Jun 25, 2021

What Are The Most Common Cycling Injuries and When to Seek Treatment?

Whether you’re a recreational or a pro cyclist, whether road biking or mountain biking, injuries are most often caused by overuse, repetitive strain or a traumatic impact from a fall.

What Causes Cycling Injuries?

Whether you’re a recreational or a pro cyclist, whether road biking or mountain biking, injuries are most often caused by overuse, repetitive strain or a traumatic impact from a fall.

Your bike setup and posture is often a factor – a saddle that is too low or too high can cause calf muscle and tendon pain; cleats that are not set in the right position can lead to pain in your calf and feet; handlebars that are too far forward can cause neck and back problems.


Of course, there are multiple types of musculoskeletal injuries that are the result of bike crashes and falls – from fractures to sprains and torn ligaments and tendons.

If you have any pain as a result of cycling, it’s always advisable to get it checked out by a medical professional as soon as possible. Many bike-related injuries can be resolved quickly and with minimal intervention, but if they are left for too long, they may require more intensive treatment or even surgery.

As soon as you have a correct diagnosis, resolving the issue could be as simple as altering your bike setup to reduce the strain on certain parts of your body. On the other hand, you may have a condition that needs a programme of intensive physical therapy, or steroid injections and surgery.

Capital Orthopaedics is a team of sports medicine professionals and orthopaedic surgeons who specialise in diagnosing and treating all musculoskeletal injuries and conditions. Contact Capital Orthopaedics here to make an appointment at one of three central London locations.

What are the Most Common Types of Cycling Injuries?

Knee pain

Cycling knee injuries are fairly common, mainly due to the repeated flexion and extension of a pedalling motion putting stress on the patellofemoral joint (knee cap). This can result in bones rubbing against each other and pinching soft tissues in the knee – leading to pain, swelling and inflammation.

Tight or unbalanced quadriceps can also pull on the tendons of your knee, potentially leading to patella tendonitis or patella tracking disorder. Knee tendon injuries lead to symptoms of pain, swelling and weakness around your knee. Knee pain may also be the result of other conditions such as arthritis.

As with any sports-related pain or injury, it’s important to get an accurate diagnosis before beginning treatment.

Treatment: You’ll need an initial consultation and MRI scan, then physiotherapy exercises for knee pain usually focus on improving hamstring, calf and iliotibial band flexibility and strengthening of your quadriceps and glutes. Conditions such as osteoarthritis may require more intervention, such as injection and shockwave therapies, or surgery.

Shoulder injuries

Injuries to the shoulder are very common in cyclists, most often as a result of falls and crashes. A fall onto an outstretched arm, or onto the side of the shoulder can cause a range of injuries including fractured collarbone (clavicle), damage to the joint on the top of your shoulder (acromioclavicular joint or ACJ), injury to the rotator cuff (the tube of tendons that stabilises and mobilises your shoulder joint), or torn cartilage. If you have had any traumatic injury to your shoulder or suffer from chronic shoulder pain as a result of cycling, it is really important to get an accurate diagnosis. Many shoulder injuries have similar symptoms (pain, muscle weakness, stiffness, swelling and tingling or numbness in the fingers), but the treatments vary, depending on the condition.

Treatment: An injury to the joint at the top of your shoulder (ACJ) may be a minor fracture or a dislocation. It may involve damage to the cartilage that could lead to arthritis if not treated effectively – usually targeted physiotherapy to help strengthen the muscles and improve mobility will help. Collarbone (clavicle) fractures need to be immobilised for four to six weeks before starting rehabilitation exercises. Badly displaced fractures of the AC joint usually require surgical reconstruction or surgical repair. Fractures to the humerus normally require a CT scan and immobilisation or surgical reconstruction.

Injuries to the large ball-and-socket joint (glenohumeral joint) tend to be labral tears (tears of the cartilage that lines the socket) or damage to other structures, including rotator cuff tears or impingement (pinching) and swelling of soft tissues in your shoulder. Many of these impact-related injuries can be treated with physiotherapy, but in some cases, surgery is needed to resolve the issue.

Neck pain

60% of cyclists suffer neck pain. The posture of leaning forward and lifting your head to look up (neck hyperextension) can put strain on your neck muscles (cervical stabilisers) and upper back muscles (upper trapezius and levator scapulae muscles).

If you are suffering from chronic or acute neck pain, a thorough diagnosis is needed to investigate any damage to the vertebrae or discs in the neck – particularly if you’ve had a traumatic injury.

Treatment: treatment for neck pain is based on the diagnosis, usually involving an MRI scan. In many cases, the pain can be resolved through physical therapy – focusing on strengthening your scapular (shoulder blade) and cervical (neck) stabiliser muscles, as well as stretching your anterior shoulder and chest wall muscles. Damage to your vertebrae or discs may need injection therapy or surgery, depending on the severity of the condition.

Back pain

Cycling can cause an increase in pressure on the soft discs between the bones of your vertebrae, which could lead to discogenic pain, as the nerves in the outer layer of the disc become irritated.

Tight hamstrings and hip flexors affect the position of your pelvis, which can, in turn, lead to a tight lower back. It’s possible that you may be suffering from this problem before you even start to ride. A long ride will just make the symptoms worse as you start to fatigue and overused muscles begin to lock up.

Treatment: You’ll need an initial consultation and MRI scan to get an accurate diagnosis of your back pain. Physiotherapy treatment focuses on core, obliques and back extensor strengthening exercises, along with pelvic tilts, will help to minimise cycling-related lower back pain. Disc damage and arthritis need to be treated in a specific way to prevent the condition worsening. This may involve targeted physical therapy, steroid injections and surgery.

Achilles tendonitis

The Achilles tendon connects your calf muscle to your ankle joint. When there is a lot of stress on your calf muscle, it can become tight, resulting in tiny tears in your Achilles tendon. The repetitive action of pedalling can lead to the pain of Achilles tendonitis.

Treatment: after an initial consultation, you will usually have an MRI scan to ascertain Achilles damage. Achilles tendonitis can almost always be treated effectively with physiotherapy and massage to encourage the tendon to heal, followed by stretching and strengthening exercises. It’s also a good idea to make sure your bike is set up to reduce strain on your calves, and make sure you stretch before each ride.

Foot numbness

Cyclists often suffer from numbness in the front of their feet – and not just from the cold. Numbness, tingling and associated pain is the result of compressed nerves, and could be associated with problems in the lumbar region – so it’s a good idea to get a careful diagnosis before attempting treatment.
Bad bike fit or cleat positioning can lead to muscle tightness, strength imbalances, leg length discrepancy – causing pressure on the nerves that lead from your back to your feet.

If you also experience a sharp pain under the ball of your foot, you may be suffering from Morton’s neuroma. This is nerve compression in your forefoot – often the result of tight fitting shoes.

Treatment: For Morton’s Neuroma, special orthotic insoles can prevent the condition, as well as switching to a wider shoe. If this doesn’t resolve the pain and numbness, steroid injections can help to reduce inflammation in the nerve, while and surgery is an option to cut away swollen tissue. If numbness is the result of nerve compression in your lower back or legs, the symptoms can almost always be resolved with targeted physical therapy.

How Can Cycling Injuries Be Treated?

Treatments are specific to the injury you have incurred. Some of the common cycling related conditions and treatments are listed above. Experienced sports medicine professionals will be able to pinpoint your problem and provide the right type of rehabilitation programme or surgery for you. Along with effective rehab, it’s also important to focus on your bike fit to prevent recurrence of injuries.

When Should I Seek Treatment?

Some cycling related pain can be resolved with a few days’ rest, ice and anti-inflammatories. However, if you have persistent or recurring problems, it’s always advisable to talk to a medical professional. The sports medicine team at Capital Orthopaedics provide expert diagnoses in our state-of-the-art clinics and physiotherapy studios. Because cycling is a fairly low-impact sport (unless you’ve had a crash), many of the musculoskeletal problems can be resolved effectively with non-invasive treatments including physiotherapy, shockwave therapy and injections. If you have more severe injuries or conditions, our orthopaedic surgeons offer the most minimally invasive surgery – aiming to get you back to full strength and fitness in the quickest time possible.

The takeaway? Get a proper diagnosis! Chronic pain or ongoing physical problems as a result of cycling can lead to worse conditions such as osteoarthritis, sciatica or disc herniation. Resolving the issues sooner with physiotherapy and altering your bike fit could prevent you from dealing with bigger problems in the months or years to come.

For more information about how Capital Orthopaedics can provide expert diagnosis and treatment for your cycling injuries, contact us here.

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