The 3 Most Common Cycling Injuries and How Physiotherapy Can Help

Cycling is a fantastic way to stay fit, commute, and compete in endurance events, but like any sport, it comes with its own risk of injuries. Whether you’re a weekend rider or a dedicated triathlete, overuse injuries, poor bike fit, and improper training can lead to pain and dysfunction that keep you off the bike.

While crashes and acute injuries do happen, most cycling-related injuries are caused by repetitive strain and biomechanical imbalances. The good news? Physiotherapy can help prevent, treat, and rehabilitate these common injuries, allowing you to ride pain-free and at peak performance.

In this blog, we’ll explore the three most common cycling injuries, their causes, and how physiotherapy can help you recover and stay on the road.

1. Knee Pain (Patellofemoral Pain Syndrome & IT Band Syndrome)

Why Cyclists Get Knee Pain

The knee is the most commonly injured joint in cycling, mainly because it endures constant repetitive motion under load. Two of the most frequent knee issues among cyclists are:

• Patellofemoral Pain Syndrome (PFPS) – Pain around or behind the kneecap, often due to poor tracking of the patella (kneecap) caused by muscular imbalances or improper bike fit.

• Iliotibial Band Syndrome (ITBS) – Pain on the outer side of the knee, caused by irritation of the iliotibial (IT) band, a thick band of connective tissue running along the thigh.

Common Causes of Cycling-Related Knee Pain

🚴 Saddle Height Issues – A saddle that’s too high or too low alters knee mechanics, increasing strain.
🚴 Incorrect Cleat Positioning – Misalignment of the foot can cause excessive inward or outward knee movement.
🚴 Muscle Imbalances – Weak glutes and tight quadriceps can contribute to improper knee tracking.
🚴 Sudden Increase in Training Volume – Rapid mileage increases without proper conditioning overload the knee joint.

How Physiotherapy Helps

✅ Biomechanical Assessment – Identifies poor movement patterns, imbalances, and incorrect cycling form.
✅ Manual Therapy & Soft Tissue Release – Reduces tightness in the IT band, quadriceps, and surrounding tissues.
✅ Strength & Stability Training – Targets hip abductors, glutes, and core to ensure proper knee alignment.
✅ Bike Fit Adjustments – Collaborates with bike fitting specialists to optimize saddle height and cleat positioning.
✅ Gradual Load Progression – Guides structured training to prevent overload on the knee joint.

🔹 Example: A cyclist with PFPS may undergo hip and quadriceps strengthening, soft tissue release, and taping techniques to improve patellar tracking, reducing pain and improving efficiency.

2. Lower Back Pain

Why Cyclists Experience Lower Back Pain

Long hours in a forward-flexed position, especially on road or triathlon bikes, can place excessive strain on the lower back. Over time, poor posture and weak core muscles can lead to chronic lower back discomfort that affects riding performance.

Common Causes of Lower Back Pain in Cyclists

🚴 Poor Core Strength – Weak core muscles force the lower back to compensate, leading to pain and stiffness.
🚴 Incorrect Bike Fit – A saddle too far back or handlebars too low causes excessive lumbar flexion, increasing stress.
🚴 Prolonged Sitting Position – Remaining in a bent-over posture for long periods can tighten the hip flexors and hamstrings, pulling on the lower back.
🚴 Lack of Mobility – Stiffness in the thoracic spine or pelvis affects how forces are distributed when riding.

How Physiotherapy Helps

✅ Postural & Core Strengthening – Strengthens deep core muscles to stabilise the spine during long rides.
✅ Manual Therapy & Mobilisation – Releases tension in the hip flexors, lumbar spine, and surrounding muscles.
✅ Bike Position Adjustments – Helps ensure a neutral spine by adjusting handlebar reach and saddle positioning.
✅ Pelvic Control Exercises – Improves hip and pelvic stability, reducing compensatory lower back strain.
✅ Flexibility & Mobility Work – Targets hip flexors, glutes, and hamstrings to reduce tightness pulling on the spine.

🔹 Example: A triathlete suffering from lower back tightness may benefit from pelvic control exercises, hip mobility drills, and handlebar height adjustments to maintain a neutral riding position.

3. Hand and Wrist Pain (Cyclist’s Palsy & Carpal Tunnel Syndrome)

Why Cyclists Experience Hand Pain & Numbness

Long rides place constant pressure on the hands and wrists, particularly when riding on drop bars or aero extensions. This pressure can compress nerves, leading to pain, tingling, or numbness.

Two of the most common conditions are:

• Cyclist’s Palsy (Ulnar Nerve Compression) – Numbness or tingling in the ring and pinky fingers, caused by prolonged compression of the ulnar nerve at the wrist.

• Carpal Tunnel Syndrome (Median Nerve Compression) – Numbness in the thumb, index, and middle fingers, often due to excessive wrist flexion and poor handlebar positioning.

Common Causes of Hand & Wrist Pain in Cyclists

🚴 Excessive Handlebar Pressure – Leaning too much weight on the hands causes prolonged nerve compression.
🚴 Incorrect Wrist Position – Keeping wrists in excessive flexion can aggravate nerve irritation.
🚴 Poor Grip Posture – Gripping too tightly or riding with bent wrists increases strain.
🚴 Inadequate Bike Fit – Handlebars positioned too low or too far forward force riders to support more weight with their hands.

How Physiotherapy Helps

✅ Nerve Gliding Exercises – Helps free trapped nerves, restoring sensation and reducing tingling.
✅ Strengthening & Grip Training – Improves wrist and forearm endurance to reduce fatigue.
✅ Manual Therapy & Soft Tissue Release – Releases tight forearm muscles contributing to nerve compression.
✅ Bike Fit Adjustments – Ensures handlebars and saddle are properly aligned to distribute weight evenly.
✅ Postural Education – Encourages proper hand positioning and grip relaxation to reduce strain.

🔹 Example: A cyclist experiencing numb fingers during long rides may benefit from nerve mobilisations, wrist strengthening exercises, and handlebar position modifications to reduce compression.

How to Prevent Cycling Injuries

While injuries are common in cycling, prevention is key. Here are some simple strategies to stay pain-free on the bike:

✅ Get a Professional Bike Fit – Ensure your saddle, handlebars, and cleats are properly adjusted to prevent strain.
✅ Incorporate Strength Training – Focus on core, glute, and leg strength to support your body on long rides.
✅ Warm Up & Cool Down – Dynamic stretches before riding and mobility work post-ride reduce tightness.
✅ Change Hand Positions Frequently – Avoid prolonged pressure by switching grip positions on long rides.
✅ Gradually Increase Training Load – Prevent overuse injuries by progressively increasing mileage and intensity.

Need Help Recovering from a Cycling Injury? We’ve Got You Covered.

At Rebound Health, our experienced physiotherapists and bike fitting specialists work with cyclists and triathletes to prevent and recover from injuries, improve biomechanics, and optimise performance.