Marks body is extremely resilient to withstanding the repetitive nature and high volume of riding that he does. He is one of very few that has ridden high volume since a young age, crossing Scotland when he was just 12 years old, so his body has been conditioned to cycle and therefore adapted to be as efficient as possible.
Apart from general body/ muscle fatigue after a hard day on the bike, if Mark gets any issues which could develop in to an injury, then it’s usually due to there being a change in something external which is the root cause. When he actually shows signs of an injury, we need to look at the key contact/ interaction points between the body and the bike ;i.e. front set up for his aero’s/ bars, saddle position/ pelvis, feet insoles/ shoe set up, kit/clothing and see if anything has changed from his norm. Having the accident last week, threw out his normal mechanics of riding for a few days and that has had a knock on affect causing some secondary issues to manage.
So current issues being treated:
Right knee – Posterior knee pain on extension of the knee, related to a neural mechanical interface. Possibly triggered by altered mechanics, due to right foot pain (see below). As I watched Mark ride yesterday, I could see that the right foot was held in supination so the inside of the foot was pulled upwards and most of the pressure was transferring down through the outside of the foot.
I had a look at the cleats and pedals and there was significant lateral wear just on the right side, so Alex changed both the pedals and cleats to new sets. Interestingly you most probably wouldn’t think to change out your pedals within 5 years if you are a normal day-day cyclist, but these have done over 4,000miles in 17 days! We have also adjusted the cleat angle to bring the shoe in to a more neutral float position, as Mark had reported he felt he was always needing to push his heel outward against the float. Immediately cycling with the new set up alleviated his pain, so no matter how much treatment you do to address neural dynamics or whatever you think the pain generator is, addressing the source/ cause of the injury has to be the priority and easiest gain.
Right Foot – due to not being able to weight bear fully through the left arm for a couple of days, this meant a transfer of increased load going through the right side. The right foot under the balls of the toes, developed pressure bruising so required additional gel padding and strapping to offload, Mark also made adjustments with ensuring his pedal stroke was smoother and I made adjustments to his insoles to provide more support through the midfoot and cushion under the toes. Although all this helped, the biggest gain was from the cleat/ pedal change. Bilaterally he gets burning in his feet on a day of big climbing, so he is now wearing his full compression socks rather than guards to reduce blood pooling in the feet.
Shins and calves – Secondary to above, with Mark making small adjustments to try and offload the foot every time he pedals, often means he compensates with gripping of the toes and holding his ankle stiff in to plantar flexion (toes down). Soft tissue release and acupuncture through the tib ant. (front of the shins muscle), aswell as the plantar fascia (sole of the foot), tib post. and FHL (big toe flexor) and soleus (deep under the Achilles/ calf muscle), has helped to ease this tension. The insole adjustment also works to support under the foot to make it feel more comfortable and allow the foot to relax.
Neck – upper occipitals and right side C2/3 (likely due to being jammed from impacting the floor during incident). By working on his thoracic mobility and postural taping his scapula (shoulder blades), this helps to offload higher up in the neck. He has also received local treatment such as acupuncture, soft tissue release and joint mobilisation to gap the joints that are irritated.
Hips – It becomes obvious towards the end of the day that his hips tighten up and he doesn’t get full range so starts to compensate with rotation in the back or the hips drifting out into external rotation. At this level of volume, if the hips were to go without treatment, it could easily lead to a secondary injury in the lower back or knees due to poor alignment and inefficient pedalling.
Apart from these things to manage alongside his left elbow and the dentistry work from the accident, Mark is holding up well and the above niggles being addressed are nothing to be concerned about. Early awareness of tightness/ niggles is good to flag, so that they don't develop in to more of an issue than needed. Preventative work also helps to keep Mark efficient by maintaining range and power, it keeps him painfree and basically it's the small percentage gains that help the miles tick away.