard sprinting. It can be treated and prevented by strengthening and stretching your quadriceps and hamstrings, plus increasing cadence and reducing pedaling resistance by using lower gears. The one bike fix is to raise the saddle by approximately 3 millimeters, as this will decrease the force put across the patella tendon.
Chondromalacia presents as anterior knee pain and pain under the kneecap. Risk factors are many and include biomechanical issues that lead to maltracking of the kneecap in its groove on the long thigh bone. Issues such as muscle imbalances and poor bike position can cause it as well as excessive use of big gears and low cadence. Treatment and prevention includes riding with a high cadence and low gears, avoiding climbing (especially in the saddle), raising your saddle and switching to bike cleats that allow more float. Cleats such as Speedplay allow approximately 15 degrees of float as compared to many others which allow approximately 9 degrees. The allowance of more float allows your leg to rotate more freely and your foot won’t be and feel as locked in.
Iliotibial band impingement syndrome
Illiotibial band syndrome presents as pain on the outside of the hip or the outside of the knee that occurs with activity and is relieved with rest. With cycling it usually occurs as we put power into the pedal stroke. Meaning between the mid portion of the stroke and the bottom of the stroke. Risk factors can include biomechanical factors such as bowlegs and flat feet. Cycling risk factors include too narrow of a stance, poor cleat position (such as toes turn too far inward), too high of a saddle and again pedals that don’t allow enough float. Treatment and prevention includes moving your cleats as far to the inside of the shoe as possible as this will widen your stance on the bike, lowering the saddle 2-3 mm and using pedals that allow more float in order to move the heel a small amount closer to the crank arm.
Piriformis syndrome presents as pain deep in the buttocks, that can at times radiate down the back of the leg. It results from a tightness or spasm of the muscle, which in turn compresses the sciatic nerve. Many athletes who have weak glutes, hip abductors and adductors develop it. With regards to cycling a very aggressive aerodynamic position and an ill-fitting saddle that does not provide enough support for the “hip bones” can cause or aggravate it. Treatment and prevention include changing out your saddle for a more supportive saddle and raising your aerobars so your hip angle is not as acute. Even switching to a road bike for a short time helps to relieve the symptoms.
It is important to be in tune with your body. With many years of training athletes often develop this skill and refine it. By doing so you will be able to initially prevent injury, recognize them if they do occur and make the necessary adjustments early on before it becomes a problem that derails your training. If you do seek out professional treatment, be sure to visit a practitioner who is familiar with all of an athlete’s needs — body and mind.
Christopher Breen, PA-C, ACSM EP-C is a Certified Physician Assistant specializing in sports medicine and orthopaedics, a Certified Exercise Physiologist by The American College of Sports Medicine, and a USA Triathlon Level I Certified Coach. He is the founder and head coach of ARIA Endurance Coaching LLC and also works at Winthrop Orthopaedic Assoc., PC in Long Island, New York. He can be reached at ariaendurance.com and firstname.lastname@example.org.
The views expressed in this article are the opinion of the author and not necessarily the practices of USA Triathlon. Before starting any new diet or exercise program, you should check with your physician and/or coach.