Dealing with pain is part of being a cyclist, but when does toughing out discomfort cross the boundary into risking injury
Cyclists ignore pain. Sometimes that’s necessary; for example, keeping going in the face of the pain caused by hard effort. But we often ride through the pain caused by illness or injury, and that’s not wise.
How can you detect where the fine line falls between the ‘good’ pain of healthy exertion and the stubborn ‘bad’ pain that is the warning sign of physical damage?
Sometimes you get away with overstepping the mark but each time you run a risk of prolonging or worsening an injury, making yourself ill or destroying hard-won form and fitness. In extreme cases, where overtraining syndrome takes hold, you could be off the bike for months.
The decision whether or not to ride through illness, injury or fatigue is a finely balanced one. For pro riders, it’s especially crucial, as lost training time can have serious consequences for form.
One Pro Cycling’s Pete Williams, winner of the mountains jersey in the Tour of Britain, has learned when to back off. “The first instinct of a sportsman is to ignore warning signs,” he says.
“As a younger rider, I’d panic and worry I’d never get the fitness back. But now I’ve got more experience, I’m not afraid to take a few days off,” he continues.
Pro riders tend to be attuned to their bodies, spotting subtle signals, and bigger teams have specialised tools available to highlight them.
Williams has been racing for 10 years and knows the signs: “Hard weeks back to back can cause niggles in the knees and Achilles, even a touch of tendonitis. They’re signs your body isn’t coping.”
For amateurs, learning to listen to your body is a skill worth developing, though acting upon it takes discipline. So, how do you know when to back off and when to soldier on?
Testing for overtraining
Some pro teams use a tool called the Daily Analysis of Life Demands for Athletes (DALDA). “This is a questionnaire that lists 25 symptoms ranging from mood to muscle soreness and sleep quality,” says Professor Mike Gleeson from the School of Sport, Exercise and Health Sciences at Loughborough University.
“If five or more symptoms are worse than normal on consecutive days, it’s a sign to back off and rest. It’s a simple tool and it can be extremely useful.”
However, the expense of online athlete training journals such as DALDA and RestQ are prohibitive for amateur riders; some coaches may have access to these technologies, but most of us have to rely either on our own judgement or the NHS.
If the problem is a non-specific feeling of being ‘off it’, with symptoms of lack of motivation, listlessness and fatigue, it may be worth requesting a blood test from your GP. This will not identify overtraining syndrome (see below) but it could diagnose specific deficiencies.
“It can be useful for diagnosing anaemia, which is fewer red blood cells than normal or less haemoglobin than normal. That can have a consequence for performance,” says Gleeson.
“A blood test may also tell you about the possibility of allergic reactions and it can also look at the total number of white blood cells, which can be an indicator of illness, ” he adds.
Get to know training zones
There is a practical limitation here: hard-pressed GPs are unlikely to offer detailed cycling-specific advice nor order blood tests unless they identify a particular clinical need. For injuries, they are likely to prescribe non-steroidal anti-inflammatories (such as ibuprofen) and rest. The prolonged use of anti-inflammatories should be avoided, says Gleeson.
“There is evidence that they can blunt adaptations to exercise, so can adversely affect fitness. They’re OK in the short term to relieve pain but long-term use should be avoided. Rest, though, never does any harm.”
Indeed, rest is almost always the best strategy to fight illness and injury; of course, staying off the bike can be difficult.
“Exercise and training have parallels to addiction. If you’re prevented from getting your dose you can get upset, so some people carry on and hang the consequences, but it’s important to pull back sometimes because [carrying on regardless] can have serious and long-term effects,” says Gleeson.
When is it best to rest? Let’s take a look at some of the common problems where cyclists need to learn to listen to their bodies.
Overuse ailments are caused by the repetitive nature of pedalling. A cadence of 80rpm means almost 5,000 revolutions per knee per hour. Patellofemoral syndrome, or cyclist’s knee, is a common injury in the overuse bracket.
The knee is the most common site for all overuse injuries, including tendonitis of the knee and of the Achilles as well as iliotibial band (ITB) friction, an irritation of the connective tissue on the outside of the thigh, and medial plica syndrome, an irritation of the membrane around the knee.
The warning signs: Overuse injuries manifest themselves as a pain in the affected area. Confusingly, sometimes pain is not directly related to the affected area, so a pain in the knee may be caused by something other than a knee problem.
Warm-up properly before riding
If ignored, there is a real risk that the inflammation will cause damage to tissue, and further repetition can lead to degenerative changes that lead to long-term injury and chronic pain.
The fix: “You need to stop training because of the danger of making it worse,” says Gleeson. The affected area will benefit from a break from the repetition causing the damage.
“You can maintain some aerobic condition by taking some non-load bearing exercise, like swimming, for instance.”
Longer-term, the source of the problem needs to be identified. Typically, a physiotherapist experienced in treating cyclists would help identify the problem and the next step may be to decide how the problem can be solved permanently.
Often that may involve a bike-fit, and especially with knee problems, this should include a detailed look at cleat position. Exercises recommended by a physio can also help.
Overtraining is a little-understood problem that, according to Gleeson, is “only ever diagnosed when everything else is ruled out in trying to work out the reasons for underperformance”.
It is usually associated with an extended period of heavy exercise and may also be related to other sources of stress, sometimes known as ‘lifestyle stress’, deriving from work or family matters.
“The body does not distinguish between different types of stress,” Gleeson says. Committed amateur riders can be prone to overtraining syndrome because they may cram in short periods of high-intensity exercise and don’t leave enough time for recovery, given all the other pressures of a busy life.
The warning signs: “Fatigue when training, disturbances of mood, a poor quality of sleep and recurrent minor infections are some of the symptoms,” says Gleeson. A lack of motivation and a failure to derive enjoyment from riding or training are others.
The fix: Rest, pure and simple. If overtraining syndrome is not stopped in its tracks, it can develop into an affliction that is almost impossible to get treated on the NHS and can keep you off the bike for months. Overtraining syndrome cannot be fixed by riding through it. Typically, a period of two weeks off the bike completely can be a successful strategy, but it can take longer.
Good nutrition can help stave off illness and keep you riding
Cyclists who train hard are more prone than the general population to viral infections.
“Continual hard training, or a period when an individual intensifies training over successive days has a depressive effect on white blood cells that fight bacterial and viral infections,” says Gleeson.
The most common viral infections are colds and flu, but others can strike, especially in the gut.
The warning signs: It’s pretty obvious when you have a cold or a stomach bug, but the bigger warning sign to watch out for is when the infections are contracted frequently. If you keep getting colds or other infections, one after the other, you need to take action.
The fix: Oral and hand hygiene are important for reducing the frequency of infections and, in serious cases, the training load needs to be reduced.
Other things can also be done. “Nutritionally, ingesting carbs during training and 20g of protein in a post-exercise meal can help,” says Gleeson.
From October to March, it can be helpful to take a vitamin D supplement of 1,000IU per day. “There’s some evidence that probiotic drinks can be useful in decreasing the frequency of gastro-intestinal and respiratory infections,” says Gleeson.
Broken bones and crash injuries
The old saying goes that there are two types of cyclist: those who have crashed and those who are going to crash. Injuries can range from the very serious to the superficial.
The broken collarbone is the most frequently seen crash injury, while injuries to the wrist are also common. Most cyclists will know the agony of a road rash.
The warning signs: You know when you’ve hurt yourself. If there is the slightest suspicion of a broken bone, an x-ray is essential. Concussion is potentially extremely serious, and any blow to the head needs checking thoroughly.
Even if there’s nothing broken, a crash can be traumatic to a rider’s general wellbeing and its effects should not be underestimated.
The fix: Rest. Return cautiously; monitor yourself continuously, and heed pain.
Pressure, abrasion, a heavy ride schedule, poor hygiene, badly fitting shorts, the wrong saddle — each of these, either individually or in combination, can produce saddle sores. They are the bane of many cyclists’ lives.
The warning signs: Persistent and worsening soreness; don’t ignore it.
The fix: The pro rider approach, as revealed by One Pro Cycling’s Pete Williams — “chamois cream and northern grit” — is one method but it won’t work for everyone, and we’re not sure we can recommend it.
Rest and your healing cream of choice if saddle sores are serious will get results but prevention is better than cure in this area.
Williams is scrupulous about hygiene and washes the affected bodily areas even if he can’t get a shower after riding: “I get them occasionally after a really hard block or riding a lot on bad roads. I wash myself and I wash my kit really thoroughly and I pay special attention to the chamois in the shorts — if there’s no washing machine available, I’ll hand-wash my shorts really carefully.”
Am I overtrained?
One of the difficulties with overtraining syndrome is that it can be tricky to distinguish from normal fatigue — a natural consequence of training. One way is to ask yourself a series of questions whenever you begin to feel worn down.
If your responses reveal that you are feeling consistently under-recovered, or getting progressively more tired, you may need to back off for a period.
The following questions have been drawn up to help you distinguish
overtraining from regular fatigue.
- Do I feel lacking in motivation to train?
- Am I more irritable than normal?
- Is my heart rate slower to rise and lower than usual while training?
- Are my muscles sorer than normal?
- Am I struggling to sleep?
- Have I had a series of colds or minor infections?
- Am I finding it harder than usual to recover between hard sessions?
- Is my appetite weaker than usual?
- Have I had a series of niggling injuries?
- Have I been feeling generally lacking energy?
- Am I more stressed than usual in the rest of my life?
If you answer ‘yes’ to more than a couple of these questions, it may be time to take a break. How long a lay-off you need depends on your circumstances; try a couple of days, all the while keeping a close eye on your symptoms and energy levels. Even if you have to take a fortnight’s rest, the moderate loss in fitness is preferable to complete burn-out, which can take months to recover from.