Cycling Injuries
Cycling can be an exhilarating activity; ripping down the mountains through the tress, or allow
you to engage in an activity with your family and get close to nature. Cycling is a rapidly
growing activity which provides a low impact alternative to running and other aerobic
endeavours, it is a fantastic method of enhancing your fitness and health, or can provide you
with a mode of transportation. But what happens when the pain starts to creep in and the fun
factor rapidly vanishes? Two of the most common injuries from cycling are knee pain and back
pain.
Knee Pain
The knee is probably the second most injured part of the body, of which most injuries are
sports related. Due to the repetitive nature of cycling (compared with sports like football that
involve direction changes), cyclists are more likely to experience iliotibial band (ITB) friction
syndrome. During one hour of cycling, a rider may average up to 5000 pedal revolutions. The
smallest amount of misalignment, whether anatomical or equipment related, can lead to
dysfunction, impaired performance and pain, ending your cycling season prematurely.
ITB Syndrome
The ITB is a thick fibrous band that runs on the outside of the leg from the hip to below the
knee. With ITB friction syndrome, you will feel the pain either just above the outside of the
knee or where the tendon attaches to the bone, just below the knee joint.
Pain usually starts as an intermittent niggle, sharp in nature and very focal. If this pain is
ignored, it can develop into a dull ache even when you are not cycling. You may also notice a
decrease in pedal power. The pain is a result of the ITB running across the bony prominence
every time you pedal, hence the name ‘friction syndrome.’
If you notice ITB pain, immediately ice the knee and begin gentle hip and hamstring stretches.
It is important to see your physiotherapist as soon as possible — as it may be necessary to stop
cycling — seek appropriate treatment and determine the cause of the pain.
The two main causes of ITB friction syndrome are inappropriate training and abnormal
biomechanics, both of which cause extra stress on the ITB.
Saddle Position
Check your bike setup, especially saddle height. Too high a saddle will increase knee extension
and irritate the ITB. If the saddle is too far back, having to reach further for the pedal will also
stretch the ITB and possibly lead to irritation. The saddle should be level with the ground,
tipped down will increase the pressure on you arms and hands often leading to pins and needles
in the hands and sore shoulders. If the nose is tipped up you will find it very uncomfortable to
sit on your saddle for an extended time.
A simple method of determining correct saddle height is to have the saddle adjusted so that
with the pedal at the bottom of the stroke (six o’clock position), you can rest the heel on the
pedal while sitting. The knee is adjusted so that the knee is bent between zero and 15 degrees.
Foot Position
Foot position on the pedal is also important. Whether using cleats or toe straps, ensure the
heel is neither rotating too far — in or out — which in turn varies the knee position. An ideal
position is such that the heel is kept in line with the lower leg through the entire pedal stroke.
Gear Choice
One of the most frequently seen causes of overuse knee injuries on the bike, such as ITB
friction syndrome, is riding in too high a gear. The optimal cadence for cycling is about 80-100
revolutions per minute, on the flat with minimal wind resistance. You should adjust your gears
accordingly to achieve this cadence. On hills, choose a gear that will get you to the top with
the least effort to minimise stress on the knees.
Anatomical Factors
There are also anatomical factors which may contribute to ITB friction syndrome, such as leg
length discrepancy, a wide pelvis, tibial rotation, and leg inflexibility. These factors would be
identified by your physiotherapist on assessment.
Footwear
Footwear can also affect your knees on a bicycle, especially if you have pronated feet (‘flat
feet’). An ideal bicycle shoe is more rigid than a running shoe and I would strongly advise a
regular cyclist to invest in a good pair of cycle shoes. There are many shoes available which
provide arch support for pronated feet. I learned from experience, that when I wore my
running shoes cycling, having forgotten to bring my clip-in cycle shoes, I experienced pain in
the arches of my feet when climbing and when using the higher gears (not to mention the pain
of the pedal cracking into my shin on the descents)! This could, in turn, lead to variations in
the position of the knee during a pedal cycle and hence, ITB pain.
So, check your bike setup at your local bike shop or with a qualified professional, check your
footwear, stretch, stretch, stretch and see your physiotherapist if you experience ITB pain.
Back Pain
Back pain can be debilitating, but riding a bike can be a cause and prevention, there are a
range of techniques to keep you fit and firing. Up to 50 per cent of cyclists experience back
pain. This may result from a variety of factors, including poor bicycle fit, damaging riding
habits and reduced flexibility. An understanding of the key predisposing factors, and knowing
how to deal with them, can help you prevent back pain and speed your recovery.
Bike Fit
A poorly fitting bike is one of the main causes of back pain. When your setup encourages
excessive bending (flexion) through the lower (lumbar) and middle (thoracic) spinal regions you
place prolonged stress on the disc, ligaments, and muscles. Incorrect handlebar height,
excessive knee bend and incorrect saddle position are the major contributors to poor position
on the bike.
To get your riding position right, there are two key strategies to consider:
i) Consulting a professional with specific training and experience in bike setup (and if an injury
has developed choosing a professional who has knowledge in both bike setup and injury
management e.g., physiotherapist).
ii) A bike fit that includes an initial setup based on your individual anthropometric
measurements and primary cycling principles; and, adjustments at a later date that
incorporate your individual needs/feedback.
Cycling Technique
Poor cycling technique can not only result in reduced power output but can lead to injury. The
power output throughout the pedal cycle is not equal. At different points, different muscles
are better positioned to deliver optimal power than others. On the down stroke, the gluteals
and quadriceps are working hard, along the bottom of the stroke, the hamstrings and calf
muscles take over and on the upstroke the legs are basically passive. With this in mind,
practise the following to encourage good technique (possibly with a mirror for feedback):
o
o
o
‘Peddling in circles’ to promote a smooth transition throughout the stroke.
Pull across the bottom stroke to assist in removing ‘thuds’ and increasing power
generation.
Ensure relaxation on the upstroke (i.e., don’t pull up on the pedal).
For those people with injuries or athletes wanting to improve their technique, video analysis
with a trained professional can assist in correcting bad habits.
Physical Factors
Core stability throughout the trunk provides essential support to the spine and pelvis and
creates a stable anchor for the legs to generate power. Poor stability can result from weak
abdominal and back muscles and lead to injury. However, learning specific exercises to train
these muscles can improve trunk control and assist in the recovery from back pain.
Your physiotherapist can assess your spinal flexibility and stability and provide guidance on how
to address these factors.
While back pain in cycling is a common complaint, it does not have to limit participation or
enjoyment of the sport. An appropriate bike set-up and correct training technique, along with
regular stretching and spinal muscle training can reduce the impact of back pain, resulting in
less discomfort, more enjoyment and improved performance.
Watch our website for the return of Spin Classes and Core Classes in the fall.
Sure to keep you in shape over the winter!