Sunday, March 23, 2014

Is Your Bike Destroying Your Health?

Richard Wolf M.D. (retired) has completed 15 century rides and many long tours. He rides both upright and recumbent bikes and has done so for decades. Cycling is one of the great pleasures in life.; we all know the health benefits. Richard knows the risks too, has seen the consequences of ignoring those risks and can tell you how much the surgeries cost.

Hopefully you have already considered the safety basics. But stuff, as they say, happens. Perhaps the numbness you've noticed in your hands, across your neck and shoulders and throughout your crotch is, as you've been telling yourself, only temporary.  If it isn't, Dr. Wolf has some advice for you.


HANDS AND WRISTS

The human wrist structure is not designed to support half the weight of the body under constant vibration for hours at a time. Something can--and will--give way if you ignore this inconvenient anatomical fact of life and try to "ride through the pain."

Carpal tunnel surgery runs about $5--10,000. But if the tiny and quite vulnerable Hamate bone is stressed to the point of fracture, you're faced with a more complex and expensive surgical repair.



Then it's back into the drop position on the new Trek, right? Yes, your bike is faster if you bend forward. But after Carpal Tunnel surgery that speed boost comes at some cost. With luck you might be able to repeat the surgery once; with lots of luck twice. After that your wrists and hands stop functioning.


Consider the drop position minus a bike. To gain speed and efficiency you sit well above the handlebars, bend over double concentrating half your body weight on your wrists. The ergonomics--adapting yourself to the needs of a machine for the sake of speed and efficiency--couldn't be worse.


Can you imagine assuming this posture without a bike for a four hour exercise session?




Recommendation: Set up your handlebars level with your seat with the bar ends pointing toward you. To reduce stress on the neck with drop bars raise them 3 inches. Vary your hand position frequently during a ride, especially when riding with drop bars. 

YOUR SKIN

The SPF ratings on skin protection creams levels off at SPF 30 (30X more protection than no cream). You can certainly pay more for "higher" SPF  ratings but you won't gain any significant protection. Protect your skin by reapplying skin cream every two hours, something few cyclists bother to do. Don't stop with the body parts you see in a mirror. The top of the scalp and ears are particularly important.


If you notice scaly deposits on your face, scalp or the tops of your ears take it as a warning and see a dermatologist. You may be able to intercept a pre-cancerous condition. Costs for removal are about $500.

Recommendation: Use a broad spectrum  sunscreen--SPF 30 or more--with protection against UVA and UVB. Don't stop with your face. Cover the back of the hands, back of the neck, ears and scalp. Use a helmet liner or cap to cover your scalp. Reapply every two hours. 


YOUR EYES


Riding fast or into headwinds greatly increases the risk to your eyes.  There are nasty bugs out there and you will get in their way on a bike.

Only you can protect your eyes from insects

Recommendation: Wear wraparound eye protection. 


FOOD SUPPLEMENTS

Food supplements are not food, may not be safe and are not regulated. To put it bluntly, when you take an unregulated supplement, you have no way of knowing what you are putting into your body. Don't waste your money and take needless health risks by consuming weird substances that make wild promises. Pills, "supplements" and snake oil "remedies" don't belong in a "health food" store. 


Skip the vitamins especially if the prefix "mega" or the words "beta carotene" appear anywhere on the label.


Recommendation: Eat real food. 

YOUR PELVIS 

Your ultra light, extremely narrow, super firm racing seat is pressing hard against some of the most delicate tissue in the body. At no time in evolutionary history have any of our ancestors managed to stress the perineum for hours at a time so it remains soft, exposed and packed with surface blood vessels.  Neither male nor female cyclists should tolerate pelvic numbness while riding a bike. Set up your handlebars and seat to relieve perineal pressure--even if doing so slows you down.


Recommendation: Cyclists who ride in the drop position should consider a split saddle to relieve pressure on the perineum.  Make sure your knees are not fully extended while riding. A well adjusted saddle reduces chafing and side-to-side hip rocking, both of which can cause saddle sores. Wear a clean, seamless chamois to minimize chafing. 


BACK PAIN

If your seat is too high, your pelvis will rock, likely leading to back pain. It can get really bad fast.


Recommendation: Have your local bike shop show you how to set your seat height. A small change can make a big difference. Proper seat height is essential if you have back issues.


YOUR KNEES

Recommendation: If you use clip-in pedals choose a set with some lateral play or "cleat float." Avoid clip ins with no cleat float because they have been linked to knee injuries. 


YOUR HEAD

Let's say you live in Copenhagen or Amsterdam and have at your disposal the world's best cycling infrastructure. Everyone you know rides a bike, to work, to the market and to the park. Helmets? Do we wear helmets for a walk in the park? If you were seen wearing a helmet you'd be ridiculed by all your friends. Even worse, you could be mistaken for an American tourist!


But before you blithely ride off to the office bare headed consider this: if you fall just once during a bike ride it's decidedly not like tripping in the park. Your helmet offers imperfect but essential protection: it will prevent life threatening fractures, not concussions. But you do have to wear it correctly if you expect to be protected.



No rear retention system. The helmet shifted back under impact.

The head is a heavy object and will usually land first in a bike accident. It makes little difference whether you fall in Los Angeles traffic or on a protected bike path in Copenhagen; the the most likely place you will land is on your head. The question is: can you afford to slam your head into pavement even once? If you survive such a fall--many do not--reconstructive face and head surgeries run $50-100,000 or more.

A few sobering statistics: The Minnesota Brain Injury Alliance reports that "When worn properly, bike helmets can reduce the risk of brain injury by 88 percent. Only 8% of Minnesotans wear a bike helmet consistently....Each year, about 567,000 people go to hospital emergency departments with bicycle-related injuries; about 350,000 of those injured are children under 15. Of those children, about 130,000 sustain brain injuries...The average bicycle injury in Minnesota costs $49,000, including hospitalization, loss of productivity, and pain and suffering."

Recommendation: Wear a helmet with an easy-to-adjust rear retention system. Read this or let your bike shop show you how to adjust your helmet straps. Stay well away from trucks, taking extra care to avoid riding in their back drafts. 


A COMMON MEDICAL MISCONCEPTION

Wounds heal faster when exposed to the air. This is false. Keeping a wound dry slows the growth of new tissue. Any open wound is more likely to become infected. And open wounds provide a tempting place for flies to lay eggs. (That actually does happen)

Recommendation: Pack a few bandages (small to large) on your ride. If you fall and sustain "road rash" washing it out asap to get rid of cinders and road debris will minimize future infections. 


WARNINGS YOU SHOULD NOT IGNORE: DON'T WAIT TO GET HELP


  • Unexpected persistent chest pain
  • Unexpected, rapid or irregular heart beat
  • An allergic reaction after a bee sting. The symptoms can accelerate rapidly. 
  • If you are diabetic: marked thirst and increased urination may indicate not only dehydration but low blood sugar. Hunger and mental confusion may also be a sign of low blood sugar.
GO IMMEDIATELY TO THE NEAREST HOSPITAL IF YOU HAVE: 

  • deep knee lacerations (if a cut penetrates to the knee bursa it will get infected) 
  • a broken bone 
  • a collar bone fracture
  • lost and regained consciousness
  • unexpected persistent chest pain
  • fallen hard on your head even if you were wearing a helmet 

SEE A DR. IF...

You feel different and can't explain why. Something has changed. Find out what it is. 

Pack on every ride: your name and address, a list of your significant medical conditions and medications,  the name and phone number of a reliable contact person. 


Addendum: I'm getting flak on Dr. Wolf's helmet recommendations from the European anti-helmet brigades. A word about the science involved and the sad statistics on childhood bicycle-induced head injuries: first, when it comes to bike injuries, the most vulnerable individuals are small children, many of whom are still learning to ride. Secondly, the science on bicycle related head injury is all too real. If you really believe the studies are faked by unscrupulous helmet manufacturers in the hopes of forcing cyclists to buy a useless product, you’re either terribly gullible or delusional. You've bought into a conspiracy theory. 

a tip of the helmet to Dick Van Hoose for this chart

Again, if you fall off your bike you will very likely land on your head. I've fallen three times in the past 30 years. Each time I landed on my head and was able to ride home afterwards only because I had been wearing a helmet. President Obama (above) is not wearing a helmet because he is on the payroll of the bike helmet lobby. It simply makes good sense to protect your head when riding a bike.  Go ahead, if you must, and ride bareheaded through the English countryside, through downtown London and across Copenhagen but have the decency not to make yourself into a role model. You’re putting little kids at risk and a lot of adults as well.