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011 Osteoarthritis: the Cyclist's Nemesis

Osteoarthritis: the Cyclist's Nemesis

All cyclists, at one or other stage will be forced by nature to stop riding. Even world champions suffer this fate. In most cases it is the bones and joints that cripple a once supple frame. If it is not the creaking bones and joints, then diabetes, hypertension, heart disorder, kidney disease, obesity, or gout will intervene. Cyclists must prepare for this eventuality.

The problem starts in the mid-forties and strikes the veteran cyclist in the nape of the neck, upper back and lower back. The worst is the lower back (base of neck). Initially the discomfort is intermittent and worse in cold weather or winter. Later it becomes chronic, continuous and knawing. This is when painkiller and NSAID abuse becomes evident if the cyclist wishes to continue. Some cyclists are unfortunate and have trouble in the neck and the knee. This is bad news and the cycling days are generally over. Knee problems, (anterior knee pain) almost always become worse and protracted.

Osteoarthritis (an ageing problem) overwelms the joints. Gout and rheumatoid arthritis are other common afflictions. Arthritis is disabling and a progressive problem. Although the cause is unknown, there is no way of preventing or reversing it. Pain pills and NSAIDS are the mainstay. On the other hand, abuse thereof is followed by side-effects such as bleeding ulcers, constipation and heartburn.

OA is characterised by slow, progressive, focal erosion and destruction of joint articular cartilage (Robbins). With time subchondral sclerosis, spurs and osteophytes occur (Robbins). The large weight bearing joints suffer the most.

OA presents with morning joint stiffness, pain, referred pain, fatigue and disability. OA may be primary or secondary (Robbins). Osteoarthritis of the cervical vertebra and the knee joint cripple the older and ageing cyclist. Initially stiffness (at first transient) and decreased mobility are experienced (Robbins). Later joint crepitation is evident. Swelling and stiffness often follows.

Diagnosis is confirmed by X-rays and MRI. Changes are visible in the second and third decades. Universal findings are the norm at 70. Onset of OA problems occur at a younger age in males. Degrees of disability and functional compromise determine the eventual outcome. In the majority of cases OA manifests subtly. With time exercise and cycling worsens the pain (neck, back, groin and ankle). With time the cycling accentuates severe synovitis, bursitis and tendonitis. Pain in the neck, behind a shoulder and in the knee may become severe and throbbing. Asthenia and malaise follow (Robbins).

OA of the neck:

This is very common. Erosion of the discs and narrowing of the foramina causes pressure on the spinal nerves. Referred pain to the shoulder is the problem. Radiculopathy and muscle weakness follows (Merck Manual). Treatment is as follows:

Know that you have an arthritic disability - it is a life long process.
Pain has to be dealt with - avoid abusing aspirin, Paracetamol, Celebrex“ and Vionxx“. Brufen also works but has side effects. Go for on demand treatment.
Reduce cycle load - reduce weekly mileage.
Get more rest.
Stretch three times a day.
In acute episodes: Wear a brace for a few days.
Get an upright stem fitted so that you sit more upright. Avoid riding on the drops - this will make pain in and between the shoulders worse.
Have the neck area massaged.
Keep warm.
Avoid bumpy roads (shaking is transmitted through the forks and drops to your neck bones and ligaments).
Avoid surgery as long as possible. It does not always work and pain occurs in other regions.
In the end a mountain bike will be better than a road bike. Speed is unfortunately sacrificed.
Decompressive or fusitive surgery may be needed for disc prolaps, pinched nerve and referred pain (for this a MRI of the neck is needed). At this stage chronic medication with NSAIDS is often needed (i.e. Celebrex“). Don't forget the side effects of drug abuse.
Eventually cycling will have to be stopped due to severe pain experienced during cycling and 2-3 days thereafter.
Have the heart and blood pressure checked at the same time, as problems do not come singly but in multitudes. Has your cholesterol recently been done?

OA of the lower back:

This can be debilitating and quickly result in cessation of cycling due to pain, stiffness and chronic discomfort.

Analgesic drug therapy will become important if you want to ride regularly (avoid abuse and side effects).
Strengthen abdominal muscles by doing gentle "crunches". Take it easy!
In males, have the PSA checked. You could be suffering from prostate cancer.
Head pads help. Keep warm in winter.
A stiff mattress is important.
Referred pain or sciatica may mean disc prolapse and spinal nerve entrapment/compression. In these cases a back operation may be needed, especially if neurological deficit is present. Results of surgery are not always good. Think twice before signing consent.
Orthopaedic braces help.
Bike set up is critical.
Soft saddle is important, acquire a light frame.
Knee angle is critical.
Avoid bumpy roads and steep inclines.
Assume a more upright position (i.e. mountain bike).
The value of APS machines, copper bangles and antioxidants is yet to be scientifically established.
Get more rest.
Avoid slouching forward in front of computers.

Final note: Osteoarthritis is final and irreversible. It is progressive. Learn to accept that you are ageing and avoid self pity. Cycle less, but enjoy it. Bike set up is critical, especially the length of your bike stem. Don't ride on the drops if you are older than 55 years. Anti-inflammatories play an important part in keeping one pain free and mobile. But don't forget side effects. Eventually, we all have to stop cycling due to a sore knee, hip, back or neck. This is only natural. Have realistic expectations!
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