Cycling-related injuries are on the rise

[The_King]

Despite never being huge into cardio-heavy Spin classes before the pandemic, I recently caved and purchased a Peloton after realizing I wouldn't be going back to my old ClassPass circuit of studios any time soon. As a result, it's become the only workout I actually do these days, partially because Cody Rigsby has become a form of therapy for me, but mostly to get my money's worth and not feel guilty whenever I see it (which, because I live in a New York City apartment, is every day).

But as it turns out, it's this well intentioned mentality that could actually be backfiring according to some doctors, who say that the explosion in interest in at-home cycling (whether it's on a Peloton, SoulCycle's at-home bike, or any of the other more affordable exercise bikes from Amazon), is causing a surge in overuse injuries and complaints of aggravated necks, backs, knees, and wrists. The 'Peloton Pandemic'? It's a whole bunch of people in pain because newbies and cycling veterans alike are doing it wrong.

 

First thing's first: It makes sense that cycling-related injuries are on the rise, says Rahul Shah, M.D., a board-certified orthopedic spine and neck surgeon at Premier Orthopaedic Associates in New Jersey. "Now that cycling is a more common routine of many who work out at home, the relative share of working out injuries seems to have shifted from CrossFit to at-home cycling," he says. It's not necessarily cycling's fault, but with more of us doing it than perhaps ever before, these injuries are just more likely to crop up, statistically speaking. And while a ride on your Peloton may not seem like it can do much harm compared to, say, attempting to lift a super heavy weight over your head, with cycling it comes down to overuse — a term used to describe damage and pain caused by repetitive movement, Dr. Shah explains.

"I have seen an uptick in cycling injuries with at-home bikes. Most are overuse and related to going from no exercise to overdoing it on the bike," agrees Christopher Mattern, M.D., a board-certified orthopedic surgeon and sports medicine physician at Westmed Medical Group in Westchester, NY.

 

One of the most common cycling-related overuse injuries is hip tendonitis, aka painful inflammation or irritation of a tendon in the hip, Dr. Shah says. This is more common with stationary bikes because, with our feet locked into the pedals, we have limited ability to move our leg at the hip level (both internally and externally), Dr. Shah explains. And the problem is, most people who are prone to this kind of injury don't know until they're in pain. "Many people have undiagnosed hip issues, which cycling can exacerbate," Dr. Shah explains. While you can buy cycling shoes that have an extra swivel in them to mimic some of the side-to-side movement that you'd be able to get while riding your bike on the road, he says the most important way to prevent injury is varying your rides as much as possible. Translation: Don't sit or stand for the entire time you're on the bike, and change the frequency, intensity, and duration.

Knee pain is another common complaint with at-home cycling, even though it's considered a low-impact workout compared to, say, running, he says, particularly if you're doing too much too soon. (Your bike setup also really matters — more on that later.) "Sometimes in the process of pushing through the knee when you bend, it can become irritated, especially if you have arthritis or irritated cartilage, so it's important to start small, and then add more time and intensity," Dr. Shah says.

This can be easier said than done, especially if you're a competitive person and checking out where your output stacks up compared to every other person you know who also bought a Peloton during the pandemic, but it's key for improving your fitness in the long run. "By taking more breaks and dividing the workout into smaller workouts, the chances for injury is minimized because the body has a chance to reset and recharge between workouts and is thus more resilient to additional stress," Dr. Shah says.

"Intensity is not always a determinant of a good workout," says Peloton instructor Kendall Toole. "In fact, the key to truly elevating one's fitness is finding the balance between active work and recovery." That includes stretching before and after every workout — a step that every doctor and trainer says is crucial, but is often skipped in the interest of time. "Invest in some great self-care tools like a foam roller or a lacrosse ball and become best friends with them," says James Lewis, a SoulCycle Instructor on Equinox+.

 

It's also crucial that you're not only cycling. Toole stresses the importance of cross-training in different modalities — Peloton, for example, offers more than 10 workout options in its monthly app subscription, including strength, yoga, barre, and stretching — that challenge your body in different planes of motion. And corny as it sounds: Listen to your body and honor the need for rest. "When you are training at your best, you should never have a 'so sore I cannot put on my skinny jeans' — at least if you're a millennial! — kind of post-training experience," Toole says.

 

While the experts note that cycling may not be the best workout for everyone (for example, anyone with pre-existing low back pain and associated core weakness might find themselves making things worse, Dr. Mattern says), by and large, they're still all for it — and doing it themselves. "Cycling has been a Godsend for so many during the pandemic. It's so beneficial for cardiovascular and muscular health and can be used for everything from active recovery to high-intensity interval training," says Rand McClain, D.O., a sports medicine doctor in Santa Monica, California and chief medical officer of LCR Health. "One of the beauties of cycling is the safety and low predilection for injury — especially indoor cycling where the risk (no small one) of a bike vs. motor vehicle accident and/or falls is eliminated," he adds.

In fact, most cycling-related pain comes down to, uh, user error. For example, "Neck and back pain are common and can be related to improper seat height and improper hand bar positioning," Dr. Mattern says. Other patients have complained of wrist and forearm pain, which can be caused by supporting their weight through the arms and gripping the handlebar too tightly, he adds.

 

So, if you've gotten on board the cycling trend during the pandemic without taking the time to read up on proper form or bike set-up, it's possible you could be unknowingly setting yourself up for pain — or just not getting as good of a workout as you could be. Here, some of the most common mistakes beginners make that can lead to injury, according to Lewis and Toole.

Your bike seat is too low.

"Knee pain is common in biking, often from the seat being too low or too high," says Dr. Mattern. Toole adds that she most commonly sees the bike seat too low. "If it looks like you're riding your little niece's bike that recently had its training wheels removed, it's time to raise up that seat," she says.

"You want your seat to be just at the height of your hip," says Lewis. "I like to measure the saddle against my waistband, right where my pants stop." The goal: "You're not on your tiptoes or 'reaching' for the pedal, and you also aren't flat-footed or pedaling down from a flexed ankle," Toole says. This will not only help prevent knee pain but will help your power and output skyrocket, she adds.

You aren't using enough resistance.

Despite what you may think looking at the front row of most cycling classes, speed isn't everything when it comes to indoor cycling. While too much resistance can over-stress your muscles, tendons, and joints, too little resistance can cause you to spin out of control, putting you at risk of falling off your bike. "Resistance is like the floor you stand on, it's foundational," says Lewis. "No resistance equates to bad form."

Your bike's seat is too far forward towards the handlebars.

If your bike's seat is too far forward, you're at risk for not only bruising your knees against the emergency break, but you can also do even more damage internally. "To give a simple comparison, the general rule when squatting is to ensure the knees don't track past the toes — and it's the same concept here," Toole says. "Just before you push through the pedal at the highest most point in your pedal stroke, your knee and toe-box should be in a vertical line. I often find that when riders complain about knee pain, this is most often what needs to be adjusted." She recommends keeping enough distance between the bike seat and the handlebars so that you can keep a soft bend in the elbows, while also keeping length in the spine.

Your handlebars are too low.

Toole says that a torso that's 'crowding' the handlebars is one of the most common bike setup mistakes she sees. "This results in an arched back, aka hello pesky lower back pain," she says. "This can often be corrected by moving the bike seat itself or by raising up the handlebars to take the pressure away from compressing the lumbar spine."

Take all of this expert advice to heart next time you jump in the saddle, and you may be riding your way out of two pandemics by summer.

 

 

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