HISTORY OF CYCLING

Bicycling was first introduced in the 1800s, and it quickly became very popular.
However, the basic bicycle design can be traced back to 1493, when Gian Giacomo
Caprotti sketched out the idea. Another version was built in France in 1791. However,
what many people consider the first practical bicycle was created in 1817 by Karl von
Drais, a German civil servant.
Cycling officially began as a sport on 31 May 1868, with a 1,200-metre race
between the entrance and fountains of Saint-Cloud Park in Paris. The United States
followed suit with its first recorded race on 24 May 1878.
An intense form of racing also became popular in the United States. They
organized a competition that lasted for six days with an international field of riders as
participants. Prizes reached up to $10,000.
This type of racing evolved from one-person teams to two-person teams in 1899.
At present, these types of races are no longer held in the United States. However, they
continue to be popular in France, Italy, Belgium, and France.
COMMON INJURIES
 Knee Pain. The knee is the most common site for overuse injuries in cycling.
 Neck/Back Pain
 Wrist/Forearm Pain or Numbness
 Foot Numbness and Tingling

KNEE PAIN
The knee is the most common site for overuse injuries in cycling. Patellofemoral
syndrome (cyclist's knee), patella and quadriceps tendinitis, medial plica syndrome, and
iliotibial band friction syndrome are a few of the more common knee overuse injuries.
The first four injuries mentioned involve pain around the kneecap, while the last
condition results in outer knee pain. Shoe implants, wedges beneath the shoes, and
cleat positions may help prevent some overuse injuries.
CAUSES
Most cycling knee pain results from a condition known as patellofemoral pain syndrome.
This condition is commonly brought on by athletic overuse or high-impact use of the
knees (among bikers, overuse is the more common culprit.) Malalignment of the patella
(kneecap) can also cause or exacerbate issues. Patellofemoral pain syndrome causes
pain both during activity and while at rest; it may also cause crackling noises and
sensations in the knee joint.
FACTORS
 Poor warm-up
 Poor fitting equipment including bike and shoes
 Poor conditioning
 Poor technique
 Riding at too high level

1|Page
SYMPTOMS
Symptoms include an aching pain in the knee joint, at the front of the knee around and
under the patella both during activity and while at rest and it may also cause crackling
noises and sensations in the knee joint. Malalignment of the patella (kneecap) can also
cause or exacerbate issues.
DIAGNOSIS
1. Inspect your knee for swelling, pain, tenderness, warmth and visible bruising.
2. Check to see how far you can move your lower leg in different directions.
3. Push on or pull the joint to evaluate the integrity of the structures in your knee.
TREATMENT
Use the (RICE) method.

 Rest: Do not put weight on the knee.

 Ice: Apply cold packs to the knee in 20-minute increments throughout the day.
Avoid placing ice directly on the skin.
 Compression: Wrap the knee in an ACE wrapping or soft bandage.
 Elevation: Raise the knee above the level of the heart.

REHABILITATION
The bicycle provides quadriceps rehabilitation while controlling the stresses to the knee
ligaments. With pedaling on the bicycle, forces are applied to the anterior cruciate
ligament, the capsular ligaments, and the posterior structures of the knee joint as the
tibial plateau is posteriorly tilted.

PREVENTION
Knee injuries in cyclists often occur due to bicycle misalignment, long-distance riding,
and a lack of conditioning before cycling. To prevent knee injury while cycling, a person
can:
 Adjust the saddle-pedal distance on their bicycle.
 Ensure their saddle is in the correct position.
 Wear appropriate shoes for cycling.
 Increase cycling training gradually.
 Warm up thoroughly before cycling.
 Perform stretching and flexibility exercises.
 Maintain a moderate weight.

FUNCTIONAL ANATOMY

2|Page
CYCLIST'S NECK

Neck and back pain are extremely common in cyclists, occurring in up to 60% of riders.
30% of elite British cyclists reported having upper back or neck pain in a 1996
report Pain in and around the neck area are often caused by bearing too much weight
through the upper limbs. This causes the neck to receive too much pressure - ideally
only 40% of weight should be transmitted through the upper limbs. Management of
overuse injuries in cycling generally involves Bike Fit adjustments as well as medical
management. Also the position in the neck in the cycling position calls for good neck
strength, The head position of a cyclist is forward of the shoulders ( not the optimal
position for neck muscles) the need for muscular activity is increased and the stress
imposed on the cervical tissues is increased. Forward head posture (FHP), defined as
the forward displacement of the head on the cervical spine, has been commonly
associated with neck pain.

CAUSES
Just as you have core stabilizers around your lower back, you have stabilizer muscles
called deep neck flexors around your neck to hold your head up. When your neck
stabilizers are weak or fatigue quickly it is left to the trapezius muscle (that goes from
the base of your skull to the tip of the shoulder) to support your head as you lean
forward. And when these ‘stand-in’ muscles fatigue you can experience pain in the back
and sides of your neck. Restore balance by keeping the neck muscles loose and
relaxed through a routine of strengthening and stretching exercises.
Be aware you may also subconsciously be tensing your neck and upper trapezius
muscles when riding. Possibly bracing yourself on uneven terrain, hurtling along at
scary speeds, or stabilizing yourself due to poor technique and swaying from your pelvis
and lower trunk. This too can result in fatigue of these muscles, development of muscle
spasm and painful trigger points as well as stiffness.
FACTORS
 Poor warm-up
 Poor conditioning
 Poor technique
 Riding at too high a level
 Poor posture

3|Page
SYMPTOMS
A variety of presentations are possible like;
 Dull ache at the base of the skull;
 Aching in the trapezius muscles;
 Twinging in the neck with turning neck or looking up;
 Neck pain with headaches;
 Tightness between shoulder blades and trapezius muscles.
DIAGNOSIS
Imaging tests might help find the cause of the neck pain. Examples include:
 X-rays. X-rays can reveal areas in the neck where the nerves or spinal cord
might be pinched by bone spurs or other changes.
 CT scan. CT scans combine X-ray images taken from many different directions
to produce detailed cross-sectional views of structures inside the neck.
 MRI. MRI uses radio waves and a strong magnetic field to create detailed images
of bones and soft tissues. The soft tissues include the disks, the spinal cord and
the nerves coming from the spinal cord.
TREATMENT
Cycling neck pain is typically caused by a poor bike fit, poor posture while riding, or in
some cases, weak neck muscles. So, you can go down the list yourself and see which
of these is the culprit in your unique circumstances. Avoid neck pain by adjusting your
bike fit or strengthening the deep neck extensors, upper back muscles (like the
trapezius muscle), and other related muscles.
In some cases, your neck pain from cycling may force you to take some time off. As
difficult as it may be, it's important for keeping you riding in the long term - so bite the
bullet and give your body time to recover. With these tips, you will be able to curb cyclist
neck pain once and for all.
REHABILITATION
Manual therapy techniques will reduce pain and stiffness by mobilizing the cervical
spine, as well as the surrounding soft tissues. Massage with trigger point therapy and
deep tissue release will relieve muscle spasm and improve flexibility. Acupuncture may
be an effective modality in treatment as well. Physical therapy will include providing you
with appropriate stretches to maintain flexibility but more importantly strengthening
exercises for the deep neck flexors. These will include lots of chin tucking exercises and
mini sit-ups/crunches with your head. It’s best to get specific exercises from your local
physical therapist, as every individual is different and there may be other underlying
pathology or previous injury (like whiplash) that could be complicating the problem.
PREVENTION
So check your form: Pull your stomach in toward your lower back, elongate your torso,
slide the shoulder blades down your upper back and keep your chest slightly lifted while
riding. Keep your chin tucked in and stretch your neck during relaxed parts of your ride.
Make sure your helmet is properly fitted too.
BODY CONDITIONING The neck muscles work together with the scapular (shoulder
girdle) stabilizing muscles, including the middle and lower trapezius muscles and the
serratus anterior muscle. Strengthening these will also help off-load the upper trapezius,

4|Page
levator scapular and anterior neck muscles. Exercises could include rowing type actions
with an emphasis on pulling the scapular back and together, as well as push ups and
many other activities using Swiss balls and resistance bands. n Your physical therapist
can provide you with a rehab programmed to manage your neck pain and preferably
prevent it. They can also offer advice regarding your ergonomics in your daily chores
and work. This is particularly important if you sit for hours at a computer or driving, or if
you are involved in manual labor and lifting/carrying, as these could all be aggravating
your neck pain. Small changes in how you carry out your work and daily chores can
make a big difference in neck posture and subsequent pain.
BIKE SET UP TIPS Change your posture on the bike. If you’re reaching too far forward,
or your handlebars are too low, shorten the stem to shorten your reach. Raise your bars
and riding more upright will reduce the strain you’re putting on your back and neck.
Don’t forget to change your hand positions at regular intervals, and sit up on the bike to
stretch, straightening out your neck and back to vary the loads on the different muscle
groups.

FUNCTIONAL ANATOMY

CYCLIST'S PALSY
The pressure on the nerves can result in numbness/tingling in the palm and/or fingers.
Sometimes hand muscles that receive energy from these nerves can weaken. When the
symptoms of numbness and weakness happen, it is called a palsy. A palsy can be
temporary and immediately improve after changing position or stretching an area.

CAUSES
During prolonged cycling, the pressures from holding and putting weight on the
handlebars can cause irritation of the nerves at the palm. The median and ulnar nerves
enter the hand where the pressure from the handlebars is greatest. Common positions
are “tops,” “ramps,” “hoods,” and “drops” (see Figure 1). The “drops” position causes the
most pressure on the ulnar nerve. There is slightly less pressure in the “hoods” position.
The “tops” position puts significant pressure on the palm at the base of the ring finger.

The “drops” position can result in extra extension of the wrist, a cause of increased
carpal tunnel pressure.

5|Page
If a cyclist already has nerve compression at the neck or elbow, it can more easily be
triggered at the palm. The combined pressures can result in carpal tunnel syndrome or
cubital tunnel syndrome.

A bike seat (sometimes called the saddle) that is not adjusted properly can result in less
body weight on the seat and more weight on the hands.
FACTORS
 Poor warm-up
 Poor fitting equipment including bike and shoes
 Poor conditioning
 Poor technique
SYMPTOMS

 Numbness
 Tingling
 Weakness
 Clumsiness
 Cramping
 Pain
 Possible motor limitation

DIAGNOSIS
Wrist pain is often caused by sprains or fractures from sudden injuries. But wrist
pain also can result from long-term problems, such as repetitive stress, arthritis and
carpal tunnel syndrome.

TREATMENT
Limiting cycling is the most effective treatment for palsies. However, there are other
things you can do that will allow you to continue cycling, including:
 Limiting the length or distance of the ride.
 Having enough rest between longer cycling sessions.
 Changing positions of grip on the handlebars.
 Changing to a transverse handlebar.
 Adjusting the seat height.
 Using gloves to reduce or distribute pressure. The pressure can be reduced with
foam or gel padding in the palm of the glove (see Figure 2).
Once the pressure is gone, there should be nerve recovery, which might be gradual
and could take weeks or even several months. A full recovery should be possible when
treated early. Steroid injections, therapy, and oral anti-inflammatory medication are
often advised. Occasionally, surgery to alleviate continuing pressure is needed.
REHABILITATION
Rehabilitation of this injury after anterior cruciate ligament (ACL) reconstruction should
consider control of postoperative pain and swelling, protection of the healing graft,
restoration of full range of motion symmetric to the contralateral knee, strengthening of
the muscles that stabilize the knee, hip, and trunk, enhancing neuromuscular control,
and a gradual progression to functional activities that are required for return to sports.

6|Page
The effects of concomitant injuries and surgical procedures must also be considered in
planning an individualized rehabilitation program.
PREVENTION
Check the fit of your bike
To protect your wrists, you’ll need to start with the right bike. Triathlon and other racing
bikes force you to lean forward, which can stress your wrists and aggravate arthritis or
nerve pain in the neck. If you’re not a competitive cyclist, a better bet is a bike that
allows you to sit up fairly straight. It’s never a bad idea to have a professional at a local
bike shop help you find the right fit, but here’s a quick look at how to check the setup.
(Hint: It isn’t much different from that of an indoor exercise bike, which you should adjust
properly, too.)
 Have your seat at hip height. Your saddle should be roughly at the height of
your hipbones as you stand next to the bike. When you sit on the bike with your
feet on the pedals, your knee should be slightly bent when the pedal under it is
pushed all the way down.
 Adjust the handlebars to suit your body. When your hands are in position,
your wrists should be straight, your elbows should have a slight bend, your
shoulders should be relaxed (not hunched by your ears), your spine should be
neutral (not rounded), and your head should be in line with your back (not
hanging down).
Get the right kind of gear
Dr. Carlson gets lots of questions about wearing wrist guards for protection when riding.
Her take? Don’t do it. “Wearing wrist guards while riding can impair braking and
steering, which could potentially increase the likelihood of a fall,” she says. Instead, try
soft handlebar grips or biking gloves padded with gel or foam to provide some extra
cushion for the palm area.
And of course, always wear a helmet that meets the latest safety standards. (Dr.
Carlson suggests visiting the Snell Foundation’s website for guidance.)
Shift position when you ride
It’s easy to start to slump when you get tired or are chatting with a fellow rider. You’ll
need to make a conscious effort to keep your wrists in proper form.
 Adjust your grip often. Change hand positions on the handlebars frequently.
Make sure your wrists are straight at all times. Experiment to see what feels best
to you.
 Ease up on your palms. Lift yourself up if you start to sink into them heavily.
Your core strength—not your hands—should be keeping your torso in position.
 Don’t ignore numbness. If you start to feel tingling in your palm or fingers, don’t
ignore it: Change your grip right away. If you don’t, it could take months for the
numbness to go away. Repeated nerve damage can also harm the muscles in
the hand, which can’t be undone.

\ UNCTIONAL ANATOMY

7|Page
FOOT NUMBNESS AND TINGLING

Foot numbness and tingling are common complaints, and shoes that are too tight or
narrow are often the cause. In addition, foot numbness can be due to exertional
compartment syndrome. This arises from increased pressure in the lower leg and
resulting compression of nerves. The diagnosis is made by pressure measurements
and is treated with surgical release.
CAUSES
Toe and foot numbness on the bike often has two main causes: nerve compression or
blood circulation restriction, Scott Holz, senior program manager for Specialized Bicycle
Components and a leading bike fit expert tells Bicycling.
Numb feet are caused by nerve pressure, too. As you exercise, the blood flowing to
your muscles increases, causing your foot volume to increase. However, your foot is
bound inside your shoe, causing pressure.
FACTORS
 Poor warm-up
 Poor fitting equipment including bike and shoes
 Poor conditioning
 Poor technique
 Riding at too high a level
SYMPTOMS
While sensation loss is the main symptom of numbness in your foot, you may
experience some additional, abnormal sensations. These include:
 Prickling
 Pins-and-needles sensation
 Tingling
 Weak-feeling foot or feet
DIAGNOSIS
Diagnosing foot numbness depends upon how severe your symptoms are. A doctor
may order a computed tomography (CT) scan if you’re having stroke-like symptoms.
This allows a doctor to view your brain and identify any blockages or bleeding that could
be causing your symptoms.
Your doctor will also take a medical history and ask for a description of your symptoms.
Questions asked may include:

8|Page
  How long does the numbness last?
 What other symptoms do you experience along with the numbness?
 When did you first notice the numbness in your foot?
 When is the numbness worse?
 What makes the numbness better?
After you share your medical history with your doctor, a physical examination typically
follows. Your doctor will most likely examine your feet and determine if the sensation
loss impacts one or both feet. Some studies your doctor may order include:
 electromyography, which measures how well muscles respond to electrical
stimulation
 magnetic resonance imaging (MRI) study to view abnormalities in the spine,
spinal cord, or both
 nerve conduction studies, which measure how well nerves conduct electric
currents
Additional tests depend upon the suspected diagnosis.
PREVENTION
While out on a ride, pay attention to your feet before the problems show up. If you’re
going for a long ride, then try unclipping and lift your foot up into the air at the top of the
pedal stroke a few times to gets your blood flowing. When you’re sitting at red lights, or
stopping for a break, then flex your toes or do some circles with your ankles. You can
even get off and walk a few paces if need be (although this can be awkward with cycling
shoes).
Always apply stretching.
REHABILITATION
 There are 3 ways to apply Rehabilitation.
 Make sure your cycling shoes fit well and are the right size.
 Sometimes, adding an arch support insert like Super feet.
 If you have clip-in pedals, try changing the cleat placement to a position more
behind the ball of your foot.

FUNCTIONAL ANATOMY

9|Page