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Speak to an Experienced Physiotherapist about your Cycling Injury

Cycling involves a complex biomechanical interaction between the body and the bike. This interaction is influenced by many variables. Here at Lambton Physiotherapy we have a clear understanding of the biomechanics and injuries involved in cycling.

During 1 hour of cycling, a rider averages about 5000 pedal revolutions (APA website, accessed 22.7.09).  Any minor misalignment (equipment or anatomical) or incorrect technique can lead to poor performance and injury.

There are many different cycling subgroups such as road cycling and mountain biking. These different styles require different bike setups such as a low seat height for BMX. Training specificity and varying bike setup for different aspects of your training are important to avoid overuse injuries.

Common causes of injury

  • Poor bicycle fit or set up such as incorrect handle bar height, excessive knee bend and incorrect saddle position.
  • Decreased back and lower limb flexibility can lead to pain and dysfunction.
  • Poor cycling technique, which can result in decreased performance and predispose to injury.
  • Over-training.
  • Falls.

Common Injuries

Back Pain

Up to 50% of cyclists experience back pain at some time during their training (APA website, accessed 22.7.09).  Back pain if often caused by inadequate spinal flexibility and stability.  Pain in the buttock and down the posterior leg can often occur with cycling due to the piriformis muscle becoming tight or cramping and putting pressure on the sciatic nerve. A seat that is too high will cause your hips to rock side to side, causing an unfamiliar repetitive lateral flexion force through your lower back. A high seat and / or low handlebars can cause too much lower back bend which can put more adverse pressure on structures such as your discs.

Neck Pain

Cervical and thoracic spine pain can be caused by incorrect handle bar positioning as well as poor bike sizing. Sudden increases in training volume may result in stress to structures unaccustomed to prolonged cycling postures. Sensitive or ‘tight’ neural structures may manifest as pain in the neck or thoracic region (as well as lower back and leg pain) due to the prolonged ‘slump’ postures adopted in cycling (especially when aerobars are utilised). Tight lower limb musculature may cause the spine to compensate by ‘rounding’ or arching too much.

Knee Pain

Knee pain in cycling is oftencaused by improper seat positioning.  A seat that is too high or too far back will increase knee extension (or knee straightening) and irritate the iliotibial band which may be felt as pain on the outside of your knee. A seat that is too low or too far forward may irritate the underside of your kneecap and cause pain at the front of your knee. This is known as Patellofemoral Pain Syndrome.

Improper bike shoe or cleat positioning can also cause knee pain. If your heel rotates too far in or out whilst pedalling, this will change your knee position and put unaccustomed pressure on certain structures resulting in pain and dysfunction. When determining seat height, it is important to wear the shoes that you will cycle in as cleat thickness effectively lengthens your leg.

Asymmetry of the body can also cause knee pain.  Cyclists with slight differences in leg length may have knee pain because the seat height is only adjusted for one side. Shoe inserts or orthotics can help correct this problem.

Hand Numbness / Ulnar Neuropathy 

Hand numbness due to cycling is often felt in the fourth and fifth fingers and it is associated with pressure on the handlebars for long periods of time. Wearing padded gloves and riding with the elbows bent can provide relief.

Foot Pain or Numbness

Foot pain or numbness can result from wearing soft-soled shoes. Cycling shoes have stiff soles that distribute pressure evenly over the pedal. This helps reduce localised pressure areas on the foot and may help you pedal more efficiently. An optimal cadence can also reduce pressure under your foot. Custom-made orthotics can also prove effective.

Shoulder Injuries

Shoulder injuries often occur as a result of a crash and they commonly involve subluxation of the A/C joint or fracture of the collarbone.

Injury prevention

  • Consult a professional with training and experience in correct bike set-up.
  • Consult a professional to assist with correct cycling technique. The use of video analysis and muscle biofeedback can be useful tools in determining optimal riding position and technique.
  • Specific core stability exercises will assist in providing support to the spine and pelvis as well as improve performance.  A physiotherapist can assess your spinal flexibility and stability and provide you with appropriate exercises.


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