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Common Cycling Injuries

Cycling is thought of as a low impact exercise that has numerous health benefits, but unfortunately it can still lead to some injuries. Cycling injuries can range from overuse type muscle, tendon, or nerve irritation to acute fracture and concussion with crashes. Here are a few common bike injuries and ways to prevent and manage.

Cyclist often experience knee pain for a number of reasons. This can be a muscle imbalance with the quads and IT bands being too tight, or the inner quad (VMO) not being strong enough. Tight hamstrings can contribute to knee pain as well due to imbalance and increased strain on the patellar tendon and knee cap.  Even though cycling is known to be a quad dominant exercise, glut strength is important for the tracking of the knee through the pedal stroke.  If the gluts are not doing their job, the knee will often track inward which can cause abnormal strain, muscle imbalances, and pain in the patella. Saddle position can play a roll in knee pain also. If the saddle is too low or too forward, cyclist will often experience anterior knee pain. If the saddle is too high, posterior knee pain may arise. Cleat position can also contribute to knee pain. A poorly place cleat can lead to abnormal strain or stress on the knee. Lastly using gears properly is important to knee health. If a cyclist is constantly in a gear that is difficult, it can also cause strain and pain in the knees.

Low back pain can be a common complaint of cyclists. Several things may play into why a cyclist may experience back pain. Core and glut strength is extremely important with cycling due to the nature of the position and activity. The core and gluts need to be a stable foundation to pedal efficiently and keep the bike balanced. The core and glut muscles also help maintain the cycling posture and take strain off the neck, shoulders, and hands. Stiffness in the low back, pelvis, sacrum (tailbone), or hips can also lead to low back pain with cycling. Stiffness in those areas can also prevent muscles from activating and working as well as they should, which can lead to weakness and pain. If the hips and pelvis are stiff, the pedal stroke will not be fluid and efficient which can lead to aches and pain. Hamstring flexibility can play a role with low back pain in cycling as well. If hamstrings are tight, it will be difficult to maintain a good posture in the pelvis and low back for optimal core and glut activation. Saddle height and position can also contribute to back pain if its not in a good position.

Unfortunately cyclist often suffer from neck pain, especially with a more aggressive style of road or triathlon bike. Road bikes and triathlon bikes force riders to be in a more forward bent position, but need to tip head up to be able to see the road ahead of them. Over time, this leads to muscle fatigue and tension. This can also lead to numbness in the fingers/hands.

Strengthening the shoulders, core, scapular stabilizers, and neck muscles can all help alleviate neck pain. Also improving thoracic (upper back) mobility can take some strain off the neck. Improved thoracic extension will allow the neck and head to raise up and be held more efficiently and with less strain. Adjustments can be made to the bike to allow the rider to be more upright as well. This may include getting a different bike stem that is shorter and/or has a higher angle, rotating the handle bars slightly up, and adjusting the saddle position.

Foot and ankle numbness and pain are common problems as well. Cycling shoes and cleat position play a roll in all types of foot and ankle pain. Cycling shoes are often tight and rigid, which can compress the foot leading to nerve irritation and foot pain. Cleat position also plays a roll in foot and ankle pain. If the cleat is place too far forward on the shoe, this can cause more achilles, arch, and calf pain.  If the cleat is too far posterior, a cyclist may also experience arch pain. Shoe inserts and wedges on the cleat can be used to alleviate foot pain in some cases. Proper pedaling form can eliminate some of these issues as well.

Have you ever been on a bike ride and see other riders out and constantly shaking out their hands? Often cyclist will experience numbness in the hands or fingers. Taking the hands off the handle bars and shaking them out can be a quick fix. Long term solutions to numbness in the hands may include a proper bike fitting. With this, handle bars and stem may be changed or adjusted allowing improve hand, shoulder, and neck position. The saddle position may play a roll if the front of the saddle is tipped down too much. This will push more pressure or weight into the upper extremity and hands versus allowing more pressure and weight to stay in the saddle.  Gloves with padding are important for longer rides giving the hands some cushioning and protection from the pressure of the handle bars. Strengthening the shoulders, core, and scapular stabilizing muscles is also important in alleviating hand pain and numbness. As these areas get stronger, pressure is taken out of the hands. Hand and wrist posture can also play a role in numbness. Its important to try to keep the wrist in a neutral position to prevent pinching of the nerve where they pass through the wrist. Cyclist can move the hands to multiple different positions on the handle bars throughout the ride to help prevent pain, numbness, and fatigue.

Acute injuries due to crashes are the last injury type we will discuss. Crashes are unpredictable and often unpreventable. However, being constantly aware of the environment around you, other cyclists, traffic, traffic signals, road conditions, and a properly maintained bike can all help eliminate crashes. Some common cycling injuries from crashes include: road rash, fractures, concussions, sprains and bruises. Wearing a properly fitted helmet, gloves, and clothing can all help reduce impact of crashes.

In summary, cycling does have numerous health benefits, but can lead to some injuries. A properly fit bike can help reduce most of these ailments along with proper conditioning and training. If you are new to cycling or have not ridden in awhile, it may take time to build up your cycling endurance. Start with reasonable goals for distance and time that may eventually lead to  bigger goals. Work on core, glut, quad, and shoulder strength to allow improved posture and strength on the bike. Flexibility of the hamstrings and quads as well as spinal mobility are all important in preventing pain with cycling. Here at Therapydia we have physical therapists that are trained in bike fitting and can help address any of the ailments that may come with cycling.


By Jenny Cannon, MPT | Therapydia Beaverton

Jessica Jones

Physical Therapist

Jessica recently moved to Seattle from Boston, MA and is excited to join the Therapydia team. Her treatment experience includes orthopedics, sports medicine, pediatrics, and vestibular therapy. Jessica received her Doctorate in Physical Therapy from Northeastern University in Boston, MA in 2016. She has completed the Pediatric Physical Therapy Residency at Boston Children’s Hospital and is in the process of completing a Comprehensive Vestibular Rehabilitation certification. Jessica believes in empowering and inspiring patients to take control of their health through education, movement, and exercise. She enjoys treating patients of all ages and levels while utilizing soft tissue techniques, neuromuscular re-education, balance training as well as therapeutic exercise. In her free time, Jessica enjoys yoga, dancing, kayaking, and hiking with her dog!


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