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Cycling pain can often be avoided

Tuesday, July 14, 2015

By: Dr. Jon Henry

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Cycling is among the best forms of low impact exercise. It is an activity I often recommend to my patients recovering from lower extremity injuries or surgeries, or for those in need of low-impact activity for general orthopedic health. Aside from its rehab potential and conditioning benefits, it is also something many of us simply enjoy doing. 


Ease cycling related pain


Endurance sports such as cycling are repetitive motion activities, and potentially put our bodies at risk for overuse injuries. As we hit our stride in this summer’s riding season it is important to be aware of common cycling injuries – and the best ways to prevent them.


Cyclists’ concerns most commonly deal with pain in the lower body: hips, knees, ankles and feet. I also see some bike-related issues affecting the hands, arms, neck and back.


  • Hip pain is often the result of tightness in the muscles that work across the hip, including the hip flexors, groin, gluteals, hamstrings and quadriceps. Imbalances between these muscle groups can lead to discomfort; it is important to strengthen all the groups affecting the hips, as well as performing adequate stretching exercises before and after your ride. Improper saddle height or position can cause hip pain. Hip impingement issues can be exacerbated through the repetitive motion of pedaling. If you experience any persistent hip pain it is best to have it examined before continuing the activity.
  • Knee pain is the most common complaint amongst cyclists. Some specific disorders that I see frequently in this group include quadriceps tendinosis, chondromalacia and Iliotibial (IT) band syndrome. There are several potential causes and/or aggravating factors. Often these relate to mechanical issues on the bike which are easily corrected, such as saddle position, riding in too high of a gear, pedaling mechanics and foot position on the pedal.  Adjustments to these often reduce or eliminate knee discomfort. A general rule regarding knee pain and saddle position is that if the pain is in front of your knee your seat is too low; pain behind your knee means the seat’s too high.
  • Ankle and foot pain from cycling is often due to tight Achilles tendons. Be sure to pedal with your heel to avoid any undue stress on your foot and ankle; the angle of the foot should remain relatively constant through the pedal stroke. Footwear with stiff soles is helpful to assure proper pedaling function and also reduces stress on the foot. For those who ride with clip-in pedals, proper cleat position is important for proper alignment and pain-free pedaling throughout the leg. If you experience any tightness in the calf down to the foot, there are several easy stretches that can help.
  • Pain in the hands, arms, neck and back is most often a sign of poor bike fit or simply gripping the handlebar too tightly. Past generations of bicycles gave little thought to comfort or ergo-dynamics, often causing the rider undue pain and soreness, especially during longer rides.  It is not uncommon for this discomfort or radiate up through the arms and into the back and neck areas.  Padded gloves can help. Many modern bicycle designs give more importance to rider comfort, with many designed exclusively with comfort in mind.  Bicycle manufacturers now offer ergo grips, high-rise handlebars, adjustable stems and many other accessories to improve rider comfort. Some simple stretching exercises for your hands, arms, neck and back can also help to relieve tension during and after your ride. If these problems persist on an older model, a new bike may be the best remedy. Otherwise, I would recommend medical evaluation in order to diagnosis and further treat the underlying problem.


Some general recommendations:


If you’re not an avid rider, make sure you ease into your riding season. Your body will need time to adapt and recover. If you experience pain, ease back from the intensity/duration of your rides. And make sure to take time to stretch and incorporate the use of a foam roller, if necessary.


The majority of bike-related pains come from improper fit in saddle position, the foot/pedal relationship, handlebar height and reach distance to the handlebar. Bikes designed exclusively for comfort generally do not need a custom fit, as the comfort is “built in.” Riders of more aggressively designed bicycles will often benefit from a professional fitting from their local bike dealer. Here, rider position, geometry and body dimensions are carefully examined to give you optimal performance and comfort, allowing you to ride longer with fewer anatomical issues.


A well-fitted and properly positioned helmet as well as protective eyewear are your most important pieces of protective cycling equipment.


For minor aches and pains an over the counter anti-inflammatory drug (Ibuprofen or Aleve) may help.  However, if you experience any continuing pain while bicycling this summer or if you incur an injury, be sure to contact your healthcare provider. 

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