Habitualmente las lesiones no traumáticas se producen como consecuencia de una sobrecarga que puede acompañarse o no de una inadecuada técnica. Estamos hablando de lesiones crónicas.
Para poder llegar al diagnóstico correcto y así poder aplicar el tratamiento adecuado, como en todas las lesiones de cualquier deportista, es necesario realizar una completa historia cínica con una anamnesis detallada, preguntando por donde presenta el punto de mayor dolor o la lesión, cómo apareció el dolor o la lesión, cuánto tiempo lleva así, la evolución desde que comenzó con el dolor o la lesión, si hay alguna situación que lo mejora o lo agrava,… Pero además en las lesiones de los ciclistas o triatletas, nos será de gran ayuda poder evaluar al deportista sobre la bici, explorando así su posición y su correcta adaptación a la bici. Muy frecuentemente estas lesiones no traumáticas suceden por una mala o incorrecta adaptación a la bici.
Anatomical review of the upper limb
In the hand we distinguish three zones with 27 bones in total: carpus (wrist with 8 bones), metacarpus (with 5 bones) and fingers. The forearm has 2 bones (ulna and radius) and the arm has only 1 bone, the humerus.
The anatomical description of muscles, tendons, ligaments, arteries, veins and nerves is quite complex, so we will not go into more detail than the images can provide.
Cycling injuries
Cyclists and triathletes often suffer from upper limb injuries that are very different from other sports where injuries such as epicondylitis, rotator cuff tendinopathy or others predominate. Other injuries occur in this sport and are described below:
Carpal Tunnel Syndrome:
It appears as a consequence of compression of the median nerve. It can even appear as a consequence of small microtraumatisms at the same level with peripheral inflammation and nerve irritation. Similarly, if the hand is placed on the upper part of the handlebars, with the carpus in maximum extension, excessive elongation of the nerve will occur, also causing irritation.
Como consecuencia, la sintomatología que aparece es la de una alteración de la actividad motriz fina, hipoestesia y parestesia (dedos dormidos) del pulgar, índice, medio y la mitad del anular. Esta situación es descrita por los pacientes como “dedos de mantequilla” ya que se le suelen caer objetos por falta de fuerza prensil. En la exploración solemos encontrar una maniobra de Phalen positiva (mantener una flexión máxima de la muñeca durante un minuto) y un signo de Tinel igualmente positivo (se reproducen las parestesias con la percusión sobre la zona comprimida)
This symptomatology usually only occurs during sports practice and disappears outside the sports environment.
As a treatment, the first option is to carry out a detailed biomechanical study, with the relevant modifications at the different levels, saddle, handlebars, handlebar stem, etc. This is usually the only treatment as the symptoms usually disappear with the relevant corrections, but if the symptoms persist, ultrasound scans, X-rays and even MRI scans should be carried out in order to resolve the situation.
2. Guyon Canal Syndrome:
In this case the affected nerve is the motor branch of the ulnar nerve. The mechanism is usually the same as in the case of Carpal Tunnel Syndrome, microtrauma or continuous compression at the level of Guyon's Canal with nerve irritation. This compression of the ulnar nerve occurs when the hand is positioned at the top of the handlebars with maximum extension of the carpus. The symptomatology that appears is also hypoaesthesia and paraesthesia, even with loss of strength of the fifth and fourth fingers. Watemberg's sign (permanent separation of the 5th finger) and Frament's sign (hypotenar atrophy and ulnar claw of the last two fingers) usually appear.
3. Quervain's tendonitis
Quervain's tendinitis is an inflammation of the abductor pollicis longus and extensor pollicis brevis at the level of the styloid process of the radius. It usually arises as a result of the wrist resting on the handlebars with ulnar deviation. Due to this alteration of the position at the level of the handlebars, an angulation of the aforementioned tendons occurs. What actually occurs is an inflammation at the level of the fibro-bone tunnel, which is called tenosynovitis.
Intense pain appears at the level of the radial styloid. The pain is aggravated by the Filkestein manoeuvre, which is positive in this case.
4. Tendosynovitis of the radial extensors and extensors of the fingers.
This injury occurs in cyclists or triathletes who train or compete over long distances and whose road surface is uneven, cobbled or paved. When training on this type of surface, the athlete grips the handlebars with greater force, as a result of which the forearm muscles are overloaded, producing hypertrophy of the abductor pollicis longus and extensor pollicis brevis muscles, which run above the radial extensors, which are compressed against the deep planes.
Se produce habitualmente un dolor continuo en los movimientos de flexo-extensión de la muñeca, incluso en ocasiones se oye una ligera crepitación. Cuando se cronifica la lesión cronifica la lesienta en ocasiones se oye una ligera crepitacixo-extensia de los extensores radiales. razo, produciendose ir aparece una zona inflamada a nivel de la cara dorsal del radio.
Treatment
Occasionally, diagnostic imaging tests are required to assess the extent of the lesion. Ultrasound or magnetic resonance imaging (MRI) are usually the techniques of choice.
The best treatment for this type of injury is prevention. There is no doubt that a biomechanical study where our anthropometric measurements are adjusted to the bike will be the best measure we can take. It is even advisable that we could do this study before buying a bike in order to choose not only for the colours, the brand or the design, but also for the brand and model that best suits our anthropometry. Sometimes it will be necessary to change the training routes with a different type of asphalt, more regular. If you want to know more about biomechanics in cycling, click here. here.
Once the relevant changes have been made to the bike, we will have to go through a phase of adaptation until we feel comfortable. In addition, with this type of study, we will achieve a more efficient pedalling.
On the other hand, if the injury appears from the point of view of conventional medicine, the much questioned NSAIDs (non-steroidal anti-inflammatory drugs) and even corticoid infiltrations will be used. There is a consensus document from sports medicine specialists indicating that the use of NSAIDs can make the sports injury chronic.
Acudir de forma temprana al fisioterapeuta asegurará una rápida curación al utilizar técnicas como ultrasonidos, masaje Cyriax, punción seca, kinesiotaping,… En los últimos años la Diatermia (radiofrecuencia) se ha posicionado como tratamiento de elección junto con el trabajo manual del fisioterapeuta. Todas estas técnicas y otras las utilizamos en Sportshealthfor the early recovery of our athletes.
As an alternative to NSAIDs, we can use supplements of B vitamins and magnesium, as these reduce nerve irritation and also act as muscle relaxants. In addition, we can use natural anti-inflammatory supplements such as turmeric (for example Green Flex). The use of a CBD-based anti-inflammatory cream together with other active ingredients such as arnica, (CBD-Cream) will help with an earlier recovery. Not to be forgotten are high-quality collagen-based supplements such as the internationally renowned Peptan (Collagen Plus), which we can use as a preventive or as a treatment, since collagen peptides are precursors of structural proteins such as collagen itself, or elastin,... glycoproteins that are essential in different tissues (tendons, ligaments, joints,...).
As a conclusion to pain in sport and also as a recommendation, you should always go to a doctor for assessment and appropriate treatment. Injuries start with a little thing and gradually increase as we do not always stop training. Professional athletes always go to their doctor or physiotherapist to recover as soon as possible.
Dr. Sacristán