Mountain biking injuries – Commons issues and ways to manage them

Introduction

Mountain biking has increased in popularity over recent years and with this we have seen an increase in the injuries associated with this great sport. Mountain biking involves off road riding over tracks with variable surface conditions. The high speeds achieved during downhill sections can lead to falls and sometimes serious injury. There are several published reports of serious head injury as a result of falls, which makes a helmet essential!

Saying this most mountain biking injuries are not serious and the majority of falls result in relatively minor cuts and grazes. Abrasions on the outside of the knees, hips and elbows are common when a rider falls, especially on hard surfaces.

The majority of mountain biking injuries occur during downhill riding, with the shoulder region, upper arm and wrist most often injured. A broken Collar bone and Acromio-clavicular joint sprain are two frequent mountain biking injuries.

Not all mountain biking injuries are traumatic. Overuse injuries can occur due to the repetitive nature of cycling. If the bike is set up incorrectly for the rider, then you can suffer from back pain and knee pain. Some research suggests that 25% of cyclists suffer from knee pain that comes on due to overuse on a bike that is not set up properly.

5 Common mountain biking injuries:

1. Cuts ad grazes

Cuts and grazes are damage to the skin and superficial soft tissues and are the most common injuries to occur following a fall from a mountain bike.

A cut or ‘laceration’ is a penetrating tear in the skin. A shallow cut will usually heal quickly without any problems, while deeper cuts may cause more serious damage to nerve tissue or larger blood vessels, which would require hospital treatment.

A graze or ‘abrasion’ occurs when the skin is scraped off. Usually this only affects a small area and the wound heals very quickly. However, large grazes that penetrate beyond the skin layers can be serious injuries, requiring input from a doctor.

What can you do to prevent cuts and grazes? Staying on your bike and avoiding falls is the surest method of steering clear of cuts and grazes. Always maintain a balanced posture with your weight shifted back and look out for tree stumps and rocks that could cause a fall.

Wearing protective padding over the elbows, hips and knees can help to reduce the extent of any cuts and grazes. Elbow pads, neoprene knee supports and padded shorts can be all provide protection to prevent cuts and grazes, even if there is a fall.

What should you do if you suffer cuts and grazes? Always carry a First Aid Kit. Any profuse bleeding, loss of sensation, or signs of infection (pain, redness, swelling) should be checked out by a doctor. If bleeding is controlled and there are no complications, then most cuts and grazes can be treated at home. The wound should be cleaned thoroughly then dressed with a sterile dressing.

2. Broken collar bone

A broken collar bone/clavicle is a very common shoulder injury in mountain bikers. A broken collar bone usually occurs during a downhill section if the rider falls onto an out stretched hand. The force transmitted up the arm is often enough to cause this painful shoulder fracture.

What can you do to prevent a broken collar bone? Try not to fall! If the front wheel comes to an abrupt halt the rider typically goes over the handlebars. Be aware that this is more likely to happen on a descent, because you’ll be moving faster and you’re tilted forward. Look out for rocks and tree stumps as these are the obstacles that will cause a sudden stop. Also make sure that your pedals are level with weight distributed evenly between the left and right pedal, because if you’re unbalanced then you’re more likely to go over the handlebars.

What should you do if you suffer a broken collar bone? Apply ice packs (never apply ice directly to the skin) to the shoulder for pain relief. Pain killing drugs prescribed by a doctor can provide relief for intense shoulder pain. Any suspected fractures should be assessed and treated at hospital. A figure of 8 shoulder support /sling can immobilise the shoulder and provide pain relief.

Once the treating doctor is satisfied that the collar bone is sufficiently healed then shoulder range of movement exercises can be progressed to gradually increase shoulder movement. These exercises may be a little uncomfortable, but with some encouragement from a Physiotherapist this discomfort should quickly resolve as normal movement returns. Shoulder strengthening should then begin using resistance bands to regain full function

3. Acromio-clavicular joint (SCJ) sprain

The ACJ is part of the shoulder. It is situated at the outer side of the collar bone where it is attached to the front of the shoulder blade with strong ligaments.

An ACJ sprain refers to damage to these ligaments. The ACJ ligaments are most commonly damaged through a fall onto either the tip of the shoulder or a fall onto an out stretched hand.

What can you do to prevent an Acromio-clavicular joint sprain? Similar to a broken collar bone – try to make sure you don’t fall – especially during fast descents. If your front wheel comes to an abrupt halt then you’re likely to go flying over the handlebars.

Keep an eye out for rocks and tree stumps as these are the most common causes of a fall. Always make sure that your pedals are level with your weight distributed evenly between left and right pedal, because if you’re unbalanced then you’re more likely to go over the handlebars.

What should you do if you suffer an Acromio-clavicular joint sprain? Apply ice packs (never apply ice directly to the skin) to the shoulder for pain relief. Pain killing drugs prescribed by a doctor can provide relief for intense shoulder pain.A Figure of 8 shoulder support and sling can immobilise the shoulder and provide pain relief.

The Mueller shoulder brace will push the collar bone downwards and provide the support of a sling. When returning to activity the Donjoy shoulder stabiliser will provide support and protection that can help to prevent re-injury.

4. Knee Pain

It may sound strange but Runner’s Knee is the most common knee injury in cyclists. Runner’s Knee is the common term for Ilio Tibial Band Friction Syndrome (ITBFS). Runner’s Knee is a painful overuse knee injury that affects the outer part of the knee. It is fairly common in cyclists due to the repetitive nature of cycling.

During cycling, where there is repeated bending and straightening of the knee joint, the IlioTibial Band can ‘impinge’ upon the prominent outer side of the knee and the resultant friction can lead to inflammation of the tissues.

What can you do to prevent Knee Pain? The most important consideration to prevent knee injury during cycling is the set up of the bike. The frame should be the correct size, with 1″-2″ of clearance between the crotch and top tube of the frame. In mountain bikes, this is not normally an issue as the top tube is lower. If the saddle is too high or too low then the stresses on the knee can lead to injury. The knee shouldn’t be over extended when the pedal reaches the bottom of its revolution. Another bad habit is to point your toes inwards when cycling as it increases the risk of developing ITBFS.

What should you do if you suffer Knee Pain? Physiotherapy treatment is effective for most cases of ITBFS. It aims to reduce the inflammation and improve the mobility of the ITB so that friction is avoided. For those who want to continue to cycle a Knee Strap can be used temporarily to help relieve or control symptoms.

5. Low Back Pain

Repeated overuse and prolonged bending during cycling can lead to low back pain. A flexed posture while on the bike can lead to degeneration of the outer layer of the disc, which allows the gel-like centre of the disc to prolapse out. This is known as a herniated disc. This presses against structures in the back and can cause back pain and even pain down the back of the legs, which is known as Sciatica.

What can you do to prevent Low Back Pain? It’s important that the bike is comfortable, with a correct set up. If the frame is too big then over reaching for the handlebars can lead to low back pain. Being hunched up on a frame that is too small can also lead to low back pain.

Research has shown that specific back exercises prescribed by Physiotherapists can help to prevent low back pain.

What should you do if you suffer Low Back Pain? Pain-relieving medication prescribed by a doctor and heat packs are usually necessary during the first few days with low back pain. Research has shown that patients with low back pain should remain as active as they possibly can, so long as their symptoms are not aggravated.

 

Disclaimer: This advice is general advice only, if you are experiencing symptoms associated with cycling or mountain biking you should seek medical advice from your Doctor of Physiotherapist.

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