Unless you fall off, cycling is a sport blessed by its body-friendliness. On the road, there’s no impact to wreck your joints or big hits to rattle your brain; in fact riding big miles is more likely to get you ﬁt than fractured.
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But just like any endurance sport, cycling can produce a catalogue of niggling aches and pains, which unless diagnosed and properly treated can often lead to something more serious.
The common-sense answer to any lasting pain is to stop what you’re doing and seek professional advice. But to give your pain a name and point you down the right road to recovery, we’ve listed the most common cycling ailments, their most likely causes, and how to go about ﬁxing each problem.
There are two main types of cycling injury, other than the obvious ﬂesh wounds and breakages caused by the trauma of falling off. They're the less impressive — but sometimes no less painful — strains and pains caused by overtraining, and injuries resulting from biomechanical stress caused by muscle imbalances or incorrect bike set-up.
“It’s the root cause of pain that you need to ﬁnd,” explains Barry Edwards, from Team Bath’s Physiotherapy & Sports Injury Clinic. “Stretching, massage and trigger points can alleviate symptoms, of course, but if you don’t deal with the causes, you get the same symptoms again as soon as you get back on the bike.”
1. Hand pain
Probable cause: Ulnar neuropathy. This condition causes a numbness or tingling sensation in the hands, commonly in the little and ring ﬁnger, and often comes about after long rides where you’ve been keeping your hands in the same position for extended periods of time. It’s not just caused by the pressure from your weight but also the transmission of road ‘buzz’ and vibration through the bars.
Treatment: If you suffer from this, the ﬁrst thing to address is your riding position to take pressure off your hands and redistribute your bodyweight more appropriately. “More often than not, the solution is to shorten your reach,” says Edwards. “That way more of your weight will be borne by the saddle.”
The problem can also be lessened by wearing gloves with gel padding over the ulnar area, plus there are many good padded bar tapes available. There are even systems that put extra foam or gel padding along the bar tops under the tape to cushion the contact area, such as Specialized’s Body Geometry Bar Phat and Fizik’s Bar Gel.
2. Hip pain
Probable cause: Piriformis syndrome. Also known as wallet syndrome, because of where it hurts, this is often caused by overtraining and speciﬁcally by overworking the gluteus maximus muscles in your buttocks. The piriformis itself is a small muscle that rotates the leg outwards. As this isn’t a movement that cyclists need to do much, the muscle can shorten and weaken. If overstressed, it can build in size to the point of putting pressure on the sciatic nerve, causing pain or numbness down the leg or in the hip — which is why it’s a common cause of sciatica.
Treatment: If this injury has been caused by an imbalance between muscles, where the underused piriformis becomes weak, the solution is fairly simple. By strengthening it, the tightness will ease off and often the pain will disappear too.
To stretch and strengthen your left piriformis muscle, lie on your back, bend both knees and cross your left leg over you right so that your left ankle rests on your right knee. Relax, breathe out and then bring your right leg towards your chest by bending at the hip to stretch the piriformis. Deepen the stretch by grabbing your right thigh with both hands and gently pulling it, and the left foot resting on it, closer to your chest. Repeat the stretch with the other leg.
3. Knee pain
Probable cause: Although knee pain is one of the most common areas of complaint from cyclists — followed by back and then neck — it can be difﬁcult to diagnose. As a cyclist, there are several common knee injuries that you can probably rule out. “Meniscus tears, and damage to the anterior and posterior cruciate ligaments, are rarely caused by cycling,” says Edwards. These injuries are more often the result of trauma, such as a heavy fall that causes the leg to bend unnaturally, or a vicious football tackle.
One of the most common cyclist knee complaints is pain in the kneecap. “This is likely to be the overuse injury, patellofemoral pain syndrome or chondromalacia patellae,” says Edwards, “where the under surface of the patella becomes inﬂamed, usually because tightness or weakness in associated muscles moves the kneecap in a way it shouldn’t as you pedal.” If the kneecap rubs on the bones behind it, this can irritate and inﬂame the cartilage at the back of the cap.
The same problem can be caused by your iliotibial (IT) band over-tightening and pulling the kneecap out of line — again causing it to rub against underlying bones. Riding in a racing tuck on tri-bars or on the drops for extended periods doesn’t help, and pulling the knees in towards the top tube can put even more tension on your IT band, causing it to tighten. Considering the repetitive nature of the pedalling action – up to 5,000 pedal revolutions an hour – it’s no surprise that a problem like this can quickly escalate into a clinical injury.
One of the most common fundamental causes of lower body and knee pain in cyclists is actually a small muscle on the outside of the hip called the posterior gluteus medius. This muscle is quite important for stabilising your hip and preventing your knees rolling inwards, and when weakened by an over-tight IT band can be the cause of many painful problems, including medial knee pain, anterior knee pain and even lower back pain. In runners this is one of the biggest causes of patellar tendonitis, or Achilles tendon injuries.
Treatment: If the knee pain is acute, the ﬁrst course of action is to apply what the experts call RICE — Rest, Ice, Compression and Elevation — and then get yourself to one of those experts. “He or she will treat the swelling of the knee and release the IT band, but most importantly get to the cause of the tightness that caused the problem so that it doesn’t recur,” explains Edwards.
As with many cycling overuse injuries, your expert needs to assess you and your bike to see if the problem is caused by poor technique, an anatomical imbalance, poor equipment choice — such as a pedal with not enough side-to-side ﬂoat — or incorrect bike set-up, such as incorrect saddle height.
To stretch your IT band, stand in a doorway with your right leg crossed in front of your left leg. Reach your left arm overhead towards the top right-hand corner of the doorway. Put your right hand on your right hip and push slightly to move your hips to the left, deepening the stretch. Hold for a few breaths, feeling the stretch along the outer torso, hip, upper thigh and knee of your left leg. Repeat on other side.
If you suspect a weak posterior gluteus medius muscle is the cause of your knee pain, you first need to confirm this. Here’s a simple test from Barry Edwards to ﬁnd out if it needs strengthening: Lie on your side with your legs straight and get someone to hold your uppermost foot about 12in in the air, parallel to the foot on the ﬂoor. Relax, and then ask the helper to let your foot go. When you try to catch and hold your leg in the air, if your outer hip muscles are weak, your foot will move forwards as the hip ﬂexors, and your knee will roll inwards as your brain recruits stronger muscles to keep your foot up, instead of using the weak posterior gluteus medius muscle.
To strengthen this little muscle, isolate it by lying on your side, with knees and hips ﬂexed to about 70 degrees, says Edwards. “Lift the top knee off the bottom one by rotating through the hip as in the test exercise above, to recruit and strengthen the posterior gluteus medius. Other functional work will include carefully analysing your bike set-up and pedal stroke, ensuring that the knee remains over the foot throughout. We’d also check the cleat alignment to ensure that the foot is neither toed too far in, nor too far out.”
Stretching out your knee is also important, and this simple stretch is ideal for helping to release tension. Lie on your side with both legs straight out below you, then gradually bend the lower leg until you feel a stretch around the knee joint.
4. Neck pain
Probable cause: Pain caused by neck hyperextension is also normally exacerbated by positional issues on the bike, combined with lack of ﬂexibility. “Just as you have core stabilisers around your middle,” says Edwards, “you have stabiliser muscles called deep neck ﬂexors around your neck to hold your head up. When they become weak it is left to the trapezius muscle that goes from the base of your skull to the shoulder to support your head as you lean forward. It’s when these stand-in muscles get fatigued that you get the aches and pains in the back and sides of your neck.”
Treatment: “To restore balance to your neck’s supporting muscles, and for a long-term solution, you need to strengthen the deep neck ﬂexor muscles,” says Edwards. Here’s how: Lie on your back with your head on the ﬂoor and knees bent.
Without moving your head at ﬁrst, ﬁx your focus on a point just above your knees, then follow your eyes with your head as if you’re nodding ‘yes’, pulling your chin in towards you Adam’s apple area without lifting your head off the ground. Hold the stretch for 10 seconds and then gently return to the start. Repeat 10 times every day.
The easiest way to avoid neck pain is to change your posture on the bike so that you don’t have to crane your neck up so severely. “If you’re reaching too far forwards, or your handlebars are too low,” says Edwards, “the obvious ﬁrst step is to use a shorter stem to shorten your reach.” Turning it upside down will also raise your bars, helping you ride more upright and reduce the strain you’re putting on your back and neck. “Don’t forget to change your hand positions from the drops to the tops at regular intervals, and sit up on the bike to stretch, straightening out your neck and back to vary the loads on the different muscle groups.”
5. Back pain
Probable cause: After knees, the back is probably one of the biggest causes of pain for cyclists, with lack of ﬂexibility and bad posture generally the cause. “The natural, neutral position for the human body is standing with all your muscles in balance,” says Edwards. “So, the minute you start reaching forward, you’re stretching some of those muscles more than they are used to, and potentially holding that stretch for hours at a time.”
This overstretches the ligaments causing them to overstrain, which can lead to localised lower back pain, though generally with no referral of pain into the legs, according to Edwards. This forward-bent position can also result in injuries to the trunk ﬂexor and lumbar muscles and the sciatic nerve, while the muscle groups not involved in the movement can easily become tightened and shortened.
If you sit at a desk all day or drive lots, you’re likely to have poor posture. “That makes you even more vulnerable to back injury from overstretching on the bike,” asserts Edwards, “putting too much pressure on the ﬁbrous outer protective discs that protect your spinal vertebrae from shock. The result can be bulging discs, herniated or slipped discs, which in turn can cause sciatica nerve pain.
Treatment: Get your workstation assessed by a physiotherapist or ergonomics expert so that your at-work posture can be the best possible. Just as important is to take regular breaks so that you’re not sitting for hours in the same position. “Every three-quarters of an hour, sit upright,” says Edwards, “and bend back on your chair to straighten out. Pull your shoulders back and down, working the body in as many directions as possible.”
Here are two exercises your can try:
1. Shrug it off: To release stress and tension from your neck and shoulders while seated at your workstation, lift your shoulders up towards your ears, squeezing them as hard as you can. Hold for a couple of seconds and roll them back as you relax down. Repeat this 8-10 times.
2. Reach for the sky: To improve your posture and stretch all the muscles in your back, sides and arms, lace your ﬁngers together and stretch straight up towards the ceiling. Breathe in deeply as you stretch as high as you can, then exhale and open your arms, sweeping them back in a wide arc down to your sides.
As with neck problems, the easiest way to avoid back pain from over-reaching is to change your bike set-up. Raising your bars by ﬂipping your stem or adding spacers to your headset, or choosing a shorter stem, will let you ride more upright and avoid overstretching in the ﬁrst place. The same goes for changing your hand positions on the bars — don’t spend all day riding on the drops, instead sit up and ride on the hoods or bar tops to give your back a break.