14-06-2018

Blog Post by PhD Paul Visintini Part 2

How do we analyse loading in cycling: Part 2

The cycling kinetic chain

In part 1 of this series, we introduced the concept of “Mastering Load” in cycling, essential knowledge for treatment and injury management, with its inherent requirements being a knowledge of:

  • tissue reaction to load,
  • tissue pathology,
  • the mechanics of cycling,
  • cycling kinetic chain deficits,
  • how to analyse and reason the findings of local, entire kinetic chain and whole body assessment
  • interpretation of training loads and wellness measures

Whilst we have touched upon the lack of ‘conversation’ regarding the cycling kinetic chain and its relationship with injury, there have been informed commentaries in the past eschewing a kinetic chain approach:

Gregor, in his classic review paper of 1996, commented “knowledge of….load sharing among all segments responsible for the co-ordination of energy delivery to the crank is important..”

In that same review he quoted Van Ingen Schenau, 1989,

“…uniarticular muscles are power producers and bi-articular power distributors….”.

FACT: The kinetic chain approach to analysing pedalling is a viable construct

As a background I think we must explore the “Perfect” vs “Imperfect” technique of pedalling, and how this imperfect technique can be a source of pain or injury. And what the measures are which guide us in assessing that a pedal stroke is imperfect – kinematics, muscle activation, co-ordination, strength, length-tension relationships, force, power, posture?

ACTIVATION

In the area of normal muscle activation in the pedal stroke, the historical perspective was simplistic, with the more realistic pattern represented in figure 1

FIGURE 1 – MUSCLE ACTIVATION in the CYCLING PEDAL STROKE

(TDC = top of pedal stroke; BDC = bottom of pedal stroke)

And whilst the gluteals and quadriceps are seen as the main muscles for power production, co-ordination of the pedal stroke utilizing the hamstrings and calves seems an important feature of “perfect” pedaling (Blake 2012).

Note the extensive range of hamstring activation, as well as the calf, especially in the power phase, in an agonist/antagonist relationship to control the pedal stroke. Also the activation of tibialis anterior, and vastus lateralis and medialis, at the end of the recovery to prepare to push over the top of the pedal stroke.

The most efficient pedaling needs to maintain power at the top and bottom of the pedal stroke (Dead Centres – Leirdal 2011). Given that the peak of power is at 3 o’çlock on the clock-face, maintaining power at the Top Dead Centre (TDC) and Bottom Dead Centre (BDC) becomes a challenge of co-ordination/activation.

CO-ORDINATION

Blake (2012) looked at muscle co-ordination patterns in cycling, finding that peak efficiency occurred at 55% VO2 max, with efficiency being the relationship between power output and metabolic cost. At optimal efficiency there was an even spread of activation levels between the muscle groups, but as the workload increases, there was a greater emphasis upon the power muscles (GMx, VL, VM), and less efficiency (least at 90% VO2 Max), with a higher level of variation in the timing of the co-ordination muscles (Hamstrings, RF, Gastrocnemius).

Blake showed that the GMx and VL/VM are the power muscles acting vertically, but with the VL/VM activating earlier in the pedal stroke at higher workloads, and GMx increasing the most relatively, as workload increases. An increase in the work done by the power muscles relative to the co-ordination muscles is a common theme with increased workload and fatigue states (Dingwell 2008, Bini 2010).

Periods of high workload (hills/powering) and fatigue have a relationship with the clinical presentation of pain in the cycling community. Rarely does pain present in “easy” riding.

The GMx has the greatest potential for increased power as it functions at low MVC at maximum efficiency. One can imagine it, and the VL/VM being the gears, and the co-ordination muscles the clutch, allowing for synchronous change in gears and timing of activation. So the “gears/power muscles” increase their activation level significantly with increased workload, whilst the co-ordination muscles don’t increase their activation for power, but they function for smooth transmission of the power, especially in the TDC/BDC positions.

The idea that the hamstrings and calf muscles work synergistically with the power muscles to co-ordinate the fast and powerful moments of hip, knee and ankle extension resonates well from a movement analysis perspective, with early activation of quadriceps and tibialis anterior at TDC to gain a good angle for the horizontal vector component, also a notion that makes sense. Add the strong and smooth transmission of force to the pedal through ball of foot contact and good foot and ankle range and position, and the proposed model of power and co-ordination presented by Blake is highly usable for the physiotherapist in optimising efficiency and injury prevention in cycling.

The co-ordination correlate on the bike is high cadence pedaling (100RPM+), with riders who struggle with their co-ordinative muscle activation finding it difficult to maintain a smooth pedal stroke and “bouncing” around on the seat. Practice of high cadence pedaling is common in well-trained cyclists – therefore the practice of optimising co-ordinative patterns exists.

So the higher the workload, the more dominant the power muscles become, with a less efficient and more vertical pedal stroke. If the power muscles are deficient other muscles must fill the gap as workload and fatigue increase. Riders with poorer co-ordination will use the power muscles more at lower loads, with earlier fatigue, less efficiency and greater potential for adverse kinematics.

FACT: There is a “more perfect” way to pedal which may influence injury risk.

KINETIC CHAIN

As a clinician analyzing the cycling kinetic chain for a relationship between pain/injury and a posture, movement or strength parameter, one soon realizes that the evidence is minimal and not strong.

We look to use the evidence base, to extrapolate from “on-land” activity theory, to use performance based knowledge, and clinically reason the findings of a thorough assessment in best practice management.

Evidence

  • Lower back pain if there is Increased Lumbar Spine Flexion (Van Hoof 2012, Salai 1999, Burnett 2004, Schulz 2010)
  • Knee pain is associated with increases in knee abduction and ankle dorsiflexion (Bailey 2003), as well as hamstring muscle inco-ordination (Dieter 2014)
  • Cycling volume (Andersen 1997, Akuthota 2005) is associated with neuropathies of the hands, feet and saddle area
  • Handlebars lower than saddle (Partin 2014) is associated with saddle neuropathy

Extrapolation to Land based presentations:

  • Gluteal Deficit is associated with patella-femoral pain syndrome (PFPS) (Souza and Powers 2009) and patterns of “anterior hip overload” (Lewis and Sahrmann 2008)
  • The ankle joint is required for load dissipation – a first order worker (Zhang 2000)
  • Quadriceps weakness is a risk factor for PFPS (Langhorst 2012)
  • Dynamic Knee Valgus is associated with PFPS and ITBFS (Powers 2009, Fairclough 2009)

Performance based parameters:

  • Knee Angle at Bottom Dead Centre (BDC) STATIC 25-35 degrees (Peveller 2007); DYNAMIC 33-43 degrees (Fonda 2014)
  • Force Transfer foot-pedal is mainly ‘ball of foot’ (Gregor 1996)
  • Fatigue/High VO2 leads to increased use of POWER muscles (Blake 2012), increased DF (Bini 2010) and Knee Splay (Dingwell 2012), increased lumbar and pelvic lateral flexion (Sauer 2007, Chapman 2008)
  • The gluteals and quadriceps are important for power; hamstrings and calf for co-ordination (Blake 2012)

FACT: Plumb Line measures and fore-aft seat measures are not represented in the evidence.

SUMMARY

It would seem that key features of the CYCLING KINETIC CHAIN are lumbar spine position, degree of lateral pelvic tilt, gluteal and quadriceps muscle ability, degree of knee valgus (splay), the ability to be smooth and co-ordinated in the pedal stroke, knee angle at BDC, ankle DF angle and ankle joint ability and the point of force application foot to pedal.

CONCLUSION

Pain and injury in the athletic population is complex in its aetiology. Clinical reasoning is essential to optimising management, and in cycling understanding the knowledge base regarding the interaction between the body and the bike is an important cornerstone to expert practice. The kinetic chain approach to analysis of cycling injury is a valid pathway and will bring cycling injury management to a level similar to other high performance sports.

Paul Visentini is a Specialist Sports Physiotherapist, with his awarded sub-speciality in the area of lower limb tendinopathy. He also completed post graduate studies in Manipulative Physiotherapy in 1994, and designed the “VISA Score”, a widely used functional outcome measure for Patellar Tendinopathy.

Paul is a keen recreational cyclist and is highly involved in teaching and management in the area of Bike Set-Up and ‘Mastering Load’. He has been involved in Cycling Injury Management at both elite and recreational level, having consulted to the AIS in Varese, and is undertaking his Doctorate in Physiotherapy, investigating “Clinical Measures of the Closed Kinetic Chain in Cycling”.

Paul is a leading clinician in Melbourne, Australia, and has a passion for cycling injury management, the evidence base involved, and the clinical reasoning process required to achieve the best result.

The ‘ScienceOfCycling-Injury Prevention’ is a platform for the education of Cycling Injury Practitioners world-wide, and the associated course has now been presented by Paul in Melbourne, Varese, Italy and Newcastle, Australia.

Stay tuned for:
PART 3: Training Load and Injury : A coaches perspective

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