Common Cycling Injuries – Fitness Blog

Cycling is a great low impact way to stay fit but it doesn’t come without its risk of injury. It is important to be aware of these so that they can be avoided where possible and treated correctly when necessary. I am not a sports injury specialist so I have called in the help of our in house physiotherapist Paul Harrison. He has helped write this article to give you a comprehensive guide to the most common cycling injuries, how to spot them and how to treat them. Prevention of these injuries is crucial where possible so please read my article on ‘10 Ways to Prevent Injury when Cycling’ to reduce the risks and take control of your training.

Important notice: Head Injury is one of the most common and serious injuries when cycling, so reduce this risk by buying a good helmet.

Common injuries associated with cycling:

Hamstring Strain

Hamstring strains are very common and involve a tear in one or more of the hamstring muscles. There are three hamstring muscles that run across the back of your thigh (Semitendinosus, Semimembranosus and Biceps Femoris).

Strains are graded 1, 2 or 3 depending on severity.Grade 1 consists of minor tears within the muscle. A grade 2 is a partial tear in the muscle and grade 3 is a severe or complete rupture of the muscle.

Symptoms

• Sudden and severe pain down the back of the thigh during exercise along with a possible snapping feeling.
• Pain whilst walking or stretching (straightening the knee whilst bending forwards).
• If the rupture is severe a gap in the muscle may be felt.
• Pain on contracting the muscle against resistance.
• Tenderness and bruising.

Treatment

It is very important to start treatment of a hamstring strain immediately. This should include the use of R.I.C.E (Rest, Ice, Compress, and Elevate). A compression bandage should also be used to minimize intra muscular bleeding.

Early mobilization of the injured lower limb is vital for the correct rehabilitation of the muscle. This includes stretching and strengthening exercises throughout the pain free range. These can aid with decreasing the swelling in the area. In addition, exercise will ensure that any new material will be laid down in correct orientation thus reducing the risk of subsequent injuries.

It is advisable to seek help from a sports injury specialist. The use of sports massage on the hamstrings can help speed up recovery. It is important in the treatment and rehab of hamstring muscle injuries as massage helps correct new muscle fibre realignment and minimizes scar tissue. In addition massage can increase the blood flow to the injured area.

Handlebar Palsy

Handlebar palsy is also known as ulnar neuritis or ulnar nerve compression. It is common in cyclists due to position of the wrist and compression on the handlebars. The symptoms are caused by compression of the ulnar nerve at the wrist against the handlebar.

Symptoms 

• Tingling, numbness or pain in the ring finder, little finger or on the outside or middle of the forearm.
• A feeling of weakness in the hand.
• Pain may be experienced during other activities which use the wrist.

Treatment

The most important feature of treating this condition is to correct the cause of the problem. In cyclists, this may mean checking the bike set up such as the height of the saddle and handlebars and the wrist position when riding. Correcting these problems will usually stop the symptoms.

If the symptoms persist then seek advice from a professional sports injury therapist who will be able to assess the injury. These symptoms could be due to compression of the nerve at any point along its course, not just at the wrist.

Posture should be checked to rule out any potential neck problems as well as other activities which may put a strain or pressure on the nerve higher up.

Back Pain

While cycling is a low impact activity on the joints, some people will experience back pain.  This can be felt in any of the 3 regions of the spine, Cervical (neck), Thoracic (mid back) or Lumbar (low back).  There are usually 2 main mechanisms of injury for back pain, sudden (acute) onset, or insidious (slow) onset.

Acute back pain usually occurs due to a particular movement, which puts the back into a position of weakness for example, turning the body or head quickly when trying to look around while on the bike.  Acute back pain may also be caused by a sudden movement such as coming up off the saddle to ride up hill.  However, there can often be an underlying cause to the problem in the first place that pre disposes a person to back pain such as underactive core stabilisers.  Acute back pain may occur in either of the spinal sections.
It is important to note that back pain may sometimes be caused by poor posture on the bike due to an incorrect bike setup.

Signs and Symptoms of Back Pain

• Sudden pain in a specific area, often localised and can be very sharp.
• Decreased range of movement.
• Pain may radiate to the buttocks or down the back of the leg.
• Occasionally a numb or pins and needles sensation may be felt in the leg.
• Pain may be felt in only one leg, or sometimes felt into both.
• Neck pain may radiate into the back of the head and sometimes cause headache.
• Mid back pain may refer into the shoulder (usually on the same side as the pain).
  Again, range of movement will be affected.

Treatment

• Initially immobilisation of the painful area is advisable; try to avoid any aggravating movements.
• If pain is severe consult your GP who may prescribe NSAIDs (Non-Steroidal Anti- Inflammatories) such as Ibuprofen.
• Find a comfortable position.  For example it could be lying on your back, on your front or on your side.
• Taping the area may help to offload muscle spasm and pain, an orthopaedic support or brace may also be used.
• A therapist may use electro therapy such as TENS of interferential.
• Avoid staying in one position for an extended period of time.

Once the initial pain has reduced

• Gentle movement is advisable to restore any loss of range, begin in pain free range and progress, as you feel able to.
• Gentle massage may be used to relieve muscle spasm.
• Once pain has reduced a strengthening programme should be commenced under guidance of a qualified professional.

Signs and Symptoms of Insidious Onset of Pain

• Comes on slowly and gradually.
• Usually begins as an aching pain, which may come and go.
• Often described as pain in a ‘band’ across the back.
• Back feels like it is beginning to stiffen up.
• Gradual loss of range of movement.
• If the pain is in the low back, pain may develop and radiate to buttocks, or down legs.
• If the pain is in the mid or upper back, head pain or headache may occur, and pain may begin to refer into the shoulder or arm (usually on the side of pain).
  Tightness in the upper shoulders and neck.

Treatment

• Initially immobilisation of the painful area is advisable; try to avoid any aggravating movements.
• Find a comfortable position.  For example it could be lying on your back, on your front or on your side.
• Taping the area may help to offload muscle spasm and pain, an orthopaedic support or brace may also be used.
• A therapist may use electro therapy such as TENS of interferential.
• Avoid staying in one position for an extended period of time.

Once the initial pain has reduced

• Gentle movement is advisable to restore any loss of range, begin in pain free range and progress, as you feel able to.
• Gentle massage may be used to relieve muscle spasm.
• Once pain has reduced a strengthening programme should be commenced under guidance of a qualified professional.
• It is important to identify any pre disposing factors such as poor posture and weakness and correct these.

Knee Pain

While cycling is a lot lower impact than other activities like running, knee pain can also be an issue for cyclists. There can be a number of reasons why a cyclist may experience knee pain.

ITB Friction – pain is caused by tightness in the Ilio Tibial Band (the outside of the thigh).  The ITB inserts into the lateral aspect of the knee.  When tight and taken through repetitive motion, the ITB can friction or rub and inflame, causing knee pain.

Signs and Symptoms of ITB Friction

• Lateral (outside of the knee joint) knee pain.
• Usually made worse by exercise.
• May not come on immediately but after a period of time during a cycle ride.
• May be sore the day after a ride.

Treatment

• Initial Ice after a ride to the painful area to reduce inflammation.
• Rest from painful activity.
• NSAIDs may be prescribed by your GP.
• Once pain has reduced gentle massage can be indicated.
• A regular stretching programme should be undertaken.
• A therapist should be consulted for a biomechanical assessment, as usually there is an imbalance in muscle activity.
• A bike set up assessment may also be indicated, as often this may be the cause of the knee pain.

Patella Tendonopathy – the patella tendon is the tendon that inserts the quads into the tibia, if the quads and hip flexors are tight, the constant repetitive motion will pull on the patella tendon and again cause inflammation and pain around the front of the knee.

Signs and Symptoms of Patella Tendonopathy

• Pain over the patella tendon.
• Pain usually occurs during exercise.
• May feel stiffness over the front of the knee with the main difficulty during knee flexion (bending).
• Knee may feel sore the day after exercise.

Treatment

• Initial Ice after a ride to the painful area to reduce inflammation.
  Rest from painful activity.
• NSAIDs may be prescribed by your GP.
• Once pain has reduced gentle massage can be indicated for the quadriceps.
• A regular stretching programme should be undertaken, focusing on quads and hip flexors.
• A bike set up assessment may also be indicated as often this may be the cause of the knee pain.

Patellofemoral Pain Syndrome – a mal tracking of the patella (knee cap) occurs when the patella is pulled out of the groove that it travels in during movements of the knee.  It is usually caused by muscle imbalances, where some are weak and some tight.

Signs and Symptoms of Patellofemoral Pain Syndrome

• Pain felt at the front of the knee.
• Pain during activity though may continue after activity has ceased.
• Usually pain during flexion of the knee.

Treatment

• Ice immediately after activity.
• Rest from aggravating factors.
• NSAIDs may be prescribed by your GP.
• Once pain has reduced gentle massage can be indicated for the quadriceps.
• A Therapist may use electrotherapy such as Ultrasound to aid reduction of pain.
• A regular stretching programme should be undertaken, focusing on quads and hip flexors.
• A bike set up assessment may also be indicated as often this may be the cause of the knee pain.
• A strength and programme should be undertaken to correct the underlying cause.

Meniscus or Cartilage Damage – though reasonably unlikely during cycling unless in the event of a fall, occasionally a cyclist may damage or injure some of the structures inside of the knee joint.  Often there is a previous history of injury or undetected injury, which may make this more likely.

Signs and Symptoms of Meniscus or Cartilage Damage

• Pain felt ‘inside’ the knee joint.
• A click or clunk felt inside the knee during flexion and extension of the knee.
• Swelling of the knee.
• Reduction in range of movement.
• The knee may feel as though it may give way.
• Unable to localise the pain.
• Often pain is not severe but may come and go with activity.

Treatment of Meniscus or Cartilage Damage

• Ice after activity.
• Compression of the area or use of a knee support.
• Rest from aggravating activity.
• Diagnosis by a health professional may require an MRI scan to confirm the extent of the damage.
• Surgery may be indicated depending on MRI results.
• Strengthening of the area is essential.

The lists contained above are not exhaustive but are aimed to give you a guide to the different types of injury that may occur as a result of cycling. If in doubt, always look to get an appointment with a qualified therapist, like Paul, who will be able to fully assess and treat the injury, which will aid your speedy return to cycling. Remember pain is the body’s way of telling us that something is happening that shouldn’t be!