Workshop organized by BOTS on stretches that can be done before byking and sports injuries

1. Workshop on sports injuries &
prevention
Dr Sushal
Shanthakumar
MS Orthopaedics

2. What s cooking …
Stretching
Getting the right fit
Common problems/injuries
The knee – an enigma to cyclists
Why physiotherapy ?
Question time !

3. Stretches
U gotta stretch
yo ! ! !

4. Why do we need to stretch ? ?
“ just not merely a stretch of imagination ”
To improve the flexibility
To prepare for an imminent increase in activity
Anatomy of stretching
What is static & dynamic stretching
What is best for us ???

5. anatomy & physiology of stretch
All muscles at rest –
contracted
Cross bridges – less
widely separated in
rest
Optimum stretch – max
pre load
Total tension = passive
tension + active
tension

6. Stretches for the upper limb
DELTOID :
stand with feet apart
Keep shoulders square
Pull arm across the body
perpendicular to the ground

7. TRICEPS :
Stand with shoulder flexed till ears
Bend elbow so the hand rests b/w
the shoulder blade
Apply pressure on the opp. elbow
with other hand

8. LEVATOR SCAPULAE:
Sit/stand with shoulders square
Look down towards opposite arm
pit
Apply slight pressure with the
near hand

9. Stretches for the lower limb
LOWER BACK STRETCH :

10. LOWER BACK contd ..

11. GLUTEAL STRETCH :
Sit on the floor
Bend the knee you are
stretching and place it across
over the opposite thigh
Pull bent knee to your chest
while keeping both buttocks on
ground

12. HIP FLEXOR ADDUCTOR STRETCH

13. IT BAND STRETCH:
cross your right foot over in front
of the left
most of your weight should be on
your left foot
reach your right hand overhead,
and lean as far as you can to your
left
push your hips out while you are
reaching overhead

14. QUADRICEPS HAMSTRINGS CALF STRETCH

15. Remember ….
‘feel’ the stretch
slow & gradual stretch
hold for 10-15 secs
do not bounce or jerk
repeat atleast once

16. Getting on the bike
Get a good fit
Be meticulous on choosing
the bike
Don’t go by opinions
Every individual is
different and so will his
bike

17. Why is it important to get the right fit
• EFFICIENCY
– Aerodynamics
80% effort required to overcome air resistance at
25mph
– Power
Cannot let the legs do the pedaling if you’re not
relaxed
• COMFORT
– Neck ache (bars too low)
– Over-reaching to handlebars (neck/shoulder/elbow pain)
– Pain
Knee (saddle too low or too high)
Perineum (saddle too high, too forward/back, tilted
up/down)
Lower back (saddle too high)
• AVOID INJURY
– Knee injury (damage to ligaments)
– Tendinitis (neck/shoulder/elbow)
– Male impotence (perineal nerve damage)

18. The right fit
A myth or reality ?
Anatomical or mechanical ?

20. Common problems & injuries
Back pain
Knee pain
Hand & shoulder
syndromes
Foot pain

21. Low back pain
Back – considered as the weak link for cyclists
Any force directed into the pedals also goes up
into the torso
If the torso is weak, that force DOESN'T go into
the pedals but is dissipated in flexing of the
torso

22. CAUSES -
80% of low back pain arises because of poor posture
Muscle spasms - inflexibility
Medical problems
TIPS-
Strengthening of abdomen n back
Stretching
If nothing helps see a doc

23. Knee pain
Most common problem –
90% have exp some kind
of knee pain
Irony ! ! ! Cycling is one
of the better exercises
for knee

24. Anatomy
Stability – rather
instability ! ! !
Bones are
incongruent
More emphasis on
muscles &
ligaments

25. Multitude of causes …
ANATOMICAL
- leg length discrepancy
- wider pelvis
- flat foot
- muscle weakness

26. BIKE FIT
- saddle too high
- saddle too low
- saddle too far forward
- saddle too far back
- internally rotated cleats
- externally rotated cleats
TRAINING
- rapid increase in activity ( 10% rule )
- faulty techniques
- early return to sports following repair

27. Variety of conditions ..
Patello-femoral pain syndrome
IT band syndrome
Chondromalacia
Tendinitis
Bursitis
Ligament & meniscal tears

28. Cruciates & Menisci
CRUCIATE LIG
- ACL & PCL
- injury – how?
- is surgery essential
- if so when ?
- results ?
‘an ACL deficient knee is the beginning of
the end’

29. Meniscus
Medial & lateral
Avascular structures
Functions
Injury
Is surgery essential ?
Results ???

30. Menisci contd ..

31. Rehabilitation
Extremely essential
Tailor made to individual case
Basic points
- achieve full ROM within 2 weeks
- strengthening hamstrings & quadriceps
- earliest return to sports – 6 months
- criteria ---
quads & hams strength at least 80% of the
normal leg
no swelling

32. Foot & ankle
FOOT :
Numbness or burning – compression of nerves
Due to tight shoes / road vibration
Flat feet
- is it congenital or acquired
- flexible or rigid
- all flat feet don’t require Rx
- effect on cycling - ?
- symptomatic – insoles , custom made shoes

33. ANKLE :
Most often results from ‘ankling’
Cleats are wrongly positioned
ACHILLES TENDINITIS:
• Tendon on back of the foot
• Indicates problem with pedaling
technique
• Ankling / cleats too far forward /
saddle too high – toe pedaling

34. Hands neck & shoulder
HANDS:
Entrapment neuropathies – ulnar & median
nerves
Pressure of handlebars / overuse of wrist/
fractures of small bones of hand
Numbness & tingling in hands
Rx – padding , gloves , wrist splints , change of
position , lowering the saddle

35. NECK:
- neck pain - common due to riding position
- overuse injuries
- reassess your posture (saddle ht position
distance)
- r/o medical conditions
- tips – stretches , freq change of hand position ,
relaxing elbows , varying head position
‘try not to ride with your neck in the same position
for long periods of time’

36. Thank you & happy cycling