Should you self-
diagnose injuries?

‘Every problem has a solution, and every solution is on the internet.’ How far does this credo get us when it comes to fixing our own cycling injuries? David Bradford and Tom Goom investigate

So you have a physical ache or niggle and it’s impeding your cycling. The temptation is to fire up your laptop and Google your symptoms in an attempt to find a quick fix.

But is that really likely to yield the desired result, i.e. good advice, or are you more likely to end up confused and terrified by the bewildering array of maladies that pop up on screen?

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>>> Common cycling injuries: treatment and prevention 

The urge to self-diagnose is understandable; seeking specialist advice from a physio or sports doctor can be expensive and time-consuming.

However, diagnosis is a very challenging area, even for qualified health professionals — that’s why their training takes years of study.

Trying to diagnose without background knowledge of anatomy and pathology renders the layman helplessly cut adrift among myriad online resources. A medical professional, on the other hand, has the knowledge needed to carefully filter through, select and apply the pieces of information that are most relevant and most likely to help.

A more serious risk for the layman is making an incorrect diagnosis and, as a result, taking unhelpful or even counter-productive and hazardous treatment measures. Self-diagnoses often lead to misconceptions, unnecessary worry, ineffective treatments and poor outcomes.

How to diagnose an injury
Experienced sports physio Tom Goom says: “I don’t recommend trying to determine for yourself exactly what your injury is.

It is helpful to get a general idea and there are some self-treatment options that work with most injuries, but for specific advice on diagnosis, treatment and rehab, it’s almost always better to see a health care professional.”

Broadly speaking, most cycling injuries fall into one of two categories: traumatic and overuse. Traumatic injuries occur following a specific incident; a fall or collision usually results in soft tissue injuries, and, thankfully less commonly, sprains, tears and fractures to the wrist, hand and shoulder.

Clearly, if you suspect you have any traumatic injuries worse than small cuts and bruises, then you should seek medical advice immediately. Telltale signs of more serious problems include swelling, severe bruising, bony deformity, and sensations of a joint giving way or locking.

What about self-treatment?
There are self-treatment techniques for reducing pain and swelling post-injury, but these should be used with guidance from a healthcare professional. A useful phrase to remember is ‘POLICE do no HARM’ (see roundels). According to research published in the British Journal of Sports Medicine, the POLICE protocol (Bleakley et al. 2012) is favourable to the older RICE (Rest, Ice, Compression, Elevation).

Modifying your workload
Overuse injuries usually occur following a change in training, often an increase in mileage or intensity. These problems are essentially a reactive response from your tissues (muscle, tendon, joint, bone etc.) to the increased load and/or stress.

Typically, there is no lasting tissue damage, which is what distinguishes these problems from traumatic injuries. The key self-treatment is reducing your training to a level that doesn’t overload the tissues.

This doesn’t necessarily mean stopping altogether, but rather adjusting to keep cycling comfortable. This can be achieved by reducing training volume, intensity or frequency of certain types of training (e.g. hill work). Tweaking your bike set-up or altering your gear selection and cadence can also help.

When is it safe to resume?
Once symptoms have settled, gradually return to previous training levels but monitor symptoms and progress only if comfortable. It’s possible that your overuse injury was not caused simply by training too much; you may have an underlying weakness that needs to be addressed and/or necessitates help with your technique. In either case, you need to seek specialist advice.

As regards selecting a qualified health professional, it’s well worth seeking recommendations from fellow cyclists, who’ll know physio or sports therapists who have experience treating injured riders.

What does the research say?
CW is not aware of any research that has been conducted into the effectiveness of the self-diagnosis of cycling injuries. However, studies have highlighted the complexity of diagnosis and some of the common misconceptions.

For example, back pain is common among cyclists; 30-70 per cent at some point report spinal pain or discomfort (Salai et al. 1999).

A recent survey in New Zealand found that 62 per cent of people with back pain assumed the cause was “something was out of place” — a common misconception. Diagnosis in spinal pain is notoriously difficult. Manchikanti et al. (2009) found that it is impossible to make an exact diagnosis in up to 85 per cent of low back pain cases.

Back pain isn’t the only area where diagnosis is a challenge; the body is astonishingly complex. Multiple structures can be responsible for pain, and determining which to address relies on subjective questioning and tests with varying reliability and validity.

Verdict: Diagnosis is complex, so is usually best left to the professionals; specialist intervention gives you the best chance of getting back on the bike asap. Simple overuse injuries can be safely self-treated by adjusting your training, but if symptoms are persistent and/or severe, seek specialist help. If in doubt, get checked out.