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Why Do Cyclists Ride With Pain and NEVER Get Better!

Leisz_Marie-Christine-2011_webThis is the question I asked myself a number of years ago when I began seeing cyclists in my endurance sports medicine clinic. Injuries that would stun a runner or Nordic skier did not seem to stop cyclists from riding.

I have a cycling injury clinic with my colleague, Miriah Dahlquist, DPT. Both of us are cyclists and understand the sport, but we found it difficult to obtain a clear injury history from cyclists, as opposed to injured runners. Many cyclists admitted to a history of crashes with very impressive injuries. But most were able to ride despite high pain levels. We noticed that when discussing pain level, we had to differentiate between what cyclists considered their “normal” pain and the symptoms compelling them to seek attention. They seemed to minimize their pain level and degree of injury. Most common injuries were to the low back, knee, neck and shoulders. When asked why they came to see us, many answered because their spouse made them!

We found this fascinating so Miriah took the lead and thus began a 3 year research adventure culminating in our article, “The Club-Level Road Cyclist: Injury, Pain and Performance”, published in Clinical Journal of Sports Medicine, March, 2015.

So, what did we do and what did we find? Briefly, we rounded up 63 experienced club-level cyclists, males and females, ages 18-60. They had ridden an average of 17 years. Most considered themselves primarily road cyclists, but many mountain-biked and rode cyclo-cross too. We screened them with a focused physical exam and obtained a baseline injury history. We asked them what their “normal” pain level was on the 1-10 scale, 10 being the worst pain imaginable. Then, they completed a two week training diary and 8 week follow-up new injury questionnaire.

The initial injury history revealed that 69% rode with pain due to an injury > 1 year old. Their injury history included an array of fractures, joint dislocations, strains and sprains. The most common pain location at enrollment was in the low back, knee, shoulder and neck. The most common injuries suffered during the season we followed them were muscle and tendon strains as well as over-use injuries. Where were those new injuries located? In basically the same areas; low back, knee, shoulder and neck.

We found that two-thirds of the cyclists experienced significant pain while riding. We also found that the cyclists with pain trained at the same intensity as their pain-free peers. It was not until pain reached >5/10, that cyclists chose to seek medical treatment. We discovered that cyclists over 40 years of age, with high pain levels, were more likely to seek medical treatment. Those who could no longer keep up with their training partners sought medical treatment.

So why do they ride hurt? We think that cyclists can ride with a high pain level unlike an injured runner or Nordic skier because they use an efficient machine. It is possible to ride on a flat surface in a group at a fairly high level even with an injury. Once demands of training intensify, the injured cyclist drops out. Although this remains to be studied, we think there is a personality “trait” amongst cyclists that allow them to tolerate and almost sublimate discomfort.

Why do they never get better? We determined that many cyclists did not seek treatment because they seemed to think that their chronic injuries would heal over the long winter off-season. Their pain would improve when they stopped or decreased riding, only to recur when the season started again.

So if you are a chronically injured cyclist out there, we stress seeking medical attention early to resolve acute injuries before they become chronic. It is not likely that injury will just get better over the winter! We have had great success resolving cycling-related low back and knee pain with a lower body core stabilization program strengthening their gluteal muscles. Most neck and shoulder pain cyclists complain of improves with a scapular stabilization exercise program. Referral to a cycling-savvy sports medicine team to resolve that nagging injury once and for all, will keep you on the road for years to come!

Marie-Christine Leisz, DO is board-certified in Physical Medicine and Rehabilitation and Sports Medicine, with advanced training in the diagnosis and management of running and endurance sports injuries. She is medical director of the Running and Endurance Sports Injury Clinic at Courage Kenny Institute and collaborates with the Courage Kenny RunSmart Physical Therapy Program. Learn more and