Iliotibial Band Syndrome (ITBS) and Cycling (part 2)

As stated in the first blog on this subject Iliotibial Tibial Band Syndrome (ITBS) is a common overuse injury that affects cyclists, triathletes and runners. Overuse injuries, otherwise known as cumulative trauma disorders, are described as tissue damage that results from repetitive demand over the course of time. The condition manifests itself as:

  • A sharp or burning pain on the lateral aspect (outside) of the knee.

  • Pain radiating up the side of the hip or thigh

Many factors can contribute to the development of this problematic condition; it can develop due to either anatomical abnormalities or bike malalignment (improper bike fit).

The demands placed on the ITB during cycling are actually significant and continuous due to the repetitive nature of the pedalling action particularly in demanding training rides, Many keen cyclists, who are often forced due to lifestyle constraints to cram their 7 to 11 hours of training into 2 /3 rides per week (1mid week & 2 at the weekend), run a high risk of developing ITBS should any of the abnormalities or malalignment issues exist.

 

This blog article will look at some of these issues and offer potential remedies.

 

Anatomical Issues

 

As stated a number of factors can contribute to the problem. ITB syndrome can simply be caused by exercise induced muscle imbalance. This situation can arise due to the overworking one muscle group more than another, or simply by a person working a muscle or group of muscles less than optimally during their daily life (poor lifestyle habits)

Muscle imbalances may also develop where some muscle groups, for example the quadriceps and or hip flexors have become too tight, while the hip abductors and extensors have become too weak or fatigued. If this is the case then a rehabilitation regime designed to strengthen the weaker hip extensors, abductors and external rotators muscles is required.

Another cause of ITB inflammation can develop  when the Tensor Fascia Latae (TFL) is overused, causing it to go into a state of spasm thus “shortening” over time. With a stiff and over-dominant TFL, the gluteus medius can be become lengthened and weakened, and can even be inhibited. This again causes issue for the ITB. The rehabilitation process in this case requires the imbalance between the gluteus medius and the TFL to be addressed and this is achieved by strengthening the gluteus medius through glute activation exercises.

As in many scenarios relief from tightness/ pain can be achieved in the early stages through foam rolling and soft tissue mobilization/ recovery stretches.

A mal-aligned pelvis and leg length discrepancies are two major causes of chronic ITB problems; these structural asymmetries can increase the frictional forces through the tract resulting in an inflammatory response; these conditions can be are difficult to correct even with if the person follows a well-structured  programme of strengthening exercises and recovery stretches. If either of these issues are the cause then it may be necessary to seek the help of a health care specialist, such as a physiotherapist.

Problems may also arise because of excessive ankle/forefoot pronation which significantly stresses the shin and outer thigh, despite the foot arch being supported in a fixed position. In severe cases, cyclists may need customised shoe orthotics placed in their cycling shoes.

The condition known as Varus Knee (bow legged) increases the stretch along the outside of the knee thereby potentially causing issues for the ITB. In order to reduce the stress it is advisable to widen the cyclist's stance on the bike. This is achieved by placing spacers between the pedals and the crank arm.

It is not uncommon for people to have a discrepancy in their leg lengths; this condition will cause excessive ITB stretch on the shorter leg again leading to an inflammatory response. If this leg length discrepancy is significant and is deemed to be the cause of ITB issues then shims placed between the cleats and the pedals help to correct this issue. Minor leg length inequalities can be alleviated by moving the cleat of the shorter leg forwards and the longer leg backwards. Functional leg length differences often due to muscle imbalances should not be corrected in a bike fit.

 

Malalignment Issues

 

Although anatomical issues can lead to the development of ITB issues the most common cause is the smallest amount of Malalignment between the cyclist and the bike. Common malalignment issues relate to bike set up and the ride position. However some simple adjustments can decrease the strain on the ITB.

 

The most common issues are:

Poor cleat position; ITBS results when cleats are excessively rotated internally, as this set up increases the tension placed on the ITB. There should be no torsional stress occurring when a person is pedalling, simplistically the feet should feel straight when clipped into the pedals. To eliminate stress on the ITB, the cleats should be adjusted to reflect the cyclist's natural anatomical alignment; alternatively the cleats can be externally rotated to reduce stretch on the ITB.

Incorrect saddle height; The saddle height should be set, so that the optimum range of motion of between 150 ° at full extension to 70 ° of knee flexion is established. A saddle that is too high should be adjusted. Cyclists whose set up creates angles outside of these optimum ranges again significantly increase the likelihood of developing ITB issues.

Incorrect ride stance; again if someone has developed knee issues then it may be worthwhile checking their stance. Stress on the ITB can be reduced by widening the cyclist’s bike stance and by improving both the hip and foot alignment. This can be identified by looking at the knee position in relation to the feet. In essence if the feet are closer than the knees there is an increased chance of ITB issues as the plane of motion at the knees is challenged. This correction can be accomplished by either increasing the size of the pedal axles or by placing spacers between the pedal and the crank arm.

Poor saddle positions; Saddles that are positioned too far back force the cyclist to reach for the pedal with each stroke this action causes a tightening of the ITB thereby increasing the chances of an inflammatory response.

Along with malalignment issues gear ratios and training loads can similarly stress the ITB creating the conditions that may cause a person to develop ITB issues. A high gearing ratio may cause excessive generation of force by the ITB, which obviously can lead to issues. Similarly changes in an individual’s training regime my easily result in the development of this common over use condition. A marked increase in mileage and intensity without an adequate training base or the introduction of excessive hill work naturally increases stress on the ITB.

Whether anatomical or equipment related, malalignment will place significant stress on the distal (away from the bodies centre – in this case near the knee) ITB. As stated it is these stresses, however caused, that lead to the development of this cumulative trauma disorder. Whatever the cause the issues need to be identified and addressed as quickly as possible; as the ITB needs to be realigned to its normal resting position, as this decreases the tension in the tissue and brings about a reduction in inflammation.

As previously stated the development of ITBS can be attributed to a number of factors but in the majority of cases the trigger tends to be a combination of physical issues (imbalances / weaknesses). the actual act of cycling and the basic cycling position. The latter two feed any underlying imbalances thereby contributing significantly to its development.

Regardless of the factors which contribute to the problem ITB pain should be addressed as quickly as possible to avoid the development of a chronic debilitating injury which would probably require time off the bike and in the worst case scenario surgery. In the first instance

  • Temporary decrease or stopping training.

  • An intensive stretching routine.

  • Strengthening of the hip abductors (gluteal muscles esp. the gluteus medius).

  • Gentle foam rolling.

  • Addressing any malalignment issues.

If the above do not help relieve the issues then, ice, non-steroidal anti-inflammatories and treatment by a qualified practitioner may be necessary. ITB pain is certainly preventable and can be quickly eliminated if treated early.

 

 

Hopefully you have found this article of interest & value to you. Should you require further information on this subject or wish to find out how we at Cyclissimo can help you realise your cycling aspirations please contact us at enquiries@gocyclissimo.com or via the contact section found on our website: www.gocyclissimo.com

 

 

 

Personal Injury Claims for Cyclists – What to do if you have an accident

Editorial

The rise in popularity of cycling in recent years has not surprisingly led to an increase in the incidence of accidents. There can also be little doubt that with developments in technology & the growth of social media there is a greater awareness of the incidence of cycling accidents (19438 reported in 2014). However the National Cycling Charity CTC believes cycling to be a relatively safe activity, in fact stating that “people are more likely to be injured in an hour of gardening than an hour of cycling”.

ROSPA (Royal Society for the Prevention of Accidents) have produced the following statistics in respect of cycling accidents:

Around 75% of fatal or serious cyclist accidents occur in urban areas

Around half of cyclist fatalities occur on rural roads

75% happen at, or near, a road junction

80% occur in daylight

80% of cyclist casualties are male

Almost one quarter of the cyclists killed or injured are children

Around three quarters of cyclists killed have major head injuries.

The following blog article written by guest contributor, Scott Beaman is designed as a useful aide memoir for anyone unfortunate enough to be involved in a cycling accident.

Personal Injury Claims for Cyclists – What to do if you have an accident

 Accidents Happen

A recent survey carried out by the Royal Society for the Prevention of Accidents (ROSPA) revealed that there were 19,438 accidents involving cyclists across the United Kingdom in 2014, resulting in 109 fatalities.

According to the survey a large proportion of the accidents were caused by moments of carelessness; for instance, 57% of reported collisions were due to a failure to look properly. This is something that many individuals may be guilty of from time to time, whether it is at a junction or when entering the road from the pavement.

 Act Rationally After an Accident

It is vital that cyclists are aware of the prevalence of accidents on the road, and the trauma and stress that the individuals involved will experience in such a situation, causing them to act irrationally or out of character. For this reason, it’s advisable that as well checking your brakes, lights and air pressure before a ride, that you understand how to behave if you have or come across an accident.

If you were to have the misfortune of becoming injured and are consequently faced with substantial medical bills, your actions in these highly tense and decisive moments could be vital to the outcome of a potential claim for compensation.  

Follow our step-by-step guide to what to do if you have or come across a cycling accident:

·         Get out of danger – it is crucial that you move yourself or the victim to as safe a place as you are able to; however, it is important to judge whether it is appropriate to move the person at all, dependent on their injuries.

·         Take refuge - but do not leave the scene of the incident in any situation.

·         Note down the details of any witnesses to the accident – ensure that you obtain the statement and contact details of any witnesses to the accident, bearing in mind that you may need to contact them at a later date.

·         Document the scene of the accident – use your camera phone, providing that it is safe to do so, to document the scene of the accident, ensuring that you capture the registration plates of any drivers involved and the location of any CCTV cameras.

 

·         Seek legal advice - if you are not in a fit state to gather this information then you should consult a lawyer as soon as you can as they will be able to obtain relevant information from hospitals and the police.

 

·         Retain all documentation – including any paperwork given to you by the police or medical personnel at the scene.

 

·         Do not admit liability – it is important, particularly at this early stage, that you do not admit any fault while at the scene of the accident as this could be held against you should legal action be pursued. Until all of the evidence is accumulated it can be unclear if other parties were in violation of the law in the lead up to the accident.

 

·         Stay Calm -  it can be difficult to retain a level head when you are in pain and adrenaline is pumping around your body, however it is vital that you take a deep breath and absorb as much of your surroundings as possible. If you are in a fit state to do so, ensure that your statement is taken immediately following the accident while you are at the scene, as trauma can alter your perception of an incident over time.

 Getting a fair outcome can be difficult for cyclists

Naturally, cyclists need to be cautious every time that they take to the saddle and being aware of how to behave in the aftermath of an accident is very much a part of that. Remember that cyclists are not protected by either the law or insurance as motorists are, which can make it much more of a challenge to receive fair judgement and compensation after an accident.

Author Bio

Scott Beaman writes for Slater Heelis (www.slaterheelis.co.uk) providers of legal services for commercial and private clients in Manchester and the North West.

 

 

 

Iliotibial Band Syndrome (ITBS) and Cycling (part 1)

Iliotibial Band Syndrome (ITBS) and Cycling (part 1)

The iliotibial band (ITB) is a tendonous and fascial band that originates on the hipbone (iliac crest) inserts on the outside (lateral aspect) of the tibia, just below the knee. The band also attaches to the gluteal muscles (your rump) and the tensor fascia latae (TFL - the muscle on the outside of your hip that assists in moving the leg outward). As the ITB descends toward the knee, it narrows considerably, before attaching to the outside of the tibial plateau (the top of lower leg bone), fibres also extend over to the knee cap (patella).

The primary functions of the Iliotibial Band are to:

Provide static stability to the lateral (outer) aspect of the knee.
Control adduction (inward motion).
Assist in controlling knee flexion, notably deceleration of the thigh.
Assists the tensor fascia latae & the gluteus maximus to support the extension of the knee while standing, walking, running & cycling

All of the above are significant as they contribute to the maintenance of an effective cycling action.

The demands placed on the ITB during cycling are actually significant and continuous and because of the repetitive nature of the pedalling action allied to the frequency and duration of training rides, many people experience issues which if not rectified can lead to a development of a common but significant over use injury – namely: Iliotibial Band (ITB) Syndrome.

Overuse injuries, otherwise known as cumulative trauma disorders, are described as tissue damage that results from repetitive demand over the course of time.

As stated Iliotibial Tibial Band Syndrome (ITBS) is a common overuse injury that not only affects cyclists but triathletes and runners alike.

It presents as:

  • A sharp or burning pain on the lateral aspect of the knee.

  •  Pain radiating up the side of the hip or thigh

Many factors can contribute to the development of this problematic condition; Anatomical abnormalities (e.g. varus knee – bow legged, leg length discrepancy), muscular imbalances (e.g. weak gluteal muscles) or bike malalignment (improper bike fit).

Many keen cyclists, who might be forced due to lifestyle constraints to cram their 7 to 11 hours of training into 2 /3 rides per week (1mid week & 2 at the weekend) run a high risk of developing ITBS should any of the above issues exist. This should not come as a surprise if one considers the involvement of the ITB in the physical actions involved in the sport.

Cycling at a moderate pedalling cadence of 90 rpm, results in 180 activity cycles per minute, therefore on a two-hour ride, the ITB is active 21,600 times.

There are two theories as to the cause of the syndrome; the most commonly stated cause of ITB irritation results from repetitive friction of the ITB across the lateral femoral (a bony projection on the lower extremity of the femur – thigh bone) flexion and extension as with each pedal stroke the ITB is pulled forward on the down stroke and backwards on the up stroke. The second suggests that a weakness of the gluteal and core muscles cause tension to develop in the iliotibial band as the muscles inserting into it have to also assist to keep the hips level. This action creates muscular imbalances which result in unnatural levels of tension leading to significant inflammation in the fibrous band.

Regardless of the cause a cyclist with ITB will complain of a sharp stabbing pain on the outside of the knee and a loss of power. If the resultant irritation is not alleviated early enough chronic inflammation and fibrosis occurs

As stated above the development of ITBS can be attributed to a number of factors but in the majority of cases the trigger tends to be a combination of physical issues (imbalances / weaknesses), the actual act of cycling and the basic cycling position. The latter two feed any underlying imbalances thereby contributing significantly to its development. In essence the smallest amount of malalignment between the cyclist and the bike, whether anatomical or equipment related (bike set up / cleat alignment) places significant stress on the distal (area closest to the knee) ITB which can lead, particularly in periods of heavy training / competition to the development of this painful and debilitating condition.

Regardless of the factors which contribute to the problem ITB pain should be addressed as quickly as possible to avoid the development of a chronic debilitating injury which would probably require time off the bike and in the worst case scenario surgery. In the first instance

Temporary decrease or stopping training.
An intensive stretching routine.
Strengthening of the hip abductors (gluteal muscles esp. the gluteus medius).
Gentle foam rolling.
Addressing any malalignment issues.

If the above do not help relieve the issues then, ice, non-steroidal anti-inflammatories and treatment by a qualified practitioner may be necessary. ITB pain is certainly preventable and can be quickly eliminated if treated early.

A follow up article will look at issues of; anatomical abnormalities, malalignment and their correction.

 

Hopefully you have found this article of interest & value to you. Should you require further information on this subject or wish to find out how we at Cyclissimo can help you realise your cycling aspirations please contact us at enquiries@gocyclissimo.com or via the contact section found on our website: www.gocyclissimo.com

Monitoring training loads

So with the third and final grand tour well under way, I was watching the coverage and the old question came up of how do the professional cyclists manage to compete in these grand tours one after the other and expect to perform the answer is simple, with great difficulty. If history is to be believed in the entire history of grand tours only 39 riders up until 2014 have finished all three grand tours in one year and of those none have won all three in the same year. Only the true greats have even won all three in a career Jacques Anquetil, Felice Gimondi, Eddy Merckx, Bernard Hinault, Alberto Contador and Vincenzo Nibali. This is due to the physical toll that it must take to ride 1 Grand tour let alone 2 or 3.
In the elite sporting world the monitoring of fatigue levels to optimising training and performance is a massive area that everyone is trying perfect to gain an advantage over their competitors. As a very simplified statement the harder you can train/race and recover before the next training or racing bout the better, but over cook it and the consequences can be massive in terms of performance.

So what can we learn from the elite world for the everyday cyclist to gain the most out of there training. Unfortunately the majority of us can’t afford or have access to the types of sports scientists, sports medics and strength and conditioners that the professionals have (unless of course you come and visit us in Italy to experience the elite athlete support). This assortment of professionals will be looking at blood fatigue markers, monitor your health and well being and scrutinise ever last inch of your riding and training data.

The real question for us mere mortals is what can the everyday man do to make sure we aim to peak for the desired day and not end up to fatigued mess from the training to take part or to maximise potential.

Firstly my advice to all of our clients is to listen to your body you’re the best judge of how you feel and if you feel to tired to train then 9/10 you probably are. Now the caveat is that we all have those days where we’d rather stay in bed than get out and train in the wet and rain of the mid winter so how do we differ between being lazy and truly fatigued.

A good way to do this more objectively is to take your resting heart rate. This is done in the mornings before you get out of bed. Over a period of time you’ll begin to know what your normal resting heart rate is. From here if your resting heart rate is elevated in the morning the chance is that your either becoming ill or over fatigued and not recovering from your training load.
To take this one step further I like to use the analogy when writing training programmes that we only have so much training fuel that our body is able to use and how you use this fuel and how soon you have to fill up again depends on the types of training that your undertaking. No one is able to go 100% 7 days a week 365 days a year.
 
We can therefore monitor how much each training session is taking out of you by combining some objective and subjective data. This is based largely on the old TRIMP calculations (Training IMPulse). This dates back to 1975 where you would monitor your training by calculating a TRIMP score of every training session by simply multiplying the time of session by the average heart rate. The disadvantage of this is that it doesn’t consider intensity of sessions as there are multiple ways one could generate the same score.
Therefore we refine this further by calculating your heart rate into zones and work out which zone your average heart rate sits in before multiplying it by the time of the training session.
Now this all works very well to give an objective score but I feel that combining this with the subjective data can give a far more accurate idea of how an athlete is coping with a training volume. Therefore we combine this score with an RPE score. RPE (Rating of Perceived Exertion) is how hard you felt a training session was and is scored between 1-10 (1 being easy, 10 being the toughest thing you could have done, lying in a pool of drool on the floor is mandatory for a score of 10). We then take this score and add it into your already calculated TRIMP score to give us an over all value for that session. For example 60mins @ zone 3 with an RPE of 5 ((60 x 3) x 5 = 900)) this is then tracked throughout the training period to make sure that your not over training and recovering from session to session.

This is obviously a very brief glimpse into the world of fatigue management but a nice way to implement it into your own training weeks to stop you becoming over trained. And it goes without saying that if your concerned reguarding your health go and visit the relevant health professional.

Come and visit us at gocyclissimo.com to see how we can help you obtain your goals and give you an unforgettable cycling experience in Tuscany.

Nathan Allwork     

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Keen cyclists can garner injuries and complaints after long periods on their bikes. In many cases, hydrotherapy can offer some much needed relief.

Core Strengthening Exercises for Cycling

Following on from the blog article “The Benefits of a Strong Core for Cyclists” this follow up article outlines how to undertake a number of relatively static basic core exercises which the Cyclissimo team believe should form the basis of a fundamental core programme for those cyclists wishing to develop greater core strength.

The Benefits of a Strong Core for Cyclists

It is an accepted fact that cyclists spend many hours in the same position while pushing hundreds of watts through the pedals. This type of constant activity can result in issues (pain) in both the lower back, the knees and even the neck. The solution...

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Regardless of experience, skill or technique, cyclists of all walks of life are fast learning the benefits of a professional sports massage; using it as an aid for a fast recovery, prevention of injury or even performance enhancement.

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Cyclissimo is offering you the chance to win one of three pairs of VIP tickets to Revolution Series at Lee Valley VeloPark in London on the evening of 25th October 2014. Revolution Series track centre lounge puts you at the heart of the action, enabling you to rub shoulders with the stars, to soak up the racing and enjoy drinks from the track centre bar.

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Give me a moment and I’ll explain why the shoulder, and in particular the acromioclavicular joint (ACJ), is so important to a cyclist’s performance and how, with some help from you ever friendly Cyclissimo Physio, can help you to improve performance and have a more pleasurable cycling experience.

Vincenzo Nibali - Tuscany's sculpting of a champion cyclist

Italian rider Vincenzo Nibali has won the Tour de France 2014. One of only eight Italians ever to have won this prestigious race and the first since the late Marco Pantani rode into Paris in 1998.  In his early years he lived and cycled near the small Tuscan village of Mastromarco, set between Lucca and the historic city of Florence.

A pain in the neck

So now the Tour de France is underway up in Yorkshire, the question always comes to mind - 'How on earth do these guys achieve this mammoth feat of cycling the best part of 200km a day for 21 days?' The question is not only the physical demands of lungs and legs, but also how they cope with the rigours of simply being in the saddle for these massive lengths of time ...

It's tough but you have to keep going...

We would all like to be able to climb like Chris Froome, time trail like Bradley Wiggins, handle our bikes like Fabian Cancellara or sprint like Mark Cavendish. I’m sure the majority of us start our training feeling like we could somehow attain these levels of these mystical levels of the professionals. Then the reality hits. We remember that we still need to somehow function in the real world, balancing that 50 hour working week and trying to spend some quality time with our nearest and dearest. Suddenly that 6 hours of training that we’d need to do every day becomes an impossibility. So how can we achieve our goals? 

Bike set up and seat position to improve performance and reduce injury risk

The size of the frame, seat position and body position on a road bike are all important areas to address to reduce injury risk. Research has now shown that these factors are important in improving performance.  Injuries in cycling are either traumatic, mainly shoulder and upper limb, or chronic or overuse injuries, mainly lower limb.

50% of cyclists are likely to develop overuse knee injuries. 

Hydration is key to distance cycling performance

For distance cyclists, it’s vital to have a basic understanding of how to fuel the body for effective performance. Regardless of the percentage of carbohydrates, fat and protein eaten, it is important that the calories burned should be matched by the calories consumed. The same is true for hydration. Experience and experimentation will allow individuals to determine their personal baseline requirements for calorific, electrolyte and water intake per hour. However it is important to provide all cyclists with guidelines so that during long distance events  and training they avoid the dangers of "hitting the wall" as the marathon runners term it.

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