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10 tips on preventing cyclist injuries from Queen Street Physiotherapy

Cycling...

... A sport I’ve tried my best to wrap my head around for a long time, but for the life of me I just can’t understand the appeal.

It’s a culture unto its own.

 From getting up at ungodly hours in the dark, squeezing into some brightly coloured Lycra (often leaving little to the imagination) and punching out a few hours on the road dodging cars, all before breakfast. 

I’ve tried my best but just can’t get into it, hats off to you mob that genuinely enjoy it. The only thing I can relate to is the post ride latte.

But hey, I’m all for exercise and getting people moving so if you fit the mould go for gold.

Donovan Baker | Physiotherapist at Queen Street Physiotherapy



That being said, cyclists tend to get a fair few injuries, and not just from the bastard neighbourhood magpie/plover. 

Any cyclical activity (cycling, swimming, running) has the potential for things to creep up slowly like compound interest. ​

Little niggles can build and build until merely the thought of your 1kg carbon fibre frame with wheels makes your knee ache. So to keep you on the road longer (much to the annoyance of local territorial birds) here are some tips to staying healthy.

1.

Zipties in the helmet magpie repellent. I really don’t know the effectiveness of this, or if there’s actually any data to back it up, but I’ll be damned if you don’t look stylish in those helmets.

2.

Make sure the bike fits you; have a PhysioBikeFit – Each person has a “window of function” regarding the shape and size of the bike, meaning there are no exact measurements. Some riders will need to change their set-up during a season as they get fitter and stronger. If the body fits the bike, and is well conditioned, there is less pain, overload, and need for recovery. With direction from your physio’s assessment, your body can be adapted and changed for the better.

3.

Have a great pedalling technique – Efficient pedalling not only allows you to go faster for longer, but also shares the load, preventing specific overload of any one joint or area of tissue and minimising discomfort. Which means less energy spent, stronger and quicker rides and a reduced risk of injury. Win, win, win.

4.

Vary your riding – There’s no need to ‘go hard or go home’ every day – There is a tendency for Australian cyclists to compete and ride hard all the time. Not even pros ride hard every day, nor should you. The day after a long, hard riding session should be easy, with high cadence, low resistance pedalling. Even at the end of a hard ride you should have 15-30 minutes of easy pedalling to recover your legs and flush out the lactic acid build-up.

5.

Warm it up – If you are suffering from stiffness or soreness, your technique may suffer. Especially those chilly winter morning rides. Also, cold muscle is more likely to be injured. The best warm-up is to allow your blood to circulate, warming the tissues. Build easy into your cycle by pedalling easy to begin with.

6.

Strength and Conditioning having a great well rounded strength program will compliment your riding immensely. Talk to your physio about a good program that includes both upper and lower body exercises, targeting any specific weaknesses identified

7.

Lifestyle - Target sleep, stress, diet and alcohol, general health can really affect your ability to perform and recover. A lack of sleep increases the risk of stress fractures by 300%; stress makes you more likely to be injured, and slows recovery from injury and also those tough rides.

8.

Diet – Eat to fuel performance. Our bodies can probably handle one hour without food, but from the second hour onwards it requires 50-100mg of carbohydrate per hour. Protein after a ride is a great idea for recovery.

9.

Have a strong and consistent recovery routine – Muscles can become sore due to inflammation and tightening of the fibres, with lactic acid build up a by-product of exercise. Gentle stretching and self-massage helps to remedy this, a spikey ball and foam roller are essential. Using cold or hot-cold therapy, like walking in the sea or hot-cold showers.

10.

Physio and Massage – Along with a good recovery routine, checking in regularly with your physio/massage therapist is a great way to keep on top of any niggles, aches and pains. And to make sure the body is functioning as it’s meant to.

If you or someone you know loves to punch out kilometres like Cadell Evans, be sure to take note of these tips. It could be the difference to being on the road or watching your bike collecting dust in the garage. With any sport it’s essential to stay as healthy and injury free as possible, otherwise what’s the point right? So take care on the road you crazy cyclists.


Thanks Donovan.

Stay tuned for another article from the Queen Street Physiotherapy team soon

In the meantime, if you have any questions regarding this interview, treatment of cycling injuries or other health issues please do not hesitate to contact Donovan and the rest of the team by visiting the Queen Street Physiotherapy website.

Queen St Physiotherapy offers ergonomic advice, custom made orthotics, running assessment, hydrotherapy, dry needling, remedial massage, exercise and stretching programs.




Other Articles From Queen St Physio:

Back Pain Mythbusting 3 – Stress Doesn’t Impact Your Recovery

Back pain is an extremely common complaint. We frequently hear of back pain and injuries from our clients, and have found it to be a difficult hurdle to overcome despite its frequency.

We have enlisted the help of Physiotherapist, Donovan Baker from Queen Street Physiotherapy in Brisbane for his expert advice on back pain management. Donovan has extensive clinical experience in musculoskeletal and sports physiotherapy and has a keen interest in achieving manageable solutions for clients living with pain and limitations.

We sat down with Donovan to continue our back pain myth busting series. If you missed the last two articles in the back pain series, read it here.

Read on to learn so tips to managing your stress to ensure a speedy recovery.





CAN STRESS IMPACT SOMEONE’S RECOVERY?

You’re damn right it can, in a big way. And not in a hippy woo woo sort of way. I'm talking a scientific and biologically measurable kinda way. Now it’s going to get a little technical/nerdy, but hang in there. A book by Joyce and Lewindon (1) gives an excellent summary, ‘In the 1970s, Robert Ader, a psychologist and immunologist, showed that the mind and body communicate with each other in a bidirectional flow of hormones, neurotransmitters and cytokines. The brain and immune system represent a single, interactive system of defence. Thoughts, beliefs and emotions have neurochemical consequences on both the immune system and individual cells. Emotions and health interact. The immune system does not only fight sickness, it has a major role in tissue regeneration and injury recovery. Marucha et al. showed healing of mouth ulcers in dental students took 40% longer during exams than holidays.’

The interaction between all of these is governed by a little part of the brain, the hypothalamus. This little guy is super important as it organises everyday functions that we don’t even think about; body temperature, hunger, thirst, sleep, libido (wink wink). It also governs the body’s response to stress, acute and chronic. Acute stress response is very important. We’ve all heard of the flight/fight response, which is generally a good thing. Step onto road, oncoming car, jump back to avoid tackling a Ford Focus travelling 30km/h above the speed limit, give driver the finger, proceed to sweat profusely, feel heart palpitations, ponder the meaning of life, quit job and start painting like you always wanted to.

But chronic stress can be a bastard. It’s associated with overproduction of cortisol, and regarding injury recovery and rehabilitation, there is an increase in pro-inflammatory cytokines and decrease in anti-inflammatory counterparts. To sum up in one sentence, stress delays injury recovery significantly.





What other factors may slow recovery?

Lots of things and the rate at which it will slow recovery cannot be measured, but these factors can be mitigated. Sleep deprivation is big. You need at least the magic 7-8hrs/night. A study by Milewski et al. showed adolescents that go less than 8hrs sleep/night were 1.7x more likely to develop an injury. Same thing rings true with injury recovery. Sleep is the body’s time to recover and repair. Make sure you get enough.

Mood, emotions, anxiety and depression levels are all massive factors for injury recovery let alone holistic health, refer back to question 1 for the detailed answer as to how and why.




What are your top 3 tips for reducing the effects of these external influences?

1. Mindfulness. Now this might be leaning a little toward the hippy side for some, but don’t worry you won’t have to identify your spirit animal just yet (cough...grizzly bear). Numerous studies have shown how a regular practice of mindfulness, in whatever form that may take for you, has a huge impact on your mental health. I’m a big fan of people like Tony Robbins, Tim Ferris, Gary Vaynerchuk etc. These guys have interviewed the top 1% of pretty much every industry out there, and about 80% of these high achieving individuals do some sort of mindfulness. A lot meditate, others do activities where time becomes irrelevant and they get lost in something they enjoy, and others have gratitude journals. The key is the disconnection from the stressful stimuli we are bombarded with and to give the mind a break. Good things happen here.

2. Set boundaries. Learn when to say no. Setting healthy boundaries allows you to do your job properly without getting too stressed out. There are a ton of analogies that work here. You can’t pour from an empty cup, you need to put your own oxygen mask on before attending to children etc. But seriously it’s true. Yeah, we know sometimes it’s difficult/impossible to say no to certain things at work and life. Learn how to set those healthy boundaries. You’ll thank yourself.

3. Exercise. It’s easily the best thing you can do for your body; physically, mentally and emotionally. A cascade of endorphins, dopamine etc. is released from the brain as a result of exercise and you feel pretty awesome. Have you ever noticed how good you feel during the day and how much you can accomplish when you set the alarm, get out of bed early and do some exercise before you get to work? It’s outrageous! Not to mention all the metabolic diseases you are fighting off one burpee at a time. 10/10 highly recommend.


Thanks Donovan.

If you missed last month's article from Queen Street Physiotherapy on whether exercise and movement is bad for back pain, check it out below.

Back Pain Myth Busting 2: Severe pain means severe damage
Back pain is an extremely common complaint. We frequently hear of back pain and injuries from our clients, and have[...]
Back Pain Myth Busting 1 – Movement and exercise is bad
Back pain is an extremely common complaint. We frequently hear of back pain and injuries from our clients, and have[...]

Stay tuned for another article from the Queen Street Physiotherapy team in January. 

In the meantime, if you have any questions regarding this interview, treatment of back pain or other health issues please do not hesitate to contact Donovan and the rest of the team by visiting the Queen Street Physiotherapy website.

Queen St Physiotherapy offers ergonomic advice, custom made orthotics, running assessment, hydrotherapy, dry needling, remedial massage, exercise and stretching programs.

Back Pain Myth Busting 2: Severe pain means severe damage

Back pain is an extremely common complaint. We frequently hear of back pain and injuries from our clients, and have found it to be a difficult hurdle to overcome despite its frequency.

We have enlisted the help of Physiotherapist, Donovan Baker from Queen Street Physiotherapy in Brisbane for his expert advice on back pain management. Donovan has extensive clinical experience in musculoskeletal and sports physiotherapy and has a keen interest in achieving manageable solutions for clients living with pain and limitations. 

We sat down with Donovan to continue our back pain myth busting series. If you missed last month's article on whether exercise and movement is good for back pain, read it here.

This month we discuss managing how we view pain and that severe pain sometimes doesn't mean you have done severe damage. 

Read on to see his insights and why movement is so important for a speedy recovery.

Why does severe pain not necessarily mean severe damage?

This is a very in depth question but I will do my best to keep it short and simple.

To understand that pain doesn’t equal damage you need to wrap your noggin around pain itself. Pain is, 100% of the time, an output of the brain. It does not come from the tissues but from the brain interpreting data and evaluating whether said data is harmful to you. Pain acts a protective mechanism. It is there to stop you doing dumb things and hurting yourself. The brains takes into account not only the signals from tissues, but also draws on past experiences, emotional state, current stress levels, thoughts, beliefs, attitudes…the list goes on. The brain and central nervous system (CNS) does an incredible job in processing all this data in an instant, but occasionally it makes mistakes and can give you the sensation of pain when really there isn’t any damage happening.

Tissue damage commonly goes hand in hand with acute pain, but not always. You sprained your ankle, it hurts like a b#$%* but typically heals up in a few weeks and you’re encouraged to stay active. On the flip side you can bend over one morning to tie your shoes and your back seizes up, again hurts like a b#$%* but it doesn’t necessarily mean tissue damage. You haven’t slipped a disc, there’s no nerve root compression it’s just painful and stiff, and takes a little time and TLC to get back to doing the things you love. The brain, for whatever reason, doesn’t like that bending move even though you’ve done it a thousand times before, and it locks up the low back. Tight muscles, stiff joints and super wired nerves can give you a great deal of misery.

There’s a really interesting case about a construction worker that ended up with a metal pole sticking straight through his boot. The guy was in agony, screaming the house down. They got him to hospital and cut the boot off. Turns out the pole had gone between his toes. Didn’t break any bones, didn’t even pierce the skin. Once he saw it he calmed down and very soon wasn’t feeling a thing. But because he thought he would have a gaping hole in his foot, his brain had conjured up the pain! Now ask him at the time and he would have sworn on dear old Nana’s life the pain was real, not in his head. This is a case of the brain misprocessing data, and creating the output of pain.

This is a very complex topic but there are some great Youtube videos that break it down nicely. Check out Understanding Pain in less than 5 minutes, and what to do about it!’ and also TEDxAdelaide - Lorimer Moseley - Why Things Hurt’.

When someone is experiencing severe pain what might be causing it?

In terms of severe low back pain, an almost countless number of things, but there are a few main ones we see at Queen Street Physiotherapy.

1

Tissue or mechanical damage

This can be bulging discs, vertebral fractures, vertebral ligament sprains, muscular strains or spasms (a very small percentage of people actually have this type of severe back pain)

2

Neuropathic pain

This is damage to or overactive nerves. A bulging disc compressing on a nerve will give you pain down said nerve. Think about hitting your funny bone and how that shoots down to your hand, similar concept.

3

Non-specific lower back pain

Exactly like what it sounds. There’s no specific structural or mechanical issue, the back just bloody hurts! See the above explanation on why this can be so.

When should we be more concerned that it's something more sinister?

Here are the main nasties/red flags we look out for in low back pain.

  • Groin pins and needles, numbness and/or changes to bladder or bowel function(i.e. feeling the urge to go to the toilet but nothing actually comes out). You need this sorted out ASAP. Google ‘Cauda Equina Syndrome’.
  • Night pain. Fine during the day, bad at night. This can be a little warning sign of cancer. But if you have it, don’t panic! Just make sure you get it checked out quickly.
  • Muscle weakness. Walking along and you can’t stop your foot from slapping the ground or you can’t do a single leg calf raise. Potentially a compressed nerve.
  • Very intense pain, like 7/10 or higher. As in ‘Oh Lord please help me this hurts so bad!’

There are other red flags which physio’s look for, but the above are the more serious ones that need urgent attention.

What are the top products you recommend to help someone manage pain?

There are a lot of great products out there that can help ease back pain.

I personally love a hot pack and my trusty trigger point ball.

Heat can help locally at the site of pain, makes it feel warm and snug. But also can decrease the ‘pain signals’ getting to the brain by giving the nerves something else to report to the brain…in this case, heat.

My trigger ball also gets a good workout. Triggering tight musculature around the low back can help a lot. I go for my glutes and ITB, but also the bigger muscles in the back, QL and erector spinae. If you don’t know these you’ll need to be shown by your physio. And if the trigger ball is too intense you can use a foam roller instead.

Thanks Donovan.

If you missed last month's article from Queen Street Physiotherapy on whether exercise and movement is bad for back pain, check it out below.

Back Pain Myth Busting 1 – Movement and exercise is bad
Back pain is an extremely common complaint. We frequently hear of back pain and injuries from our clients, and have[...]

Stay tuned for another article from the Queen Street Physiotherapy team in January. 

In the meantime, if you have any questions regarding this interview, treatment of back pain or other health issues please do not hesitate to contact Donovan and the rest of the team by visiting the Queen Street Physiotherapy website.

Queen St Physiotherapy offers ergonomic advice, podiatry, custom made orthotics, running assessment, hydrotherapy, dry needling, remedial massage, exercise and stretching programs.

Back Pain Myth Busting 1 – Movement and exercise is bad

Back pain is an extremely common complaint. We frequently hear of back pain and injuries from our clients, and have found it to be a difficult hurdle to overcome despite its frequency.

We have enlisted the help of Physiotherapist and Exercise Physiologist, Phill Forostenko from Queen Street Physiotherapy in Brisbane for insight and expert advice on back pain management.

Phill has over 10 years’ experience as both owner and directing physiotherapist at Queen Street Physiotherapy. He has interests in sports and work related injuries including neck, shoulder and back pain. He is also highly experienced in managing mobility issues and post surgery rehabilitation.

We sat down with Phill earlier this month to break down some common myths around back pain.

Read on to see his insights and why movement is so important for a speedy recovery.

You often hear that exercise and movement is bad for recovery, is that the case?

Absolutely not. The right exercise has been shown hands down to be the best rehabilitation for just about any injury or niggle. The real question should be, ‘What is the RIGHT exercise?’ This is where things can get a little complicated and it’s like asking, ‘How deep’s a hole? Or how long is a piece of string?’ It really depends on you, your injury and your personal circumstances. At Queen Street Physiotherapy we can advise and guide you on the right types and amount of exercise.

But for a very basic baseline you want to exercise within a tolerable pain limit (i.e. it’s a bit sore but I can do the exercise without it getting worse) and you want to reach small milestones along the way. Typically that will reduce the swelling/inflammation, achieve pain free range of motion, gentle return to activity, then a full return to performance. And your activity or performance is very dependent on you. It might be rep level sport, or gasping for air in a PT circuit wishing it was time for that post workout cappuccino. 





When should you rest, and how long for?

For most acute injuries, typically 48hrs, but the consensus is evolving.

The old acronym RICE (say it with me…rest, ice, compression, elevation) has now been given a shiny new upgrade to POLICE (protect, optimal loading, ice, compression, elevation). And it’s the optimal loading part that’s key.

Early movement, early rehab, early exercise equals faster and better recoveries. The best example of this is a knee replacement. The morning after you’ve been cut open, bones and joint removed replaced with titanium then stitched back together again, you’ll have a nasty physio like me getting you to stand up and walk around…while you’re still drugged up, in your flattering surgical nightie and connected to a bunch of drips and beeping machines.

Why? Because we know it’ll be that much better later down the track.

What simple exercises can you recommend to get someone back moving again?

In regards to getting back into exercise, whether you have been absent due to injury or you have just had a large break due to the hectic nature of life, the key is to take it slowly but keep it on a daily basis.

Generally we have all done some form of exercise at some point in our life, whether it was in a sporting team, a PE class at school, or a group fitness session.

The first place to start is by simply walking.  Increase your endurance and your physical capacities to handle 30 mins of brisk walking.  Stretches to your lower limbs should be performed prior & post walking that include stretches to your calves, hamstrings, quadriceps and gluteals.

If you are still unsure, the professional staff at Queen Street Physiotherapy can advise you on all your stretches or exercise program.



How can a physiotherapist help with back pain?

Not all lower back injuries have a singular diagnosis and a sequential rehabilitation program. Lower back pain management strategies need to be designed specifically for your particular injury and lifestyle. First and foremost, a physiotherapist can reduce your immediate pain with treatment including manual therapy, massage therapy and strapping. Alleviation of pain will be your paramount concern and is an important first step in your rehabilitation.  Physiotherapists can advise you on the duration of your rehabilitation and treatment needs, which will vary for each individual and injury. It is also important to be aware of the correct techniques for activities and daily living to support your injury throughout the rehabilitation phase. A physiotherapist can advise you:

  • When to rest
  • When to start the right exercises - should you be stengthening muscles or stretching them?
  • minus
    Tips on getting to sleep and staying asleep with your back injury
  • minus
    How to lift objects correctly
  • How to manage your pain outside of your treatment session - should you be icing or heating when it's sore and for how long? Should you be taking anti-inflammatories? 

Thanks Phill. 

Stay tuned for Phill's next interview in December. 

In the meantime, if you have any questions regarding this interview, treatment of back pain or other health issues please do not hesitate to contact Phill and his team by visiting the Queen St Physiotherapy website.

Queen St Physiotherapy offers ergonomic advice, custom made orthotics, running assessment, hydrotherapy, dry needling, remedial massage, exercise and stretching programs.