{"id":75,"date":"2020-04-24T13:15:58","date_gmt":"2020-04-24T20:15:58","guid":{"rendered":"http:\/\/bestrides.org\/manual\/?page_id=75"},"modified":"2021-03-01T08:25:44","modified_gmt":"2021-03-01T16:25:44","slug":"your-boy-part-2-physical-therapy-injury-and-illness","status":"publish","type":"page","link":"http:\/\/bestrides.org\/bikeschool\/?page_id=75","title":{"rendered":"Physical Therapy, Injury, and Illness"},"content":{"rendered":"\n
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Put me back on my bike. (<\/em>Pro cyclist Tom Simpson, after collapsing
while climbing Mont Ventoux, and just before dying)<\/p>

It doesn’t get easier\u2014you just go faster. (Greg Lemond)<\/p><\/blockquote>\n\n\n\n

Staying Healthy<\/strong><\/p>\n\n\n\n

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\u2026the list is endless. I\u2019ll give you an introduction to, and an idea of how much pay-off in your riding you can expect from, the most common ones.<\/p>\n\n\n\n

Stretching<\/strong><\/p>\n\n\n\n

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\u2019s a consensus middle-ground position, it\u2019s this: 1) Stretching before exercise is bad, because all you\u2019re doing is tiring out and mildly injuring your muscles. 2) Stretching after the ride probably doesn\u2019t hurt, so do it if it feels good and you do it gently\u2014you aren\u2019t attempting to expand your range of motion here, you\u2019re 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\u2019t stretch to go faster.<\/p>\n\n\n\n

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.<\/p>\n\n\n\n

All stretches are about mindfulness<\/em>. It\u2019s 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\u2019s 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\u2019s a lot easier to just pay attention\u2014if the stretch isn\u2019t exactly where you want it, tinker with your position until it is. Which means, skip the headphones.<\/p>\n\n\n\n

Never push a stretch to the point of pain. This is not a machismo test.<\/p>\n\n\n\n

Basic Stretches<\/strong>: Every issue of every bike magazine has an article called \u201cThe Best Stretches for Cyclists,\u201d and every month they\u2019re different. This can drive you nuts. To keep it simple, here\u2019s a generic stretching regimen. Hold each stretch for 20-60 seconds:<\/p>\n\n\n\n

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.<\/p>\n\n\n\n

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.<\/p>\n\n\n\n

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.<\/p>\n\n\n\n

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\u2019d give this one at least two minutes. If you\u2019re going to do one and only one stretch, do this one, because tight hamstrings contribute to back problems.<\/p>\n\n\n\n

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.<\/p>\n\n\n\n

Stretching on the Bike<\/strong>: The only time that stretching is a sure win is during the ride\u2014you\u2019re 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\u2014about 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:<\/p>\n\n\n\n

For calves: 1) stand, put one foot at 6 o\u2019clock and lower the heel as far as possible; or 2) stand with feet at 3 and 9 o\u2019clock and lower both heels. Move the stretch around and experiment until you feel the stretch in the rear hamstring.<\/p>\n\n\n\n

For hamstrings: same as calves<\/p>\n\n\n\n

For lower back: stand and bend your back concavely\u2014try to push your genitals into the center of the handlebar.<\/p>\n\n\n\n

For quads: there is no good quad stretch on a bike, but luckily quads are the easiest muscles to massage (see below). I\u2019ve 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.<\/p>\n\n\n\n

Yoga<\/strong> is just group stretching under expert supervision. It\u2019s wonderful as a lifestyle thing\u2014it\u2019ll keep you flexible and vigorous\u2014but it\u2019s time-consuming. And the direct payoff for cycling isn\u2019t much, since only in a few cases does cycling demand flexibility. My wife keeps begging me to go to her yoga classes, and I\u2019d love to be as lithe as she is, but I just don\u2019t have the time.<\/p>\n\n\n\n

Massage<\/strong><\/p>\n\n\n\n

Massage\u2014the full-on, lie-on-the-table hour-long session\u2014won\u2019t 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.<\/p>\n\n\n\n

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\u2019s easy, it\u2019s fun, it feels good, and the benefits are instantaneous. There is no subtle art to self-massage\u2014just 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).<\/p>\n\n\n\n

Off-the-bike massage should hurt, a little. Every therapeutic masseur I\u2019ve 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\u2019t hurt, ignore it and move on to the painful area, and work it as hard as you can bear.<\/p>\n\n\n\n

Since it\u2019s 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.<\/p>\n\n\n\n

Heating Pads and Balms<\/strong><\/p>\n\n\n\n

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.<\/p>\n\n\n\n

A supposed substitute for heat is a pain-relieving balm. It\u2019s typically a cream, but it can be a spray, gel, or liquid. Ben-Gay is the best known, but there are dozens\u2014Tiger 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\u2019re getting the therapeutic benefit of heat, but you aren\u2019t. One exception is Bio-Freeze, which actually may do some good.<\/p>\n\n\n\n

Acupressure, Acupuncture, and Chiropractic<\/strong><\/p>\n\n\n\n

Acupressure is Eastern, intense, pressure-point massage. Acupuncture is tiny needles stuck in you to cure specific ills. Chiropractic is getting your joints \u201ccracked\u201d 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\u2014if it works, go back. By the way, if you’ve never done acupuncture you’ll be wondering how much it hurts\u2014the answer is, depends on the acupuncturist. I’ve experienced the range from painless to unbearable.<\/p>\n\n\n\n

Sports Clubs and Gyms<\/strong><\/p>\n\n\n\n

Pro cyclists used to never go to the gym, on the theory that gym work builds muscle mass, and muscle mass, unless it\u2019s in your legs, is useless weight on a bike. Now all pro cyclists do weight training, and so should you, for two reasons:<\/p>\n\n\n\n

1) There are parts of your body that contribute to cycling but that for some reason cycling itself doesn\u2019t develop\u2014your core, your lower back, and your triceps, for instance. Targeting them with weight machines or free weights will pay dividends.<\/p>\n\n\n\n

2) You can\u2019t spend your life on your bike. The sad irony is, cycling is bad for your health<\/em>. It develops only your CV system and leg muscles, and only one highly specific set of leg muscles that aren\u2019t good for anything else (tried walking up stairs recently?). If all your exercise is cycling, you\u2019ve got a strong heart and little else.<\/p>\n\n\n\n

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\u2019s a 5-second training program: do push-ups, pull-ups, triceps exercises, planks, and brisk walks, especially uphill. Again, don\u2019t assume that cycling is all your legs need\u2014cycling and hiking use legs in opposite ways.<\/p>\n\n\n\n

You don’t need a gym membership. All of these body parts are easy to work without entering a gym and without exercise equipment. Google will give you details. Because they’re often overlooked, I’ll walk you through an at-home exercise for triceps:<\/p>\n\n\n\n

Lie on your back.
Keep your upper arms at your sides and bend your elbows 180 degrees so your hands are by your shoulders.
Hold large soup cans, dumbbells, or anything else that gives you moderate resistance, in your hands.
Keeping your upper arms relatively still, swing the weights in an arc toward your knees until your hands are pointing straight up.<\/p>\n\n\n\n

If you like your exercise social, sports clubs offer a long list of classes\u2014Pilates, jazzercise, cardio, African dance, step classes, kickboxing\u2014that are all, like yoga, great for your general conditioning and cardiovascular health but will translate into very little in the way of cycling performance.<\/p>\n\n\n\n

Warming Up and Cooling Down<\/strong><\/p>\n\n\n\n

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, \u201cThe best way to warm up is to warm up\u201d\u2014in other words, the best way to warm up for riding a bike is to ride a bike at a low level of intensity. <\/p>\n\n\n\n

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\u2019re warm, or you can judge it by your heart rate: when you\u2019re warm, you\u2019re heart will \u201copen up\u201d (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\u2019m not fully warm until I\u2019ve ridden for 45 minutes, so if I\u2019m 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.<\/p>\n\n\n\n

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\u2019ve 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.<\/p>\n\n\n\n

Climbing is different than riding on the flats, so if you\u2019re doing a hill climb or other climbing event you\u2019ll want to warm up your climbing muscles through similar exercises on an incline. If it\u2019s 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\u2019ve already done.<\/p>\n\n\n\n

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\u2014the latest research says jumping off the bike hot won\u2019t do you any harm.<\/p>\n\n\n\n

Pain, Injury, and Sickness<\/strong><\/p>\n\n\n\n

Don\u2019t ignore pain, injury, or sickness. Cycling has a tradition of macho suffering, and riders praise others for their ability to go \u201cdeep into the pain locker\u201d without complaint, but what they\u2019re calling \u201cpain\u201d is really just tiredness and soreness. We\u2019re talking about something else. Cycling shouldn\u2019t make you go \u201couch\u201d\u2014if it does, fix the problem.<\/p>\n\n\n\n

Granted, some pain can be \u201cridden out.\u201d Knee pain, for instance, can flair up on a ride and go away with continued low-stress riding. But if it doesn\u2019t, change something until it does.<\/p>\n\n\n\n

Common Pain Sources<\/strong><\/p>\n\n\n\n

Saddle sores<\/strong>: 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:<\/p>\n\n\n\n