A retrospective international study on factors associated with injury, discomfort and pain perception among cyclists

Bicycle Set-Up Dimensions and Cycling Kinematics: A Consensus Statement Using Delphi Methodology

Bicycle set-up dimensions and cycling kinematic data are important components of bicycle fitting and cyclist testing protocols. However, there are no guidelines on how bicycles should be measured and how kinematic data should be collected to increase the reliability of outcomes. This article proposes a consensus regarding bicycle set-up dimensions and recommendations for collecting cycling-related kinematic data. Four core members recruited panellists, prepared the document to review in each round for panellists, analysed the scores and comments of the expert panellists, reported the decisions and communicated with panellists. Fourteen experts with experience in research involving cycling kinematics and/or bicycle fitting agreed to participate as panellists. An initial list of 17 statements was proposed, rated using a five-point Likert scale and commented on by panellists in three rounds of anonymous surveys following a Delphi procedure. The consensus was agreed upon when more than 80% of the panellists scored the statement with values of 4 and 5 (moderately and strongly agree) with an interquartile range of less than or equal to 1. A consensus was achieved for eight statements addressing bicycle set-up dimensions (e.g. saddle height, saddle setback, etc.) and nine statements for cycling kinematic assessment (e.g. kinematic method, two-dimensional methodology, etc.). This consensus statement provides a list of recommendations about how bicycle set-up dimensions should be measured and the best practices for collecting cycling kinematic data. These recommendations should improve the transparency, reproducibility, standardisation and interpretation of bicycle measurements and cycling kinematic data for researchers, bicycle fitters and cycling related practitioners.

Injuries and complaints in the Brazilian national volleyball male team: a case study

BACKGROUND

The literature reports a vast amount of epidemiological information on injuries in volleyball athletes. However, little is known about the incidence of injuries in elite athletes of international level participating in major competitions, such as world championships and Olympic games. The objective of the study was to analyse the incidence of injuries in elite professional volleyball athletes, and the prevalence of complaints reported by athletes.

METHODS

This is a case study in which data were collected between April 2018 and August 2021. All the athletes called to play for the Brazilian national male volleyball team during the analysis period participated. From the athletes' medical records, the occurrence of injuries (injurious events that lead to a time off from activities) and complaints (discomforts that did not lead to a time off from activities) were analysed. Frequency data were used to calculate incidence, prevalence and ratios.

RESULTS

From 41 athletes who played for the team during the analysed period, 12 athletes had 28 injuries and 38 athletes reported 402 complaints. For injuries, an incidence of seven injuries/1,000 h of competition and two injuries/1,000 h of training was observed. The average recovery time of the athletes was 10 days. The regions with the highest prevalence of injuries were the knee (111/1,000 athletes) and ankle (69/1,000 athletes). For complaints, 402 complaints required 1,085 treatment sessions, with the regions with the highest prevalence of complaints being the knee (261/1,000 complaints) followed by the shoulders (236/1,000 complaints). Athletes aged above 23 years and those playing as middle blockers and outside hitters presented a higher prevalence of injuries and complaints.

CONCLUSIONS

Almost one-third of the athletes had injuries and almost all athletes reported complaints during the study period. Injuries and complaints were more prevalent in the knees. Complaints caused a high demand for the healthcare team. To manage risk of injuries for overload, specific injury prevention strategies are needed and should be included as an essential component of the training plan for elite volleyball players.

Effects of cycling on the morphology and spinal posture in professional and recreational cyclists: a systematic review

The aim was to know if cycling affects spinal morphology in postures off the bicycle, such as adapting the spinal curvatures on the bicycle depending on the handlebar type and position on the handlebars. A systematic review was conducted following the PRISMA guidelines. The studies selected met the following criteria: a) the study design was cross-sectional or longitudinal (experimental or cohorts); b) the study evaluated the sagittal morphology of the spine on the bicycle; c) the study included healthy and trained participants without injuries or cyclists reporting low back pain. Fifteen studies reported that a greater pelvic tilt was observed that when the handlebar was in a lower position. Sixteen studies found that lumbar kyphosis was greater when the handlebar grip was lower and farther from the saddle. Twelve studies reported that a tendency towards greater thoracic flexion as the time spent pedalling on the bicycle increased. In conclusion, the practice of cycling produces adaptations in the morphology of the spine of the cyclist compared to non-cyclists, such as an increase in pelvic tilt and a greater capacity for lumbar flexion in trunk flexion positions, and a greater thoracic kyphosis in the standing position.

Low Back Pain in Cycling. Are There Differences between Road and Mountain Biking?

Low back pain (LBP) is known to affect cyclists. This study aimed to describe perceived lumbar dysfunction and compare the pain sensation in recreational cyclists who practice road and mountain biking. Forty males were randomly assigned to carry out a 3-h road cycling (RC) and mountain biking (MTB) time trial (TT) at submaximal intensity. LBP and pain pressure threshold (PPT) were measured before and after the TT. A significant increment at the LBP was found after RC TT (p < 0.001; d = 2.61), similar to MTB TT (p < 0.001; d = 2.65). However, PPT decreased after completing the RC TT (p < 0.001; d = 1.73) and after MTB TT (p = 0.024; d = 0.77). There were no differences in the LBP evolution between both interventions (p > 0.01). Low back pain perception increases with cycling in recreational cyclists. Nevertheless, this increase appears to be more related to the traits of the cyclist than the modality practiced.

Effectiveness of a 3D bikefitting method in riding pain, fatigue, and comfort: a randomized controlled clinical trial

To investigate the effects of bike fitting compared to qualitative-based riding posture recommendations on comfort, fatigue, and pain in amateur cyclists. This was a randomised controlled parallel trial of 162 amateur cyclists divided into two groups: bike fitting group (BFG) - participants received a bike fitting session based on 3D kinematic assessments; and a control group (QG) - participants who received a handout containing qualitative-based cycling posture recommendations. Primary outcomes were perceived comfort (FEEL Scale), perceived fatigue (OMNI Scale), and perceived pain (numeric rating pain scale, NRPS). Outcomes were assessed at baseline, when the interventions were delivered, and after 15 days. Intention-to-treat analyses were conducted using student t-tests between pre and post intervention on both groups. All dependent variables from BFG displayed significant statistical difference between both groups post-intervention (p < 0.05). FEEL Scale and OMNI Scale results showed the highest changes of all variables under analysis (mean differences of 3.12 and 3.95 points, respectively); while the body parts with more reduction in riding pain were Groin and Back (mean differences of 1.68 and 1.35, respectively). In conclusion, 3D kinematic bikefit demonstrated superior improvements over riding pain, comfort and fatigue compared to qualitative riding posture recommendations.

Long-Term Effects of a Kinematic Bikefitting Method on Pain, Comfort, and Fatigue: A Prospective Cohort Study

The purpose of this study is to analyze the long-term riders' subjective responses to a standardized bikefitting method on their bicycles. Eighty-six amateur mountain bikers had their riding posture and bicycle components ergonomically adjusted through a 3D kinematic bikefitting method. Validated subjective scales (Feeling, OMNI, and Numerical Rating Pain Scale) were used to assess their overall riding comfort and fatigue along with localized pain for six body parts. Data were collected just before intervention (baseline or pre), immediately after (or post), and 30, 60, 90, and 120 days after the bikefit session. A Student's t-test comparing before bikefit and after 120 days showed significant (p < 0.05) reduction in localized pain for all six body parts and riding comfort along with a large effect size effect (d = 1.18) for riding comfort. Although initially reduced, fatigue scores gradually increased over the months, showing a high correlation (r = 0.946) with increased monthly training volume. In conclusion, overall riding discomfort and pain were significantly decreased after a standardized kinematic bikefit session even after 120 days post intervention. However, fatigue scores began to rise after 30 days, showing a high correlation with increasing monthly training volume.

Methods to determine saddle height in cycling and implications of changes in saddle height in performance and injury risk: A systematic review

The objective of this systematic review was to assess the methods to determine bicycle saddle height and the effects of saddle height on cycling performance and injury risk outcomes. The key motivator of this review was to update and expand the finding reported by a previous narrative review published in 2011. The literature search included all documents from the following databases: Medline, Scopus, CINAHL, OVID and Google Scholar. Studies were screened against the Appraisal tool for Cross-sectional Studies to assess methodological quality and risk of bias. After screening the initial 29,398 articles identified, full-text screening was performed on 66 studies with 41 of these included in the systematic review. Strong evidence suggests that saddle height should be configured using dynamic measurements of the knee angle, and limb kinematics is influenced by changes in saddle height. However, moderate evidence suggests that changes in saddle height less than 4% of the leg length results in trivial to small changes in lower limb loads, and no effect on oxygen uptake and efficiency. It is also possible to state that there is limited evidence on the effects from changes in saddle height on supramaximal cycling performance or injury risk.

Discomfort, pain and fatigue levels of 160 cyclists after a kinematic bike-fitting method: an experimental study

Objective

To analyse rider’s subjective responses after a standardised bicycle ergonomic adjustment method.

Methods

Experimental study of 160 healthy, amateur mountain bikers analysed previously and 30 days after a bike-fitting session. The main outcome measures were subjective comfort level (Feeling Scale, FEEL), fatigue (OMINI Scale) and pain (Visual Analogue Scale, VAS).

Results

All variables demonstrated statistical significance between groups pre and post bike-fit session (p<0001). FEEL, OMNI and VAS-knee demonstrated large effect sizes (d=1.30; d=1.39 and d=0.86, respectively). VAS-hands, VAS-neck and VAS-back indicated moderate effect size (d=0.58; d=0.52 and d=0.43, respectively). VAS-groin and VAS-ankle indicated a small size effect (d=0.46 and d=0.43, respectively).

Conclusions

Overall discomfort, fatigue and pain in healthy mountain biker adults improved according to all three scales. The major improvements in pain levels were detected on the knee, hands, back and neck compared with presession values. Groin and ankle pain had smaller improvements but were still significant. Future clinical trials should address the bias effects of this experimental study.

Validation of a 3D Camera System for Cycling Analysis

BACKGROUND

Kinematic analysis aimed toward scientific investigation or professional purposes is commonly unaffordable and complex to use.

OBJECTIVE

The purpose of this study was to verify concurrent validation between a cycling-specific 3D camera and the gold-standard 3D general camera systems.

METHODS

Overall, 11 healthy amateur male triathletes were filmed riding their bicycles with Vicon 3D cameras and the Retul 3D cameras for bike fitting analysis simultaneously. All 18 kinematic measurements given by the bike fitting system were compared with the same data given by Vicon cameras through Pearson correlation (r), intraclass correlation coefficients (ICC), standard error measurements (SEM), and Bland-Altman (BA) analysis. Confidence intervals of 95% are given.

RESULTS

A very high correlation between cameras was found on six of 18 measurements. All other presented a high correlation between cameras (between 0.7 and 0.9). In total, six variables indicate a SEM of less than one degree between systems. Only two variables indicate a SEM higher than two degrees between camera systems. Overall, four measures indicate bias tendency according to BA.

CONCLUSIONS

The cycling-specific led-emitting 3D camera system tested revealed a high or very high degree of correlation with the gold-standard 3D camera system used in laboratory motion capture. In total, 14 measurements of this equipment could be used in sports medicine clinical practice and even by researchers of cycling studies.

Data Science Methods for Nursing-Relevant Patient Outcomes and Clinical Processes: The 2019 Literature Year in Review

Data science continues to be recognized and used within healthcare due to the increased availability of large data sets and advanced analytics. It can be challenging for nurse leaders to remain apprised of this rapidly changing landscape. In this article, we describe our findings from a scoping literature review of papers published in 2019 that use data science to explore, explain, and/or predict 15 phenomena of interest to nurses. Fourteen of the 15 phenomena were associated with at least one paper published in 2019. We identified the use of many contemporary data science methods (eg, natural language processing, neural networks) for many of the outcomes. We found many studies exploring Readmissions and Pressure Injuries. The topics of Artificial Intelligence/Machine Learning Acceptance, Burnout, Patient Safety, and Unit Culture were poorly represented. We hope that the studies described in this article help readers: (1) understand the breadth and depth of data science's ability to improve clinical processes and patient outcomes that are relevant to nurses and (2) identify gaps in the literature that are in need of exploration.

Equations to Prescribe Bicycle Saddle Height based on Desired Joint Kinematics and Bicycle Geometry

METHODS

Forty healthy adults (17 women, 23 men; mean (SD): 28.6 (7.2) years; 24.2 (2.6) kg/m²) participated. Kinematic analyses were conducted for 18 three-minute bicycling bouts including all combinations of 3 horizontal and 3 vertical saddle positions, and 2 crank arm lengths. For both minimum and maximum knee flexion, predictors were identified using Least Absolute Shrinkage and Selection Operator (LASSO) regression, and final models were fit using linear regression. Secondary analyses determined if saddle height equations were sex dependent.

RESULTS

The equation to predict saddle position from minimum knee flexion angle (R²=0.97; root mean squared error (RMSE) = 1.15 cm) was: Saddle height (cm) = 7.41 + 0.82(inseam cm) - 0.1(minimum knee flexion °) + 0.003(inseam cm)(seat tube angle °). The maximum knee flexion equation (R²=0.97; RMSE=1.15 cm) was: Saddle height (cm) = 41.63 + 0.78(inseam cm) - 0.25(maximum knee flexion °) + 0.002(inseam cm)(seat tube angle °). The saddle height equations were not dependent on sex.

CONCLUSIONS

These equations provide a novel, practical strategy for bicycle-fit that accounts for rider anthropometrics, bicycle geometry and user-defined kinematics. HighlightsThis work developed simple equations to prescribed bicycle saddle height that elicits desired knee kinematics.Separate equations are presented for prescribing minimum or maximum knee flexion angle.Equations can be generalized to riders of both sexes, and a breadth of anthropometrics and ages.

The relationship of recreational runners' motivation and resilience levels to the incidence of injury: A mediation model

Running participation has increased significantly in the last decade. Despite its association with different health-related aspects, athletes may experience adverse outcomes, including injuries. The aim of this study was twofold: to examine the relationship between runners’ resilience levels, motivation and incidence of injury, on the one hand; and to analyse the mediation that intrinsic and extrinsic motivation has on the association between the number of injuries and psychological resilience levels among amateur athletes. The sample consisted of a total of 1725 runners (age: 40.40 ± 9.39 years), 1261 of whom were male (age: 43.16 ± 9.38), and 465 of whom were female (age: 40.34 ± 9.14). Athletes completed the Behavioural Regulation in Exercise Questionnaire (BREQ-3), the Resilience scale (CD-RISC 10), and an Injury retrospective survey. Three mediation models were constructed, and the results showed a significant indirect association of athletes’ intrinsic motivation and resilience on the number of injuries (β = 0.022, CI = 0.007, 0.0) in mediation model 1, whereas extrinsic motivation was found to have no significant association on those variables (β = -0.062, CI = -0.137, 0.009) in mediation model 2. Model 3 showed significant differences with respect to resilience (p < 0.05) and intrinsic motivation (p < 0.05). Therefore, the mediation of intrinsic motivation on athletes’ resilience levels and incidence of injury was demonstrated, i.e., it was found that intrinsic motivation was associated with a higher incidence of injury, while no such correlation was found for extrinsic motivation. This study shows that the amateur long distance runners with a high level of intrinsic motivation tend to suffer from a greater number of injuries, and at the same time psychological resilience was associated with a lower number of injuries.

Development and Validation of the Overall Foot Pain Questionnaire in Motorcycle Riders

Objectives: Our primary aim was to develop a transcultural adaptation of a cycling questionnaire using the Borg CR-10 scale as a tool to describe the discomfort among motorcyclists during the riding process in two trial sessions. Design: A transcultural adaptation and descriptive cross-sectional study. Settings: Jarama motorcycling circuit (Madrid, Spain). Participants: The participants were riders recorded across in a final motorcycling race. Interventions: The study design is based in two tools, the adapted Motorcyclist Questionnaire (MQ-21) with 21 items and Borg CR10 Scale^® was used to determine discomfort level during motorcycling performance. The translation procedure, reliability, and reproducibility were performed. Results: All items showed an almost perfect intraclass correlation coefficient (ICC) (ICC = 0.909–1.00), except for item 9 (ICC = 0.881). Almost perfect internal consistency was shown for the total score (Cronbach α = 0.899). No systematic differences existed among test and retest in all items (p > 0.05) according to Bland–Altman plots. Respondents experienced slight discomfort on their body parts during the test-retest 1 h riding process. Foot discomfort was scored as 1.20, being the eighth of the 12 studied body parts. Conclusions: Internal consistency and test-retest reliability of the MQ-21 questionnaire were excellent and this questionnaire may be recommended to be used in motorcycling sports and clinical settings to evaluate the discomfort.