If it hasn’t already, it’s going to happen. You will sustain a mountain biking injury. The thrill of mountain biking is unfortunately balanced out by the spill of mountain biking. Hey, we can’t have everything… We can do our best to prevent becoming injured, either through improved skill and control, or correct set-up. But this is mountain biking. Nothing is predictable. It’s what makes mountain biking so exciting; it’s what makes mountain biking risky. – By Dr Merchen Naude
Mountain biking injuries generally fall into two categories; acute injuries, mainly due to the trauma of a fall; and overuse injuries, caused by spending lots of time in the saddle with possibly incorrect set-up or inadequate conditioning.
Research has shown that falling forwards over the handlebars results in more serious head and neck injuries, whilst falling to the side results in largely limb injuries. Makes sense really. What is interesting though is that female riders, who are generally lighter and are more prone to falling over the handlebars easier than males, tend to be more seriously injured than male riders. However, male cyclists between the ages of 20–39 years old incur the large proportion of serious injuries sustained while mountain biking.
Injuries are usually caused by loss of control, high-speed descents and competitive activity, i.e. riders are most likely to be injured racing on a descent rather than training on the same descent. Incorrect cornering control, loss of traction and mechanical problems can also lead to injury. Many of these could be avoided by improved rider skill and judgement, but even skilled, experienced riders crash, usually due to pushing their limits.
The most common injuries (60–75%) are soft-tissue abrasions, cuts and bruises. The most common bone fractured is the clavicle (collar bone), and the most common dislocation is the acromio-clavicular (AC) joint (where the collar bone meets the shoulder).
An Austrian study on abdominal trauma due to mountain biking accidents, found that all of the patients had blunt focal blows to the right side of the abdomen due to the handlebars, and all were using ‘bar-ends’ on their handle bars. These forward facing bar extensions allow additional hand positions for comfort and energy efficiency. After awareness campaigns, bar-ends ceased to be used in mountain biking in Austria, with an almost complete cessation of liver injury from the sport…
THE MOST COMMON ACCUTE INJURIES
Suspected fractures (broken bones)
For any professional mountain bike racer, the words “broken collar bone” mean a serious interruption to their racing schedule, escpecially if it requires surgery. For us mortals, it means the end of our race or training ride and a few frustrating weeks out of the saddle… This type of injury is usually caused by falling on the shoulder with the arm in an adducted (across the body) position, or on an outstretched arm trying to break a fall.
Very sharp pain is experienced over the collar bone (in front of the shoulder). There may be some bruising, swelling or even a deformity. Feel alongside the collar bone, and if a fracture is suspected, immediately immobilise the arm by keeping it in front of the body, elbow bent, and fix it to the body with a shirt/jacket, or even tuck the thumb into the front of the cycling shirt/pants. Get qualified medical help as soon as possible. Apply ice to the affected area as soon as possible. A painkiller may be given if necessary, but do not give any unnecessary food/fluids, as the injured person may need surgery.
Other fractures: Severe pain, swelling and bleeding, deformity and the inability to bear weight, use of a limb or joint, may indicate a fracture. Immobilise the injured area by any practical means, even using hydration packs or bottles and duct tape to splint an arm or leg. Keep the injured rider as still and calm as possible. Apply ice, elevate the injured part above the heart if there is bleeding, and get help as soon as possible.
Soft tissue injuries
Often not as serious as fractures, but still very sore, are the various soft tissue injuries that may result from getting to know Mother Earth in an intimate way. Application of ice and compression as soon as possible may decrease swelling and thus improve healing time. Elevate the injured area and rest it for a day or two. Anti-inflammatory medication may also speed up healing. Visit a sports physician if the pain and swelling persists after 48 hours.
Cuts
Deep cuts with a lot of bleeding may be quite distressing. If available, the wound can quickly be rinsed with clean water. Stop the bleeding by approximating the wound edges (closing the wound) with whatever is available. Duct tape may not be pretty, but works well to get you to a first aid station or doctor. Apply constant pressure to the wound. Serious cuts may accompany a fracture, thus immobilising the part may be a good idea. Tourniquets are only used in life threatening injuries, applying even pressure over the wound is much safer. Most deep cuts should be attended to by a doctor, as they need to be thoroughly cleaned and washed, and may require stitches. A tetanus shot and antibiotics may be given if deemed necessary by the treating doctor.
“Roasties” and bruises
Roasties are very bad abrasions and pretty sore! Clean them well by scrubbing the area, and keep them moist. They get worse when they dry out. Apply an antiseptic cream as soon as possible, and keep them occluded for a few days until healing sets in. Keep an eye out for infection. Underlying bruising accompanies most roasties. Applying ice to the bruised area may reduce swelling. For any other bruising, apply ice and an anti-inflammatory ointment, and rest the injured part if necessary.
Loss of consciousness
Loss of consciousness may indicate serious head trauma. Always call urgently for help. Check a non-responsive rider’s breathing and pulse, and commence CPR if necessary. Head trauma is often accompanied by C-spine (neck) injuries. Keep the rider as still as possible, and leave his helmet in place if it does not interfere with his breathing. Do not allow any head movement, and if the injured rider needs to be moved, secure his head position. If no neck injury is suspected, the rider may be put in the recovery position – on his side with upper leg bent and crossed over lower leg to stabilise the body. The injured rider must be put in the recovery position immediately if he starts to vomit. Check the pupil size and note any changes or differences between the two pupils.
Recovery position:
THE MOST COMMON OVERUSE INJURIES
Due to the repetitive nature of mountain biking, and the long hours spent in the saddle, overuse injuries are common. The most common overuse injuries seen in practice are:
Back pain
Lower back pain, and pain in the neck and thoracic area (between the shoulder blades) are mostly due to incorrect set-up (saddle position, handle bar height or width). Rider fatigue and weak stabilising muscles can cause a rider to experience discomfort when riding for long hours.
Disc herniation, where a flexed posture when on the bike leads to degeneration of the outer layer of the disc, which allows the gel-like centre of the disc to prolapse, and facet arthrosis (degeneration and inflammation of the spinal facet joints) are other leading causes of back pain. Strengthening of weak core and stabilising muscles, regular stretching and correct set-up may increase your comfort considerably. Consult a sports physician if the pain does not subside or if there is any weakness or referred pain.
Knee pain
Due to the repetitive nature of cycling, Iliotibial band friction syndrome is a common ‘knee injury’. The ITB is a fascia band running down the outside of the leg. Pain is usually experienced at the outside of the knee. ITB pain is mostly due to overuse in individuals with weak gluteus and stabilising muscles and tightness in the IT band. A sports physician will assess the injury and may refer you to a sports physiotherapist to assist in loosening the ITB, and treat the inflammation at the knee. A strength programme focusing on the core and stabilising muscles, is vital. Rolling the ITB on a foam roller may decrease myofascial trigger points.
Patello- femoral pain is experienced as pain around the kneecap. It is similar to ITB in that poor quality of motion caused by cycling gait or poor bike set-up creates poor biomechanics that alter how you should move on your bike. Over time this causes abnormal tracking (pulling towards the overused outer thigh muscles) of the patella (kneecap) as it goes up and down in a track, known as the femoral groove. The result is pain and swelling around the kneecap that might be felt first only after a ride, then over time, during the ride, and then becomes a full-time injury with pain when squatting down or stepping up. Treatment follows the same principles as mentioned above.
Wrist pain
Mountain biking places high loads on joints that we normally don’t consider as load bearing (i.e., elbows, shoulders, wrists). Wrist pain is common due to the shock transferred from the bike to the upper extremity. It varies from mild discomfort to debilitating pain. A main cause of wrist pain is a ganglion. A ganglion is a distension of a weakened portion of a joint capsule or tendon, and is characterised by a painful lump on the back of the hand or wrist. It is caused by repetitive mechanical stress, as in mountain biking.
Perineal pain
Perineal numbness due to nerve compression after long periods of sitting on a hard saddle will be familiar to the majority of riders, and modern saddles are shaped to reduce pressure on the pudendal nerves in the perineum. A conditioning period should be expected. If you still have pain or numbness after a month of riding (2-3 rides per week), then consider a different saddle or have your set-up checked by an expert.
The scrotal contents can be subjected to repeated micro-trauma during mountain biking. According to a recent study (lancet 2000), a total of 96% of extreme mountain bikers had pathological abnormalities of scrotal contents compared with 16% of a control group on ultra sound examination. It’s not something the majority of male mountain bikers should be concerned with though.
It is not just the male genitalia which have been shown to suffer from prolonged riding. Female road cyclists have been reported to develop unilateral vulval hypertrophy (painful thickening of the skin). A saddle with adequate fit and support, and good cycling shorts are important to decrease these problems. Take notice of any perineal symptoms or lumps, and consult a sports physician if any symptoms persist.
Saddle sores or folliculitis (infection of a hair follicle or sweat gland) may keep a rider “grounded” for some time. Limit skin problems by keeping the chamois of the cycling pants clean and dry, and using a cream designed to limit skin infections and inflammation. Consult a sports physician if it does not clear, or if there is any sign of infection (swelling, redness, heat) or any worrisome lump.
A very interesting study by a group of Austrian Orthopaedic surgeons published in 2010 found a significant correlation between inappropriate mountain bike adjustments and the occurrence of overuse injuries in competitive mountain bikers. Numbness in the hand, pain in the lumbar spine (back), the knee and the buttocks were identified as the predominant overused body regions reported by athletes. The inclination of the saddle and the saddle-pedal distance were responsible for two thirds of the recorded injuries. Hence, the saddle position is obviously the crucial point in the bike’s adjustment, affecting the entire rider’s position on the bike. It was found that an anterior (forward) inclination of the saddle between 10 to 15 degrees reduced the occurrence of low back pain significantly.
FIRST AID FOR MOUNTAIN BIKERS
We are classified into two groups: those who have had a fall (and will probably fall again), and those who are yet to fall. So what to do when you meet the dirt head on? Basic first aid will help you deal with most of the acute injuries mentioned in this article, and can make all the difference when out on the trial. But, before heading out, remember:
- Always wear your helmet!
- Never ride alone. An unexpected fall may land you in trouble, and a partner’s presence may be life saving (though sometimes humiliating…)
Common sense should prevail. After an accident, always get yourself in a safe area, or if you are the rider attending to an injured rider, always make sure you both are out of harm’s way (off the trail or race route). For serious injuries, call for help first. Check the injured rider’s level of consciousness, breathing, and feel for a pulse. Start CPR if needed. If the rider is conscious, stay calm and keep the injured rider calm. Ask what hurts most, or attend to the most obvious injuries. Stop any bleeding, and immobilise any suspected fractures. Try not to move the injured rider unnecessarily. Keep talking to the injured rider, to assess any change in consciousness. A painkiller may be given if necessary, but do not give any unnecessary food/fluids, as the injured person may need surgery.
Most important is to stay calm and think! Most acute injuries can be dealt with effectively on a trail, or be stabilised until help arrives. Overuse injuries can be minimised by a good bike fit and set-up, adequate conditioning and strong core muscles. Consult a sports doctor if pain persists for more than 48 hours, or if there is any sign of infection.
Dr Mérchen Naudé is a Sports Physician practising in Pretoria, and is an avid triathlete and mountain biker. She has completed several Ironman triathlon, Xterra, mountain biking events and stage races. And yes, she has sustained mountain biking injuries. She can be reached on 012 753 1257 or merchensport@gmail.com
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Originally published in TREAD Issue 23, 2013 – All rights reserved
