Cycling is traditionally thought of as a safe, low-impact sport with a low chance of injury — especially compared to running. To a degree, that’s true. “When we look at the major endurance sports — cycling, running and swimming — all of them have different types of injuries,” explains Joseph E. Herrera, DO, FAAPMR, an advisor to Patch. However, Herrera says most endurance sport injuries are the result of running due to the sport’s high-impact nature but he still sees a fair amount of cycling injuries.
According to Herrera, the three main causes of pain for cyclists are overuse, incorrect mechanics and trauma. “We tend to see [overuse injuries] when cyclists do too much too soon or ramp up,” he says. “Injuries can also result from a poor bike fit,” he explains. “For example, you can sustain back or knee injuries if your seat is placed too high or too low.” More on that later. Finally, trauma may thankfully be less common, but still worth mentioning. “The last reason for injury is either a fall off of a bike or being struck by a motor vehicle.”
While you can prevent trauma on the road by taking safety precautions, preventing overuse and mechanical injuries is more in your control. Here, cycling and rehab experts outline the most common cycling injuries they see, plus how to prevent and deal with them to minimize your downtime.
One of the most common complaints among cyclists, lower back pain can easily leave you sidelined. Though it can certainly be the result of a bad bike fit — which is why you should have your bike professionally fitted at your local bike shop before each training season — it can also be a lack of core strength, according to Bob Seebohar, an exercise physiologist, elite triathlon coach and owner of eNRG performance. “I’m a big fan of getting strong off the bike before even stepping foot on a bike to help prevent those muscular imbalance injuries,” he says.
Aside from strength work, sometimes keeping the right cues in mind can help. “I remind cyclists to engage their core (suck in your stomach is a good cue) when riding, as it is very easy to get lazy and let the ‘gut’ hang down,” Seebohar says. “Additionally, I like to cue people to push their heel toward the ground at the bottom of the pedal stroke to engage their glutes more, since they’re part of the core and a very important muscle to have activated during the pedal stroke.”
“Anterior knee pain is pretty common,” Seebohar says. This could also be due to a not-so-great fit, but one of the most common culprits is improper cadence or how many revolutions your pedals make per minute (rpm). “I see a lot of ‘mashers,’ or low-cadence cyclists, who should not be doing this because they haven’t trained their body to be efficient in this movement pattern,” he explains. “I recommend starting with moderate-to-high rpm in an easier gear before moving to lower rpm and a harder gear, as this puts more force on the knee.”
Rest is also part of the solution when it comes to knee pain. “Taking a few days off or switching to a different type of exercise that doesn’t stress the knee for a few days can help,” says Dr. David Geier, an orthopedic surgeon and sports medicine specialist in Charleston, South Carolina. “Ice on the painful area, use of a foam roller, gentle stretching and even working with a physical therapist can be enough to prevent a more serious injury.”
When you start to feel better, active prevention becomes key. “Once you’re pain free, it can be important to work with a physical therapist to learn some stretching and strengthening exercises to do on a regular basis to prevent the problems from coming back,” Geier says.
“Another common complaint is neck pain,” Herrera says. This is mainly due to keeping the neck in an extended position for a long period of time, which can be uncomfortable and cause muscle strain in the neck and shoulders. The main solution is a proper bike fit. Most people know they need to have this done when they first start cycling, but Seebohar says it’s also important to get a refit anytime your body changes, whether that’s in terms of flexibility, injuries, imbalances, aging or anything else. If an updated fit doesn’t do the trick, Herrera recommends rest and physical therapy.
If you get tingly fingers after a long ride, you’re not alone. But, this can escalate into an actual injury if you don’t do something about it. “Often times, cyclists will experience nerve-related hand and wrist injuries because of the stretching and compressing of nerves,” notes Ryan Waldman DPT, a physical therapist who works with Patch. “Most commonly, it is the ulnar nerve, due to the hyperextension of the wrist on the handlebars.”
His first fix for nerve-related pain such as tingling, numbness or sharp and shooting pains into the fingers is wearing padded cycling gloves. It can also help to raise the handlebar slightly or position the wrists in a more neutral position, he says. Lastly, tune into the type of pain you’re experiencing. “Usually stiffness and overuse injuries will not cause the nerve-related symptoms of tingling, numbness and shooting pain,” Waldman explains. If your pain seems to be nerve-related, it’s a good idea to check in with your doctor or a physical therapist for a treatment strategy, as rest alone might not cut it.
If you have a pain in your butt, it could be coming from your hips, Geier says. “I see hip issues, like hip flexor strains and piriformis syndrome, in cyclists,” he notes. “Piriformis syndrome is a cause of buttock pain from pressure on the sciatic nerve from some of the gluteal muscles.” Hip flexor strains can also be an issue, but tend to come on over time rather than suddenly. In both cases, rest, icing, foam rolling, physical therapy and a proper bike fit are all part of the treatment plan.
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“Achilles injuries are very common in cyclists, just like they are in runners,” Waldman says. Just because the Achilles tendon is the strongest tendon in the body doesn’t mean it can withstand unlimited stress. “Usually the tendon gets irritated in cyclists because they are pedaling with too much plantar flexion (with their foot pointed down) or with the cleat positioned too far forward, which increases the lever arm on the calf,” he explains. The fix? “Try to pedal with more of a neutral foot position or move the cleat further back, so that the lever arm is reduced.”