We’re in the final stages of what has been a fascinating Tour de France. We’ve seen some heroic climbs, nail-biting descents, and more than a few changes of fortunes for cyclists who started out as top contenders. The once unbeatable Lance Armstrong is now far back in the field, his best hopes dashed by a series of crashes, and Team RadioShack is now working for Levi Leipheimer. Andy Schleck saw a mechanical problem steal away his hopes for a Tour win. And other favorites, such as Cadel Evans and Fabian Cancellera, are now out of serious contention. Alberto Contador appears poised to ride victorious into Paris… but, as this Tour has demonstrated, all it takes is one bad or unfortunately timed crash to completely change the standings. There’s surely plenty more excitement to come!
The crashes started early, in stage two, when it seemed like hardly anyone could stay on their bikes as they rode over slick terrain. In addition to some serious injuries, there was a lot of road rash that day. “Road rash,” as you may know, is the grimly lighthearted name that cyclists give to the extensive abrasions they often get when they fall off the bike and slide along pavement. Along with saddle sores, which are caused by the constant rubbing of the bike seat, road rash is one of the most common injuries in cycling. I spent a lot of time treating them both when I was the assistant medical director and head athletic trainer for the Tour de Georgia.
Treating road rash and saddle sores is, frankly, pretty straightforward. The interesting work on the Tour de Georgia had to do with figuring out and fixing the root causes of neuromuscular and mechanical issues. For example, we once had a cyclist – a talented, experienced competitor – whose cadence inexplicably became very inefficient, and he started having some trouble with his IT band (also a common problem for cyclists). We spent a day following him in a car, and I noticed that his right knee was dropping with every revolution. We ended up tracing the problem to weakness in his right adductor, which wasn’t properly supporting the force that his legs were delivering. The result? He had to compensate for that weakness, and that led to an overuse injury.
Scenarios like this happen quite a bit in sports medicine. A neuromuscular problem in one area of the body frequently ends up being the result of muscle deficiencies elsewhere. If you solve that deeper problem, the presenting issues go away as well. In the case of this cyclist, we worked with him to strengthen his adductor. He then went from having trouble even keeping up with the peloton in the early stages to being one of three cyclists in a breakaway in the final stage. It’s deeply satisfying when we can deliver those kinds of results.
At Emory Sports Medicine, we also use cycling as an important component of physical therapy, most commonly in the case of knee injuries and procedures such as ACL surgery. A lot of this therapy starts out on stationary bikes. We try to get many of our knee patients onto the bike as soon as possible after surgery – often within a week of the procedure – in order to keep down swelling and restore range of motion. At first, they’re cycling with no resistance – just spinning, promoting blood flow and range of motion. Then we gradually increase resistance to build back strength. Some patients eventually choose to graduate from the stationary bike to riding outside. Of course, fans of cycling might want to stick with the stationary bike for a little bit longer, so that, while they ride, they can turn on the TV and watch a very exciting Tour de France!
About Forrest Q. Pecha:
Forest is the Director of Athletic Training Services at Emory Sports Medicine. He was the assistant medical director and head athletic trainer for the Tour de Georgia from 2005 through 2008. He also serves as the liaison between Emory Sports Medicine and the United States Soccer National teams for athletic training coverage, and provides support coverage to the US Men’s Alpine Ski Team. Forest has been with Emory Sports Medicine since 2004.