INJURIES IN SPIN

WHY SAFETY IS IMPORTANT IN SPIN

For first-time riders, spinning can get overwhelming very easily, especially in a high adrenaline-pumped state. Many exert too much effort pedalling and push themselves past their bodies’ limit, which naturally poses a higher risk for injury.

However, with the right care, knowledge and habits, you can avoid these risks.

To spin well is to spin safely, not to push beyond your limits.

Spin participants typically ride at 60 - 100 revolutions per minute, a high speed even for road cyclists!

COMMON SPIN INJURIES

The most dominant movement in spin is pedalling, which is done repeatedly throughout the workout. By increasing or decreasing the resistance of the pedal, the speed and energy used to pedal changes as the workout progresses.

A spin workout works predominantly on the muscles of your lower body, increasing exertional stress on specific areas, which are thus more prone to injury.

KNEE INJURY

The most common region of knee pain in cyclists (including spin cyclists) is pain at the front of the knee in the region of the kneecap, which is caused by a condition known as patellofemoral pain syndrome (PFPS). Symptoms of PFPS include: Pain after a recent increase in the intensity of exercise; Pain when knees are bent, or after prolonged sitting; And /or pain when climbing stairs. Another common cause of knee pain in spin cyclists is iliotibial band friction syndrome (ITBFS), which typically causes pain over the outer portion of the knee. This is often a result of prolonged and repetitive activity, and is thus prevalent in spin cyclists due to the repeated pedalling action in a class.

back pain and shoulder pain after spinning

BACK AND SHOULDER PAIN

Lower back pain is a common complaint amongst spin cyclists. While getting the correct bike fit (i.e. correcting the saddle height and angle) can help to mitigate this, muscle fatigue can also be a contributing factor. This results from participants pedalling to exhaustion, causing the hamstrings and calf muscles to fatigue, thereby altering the biomechanics (increased forward bending in the back, greater splaying out of knees), predisposing to back strains. Shoulder pain is also prevalent in cyclists and spin cyclists alike. One cause of shoulder pain in this population is shoulder impingement. The rotator cuff of the shoulder helps to stabilise the shoulder joint. When the participant in on the bike, the position that the arm assumes causes some degree of narrowing of the space through which the rotator cuff passes through, and this persistent narrowing can result in shoulder impingement. Should the narrowing be severe, a rotator cuff tear can occur, which will require further intervention.

EXERTIONAL RHABDOMYOLYSIS

WHAT HAPPENS WHEN YOU OVEREXERT?

magnified diagram of leg muscle after spinning with rhabdomyolysis

myoglobin enters bloodstream text with arrow

WHAT IS EXERTIONAL RHABDOMYOLYSIS?

Exertional rhabdomyolysis (ER), or informally referred to as "rhabdo", happens when you overexert your muscles to the point that they break down, most typically in the quadriceps (“quads”) and/or gluteus maximus (“glutes”) muscles.

Rhabdomyolysis commonly occurs as an occupational hazard among firefighters, construction workers and even athletes.

HOW DOES EXERTIONAL RHABDOMYOLYSIS HAPPEN?

Because of the high-intensity nature of spinning, much effort is required to pedal against resistance and coordinate arm movements, often with minimal rest time. ER happens when the energy supply to the muscle is insufficient to meet physical demands, and can occur after prolonged and intense physical exertion. It is characterised by muscle pain, markedly elevated levels of serum creatinine kinase (CK), and myoglobinuria or the presence of myoglobin in the urine. After a period of intense physical exertion, soreness typically sets in as part of muscle healing. However, in the case of ER, overexertion results in muscle breakdown instead.

IF NOT TREATED QUICKLY, ER CAN RESULT IN THESE HEALTH CONDITIONS

KIDNEY FAILURE

HEART ATTACK

LOSS OF LIMB

Thankfully, most ER victims seek medical attention early, and do not develop these severe complications.

WHEN YOU DEVELOP ER, YOU MAY FEEL SOME OR ALL OF THE FOLLOWING SYMPTOMS:

Severe muscle pain and weakness
Loss of muscle control
Dark-coloured urine
Nausea
Dehydration
Decreased urine input
Irregular heartbeat

leg crutches from exertional rhabdomyolysis

muscle pains from exertional rhabdomyolysis

inability to climb stairs from exertional rhabdomyolysis yellow sticker

muscle ache from exertional rhabdomyolysis yellow sticker

It is almost impossible to feel your muscles breaking down during the spin class itself.

However, some victims have felt early signs of ER after their spin class, such as:

Needing help getting off the bike after class
Having difficulty lifting legs to change out post-spin class
Inability to climb stairs after class

While your muscles could ache after class, weakness is an indication that something more sinister is brewing, and one should seek medical attention.

URINE COLOUR CHANGES

Most victims seek help after noticing the change in their urine colour. Use the Pee Check card to gauge your urine colour.

CHECK YOUR URINE COLOUR

toilet bowl to check for urine colourfrom exertional rhabdomyolysis

WHAT KIND OF TREATMENT IS EXPECTED FOR ER PATIENTS?

ER cases are usually sent to the emergency departments first, and patients are typically admitted for inpatient management.

The primary treatment is hydration, conventionally via an intravenous (IV) saline drip to maintain a high urine output, aiming to increase the removal of myoglobin via the kidneys.

In severe cases where patients' condition are not improving with hydration, acute renal dialysis may be needed.

INTRAVENOUS (IV) DRIP

OTHER IMPORTANT MEDICAL INFORMATION ABOUT ER

How long does an ER patient stay in the hospital?

Patients are usually discharged when CK levels are downtrending, typically after two to seven days. They are then followed up in an outpatient clinic until CK levels normalise and their symptoms have resolved.

How long does an ER patient take to fully recover?

Recovery periods vary between individuals, ranging from days to months. There are usually no long-lasting effects unless the initial presentation was severe enough to cause permanent kidney injury.

Can I self-treat myself?

Self-treatment of SER is strongly discouraged! Without proper medical supervision, there is a higher risk of developing long-term health complications.

HOW TO DIAGNOSE ER?

Exertional rhabdomyolysis is diagnosed through a blood test to check your creatine kinase (CK) levels – an indicator of muscle breakdown in your body.

If you’re found to have abnormally high CK levels, there is high muscle damage in your body and your kidney is unable to filter out the CK quickly enough. This will necessitate treatment.

What constitutes a high CK level?

There’s no universal diagnostic CK value for rhabdomyolysis. However, a CK level of more than five times the normal CK range (22-198 IU/litre) is usually sufficient to come to the diagnosis.

Note: Information is provided by Dr Jade Chee, Division of Sports, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, National University Hospital (NUH)

AVOID SPIN INJURIES

Spin injuries are preventable, especially when the right steps are taken.

LEARN HOW TO STAY SAFE

woman drinking water after spin class spinning workout