As a sports therapist, I spend half of my week conducting bike fit assessments on cyclists and triathletes, but I always ensure I dedicate a significant amount of my time to my clinical work where most of my clients are not bike riders. Spending time in the clinic allows me to keep on top of what can go wrong with the human body and how injuries or chronic conditions can be managed. It's great to be able to help these patients but this clinical work also helps me have a better understanding of what contributes to pain and discomfort when working through bike fit assessments.
I recently ran through some of my clinical notes to see what the most common presentations are for me in the clinic. Here are the results;
Low Back Pain: Close to one in every five clients I see in clinic come to me with back pain. It's pretty evenly split between chronic back pain and acute injuries. The specific pathologies that drive the pain vary from lumbar disc or arthritic conditions to non-specific muscular pain that may not have a clear structural cause.
Neck Pain: Almost as common as low back injuries are neck pain. Sometimes, there is a history of traumatic injury from bike crashes or motor vehicle accidents. Often, people present with some cervical joint irritation that elicit pain and significantly reduces their ability to rotate or extend their necks. Students and academics are a common group who present with neck pain, particularly toward the end of the year, as people punch out essays and cram for exams.
Rotator Cuff Injuries: One in ten clients sees me due to a rotator cuff injury. Sometimes, people present with a traumatic injury such as a fall or sporting incident. Still, quite often, particularly in older populations, degenerative changes to the muscles, tendons, and bones around the shoulder lead to the onset of pain and reduced function. I used to hate working on shoulders when I was a graduate therapist but over the past decade, I have leant to enjoy helping clients manage pain in this area. Shoulders are a complex part of the body that we rely on for basic daily activities, but when injured can create debilitating pain even at rest.
Pre or Post Event Tune-Ups: Sports therapists have a strong foundation in manual therapies, so I still see quite a lot of clients who don't have any injuries; instead, they need a quick tune-up session before they head to a big sports competition, or sometimes just to help them recover from demanding training workload. A couple of broken bodies are always hobbling through the door after big events like the Peaks Challenge or Melbourne Marathon.
Meniscal Tears: Meniscal tears are the most common knee injury that I see and one that I enjoy treating. As a cyclist, I've always considered knees to be my bread and butter in terms of injury management. My focus is on conservative management of meniscal tears as well as post-surgical care, working alongside the physio rehab team. Nothing is more satisfying than helping a client avoid surgical intervention with conservative care.
Post Orthopedic Surgical Treatment: Quite a few clients seek my help after undergoing orthopedic surgery. Ankles and shoulders are the most common areas I work with here, but I also see clients who have had or are preparing for knee and hip replacements. These clients usually need a collaborative team approach to their rehabilitation program.
Ankle Tendinopathies: Most ankle injuries that I see are from young athletes. Achilles and tibialis posterior tendinopathies are common, as are ligament sprains from inversion injuries. Aussie Rules football, soccer and athletics are the three main sports that bring people to see me in this area. I see more ankle tendinopathies in female athletes, particularly those competing at the elite level.
Elbow Tendinopathies: Occasionally, I see tennis players with tennis elbow but in a decade of clinical work, I'm yet to see a golfer present to me with golfer's elbow. Elbow tendinopathies are a common presentation, with one in every 20 presentations coming to me for these injuries. More often than not, tradies and manual laborers come to me with elbow injuries. Some are stubborn to treat, and others respond satisfyingly well.
Hamstring Strains: Runners and football players come to me with hamstring injuries. The vast majority are male athletes who often have a history of recurring hamstring injuries. Thes injuries require a collaborative rehab approach with other sports medicine practitioners, and we work with athletes to make a smooth transition back to their sport, trying to reduce the risk of future reinjuries.
Plantar Fasciitis: More often than not, plantar fasciitis presents in middle-aged clients, usually in non-athletic populations or recreational runners. Plantar pain can be frustrating and debilitating for patients. Symptom relief is what most people are seeking when they present to me with this, but I ensure we screen for and address some of the broader risk factors that predispose people to this injury. I often work alongside a podiatrist when dealing with chronic or severe plantar issues.
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