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Health

Take care on the trail

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Running and cycling are two of the most utilized endurance sports in the world. We frequently see musculoskeletal injuries both at the recreational and competitive levels.

The most common injuries we see in running are from the hip downward. The iliotibial band is probably one of the most common soft tissue injuries we see. Runners knee, or patellofemoral pain syndrome, is another common injury in runners. This is typically secondary to some asymmetric strength deficits of the muscles that attach to the knee and/or the patella (kneecap). Achilles tendinosis is also commonly seen in runners and is usually secondary to tight calf musculature. Lastly plantar fasciitis is another common overuse injury in runners, most of the time also related to calf tightness. This pain is typically in the arch of the foot.

Cyclists can also experience some of these injuries, as well as upper body injuries. Many of these are secondary to falls or nerve compression.

One of the most common injuries for cyclists is a clavicle fracture secondary to a fall. Cyclist tend to fall and reach out their arm, which creates ideal forces to fracture the clavicle. We also see nerve impingement in cyclist, which can be either the median or ulnar nerve from the prolonged amount of pressure they put on the extended wrist.

Many cyclists also suffer from thoracic myofascial pain secondary to how tightly they grip the handlebars. This sometimes can become a chronic issue.

Another issue experienced by runners and cyclists alike are weakened or injured joints. Generally speaking, the bones of the joint tend to not be weak, but rather it is the soft tissue structures around the joint that causes the weakness such as tendon, ligament, and/or muscle. There are many different reasons the soft tissues can become weak. Many times a tight and overused muscle can become weak over time. Sometimes there is an asymmetry in muscle strength from one side to the other which promotes weakness in the less used muscle. Alternatively, anything that pinches a nerve in the body can create weakness around the joint. Muscle atrophy from an injury and/or disuse can also cause weakness around the joint.

We frequently are asked how people can protect and strengthen their joints naturally, without having to consider invasive options such as surgery or even injections. Fortunately there are some very reliable ways to approach this that most athletes will be very successful with. First and foremost making sure that you are at or close to an ideal weight is extremely helpful. This takes a lot of pressure off of your joints no matter what activities are doing. Some patients are able to do this on their own, and other patients I will use one of our sports dietitians for more specific help. Core strengthening is also extremely important for protecting our joints during activities. A weak core will put more pressure on all of the joints, and increase your risk of injury. Some patients are able to do this on their own as well, and other patients we will use a personal trainer, athletic trainer, or physical therapist to help individualize a program to the athlete. In addition to core strengthening we would like the muscles around the joints in question to be symmetric and strong and this is something that a physician, therapists, or athletic trainer can evaluate individually. Another recommendation for keeping joints healthy is to participate in cross training. For example, I will tell runners to participate in cycling or swimming so they are not using the same exact muscles over and over again. This tends to keep the joints healthy and help prevent overuse injuries.

While the treatment for common running and cycling injuries will depend on the specific injury at hand, there are certainly general principles that can be discussed and considered.

Most running and cycling injuries that we see are related to some form of asymmetry and/or weakness in the kinetic chain that stabilizes your body's movements. This stability typically comes from the core musculature around the torso and abdomen, as well as the hips. For any of these lower extremity injuries making sure we do a thorough assessment of the stabilizing muscles both of the core, hips, and leg are very important. Typically, we can find where the weaknesses are and specifically address them through targeted exercises and stretches. Along these lines, we are able to provide these athletes with prevention techniques going forward.

Cycling and running tend to cause a lot of injuries because the motions that they go through are only straight ahead and not side to side. Because of this, many times we want to focus on exercises that strengthen the muscles that bring the leg inward or outward instead of forward and backward to more evenly stabilize the body in the extremities. This will also cut down on overuse injuries and symptoms.

Examples of more specific treatment are as follows: Iliotibial band pain and tightness is treated with stretching, foam rolling, and specific exercises including hip strengthening as well. Patellofemoral pain is treated with hip and core strengthening as well as quadriceps strengthening and hamstring stretching. Achilles tendinosis and plantar fasciitis is treated primarily with core and hip strengthening as well as diligent calf stretching. The nerve compression disorders in the upper extremity cyclists can sometimes have are treated by removing the compressive activity and sometimes an injection or even surgery needs to be considered depending on the severity of the injury. Clavicle fractures fortunately usually will heal without surgery over several weeks.