Int J Sports Med 2015; 36(03): 241-248
DOI: 10.1055/s-0034-1389983
Orthopedics & Biomechanics
© Georg Thieme Verlag KG Stuttgart · New York

Changes in Sports Injuries Incidence over Time in World-class Road Cyclists

C. Barrios
1   School of Medicine, Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain
N. D. Bernardo
2   Department of Physiotherapy, University CEU-Cardenal Herrera, Valencia, Spain
P. Vera
3   Podology Clinic, Clinica Artes, Valencia, Spain
C. Laíz
4   Physioterapy, Physical Therapy and Exercise Center, Valencia, Spain
M. Hadala
4   Physioterapy, Physical Therapy and Exercise Center, Valencia, Spain
› Author Affiliations
Further Information

Publication History

accepted after revision 25 July 2014

Publication Date:
06 November 2014 (online)


This is a descriptive epidemiologic survey on all traumatic and overuse injuries which occurred in 2 groups of male elite road cyclists based on retrospective clinical interviews and physical examinations. The historical group consisted of 65 professional road cyclists surveyed from 1983 to 1995. The contemporary group included 65 elite racers still active and reporting injuries from 2003 to 2009. Injury/cyclist ratio was 1.32 in the historical group and 2.13 in those still active. Traumatic injuries increased from 39.5% (historical) to 53.9% (contemporary) (p<0.05). Severe traumatic lesions decreased from 49.9% in the historical group to 10.5% in the contemporary group (p<0.01). Patellofemoral pain decreased from 28.8% (historical) to 6.1% (contemporary) (p<0.01). Muscle injuries substantially increased from 13.4% to 44.9% (p<0.01). In the historical racers, the rates of risk for traumatic injury were 0.104 per year per cyclist, and 0.003 per 1 000 km of training and competition. These figures increased to 0.287 and 0.009 respectively in the contemporary group. In summary, contemporary professional road cyclists are exposed to double the risk of traumatic injuries than those competing in the 80s and early 90s. However, these lesions have less severity. Overuse injuries had a completely different clinical pattern, with the currently active cyclist exhibiting more muscle injuries and less tendinous lesions.

  • References

  • 1 Abraham P, Bouye P, Quere I, Chevalier JM, Saumet JL. Past, present and future of arterial endofibrosis in athletes: a point of view. Sports Med 2004; 34: 419-425
  • 2 Amoros E, Chiron M, Martin JL, Laumon B. Bicycle helmet wearing and the risk of head, face, and neck injury: a French case-control study based on a road trauma registry. Inj Prev 2012; 18: 27-32
  • 3 Bahr R, Maehlum S. Clinical guide to sports injuries. Champaign: Human Kinetics; 2003: 1-23
  • 4 Barrios C, Sala D, Terrados N, Valenti JR. Traumatic and overuse injuries in elite professional cyclists. Sports Exerc Inj 1997; 3: 176-179
  • 5 Bender MH, Schep G, de Vries WR, Hoogeveen AR, Wijn PF. Sports related flow limitations in the iliac arteries in endurance athletes: aetiology, diagnosis, treatment and future developments. Sports Med 2004; 34: 427-442
  • 6 Benson BW, Hamilton GM, Meeuwisse WH, McCrory P, Dvorak J. Is protective equipment useful in preventing concussion? A systematic review of the literature. Br J Sports Med 2009; 43: 56-67
  • 7 Clarsen B, Krosshaug T, Bahr R. Overuse Injuries in Professional Road cyclists. Am J Sports Med 2010; 38: 2494-2501
  • 8 Cook A, Sheikh A. Trends in serious head injuries among English cyclist and pedestrians. Inj Prev 2003; 9: 266-267
  • 9 Ekstrand J, Gillquist I. Soccer injuries and their mechanisms: a prospective study. Med Sci Sports Exerc 1983; 15: 267-270
  • 10 Faria EW, Parker DL, Faria IE. The science of cycling: physiology and training – part 1. Sports Med 2005; 35: 285-312
  • 11 Faria EW, Parker DL, Faria IE. The science of cycling: factors affecting performance – part 2. Sports Med 2005; 35: 313-337
  • 12 Farrell KC, Reisinger KD, Tillman MD. Force and repetition in cycling: possible implications for iliotibial band friction syndrome. Knee 2003; 10: 103-109
  • 13 Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Hägglund M, McCrory P, Meeuwisse WH. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med 2006; 40: 193-201
  • 14 Fuller CW, Molloy MG, Bagate C, Bahr R, Brooks JH, Donson H, Kemp SP, McCrory P, McIntosh AS, Meeuwisse WH, Quarrie KL, Raftery M, Wiley P. Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union. Br J Sports Med 2007; 41: 328-331
  • 15 Hadala M, de Bernardo N, Vera P, Laiz C, Barrios C. Pre-season screening of core muscle balance and control tests in the lumbar spine in professional road cyclists can we prevent uncontrolled movement?. Br J Sports Med 2011; 45: 351
  • 16 Harriss DJ, Atkinson G. Ethical standards in sports and exercise science research: 2014 update. Int J Sports Med 2013; 34: 1025-1025
  • 17 Holmes JC, Pruitt AL, Whalen NJ. Cycling knee injuries: common mistakes that cause injuries and how to avoid them. Cycling Sci 1991; 3: 11-14
  • 18 Holmes JC, Pruitt AL, Whalen NJ. Iliotibial band syndrome in cyclists. Am J Sports Med 1993; 21: 419-424
  • 19 Holmes JC, Pruitt AL, Whalen NJ. Lower extremity overuse in bicycling. Clin Sports Med 1994; 13: 187-205
  • 20 Jeukendrup A, Craig N, Hawley J. The bioenergetics of world class cycling. J Sci Med Sport 2000; 4: 414-433
  • 21 Jobson SA, Passfield L, Atkinson G, Barton G, Scarf P. The analysis and utilization of cycling training data. Sports Med 2009; 39: 833-844
  • 22 Joint Committee on Injury Scaling (ed.) The Abbreviated Injury Scale (AIS). Arlington Heights, Illinois: American Association for Automotive Medicine; 1980: 61
  • 23 Junge A, Engebretsen L, Alonso JM, Renström P, Mountjoy M, Aubry M, Dvorak J. Injury surveillance in multisport events: the International Olympic Committee approach. Br J Sports Med 2008; 42: 413-421
  • 24 Klesges RC, Eck LH, Mellon MW, Fulliton W, Somes GW, Hanson CL. The accuracy of self-reports of physical activity. Med Sci Sports Exerc 1990; 22: 690-697
  • 25 Mellion MB. Common cycling injuries: management and prevention. Sports Med 1991; 11: 52-70
  • 26 Mellion MB. Neck and back pain in bicycling. Clin Sports Med 1994; 13: 137-164
  • 27 Mujika I, Padilla S. Physiological and performance characteristics of male professional road cyclists. Sports Med 2001; 31: 479-487
  • 28 Paton CD, Hopkins WG. Combining explosive and high-resistance training improves performance in competitive cyclists. J Strength Cond Res 2005; 19: 826-830
  • 29 Robinson DL. Changes in head injury with the New Zealand bicycle helmet law. Accid Anal Prev 2001; 33: 687-691
  • 30 Rønnestad BR, Hansen J, Hollan I, Ellefsen S. Strength training improves performance and pedaling characteristics in elite cyclists. Scand J Med Sci Sports 2014; [Epub ahead of print]
  • 31 Sheikh A, Cook A, Ashcroft R. Making cycle helmets compulsory: ethical arguments for legislation. J R Soc Med 2004; 97: 262-265
  • 32 Thomas S, Acton C, Nixon J, Battistutta D, Pitt WR, Clark R. Effectiveness of bicycle helmets in preventing head injury in children: case-control study. BMJ 1994; 308: 173
  • 33 Thompson DC, Patterson MQ. Cycle helmets and the prevention of injuries. Recommendations for competitive sport. Sports Med 1998; 25: 213-219
  • 34 Thompson DC, Rivara FP, Thompson RS. Helmets for preventing head and facial injuries in bicycling. In: Cochrane Collaboration. Cochrane Library. Oxford: Update Software; 2004: 1-31
  • 35 Tuite MJ. Imaging of triathlon injuries. Radiol Clin North Am 2010; 48: 1125-1135
  • 36 van Zyl E, Schwellnus MP, Noakes TD. A Review of the etiology, biomechanics, diagnosis, and management of patellofemoral pain in cyclists. Int SportMed J 2001; 2: 1-34
  • 37 Wanich T, Hodgkins C, Columbier JA, Muraski E, Kennedy JG. Cycling injuries of the lower extremity. J Am Acad Orthop Surg 2007; 15: 748-756
  • 38 Watsford M, Ditroilo M, Fernández-Peña E, D’amen G, Lucertini F. Muscle stiffness and rate of torque development during sprint cycling. Med Sci Sports Exerc 2010; 42: 1324-1332
  • 39 Wijesinghe LD, Coughlin PA, Robertson I, Kessel D, Kent PJ, Kester RC. Cyclist’s iliac syndrome: temporary relief by balloon angioplasty. Br J Sports Med 2001; 35: 70-71