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Five common overuse injuries in cyclists & what to do about them

We often read about the catastrophic and brutal injuries cyclist go through when they have a bike crash. However, rarely do we hear about the injuries that don’t involve crashes but can still keep cyclists off their bikes.

Did you know if your helmet is too heavy or loose it could increase your risk for neck pain? If your saddle is adjusted too fore or aft (forward or back), your knees can hurt. If your hamstrings are too tight, then your pelvis won’t be able to sit in the proper position and your back may become overloaded. These are some of the small issues that can be addressed to improve your symptoms on and off the bike.

Cyclists can be predisposed to overuse injury if they have:

  1. Leg length discrepancy >3-6mm

  2. A wider pelvis

  3. Excessive pronation

  4. Increased tibial internal rotation (when the femur turns inward) OR femoral anteversion (when the head of the femur is tilted forward)

  5. Poor training habits

  6. Poor or no bike fit

The top five types of cycling injuries and how they present:

  1. Patellofemoral pain: This is pain typically in the front of the knee. Swelling and crepitus (creaking sound in the knee) often accompany the pain. The pain is most commonly noticed with prolonged sitting, squatting or bending, or when ascending or descending stairs

  2. Illiotibial band syndrome: This is pain typically on the outside of the knee. It can feel like burning or sharp pain or stiffness in the hip or knee. Typical symptoms are pain walking following a bike ride (possibly even limping), difficulty exerting force while cycling, especially uphill, and pain with sit to stand.

  3. Lumbar spine pain:Lower back pain in cyclists is very non-specific. This type of pain can feel achy or sharp, and like soreness, tiredness or discomfort. It can be located on both sides or just one side. Often, people complain of pain with transitions off the bike or with bending or lifting. Lower back pain is a result of prolonged flexion (bending forward).

  4. Cervical spine pain:Neck pain is more common in touring cyclists than in professional cyclists. Symptoms are often non-specific but can include headaches, aching, pain in one or both shoulders, increased trigger points and even difficulty holding up your head.

  5. Compression syndromes:There are a few types of compression syndromes (ulnar nerve in wrist and pudendal nerve in pelvis). Compression injuries typically present with numbness and tingling, and sometimes weakness. The exact places symptoms occur are based on where the nerve is being compressed.

Okay so now that you know what the overuse injuries are, what can you do about them?

The very first thing to do is to get a bike fit.Whether you are new to cycling or have been on a bike for years, a proper bike fit makes all the difference in the world. A bike fit is not when you buy a bike and someone makes sure it fits you – there is much more to it than that! You will need to make an appointment. In Atlanta, we are very lucky to have great bike fitters. If you need a recommendation, please reach out to us!

A proper bike fit professional will spend anywhere from 1.5-2.5 hours with you and your bike making sure you are comfortable on your bike and that your bike is fit based on your goals. A bike fit can be very different for someone racing as opposed to someone who wants to ride for exercise. Your bike fitter should ask you about your medical and injury history and make adjustments for any pain or previous injuries if they impact your riding. Remember, a bike fit is fluid, so if you leave and after a couple of rides aren’t feeling comfortable, reach out to the person that fit you so you can get it  right.

Once you have been fit, if you are still having pain consider your training. Have you done too much too quickly? Did you ride too hard for too many days in a row? Are you taking rest breaks? Do you cross train? Are you getting enough sleep? Are you stressed out at work? These are all important questions that you need to ask yourself if you are injured.

Lastly, if it is not your equipment and it is not your training, then it is time to see a physical Therapist. As physical therapists, it is our goal to keep athletes participating in what they love. If you are a cyclist, make sure you find a physical therapist that understands your sport. When it comes to cycling, your therapist should not only understand what your body is required to do on a bike but also should understand the typical training requirements, equipment, components of a bike and bike fit. Your therapist doesn’t have to necessarily do bike fits but should understand what goes into them so he or she can communicate with the specialists that do.

Therapists will assess your movement patterns, strength and flexibility. They should look at you in functional positions, such as squatting with your arms elevated, on your hands and knees and on the table. If they find impairments in soft tissue (muscles or fascia), joints or nerves, they will need to do some kind of manual therapy (meaning put their hands on you) to help fix the problem. They will also give you stretches and exercises in conjunction with the hands-on work to maintain and promote your progress.


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