As devoted cyclists, we often have a hard time setting our bikes aside in the off-season. After all, for many of us, cycling is a critical component of our physical, social, and mental well-being. When time becomes a limited resource, creating space for exercise off the bike can be something we resist, or even fear.
However, a movement literacy program isn’t about stealing time from the bike. It’s about improving and extending your ride.
Building a strong cyclist is relatively straightforward: pedal harder, pedal faster, pedal further, rest and repeat. Building a resilient and durable cyclist is more complex and requires additional tools.
The objectives of this series of articles are to:
- Identify demands in cycling that lead to common musculoskeletal impairments
- Outline how to triage these impairments
- Provide a basic framework for a movement literacy training program to address these impairments
Many cyclists find the act of pedaling to be second nature. However, cycling is not a natural part of human movement. While humans have been ambulating (walking) upright for nearly 6 million years, movement via bicycle was only recently introduced, roughly 200 years ago.
Bodies are not optimized for the repetitive motion of cycling. The legs move with near-maximal hip flexion, confined to a single plane and anchored at fixed contact points (saddle and handlebars). Pedaling a bicycle demands opposing muscles in the sagittal plane (i.e. split down the middle into right and left halves) to be chronically positioned in shortened and lengthened positions, respectively.
Over time, this posture can lead to musculoskeletal imbalances that are often referred to as cross-over syndrome. In addition, the lack of impact-loading and eccentric contractions can diminish bone health and the tensile strength of tendons.
Cross-Over Syndrome
Cross-over syndrome of the upper extremities is characterized by tightness through the pectoral muscles of the chest, upper trapezius, and sub-occipital muscles at the base of the skull. The opposing muscles, namely the middle and lower trapezius and deep neck flexors, may develop weakness as they are chronically held in a sub-optimal lengthened position (this is called stretch weakness).
These muscle imbalances are exemplified by a forward head and thoracic kyphotic posture. Cyclists may experience a myriad of symptoms secondary to this postural dysfunction, including neck and shoulder pain.
In the lower extremities, the imbalance creates tightness through the hip flexors and low back extensors, which act on the pelvis. The gluteal and abdominal muscles, placed in a non-optimal stretch position, struggle to counter the forces on the tight muscles on the pelvis. The resulting posture is one of increased anterior pelvic tilt and hyper-lordosis (a condition where the spine curves inward excessively in the lumbar region, or lower back).
This places strain on the ligaments of the lower lumbar vertebrae and sacroiliac joints. Due to the nature of the human kinetic chain, dysfunction at one segment—in this case the lumbo-pelvic segment—frequently leads to dysfunction at adjacent and distal segments, including the hip and knee. Furthermore, cycling is a quadriceps-dominated activity. Ensuring the proper hamstring to quadriceps strength ratio is critical for knee stability in other sports.
The foot-ankle complex is another region that may suffer during cycling. The foot-ankle complex is designed to undergo both supination (plantarflexion, adduction, and inversion) and pronation (dorsiflexion, abduction, and eversion) during push-off and mid-stance phases of our gait, respectively. This allows the foot to be locked in a rigid and stable position during push off and unlocked to accommodate ground reaction forces during midstance.
Cycling eliminates the natural biphasic motion of walking. As a result, the foot remains in a prolonged pronated position, which can strain the arch and compress neurovascular structures, causing ‘hot foot.’
All this being said, the cyclist is not doomed to discomfort. However, it takes a concerted effort to build a plastic, resilient, and durable cyclist that requires tools in the training toolbox beyond pedaling.
Movement Literacy
These tools are part of what is referred to as movement literacy, built on a hierarchy of mobility, flexibility, stability, strength, and skill/functional proficiency. Armed with these tools, musculoskeletal impairments that hinder movement patterns on and off the bike may be mitigated.
Finding the right “technician,” who has a mastery of the tools to work on your body, can be a daunting task. Many cyclists take the whack-a-mole approach. Desperate to be back in the saddle pain free, they engage practitioners across a variety of disciplines to render aid. While this approach is rarely dangerous and may ultimately help relieve symptoms, collateral damage may occur to your bank account and delay effective treatment.
Time is a precious resource, so why squander it? A silly but relevant analogy is triaging a poorly running vehicle. Desperate to get the car running smoothly, you may solicit several service technicians who replace the battery, fuel line, and alternator before running a diagnostic test, only to learn the problem is a faulty spark plug.
No damage was done to the vehicle—in fact, it has lots of new parts that didn’t need replacing—but precious time and money were used treating symptoms rather than identifying the underlying cause. Thus, the best place to start when your body isn’t running smoothly is with a proper diagnosis.
If the tools in your toolbox (stretching, yoga, strengthening) aren’t moving the needle, and symptoms have persisted for more than six weeks with rest, it would be prudent to investigate the source, rather than continue to treat the symptoms.
A physician or physical therapist trained in sports medicine is a good starting point. A physician may order diagnostic tests, such as a radiograph or MRI. While not every musculoskeletal injury requires diagnostic imaging, identifying the underlying etiology of the impairment or complaint is paramount to providing effective treatment. While rare, in my role as a physical therapist treating cyclists, I have come across lateral knee pain caused by an osteosarcoma masquerading as iliotibial band syndrome, as well as recalcitrant back pain caused by a tumor. The whack-a-mole approach would not have served these athletes well.
More commonly, cyclists are plagued by overuse musculoskeletal issues such as tendinopathy, patellofemoral stress syndrome, or low back, neck, and shoulder pain. This is where imaging may be ordered to confirm the diagnosis and inform the conservative treatment. These pathologies are often best addressed by a physical therapist with working knowledge of cycling demands and bicycle fit.
The Human Puzzle
Solving biomechanical puzzles can be complicated since cycling involves two machines: one with two legs interfacing with another with two wheels. There are very few other sports in which the solution may lie with either or both machines.
Here is a case scenario to illustrate the point: A cyclist with 20 years of experience presents with a gradual onset of knee pain at the end of his cycling season in October, without changes in training volume or injury. His coach recommends the athlete see a physical therapist.
Evaluation reveals a lack of hamstring and iliotibial band flexibility with poor gluteal firing, leading to patellofemoral stress syndrome (PFSS). These findings could certainly predispose the athlete to PFSS. However, there is little in his history to suggest that these impairments alone, likely present for many years, are the only precipitating factors in developing knee pain late in the season. Further evaluation of his equipment reveals worn cleats, and the cyclist recalls a recent adjustment after the saddle became loose, resulting in a nose-down 5-degree tilt.
A myriad of factors contributed to the onset of knee pain, and only careful evaluation of the body and bike together allowed for a full understanding. Once the underlying factors had been identified, skilled technicians with the appropriate tools stepped in. His PT prescribed exercises to address the impairments, a bike mechanic replaced the cleats, readjusted the saddle position, and educated the client on how to tighten the saddle without creating tilt, and the client asked his massage therapist to focus the session on his IT band.
There is a wide variety of practitioners with similar tools: chiropractors, physical therapists, massage therapists, strength and conditioning coaches, personal trainers. Nobody has every tool in their toolbox. Some offer many tools but have little experience using them, while others have only a few tools but have mastered their craft. The best technicians are those who know what they don’t know and have created a network of technicians to collectively offer the largest toolbox for the athlete.
