Cycling Injuries: Preventing Overuse and Trauma

Cycling is an excellent form of exercise that can be enjoyed throughout life, but the repetitive nature of pedaling—combined with prolonged positioning on the bike—creates unique injury patterns. At M.O. Therapy in Markham, we help cyclists of all levels address injuries and optimize their bike fit for pain-free riding.

Understanding Cycling Injuries

Cycling injuries fall into two main categories:

Overuse Injuries (Most Common):

• Develop gradually over time
• Result from repetitive motion and positioning
• Often related to bike fit issues
• Account for 85% of cycling injuries

Traumatic Injuries:

• Result from crashes or falls
• Include fractures, abrasions, and contusions
• May require immediate medical attention
• Prevention through safety practices

This guide focuses primarily on overuse injuries, which are more preventable and treatable through conservative care.

Knee Pain: The Cyclist's Most Common Complaint

Knee pain affects up to 65% of recreational cyclists at some point. Understanding the location and type of pain helps identify the cause and appropriate treatment.

Anterior Knee Pain (Front of Knee)

Common Causes:

• Patellofemoral pain syndrome
• Patellar tendinopathy
• Quadriceps tendinopathy
• Fat pad irritation

Contributing Factors:

• Saddle too low
• Saddle too far forward
• Cranks too long
• High gear grinding
• Weak quadriceps or VMO

Bike Fit Adjustments:

• Raise saddle height (aim for 25-35° knee bend at bottom of stroke)
• Move saddle back (knee should be over pedal spindle)
• Consider shorter cranks
• Use easier gears with higher cadence

Rehabilitation:

• Quadriceps strengthening (especially VMO)
• Patellar mobilization
• Hip strengthening
• Gradual return to riding

Posterior Knee Pain (Back of Knee)

Common Causes:

• Hamstring tendinopathy
• Biceps femoris strain
• Popliteus muscle issues
• Baker's cyst irritation

Contributing Factors:

• Saddle too high
• Saddle too far back
• Overextension at bottom of stroke
• Excessive climbing

Bike Fit Adjustments:

• Lower saddle slightly
• Move saddle forward
• Check cleat position

Rehabilitation:

• Hamstring stretching
• Eccentric strengthening
• Hip mobility work
• Gradual volume increase

Lateral Knee Pain (Outside of Knee)

IT Band Syndrome: The iliotibial band runs from the hip to just below the knee, and friction at the lateral knee is a common problem for cyclists.

Symptoms:

• Pain on outside of knee
• Starts after certain distance or time
• May feel sharp or burning
• Worse with climbing or high resistance

Causes in Cycling:

• Saddle too high (increases IT band compression)
• Saddle too far back
• Cleats with excessive toe-in
• Weak hip abductors (especially gluteus medius)
• Tight TFL and IT band

Bike Fit Solutions:

• Lower saddle if too high
• Move saddle forward if too far back
• Adjust cleat rotation to neutral or slight toe-out
• Ensure proper stance width (Q-factor)

Treatment and Rehabilitation:

• Reduce training volume initially
• Foam rolling of quadriceps and glutes (avoid rolling directly on IT band)
• Gluteus medius strengthening (side-lying leg raises, clamshells)
• Hip mobility exercises
• Gradual return to cycling

Medial Knee Pain (Inside of Knee)

Common Causes:

• Pes anserine bursitis/tendinopathy
• MCL strain
• Medial plica irritation
• Foot pronation issues

Contributing Factors:

• Excessive foot pronation
• Cleats rotated too far outward
• Saddle too low
• Weak hip external rotators

Solutions:

• Address foot mechanics with orthotics or cleat adjustments
• Strengthen hip external rotators
• Ensure proper saddle height
• Consider cleat wedges if needed

Lower Back Pain in Cycling

Back pain is the second most common complaint among cyclists, affecting 30-70% of riders.

Causes of Cycling Back Pain

Position-Related:

• Excessive reach to handlebars
• Handlebars too low
• Saddle too high or tilted forward
• Poor core stability
• Lack of hip flexibility

Technique-Related:

• Rocking pelvis while pedaling
• Asymmetric power output
• Gripping handlebars too tightly

Equipment-Related:

• Wrong frame size
• Inappropriate stem length
• Saddle shape or angle

Bike Fit Adjustments for Back Pain

Handlebar Position:

• Raise handlebars to reduce forward lean
• Shorten stem to decrease reach
• Consider wider bars for comfort

Saddle Position:

• Level or slightly nose-down
• Not too far forward or back
• Appropriate height

Frame Considerations:

• Consider endurance geometry for comfort
• May need different frame size

Treatment and Prevention

Strengthening:

• Core stability (plank, dead bug, bird dog)
• Hip flexor flexibility
• Gluteal activation
• Back extensor endurance

On-Bike Habits:

• Change hand positions frequently
• Stand periodically
• Relax grip
• Focus on smooth pedaling

Neck and Shoulder Pain

Prolonged positioning on the bike creates significant stress on the neck and shoulders.

Causes

• Extended cervical spine from looking ahead
• Weight bearing through arms
• Handlebar position too low or far
• Tension from gripping

Solutions

Bike Fit:

• Raise handlebars
• Shorten stem
• Consider aero bars for long rides (if appropriate)

Strength and Flexibility:

• Neck strengthening exercises
• Upper back mobility
• Shoulder stabilization
• Regular position changes during rides

Hand and Wrist Issues

Handlebar Palsy (Ulnar Neuropathy)

Symptoms:

• Numbness in ring and small fingers
• Weakness of hand grip
• Tingling or burning sensation

Causes:

• Pressure on ulnar nerve at wrist
• Improper hand position
• Vibration transmission
• Insufficient padding

Solutions:

• Padded gloves
• Gel handlebar tape
• Change hand positions frequently
• Check handlebar width and angle
• Avoid excessive weight on hands

Carpal Tunnel Symptoms

Symptoms:

• Numbness in thumb, index, middle fingers
• Wrist pain or aching
• Weakness of grip

Solutions:

• Maintain neutral wrist position
• Reduce weight through hands
• Padded gloves
• Proper reach and handlebar height

Saddle-Related Issues

Saddle Sores

Prevention:

• Quality chamois cream
• Proper fitting shorts
• Good hygiene
• Correct saddle position and height

Treatment:

• Rest from cycling
• Keep area clean and dry
• Antibiotic ointment if needed
• See doctor if infected

Numbness and Pressure Issues

Causes:

• Pressure on pudendal nerve
• Saddle too narrow or wide
• Saddle tilted up
• Position too far forward

Solutions:

• Saddle with cutout or relief channel
• Proper saddle width for sit bones
• Level or slightly nose-down angle
• Stand frequently during rides
• Consider different saddle shape

Achilles and Foot Problems

Achilles Tendinopathy

Causes:

• Saddle too high
• Ankling excessively while pedaling
• Cleats too far forward
• Sudden increase in climbing

Treatment:

• Lower saddle slightly
• Move cleats back
• Calf stretching and strengthening
• Eccentric heel drops
• Gradual return to riding

Foot Numbness

Causes:

• Shoes too tight
• Cleats positioned incorrectly
• High arches unsupported
• Long rides without position changes

Solutions:

• Properly fitted shoes (size up if needed)
• Custom or quality insoles
• Move cleats back slightly
• Loosen straps during rides

The Importance of Bike Fit

Professional bike fitting can prevent the majority of overuse injuries. A proper fit addresses:

Contact Points:

• Saddle (position, height, angle)
• Handlebars (reach, drop, width)
• Pedals (cleat position, stance width)

Body Measurements:

• Inseam length
• Torso and arm length
• Flexibility assessment
• Injury history consideration

Dynamic Assessment:

• Pedaling mechanics
• Hip drop and rock
• Knee tracking
• Upper body stability

Strength Training for Cyclists

Off-bike strength training prevents injuries and improves performance:

Essential Exercises

Lower Body:

• Squats (bilateral and single-leg)
• Deadlifts
• Step-ups
• Calf raises

Core:

• Plank variations
• Dead bugs
• Pallof press
• Bird dogs

Upper Body:

• Rows for postural muscles
• Push-ups
• Shoulder stability work

Sample Weekly Program

Monday: Leg Strength

• Back squats 3x8
• Romanian deadlifts 3x10
• Step-ups 3x10 each leg
• Calf raises 3x15

Wednesday: Core and Stability

• Plank series
• Dead bugs 3x10 each
• Single-leg balance
• Hip mobility work

Friday: Full Body

• Goblet squats 3x12
• Rows 3x12
• Push-ups 3x15
• Glute bridges 3x15

Treatment at M.O. Therapy

Physiotherapy

• Comprehensive injury assessment
• Movement analysis
• Manual therapy
• Exercise prescription
• Return-to-cycling programs

Massage Therapy

• Sports massage for muscle tension
• Deep tissue work
• Pre and post-ride treatment
• Recovery optimization

Chiropractic Care

• Spinal assessment and treatment
• Joint mobilization
• Postural correction
• Movement optimization

Frequently Asked Questions

What causes knee pain when cycling? Knee pain in cycling usually results from bike fit issues (saddle height, position, cleat alignment), muscle imbalances, or training errors (too much volume or intensity too quickly). A professional bike fit and proper strengthening can address most knee pain.

How high should my bike saddle be? A general guideline is 25-35 degrees of knee bend at the bottom of the pedal stroke. However, this varies based on individual anatomy, flexibility, and riding style. Professional fitting provides the most accurate positioning.

Can cycling cause IT band syndrome? Yes, IT band syndrome is common in cyclists. It's often related to saddle height being too high, cleats rotated improperly, or weak hip muscles. Addressing these factors typically resolves the condition.

Should I stop cycling if I have knee pain? You don't necessarily need to stop completely. Reducing volume, adjusting bike fit, and avoiding high resistance can allow continued riding while addressing the underlying issue. Significant pain warrants rest and professional evaluation.

Book Your Assessment

Whether you're dealing with a cycling injury or want to optimize your position for pain-free riding, M.O. Therapy in Markham can help. Our team understands the unique demands of cycling and provides specialized care.

Call (905) 201-5827 or book online for your assessment. We offer direct billing and same-day appointments.