Most Common Cycling Injuries

The popularity of cycling has increased by leaps and bounds over recent years. Bicycling has always been a favorite form of recreation for children, but, recently, more adults have migrated to cycling for its benefits as an aerobic exercise and as an inexpensive mode of transportation. Unfortunately, along with the increase in cycling popularity, there has been an increase in cycling related trauma.

Cyclists account for about 75 per cent of transport injuries. About 6 cyclists out of every 10 who are injured are children, aged five to 14 years. Only 7% of transport-related cycling injuries involve collisions with other vehicles. You are much more likely to hurt yourself by falling off your bike or hitting a stationary object. Common injuries involved in cycling are:

• Abrasions and lacerations: Although they are usually minor, abrasions and lacerations (torn or jagged wound) require proper care. Most can be taken care of at home with cleaning and bandage changes. However, severe cases of road rash, which involve large surface areas or contamination by dirt or debris, or deep lacerations should be properly evaluated and cleaned.

• Sprains and contusions: Sprains and contusions (bruises) usually heal with the application of rest, ice, compression, and elevation (RICE). Over the counter anti-inflammatory medications can also help control swelling and pain. Sprains that do not improve with these simple measures may be a more serious ligament injury and should be evaluated more thoroughly.

• Fractures: For cyclists, fractures (broken bones) are most common in the hand, wrist, forearm, or shoulder. They occur when the rider attempts to break his or her fall with an outstretched arm. After a fall, marked and immediate pain and swelling usually indicates a fracture of the distal radius, scaphoid, hamate or clavicle (collarbone). Separations or dislocations of the acromioclavicular joint (joint between the clavicle and shoulder blade) are also common when the rider lands directly on the shoulder.

• Head and facial injuries: Head and facial injuries are most common in children, who often react more slowly than adults when protecting themselves during a fall. Helmet use has significantly reduced serious head injuries, however, it does little to protect the face. After a fall, any symptoms of confusion, dizziness, diplopia (double vision), loss of consciousness, excessive sleepiness or severe headache should be promptly evaluated.

• Buttock Pain: If the buttock muscles become tight or cramped, this can put pressure on the nerve below the muscles and cause buttock pain. Sustained pressure over the bony prominences (areas where the bones protrude slightly below the skin) over the buttock can also produce buttock pain, especially in the new rider. Repeated friction on the skin over the bony prominences can result in the formation of painful blisters and sores.

• Lower back pain: The back can be a weak link for many riders. Cyclists usually develop strong leg muscles but don't always have the torso strength to support and resist the force from the legs. This forces the back to overwork and spasm, causing rapid fatigue.

• Neck pain: When riding, the load on the cyclist's arms and shoulders is increased by riding in the 'drops' of the bicycle handlebars, as his/her weight is projected forward and the neck is hyper-extended. Road vibrations magnify the impact felt by the cyclist's body, transmitted through the handlebars to the shoulder girdle and neck, especially when the handlebars are set in the 'hands low' position. This results in two problems. First, the cyclist can develop painful muscle spasms (called 'trigger points') in and around the neck. This, in turn, sends pain signals to the central nervous system and triggers a spasm-pain-spasm cycle. Subsequently, additional trigger points are recruited, resulting in further pain. The second problem relates more to endurance cyclists. A long, hard ride in the 'drops' with the neck hyper-extended may produce thousands of micro-whiplash motions to the neck. Taken together, they cause recurrent micro-tissue damage, including strains and spasms.

• Hand injury: The earliest sign of a hand injury is tingling or numbness in the palm or fingers.

• Shoulder pain: Injury to the shoulder usually occurs during longer rides. It is mainly caused by placing too much weight on the hands, and riding with straight elbows.

• Knee pain: This is the most common lower extremity overuse problem in cyclists. Patellofemoral pain syndrome, characterized by pain behind the knee cap, may be precipitated by hilly rides, riding in big gears or at too slow a cadence. This may be aggravated by other knee-joint-loading activities, such as stair climbing/descending, squatting or weight room activities. In a cyclist with patellofemoral pain, the bike saddle may be too low and/or too forward, causing excessive knee joint loading throughout the pedaling stroke.

To avoid injuries, cyclists and motorists should be aware of each other's presence and follow traffic regulations. Cyclists should follow the same traffic rules motorists do and should always dress appropriately with a helmet and bright reflective clothing. Motorists, in turn, should always be on the lookout for cyclists and should yield them the right of way when possible. Cyclists should be aware of road damage and debris, which can cause a fall and lead to injury. Interestingly, 47% of cyclists involved in accidents in urban settings, cited themselves as being at fault; therefore, an "ounce of prevention" truly is worth a "pound of cure."