TREATMENT: SOME THINGS TO KEEP IN MIND

REALIGNMENT REMAINS THE ONLY DEFINITIVE TREATMENT
In someone with malalignment, toe clips, orthotics, cleat shims, a change in seating, or adjustments to the saddle, pedal, or crankshaft usually result in only some limited, if any, improvement of malalignment-related problems. They run the risk of triggering new problems by causing additional, unwanted biomechanical changes. Alternate methods of treatment, such as acupuncture, massage, intramuscular stimulation (IMS), stretching, and injections, may relieve tissue tension and pain temporarily but are unlikely to achieve realignment of the pelvis.

If a rider continues to go out of alignment, consider the possibility that they may be causing recurrences by:

THE WAY THEY GET ON AND OFF THE BIKE
The action of bearing weight with one leg on the ground or pedal while swinging the other one up and over the saddle creates unwanted, completely asymmetrical twisting-type forces through their pelvis and trunk. Leaning the bike toward them will decrease these torquing forces. A bicycle with a lowered or no crossbar at all makes getting on and off less demanding and is therefore preferable (Fig. 22). As in the case of a horseback rider, making use of a foot stool, steps, or the curb also cuts down on how much they have to raise the opposite leg and decreases the amount of asymmetrical rotation through the hip girdle and pelvis that would otherwise occur (Fig. 23).

THE RIDER MAY BE INADVERTENTLY CAUSING RECURRENCES

Fig 22

Fig 23

Fig 24A

Fig 24B

Fig 24C

The problem may be as simple as that of the runner who had stopped running during the course of manual therapy treatment but continued to go out of alignment. It turned out that he had taken up a symmetrical activity—cycling—as an alternative exercise. The recurrences of the malalignment were attributable to the torquing of his pelvis required to swing one leg over the seat and high crossbar when getting on and off the bicycle. He was resistant to the idea of switching to a bicycle without a crossbar. The problem was resolved by having him use a step stool or the curb to decrease any torsional strain.

LIFTING THE BIKE AWKWARDLY
Cyclists lifting a bike on and off a rack that is mounted to the top of the car ranks as a separate athletic event that can result in torsional stresses on their spine and pelvis and may cause them to go out of alignment again (Fig. 24A). Preferable are racks mounted to the back of the car. They are lower and let them lift the bike in a more-or-less symmetrical fashion while facing the rack; some allow rolling the bike on/off the mount using a detachable ramp (Fig. 24B,C).

CHOOSING TO RIDE THROUGH DEMANDING TERRAIN
Tackling jumps, tight turns, and sudden sideways stops when riding on mountain trails or in a bike park places increased demands on their whole body—often with a torsional component of the pelvis and trunk—that make it more likely for them to go out of alignment. It may be in their best interest to avoid these venues and stick to regular roads until they are starting to maintain alignment.

A PROVEN APPROACH TO TREATING MALALIGNMENT

Realignment of the pelvis is possible in most and the chances of eventually staying in alignment are increased by following a progressive treatment programme that includes:

GETTING THE RIGHT HELP

The rider’s recovery program should be supervised by a qualified manual therapist: osteopath, chiropractor, or other professional who has done the extra training to become proficient in using this treatment approach. They may choose to add compensatory techniques, like acupuncture or massage, to settle down ongoing pain and muscle tension and improve the rider’s chances of maintaining realignment.

BECOMING INVOLVED ON A DAY-TO-DAY BASIS

  • Learn to do a self-assessment for alignment, to spot recurrences of malalignment early on and seek treatment before they cause problems
  • Carry out some simple self-corrective manoeuvres that may allow them to temporarily achieve partial or complete realignment; this can prove particularly valuable when they are out on the road and away from any help, to prevent or minimize any SI joint instability and the development of pain until they can see their therapist

Fig 25

STRENGTHENING THE CORE STABILIZING MUSCLES

Regaining the stability of their pelvis and spine is essential for carrying out all actions (e.g., mounting the bike) in a controlled way. When SI joint instability is present, a sacroiliac belt may be helpful initially to decrease recurrences of malalignment until core muscle strength has improved (Fig. 25).

RE-ESTABLISHING NORMAL BODY MOVEMENT PATTERNS AND BALANCE

This can be achieved by starting a proven approach, such as Pilates, once they have built up core strength and are maintaining realignment for longer periods of time.

A GRADUATED RETURN TO CYCLING

Start with workouts on a reclining bicycle or, if that is not available, a stationary one, sitting upright to start, with the arms dangling relaxed at the sides and the legs doing all the work. When getting back on a bike, initially avoid low handlebars for the reasons mentioned above. A mountain bike is, therefore, preferable to one with dropped handlebars, and also provides more shock absorption.

AVOIDING RECURRENCES OF MALALIGNMENT OR TRIGGERING SYMPTOMS

Aggravating factors to appreciate include starting up or accelerating their cycling program too quickly, or subjecting specific areas of their body to increased forces that they are not yet ready to cope with by:

  • Exceeding their current physical capabilities in the course of training or competition
  • Changing equipment or terrain; for example, including terrain with sloped surfaces or suddenly adding up- and downhill components to a previously all-flat cycling workout
SUMMARY

Cyclists are vulnerable to developing problems caused by the pelvis and spine being out of alignment. The overall effect is to change their style, decrease their energy efficiency, and make them more vulnerable to injury. Making some changes in their approach to cycling, learning some simple self-assessment and self-adjustment techniques, and adhering to a progressive treatment program supervised by a manual therapist goes a long way to finally being able to realize their full potential in training and competition