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Cycling and Common Injuires
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Now that the weather is becoming more cooperative for outdoor interests, a boom in activity is taking place.  Accompanying this is an increase in injuries related to the natural process of coming out from hibernation and waking up those sleepy muscles.  

The more common injuries seen in cycling are either overuse problems due to the poor set up of bike to cyclist, or because the training is one dimensional and the athlete does not incorporate other elements necessary for developing their all round fitness.  

Bike Set Up

Usually speed and efficiency is the prime reason for the setup of the athletes bike, it is quite different from the more casual rider, who is not entering a triathalon or duathalon.  The basis for their set up is more likely geared towards the comfort side of things.  In both cases it is vitally important that the set up is appropriate and does not unduly stress areas of the body.

Whether you are just starting out or have been cycling for years, the right set up for your body type and particular discipline is essential to remaining injury free. There are a vast range of bikes such a mountain bikes, road bikes, and hybrids.  The appropriate position is based on the body parts that make contact with the bike.  The three points that determine this are the hands, feet and seat.   The relative position of each of these will affect the efficiency and comfort of the bike.  

There are several variables that will determine the position of each of these; the crank length, distance from crank centre or bottom bracket to the saddle, saddle angle, seat tube angle and saddle offset, distance from saddle to handlebar, relative height of saddle and handlebar, handlebar width and handlebar drop on road style handlebars.

Even if your client has been cycling for years, or competes at a semi professional level, they may never have had their set up evaluated and not realise how much more comfortable and efficient their ride could be. The fitting is best left to professional bike fitting services unless the person has the relevant knowledge.

If they are running into problems, this is definitely one area that should be assessed.  

Common Injuries

Most of the conditions listed below are related to overuse/overtraining.  An overall remedial approach would be to decrease the amount and type of training. Other changes need to include a stretching regime and an increase in rest days.  As noted previously, the bikes set up needs to be taken into account as well.

Ulnar Neuropathy

Or hand numbness, this is related to pressure on the handlebars for extended periods of time.  Adjustments to the cyclists position is essential, this will enable the pressure to be taken off of the area and redistribute the weight of the body appropriately.  


Athletes sometimes in order to reach a goal forget to rest and allow the body to have enough time to build on the effects of the training.  Too much of something is not necessarily a good thing, and in this case, less is best.  Some of the signs and symptoms of overtraining are: tiredness, pain in muscles and joints, a drop in performance despite the amount of training, increased incidence of injuries, insomnia, headaches, moodiness, irritability, depression, loss of enthusiasm for the sport, decreased appetite, decreased immunity seen by an increase in colds.

Piriformis Syndrome

This is related to overtraining, in particular working the area of the gluts.  Piriformis is an external hip rotator, and if overstressed 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.  Other factors that need to be taken into consideration are postural and biomechanical behaviours as well as the set up of the bike.  

Knee Pain

This can be difficult to diagnose unless you have an appropriate level of knowledge and training.  It can range from ligament problems (ACL, PCL, LCL, MCL), meniscus tears, to conditions such as Patellofemoral Pain Syndrome, and Chondromalacia.  Accurate diagnosis is key, immediate treatment if acute is to apply R.I.C.E.

Achilles Tendinitis

It is a chronic overuse of the tendon which crosses the posterior portion of the ankle joint.  Further recommendations are to stop speed and hill training, and to include remedial massage techniques to increase length and decrease tension of the tendon.  

Case History

Client is male, 24 years old, has been cycling at a semi professional level for 6 years.  He trains almost every day, mostly he travels to &  from work via his bike, 30 miles each way.  His other training might include some weights, swimming and running.  His main hobby is guitar playing.  He works part time in IT, sitting at a computer for extended periods of time.  His reason for attending the clinic, he is complaining of pain/discomfort in mid back and shoulder area, which has been ongoing for years.  He has ignored it as he felt it was part and parcel with his training and the job.  It has gotten to a point where the underlying discomfort does not go away and is with him at a low level throughout the day.

On observation, a key factor that has led to his problem, is the position his body is in, which is continually in flexion.  During training he is forward on his bike, his job he sits at a desk, and his hobby he is bent over a guitar. All of this leads to an overuse problem and muscle imbalance.  

The initial step is to get an accurate diagnosis, then plan and implement a rehabilitation program. He would benefit from a postural and biomechanical assessment.   Usually in this initial process the main focus is to reduce the pain and discomfort to promote healing.   Followed by exercises and changes in the training regime.  

What is lacking in his training regime are activities that counteract this rounded positioning. It is important that he starts to include a stretching routine.  He should also be encouraged to do back strokes when swimming to help open up the musculoskeletal structures of his anterior trunk. Generally, the initial remedial massage treatment will be focused on addressing the shortness of the anterior trunk muscles and to re-engage those that have switched off due to lack of use.  Cyclists notoriously need attention to all those areas that are at right angles, so once the signs and symptoms of discomfort in the shoulders and back are being controlled, the treatment needs to look at the body as a whole and determine what other underlying issues there might be.    

Some of the best advice you can give anyone is to vary the training, and include rest days to allow the body to build on the good things.  

By Susan Findlay BSc RGN, Dip SMRP, MSMA
All rights reserved. Any reproducing of this article must have the author name and all the links intact.


Biography: Susan comes from a background in dance (22 years) and gymnastics in which she competed nationally in Canada. She originally trained as a Nurse in her home country and practiced for 7 years before coming over to England in 1993.

After a year in the NHS she retrained as a health and fitness instructor working with GPs and health centers. After years of teaching 20+ classes a week and running health programmes she wanted to integrate her medical, health and fitness background under one umbrella. Hence, she trained once more in Sport & Remedial Massage, incorportating her background into her treatments. She has a busy private practice in North London.

She has been teaching since 1998 at numerous colleges, as well as lecturing nationally and currently continues to do both.

As is expected from the evolutionary process, Susan founded the NLSSM from a desire to see other high quality centers offering a professional course in Sport & Remedial Massage. She is also on the council of GCMT (General Council for Massage Therapy).

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