Common Cycling Injuries

Injuries in cycling can be broadly classified as either traumatic or overuse. Traumatic injuries tend to result from a crash or fall such as fractures, tears, road rash, contusions, and concussion.

Overuse or overload injuries are related to the highly repetitive nature of the sport performed over extended periods of time. They occur when a tissue accumulates damage caused by repetitive sub-maximal loading, referred to as micro-trauma. Cumulative micro-trauma from further repetitive activity without adequate recovery sets up a chronic cycle of improperly healed inflammation and tissue break down, experienced as pain, weakness and stiffness, and eventually clinical injury.

The distribution of overuse versus traumatic cycling injury seems to be consistent over a range of studies, and between professional and recreational cyclists, with overuse injuries shown to represent 50 to 60% of cycling injury. However, it can be argued that overuse injuries are under-represented as often cyclists can continue to ride, and may not seek any intervention unless they are unable to do so.

Knee pain is the most common cycling injury amongst cyclists of all levels, with patellofemoral (knee cap) joint pain being the most common. It is generally an overuse of overload problem, but can also be preceded by trauma (eg. a crash) or surgery, becoming an issue on return to cycling.

Patellofemoral pain is often described as a vague pain under or around the patella, which is felt during or after loading. There are few definitive medical tests, and scans will often show minimal structural changes. It is often due to mal-tracking of the patella and imbalanced forces acting on the patellofemoral joint.

The next most common complaint is low back pain, occasionally with actual disc prolapse and nerve compression, although this is not as common as people think. Most the time it is due to strain of the lower joints and ligaments of the spine or overuse of the muscles in the area, which can also refer pain into the buttock and leg. This likely isn’t helped by the fact that most people sit (often badly) all day.

Neck or upper back pain is often fairly common, usually related to the prolonged time that our neck’s spend in an extended position whilst cycling, placing stress on our neck and upper back joints and muscles. Bike set up and poor posture often contributes to this issue, as well as joint stiffness and a lack of conditioning.

Other less common issues are hip impingement, sciatic nerve irritation, hamstrings or achilles tendinopathy, ulnar nerve palsy, and fractures (mainly upper limb, with clavicle the most common) to name a few.

How can Physio specifically help?

One of the main roles of Physiotherapy in the management of cycling injuries is to identify the causes of the injury or problem, then specifically address and treat it. This could be tightness, weakness, poor activation patterns, lack of motor control, poor stability, poor proprioception… the list can be long and individual. There are some common findings seen across a variety of cycling-related pains and injuries that may need addressing, from a tight posterior chain (hamstrings, hips), under-utilisation of gluts, poor hip hinging pattern, lack of trunk and core strength in the lean forward position, tight and overactive hip flexors and TFL, or poor VMO function (particularly after injuries involving swelling or prolonged pain).

Physio’s will also guide and supervise you back to cycling, training or racing, which will be influenced by factors such as the actual injury, how conditioned and resilient you are and what events and goals are in the horizon. Cycling is a relatively low load sport, so most the time you can continue to cycle as long as you stick to certain parameters that are set. In most cases it will help your recovery to continue to ride at a lower load than normal to build up some conditioning. Conversely, cycling is also a very repetitive high volume sport, so understanding this and progressing at an appropriate rate to be able to absorb this sustained repetitive load is also important.

Prevention

Prevention of injury can be aided by using common sense in the first place - it sounds simple but it isn’t always! Many issues arise from training load error, which can be described as a training load that is beyond the individual’s capacity, resulting in failed adaptation. This can occur in a range of situations - too much too soon, increasing volume, intensity and frequency all at once, high muscular load, insufficient recovery/rest days, adding intensity without having a good enough base, boom-bust training load, or following a period of reduced training or time off training (eg. following an injury or illness, or off-season break), in which the body has de-conditioned and can no longer adapt to previous training loads. 

Monitoring your body’s response to training is important, as is trying to gain an insight into what your capacity or resilience is. Everyone is different and some people can absorb and adapt to more  load before they break down than others.

You can also make yourself as resilient as possible, whether this is strength, mobility or core stability. If you are strong AND flexible AND have good core stability, you are less likely to run into overload issues. This is best done BEFORE you are injured.

And lastly, but probably most importantly, make sure your bike is fitted appropriately to you. Whether you are new to riding or someone who has been riding for years, a comprehensive bike fit is a great way to ensure you are comfortable on the bike, allowing you to ride consistently, and help you to remain injury-free. The longer you can spend riding without injury, the faster and more efficient you become. 

A Physio-led bike fit will assess you on and off the bike in order to determine the cause of discomfort or injury and identify any potential limitations to your bike position, then make the appropriate adjustments to your bike, and give any further recommendations.