Enjoy the Ride - Common Cycling Overuse Injuries and How to Avoid Them

By Patricia Staszak, PT

Proper bike fit and riding position can go a long way in ensuring glorious riding comfort for miles to come. But that doesn’t mean you should hop on your bike and put in 50 miles the first day. Like all activities, you need to give your body a chance to adjust to new physical demands. And you also need to be mindful of your form and positioning on the bike to avoid overuse injuries.

In general, you can avoid overuse injuries the way all athletes do -- by staying strong and flexible and using good mechanics. Good core strength will support your body while you’re on the bike and will assist in absorbing shock from bumps in the road.

Let’s cover some specific common overuse injuries and, more importantly, how to avoid them. As always, if you feel pain beyond the pleasant fatigue of a good workout, especially in a joint, you need to stop that activity and figure out what’s causing the pain. Often a small adjustment in your bike fit or your riding form will help. If your discomfort continues, give us a call for an assessment on your riding form and body mechanics.

1. Achilles tendon pain can develop if your toes are pointed downward while pedaling, which causes the overuse of calf muscles and those supporting tendons. Keep your heels down through the entire pedal stroke.

2. Metatarsalgia (pain at ball of foot) occurs because the force from pushing your foot on the pedal is absorbed in just the front of the shoe instead of the whole shoe. Riding in soft shoes such as a running shoe is often the culprit here. A stiff cycling shoe can usually help. Shoes that are too tight also can cause compression at the ball of the foot and will sometimes cause numbness.  

3. Anterior knee pain usually means compression at the patellofemoral joint, which could be an indication that your seat is too low or too far forward. This is another instance where a bike fit professional or physical therapist can help.

4. Patellar tendonitis can result from pedaling in too high of a gear (i.e., you’re pushing really hard instead of spinning) or riding hills. Not pedaling through the full 360 degrees can also cause overuse and pain at the patellar tendon, because your quadriceps are working more than the hamstrings.

5. Posterior knee pain, or pain at the back of the knee, hamstrings or upper calf muscles can result from the seat being too high.

6. Iliotibial band pain (lateral knee or thigh) can be caused by excessive toeing in or pronation, which results in the knee moving in and out.

7. Low back and neck pain are often related to poor posture on the bike. Low back pain may occur because of excessive rounding at the low back. Riders tend to round because of an uncomfortable saddle that causes them to tuck their pelvis under instead of having the pelvis tilted forward; tight low back or hamstring muscles can also cause this. If your seat makes you sore or numb, try one with a center cut out to unload the pubic area.

• Low back pain can also be caused by excessive stress through your joints in your lower back. This can occur from sitting with too much arch (or extension) in the low back, or with a seat that is too high and causes the hips to rock from side to side while riding.
  
• Excessive rounding at the low back can also cause too much rounding at the mid back, which can contribute to compression through the neck and increased stress through shoulders.
  
• By the way, a helmet (which you should of course always wear when riding…right?) that’s sitting too low in the front can cause compression at the neck, because you’re continually tiling your head up to see the road.

8. Shoulder and wrist pain can be caused by a seat that is tilted down at the front, because you’re slipping forward and putting more weight through the hands and arms. Neck, shoulder, and wrist pain can also be caused by a variety of cockpit issues -- handlebars that are too high or too low, a stem that is too long or too short or uneven brake hoods.

All that said; don’t let these potential issues scare you away from riding! The weather is perfect, biking is a wonderful form of exercise, and, with the proper fit and overall mindfulness when you ride, you’ll enjoy many miles on your bike. If you would like us to take a look at your riding position or even help you pick the best bike for you, we’re here to help.