Elite Sports Therapy is an integrated manual therapy approach designed to enhance athletic performance, prevent and eliminate sports injuries.
Author James Waslaski, shown here, is an avid cyclist. Certain injury patterns are common in cyclists.

Elite Sports Therapy is an integrated manual therapy approach designed to enhance athletic performance, prevent and eliminate sports injuries, and align sports massage therapists with allied health professionals.

Those include athletic trainers, chiropractors, osteopaths, strength-and-conditioning coaches, and sports medicine physicians.

This article will address common injury patterns in cyclists. (Figure 1.)

Cycling Injury Patterns

Even when a bike shop performs a retrofit, many cyclists are left-flexion prone. If that same person works at a desk all day — putting them further into a flexed position — the risk of pain or injury is drastically increased.

As tension increases from the strong iliopsoas and quadriceps muscles, anterior hip capsular patterns develop, gluteus maximus becomes inhibited, and the compensatory QL firing on the opposite side contributes to constant low-back pain.

Sacral torsion patterns can also be very common in cyclists. As the cervical vertebrae and discs are drawn forward from T1 upward to C3, the SCM muscles draw the occiput back onto C1, fixating it onto C2. This creates dermatome-related nerve pain, articular ligament referral pain and non-dermatomal disc pain.

Depending on the position of the handlebars, the cyclist is also very prone to median and ulnar nerve entrapments at both the elbow and wrist.

This article will address manual therapy corrections starting with low back, hip and SI joint pain.

Low Back, Hip & SI Joint

The therapist should start by addressing the hip capsular patterns. (See Figures 2, 3 and 4.)

Effective manual therapy corrections start with the low back, hip and SI joint pain. The therapist should start by treating the hip capsular patterns (2), then treat the tight psoas (3), and then lift and separate the rectus femoris of the quadriceps (4) to free up the femoral nerve.
Effective manual therapy corrections start with the low back, hip and SI joint pain. The therapist should start by treating the hip capsular patterns (2)
The therapist should start by treating the hip capsular patterns (2)
The therapist should then treat the tight psoas (3) .
The therapist should then lift and separate the rectus femoris of the quadriceps (4) to free up the femoral nerve.

Next, treat the tight psoas and lift and separate the rectus femoris of the quadriceps to free up the femoral nerve. Then use positional release and posterior traction to treat the forward neck posture from T1 up through C3 that contribute to nerve, ligament and disc pain, and causes compensatory O/A joint fixations. (See Figures 5, 6 and 7.)

The second step in manual therapy correction is using positional release and posterior traction to treat the forward neck posture from T1 up through C3 that contributes to nerve, ligament and disc pain, and causes compensatory O/A joint fixations.
The second step in manual therapy correction is using positional release and posterior traction to treat the forward neck posture from T1 up through C3 that contributes to nerve, ligament and disc pain, and causes compensatory O/A joint fixations.

Then treat the SCMs and compensatory sub-occipital muscles that pull the occiput back onto C1 fixating it onto C2 and limiting cervical rotation, twisting the vertebral artery and compressing the basilar artery. (See Figures 8, 9 and 10.)

The third step in manual therapy correction is treating the sternocleidomastoid muscles and compensatory sub-occipital muscles that pull the occiput back onto C1, fixating it onto C2 and limiting cervical rotation, twisting the vertebral artery and compressing the basilar artery.

Cycling Palsy

Many cyclists develop a condition called cycling palsy due to multiple compression patterns of the ulnar nerve. This ulnar nerve pattern is further compromised from the position of the neck and shoulders. (See Figures 11, 12 and 13.)

Depending on the retro fit of the bicycle and the position of your wrist on the handlebars, many cyclists develop a condition labeled “cycling palsy” due to multiple compression patterns of the ulnar nerve.

That distal nerve pain cannot be effectively treated if we do not restore a normal cervical curve and address thoracic outlet contributions, such as collapsed clavicles, and fixated first rib patterns from tight anterior and posterior scalene muscles.

But we do have to look at athletes’ ulnar nerve, which feeds off cubital tunnel and Guyon’s Canal (ulnar tunnel entrapments). The ulnar nerve can get entrapped at the elbow from chronic elbow flexion, and again at the wrist in the ulnar canal if the wrist is in ulnar deviation on the lower portion of the handlebars.

Note that the ulnar nerve dermatomes are very different from the dermatomes for the radial nerve. Unfortunately, many cyclists get diagnosed with carpal tunnel syndrome when their problem is actually cubital tunnel and ulnar tunnel entrapments.

Cubital tunnel entrapment is when the ulnar nerve cannot glide properly between the medial epicondyle and proximal ulnar head. It can be further compromised by a strain to the flexor carpi ulnaris as the ulnar nerve passes through the proximal heads of that muscle. That would be further compromised on the ulnar side of the wrist from poor handlebar positioning in ulnar deviation patterns.

Cyclists’ Self-Care

Now let’s look at simple exercises your client can do before and after cycling to avoid back, neck, shoulder, elbow and wrist pain — if suggesting exercise or stretching is within your scope of practice where you practice.

Cyclists can often be in flexion patterns for hours at a time. Here we present some critical exercises that should be done once they get off the bike to prevent cervical pain, thoracic outlet, shoulder impingement, O-A and C1/C2 fixations, and ulnar nerve entrapment common to most cyclists. (See Figures 14, 15 and 16.)

 By targeting cyclists as a specialized population in need of advanced sports massage skills, you will position yourself as a valuable care component for professional and recreational cyclists alike.

These three images illustrate simple exercises your client can do before and after cycling to avoid back, neck, shoulder, elbow and wrist pain. Start by lying supine on an exercise ball and stretch the entire body into extension. Allow the legs to relax to get a passive stretch on the hip flexors. As you extend the upper body, reach down with the arms and externally rotate the humerus to stretch the pectoralis minor muscles (left). This will prevent shoulder impingement and thoracic outlet by lifting the clavicle off the first rib and reducing the compression of the acromium on the supraspinatus tendon.
Next, draw C7-C3 back using posterior cervical traction, and with one hand on the occiput lift the occiput up off C1 to increase cervical rotation between C1 and C2 (middle).
Finally, if your position on the handlebars involves prolonged ulnar deviation patterns, take the wrist into extension and radial deviation to free up the ulnar nerve entrapment in Guyon’s Canal (right).

References

• Dalton, Erik, Dynamic Body, Exploring Form/Expanding Function. Freedom From Pain Institute.

• Lowe, Whitney, Orthopedic Assessment in Massage Therapy.

• Waslaski, James, Clinical Massage Therapy: A Structural Approach to Pain Management. Pearson Education.

• Mattes, Aaron (1995). Active Isolated Stretching.

• Waslaski, James, DVD Series: Assessment & Treatment of Multiple Nerve Compression Patterns for Upper Body & Lower Body Conditions.

• Janda, Vladimer, (1983). On the concept of postural muscles and posture in man. Aust J Physiother, 29 (3), 83-84.

• Myers, Thomas, Anatomy Trains, (Elsevier 2001, 2009, 2013).

• McGillicuddy, Mike, (seminars).

• Vaughn, Benny (seminars).

About the Author:

James Waslaski
James Waslaski

James Waslaski, LMT, CPT, teaches orthopedic and sports massage to practitioners including massage therapists, chiropractors, physical therapists, osteopaths and athletic trainers. His integrated manual therapy program was developed to bridge the gap between all health care professionals who specialize in eliminating chronic pain and sports injuries and to help optimize performance potential. He teaches about 40 seminars around the world every year and authored the book Clinical Massage Therapy: A Structural Approach to Pain Management. James is also a MASSAGE Magazine All-Star, one of a group of body-therapy masters who have dedicated their lives to empowering and informing massage professionals. These innovative therapists and teachers are educating the magazine’s community of massage therapists in our print magazine, on our social media channels and on massagemag.com.

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