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Common cycling pains and how to avoid them

Alia Parker's picture
Physiotherapist performing a bike fit. Cycle Traveller

Cycling may be a great form of low-impact exercise, but it can still cause stress on the body and lead to annoying pain. That sucks. Cycling shouldn't be a pain in the butt. But the good news is much of this pain can be prevented.

To find out more, I had a chat with someone who knows a lot about pain: Paul Visentini, who is not only a cyclist and specialist sports physiotherapist at PhysioSports in Brighton, Melbourne, but also one of the Australian Physiotherapy Association's most highly regarded bike fit specialists.

As you could imagine, he's treated a lot of injured cyclists over the years, so I tapped his brain about the most common non-traumatic injuries that affect cyclists, what causes them and how they can be prevented.

A plum bob will show you the position of the knee over the pedal.The four most common cycling pains

  1. Knee pain
  2. Lower back pain
  3. Shoulders, neck and hand pain
  4. Soft tissue pain from the saddle

That's quite a broad list, but when these pains relate to cyclists, Visentini says they can be simplified into three areas:

  1. Bike – bike size and fit
  2. Body – rider position and style
  3. Load – fitness, strength and training error

Training error

We'll start with the easiest – fitness and training error. This is simply where a rider goes out too hard; that is, doing that massive ride without building your body up towards it.

“And so your body and your tissues and your coordination and your muscles are just not accustomed to that high load and you'll get sore, but often you'll also irritate, aggravate or cause a real pathology,” Visentini says.

“There's a difference between a two or three-day soreness and then that thing that just doesn't go away because you've irritated the joint surface.”

This sort of pain is easy to avoid (although we're probably all guilty of pushing our bodies to the limits from time to time). Start with easier days and build yourself up from there and you'll avoid these types of injuries.

Determining whether pain is being caused by the other two remaining sources – bike fit and riding style – is a little more complicated, so let's break it down by pain type.

Knee pain

We'll start with knee pain, as that's the most common non-traumatic injury suffered by recreational cyclists. Visentini says knee pain is most often caused by an improper bike fit.

The first thing to check is the rider's knee angle; if it is too great (often caused by the saddle position being too low), a cyclist will not get enough extension throughout the legs, leaving the quadriceps to do all the work.

Visentini says overworked quads in relation to the other muscle groups, combined with the wrong knee angle will lead to too much stress through the knee.

Research shows the knee angle, measured with an instrument called a goniometer, should be between 25° and 35° for injury prevention. Finding the right angle will differ for each rider as a bike fit should suit an individual's “window of function”. For instance, flexibility and muscle strength will also play a role in determining a suitable fit.

Goniometer bike fit. Cycle Traveller

Riding style can also lead to knee pain. Visentini says a classic example are the “stompers”.

“They will just push, push, push down, and a lot of that is really inefficient as they'll just use quads, quads, quads, quads – super large quads,” he says. “The more you use your quads, the more compression you'll get at the front of the knee and the more likely you are to get knee pain.”

Clipping into the pedals and focusing on a pedalling style that involves pushing and pulling the pedals will help to even out the movement and reduce pressure on the quads.

If pain persists, there may be other factors attributing to the knee pain, such as the saddle's fore and aft position, or the position and angle of the rider's food on the pedal.

Lower back pain

Posture-related lower back pain is another very common source of pain caused by cycling. Visentini says there are a number of bike-fit issues that can lead to lower back pain.

One common cause is the saddle position being too high, which will cause the rider to overreach with the foot, often resulting in a rocking of the hips.

Another cause may be that the saddle is positioned too far back in the rails, causing the rider to be to flexed forward or overreaching to the handlebars.

However, Visentini says it may also be a rider's physical capability causing the pain. For instance, recreational cyclists may not have the core strength to support the weight of their torsos in an aggressive set up. A less aggressive bike fit, which allows the rider to be positioned slightly more upright, will reduce pressure on the lower back until the rider has developed the core strength needed to maintain a more aggressive riding position. Basically, the more upright a rider is positioned, the less pressure is placed on the lower back.

Shoulder, neck and hand pain

Pain through the upper back, shoulders, neck and hands is often all linked to the same issue – most commonly where the rider is set up aggressively or overreaching to the handlebars.

“An aggressive set up would be: seat too high, seat too far back or reach too far forward,” Visentini says.

Core strength also plays a role here because if the core muscles are lacking in strength, the rider will overcompensate by placing too much pressure into the hands, known as 'white knuckle syndrome'.

Getting a bike fit. Cycle Traveller

“It's like the old Eddy Merckx line: it should be like playing the piano, you should be so strong in your middle area and trunk that you shouldn't put any weight through your hands,” Visentini says.

“But a lot of riders aren't strong so they hold on too tight. So that situation where you need to stabilise at the front end means you're going to put a lot of stress through your shoulders, your upper back and neck.”

Some cyclists, (predominately those with small hands, such as women) experience hand pain because the brake levers are too far to reach or the handlebars are not an ideal shape. Adjustments can be made to improve such issues. Hand pain should be addressed as it may lead to nerve damage and numbness in the fingers.

Saddle pressure

Many cyclists, especially those riding in more aggressive positions, experience soft tissue discomfort. Visentini says sliding the saddle forward a little in the rails may help to relieve pressure at the front. Be careful, however, as this will change the position of your knee over the pedal and your reach to the handlebar.

The type of saddle used will also impact comfort. There is a wide range of different shaped saddles on the market to choose from and women in particular should use a women-specific saddle.

Getting the fit right

When it comes to the perfect bike fit, there's no one-size-fits-all solution – it's really a matter of getting the fit right for the individual.

“You need to be within your 'window of function' on the bike, and if you're not, you're going to stress your body,” Visentini says.

“If you don't have good coordination and gluteal function, you'll overload the quads, get knee pain, you'll overload the front of the hip, get hip pain; psoas overload, tensor fascia lata overload; you'll overload your deep rotators in the pelvis and the buttock and the sciatic nerve passes through there, so you'll get nerve related problems; and you'll overload the controlling muscles of the back as well.”

Most of the pain and discomfort issued suffered by cyclists can be addressed by adjusting the bike fit. For some, they may need to alter their riding style. Either way, don't accept pain being 'normal'; explore the reasons behind why it's happening and there's a good chance you'll be able to resolve it. 

Comments

Great read Alia!

Really helpful thanks.

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