Recovering from a clavicle fracture

So you have a major biking vacation planned or an important bike race on the calendar when you crash while out training or in a race. Are your plans ruined? What can you do to maintain your cycling fitness while healing?

According to Dr. Jonathan P. Braman of TRIA Orthopaedic, broken collarbones are a frequent injury for cyclists and can be very tough to ride through. Whether they are operated on or not, they can take weeks or months to heal. During the healing process, there are many ways to stay in shape for returning to the road.

Probably the best way is on a stationary bike. It must be stable enough to allow you to ride without using your injured arm, and you should lower the resistance to the point where you aren’t swaying too much in the sling. For many cyclists, this is best done with a recumbent stationary bike where you can sit down while you ride with your feet in front of you. This lowers the risk that you will use your injured arm to steady yourself. Other exercise like walking on a treadmill can also be helpful at keeping up general fitness while you wait for your broken collarbone to heal.

The Importance Of Moderate Training Intensity

By Dan Carey, Phd., Univ. of St. Thomas

The “no pain no gain” mindset of competitive athletes probably detracts from performance rather than enhances it. As a physiologist, I would like to explain the importance of “easy” training days.

One of the oldest and probably still most respected training philosophies is “hard-easy.” Physiologically the body needs to recover from a hard day. Intense training depletes glycogen stores. It takes approximately 48 hours to completely replenish glycogen (carbohydrate) stores. This is why 2 consecutive hard days are difficult to maintain.

In addition, hydration needs to be restored. A simple way to monitor your hydration status is with a bathroom scale. Large fluctuations in weight from day to day are the result of hydration status and not fat gain/loss.

Joel Friel, author of “The Cyclist’s Training Bible”, stated “Of frequency, intensity and duration, the one most important to get correct is intensity.” In addition to allowing the body to restore glycogen and water levels, easy days also train the body to metabolize fat better.

For endurance events of one hour or longer, burning fat allows the body to store glycogen for the next hard day. While I believe some advice given about “the fat burning zone” is very misleading, it is still true that a moderate intensity of training optimizes fat metabolism. This is both an acute and chronic effect.

In my research on the “fat burning zone” to be presented at a local sports medicine conference, optimal fat burning occurs at 59-76% of maximal heart rate. While this intensity is indeed moderate, it overlaps the low end of the target heart rate zone for improved aerobic endurance established by the American College of Sports Medicine (70-85% maximal heart rate).

A final point is that all of the desired changes in fitness occur when the body is at rest, not when the stress of exercise is applied. If the body is not rested, it cannot optimize these changes. A good example of this is tapering, which is a reduction in training volume/intensity for 10-21 days prior to an important race. Tapering has been shown to enhance performance 3-5%. While this may seem small, it may be the difference between an average and good performance.

While a training schedule will fluctuate from week to week, depending on the training period, I think a good program has at least 2 days of moderate training per week. I believe one of the primary benefits of training with a heart rate monitor is not in ensuring that you are in your “threshold” or “anaerobic zone.” Rather the best use of these monitors is for “holding back” your intensity and forcing yourself to stay within this moderate aerobic zone.

Injury Prevention 101 - Flexibility

by Dr. Josh Sandell
Spine and Sports Institute

[also see part 1 on Strength Training]

Flexibility

The Australian triathlon team was screened in November 2003 prior to the World Championships in New Zealand, and found two main predisposing factors to injury: thoracic spine stiffness and tight hip flexors.

This pattern is extremely common in cyclists. Cycling training is one potential cause of thoracic stiffness because of the time spent in the time-trial position. If good spinal posture is not maintained on the bike, the thoracic spine can become excessively hunched when the cyclist becomes fatigued. If this posture is not corrected and the mid-spine is not regularly stretched, stiffness can develop and a drop in cycling performance may follow as a result of the athlete adopting a less efficient aerodynamic position.

The thoracic spine's mobility can be improved with laying on your back over a physio ball or lying on one’s back with a towel on the floor.

Tight hip flexors are a major injury risk factor and are a common problem because of the length of time cyclists spend with the hip bent in the time-trial position while cycling. Low back injuries, hamstring strains, hip flexor strains and most lower limb overuse injuries can be linked to tight hip flexors. Hip flexor and quadriceps stretching are essential to prevent this pattern from developing.

The muscle groups should be stretched daily, before and after activity (especially after cycling). Stretches should be held for approximately 30 seconds to one minute without bouncing, performed gently and slowly to the point of tension but never pain.

While an effective stretching program may reduce injuries, many athletes look to stretching as the answer to injuries. Athletes do become injured because of overflexibility. Be consistent with your stretching, but don’t go to extremes and don’t look to it as the injury cure-all.

STRETCHING YES, STRETCHING NO…

Fernando A Pena, MD – TRIA Orthopaedic Center

In spite of scientists’ best efforts, we are still missing the scientific evidence that regular stretching prevents injuries. At the most, there is some suggestion that it may help to recover from an injury, like a muscle strain or pulled groin, but still it is a very soft correlation.

The benefit from stretching comes from preparing a muscle group for an athletic activity and sending the proper “signals” to get ready. The benefit is believed to be related to the increased blood flow to the muscle fibers as well as the connective tissue surrounding the muscle. Excessive stretching may be counterproductive, as it may create some degree of instability to a specific joint and therefore make it more susceptible to injuries.

The human body has to get ready to exercise. Similarly, it has also to get ready for something apparently as trivial as stretching. Something as simple as a brisk walk or a light vertical jumping for a few minutes would help to get the blood flow going and therefore it will facilitate the stretching program.

The golden rule for stretching is to avoid pain. To stretch until the rider feels pain it is considered to be excessive and definitely not beneficial. It is recommended to feel tension and a “stretch” but not necessarily pain. A good stretch should be held under tension for 10 to 30 seconds. Beyond that point it does not seem to be of an extra benefit either.

It is very important to avoid any “bouncing” of the muscle group while stretching. The “bouncing” will generate neurological signals at the level of the spinal cord which will be transmitted to the muscle and prevent further stretching, making the rest of the session useless and in some cases even injury prone.

In the case of a cyclist, the muscle groups, to benefit from stretching will include the lumbosacral spine (lower back) and lower extremities. The cervical spine (neck) and upper extremities will be positioned almost completely static during a ride. Regular stretching of those areas while riding will be of benefit to avoid overload injuries to tendons and ligaments of the neck and upper extremities.

Regarding the lower extremities, special attention has to be paid to the iliotibial band also known as the IT band (a ligament that stretches from the hip to the knee along the outside of your thigh). Both at the level of the hip and the knee joint, the IT band is prone to irritation. When the pain is felt at the hip level, it is also called the “snapping hip” as the IT band “jumps” over the bony prominence of the hip area with every flexion-extension of the hip joint. At the knee level, it is very unlikely to feel any snapping, but still it may be of significant discomfort after long rides in the presence of a tight IT band. Proper stretching of the IT band is the best initial remedy to avoid those conditions as well as a very diligent program of icing to the affected area.