How to Avoid and Treat the Most Common Cycling Injuries

Cycling is an increasingly popular method of working out. However, as with all forms of exercise, injuries may arise, particularly with overuse, improper use or form, and/or improper fit of the bicycle or cycling gear.

This blog will discuss 7 of the most common cycling injuries, as well as how to avoid and treat them when they arise.

Handlebar Palsy

Handlebar palsy is caused by irritation of the ulnar nerve at the hand or elbow, which may occur from stretching of the nerve from either holding the handlebar for a prolonged time or by direct compression with the pressure from riding with the hands gripping the drop handlebars.

Signs/symptoms are usually temporary and typically include numbness and tingling in the fifth finger and the half of the adjacent ring finger. In more severe cases, weakness in these fingers can also occur.


Conservative therapy is often simple and effective. Because the most common cause of handlebar palsy is prolonged irritation of the nerve, the simplest treatment is to intermittently change hand positions and thus take pressure off the nerve. If signs/symptoms recur with each cycling session, moving the position of the handlebar may provide relief. Physiotherapy, temporary splinting, and rest, as well as the use of NSAIDs can be helpful.

If signs/symptoms persist for a prolonged period of time, a medical opinion is needed in case surgical decompression is indicated.


The following adjustments may help cyclists to avoid handlebar palsy

  • Raise the handlebar position, and move the saddle back
  • Ensure the saddle is level, not tilted down
  • Wear cycling gloves, or add padding to the handlebars
  • Change the bicycle to one with an upright style

Neck Pain

Neck pain is common in cyclists, particularly when using a bicycle that places the rider in the traditional forward flexed riding position. This problem is more likely to occur when the rider's head is held upward for prolonged periods to watch a cycling group leader or see where you are heading.

Management and prevention

Early on neck pain from cycling can be managed with rest, ice, and NSAIDs. Manual therapy, stretching and strengthening in conjunction with postural and positioning advice from a physiotherapist is important if pain persists.

Tips for preventing neck pain include the following

  • Frequently alter the head and neck positions
  • Change the bicycle to an upright style
  • Raise the handlebar height and/or bring the handlebar position closer to the saddle
  • If on a bicycle with drop handlebars, ride with the hands on the hoods or top bar
  • Perform neck-strengthening exercises

Low Back Pain

Low back pain in cyclists is more common when they ride a traditional road-style bicycle with the back bent forward as compared to an upright bicycle. Biomechanical analysis of the lumbar spine has shown that changes in lumbar disc pressures increase with preload forces and with changes in posture, particularly in the flexed forward position. Factors that contribute to low back pain in cyclists include a poor bike fit, poor posture, prolonged use, and weak core muscle strength.

Management and prevention

The Medical management of low back pain generally consists of rest, ice, and NSAIDS. Physiotherapy can further help with modifying contributing factors, manual therapy, soft tissue release, taping, stretching and strengthening the appropriate muscles.

The following adjustments may help cyclists to avoid low back pain

  • Select an appropriately fitting bicycle
  • Raise the handlebar height and/or move the saddle forward
  • Perform core muscle–strengthening exercises

Bicycle Seat Neuropathy

Bicycle seat neuropathy is when a nerve is compressed between the pelvis and saddle. This is a very common condition in cyclists, especially after prolonged riding on narrow seats.

Signs/symptoms are generally self-limited and include numbness, tingling, or pain in the groin or perineum; men may report impotence.

Management and prevention

The mainstay of treatment for bicycle seat neuropathy is adjustment of the bicycle seat and bicycle position (eg, tilting the nose of the seat down or lowering the seat height to relieve pressure off the perineum). Changing the style of riding, such as periodically standing up from the seat and making other positional changes, and/or changing the saddle may be helpful. Bicycle adjustments such as the lowering the saddle, raising the handlebars, and bringing the handlebars closer to the saddle may provide relief.The saddle should be level. Although many different seat styles and types of padding have been studied, to date no specific style or padding has been shown to prevent bicycle seat neuropathy.However, recent studies have shown some promise in decreasing perineal numbness in seats with "no nose”

Saddle Sores

Saddle sores are caused by skin breakdown from pressure and friction, and they range in severity from mild chafing to ulcers. Contributing factors include heat and moisture combined with improperly fitting clothing, prolonged riding, and improper seat position/fit.

Signs/symptoms include tenderness and redness in the regions that have contact with the saddle (eg, groin, perineum, inner/back of thighs); the affected skin may be raised and/or accompanied by a rash.

Management and prevention

Saddle sores are generally self-limited following a short period of rest from riding and with maintenance of good hygiene. Protect the affected skin with a bandage if friction is unavoidable; otherwise, allow it to "breathe" or air out, as feasible. If inflammation persists or progresses, medical evaluation is appropriate and antimicrobial therapy may be warranted. Preventive measures include wearing clean, well-fitting, padded bicycle shorts, and/or using a wider and more padded seat. Gel seat covers may provide additional padding and reduced friction.

Patellofemoral Pain Syndrome (Cyclist's Knee)

Patellofemoral pain syndrome (PFPS), or cyclist's knee, is an overuse condition caused by repetitive friction between the kneecap and the thigh bone.

Signs/symptoms include generalized knee pain, joint line pain, or retropatellar pain that manifests most often during activities requiring knee flexion and contraction of the quadriceps or occur afterward.

There are considerable quadriceps-patellar vector forces exerted by the surrounding muscles on the patella during repetitive knee flexion - In particular the biomechanical causes for functional or dynamic valgus where the knee positions medially can also involve internal rotation of the femur, the tibia, or both. Tight Quads and weak Gluteals can accentuate the problem

Management and prevention

The initial treatment for PFPS is rest and ice. Short-term use of NSAIDs and/or medially directed taping may be helpful for acute pain. Assessment and treatment by a physiotherapist for strengthening and stretching the muscles is advisable

Preventive measures include the following

  • Ensure the saddle is not too low
  • Raise the seat or move the seat back to decrease the amount of knee flexion
  • Use shorter length crankshafts
  • Ride in smaller (lower) gears with a higher cadence
  • Perform muscle-strengthening exercises, particularly of the vastus medialis
  • Hip, core and gluteal strengthening

Metatarsalgia (Hot Foot Syndrome)

Burning and tingling in the feet is also a frequent complaints of cyclists. Compression of one of the smaller nerves of the forefoot against the metatarsal bones of the foot is the culprit. Causative factors include pressure between the foot and the pedal, wearing shoes that are too tight, and improper positioning of the bicycle cleats.

Management and prevention

Usually, temporarily taking the foot off the pedal and shaking it will allow the symptoms to resolve.Placing a metatarsal pad on the insole of the shoe may relieve the pressure on the nerve. Our physiotherapists can assist with this. Preventive measures include reducing the intensity of the workout, changing the shoes to a larger size or with a different stiffness of the sole, moving the cleats back, lowering the saddle, and/or changing to a different pedal type. A study found that the most effective forefoot pads for reducing forefoot pressure and pain in older people were those that placed the metatarsal dome 5 mm distal to the metatarsal heads


Keys to avoiding cycling injuries include the following:

  • Starting out slowly and gradually increasing the intensity of the workout. Cyclists should pay attention to their bodies, reduce the frequency/intensity before any signs/symptoms progress, and allow their bodies time recover between training sessions
  • Changing positions often
  • Adjusting the bicycle to fit properly. Keep in mind that fit for performance, fit for comfort, and fit for treatment of an injury may all result in different adjustments
  • Potentially changing the bicycle, seat, or peddle styles
  • Wearing padded shorts and gloves
  • Cyclists should seek medical and physiotherapy evaluation when signs/symptoms do not resolve.

Adapted from an article by Author Craig Young

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