Different leg lengths
Question:
My sports doctor diagnosed a leg length difference of two centimetres. What measures do you suggest?
Answer from Dr Merkl:
Around ten per cent of all people have a congenital difference in leg length and therefore a pelvic obliquity, which the spine has to compensate for by curving sideways. This results in a higher probability of back problems. I consider a difference of around five millimetres or more to be significant, as this leads to lateral curvature of the spine when walking, standing or cycling. Compensating for congenital differences in leg length is controversial in medicine. I do not compensate for every difference, as - particularly in the case of congenital conditions - the body corrects itself as it grows, for example by changing the position of the vertebral joints. This is not the case with leg length differences in adults after fractures, which I would always compensate for. As a measure, I can recommend fitting a wooden plate that is screwed between the sole of the shoe and the pedal hook on the outside - either by yourself or on request from an orthopaedic mechanic. I would strongly advise against using cranks of different lengths, as this results in an uneven pedalling cycle, which causes new problems.
Pain in the thigh
Question:
After every ride, I feel pain in my thigh muscles the next day or the day after, which feels like sore muscles. After three to four days I am pain-free again. My riding position has been professionally adjusted and the bike also corresponds to my body measurements. What could be the cause of this pain in my thighs?
Answer from Dr Merkl:
Leg pain when cycling often has different causes. One possibility is radiation from the spinal region to the pelvic-leg region, which is caused by nerve irritation. Functional problems in the vertebral joints can also trigger irritation of the muscles. Old muscle scars or painful muscle attachments can sometimes lead to problems that are difficult to localise on both the front and back of the leg. On the front of the leg, arthrosis pain in the hip joint can lead to pain that is reminiscent of sore muscles and can last for days after exertion.
If non-specific pain only occurs during exercise and disappears immediately afterwards, it should be investigated whether the blood supply may be impaired. This may be due to chronic arterial occlusive disease, which is very common from midlife onwards. The arterial wall loses its elasticity, the inner wall becomes thicker and the vessel becomes narrower. Intensive treatment often leads to an astonishing self-healing process - the blood vessels bypass the bottleneck in many small new connections. Nevertheless, high levels of stress can lead to insufficient blood flow and a lack of oxygen in the working muscles. I would advise you to have the vessels examined by arteriography, for example.
All in all, you should also involve neurologists and vascular specialists in the assessment of leg pain in addition to the orthopaedist.
Shin splints
Question:
I have had an irritation on my right shin for some time now, which causes me constant pain when cycling. What can I do about it?
Answer from Dr Merkl:
On the front of the lower leg, between the tibia and fibula, lies the anterior tibialis anterior muscle box. Vascular and nerve bundles run through it, which supply the front of the lower leg and the foot. An increase in pressure in this box due to an injury with haemorrhage, but also as a result of overloading during intensive running on a hard surface, can lead to acute pain. Overtraining (muscle growth occurs faster than the muscle sheath can provide space) can also lead to an increase in pressure in the muscle. Under stress, this leads to reduced blood flow. The result is an accumulation of lactic acid, which causes the muscle to swell. A vicious circle develops with increasing pain during exertion, numbness down to the feet and considerable pressure pain. In addition to rest, lymphatic drainage as well as diuretic and anti-inflammatory tablets can provide relief.
