Mountain Biking




General Principles


Definitions





  • The term “mountain biking” broadly refers to riding bikes with specific design characteristics in various off-road settings.



  • Mountain bikes generally differ from road bikes in several ways: a smaller frame, stronger wheels, larger range of gears, a wider flat or upright handlebar, hydraulic brakes, suspension, and wider, knobby tires.



  • There are many riding and bike types, with some overlap between bikes and riding styles.



  • The five main mountain biking categories are cross-country (XC), downhill (DH), freeride (FR), all-mountain (AM), Enduro, and trials and urban riding (TR) ( Fig. 95.1 ).




    Figure 95.1


    Mountain bike styles and characteristics.

    (Photographs from Yeti Cycles with permission. Data from Lopes B, McCormack L: Mastering Mountain Bike Skills: Techniques to Excel in all Riding Styles. Champaign, IL: Human Kinetics, 2005.)



Demographics





  • Participation is open to all age groups, with the average age dependent on the type of biking; 22 to 36 years is the gross average, with most competitors aged between 19 and 44 years. There are more males than females, but female participation is increasing; the sport is especially popular among young males.



  • Mountain bikes are the largest category of bikes sold in United States (US) bike shops.



  • Racing is now common in XC, DH, FR, and other styles.



  • The number of noncompetitive mountain bikers is increasing; less is known about their injury epidemiology.



  • The sport attracts risk-tolerant personalities.



Research





  • Injuries are reported inconsistently in the literature, ranging from specific injuries to general types of injury (e.g., laceration, fracture) to injured body areas (e.g., joint, upper or lower extremity, head).



  • Early data are from competitive XC; now more data are from all areas: XC, DH, and FR. Some recreational data are available; data from other areas are minimal.



  • Available studies are primarily descriptive and focus mainly on injuries themselves (generally defined by body or joint area); there are fewer details available regarding mechanisms of injury.



  • Most injury studies have a preponderance of male participants (75% to 80%). Many studies depend on victim recall.



Competition





  • XC still popular, but a shift to Enduro, DH, and other events is being seen.



  • Categories are established based on age, gender, and rider skill.



  • Rider skill categories were changed in 2009 (applicable to riders 15 years of age and above): Pro, Category 1 (previously Expert), Category 2 (previously Sport), and Category 3 (previously Beginner); previous riders classified as “Semi-Pro” must choose between the new Pro or Category 1 tiers.



  • Age categories: Youth (<10 years old), Junior (10–18 years old), Under 23 (19–22 years old), Senior (23–29 years old), and Master (>30 years old)



Protective Equipment





  • Protective torso armor and extremity padding: Primarily for FR and DH; use of lighter, flexible pads increasing in XC



  • Helmet designs: Full face (mainly DH, FR) and standard (mainly XC, Recreational); helmets should be Snell-, CPSC-, or ANSI-approved and tested. Recommend replacement after any significant crash.



  • Shorts: Multiple types of synthetic moisture-wicking chamois; some have built-in hip padding, loose-fitting shorts with inner chamois are becoming more popular



  • Gloves: Varying thickness, with shell protection (dorsal fingers and hand) and padding



  • Eyewear: Ultraviolet protection, shatterproof, changeable light-reducing and colored lenses for varying conditions; clear lenses for night riding; goggles in DH and extreme cold



Mountain Bike Fit





  • Start with a professional fit (see Chapter 94 : Road Biking).



  • Mountain bike fit not as straightforward as road fit; use the initial road fit to help achieve a mountain bike fit window (an ideal, individualized fit that may deviate slightly from a virtual perfect fit).



  • For more information, see eAppendix 95-3 .





Physiology and Training


Physiology





  • High intensity sport—probably higher (especially XC) than road stage races



  • XC circuits average about 2 hours, performed at a heart rate (HR) of approximately 90% (± 3%) of HRmax, corresponding to a V̇O 2 max of approximately 84%; more than 80% of race time is spent above the lactate threshold (LT).



  • Intensity is related to a fast start, several climbs, rolling resistance, and isometric and eccentric arm and leg muscle contractions that are required for shock absorption, bike handling, and stability over rough terrains (increases HR response to submaximal cycling).



  • Start has fundamental importance to the entire race as XC riders race to the narrows (where the trail becomes singletrack) to achieve a good position; fast starts and early steep climbs lead to high intensity and HRmax early in the race.



  • Anaerobic energy systems taxed, especially during steep climbs (require high power output: up to 250 to 500 watts); anaerobic power and ability to sustain high work rates for prolonged periods are prerequisites for competing in high-level off-road cycling events.



  • Various factors may affect off-road XC performance, especially in elite cyclists: V̇O 2 max, peak power output (PPO), power output (PO), and V̇O 2 at the ventilatory threshold (VT) and at the respiratory compression threshold (RCT); studies are conflicting regarding which is most important:




    • PO and V̇O 2 at the RCT normalized to body mass are predictors of off-road performance times.



    • V̇O 2 max, PPO, and LT normalized to body mass correlate with XC performance in some studies.



    • PO at the VT may correlate with time trial performance.




  • Body mass is a factor: power to weight characteristics are important for success in off-road events; high power-to-weight ratio is good for strong hill climbing ability; higher mass may assist with rapid descents.



  • Factors other than aerobic power and capacity may affect off-road cycling performance: cycling experience and economy (specificity of principle), technical ability, and pre-, during, and postcompetition nutrition



Training





  • Need to develop good aerobic endurance, anaerobic capacity, overall muscle strength, good coordination, and bike-handling skills



  • Significant upper body and core muscular strength is necessary for repeated isometric and/or eccentric muscle contractions required to absorb shocks and constantly adjust to changing terrain; accomplished using weight training and riding off-road



  • Many competitive XC riders train for 10 to 14 hours weekly; some XC racers train systematically in a similar fashion to road racers. Others train with much less structure.



  • Athletes ride at varying aerobic and anaerobic intensities (zones); it is helpful to use a HR monitor.



  • Mountain bikers train both on- and off-road.




    • Use different types of training in a similar manner to other endurance events (listed in order of decreasing intensity): race pace, intervals and hills, speed and tempo, endurance, strength, recovery, or overdistance



    • Training cycle (depends on peaking goals): base (4 months), intensity (4 months), peak (4 to 6 weeks), racing (8 to 12 weeks), or recovery (4 to 6 weeks)



    • Off-road terrain incorporates various training types and is less flexible than road riding under controlled intensity.



    • Long off-road rides over rough, technical terrain, especially if at altitude, require longer recovery compared to equidistant road rides.



    • Use periodization and monitor overtraining, especially if training at high altitude and/or frequently on rough terrain.






Injury Overview


Epidemiology





  • Injury types and numbers likely grossly under-reported secondary to varying and limited study design, difference in injury definitions, understudy of a large population of recreational and noncompetitive aggressive riders in all styles.



  • Peak incidence: June to August



  • Mixed competition and noncompetition data indicate that 50% to 90% riders have been injured in the previous year; one study showed 20% had a significant injury requiring medical attention and were prevented from cycling for at least 1 day; competitive cyclists were injured more than recreational cyclists in earlier studies, but unclear if this still reflects the current trend.



  • Reported injury rates (multiyear data) is as low as 0.45% to 0.6% per year in XC, DH, and DS competitions; 0.30% injury rate for recreational cyclists, but some reports are higher; definition of injury rate may vary (e.g., number of injured cyclists per number of starts per 100; number of injured cyclists per 100 hours of race time).



  • Injury rates are greater for DH versus XC relative to time spent on bike (0.37 injuries per 100 hours on bike for XC vs. 4.34 injuries per 100 hours on bike for DH).



  • There is a possible association between increased hours on bike and injury severity, but some data indicate the presence of fewer injuries in competitive cyclists who spent 1 hour per week more on the bike during the competition season and 3.5 hours per week more on bike during the off-season compared to those who experienced major injuries.



  • Cannot extrapolate injury data from road bikers because road bike crashes are often specific to riding on pavement; many more collisions with motor vehicles, which is rare in off-road cycling (a few case reports of serious injury resulting from mountain bike–motor vehicle collision do exist)



  • Experienced cyclists injure bones and joints more frequently than beginners.



  • Professional DH racers are more likely to sustain injuries than amateurs.



  • Young males are the most frequently injured population, because of the popularity of the sport in this group and the likelihood to engage in aggressive and technically demanding riding styles.



  • Injury risk in competing females may be greater than in males.




    • Loss of bike control, less upper extremity strength, fewer riding years




  • The number of injuries occurring during racing and training are about equal, but traumatic injuries are more common in races, while overuse injuries are more common in training.



  • Injuries are divided into overuse, acute traumatic, and environmental.



Mechanisms of Injury and Risk Factors





  • Most commonly reported: excessive speed , unfamiliar terrain , loss of control (encompasses multiple factors), inattentiveness , riding beyond ability , and riding DH , slippery terrain (approximately 90% may be viewed as errors in judgment) ( Table 95.1 )



    TABLE 95.1

    SPECIFIC REPORTED CAUSES AND RISK FACTORS















    Rider-related


    • Errors in judgment and riding technique



    • Excessive speed



    • Inattentiveness



    • Riding beyond ability and loss of control



    • Incorrect braking



    • Improper training and overtraining



    • Female or young male



    • Intoxication



    • No helmet; especially children

    Bike/equipment-related


    • Mechanical failures (more common in DH): flat tires, brakes, chains, forks, handlebars, pedals, suspension parts, seatposts, frames



    • Improper fit

    Terrain-related


    • Surface: mud, gravel, loose dirt, wet



    • Unfamiliarity



    • Downhill



    • Obstacles and jumps

    Environment-related


    • Competition



    • Heat



    • Cold



    • Sun



    • Lightning



    • Orienteering mishaps



    • Animals and reptiles (attacks and collisions)




  • Most crashes occur while riding DH.



  • Injuries from loss of control, loss of traction, and mechanical failure result in similar injury patterns.



  • Special attention is applied to the cyclist–bike–terrain interface and how it relates to injuries.



Falls





  • Forward fall over handlebar (endo)




    • Most common direction of fall and mechanism of acute traumatic injury



    • Common causes are rapid deceleration during downhill descent (most common cause of severe injury), hitting an object, improper jump landing, improper braking.



    • Reported injuries are soft tissue injuries and trauma to head, torso, shoulder, upper extremity; head, neck, and face injury.




  • Side falls




    • Common causes are sliding out around corners (sideslip), misjudged handling resulting in tip over, and dabbing of hand after losing balance in technical terrain.



    • Reported injuries are mainly soft tissue injuries; leg injuries, especially to knee and ankle; some upper extremity (reaching out or a fall on lateral shoulder).




  • Rear falls




    • Common causes are forceful wheelie, preloading (compressing suspension) to adjust for change in terrain, or a jump too early.



    • Reported injuries are soft tissue, upper extremity (especially hand and wrist), head, spine and torso, tailbone.




Collisions





  • Collisions with other cyclists are common in XC.



  • Sometimes with stationary object (trees or rocks)



  • Collisions with bike parts are common, especially bar, stem, and pedals; frame, brakes, and seat less common



  • Animals (prairie dogs and other)



  • Injuries from collision and noncollision similar in severity and anatomic location



  • One reported fatality in 2015 from blunt force trauma to the chest in an Enduro event



Evaluation


History





  • Review athlete training history to detect common errors (e.g., volume, intensity, hill work, periodization).



  • Acute traumatic versus overuse injury



  • Bike fit history (professional vs. self)



  • Experience, type of bike and riding, type of terrain and challenges



  • Helmet and other protective equipment use



Examination





  • Use the stationary trainer in the office for overuse and fit issues (dynamic evaluation); may use digital video.



  • Evaluate on and off the bike. Identify anatomic variations or malalignments (e.g., excessive knee valgus, leg length discrepancy (LLD) and errors in bike fit; adjust rider; evaluate shoes and orthotics if used.



  • Helpful tools: plumb line, long carpenter’s level, laser level, goniometer, suspension pump, zip ties (for sag settings), Allen wrenches and screwdrivers (for quick office adjustments)



General Treatment





  • General treatment approaches for traumatic and overuse injuries in off-road cyclists are similar to approaches used with other athletes (e.g., physical therapy, cryotherapy, anti-inflammatory medication).



  • Specific cycling injury diagnosis and treatment is a highly individualized area; affected by multiple variables including training, experience, riding style/type, and bike fit.



  • Relative rest and activity modification: temporarily decrease mileage, intensity, hill work; spin using low-resistance and high-cadence pedaling; correct training errors.



  • Consider placing rider back to neutral position, especially if bike was never fit; adjust from there



  • Medication: nonsteroidal anti-inflammatory drugs (NSAIDs) for analgesia and inflammation, bacitracin ointment for soft tissue trauma



  • Ice appropriate overuse injuries after rides and intermittently throughout day; keep the affected joint warm during ride (e.g., knee warmers)



  • Physical therapy (see specific injuries )




    • Lower extremity (especially hamstring, iliotibial band) flexibility



    • Back and neck flexibility



    • Strengthening: lower extremity (eccentric programs for Achilles, patellar, and hamstring tendinopathy), dynamic core stabilization, upper extremity



    • Plyometrics, proprioreceptive, and other cycling-specific coordination training



    • Deep tissue massage and release techniques



    • Neural stretching maneuvers




  • Consider ionto- or phonophoresis in the appropriate settings.



  • Bracing, strapping, or taping where appropriate




    • Knee: soft patellofemoral brace, infrapatellar strap, McConnell taping



    • Hand and wrist: use an off-the-shelf wrist or thumb spica split (can bend steel stay to handlebar, most cycling gloves fit over), custom-molded orthosis (e.g., Orthoplast)




  • Corticosteroid injection




    • Upper extremity: carpal tunnel syndrome, de Quervain’s tenosynovitis, intersection syndrome



    • Lower extremity: pes anserine bursitis, trochanteric bursitis, iliotibial band syndrome, Morton’s neuroma






Specific Injuries


Overuse Injuries


Epidemiology





  • Retrospective questionnaire surveys indicate 45% to 90% of mountain bikers have been affected.



  • Body regions most commonly involved: knee and low back most common, then hand, wrist, neck, and buttocks/saddle region



  • Likely grossly under-reported: poorly studied, probably common



  • Many studies evaluate injuries resulting in lost time on bike; excludes many overuse injuries



  • Bike fit is closely linked ; interaction between cyclist, bike, and terrain



  • Anatomic variations and fit errors (even by a few mm) magnified by many hours of training and cumulative repetition; especially affects lower extremity



  • Upper extremity injuries related to weight distribution over the front of the bike and are affected by bars, bar ends, grips, and stem height relative to saddle; also related to shifter type and front suspension (travel, preload, rebound)



  • Causes and risk factors: too much training and improper training progression (e.g., sudden increases in mileage or riding intensity, climbing too many hills during the early season, inadequate recovery), too many hours of training/racing, too many different types of riding, too much rough terrain, improper fit, anatomic variations and faults, incorrect saddle position (dynamic), insufficient stretching, incorrect gear ratio (pushing large gears too much, especially during the early season), not enough warm-up, wrong shoes, not enough training (inadequate preseason conditioning), cold weather



  • Treatment and prevention focuses on training and fit.



Knee


May be the most common joint affected by overuse; affects 30% to 40% of mountain bikers


Patellofemoral Pain (Biker’s Knee, Patellar Tendonitis, Quadriceps Tendonitis)





  • Causes: Saddle set too low, aggressive sprinting, pushing big gears and aggressive climbing during the early season, pes planus and overpronation, excessive genu valgum, LLD, crank arm too long



  • Treatment: Pedal spacers, medial wedge, or a cycling orthotic for excessive knee valgus, raise seat, move cleats rearward, move seat back, set a higher cadence (90 to 100 rpm), easier gears, avoid hills, shorten crank arm, correct LLD (shim), correct training errors



Pes Anserine Bursitis





  • Causes: Saddle set too high, pedals with too much float, stance too wide on pedals, LLD, overpronation, tight hamstrings, cleats inappropriately neutral or internally rotated, external tibial torsion



  • Treatment: Lower saddle, correct LLD (short leg) and overpronation with an orthotic, shim, wedge, or by adjusting cleat position (move anterior); adjust cleats to match foot alignment (e.g., toes point out slightly)



Iliotibial Band Friction Syndrome





  • Causes: Stance too narrow on pedals, cleats inappropriately neutral or internally rotated, saddle set too high, pedals with too little or too much float, genu varum



  • Treatment: Add a threaded spacer or washer between the crank arm and pedal (correct varus), adjust cleats to reflect foot alignment (toe out), lower the saddle, use pedals with appropriate float, introduce cycling orthotics to control excessive lower leg rotation



Plica Syndromes (Especially Medial)





  • Causes: Saddle set too low, genu valgum, overpronation, internal tibial torsion, excessive pedal float



  • Treatment: Raise saddle, introduce cycling orthotics, adjust cleats to reflect foot alignment (toe in), decrease pedal float.



Hamstring, Popliteus Tendonitis, and Posterior Capsule Strain





  • Causes: Saddle set too high and/or posterior, riding a fixed gear bike (hamstrings used to decelerate), genu varum, pedals with too much float, LLD



  • Treatment: Lower and/or slide the saddle forward, slide forward on seat during steep climbs in granny gear (increases quad workload), pedals with minimal float, use of a threaded spacer or washer between crank arm and pedal, correct LLD, eccentric strengthening program



Hip


Gluteus Medius Pain Syndrome, Trochanteric Bursitis, Ilipsoas Tendonitis, and Hip External Rotator Tendonitis





  • Causes: Weak and/or inhibited hip abductors and external rotators, genu valgus, overpronation, pedals with too much float, LLD, saddle set too high



  • Treatment: Strengthen hip abductors and external rotators, decrease pedal float, introduce a cycling orthotic, medial wedge or shim, lower the saddle, consider trochanteric bursa corticosteroid injection if there is evidence for bursal fluid on ultrasound (avoid multiple injections due to concerns for gluteus medius tendon rupture)



Leg and Ankle


Achilles Tendonitis and Retrocalcaneal Bursitis





  • Causes: Improper pedal form (drop heel, toe pedaling, or combination of both called ankling—excessive dorsiflexion and plantar flexion during pedaling), cleat too far forward, overpronation, tight Achilles, shoe rubbing (with Haglund’s deformity), saddle set too high or too low



  • Treatment: Correct pedal form, move cleat rearward, stretch Achilles, raise or lower saddle depending on problem



Tibialis Anterior Tendonitis





  • Causes: Saddle set too high, ankling



  • Treatment: Lower saddle, anterior ankle stretching, tibialis anterior eccentric strengthening, establish proper pedal stroke



Posterior Tibialis Tendonitis





  • Causes: Overpronation, ankling



  • Treatment: Cycling orthotic or medial wedge, posterior tibialis eccentric strengthening, establish proper pedal stroke



Foot


Hot Foot (Forefoot/Toe Numbness and Pain, Metatarsalgia, Paresthesias, and Morton’s Neuroma)





  • Causes: Improper cleat position, irregular sole (cleat bolt causing localized plantar pressure), tight or narrow shoes, small pedal platform, toe clips, improper rotational cleat adjustment



  • Treatment: Move cleats back (lower saddle same amount) and adjust rotation to individual mechanics, loosen toe clips or convert to clipless pedal, install thinner insoles and/or add metatarsal or neuroma pad, larger pedaling platform, wider shoe or shoe with anatomic footbed, occasional corticosteroid injection



Plantar Fascitis





  • Causes: Tight plantar fascia, overpronation, excessive pedal float, saddle set too low



  • Treatment: Stretch plantar fascia, introduce night splint or sock, cycling orthotic or anatomical footbed, decrease pedal float, raise saddle, neutral position or dorsiflexion night splint or sock



Hand and Wrist


Wrist pain in 19%, hand numbness in 19%, and finger tingling in 35% of all mountain bikers.


Ulnar (Cyclist’s Palsy) and Median Neuropathy (Carpal Tunnel Syndrome)





  • Description: Incidence of compression of nerves at Guyon’s canal and carpal tunnel syndrome is probably similar in road and mountain cyclists; presents with motor, sensory symptoms or both; ulnar nerve presents with the most sensory symptoms; experienced and inexperienced cyclists equally affected



  • Causes: Improper grips (size, shape, firmness), infrequent change in hand position, bumpy terrain, improper suspension settings and tire pressure relative to terrain, lack of suspension, “death grip,” lack of glove padding



  • Treatment: Proper grip size and comfort fit, frequent changes in hand position (bar ends can be helpful), proper weight distribution on bars and seat (affected by fit and riding style), experimentation with bar angles, padded gloves, instructing the athlete to loosely grip bars, decrease suspension preload and tire pressure, consider front suspension if rigid, stretching while on the bike.



De Quervain’s Tenosynovitis, Extensor Carpi Ulnaris Tendonitis, and Intersection Syndrome





  • Causes: Occurs especially with grip shift, sometimes with integrated shifters



  • Treatment: Wrist and/or spica splint (dynamic) to minimize provocative motion, change shifters to trigger, consider a local steroid injection



Muscle Cramps





  • Description: Especially affects quads, hamstrings, and calves, some upper extremity (especially triceps)



  • Treatment: Hydrate with appropriate electrolyte drinks (especially when hot), decrease riding intensity slightly, soften suspension, ensure appropriate training volume, stretching



Low Back Pain





  • Description: 37% of cyclists are affected; one of the most common overuse complaints, may be as common as knee pain



  • Causes: Most frequently by improper fit, riding position, or inappropriate progression of training volume and intensity. Specific causes are over-reaching (stem too long or seat too posterior), too much drop, rough terrain, incorrect suspension preload and tire pressure settings relative to terrain, and training errors (especially too many hills and long rides early in season).



  • Treatment: Proper fit, raise handlebars (especially during early season), shorten stem, correct LLD, core strengthening (also addressing abdominals and iliopsoas), adjust suspension setting to terrain, lower tire pressure slightly and consider changing to wider tires, hamstring flexibility, proper riding form, avoid excessive bumpy terrain and intense hill climbs early season, change positions on the saddle during a ride and stand intermittently, sometimes may need to increase reach if pain is related to crowded position (lengthen stem). Disc injuries and radiculopathy frequently worsen with hills and rough terrain. Certain styles of yoga may be helpful.



Neck Pain





  • Description: Common in mountain cyclists, similar rider–bike causes and treatments to low back pain



  • Treatment: Ride with elbows appropriately flexed, change neck positions frequently, avoid tensing. Hydration packs worn by most mountain cyclists can augment neck pain. Make sure pack straps are adjusted appropriately. Consider decreasing weight of or eliminating the pack by using water bottles and/or an under-the-seat storage pack.



Scapulothoracic Pain





  • Causes: Common in mountain cyclists, similar causes to neck pain. Scheuermann’s kyphosis (classic or atypical) can worsen with mountain cycling, especially over more aggressive terrain. Hydration packs especially contribute to levator scapula, trapezius, and rhomboid myofascial pain and trigger points.



  • Treatment: Stretching, needling or acupuncture, fascial release, establishing proper rider form, stretching on the bike (especially during long rides)



Genitourinary


Pudendal Neuropathy





  • Description: Numbness in saddle region reported in 19% of cyclists. Males affected more than females; females report sensory symptoms.



  • Causes: Compression of the pudendal nerve (and possibly the artery), especially after repeated long hill climbs and many hours on the bike.



  • Presentation: Perineal, penile shaft, and scrotal numbness; impotence/erectile dysfunction and priapism (rare)



  • Treatment: Ensure proper bike fit (especially seat height, fore-aft position, and tilt), proper weight distribution between bars and seat, make sure saddle not tilting up, lower seat, consider change to a softer with a central cutout, use quality cycling shorts with adequate padding, increase handlebar height (which distributes weight more posteriorly over ischial tuberosities), recommend standing during long climbs



Skin Problems Related to Saddle





  • Description: Chafing, callus (ischial tuberosities), maceration and ulceration, and painful nodules. Painful nodules (saddle sores) likely inflammatory (repetitive friction of hair follicle with resultant inflammation and scarring), but can be infectious; considerations: folliculitis, furuncles, carbuncles, pseudocysts, hidradenitis suppurativa



  • Treatment: Mostly aimed at prevention. Proper seat height and fore-aft, level seat position; individualize saddle fit (consider softer saddle with center cutout and/or broader rear); proper reach and bar height; proper hygiene (skin and shorts, shower immediately after ride, and wash cycling shorts between every ride); intermittent standing; avoid wearing low-quality underwear; use well-padded cycling shorts; lubricants or chamois creams are frequently used (petroleum-based probably better than water-based); antibiotic ointments or gels (bacitracin, clindamycin) can be used for infection and for prevention if recurrent folliculitis or hidradenitis suppurativa; occasional corticosteroid injection of nonresolving painful nodule; sometimes requires surgical resection



Urethritis





  • Description: Traumatic irritation of urethra from rough terrain and/or improper rider position and fit



  • Symptoms: Variable; urethral paresthesia, dysuria, hematuria, sometimes pyuria



  • Treatment: Similar to pudendal neuropathy



Prostate





  • Description: In healthy men, the measurement of total prostate specific antigen (PSA), free PSA, and complexed PSA is not disturbed by long distance mountain biking or endurance exercise.



  • Treatment: Based on the present data, there is no evidence for a recommendation to limit bicycle riding or physical activity before any measurement of PSA.



Scrotal Ultrasound





  • Description: One study compared mountain bikers to healthy males and found 94% of mountain bikers had abnormal findings compared to 16% of the control group. Another study compared mountain bikers to road cyclists, and found that 94% of the mountain bikers had abnormalities versus 48% of the road cyclists. Most common abnormalities include scrotoliths, spermatoceles, and epididymal calcifications.



  • Treatment: Clinical significance is unclear.



Overtraining





  • Description: Aggressive terrain, often with repeated hill climbing, may contribute to overtraining in mountain bikers who are not careful to incorporate adequate recovery between rides. May especially be a factor during the early season, after a “melt out” in colder regions, when mountain bikers tend to get spring fever and increase their training volumes rapidly because of a desire for trail time. Altitude training may increase need for recovery.



  • Treatment: See Chapter 23 : High Altitude Training and Competition and Chapter 28 : Overtraining. Mountain cyclists often complain of “heavy” legs on the bike, especially during hill climbs (a loss of power is also noted) and with stairs.



Acute Traumatic Injuries


Epidemiology



Jul 19, 2019 | Posted by in SPORT MEDICINE | Comments Off on Mountain Biking
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