Blog 1: Everything Cycling
Part 1: The Most Common Cycling Injuries and What Is Really Behind Them
Welcome to Everything Cycling!
Dr. Keirstyn dives into this five part series built for riders of every level and every discipline. Whether you are a recreational cyclist logging weekend kilometres, a competitive road rider chasing watts, or a triathlete putting in big bike blocks between swim and run sessions, this series is for you.
We are starting where it matters most: the injuries. Understanding what breaks down in cyclists and more importantly why is the foundation for everything that follows in this series.
1. Knee Pain: The Most Common Complaint in Cycling
Knee pain is by far the most frequent injury presentation I see in cyclists across every level and discipline. The repetitive nature of the pedal stroke means the knee is cycling through the same range of motion thousands of times per ride. When the mechanics of that motion are even slightly off, the cumulative load on the knee structures becomes significant very quickly.
The two most common knee presentations in cyclists:
Patellofemoral pain — pain around or behind the kneecap, typically worse on climbs, during seated sprints, or after long rides. In cyclists, this is almost always driven by a combination of quad dominance, weak hip stabilizers, and saddle height that is too low. When the saddle is too low, the knee is loaded at a high flexion angle through the entire pedal stroke, dramatically increasing the compressive force on the patellofemoral joint.
Patellar tendinopathy — pain at the tendon just below the kneecap, worst after hard efforts and during the first few pedal strokes of a ride before it warms up. More common in cyclists with high training volumes, those who have recently increased intensity, or those riding with excessive resistance at low cadence.
Warning signs worth taking seriously: knee pain that is present on every ride regardless of effort level, pain that is getting progressively worse across a training block, or any sharp pain during the pedal stroke rather than a dull ache afterward.
2. Lower Back Pain: The Sustained Posture Problem
Lower back pain in cyclists is one of the most predictable injury patterns I see. The cycling position places the lumbar spine in sustained flexion for hours at a time. The discs are under continuous compressive load. The hip flexors shorten progressively. And the glutes, which are supposed to be the primary movers of the pedal stroke, gradually switch off as fatigue accumulates.
The result is a lower back that is being asked to do the work the glutes and hips should be doing, in a position it was never designed to sustain under load for extended periods.
Lower back pain in cyclists tends to present as a dull ache that develops progressively through a long ride and lingers for hours or days afterward. It is often accompanied by hip flexor tightness and a noticeable reduction in hip extension range of motion. Triathletes are particularly vulnerable because the back is already loaded from the bike before the run even begins.
3. Neck and Shoulder Issues: The Price of the Riding Position
The riding position requires sustained cervical extension to keep the head up and the eyes on the road. Over the course of a long ride, the deep neck flexors fatigue, the upper trapezius overworks, and the cervical spine is loaded in extension under the weight of the head for hours at a time.
What I see clinically:
Cervical and upper thoracic stiffness that does not fully resolve between rides, progressively worsening across a training block
Upper trapezius trigger points and tension that refer into the neck, base of skull, and sometimes the shoulder
Shoulder impingement in cyclists who ride in an overly aggressive position with the shoulders rounded and internally rotated around the handlebars for extended periods
Numbness or tingling in the hands during rides, often from sustained weight bearing through the wrists and forearms in a compressed position
4. Hip Flexor and IT Band Problems: The Repetitive Flexion Injuries
The cycling pedal stroke is a repetitive hip flexion movement. The hip never reaches full extension during cycling the way it does during running or walking. This means the hip flexors are working in a shortened, contracted position for the entire duration of every ride. Over time this creates chronic shortening, trigger point development, and in some cases genuine tendinopathy at the hip flexor attachment.
The IT band becomes problematic in cyclists primarily through its connection to the TFL and the repetitive friction that occurs at the lateral knee when the IT band crosses the lateral femoral condyle with each pedal stroke. Cyclists with saddles that are too high, those with a significant leg length discrepancy, or those with hip instability from weak glutes are most susceptible to lateral knee and IT band irritation.
Up Next: Why the Bike Position Creates Such a Unique Injury Environment
You know what breaks down. Part 2 of Everything Cycling explains exactly why the demands of cycling create such a specific and predictable injury landscape, what the sustained posture on the bike does to the body over thousands of pedal strokes, and why the injuries you just read about are almost never about bad luck. See you there.
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If any of these injury patterns sound familiar, do not wait until they sideline you. I work with cyclists at every level at Endurance Therapeutics to find what is actually driving the problem and fix it properly. Reach out to book an assessment with Dr. Keirstyn today!
📍 Endurance Therapeutics | Oakville, Ontario
📞 905-288-7161