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Christopher Schwenker
- May 10, 2022
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Ever wonder the difference between a sprain and a strain? Or a cramp and a stitch? Knowing just might make dealing with them more manageable.
Some questions have answers, but the fortunate who have figured them out aren’t inclined to share. Others are investigated and reported every time you turn around to the point that you’d rather not know anymore.
Still, some we take for granted, and you go along because you always have, and everyone else does. Then there are those questions that remain a mystery because no one has thought to ask.
I don’t know where the following fall on your list, but they are worth asking. The answers just might make you a better cyclist. Or at the very least, one with interesting information to share at the group ride coffee stop.
What is the Difference Between a Sprain and a Strain?
Sprains and strains describe damage to our body’s soft tissue, like ligaments, tendons, and muscles. Both are common injuries that affect cyclists and athletes in general. If you ride or race for long enough, chances are you will encounter one or both. Knowledge of the distinction will determine how you react and help you prevent them from occurring in the future.
A Sprain is a damaged, overstretched, or ruptured ligament. Ligaments are the solid fibrous structures that connect bones to other bones and cartilage located around joints.
A Strain is a damaged, overstretched, or torn tendon or muscle. The tough fibrous structures that connect muscles to bones are tendons. When a muscle contracts, the force is transferred to the bone through a tendon, causing motion at a joint.
Symptoms and Onset of Sprains and Strains
A Sprain of a ligament surrounding a joint typically happens suddenly as the result of a traumatic incident. Symptoms of a sprain range from mild to severe, and we characterize them according to the magnitude of tissue fiber damage. Pain, swelling, bruising, loss of motion and difficulty bearing weight through the affected joint are common symptoms. An athlete often reports hearing a popping sound coming from the joint at the time of injury.
A Strain frequently develops over time but can occur suddenly in some cases and is described as acute or chronic. Symptoms of a tendon or muscle strain include tenderness, swelling, bruising, and tightness of the muscle, sometimes described as spasms. A strain injury often causes muscle weakness and limits movement of the affected area.
Causes of Sprains and Strains
Sprain injuries are most commonly the result of trauma, like falling or twisting awkwardly. The force of the incident forces the joint to move outside of or beyond its normal range of motion. Tearing or stretching of the ligament surrounding the joint occurs.
Cyclists rarely develop sprain injuries unless they are the result of an unfortunate crash. Cyclocross riders may experience ankle sprains if they awkwardly step when jumping a barrier or during a run-up.
Strain injuries that occur suddenly, called acute, happen when lifting a heavy object, running, and jumping. The rapid and forceful contraction of the muscle can cause its fibers or tendons to be damaged. Chronic strains develop gradually over time and involve sports and activities with repetitive movements. The repetitive nature of the pedal stroke lends itself to cycling strain injuries if the bike is improperly fit or the rider has musculoskeletal asymmetries.
Treatment and Prevention of Sprains and Strains
If you have suffered a Sprain or acute Strain, it is essential to treat it immediately by following the five-step PRICE principle. Follow this approach for two to three days after the onset of the injury.
- Protect - To eliminate further injury, stop the exercise or activity.
- Rest - Allow the healing process to begin by avoiding excessive weight-bearing and motion of the affected joint.
- Ice - Apply appropriate cold therapy to the affected area for approximately 20 minutes every two to three hours.
- Compression - By wrapping the affected area before applying cold, you will protect the joint and reduce the swelling.
- Elevation - If you position the injured joint above the level of your heart, gravity will assist your circulatory system in eliminating the swelling.
Some Sprain and acute Strain injuries are unavoidable, but you can help prevent the others.
Strengthening
The inclusion of resistance training not only improves cycling performance, as described in this article previously posted on The ZOM, but it also helps to prevent injury. A strong Core is critical to optimizing performance and decreasing injury, and you can find several exercise protocols on the Core Strengthening page of The ZOM.
Stretching
Proper flexibility is essential for cyclists, as this ZOM article shows, and is critical in preventing injury.
Warm-up and Cool-down
A proper Warm-up is vital for many reasons, as stated in this article previously posted to The ZOM. By following a good Cool-down routine as described in this ZOM article, in addition, you will decrease the likelihood of injury.
Training and Recovery
Overworking your ligaments, tendons, and muscles cause overuse injuries that are preventable by following a periodized training program with adequate recovery.
For tips on identifying, treating, and preventing common cycling injuries, check out the Injury Prevention & Treatment page on The ZOM.
What is the Difference Between a Cramp and a Stitch?
Unlike sprains and strains, cyclists commonly experience the painful and performance-limiting effects of the Cramp and the Stitch. Although they are not injuries, these two conditions have significant detrimental consequences to endurance athletes.
Muscle Cramps are the continuous, involuntary, painful contraction of a muscle group. Cramps generally last from seconds to minutes and usually come on without warning. The affected muscle goes into a state of intense and forceful contraction, and the athlete can usually not continue.
A Stitch, or Exercise-Related Transient Abdominal Pain (ETAP), is pain localized to the outer portion of the abdomen below the ribs but can occur in any part of the abdomen. The pain of ETAP is described as sharp and stabbing when severe, and cramping, aching and pulling when less serious.
Exercise-Associated Muscle Cramps
Exercise-associated muscle Cramps are not well understood but frequently occur during or after physical activity. Several theories exist. The first and perhaps most commonly accepted is the concept of dehydration and electrolyte imbalance. Research examining human models doesn’t substantiate the relationship.
Another more recent theory links cramps to muscle fatigue resulting from altered nerve-muscle control. In short, the excessive repetitive contraction of the muscles causes them to be overtired, and the nerves overload the circuits, causing a continuous contraction.
What is the Cause of Muscle Cramps?
A recent study published in the Journal of Strength and Conditioning Research followed 98 runners preparing to run a marathon. The researchers tested the athletes before and after running a marathon. Twenty of the runners experienced cramps.
Pre- and post-race blood testing showed no differences in dehydration or electrolyte levels between those who cramped and didn’t. The authors did find elevated levels of markers of muscle damage in the cramping athletes. It is a finding that is consistent with other studies that support the theory that cramping occurs in a muscle that is fatigued to the point of harm.
The other training variables the researchers assessed, like running history, training volume, and even pacing, were similar in both groups, except for one. Only 25% of the runners that included strengthening in their pre-race training experienced cramps. 48% of the runners that cramped did not.
What Can I Do To Prevent Muscle Cramps?
Perhaps strength training is the key to avoiding cramps. Unfortunately, much more research into this topic and other causes of exercise-associated muscle cramps is necessary. The fact remains that athletes get cramps for many different reasons.
Underlying injury, possible disease, the side-effects of medications, and maybe even dehydration or electrolyte imbalance are to blame. Or the cause may be entirely genetic because if you’ve had cramps in the past, there is a strong likelihood that you will cramp in the future.
What Should I Do If I Get a Muscle Cramp?
We may not know why cramps occur or how to prevent them, but there are a few things you can do to address the problem when it appears. If you get a cramp, this is what you should do.
Stretch the muscle that’s cramping, even if it hurts, while massaging the area vigorously. Once the cramp subsides, continue to stretch and massage gently for a few minutes. Follow up the procedure by applying ice to the site for twenty minutes every two to three hours throughout the day. That should do the trick.
Exercise-Related Transient Abdominal Pain (ETAP) - The Stitch
Exercise-related transient abdominal pain (ETAP), otherwise known as a Stitch, is very commonly observed during athletic activity, but we know little about the condition. ETAP is most common in the young, and well-trained athletes experience the condition less frequently.
You are more likely to experience a stitch if you engage in sports requiring arm and trunk movement, like swimming and running. You have a ten times greater chance of getting a stitch when running than cycling. In a study of 110 triathletes, 52% had a stitch during the running portion of the race and only 8% when riding (Sullivan et al. 2016).
Why Do I Keep Getting a Stitch?
Research suggests exercise intensity is a factor, although ETAP frequently occurs during low-intensity activities involving arm and trunk movement like horseback riding. If you eat and/or drink before a workout, there’s a solid correlation to ETAP development. 52% of athletes surveyed cited eating before exercise, and 38% pointed to drinking as the cause of their stitch (Morton et al. 2000). A poor warm-up and exercising in cold temperatures are other theories that require clarification.
Experts once thought that decreased blood flow to the diaphragm was the underlying reason for ETAP, but several studies argue against it as a cause. The widely accepted belief is that ETAP is due to mechanical stress of the ligaments holding our internal organs, like the liver and stomach, attached to the diaphragm and abdominal wall.
The theory explains the greater incidence in activities involving the bouncing of the trunk when running and riding a horse—in addition, consuming food and fluid before exercise increases the stress on the ligaments holding the stomach. It doesn’t explain why wearing a belt supporting the abdomen doesn’t decrease the prevalence.
Nor does it explain the sharp pain that isn’t reflective of insult to internal organs. Although irritation of the parietal peritoneum, the outer layer of connective tissue lining the abdominal cavity that supports the internal organs, does produce sharp pain and is a potential explanation.
How Can I Avoid Getting a Stitch and What Should I Do If I Can’t?
Much as there is little consensus in illustrating ETAP’s cause, there is little concrete in the way of treatment or prevention. Limiting the amount you eat or drink at least two hours before exercise is a recommended strategy. Paying attention to proper spinal posture and doing exercises to improve it is another, especially movements to increase core strength and stability. Perhaps the most effective preventative measure is being fit, although I know many elite athletes who experience ETAP frequently.
We know little about why or how to prevent a stitch and even less about what to do when it happens. Breathing deeply and slowly, applying heavy pressure to the area, stretching the affected side of your trunk, and bending forward are a few suggestions. Your guess is as good as mine, and even if these techniques are little more than placebos, it beats stopping your ride or race.
Bonus Question
Sprains, strains, cramps, and stitches happen to most, if not all, cyclists at one time or another. If you are a competitive rider or racer that enjoys pushing the limits, then you have experienced this somewhat troubling phenomenon. Why do you taste blood during or after an intense training ride or challenging race?
Don’t be alarmed. You do not imagine the metallic taste in your mouth, and chances are it isn’t harmful. Although anecdotal reports are rare, the occurrence is more common in endurance athletes. The taste is generally associated with high-intensity exercise sustained for an extended period.
It has happened to me a few times, but only after races when I have gone deeper than I knew I could. It isn’t a pleasant sensation. However, once you realize that you are okay, it becomes associated with a feeling of satisfaction to the competitive cycling mentality. My body signals that I have successfully explored an uncharted region of my hidden ability and can taste it.
Oh yeah, why does it happen? The short answer is, “Who knows?” A simple explanation is that the extreme aerobic effort irritates the lining of your nose and throat, and it bleeds a little. Another popular theory involves your heart and lungs.
During an intense race, your heart is overworked, leading to a small amount of fluid buildup in your lungs. Red blood cells leak into your airways because of the pressure on your lungs. The iron-rich hemoglobin in the cells gives it a metallic taste.
As I stated earlier, it likely isn’t harmful and little more than a sign that you set the bar a bit higher. Just like with sprains, strains, cramps, and stitches, if it happens repeatedly, seek a health professional’s advice.
Conclusion - Knowledge is Power, Even if You Don’t Know
The difference between a sprain and a strain is valuable in determining the most effective course of action. The proper identification and treatment of acute and repetitive use injuries make the difference between a speedy recovery or extended downtime. Having a sound knowledge of this issue is invaluable.
You may not feel the same way about the cramp vs. stitch issue. I agree, even knowing a lot about them both gives us little useful information. Except if you look at it this way. Whether a cramp or a stitch, both are benign conditions without adverse health or performance-limiting consequences.
We know what to do if we get a sprain or strain, and we must do it right away. To answer your personal cramp or stitch question will require observation, self-awareness, and trial and error. Take comfort in knowing that neither will cause you long-term harm.
Your Thoughts?
Are there any other cycling-related mysteries or debates worth knowing about? Comment below. Your fellow virtual cyclists want to know.
Check out the Injury Prevention & Treatment page of The ZOM to find the helpful hints mentioned above.
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Semi-retired as owner and director of his private Orthopedic Physical Therapy practice after over 20 years, Chris is blessed with the freedom to pursue his passion for virtual cycling and writing. On a continual quest to give back to his bike for all the rewarding experiences and relationships it has provided him, he created a non-profit. Chris is committed to helping others with his bike through its work and the pages of his site.
In the summer of 2022, he rode 3,900 miles from San Francisco to New York to support the charity he founded, TheDIRTDadFund. His “Gain Cave” resides on the North Fork of Long Island, where he lives with his beautiful wife and is proud of his two independent children.
You will read him promoting his passion on the pages of Cycling Weekly, Cycling News, road.cc, Zwift Insider, Endurance.biz, and Bicycling. Chris is co-host of The Virtual Velo Podcast, too!
