Road cycling has become a very popular pastime and events such as the Cape Town Cycle Tour (CTCT), previously known as the Argus Tour, and the Telkom 947 Cycle Challenge see thousands of participants riding on the streets of Cape Town and Johannesburg each year. Cycling is a great way to spend time outdoors in a beautiful country like South Africa, and it is a healthy activity that can be shared with family and friends. It is a non-restrictive sport, suitable for all shapes, sizes and levels of fitness.

While recreational cycling grows in popularity and mass community-based cycling events like those mentioned above are on every recreational cyclist’s bucket list, very few studies have been done on the epidemiology and risk markers for non-traumatic or ‘overuse’ injuries among recreational cyclists.

Francois ‘FC’ du Toit, a senior biokineticist at the University of Pretoria’s Department of Physiology, is conducting a cross-sectional study to determine the prevalence of non-traumatic injuries (NTIs) in recreational cyclists, and to better understand the anatomical distribution and severity of these injuries. This is part of a large study that SEMLI (the Sport, Exercise Medicine and Lifestyle Institute) is conducting in collaboration with Dr Jannelene Killops of Mediclinic Events, which analyses 22 560 of the 37 425 cyclists from across the world that participated in the 2016 CTCT. Said to be the world’s largest timed race, the 109-km event takes cyclists past some of Cape Town’s iconic spots such as the Castle of Good Hope, up Chapman’s Peak Drive and around the Cape Peninsula.

Du Toit says this study is essential to ensure the longevity of recreational cycling. Through it, he hopes to not only identify the common NTIs sustained by participants, but also initiate further studies that develop guidelines and recommendations to reduce the incidence of such injuries.

Du Toit has already determined from the crude data (not yet adjusted for age and sex) that 1 in 20 recreational cyclists have suffered from an NTI. The most common areas of injury are the knees, followed by the lower back and shoulders. Injuries mainly occur in the muscles and tendons of these areas. Du Toit explains that the most common NTI is a condition in which the cartilage under the kneecap is damaged due to injury or overuse, known as patellofemoral pain syndrome. Other common NTIs include lower back pain and iliotibial band friction syndrome (commonly known as ITB syndrome), a painful condition in which connective tissue rubs against the thighbone. Such injuries can be so painful and inhibiting that they affect cyclists’ training and in severe cases, even prevent them from cycling completely.

From the data, Du Toit plans to find identifiable markers that highlight a predisposition to the common injuries described above. While analysing thousands of participants’ data takes a lot of time, Du Toit says the large number allows for more accurate correlations to be made. The data are taken from a pre-race questionnaire that each participant must complete when entering the event. Questions give insight into the prevalence and type of injury over specific and extended periods of time, enabling Du Toit to link information and make accurate conclusions regarding risk markers for NTIs. 

As a biokineticist, Du Toit is trained to help people maintain an optimal quality of life through physical activity. A biokineticist’s goal is to help patients resume pain-free functional activity. Typically, biokineticists develop one-on-one training that is scientifically based on the results of each patient assessment. However, Du Toit says that developing general guidelines based on results from the Cycle Tour’s questionnaire can serve as a very constructive way for recreational cyclists to improve their cycling and reduce their risk of injury.

‘Prehabilitation’, a term used frequently in biokinetics in sporting, refers to injury prevention. It also considers all the demands and risks of the sport in question and identifies common injuries and joints that are most vulnerable.

As results from Du Toit’s study show, the knees, lower back and shoulders are the areas most prone to injury. Using prehabilitation techniques and effective screening tools, Du Toit is able to determine reliable and valid identification of weaknesses or predisposing factors that put someone at risk of injury.

Once collated, Du Toit’s final results will serve as a valuable contribution towards decreasing risks of injuries and providing recommendations for an optimal cycling experience. Du Toit says ensuring correct bike set-up and cycling mechanisms can prevent unnecessary strain on areas like the knee. Being on a bike for an extended period with an incorrect bike set-up is sure to cause problems, especially for individuals with predisposing risk factors.

With all the practical experience he has gained at the University of Pretoria’s Biokinetics Rehabilitation Centre, Du Toit is in an ideal position to make these recommendations and guidelines. Always striving for a holistic approach to wellness, Du Toit recognises that he may be the one to develop a standard format that gives participants better guidance in optimising their cycling experience, and thereby ensuring that their bodies are well looked after, which is one of the reasons he loves being a biokineticist.

*This study forms part of a broader study, ‘Reducing medical complications and injuries at endurance sports events: A 5-year longitudinal study (2016–2020) SAFER STUDIES’, which looks at a range of endurance events and assumes a multi-disciplinary approach within the health sciences.