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Injury Rehab and Prevention for Cyclists

Words by Mike Marino

Injuries suck.

It goes without saying, although most times saying it reinforces that they really do. They usually hurt, sometimes a lot. They can be frustrating. They can be expensive. They take longer to recover from than we think at first, too, and we can make it worse by rushing back.
It’s that last sentence that sets us up on a spiraling cycle that can have us hobbling around or gobbling medication for far longer than we want or need to. Whether we’re a racer, a weekend warrior or an occasional rider who loves time on the bike, being on the sidelines with an injury requires a patience that most of us don’t possess.
We’re like an antsy child in the back seat on a family road trip. Can I ride yet? Can I ride yet?
We asked Ben Turits, the coach of the Duke University cycling team and a Licensed Massage Therapist, about how to address the physical and mental aspects of being injured, and what we can do keep from being injured.
Cyclist visiting doctor

What is it about cycling and injuries? 

We do a sport that’s inherently dangerous and it is difficult. There are going to be fun parts and not so fun parts of that difficulty. When you feel that initial pain, your body is trying to tell you something, so listen to it. Pushing through chronic pain is going to make your rehab longer.

So, pain is bad, then?

It’s OK to experience pain. It’s a matter of whether the level is tolerable or it’s at such a level that we have to take a break.

If something starts to hurt, what’s the biggest danger for a cyclist?

Cyclists are not patient. A lot of times, it’s a symptom of our medical system. One, they’ll go too high up the treatment pyramid. There’s sports therapy, then orthopedics and then surgery. Too often they go directly to a doctor. If you’re giving somebody a hammer they’re going to want to nail something.

They don’t look for the right level of treatment first. When they go to an orthopedic surgeon, a lot of times they get an orthopedic surgery diagnosis. People will get a spinal fusion and what they really needed was hip flexor and core strengthening.
People don’t look for the right level of treatment. Looking at a soft-tissue solution first – and finding a massage therapist or DPT [Doctor of Physical Therapy] that is athlete-focused – is important.

Recovery isn’t linear, is it?

Not at all. You’re going to take steps forward, but a lot of times its two forward and one back. Sometimes it’s a huge step back. This is a big part of concussion protocol. It can be very frustrating for athletes who have had a concussion because they’ll have really good aerobic rides and then they’ll do a workout and experience symptoms again.

What injuries do you see the most?

Hip- and back-related injuries are the most common on the bike followed by knee injuries, but most of them tie back to some hip issue.
With knee pain, your knee is just a hinge. It’s often related to pelvic position and hip position, because of hip flexor weakness or glute weakness, or a soft-tissue imbalance. They often have very simple solutions, initially.

You hear a lot about riders breaking their collarbone, and that’s an automatic six to eight weeks off the bike. What can you do to stay in shape?

For collarbone breaks and most shoulder or upper-body-related injuries, you can get on the trainer. Zwift has been a huge help because people can still feel like they’re riding. Making aerobic fitness a part of your recovery does not set you back negatively. [It should be noted that Australian professional Matthew Hayman won the Paris-Roubaix race 43 days after he fractured the radius bone in his right arm and credited Zwift with helping him stay in shape.]

How to you get a cyclist, of all people to take it easy?

That’s really challenging for me as coach. A cyclist’s self-worth is attached to training and competing. You have to counsel them and treat their comeback from injury just like their training. It is part of their training. You have to treat the recovery as though it was your race specialization phase or whatever.

Is there a mental component, too?

Very much so. You have to be very sensitive to the fact that, psychologically, it’s a big part of what it does to you as a person. Give yourself a break. It’s OK not to ride your bike a little bit. You need to address your rehab like you would learning new skills on the bike. You make take away from that some really helpful exercises that will sustain you off the bike.

It’s going to take time to get back to where you want to be. That’s really hard for a competitive person to do.

Are there things you can do as a distraction? To take your mind off being injured?

When I do an intake and interview with a new athlete one of the first things I ask is, “What do you like to do other than ride your bike?” Reading, watching videos, hunting, fishing. I encourage them to develop a passion for something other than bikes. Because at some point you’re going to be off the bike.

I have a guy who’s really into woodworking. He had plantar fascia issues last year and he built a table while he was down. He spent some time on YouTube learning. Then he came back and had a rip-roaring 'cross season last year.

What else can a cyclist do?

People need to do their exercises. I always send people home with homework. Making sure that they understand why they’re doing the exercises is important because then they buy into the treatment.
And then they should always ask questions. Know the whys of why you’re doing this stuff.
Yoga can help cyclists

What exercises do you recommend?

Foundation training, yoga and stretching. It’s like 10 minutes of work every day to strengthen your posterior chain around your spine. If you do that on regular basis, it supports you so well on bike it even helps with your pedal stroke.

If it comes down to one thing, is being patient the most important thing?

Patience, but I’d also add in diligence. Train hard but rest harder. It’s so important. People do not understand how seriously pro athletes approach rest and recovery. They take their recovery almost more seriously than they take their training. They know if they don’t do that it will multiply the amount of time to get back.