BP MS 150 lunch and learn: Stretching and injury prevention. Dr. Bart Kennedy (Sports Chiropractor) and Josh Thompson February 04, 2015

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1 BP MS 150 lunch and learn: Stretching and injury prevention Dr. Bart Kennedy (Sports Chiropractor) and Josh Thompson February 04, 2015

2 Epidemiology Overuse injuries most common, traumatic event second Improper training (skill) Improper bike fit Cycling is a repetitive activity 1 hour = 5400 pedal revolutions Can result in micro trauma or overuse injuries Knee is common location or overuse injury 2

3 Where injuries occur Neck 48.8% Knee 41.7% Groin/buttock 36.1% Hands 31.1% Back 30.3% 3

4 Injury predictors Low weekly mileage 26 miles per week Duration in low gears (skill) Years of cycling experience Average speed 14 mph 4

5 Ideal cycling position for road bike Lower back (lumbar spine) as flat as possible Allows for efficient hip movement Centers weight between the front and back tires Keeps hips, knees and ankles in alignment Keep your upper body compact and fairly relaxed Knuckles, wrists and arms fairly in line Any break in the above position will sacrifice performance and efficiency and can lead to injury. 5

6 Pedal stroke tips Get bike fitted A professionally fitted bicycle is the first step in maximizing power, speed, performance, efficiency, comfort, sustainability, recovery and enjoyment of your bike. Use an expert Saddle position Level Saddle height and fore-aft adjustment Knee over the ball of your foot with the pedal at 3 o'clock Knee slightly bent with the pedal at 6 o'clock Spinning class for practice and tips 6

7 Pedal stroke There may not be one correct way to pedal for everyone Focus on the movement Establish a smooth and comfortable pedal stroke to improve your speed and optimize muscle coordination. You don't want knee wobble Hip, knee and ankle aligned 7

8 Circular motion Zone 1: Power Phase 12 o clock to 5 Greatest muscle activity Drop heel 10 degrees past parallel to use more hamstring Zone 2: Bottom of stroke Point toe down 20 degrees Fire calf muscles Transitions to backstroke Like scraping mud off your shoe 8

9 Circular motion Zone 3 Try to lose as little power as possible Get foot out of the way Use glute and hamstring strengthening exercises (squats and lunges) Zone 4 Second half of upstroke Think about initiating downstroke As you come across the top, push knee forward Pelvis remains stable Ultimately think about the movement and not the muscles being used. Focus on maintaining ideal position on the bike. 9

10 Ankling Ankling a pedaling technique that recruits different muscles to either produce more power or to give your primary pedaling muscles brief rest Many factors affect which muscles are involved at any given time. 10

11 Dr. Bart Kennedy DC, CCSP Sports Chiropractor 11

12 Common Overuse Injuries Neck 48.8% Knee 41.7% (26 to 65%) Groin/buttock 36.1% Hands 31.1% Back 30.3% 12

13 Knee Pain The knee is vulnerable in cycling. Anterior (Front side) Patellofemoral pain Patellar tendonitis Lateral (Outside) Iliotibial band syndrome Posterior (Back side) Hamstring 13

14 Patellofemoral pain AKA retropatellar knee pain Excessive compressive load between knee cap and femur Causes: 1. Muscular imbalances 2. Alignment problems 3. Trigger Points 4. Improper pedaling 5. Seat too far forward or Low 6. Gears too high 7. Excessive hill riding 8. Improper training 14

15 Knee pain 15

16 Patellofemoral pain 16

17 Treatment PFP Improve Flexibility (PNF Stretching) (Do 1 st ) Quad Hip flexor Hamstring Fix the Alignment Issue (Sports Chiropractor) Strengthen the Muscle (Rehab Therapy) Weight bearing co-contraction Glutes, hamstrings, quadriceps Proper pedaling mechanics 17

18 Patellofemoral Pain Exercises Single leg squatting Hip strengthening

19 Patellar Tendonitis Adverse line of pull on tendon Causes Muscular imbalances Muscular Trigger Points Knee Alignment Problem LE alignment (twisting leg) Seat too low Seat too far forward Improper training 19

20 Treatment Patellar Tendonitis Stretch Quads Articularus Genu Foot mechanics Orthotic for shoe or cleat

21 IT-Band Syndrome

22 Iliotibial Band Syndrome Excessive friction of distal IT band over knee (medial femoral condyle) Friction can be caused for many reasons Causes Muscular imbalances LE (leg) length Leg alignment Foot placement on pedal Seat too far back Seat too high Training error

23 Treatment Iliotibial Band Syndrome Fix it! IT band mobility (1 st ) Foam roller massage Stretch glutes and TFL Strength Gluteals Core Orthotics for leg length and alignment Pedaling mechanics knee position

24 Treatment Iliotibial Band Syndrome X

25 Hamstring strain Excessive load on tendon in lengthened or stretched position Grade 1 Grade 2 Grade 3 Grade 4 Causes Muscular imbalances Pelvic Alignment Trigger Points Leg length discrepancy Previous hamstring injury Seat too high Seat to far back

26 Treatment Hamstring Strain Fix it! Pelvic Alignment, Knee Alignment Ultra Sound, Interferential Therapy, Cold Laser Therapy Strengthen Eccentric hamstring strength Work hamstring in lengthened position Improve glute strength and pedal mechanics Core Flexibility (Soft, Easy Stretching) Hip flexors or pelvic position Correct leg length, usually short side

27 Treatment Hamstring Exercises

28 Hip Pain Soft Tissue Impingement Excessive compressive load to soft tissue in front of hip Causes Decreased glut and hamstring strength Poor hip or back mobility Aggressive tri position Poor riding technique

29 Treatment Hip Pain Stretching Psoas TFL Hip joint and back mobilizations (Adjusting) Gluteal strengthening Pedaling mechanics

30 Lower back pain Causes Tight Musculature Misalignments Disc, Facet Syndrome Poor core strength Leg length discrepancy Seat too high Handle bar too low Seat too far back Unilateral riding

31 Treatment - Low Back Pain Fix it! Ice (20 min.) Flexibility Hamstrings, hip flexors Adjust the Lumbar and Pelvis Segments Core strengthening Glutes, abdominals, back extensors

32 Core strengthening Plank positions Physioball exercises

33 Neck pain Causes Excessive neck extension Poor thoracic spine mobility Seat too far back Handle bars too low

34 Treatment - neck pain Thoracic spine mobility Strength Shoulder blades Neck chin Neck Stretches (PNF) Fix the Misalignments

35 Prevention Good bike fit Appropriate training progression Multi-planar strength Mobility Great overall body alignment

36 Other Important Factors Bike safety classes here Proper hydration Proper diet Sleep and rest

37 Local Resources BP Fitness Centers Dr. Bart Kennedy (Sports Chiropractor) Westlake Health and Wellness Center Brad Webb Bike Barn Bicycle World and Fitness Online

38 Questions -Stretches Office #

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