Time in the Saddle: Clinical Considerations for Endurance Riding

A three-day mountain bike event often has a different impact on your body than the usual single-day training rides many non-professional cyclists participate in. 

Dr Darren Green, Mediclinic’s Medical Director at FNB Wine2Whales, highlights the key touchpoints to consider when preparing for a successful Wine2Whales event.

1. Skin integrity & saddle sores

“Remember, prolonged pressure, moisture, and friction can lead to chafing, folliculitis, and ulceration. It is essential to use well-fitting, high-quality padded cycling bibs. I urge you not to introduce a new kit on race day – if you have sponsored clothing, test this during your preparations to ensure you know the fit and can address any issues timeously,” highlights Dr Green.

Apply chamois cream to reduce friction and bacterial load. “If you notice broken skin, swelling, or signs of infection (redness, warmth, discharge), please visit the Mediclinic Race Hospital to ensure we catch it before it interrupts your ride!” he emphasises.

Maintaining hygiene can be a challenge in a race village, so change out of damp kit promptly after the stage and shower to remove all dirt from your skin. Adjust the saddle height/tilt and position to reduce any pressure points if you are experiencing problems.

2. Neck, back & posture-related pain

It is important to recognise that a sustained flexed posture may strain the cervical and lumbar spine, especially after 3 days of intense riding in South African conditions. Before you arrive, ensure a professional bike fit, including saddle height, reach, and handlebar position. Work on your core strength and flexibility (hamstrings, hip flexors) to reduce load on the spine.

“During the race, we suggest that you vary hand positions and take brief posture resets during long climbs or flats. However, if you are experiencing persistent pain, weakness in any muscle groups (grip strength or foot power), numbness or radiating prolonged pins and needles symptoms, these warrant medical assessment. We are here to keep you in the saddle and have teams situated across the route – consult the experts before it ruins your experience,” Dr Green explains.

3. Knee pain & patellar tracking issues

Knee pain is commonly caused by poor saddle height, incorrect cleat alignment, and overuse. Pain at the front of the knee may indicate patellofemoral stress or tracking issues. It is important to optimise the bike setup (saddle height/fore-aft, cleat position, cadence) to prevent such injuries. Resting muscle tone and ligament laxity can also predispose riders to patellar issues. Sometime simple adjustments in limiting lateral displacement movement can reduce pain considerably.  

Dr Green explains that during your race, you should avoid pushing big gears at low cadence; instead, aim for smoother, higher-cadence riding. And of course, early symptoms should prompt load reduction and give you time to prevent further progression. “We want our riders to complete their race in the best possible condition – ultimately getting the most out of this experience.”

4. Overuse injuries & cumulative fatigue

Multi-day events increase the rider’s risk of tendonitis, muscle strain, and joint irritation. Warning signs for this include persistent soreness, swelling, reduced power output and altered biomechanics.

“Please prioritise your recovery between stages: focus on hydration, nutrition, stretching, and sleep. And remember - taper your training before the event and avoid sudden increases in intensity or volume,” urges Dr Green.

5. Falls, trauma & risk behaviour

“Even the world’s best riders can experience fatigue, and technical terrain increases the risk of falls, especially late in stages. Common injuries seen in our race hospital and by the medics include abrasions, concussions, and clavicle (collarbone) fractures. This is why Mediclinic and ER24 are positioned across the route each day, to ensure we are there for the unexpected,” assures Dr Green.

But he emphasises that the basics remain important:

• Always wear appropriate protective gear (helmet, gloves).
• Avoid riding under the influence of sedating medications or while managing unresolved injuries.
• Riders with recent injuries or acute illnesses (e.g. prior clavicle fracture) should be medically cleared and ride conservatively.

6. Red flags requiring medical attention

Dr Green believes that the medical team’s aim is to get each rider safely to the end of the race. However, severe or worsening pain, especially when it affects breathing or limb function, should not be ignored or left until the end of the stage.

He explains that key things to look out for during event are head injury symptoms such as dizziness, confusion, nausea, or loss of consciousness. Signs of infection in skin lesions – we can work with you to prevent these. Finally, neurological symptoms such as numbness, weakness, or loss of coordination. In terms of illnesses, never race with a fever or flu-like illness, chest pain or worsening shortness of breath or when you are on antibiotics. When unsure of any concerning symptoms, check in with our experienced medical teams for peace of mind.

Finishing healthy!

Remember, Mediclinic and ER24 have decades of experience in supporting world-class events. Trust us for the expertise you need to finish your best race. We are here for you.