Common Cycling Injuries

This post discusses the most common cycling injuries.  The most frequent areas of the body that cyclists report having pain are at the knee and lower back. The latter being the most common and both are well documented from collected data over the last twenty years. Unfortunately, the research into causes of these problems are sparse and often anecdotal.

The very nature of cycling (in particular road cycling) and the pedalling action is repetitive with often long hours in the saddle. Minor discomforts and niggles can therefore become exaggerated and in the worst case scenario, cessation of cycling. Comfort and efficiency are important to the majority of the recreational cyclists although some compromises on comfort will occur in time trial positions for short periods of time.

Increasingly ‘bike fits’ have become more common with heightened awareness of the importance of fitting a bike to an individual. Anecdotally it seems to make sense that assessing an individual’s flexibility and anatomical variations in conjunction with adaptations to their bike should reduce their chances of injury. This is an area that needs more research in order to clarify and support these theories and already practised assessments.


Wattbike cycling, Hallamshire Physio Clinic



Some cyclists can accommodate a poor bike fit and be less sensitive to minor adjustments to their bikes whereas the opposite can occur with other riders and they seem more prone to injuries. The phrase ‘macroadjusters’ has been used for the former type of rider as opposed to latter microadjuster (Burt 2014).

The most recent evidence reporting lower back pain in cyclists suggests that a certain group of cyclists are often bending at the lower part of their lumbar spine when sitting. This is also demonstrated when they were sitting off their bicycles and the way that this group bend forward in standing. (O’Sullivan 2012)

When assessing a cyclist the bike position is fundamental and may be adapted to minimise this but equally important is what that individual does when they are off the bike i.e when working and moving. The sitting posture should be addressed as the poor position will be cumulatively adding to the altered sitting position on the bike. This slowly increasing low back pain on the bike may be a result of what is known as ‘tissue creep’ whereby the disc and ligaments are stretched past their end point for prolonged/sustained periods causing micro trauma that can eventually lead to pain.

From experience a riders posture will also be dictated from poor positions rather than learned movement patterns. In theory this cause of lower back pain should be easy to identify and relatively quick to change but can be anything from the wrong size bike, incorrect stem length and a saddle that is too high or too forward/backward.

Reasons for knee problems are less documented but again correlations with incorrect saddle heights and positions have been observed. Certain movement patterns have been identified in cyclists with knee pain. These studies found that the group with knee pain demonstrated increased inward movement at the knee on the downward pedal stroke, a combination of adduction and internal rotation at the hip and arguably increased pronation of the foot. (Bailey 2003). Whether this group had developed this pattern as a result of pain or whether this pattern of movement caused the pain is unknown. More research is needed.

From experience too low a saddle will increase compressive forces through the front of the knee at a more bent position. A high saddle can cause posterior knee pain ( back of knee) as the knee is too extended at the end of the pedal stroke thus stretching the posterior structures as well as being a less efficient position for optimal power.

Ultimately an individual needs to be assessed holistically on and off the bike to determine what their optimal position is. This initial position may change as the cyclist adapts to it perhaps after gaining some flexibility, increasing fitness or leg strength.

If you are having problems on your bike speak to Matt or make an appointment at the Hallamshire Physiotherapy Clinic (0114 2671223).

Matt Withycombe