Prehabilitation for Bike Addicts

While your healthcare professionals are unavailable, you’re stuck at home, and advised to stick to zero risk activities, I can think of no better time than now to consider Prehabilitation, otherwise known as injury prevention!

As a physiotherapist working in a population full of outdoor sport and type B fun enthusiasts, I am fortunate to treat a wide variety of chronic and traumatic injuries. Chronic injuries are those that manifest gradually over time, and typically arise from an error in technique, training, or equipment. While we can’t always predict and thus, prevent the traumatic injuries, we can certainly take simple measures to prevent the chronic ones.

Being that I have a biased participation in all forms of two wheeled fun, I am going to highlight the most common preventable injuries I observe in cyclists and mountain bike athletes, accompanied by your new essential off-bike prehabilitation tool box, to follow.

Disclaimer: This article is based on my own clinical experience/observations. So, while not directly based on research, my clinical practice is predominantly evidence-based.

Inadequate ‘cross-training’ or off-bike conditioning is the most common contributor to preventable injuries. Given that the physical requirements of pedaling are relatively homogenous in comparison to the diverse muscular demands of other sports, we develop common patterns of muscular imbalances. These imbalances alter our harmonious balance between mobility (flexibility); how well our joints move, and stability; how well our muscles’ control those movements and absorb impact. Cross-training, or off-bike conditioning aims to restore this balance while ensuring that we are recruiting the best suited muscles for the job.

Problem #1

Consider that our position on a bike looks a lot like our position at a desk. Compiled with the fact that we collectively spend far too much time sitting, we develop tight hip flexors and dominant quadriceps along with weak, under-active gluts. This imbalance commonly contributes to patella-femoral pain syndrome (knee pain).

In a nutshell, tight hip flexors and dominant quadriceps create increased loading and compression at our patella-femoral joint while riding, but also with off-bike activities (running, stairs, hiking etc.). Thankfully we are well informed that an optimal desk set up, and posture can alleviate pain. Similarly, an optimal bike fit and position, although not widely prioritized in the mountain bike world, can play a huge role in alleviating knee pain, among other sources of pain. If you’re doing any pedaling at all, ask your Physio or local bike shop to consider your bike fit.

Problem # 2

It might not surprise you that this positional redundancy, combined with insufficient core function and endurance can also commonly lead to lower back pain. Our core muscles serve to maintain dynamic control and alignment of our spine and pelvis for optimal loading of our joints while we descend, but also for optimal power output while we pedal. When these muscles are functionally inept, the system crumbles, and our hip flexors and back extensors are burdened with a task they weren’t designed for, creating tension-type lower back pain, followed by other sequelae if left unaddressed.

Problem # 3

Another common complaint, stemming from the positional demands of riding, is upper back and neck pain. On the road and the mountain, this is typically associated with a lack of thoracic spine (mid-upper back) mobility and insufficient shoulder and core stability, resulting in excessive weight distribution through your upper body. Thinking back to the importance of your bike position, your pain may also be associated with inappropriate bar width, seat height and/or reach (distance between seat and bars).

Excluding improper bike fit as the source of your pain, if the muscles that should stabilize your shoulder complex while descending are slacking, your body is clever to recruit other muscles, namely your pecs, upper trapezius, and neck extensors, to assist in absorbing impact.

Similarly, if you’re lacking adequate hip, pelvis and spinal mobility to achieve and maintain a neutral spine while pedaling your road bike for long hours, you may experience fatigue-related discomfort of these same muscles as they attempt to compensate, outside of their line of duty. Over time, if not addressed with appropriate off-bike interventions, these muscular imbalances, and their resultant pain will become reinforced, taking away from our love of the ride!

To help reinforce this concept, think of the repercussions we might observe if we asked our accountant to do our handy work, or a construction worker to file your taxes…… Both would perhaps step up to the challenge, but would lack the endurance and skillset to excel at the untrained task.

Stay tuned, in the next couple days I will be walking you through my recommended off-bike exercise toolbox, so that you aren’t using up your limited extended health benefits on healing preventable injuries! In the meantime, ride safe!