The cycling injuries we see most, and how bike set-up causes them

Cycling has few of the impacts that make running hard on the body, which is why it is recommended to so many people recovering from something else. What it has instead is repetition. You will turn the pedals somewhere near five thousand times in a two hour ride, always through the same small arc, always in the same position. Anything slightly wrong in that position gets repeated five thousand times too.

That is why cycling injuries behave differently from the ones we see in field sports. They rarely announce themselves. They creep in over weeks, feel manageable for a while, and then stop you riding.

Pain at the front of the knee

The most common complaint by a distance. It usually builds gradually, hurts most on climbs or into a headwind, and eases when you spin an easier gear.

Saddle height is the first thing to look at. Too low and the knee never straightens enough, so the front of the joint takes load through a compressed range for hour after hour. Saddle position too far forward does something similar. Cleat position matters as well, since a foot held at an angle its ankle and knee do not want will pass that rotation up the leg.

Training load is the other half. A sudden jump in hours, a move to bigger gears or a winter spent grinding uphill at low cadence will all provoke it. If changing the position does not settle it within a few weeks, it is worth having the knee assessed properly rather than continuing to adjust the bike.

Lower back pain after an hour

Usually a combination of reach and hip mobility. A position that is long and low looks fast and asks for a good deal of movement at the hips. If the hips do not give it, the lower back makes up the difference, and it does so every pedal stroke.

The answer is rarely just to raise the bars, though that often helps. Working on hip mobility and on trunk strength changes what your body can tolerate, which is more useful in the long run than making the bike easier. Our article on winter training covers where that work fits in the year.

If the pain travels down a leg, goes with pins and needles, or is present off the bike as well, that is a different problem and worth an assessment rather than a position change. Lower back pain of that kind is common and treatable, but not by moving a saddle.

Numb or tingling hands

Weight through the handlebars compresses nerves at the wrist and in the palm. Riders describe it as fingers going to sleep, usually the outer two or the thumb side, and it typically comes on after an hour and clears within minutes of stopping.

More often than not, too much body weight is being carried through the arms, which points back to reach, saddle tilt or core endurance. Padded gloves, wider bar tape and changing hand position regularly all help. Numbness that persists after the ride, or that appears off the bike as well, deserves an opinion, since carpal tunnel syndrome and nerve irritation at the neck can both present this way.

Neck and shoulder ache

The position asks you to hold your head up while your torso is tipped forwards, and the muscles at the base of the neck do that work continuously. Long rides in a low position, a helmet that sits heavily, or simply riding more than your neck is conditioned for will all produce it.

Raising the front end helps. So does looking up regularly rather than staring at your front wheel, and so does strengthening the neck and upper back off the bike. Persistent neck pain, particularly with headaches, is worth treating rather than tolerating.

What is worth doing about it

Most of these settle with a position change and a sensible training load, and much of that you can do yourself. What justifies an appointment is a problem that has not responded to the obvious changes, one that recurs every season, or one that is stopping you riding at all.

An assessment looks at the injury, at how you move off the bike, and at your position on it, because in cycling those three are rarely separable. Sports injury assessment and treatment and biomechanical assessment and gait analysis are the services involved. Bring the bike details you know, and if your shoes and cleats are part of the story, bring those too.