Training and Injury Considerations in Female-Identifying Cyclists

Authors

  • Dana Kotler, MD Department of Physical Medicine and Rehabilitation, Harvard Medical School
  • Sarah Rice, DPT, PhD Athletico Physical Therapy
  • Nicole Katz, MD 1) Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 2) Spaulding Rehabilitation Network, Charlestown, MA
  • Nancy Gomes, MBA, MS, CISSN 1) Nutrify Performance Nutrition for Women, Franklin MA, 2) Lasell University, Auburndale, MA
  • Wendy Holliday, PT, PhD WH Bike Fit, Cornelius, NC
  • Karen Zunti, PT Spaulding Rehabilitation Network, Charlestown, Massachusetts, U.S.A.
  • John Moore, BA Empirical Cycling, Durham, NC

DOI:

https://doi.org/10.53646/jwsm.v3i2.45

Keywords:

cycling, bicycle, bicycle fit, overuse injury, nutrition, hormones, women's sports, female-identifying

Abstract

Alongside the growth of cycling has been a corresponding increase in the proportion of female-identifying cyclists on the roads and trails. Assumptions about anatomic differences have historically inspired specific equipment design for women cyclists, while most of the cycling research has included only male-identifying participants. More recently, the industry has shifted towards a more gender-inclusive design, in line with the heterogeneity seen in cyclists of any gender identity.  There has been research into biomechanical and metabolic differences of female athletes, which can impact female cyclists’ performance and injury risk.  However, women cyclists are not defined solely by their anatomy or physiology. Their experiences, needs, access, and goals must be considered in developing strategies for prevention and rehabilitation of cycling-related injury, as well as training and performance.

References

Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. The American journal of sports medicine. 2005;33(4):492-501.

Nakagawa TH, Moriya ÉT, Maciel CD, Serrão FV. Trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during a single-leg squat in males and females with and without patellofemoral pain syndrome. Journal of orthopaedic & sports physical therapy. 2012;42(6):491-501.

Weeks BK, Carty CP, Horan SA. Effect of sex and fatigue on single leg squat kinematics in healthy young adults. BMC musculoskeletal disorders. 2015;16(1):271.

Cowley ES, Olenick AA, McNulty KL, Ross EZ. “Invisible sportswomen”: the sex data gap in sport and exercise science research. Women in Sport and Physical Activity Journal. 2021;29(2):146-151.

Arthurs-Brennan M. Was the women's cycling boom of Covid lockdown about more than quiet roads? . Cycling Weekly. 2022. January 31, 2022. Accessed 6/14/23. https://www.cyclingweekly.com/news/covid-lockdowns-saw-more-women-cycling-but-why-do-the-numbers-keep-swelling-now-our-roads-are-busier-than-ever

Best I. You’ve come a long way, baby - Vital statistics show sea change in women’s cycling. CyclingNewscom. 2022. August 16, 2022. Accessed 6/14/23. https://www.cyclingnews.com/features/youve-come-a-long-way-baby-vital-statistics-show-sea-change-in-womens-cycling/

United States Census Bureau. Data from: S0801 Commuting Characteristics by Sex. American Community Survey 5-Year Estimates. 2021.

Battiston A, Napoli L, Bajardi P, et al. Revealing the determinants of gender inequality in urban cycling with large-scale data. EPJ Data Science. 2023;12(1):9.

Gauthier A. Cycling’s Gender Gap: Breaking The Cycle of Inequality. Transport Matters blog. July 6, 2022, 2022. https://www.itdp.org/2022/07/06/cyclings-gender-gap/

Hosford K, Winters M. Quantifying the Bicycle Share Gender Gap. Findings. 2019:10802.

Ayala EE, Waniger KJ, Faulkner KP, Riley-Schmida A. Experiences that affect participation of women and gender diverse athletes in competitive cycling. Journal of Outdoor Recreation, Education, and Leadership. 2020;12(1)

Goldbaum C. Why Women Are Biking in Record Numbers in NYC. NY Times. October 7, 2020. Accessed 6/14/23. https://www.nytimes.com/2020/10/07/nyregion/nyc-biking-covid-women.html

Aicale R, Tarantino D, Maffulli N. Overuse injuries in sport: a comprehensive overview. Journal of orthopaedic surgery and research. 2018;13(1):1-11.

Yang J, Tibbetts AS, Covassin T, Cheng G, Nayar S, Heiden E. Epidemiology of overuse and acute injuries among competitive collegiate athletes. Journal of athletic training. 2012;47(2):198-204.

Insler V, Melmed H, Mashiah S, Monselise M, Lunenfled B, Rabau E. Functional classification of patients selected for gonadotropic therapy. Obstetrics & Gynecology. 1968;32(5):620-626.

Albert-Gascó H, García-Avilés Á, Moustafa S, et al. Central relaxin-3 receptor (RXFP3) activation increases ERK phosphorylation in septal cholinergic neurons and impairs spatial working memory. Brain Struct Funct. Jan 2017;222(1):449-463. doi:10.1007/s00429-016-1227-8

Casey E RM, Press J. Sex Differences in Sports Medicine. Demos Medical Publishing; 2016.

Chidi-Ogbolu N, Baar K. Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Front Physiol. 2018;9:1834. doi:10.3389/fphys.2018.01834

García-Díaz C, Gil-Miravet I, Albert-Gasco H, et al. Relaxin-3 Innervation From the Nucleus Incertus to the Parahippocampal Cortex of the Rat. Front Neuroanat. 2021;15:674649. doi:10.3389/fnana.2021.674649

Haidar M, Guèvremont G, Zhang C, et al. Relaxin-3 inputs target hippocampal interneurons and deletion of hilar relaxin-3 receptors in "floxed-RXFP3" mice impairs spatial memory. Hippocampus. May 2017;27(5):529-546. doi:10.1002/hipo.22709

Lovering RM, Romani WA. Effect of testosterone on the female anterior cruciate ligament. Am J Physiol Regul Integr Comp Physiol. Jul 2005;289(1):R15-22. doi:10.1152/ajpregu.00829.2004

Yu WD, Panossian V, Hatch JD, Liu SH, Finerman GA. Combined effects of estrogen and progesterone on the anterior cruciate ligament. Clin Orthop Relat Res. Feb 2001;(383):268-81. doi:10.1097/00003086-200102000-00031

Räsänen T, Messner K. Estrogen-dependent tensile properties of the rabbit knee medial collateral ligament. Scand J Med Sci Sports. Feb 2000;10(1):20-7. doi:10.1034/j.1600-0838.2000.010001020.x

Romani WA, Belkoff SM, Elisseeff JH. Testosterone may increase rat anterior cruciate ligament strength. Knee. Dec 2016;23(6):1069-1073. doi:10.1016/j.knee.2016.07.004

Slauterbeck J, Clevenger C, Lundberg W, Burchfield DM. Estrogen level alters the failure load of the rabbit anterior cruciate ligament. J Orthop Res. May 1999;17(3):405-8. doi:10.1002/jor.1100170316

Sims ST, Kerksick CM, Smith-Ryan AE, et al. International society of sports nutrition position stand: nutritional concerns of the female athlete. Journal of the International Society of Sports Nutrition. 2023;20(1):2204066.

Holtzman B, Ackerman KE. Recommendations and nutritional considerations for female athletes: Health and performance. Sports medicine. 2021;51(Suppl 1):43-57.

Areta JL, Taylor HL, Koehler K. Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males. European Journal of Applied Physiology. 2021;121(1):1-21.

Keay N. Hormones, health and human potential: A guide to understanding your hormones to optimise your health and performance. Sequoia Books; 2022.

Fahrenholtz IL, Melin AK, Wasserfurth P, et al. Risk of low energy availability, disordered eating, exercise addiction, and food intolerances in female endurance athletes. Frontiers in sports and active living. 2022:160.

Viner RT, Harris M, Berning JR, Meyer NL. Energy availability and dietary patterns of adult male and female competitive cyclists with lower than expected bone mineral density. International journal of sport nutrition and exercise metabolism. 2015;25(6):594-602.

Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. British Journal of Sports Medicine. 2018;

Female Athlete Issues for the Team Physician: A Consensus Statement—2017 Update. 2018;

Joyner MJ, Coyle EF. Endurance exercise performance: the physiology of champions. J Physiol. Jan 1 2008;586(1):35-44. doi:10.1113/jphysiol.2007.143834

Brink MS, Frencken WG, Jordet G, Lemmink KA. Coaches' and players' perceptions of training dose: not a perfect match. Int J Sports Physiol Perform. May 2014;9(3):497-502. doi:10.1123/ijspp.2013-0009

The National Academies Press. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. 2005;

Linsenmeyer W, Garwood S, Waters J. An Examination of the Sex-Specific Nature of Nutrition Assessment within the Nutrition Care Process: Considerations for Nutrition and Dietetics Practitioners Working with Transgender and Gender Diverse Clients. J Acad Nutr Diet. Jun 2022;122(6):1081-1086. doi:10.1016/j.jand.2022.02.014

Fonda BS, Nejc. Biomechanics of cycling. Sports Science Review. 2010;XIX:187–210. doi:10.2478/v10237-011-0012-0

Priego Quesada JI, Pérez-Soriano P, Lucas-Cuevas AG, Salvador Palmer R, Cibrián Ortiz de Anda RM. Effect of bike-fit in the perception of comfort, fatigue and pain. Journal of sports sciences. 2017;35(14):1459-1465.

Swart J, Holliday W. Cycling Biomechanics Optimization—the (R) Evolution of Bicycle Fitting. Current sports medicine reports. 2019;18(12):490-496.

Jett R, Chabra S, Carver T. When to Share Product Platforms: An Anthropometric Review. Accessed 1/21/21.

Lukas S. Where have all the women’s bikes gone? A look inside an ever-changing market. 2019. October 10, 2019. https://cyclingtips.com/2019/10/where-have-all-the-womens-bikes-gone-a-look-inside-an-ever-changing-market/

Moen E. Bike PT - Bronze. 2013.

Serotta International Cycling Institute. SICI Personalized Bike Fit Certification Companion Manual. 2018.

Robidoux CG. A Practical Approach to the Evaluation of a Cyclist with Overuse Injury. Physical Medicine and Rehabilitation Clinics. 2022;33(1):15-29.

Kotler DH, Babu AN, Robidoux G. Prevention, evaluation, and rehabilitation of cycling-related injury. Current sports medicine reports. 2016;15(3):199-206.

Ruby P, Hull M, Kirby KA, Jenkins DW. The effect of lower-limb anatomy on knee loads during seated cycling. Journal of Biomechanics. 1992;25(10):1195-1207.

Silberman MR, Webner D, Collina S, Shiple BJ. Road bicycle fit. Clin J Sport Med. Jul 2005;15(4):271-6.

Puleo RM, Barreveld A, Rice S, Plante AMA, Kotler DH. Unique Concerns of the Woman Cyclist. Physical Medicine and Rehabilitation Clinics. 2022;33(1):61-79.

Verma R, Hansen EA, de Zee M, Madeleine P. Effect of seat positions on discomfort, muscle activation, pressure distribution and pedal force during cycling. Journal of Electromyography and Kinesiology. 2016;27:78-86.

Priego Quesada JI, Kerr ZY, Bertucci WM, Carpes FP. The association of bike fitting with injury, comfort, and pain during cycling: An international retrospective survey. European journal of sport science. 2019;19(6):842-849.

Moore K. A coaching perspective on modern training metrics and return from injury and illness. Physical Medicine and Rehabilitation Clinics. 2022;33(1):173-186.

Ferrer-Roca V, Bescós R, Roig A, Galilea P, Valero O, García-López J. Acute effects of small changes in bicycle saddle height on gross efficiency and lower limb kinematics. The Journal of Strength & Conditioning Research. 2014;28(3):784-791.

Clarsen B, Krosshaug T, Bahr R. Overuse injuries in professional road cyclists. Am J Sports Med. Dec 2010;38(12):2494-501. doi:10.1177/0363546510376816

Deakon RT. Chronic musculoskeletal conditions associated with the cycling segment of the triathlon; prevention and treatment with an emphasis on proper bicycle fitting. Sports Med Arthrosc. Dec 2012;20(4):200-5. doi:10.1097/JSA.0b013e3182688fa0

Jacobs CA, Uhl TL, Mattacola CG, Shapiro R, Rayens WS. Hip abductor function and lower extremity landing kinematics: sex differences. J Athl Train. Jan-Mar 2007;42(1):76-83.

Johnston TE, Baskins TA, Koppel RV, Oliver SA, Stieber DJ, Hoglund LT. The influence of extrinsic factors on knee biomechanics during cycling: a systematic review of the literature. International journal of sports physical therapy. 2017;12(7):1023.

Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. journal of orthopaedic & sports physical therapy. 2010;40(2):42-51.

Petersen W, Ellermann A, Gösele-Koppenburg A, et al. Patellofemoral pain syndrome. Knee surgery, sports traumatology, arthroscopy. 2014;22(10):2264-2274.

Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scandinavian journal of medicine & science in sports. 2010;20(5):725-730.

Francis P, Whatman C, Sheerin K, Hume P, Johnson MI. The proportion of lower limb running injuries by gender, anatomical location and specific pathology: a systematic review. Journal of sports science & medicine. 2019;18(1):21.

Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med. Apr 2002;36(2):95-101. doi:10.1136/bjsm.36.2.95

Isidro T, Gregory E, Lachman L, Isidro S, Cortez AN. Lumbar spine and lower extremity overuse injuries. Physical Medicine and Rehabilitation Clinics. 2022;33(1):201-214.

Asplund C, Ross M. Core stability and bicycling. Curr Sports Med Rep. May-Jun 2010;9(3):155-60. doi:10.1249/JSR.0b013e3181de0f91

Dingwell JB, Joubert JE, Diefenthaeler F, Trinity JD. Changes in muscle activity and kinematics of highly trained cyclists during fatigue. IEEE Trans Biomed Eng. Nov 2008;55(11):2666-74. doi:10.1109/tbme.2008.2001130

Iverson GL, Gardner AJ, Terry DP, et al. Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941-948.

Rebbeck T, Evans K, Elliott JM. Concussion in Combination With Whiplash-Associated Disorder May Be Missed in Primary Care: Key Recommendations for Assessment and Management. The Journal of orthopaedic and sports physical therapy. Nov 2019;49(11):819-828. doi:10.2519/jospt.2019.8946

Slane J, Timmerman M, Ploeg HL, Thelen DG. The influence of glove and hand position on pressure over the ulnar nerve during cycling. Clin Biomech (Bristol, Avon). Jul 2011;26(6):642-8. doi:10.1016/j.clinbiomech.2011.03.003

Cyr A. Cervical Spine, Upper Extremity Neuropathies, and Overuse Injuries in Cyclists. Physical Medicine and Rehabilitation Clinics. 2022;33(1):187-199.

Patterson JMM, Jaggars MM, Boyer MI. Ulnar and median nerve palsy in long-distance cyclists: a prospective study. The American journal of sports medicine. 2003;31(4):585-589.

Akuthota V, Plastaras C, Lindberg K, Tobey J, Press J, Garvan C. The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy. Am J Sports Med. Aug 2005;33(8):1224-30. doi:10.1177/0363546505275131

Tafazzol A, Arjmand N, Shirazi-Adl A, Parnianpour M. Lumbopelvic rhythm during forward and backward sagittal trunk rotations: combined in vivo measurement with inertial tracking device and biomechanical modeling. Clinical Biomechanics. 2014;29(1):7-13.

Wadsworth DJ, Weinrauch P. The role of a bike fit in cyclists with hip pain. a clinical commentary. International journal of sports physical therapy. 2019;14(3):468.

Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. Mar 2009;467(3):638-44. doi:10.1007/s11999-008-0680-y

Martin J, Spirduso W. Determinants of maximal cycling power: crank length, pedaling rate and pedal speed. European journal of applied physiology. 2001;84:413-418.

Nachemson A. Disc pressure measurements. Spine (Phila Pa 1976). 1981;6(1):93-7. doi:10.1097/00007632-198101000-00020

Sairyo K, Nagamachi A. State-of-the-art management of low back pain in athletes: Instructional lecture. Journal of Orthopaedic Science. 2016;21(3):263-272.

Zhou Y, Abdi S. Diagnosis and minimally invasive treatment of lumbar discogenic pain–a review of the literature. The Clinical journal of pain. 2006;22(5):468-481.

Usabiaga J, Crespo R, Iza I, Aramendi J, Terrados N, Poza JJ. Adaptation of the lumbar spine to different positions in bicycle racing. Spine (Phila Pa 1976). Sep 1 1997;22(17):1965-9.

Van Hoof W, Volkaerts K, O'Sullivan K, Verschueren S, Dankaerts W. Comparing lower lumbar kinematics in cyclists with low back pain (flexion pattern) versus asymptomatic controls--field study using a wireless posture monitoring system. Man Ther. Aug 2012;17(4):312-7. doi:10.1016/j.math.2012.02.012

Streisfeld GM, Bartoszek C, Creran E, Inge B, McShane MD, Johnston T. Relationship Between Body Positioning, Muscle Activity, and Spinal Kinematics in Cyclists With and Without Low Back Pain: A Systematic Review. Sports Health. Jan/Feb 2017;9(1):75-79. doi:10.1177/1941738116676260

Burnett AF, Cornelius MW, Dankaerts W, O'Sullivan P B. Spinal kinematics and trunk muscle activity in cyclists: a comparison between healthy controls and non-specific chronic low back pain subjects-a pilot investigation. Man Ther. Nov 2004;9(4):211-9. doi:10.1016/j.math.2004.06.002

Van der Walt A, Janse van Rensburg DC, Fletcher L, Grant C, Van der Walt A. Non-traumatic injury profile of amateur cyclists. South African Journal of Sports Medicine. 2014;26(4):119-122.

Sauer JL, Potter JJ, Weisshaar CL, Ploeg H-L, Thelen DG. Influence of gender, power, and hand position on pelvic motion during seated cycling. Medicine and science in sports and exercise. 2007;39(12):2204.

Fischer B, Mitteroecker P. Allometry and sexual dimorphism in the human pelvis. The Anatomical Record. 2017;300(4):698-705.

Chen ML, Reyblat P, Poh MM, Chi AC. Overview of surgical techniques in gender-affirming genital surgery. Transl Androl Urol. Jun 2019;8(3):191-208. doi:10.21037/tau.2019.06.19

Guess MK, Partin SN, Schrader S, et al. Women's bike seats: A pressing matter for competitive female cyclists. The journal of sexual medicine. 2011;8(11):3144-3153.

Bressel E, Larson BJ. Bicycle seat designs and their effect on pelvic angle, trunk angle, and comfort. Medicine and science in sports and exercise. 2003;35(2):327-332.

Potter JJ, Sauer JL, Weisshaar CL, Thelen DG, Ploeg HL. Gender differences in bicycle saddle pressure distribution during seated cycling. Med Sci Sports Exerc. Jun 2008;40(6):1126-34. doi:10.1249/MSS.0b013e3181666eea

Partin SN, Connell KA, Schrader S, et al. The bar sinister: does handlebar level damage the pelvic floor in female cyclists? The journal of sexual medicine. 2012;9(5):1367-1373.

Bury K, Leavy JE, Lan C, O’Connor A, Jancey J. A saddle sores among female competitive cyclists: a systematic scoping review. Journal of Science and Medicine in Sport. 2021;24(4):357-367.

Pidd H. How scientific rigour helped Team GB’s saddle-sore cyclists on their medal trail. The Guardian. 2016. August 15, 2016. Accessed 1/14/2021. https://www.theguardian.com/sport/blog/2016/aug/15/team-gb-cycling-saddle-sore-medals

McCluggage WG, Smith JH. Reactive fibroblastic and myofibroblastic proliferation of the vulva (Cyclist's Nodule): A hitherto poorly described vulval lesion occurring in cyclists. The American journal of surgical pathology. 2011;35(1):110-114.

Cohen Sacher B. The Normal Vulva, Vulvar Examination, and Evaluation Tools. Clin Obstet Gynecol. Sep 2015;58(3):442-52. doi:10.1097/grf.0000000000000123

Baeyens L, Elston MA, Vermeersch E, Bourgeois P. Bicyclist's vulva: observational studyCommentary: Attitudes to women's bicycling have changed. Bmj. 2002;325(7356):138-139.

Meltzer T. Vaginoplasty procedures, complications and aftercare. 2016. June 17, 2016. https://transcare.ucsf.edu/guidelines/vaginoplasty

Baradaran N, Awad M, Gaither TW, et al. The association of bicycle-related genital numbness and Sexual Health Inventory for Men (SHIM) score: results from a large, multinational, cross-sectional study. BJU Int. Aug 2019;124(2):336-341. doi:10.1111/bju.14396

Greenberg DR, Khandwala YS, Breyer BN, Minkow R, Eisenberg ML. Genital Pain and Numbness and Female Sexual Dysfunction in Adult Bicyclists. J Sex Med. Sep 2019;16(9):1381-1389. doi:10.1016/j.jsxm.2019.06.017

Downloads

Published

2023-07-26

Issue

Section

Articles

How to Cite

Training and Injury Considerations in Female-Identifying Cyclists. (2023). Journal of Women’s Sports Medicine, 3(2), 11-24. https://doi.org/10.53646/jwsm.v3i2.45

Similar Articles

1-10 of 37

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)

1 2 3 4 > >>