Ask the Physio
Sports physio Leanne Simoncelli tackles post-ride hip, neck and shoulder pain
I have been diagnosed with FAI (femoral acetabular impingement) after suffering front hip and groin pain. How can I optimise my cycling to ensure the long-term health of my hip?
You need to get your position sorted. The hip is most uncomfortable in the peak of the pedal stroke (12 o’clock, or top dead centre) because this is the maximum range of hip flexion, where the hip joint is the most compressed in the front. To open your hip angle on your bike, you can do all or a combination of the following:
1. Optimise the height of your seatpost and the tilt of your saddle 2. Tilt your pelvis forward on the saddle 3. Increase the height of your handlebars (stack)
4. Avoid holding the drops or TT bars for too long 5. Shorten your reach (stem length) 6. Shorten your crank length 7. Externally-rotate your cleats.
You also need to focus on your effort during the downstroke. This avoids maximum effort through the 12 o’clock mark of maximum hip flexion. You may want to moderate the frequency, duration and intensity of your rides. Pain and stiffness during and within 24 hours after your ride would indicate that you may have cycled too fast, too far or too often that week – all these factors contribute to the total number of pedal strokes. Your hip joint will have a level of comfortable load tolerance. Try to choose one of these aspects as the dominant training emphasis. Using a performance tracking app is a great way to track your speed, distance and climb-to-descent ratio to calculate your threshold tolerance.
Finally, your physio can help individualise your rehabilitation to avoid excessive hip flexion and work in greater hip extension with single-leg exercises.
I get Achilles tendon pain during multi-day long rides. Is there a way to prevent this and what is the best treatment for it?
This often happens when you point and flex your foot while you are cycling, as opposed to keeping your foot horizontal (ankling versus piston stroke).
Your cleats could be too far forward, increasing the toedown pedalling angle.
The Achilles tendon gets repeatedly compressed and stretched during each pedal cycle, and this can cause friction and irritation of the tendon sheath or bursa (fluid-filled sac). It is common with long rides and multi-day events due to the large number of strokes and fatigue. The fit of your shoe could be incorrect. In the evenings between multi-day rides, wear flatter-soled shoes and try not to walk around in your cleats too much, as this increases your ankle angle and over-stretches the Achilles. Try both bent-knee and straight-knee calf stretches, and also strengthen your soleus prior to your next event with some bent-knee single-leg heel raises.
For a few days following a long ride, I experience a stiff neck and achiness between my shoulder blades. What are the best ways to stop this?
This may be due to fatigue of your trapezius muscle and stiffness of your upper back. Optimise your set-up and position on your bike to reduce excessive pressure through your hands and shoulders.
On your bike: Relax your grip, vary your hand positions, relax your shoulders away from your ears. On a long, flat ride, sit up tall and try to lift your breastbone up out of the aerodynamic position for a short while to open the width of your shoulders. Focus on belly-breathing using your diaphragm and not breathing into the top of your shoulders. Vary your head position by varying the distance of your gaze.
Off the bike: Mobilise your upper back and neck with exercises such as clasping your hands behind your head while leaning backwards; cat-camel; thread needle; lying lengthways on a long roller; neck stretches; leaning your ear to your shoulder; and turning your head and looking down towards your armpit.
Without access to a gym, which exercises can I do at home that will benefit my cycling?
The best basic, bodyweight exercises for cyclists are: Bulgarian split squat; single-leg high step-up (two-step height); single-leg hip thrust; standing scooter sliding exercises (using a sliding disk or microfibre cloth); superman (lift and tap down in the elongated position); side plank; clam against resistance band – plus stretches of course.