Cyclists Can Reduce Risk of Hip Pain and Injury with Preseason Preparation

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Cyclists Can Reduce Risk of Hip Pain and Injury with Preseason Preparation
Leading sports orthopaedist discusses how to prevent ITBS, a common repetitive stress injury

NY, NY and Greenwich, CT, April 2007 â€“ Bicycling is one of America’s favorite fair-weather pastimes, and as spring approaches, more than 40 million Americans will prepare for another season of cycling for pleasure and for transportation. Their anticipation for the enjoyment of riding, however, is often tempered by fear and worry over common hip pain and injuries that plague avid cyclists.

“Cyclists who experience severe hip pain are usually suffering from a repetitive stress injury (RSI) affecting the Iliotibial Band, segment of fibrous tissue like a rubber band that stretches from the pelvic region to the knee,” explains Kevin Plancher, MD, a leading sports orthopaedist in the New York metropolitan area and an official orthopaedic surgeon for the U.S. Ski & Snowboard teams. “Called Iliotibial Band Syndrome, or ITBS, it’s a common RSI in cyclists, as well as in long-distance runners, tennis players and other athletes who put active, long-term stress on their hips,” Dr. Plancher adds.

Iliotibial Band Syndrome develops when the iliotibial tendon rubs against the hip bone during the cyclist’s pedaling motion. “The Iliotibial Band runs over the outside of the hip, down the outside of the thigh to the knee,” Dr. Plancher points out. “But its position is quite flexible, so during the circular motion of a cyclist’s pedaling action, the Iliotibial tendon is rotating rapidly over the bones of the hip pointer and the knee,” he notes. It’s this rapid and repetitive motion that can lead to the inflammation of the Iliotibial tendon and the band of tissue surrounding it, resulting in ITBS.

Prevention is possible
Many active adults believe that, to a certain extent, repetitive stress injuries to their joints, muscles, tendons and ligaments are simply par for the course. However, Dr. Plancher insists that prevention of RSIs is possible with careful planning and preparation for athletic activity. In the case of cycling and ITBS, riders must prepare themselves and their bicycles for the season before taking the first spin.

“Preparing physically for the cycling season should involve strengthening the muscles of the legs and the core,” explains Dr. Plancher. In particular, the quadriceps muscles – which play a major role in powering the cyclist’s pedaling motion – should be strengthened, as these muscles can help cyclists retain proper pedaling form, avoid placing your feet in clips with toes pointing inward as this may exacerbate symptoms of ITB, and avoid poor positioning, which can lead to RSIs. In addition, core training provides strength throughout the spine, abdomen and even the neck and shoulders, all of which also contribute to proper posture and positioning on the bicycle. “The stronger the core of the body and the legs are, the less likely cyclists are to lapse into the kinds of physical positioning that can lead to repetitive stress injuries like ITBS,” Dr. Plancher advises.

As for cyclists’ equipment, the bike cleats – specialized shoes that clip or mount to the pedals in order to enhance speed and reduce disconnects between the cyclist’s feet and the pedals – and seat positioning are the two criteria most linked to development of ITBS. Dr. Plancher advises, “Riders should conduct an annual pre-season evaluation, preferably with a cycling professional, to ensure that their saddle positioning is still appropriate for their height and posture.” He explains that both the height and the angle of the seat should be checked; the proper height prevents bikers from overextending the legs or compressing them during the pedaling motion, while the right angle prevents the rider from sliding too far forward or back on the bicycle – both of which can be precursors to an RSI. Cleat mounts should also be checked to ensure that their positioning does not force the legs to rotate too far inward or outward. “An unnatural rotation of the leg can manifest itself rather quickly in ITBS,” Dr. Plancher warns.

Treatment is key to getting back in the saddle
For cyclists suffering from ITBS, a range of treatment options makes getting back in the saddle easier. Dr. Plancher recommends the following steps to reducing or eliminating the symptoms of ITBS:

  1. R-I-C-E – In the case of ITBS, relative rest (along with icing, compressing and elevating the hip when practical) is the key phrase. “Mixing rest with measured movement, preferably in a physical therapy setting, can have a positive effect on the outcome of ITBS,” says Dr. Plancher.
  2. Pain relief can be achieved with NSAIDs, over-the-counter and prescription pain relievers. “Many ITBS patients have found even better pain management through the injection of corticosteroids to the affected area,” Dr. Plancher notes. Again, consulting with a board-certified sports orthopaedist or surgeon can afford patients a wide range of treatment options.
  3. Imaging is everything – Patients who believe they have developed Iliotibial Band Syndrome should see a sports medicine physician or orthopaedist, have a complete history and physical examination and an MRI scan of the affected hip. “MRI is the most reliable way to confirm the diagnosis, as well as to rule out any other possible pathologies in the hip region which could be causing the pain and inflammation when regular xrays and conservative treatment has failed,” Dr. Plancher explains.
  4. Arthroscopy can be performed to release the Iliotibial tendon or relieve the pressure of the Iliotibial Band in patients for whom physical therapy and pain management are ineffective over time. “The arthroscopic treatment component is a relatively new development in the management of ITBS,” Dr. Plancher concludes. “However, it has been met with encouraging success in patients for whom all other options had been exhausted. 
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