Insights from the Giro d’Italia

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Matt Rabin, Chiropractor for the Cannondale Pro Cycling team, reports from the Grand Tour

It’s the final rest day of the 2016 Giro D’Italia, and we are camped up in Bressanone in Alto Adige, as far north as you can almost go in Italy before hitting Austria. For a rest day there can be far less beautiful places to sIMG_20160521_121911tay, at least in the ten years since I’ve been with the team there certainly have been. Pre WWII this area in fact ‘was’ Austria and it still very much feels like it. While there are some nods to being Italian, the staff at the hotel all speak German first, the food is more Austrian than Italian, and on asking our Italian riders, they say the locals certainly consider themselves more ‘Austrian’ than Italian. But only 20km down the road to Trentino where tomorrow’s stage starts, and back into ‘Italy’ we go…

I’m one of two chiropractors that will be with the team (Cannondale) throughout this Grand Tour. I came in on the first Italian rest day to Florence to take over from Rob (Palmer), the other chiro serving this race. We had a crossover day on that rest day to catch up on the current situation of all the riders’ ongoing concerns from the first week. This was helpful. Our medical team, which consists during a race of the chiropractor and Doctor, split the races almost 50/50. This is how we’ve done it the past few years – it works well as it keeps everyone fresh and gives a new perspective on the status of the riders. Continuity of care is really important, which is why there have to be excellent lines of communication and you have to know how your colleagues work, otherwise it won’t.

We had a few crashes in the first week, which meant some of the riders were limping into the rest day a little bit banged and bruised. Luckily nothing serious, and importantly for us nothing we want to see any of our riders have to quit this race for. With one week to go we still have all nine ridersIMG_20160517_173001 – which is good news. At the moment we’re all busy. The Doc is separating riders who are getting colds to prevent the spread, and seeing to changing any wound dressings, amongst other things. When I took over there were a couple of guys suffering from low back pain. One rider had some knee pain after hitting his knee on the handlebar during a stage, and a couple of riders felt ‘twisted’ on the bike – one because of a saddle sore (an occupational hazard causing him to sit skewed on the bike) and one from a crash. All small stuff really, but small things can become bigger things quite quickly with the stresses and exertions of a Grand Tour. This Giro is no exception – the parcours, to say the least, has been difficult.

In time-honoured tradition the second and third weeks of a Grand Tour ramp up in difficulty, so as we left the rest day last week and headed into the Dolomites – some of the most spectacular scenery I’ve ever seen in my life, it must be said – naturally some of the boys were concerned that their small issues would become bigger ones. My job is to try and ensure they do not. This time, as we head into a week to go – touch wood – we’ve been able to manage their issues and come through the other side, and everyone looks ready to perform from a biomechanical perspective. Great news.

So the question I often get asked is, how? As a chiropractor I am interested in the biomechanics of the human body and how they are fit for purpose for cycling. And with a thorough physical examination you can determine how the body is working. Are certain IMG_20160521_144053joints too stiff, are certain muscles too short and too tight, is there a balance from left to right, are certain muscles inhibited, what are the key drivers to that individuals presenting complaint? etc. etc. Once this is established, we then work through the different layers fundamentally to reduce pain and improve function, that’s the bottom line. Anything from chiropractic manipulation, Active Release Technique (which is a type of myofascial release), mobilisations, neurological integration (which is an approach that helps to determine if certain ‘reflexes’ are appropriately working), kinesiotape, cryotherapy (good old-fashioned ice), whatever it takes to make the biggest difference with the most minimal input. Why with minimal input? Because you don’t want them getting on the bike the next day feeling like they have been pulled from pillar to post. Everything should just feel better than it had done –that’s the goal. Doing too much is as bad as not doing enough, and getting this balance right is the key, something that comes with experience.

This is my seventh or eighth Giro I’ve been at, and my experience tells me that we cannot rest on our laurels just yet and inevitably more issues will crop up as we move into the last week. Between myself, the Doctor and the soigneurs (‘carers’ – who the riders each receive a massage from every day too) we’ve hopefully got their needs covered. The mood is good in the team at this stage, despite Rigo – Rigoberto Uran – dropping out of the top 10 over the weekend. He’s been fighting a cold, and unless you are totally fit it can be hard to compete with the guys that are. Nobody is feeling sorry for themselves, even though we haven’t won a stage yet. There’s a lot of racing to go in this final week and everyone is fit, ready and looking forward to it. All of which bodes well for the final week.

9781472906595Want to hear more from Matt? The Pain-Free Cyclist by Matt Rabin & Robert Hicks is available to buy at discount from

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