It’s easy to see why cycling is one of the most popular forms of exercise. There’s nothing quite like heading off on your bike with the wind in your hair and an ever-changing vista ahead of you. As well as being good for your mental health, cycling is a great form of exercise that can help you build cardiovascular fitness and muscle strength.
But, like any form of exercise, it can cause injuries. The most obvious of these are acute injuries that occur as the result of a collision or falling off the bike which can cause serious fractures.
In this article, however, rather than focusing on traumatic injuries like these, we will be looking at stress fractures which are overuse injuries that develop over time.
Why stress fractures occur in cycling
When you cycle you put pressure on the pedals to propel you forward. Over time this can cause stress fractures in your foot or ankle. A stress fracture is a hairline crack or severe bruising in the bone, which can be painful and debilitating. They are common overuse injuries caused by repetitive actions and are especially common in sportsmen and women, including cyclists. Left unchecked, a stress fracture can propagate and become a frank break in the bone.
Bone is constantly remodelling itself, replacing older bone with new bone. However, when the bones are subjected to too much pressure, microscopic damage occurs and the bones may not have enough time to heal themselves in between exercise sessions. The breakdown of older bone occurs more rapidly and the body cannot repair or replace the bone quickly enough. This leads to bone weakening and becoming more vulnerable to stress fractures.
Recognising a stress fracture
The pain of a stress fracture develops gradually and the fractured area may feel tender to the touch. Stress fractures often feel worse during weight-bearing activities such as walking or running (or cycling). In the foot and ankle, stress fractures are most common in the metatarsal bones, which are the long bones that run from the top of the foot into the toes. You may also develop stress fractures in the heel, outer bones of the lower leg and ankle, the lower bones of the ankle joint and the toes.
Stress fractures cause a range of symptoms including:
- Pain which is normally better when you rest the affected area
- Swelling at the top of the foot or outside of the ankle
- Tenderness at the site of the fracture
- Possible bruising
Who is at risk of cycling-related stress fractures?
Stress fractures often occur when you change your normal pattern of exercise. This might be going from not exercising to embarking on an exercise regime, or changing the type, duration or intensity of the exercise you do. Even if you exercise regularly, it is important to build up slowly so your bones have an opportunity to repair themselves in between sessions. You may be particularly at risk of stress fractures if you have a condition like osteoporosis which causes bone weakness. Certain types of medication can also lead to a decrease in bone density and you may be more at risk of stress fractures during the winter months when Vitamin D is lower in the body.
The bones of the foot and lower leg can be especially prone to stress fractures as they are subjected to repetitive forces when you walk, run or pedal. The risk rises if you have poor technique or inadequate or worn footwear.
Preventing stress fractures from cycling
While it is not always possible to prevent injuries, there are some measures you can put in place to reduce the risk of stress fractures. Always warm up before exercise and cool down afterwards with some simple stretches. Be careful not to increase the intensity of your bike rides too quickly but instead build up gradually.
Wear the right kind of footwear and make sure your cycling shoes are a good fit and not too tight. Choosing socks that allow the feet to breathe can prevent swelling and the formation of blisters. Make sure your seat is positioned at the right height so your heel is fully in contact with the pedal.
Positioning your feet correctly so the force is evenly distributed when you push down on the pedal can help prevent injuries. If you experience pain in your feet or ankles, take a break from pedalling. You can freewheel downhill to give your feet and ankles a rest. Never push through if you are experiencing constant or severe pain.
What to do if you suspect a stress fracture
If you think you might have sustained a stress fracture from cycling, it is important to see a specialist orthopaedic surgeon as soon as possible.
Rest the affected area as continuing to use it can result in a complete fracture. Use an ice pack to reduce the swelling and wrap the area in a soft bandage to prevent further swelling. As often as you can, rest with your foot elevated above the level of your heart. Your doctor will recommend an X-ray, or sometimes an MRI scan, to confirm whether or not the bone is fractured.
Most stress fractures heal by themselves with rest but sometimes you might need a surgical repair, particularly if the stress fracture leads to a complete break.
Talk to an orthopaedic consultant | Cambridge
If you sustain an injury while cycling, Carrothers Orthopaedics offers expert diagnosis and treatment. For more information, please contact us.
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For your convenience, we offer appointments at both Nuffield Hospital Cambridge and Spire Cambridge Lea Hospital.
