When cyclists line up at FNB Stadium in Joburg on Sunday for the 947 Ride Joburg, there’ll be a few grimaces of pain behind the sports sunglasses and sunblock. Many of the twinges will be in the shoulder, lower back or buttock, but most will be in the knees, and the riders experiencing the worst pain will be men over 50. Nearly half the injuries will have been noticeable for more than a year.
We know this because some sports medics have just published their findings after collecting data about niggling injuries from almost 63,000 Cape Town Cycle Tour entrants between 2016 and 2020.
Only about 3% of riders said that in the previous year they had suffered gradual-onset injuries severe enough to interfere with cycling or require treatment. Almost one third of the injuries were in the knees, usually the patella region.
Many of the injuries (40%) were severe enough for the riders to reduce or stop training, and 20% eventually required surgery, according to Prof Martin Schwellnus and his colleagues, who include PhD candidate Francois du Toit, at the University of Pretoria’s Sport, Exercise Medicine and Lifestyle Institute (Semli).
This is why recreational cyclists fit perfectly into a programme Schwellnus has been running since he moved north from the University of Cape Town to open SEMLI seven years ago.
The paper his team has just published in The Physician & Sportsmedicine is the 27th in its “Safer” studies series, which aims to reduce injuries, illnesses and even fatalities during mass sporting events.
The studies have led to the development of screening and educational intervention programmes that have reduced overall medical incidents by 30% during events such as the Two Oceans Marathon and have cut life-threatening incidents by 60%. The online screening and educational intervention system was used at the Comrades Marathon for the first time this year.
After working out which gradual-onset injuries plague recreational cyclists, and which demographic suffers the most, the Pretoria scientists have moved on to asking why. Papers based on this work are in peer review, and Schwellnus is reluctant to jump the gun by revealing the findings.
But Cape Town Cycle Tour Trust director David Bellairs thinks he knows. “It’s directly related to bike set-up. And the knee pain comes from pushing too big a gear,” he says. “Higher cadence means lower stress,” something riders might be glad to know on Sunday’s long uphill slog from Kyalami to the top of Jan Smuts Avenue.
Bellairs, 59, has had his share of gradual-onset injuries during 40 years of cycling, but says the last decade has been easier since he splashed out on a professional set-up. “Cramp, neck pain, back pain — they all disappeared. It was a total game-changer,” he says.
“The trouble with guys in my age group is that a lot of us think we know better. We’ll buy a R100,000 bike or a R1,500 tyre but we won’t spend R900 on a set-up consultation.”
His view is borne out by SEMLI’s statistics on the ways cyclists tackled their injuries: 33% tried medication, less than half the number had a bike set-up, while 2.5% bought new shoes, pants or gloves.
Anterior knee pain — soreness around the kneecap, in layman’s terms — is one of the most common injuries in active people in general, especially runners.
In cyclists, it’s linked to the way various muscles are engaged during the push phase of pedalling. Overdevelopment of muscles in the outer thigh pulls the patella out of alignment, leading to pain.
SEMLI’s latest findings echo a 2012 study at what was then the 94.7 Cycle Challenge. Of those who took part, 88% said they had experienced nontraumatic injury, pain or neurological symptoms in the past year. “Knee pain was responsible for the need to stop training for the largest percentage of respondents,” the paper reported.
This is a key worry, says Schwellnus, because exercise and activity are so important to wellbeing. “As doctors, we need to be able to mitigate the risk of injury or medical problems when we prescribe exercise,” he says.
The Safer research studies he has led since 2015 aim to tackle this in four steps: identifying a problem and its extent, understanding why people have the problem, implementing a prevention programme and monitoring the outcome.
The work has its genesis in Schwellnus’s experience as a medical officer for the Two Oceans Marathon. Several competitors died during the 56km race in Cape Town between 2008 and 2011.
One of the early Safer studies analysed 539 medical incidents, including three cardiac arrests and one death, that took place during the Cape Town Cycle Tour between 2012 and 2014. This led to an investigation into risk factors for injuries during the event: the biggest were being a woman, being older, cycling faster and cycling when wind speed is high.
Being older and cycling slower were the main risk factors for serious, life-threatening or fatal illnesses while cycling 109km round the Cape Peninsula.
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