Physical Therapy, Injury, and Illness

Put me back on my bike. (Pro cyclist Tom Simpson, after collapsing
while climbing Mont Ventoux, and just before dying)

It doesn’t get easier—you just go faster. (Greg Lemond)

Staying Healthy

There is a long list of practices you can do before, during, and after riding that say they will help you be healthy and help you recover faster: stretching, yoga, Pilates, massage, acupuncture, acupressure, chiropractic, weight training, core strengthening, Zumba…the list is endless. I’ll give you an introduction to, and an idea of how much pay-off in your riding you can expect from, the most common ones.

Stretching

No one can figure out if stretching is good or bad for you. Yoga enthusiasts swear by stretching, the more the better. But there is a new school of thought that says that stretching is positively bad for cyclists. If there’s a consensus middle-ground position, it’s this: 1) Stretching before exercise is bad, because all you’re doing is tiring out and mildly injuring your muscles. 2) Stretching after the ride probably doesn’t hurt, so do it if it feels good and you do it gently—you aren’t attempting to expand your range of motion here, you’re just relaxing your tired muscles. 3) Serious stretching, to expand range of motion, should only be done hours away from riding, preferably on your recovery day, because you are putting a big load on your muscles and they need to repair afterwards. 4) Stretching may help with lower back pain and will certainly make you more flexible, but there is no measurable performance gain, so don’t stretch to go faster.

No one agrees on how long a stretch should be held either. Yoga moves through poses smoothly, holding each stretch for a breath or two. A Chinese acupressurist told me to hold all stretches for 30 seconds. A physical therapist said to aim for 2 minutes minimum, and the longer the better.

All stretches are about mindfulness. It’s easy to render any stretch useless by thoughtlessly assuming the position and not noticing exactly where the stretch is occurring and how your muscles are responding. Our musculature is so complex that it’s easy to do something that looks just like the stretch and get no therapeutic effect at all. You could hire a yoga master to coach you, but it’s a lot easier to just pay attention—if the stretch isn’t exactly where you want it, tinker with your position until it is. Which means, skip the headphones.

Never push a stretch to the point of pain. This is not a machismo test.

Basic Stretches: Every issue of every bike magazine has an article called “The Best Stretches for Cyclists,” and every month they’re different. This can drive you nuts. To keep it simple, here’s a generic stretching regimen. Hold each stretch for 20-60 seconds:

For calves: stand near a wall and press the ball of one foot against it, then lean into the stretch, so your ankle is flexed and you feel the pull in your calf.

For quads: 1) stand on one leg and pull the other foot up behind you until you feel the stretch in the quad. Keep your back straight and your knee in line with your butt cheek; or 2) kneel with knees close together and lean back until you feel the stretch in your quads.

For shoulders: standing straight, reach one arm across your body under your chin, grab it at the elbow with your other hand, and pull it back as if to pull it over your shoulder.

For hamstrings: stand in front of a knee-high surface like a coffee table. Place one straight leg across the surface of the table with your toes pointing straight up and lean forward until you feel the stretch. Hammies seem to take a long time to release, so I’d give this one at least two minutes. If you’re going to do one and only one stretch, do this one, because tight hamstrings contribute to back problems.

For hip flexors: kneel on one knee with the other foot on the floor in front of you, so both legs are making an L. Keep your back straight and your butt tucked in. Lean forward at the hips until you feel the stretch in your rear quad. Tight hip flexors contribute to hip and pelvic problems.

Stretching on the Bike: The only time that stretching is a sure win is during the ride—you’re riding along, your muscle starts to feel tight, and you stretch it out while you keep rolling. This kind of stretching should be kept low-key—about the same intensity with which you stretch your arms and back when you get out of a chair after a bout of reading. Feel free to experiment and invent stretches that reach various muscle groups while riding, but these usually work:

For calves: 1) stand, put one foot at 6 o’clock and lower the heel as far as possible; or 2) stand with feet at 3 and 9 o’clock and lower both heels. Move the stretch around and experiment until you feel the stretch in the rear hamstring.

For hamstrings: same as calves

For lower back: stand and bend your back concavely—try to push your genitals into the center of the handlebar.

For quads: there is no good quad stretch on a bike, but luckily quads are the easiest muscles to massage (see below). I’ve seen super-flexy riders with great balance stand on one leg, put the top of the other foot across the saddle behind them, and stretch the quad that way, but for most of us this is impossible and inviting a crash.

Yoga is just group stretching under expert supervision. It’s wonderful as a lifestyle thing—it’ll keep you flexible and vigorous—but it’s time-consuming. And the direct payoff for cycling isn’t much, since only in a few cases does cycling demand flexibility. My wife keeps begging me to go to her yoga classes, and I’d love to be as lithe as she is, but I just don’t have the time.

Massage

Massage—the full-on, lie-on-the-table hour-long session—won’t harm you, and some pro cycling teams think so highly of it they provide it for their riders after every stage. Whether there is lasting therapeutic benefit is arguable. Do it if it makes you feel better. Some people get a massage and feel better for a week; I get a massage and feel better for thirty minutes.

As with stretching, the one time massage pays off mightily is during the ride. Whenever a leg muscle starts to get tight, reach a hand to it and rub the soreness out as you roll along. It’s easy, it’s fun, it feels good, and the benefits are instantaneous. There is no subtle art to self-massage—just take your knuckles or the base of your palm and rub hard along the muscle (for your quads or IT bands) or grab the muscle with your fingers and thumb and knead/pull away from the bone (for hamstrings and calves).

Off-the-bike massage should hurt, a little. Every therapeutic masseur I’ve ever been to has applied pressure to the limit of my pain threshold. The more an area hurts when you work it, the more that tells you the area needs work. If the area doesn’t hurt, ignore it and move on to the painful area, and work it as hard as you can bear.

Since it’s hard to apply the necessary force with bare hands, there are devices that amplify your leverage: sticks, foam rollers, and electric muscle stimulators. Massage sticks (like The Stick, its actual brand name) work well, though the profit margin on them is hard to swallow. Foam rollers are primarily used between you and the floor with you lying down, and are especially good for working IT bands, which are hard to stretch or reach with a stick. Electric stimulators are expensive ($400 and up) and work via wired pads stuck to your body through which electric pulses are sent. I used one for a couple of seasons, and as far as I can tell they’re worthless.

Heating Pads and Balms

All sore-muscle therapies work better with the addition of heat (as opposed to joint pain or inflammation, which responds to cold). The best heating pads are the ones filled with granules that you heat in the microwave, but electric pads are OK. Heat the area for 15 minutes, as often as you like. Moist heat is better than dry heat, but it’s messy.

A supposed substitute for heat is a pain-relieving balm. It’s typically a cream, but it can be a spray, gel, or liquid. Ben-Gay is the best known, but there are dozens—Tiger Balm, Heet, Capsaisin, Aspercreme, and so on. Most of them are benign frauds. They work by creating the illusion of heat on your skin, so you think you’re getting the therapeutic benefit of heat, but you aren’t. One exception is Bio-Freeze, which actually may do some good.

Acupressure, Acupuncture, and Chiropractic

Acupressure is Eastern, intense, pressure-point massage. Acupuncture is tiny needles stuck in you to cure specific ills. Chiropractic is getting your joints “cracked” and your skeleton realigned. All are administered by doctors or therapists at office sessions. How well they work seems to be a personal thing, so you just have to try each one—if it works, go back. By the way, if you’ve never done acupuncture you’ll be wondering how much it hurts—the answer is, depends on the acupuncturist. I’ve experienced the range from painless to unbearable.

Sports Clubs and Gyms

Pro cyclists used to never go to the gym, on the theory that gym work builds muscle mass, and muscle mass, unless it’s in your legs, is useless weight on a bike. Now all pro cyclists do weight training, and so should you, for two reasons:

1) There are parts of your body that contribute to cycling but that for some reason cycling itself doesn’t develop—your core, your lower back, and your triceps, for instance. Targeting them with weight machines or free weights will pay dividends.

2) You can’t spend your life on your bike. The sad irony is, cycling is bad for your health. It develops only your CV system and leg muscles, and only one highly specific set of leg muscles that aren’t good for anything else (tried walking up stairs recently?). If all your exercise is cycling, you’ve got a strong heart and little else.

What exercises to do is a huge question and there is an army of coaches, personal trainers, and YouTube videos waiting to answer it for you, but here’s a 5-second training program: do push-ups, pull-ups, triceps exercises, planks, and brisk walks, especially uphill. Again, don’t assume that cycling is all your legs need—cycling and hiking use legs in opposite ways.

Sports clubs offer a long list of classes—Pilates, jazzercise, cardio, African dance, step classes, kickboxing—that are all, like yoga, great for your general conditioning and cardiovascular health but will translate into very little in the way of cycling performance.

Warming Up and Cooling Down

We used to believe that extensive warming up and cooling down before and after exercise was essential. Now, not so much. Warming up is good, but keep it simple. As a friend of mine once said, “The best way to warm up is to warm up”—in other words, the best way to warm up for riding a bike is to ride a bike at a low level of intensity.

How long you should warm up is up to your body. Mine likes to ride for 20 minutes before exertion. You can just time yourself and assume you’re warm, or you can judge it by your heart rate: when you’re warm, you’re heart will “open up” (feel less sluggish) and it will be easy to get it up to elevated rates. But there is more than one kind of warm, and I’m not fully warm until I’ve ridden for 45 minutes, so if I’m doing some sort of event where my performance is going to be measured (like a time trial) I need to warm up for 45 minutes.

You can just ride lightly, but if you want to do a more formal, thorough warm-up, run your legs and cardio-vascular system through a variety of paces: ride for 10 minutes with light effort, then raise your heart rate slightly for 30 seconds, then let it fall, then raise it more for 30 seconds, then let it fall, and continue like this until you’ve reached whatever heart rate you intend to ride at. At the same time, work your legs similarly: ride for ten minutes with minimal effort, then ride pushing a slightly hard gear for 30 seconds, recover, push a slightly harder gear, recover, and push a big gear and recover. This entire process takes no more than 20 minutes.

Climbing is different than riding on the flats, so if you’re doing a hill climb or other climbing event you’ll want to warm up your climbing muscles through similar exercises on an incline. If it’s a rec ride, remember that when you hit the first hill your climbing muscles will be cold and need to take the first 10-20 minutes easy, no matter how much flat riding you’ve already done.

Cooling down is less complicated. Just go spin for a few minutes, or until your heart rate is low (110 bpm or lower). Or do nothing—the latest research says jumping off the bike hot won’t do you any harm.

Pain, Injury, and Sickness

Don’t ignore pain, injury, or sickness. Cycling has a tradition of macho suffering, and riders praise others for their ability to go “deep into the pain locker” without complaint, but what they’re calling “pain” is really just tiredness and soreness. We’re talking about something else. Cycling shouldn’t make you go “ouch”—if it does, fix the problem.

Granted, some pain can be “ridden out.” Knee pain, for instance, can flair up on a ride and go away with continued low-stress riding. But if it doesn’t, change something until it does.

Common Pain Sources

Saddle sores: This is the catch-all term for any abrasion, inflammation, pustule, pimple, or other spot of pain in your crotch brought on by friction between your skin and your bibs. There are lots of things you can do to help:

  • 1. Apply chamois cream to your crotch before every ride.
  • 2. Remove your shorts as soon as possible after every ride.
  • 3. Wear a clean pair of shorts for every ride.
  • 4. Swab your crotch with a Handi-Wipe or other disinfecting product before and immediately after every ride.
  • 5. Shower as soon as possible after every ride.
  • 6. Put Neosporin or other antiseptic cream on the problem area.
  • 7. Put a sports bandaid over the problem area, ideally before the problem occurs.
  • 8. Buy better shorts.
  • 9. Get a different saddle.

Knee pain: This is the hardest pain in cycling to fix, and many riders chase solutions to their knee problems for years. These may help:

  • 1. Make sure your saddle height and saddle fore-and-aft position are perfect.
  • 2. If your knee hurts in the front, move your seat back; if your knee hurts in back, move the seat forward.
  • 3. Warm up thoroughly before exertion.
  • 4. Dress to keep your knees warm in cold weather.
  • 5. Keep your knees in the pedaling plane.
  • 6. Spin a lower gear.
  • 7. Apply ice after a ride.
  • 8. Get quality insoles, orthotics, or cleat wedges (all discussed in the shoe section of the Clothing chapter).
  • 9. See a podiatrist who works with cyclists.
  • 10. See a sports doctor.
  • 11. Get a pro bike fit.
  • 12. Switch pedals—Speedplay X’s work well for some, Speedplay O’s work well for others.

Sore or numb hands: Everybody’s hands get sore on long rides, especially on long descents. Usually all you need to do is stretch. You can do this without stopping or releasing the handlebar, just by making jazz hands (stretch the fingers as far apart as possible) while flexing the wrist. Some people like to shake their hands vigorously, which always makes the rider behind you think you’re pointing out obstacles in the road. If that isn’t enough, try these fixes:

  • 1. Add thicker handlebar wrap to your bar, double-wrap your bar, or place strips from old handlebar wrap under the new wrap on the places where your hands typically rest.
  • 2. Replace your gloves or add padding to old gloves (see the glove discussion in the Clothing chapter). The only padding that matters is what’s over the ulnar nerve, along the base of your palm, especially at the corner on the opposite side from your thumb.
  • 3. Change your riding position so you sit more upright.
  • 4. Tilt your seat back slightly (slightly!) to take weight off your hands.
  • 5. Learn to ride with less weight on your hands (this may require you to strengthen your core).

Sore neck:

  • 1. Sit more upright.
  • 2. Keep your hands on the top of the bar.
  • 3. Keep your head down more.
  • 4. Use Biofreeze.

Sore lower back:

  • 1. Sit more upright.
  • 2. Keep your back straight.
  • 3. In other words, don’t arch your back.
  • 4. In other words, don’t let your belly sag.
  • 5. Spin a lower gear.
  • 6. Stretch regularly on and off the bike.
  • 7. Use Biofreeze.
  • 8. Strengthen your core through planks, push-ups, and pull-ups.

Sore feet, Numb Feet, or Hot Foot (Tingling, Burning):

  • 1. Make sure your shoes fit.
  • 2. Get better insoles.
  • 3. Go to a podiatrist who specializes in cyclists.
  • 4. Get orthotics or cleat wedges.
  • 5. Have a professional check your cleat placement.

Cramps and side aches: No one really knows what causes cramps or side aches, but these things might help:

  • 1. Warm up thoroughly on the bike before exertion.
  • 2. Increase your water intake.
  • 3. Back off the exertion level.
  • 4. Take electrolytes.
  • 5. Take more electrolytes.
  • 6. Don’t push salt.

Riding Injured

See a doctor if you know it’s serious or you don’t know what’s going on. In all other cases, you’re limited to common-sense medicine:

1. Rest the injury.

2. Take pain-controlling medicine so you can rest. Aspirin is best, unless you want the med to work through the night, in which case use Aleve.

3. Anti-inflammatories, like Ibuprofen, are the subject of much debate. Despite “Vitamin I’s” cult status among athletes, studies suggest anti-inflammatories actually delay recovery, on the same principle that says that medically reducing a fever slows recovery—you’re interfering with your body’s wise ways of healing. Still, they “work,” in that they do reduce swelling. I’ll leave the decision to you, saying only that using Ibuprofen as a preventative, popping it before hard rides to “get ahead of” the soreness, as many athletes do, is a terrible idea—long-term use of any NSAID damages your liver or kidneys.

4.Use heat and cold appropriately. Which one you want to use when is such a confusing issue that there are a dozen websites devoted to the question. The last time I worked with a physical therapist on my back, I asked, “Should I use heat or ice?” and he said, “Whichever feels better.”

Here’s what we know: Heat brings blood to sore muscles. Cold reduces swelling. If you have swelling, bringing more blood to the area makes matters worse by causing more swelling. Use heat on sore or stiff, but not injured, muscles (15 minutes, 4 or more times a day for the first two days, then as needed); use cold on sore joints (remember how pitchers ice their elbows after a game?) and any inflammation (same regimen as with heat). Once the swelling goes down (usually about 2-3 days), switch to heat. A rule of thumb: ice can’t hurt, so try ice on anything; heat makes swelling and inflammation worse, so use it only when you’re sure you don’t have either. Don’t assume that because heat feels good that heat is good for the injury.

5.Road rash, the scraped skin that is the result of most falls, needs little attention. It will heal by itself. Just clean it once when it’s new, apply Brave Soldier or some such antibiotic ointment to fight infection, and cover it if you want to. Most people are too aggressive about cleaning wounds—just use soap and water. Hydrogen peroxide, alcohol, or any other sterilizing solution will damage the wounded skin and delay healing.

Riding Sick

Everybody knows what to do when you’re sick: rest, push fluids, drink hot tea with lemon and honey, let your body fight it naturally (it knows best), and don’t take antibiotics unless a doctor says you have an infection. The only real question is, should you ride? The rule of thumb is, if it’s in your head, ride; if it’s in your body, don’t ride. If your symptoms are all above your neck (congestion, drainage, headache, sore throat) you can do moderate, fitness-preserving rides. If you’re aching and sore in your body, riding will do you damage and prolong the illness.

The average cold/flu illness lasts about 14 days, and fitness starts to seriously deteriorate after 7 days of idleness, so if you stay off the bike for all of it you’ll lose conditioning. So I try to ride moderately through the first 2-3 days (the “I think I’m getting sick” stage) and start riding again after being off the bike for 7-9 days—by then I don’t feel like riding, but if I do moderate 1-hr rides I don’t feel worse or relapse and I can keep the loss of fitness to a minimum. If you try this and you don’t feel any sicker afterwards, keep riding; if you do feel sicker afterwards, stop.

Bonking

Bonking—running totally out of gas—is more than just getting really tired. You shake, you tremble, you can hardly stand, you’re dizzy and disoriented. It’s not called “hitting the wall” for nothing.

It’s totally preventable. Just eat good stuff regularly, drink adequately, and supplement with electrolytes and it should never happen. But the day will come when you inexplicably forget to do those things, or don’t do them enough.

Treatment is just common sense: get off the bike, rest, drink, eat (preferably something sugary), take a mega-dose of electrolytes, and wait for it to pass. When it does you will probably feel totally OK.

Long-Term Prevention

Preventing Skin Cancer

Sunblock sounds like the most trivial issue in this chapter, but ironically it’s about the only one that can save your life. Skin cancer is no joke. Apply sunblock to all exposed surfaces before every ride. Sun damage is cumulative throughout your life, there’s no way to “undo” it, and you’re going to be out in the sun for thousands of hours.

There’s a myth among European riders that cyclists shouldn’t use sunblock because it clogs pores and leads to overheating. This is not true, which you can prove to yourself by sunblocking one arm and ear and not the other and going for a ride on a hot day.

Don’t forget to sunblock the top of your head if you have thin hair. Apply in winter too—UV rays don’t care how overcast it is. Sunblock your face, nose, and ears every morning of your life, just like you brush your teeth.

Use a SPF of at least 30. The directions say to reapply every couple of hours, but I think that’s just to sell more sunblock. Make sure it’s waterproof, or it will run into your eyes when you sweat and ruin your day. Wash your hands thoroughly after applying, or you’ll rub it into your eyes during the ride.

Preventing Osteoporosis

Bones need low-impact exercise—shaking, jiggling, bouncing—to stay strong. Idle bones become brittle—or develop osteoporosis, as the doctors say. Cyclists’ bones are usually idle, as idle as if we were sitting at an office desk, even when we’re working hard on the bike.

Realize that our sport makes you susceptible to osteoporosis and take steps to combat it. Walking/hiking won’t help (no impact). Mountain biking will, jogging will, low-impact aerobics classes will. But the easiest way for a cyclist to get low-impact exercise is to ride over moderately rough road surfaces. We’re not looking for big potholes or railroad tracks—nothing that tries to knock the handlebar out of your hands. Rather, we want road buzz, a persistent low-key tooth-rattling, the kind you get from new chipseal or bad pothole patching.

So seek out imperfect road surfaces and make riding them a part of your training. Every other ride or so, ride the roughest line you can find for 2-3 minutes. You won’t reap the health benefit of this until you’re 60 years old, but if you don’t do something about it now, when you’re 60 it will be too late. And there is a benefit you can reap today: a brand-new positive attitude toward broken pavement. Now when you hit a rough stretch of road, instead of saying to yourself, “Jeez, I hate this stuff!”, you’ll say, “Oh good, I’m working on my osteoporosis.”