The city of Adelaide is an accessible and great place to cycle, whether you’re riding through the city and parklands on a road bike, or venturing off road in the Adelaide hills on a mountain bike. As of 2019, 15% of all Australians rode a bicycle during the week for sport, recreation or transport. The introduction of more bike lanes and bike accessibility makes cycling a more viable option for commuting. Considering other forms of cardiovascular fitness such as running, cycling is certainly a more appealing form of low impact cardiovascular exercise, especially for those with a history of hip and knee injuries from higher impact cardiovascular exercise such as running. On top of this, a recent increase in the popularity of cycling due to reasons such as increasing petrol prices and post COVID-19, cycling has certainly become more common in our communities. As a result of increased cycling participation, we are seeing more cycling injuries in our Core Physio clinics.
Types of Cycling Injuries
In cycling, there are three main types of injury: traumatic, overuse and contact injuries. Traumatic injuries may include accidents or falls, typically which are sudden and often unavoidable. Overuse injuries on the other hand occur over periods of time which are very often preventable and often manageable. Contact injuries result from direct contact with one self to the bike, such as your hands on the handles, feet on the pedals or buttock on the seat/saddle. In this blog post, Physiotherapist Luke from our Burnside practice will discuss common overuse injuries, ways to get on top of these injuries early and the role of physiotherapy in managing these injuries.
Overuse injuries, repetitive strain injury (RSI) or overloading is defined as when damage to body tissue such as muscle or tendon occurs due to repetitive movements over a period of time. Overuse injuries account for just over half of all injuries related to road and mountain bike riding. Common causes of cycling overuse injuries include inappropriate postures, in which having an inappropriate seat, handle or pedal height or new adjustments to your bike can impact biomechanics of your hips, knees and ankles. Overloading/exceeding tissue capacity can occur when riding for periods of time longer than normal, more frequent rides with or without rest days leading to an inability of your muscles to cope with the demands of cycling at certain distances, terrains or inclines. Pre-existing or current injury may place additional stress on the injured area, or other parts of the body may compensate for the injured area, possibly leading to overloading. Most of these common injuries or issues which may be experienced by cyclists are treatable and avoidable with tailored management and physiotherapy.
Novice cyclists often report higher incidences of neck/shoulder, knee and low back/hip pain which may be accounted for by poor bike fitting and overload tissue in the body. More experienced cyclists however may experience overuse injuries during competitions or with limited rest time between rides, such as the Tour de France or cycling the Great Ocean Road here in Australia.
Muscles used during cycling
Cycling Injuries in Different Body Regions
Anterior knee pain: This is the most common region for knee pain during cycling and often occurs from sustaining a pedal stroke with increased ranges of knee flexion can overload the patella, especially when climbing, in windy conditions or riding longer distances than normal. Common injuries include patellofemoral pain syndrome, patellar tendinitis, quadriceps tendonitis and chondromalacia patellae. These conditions affect around your patella generally and are often caused by having a low saddle height, saddle which is too far forward, cranks being too long or cycling on high resistance with low revolutions per minute (RPM). Sustaining a pedal stroke with increased ranges of knee flexion can overload the patella.
Lateral knee pain: The most common lateral knee injury during cycling includes Iliotibial band syndrome (ITBS), followed by the more uncommon biceps femoris tendinopathy which occurs posteriorly and laterally. Often fatty pads under the ITB are compressed when cycling cleats that encourage the toes to point in, having excessive or no float and the feet too close together. Other conditions including large climbs, time trialing and increased mileage can increase the incidence of ITBS.
Medial knee pain: Common injuries include pes anserine bursitis, MCL bursitis, medial plica syndrome and less commonly medial meniscus tears. These can occur from an inappropriate saddle height with or without an externally rotated/outward pointing cleat position and foot position, excessive or no flat or having the feet too far apart.
Back/Neck: Discomfort in the shoulder blade region or posterior neck area may be caused from poor postures on the bike, such as improper seat or handlebar heights, reduced scapular control, poor head positioning while cycling.
Ankle: Achilles tendinopathy is the most common cause of ankle pain while road cycling. This is seen to cause pain and discomfort just above your heel at the back of your ankle. This may occur from riding more than you’re used to over a short period of time, excessive plantarflexion stretch from a high saddle, excessive dorsiflexion from a low saddle to generate more power, or an ‘ankling’ pedal stroke pattern in which force is purposely concentrated through the heel as opposed to the forefoot.
Hip: proximal iliotibial band syndrome (PITBS) is the most common cause of hip pain while road cycling, followed by greater trochanteric pain syndrome, piriformis syndrome and less commonly labral tears. These are often characterized by pain and discomfort at the side or back of the hip region. These often occur with excessive amounts of riding, reduced hip stability, riding against resistance or poor saddle position.
Wrist/Hand: Ulnar neuropathy, otherwise known as ‘Cyclist’s Palsy’ occurs when overpressure of the guyon’s canal in the hand, which houses the ulnar nerve, results in pain and neurological symptoms. This is often caused by excessive riding amounts, hand positions on the bike, inappropriate seat / handle positions or poor quality gloves.
How Can a Physio Help With Cycling Injuries?
In the absence of crashes, common road cycling injuries are certainly avoidable and manageable. Depending on the nature of your symptoms, a physiotherapist will be able to help you through adjustments or minor tweaks to your bike setup, changes to your training and riding loads, or help guide you through a specific muscular strength, endurance and conditioning exercise program.
If you are experiencing any of the symptoms previously mentioned, if you have aches or niggles while riding which just aren’t going away or if you are new to riding with concerns of these injuries occurring, I would invite you to come in for a clinical assessment and treatment at our clinic. The nature of most road cycling contact or overuse injuries are treated adjustments to bike fit or postural adjustment, equipment adjustments, modifications to riding amounts/loads, prescription of individualized exercises to increase strength, endurance, control and/or mobility, as well as manual therapy techniques if indicated, With spring here and summer just around the corner, now is a great time to get your body set for the beautiful riding weather.
This blog was written by Luke Mrowka (Physiotherapist), from our Burnside practice.
Clarsen, B., Krosshaug, T. and Bahr, R., 2010. Overuse injuries in professional road cyclists. The American journal of sports medicine, 38(12), pp.2494-2501.