• Dr. Melissa Corso

Cycling: The Roadmap to Pain and Injury

Updated: Jun 22

It's Like Riding a Bike

My dad is a cyclist. It was always his “thing” growing up in the South of France, and with those views, who can blame him? After 40 years of work, he finally decided to retire. And as any new retiree might do, he spends his days sleeping in and re-acquainting himself with his old hobbies. What is new is his commitment to improving his performance. The desire was always there before but the time wasn’t. When he came to me asking about various website recommendations on stretches and exercises that would help cyclists prevent pain, I finally saw the opportunity to give my father some advice he might actually take. (Have you ever tried to give your parents advice in your field of expertise? It’s basically a guarantee that they’ll do the opposite.)


Everyone has heard the expression “it’s like riding a bike”, when it comes to doing something you haven’t done in a long time. As if riding a bike is the simplest thing to do. And if you’ve ever tried a new workout routine and you’re generally not active, the recommendation is usually “try biking, it’s easier on your joints”. Because you’re not pounding on your feet like you do when you go for a jog. But these are things that are just said, and things we usually assume are true. Is riding a bike really simple? Can you just hop on and go for a ride, no problem? And if you start cycling, instead of jogging, are you guaranteed to avoid pain or injuries, because you aren’t pounding the pavement? Today’s article will try to answer these questions.

The Wheels on the Bike Go ‘Round and ‘Round

Actions like walking, running and cycling allow us to travel through the world at different speeds, repeating the same movement over and over again. Just like a machine, we want to make sure that the pieces and parts are well oiled and working at their best so they can keep working without any issues. Our bodies are the same, with the exception of our brain, that tries to make things easier and more efficient the more we do and practice things. These, let’s call them “updates” are meant to be helpful, adapting to the environment around us and what our body is capable of. And while these updates are usually helpful in the short-term, they aren’t always meant to be long-term solutions. Over time or with more repetition, they can lead to pain or injury. Just like you might have a quick fix on a part that isn’t working well, the more you use it, the sooner that quick fix will break down and lead to a potentially more severe problem.


Compared to walking or running, cycling is more constrained because your lower body is limited to the dimensions of the bike. So, when we consider pain or performance in cyclists, we need to think about external factors (factors outside of the cyclist), as well as the internal factors (factors inherent to the cyclist). External factors include the position of the seat (high/low, forward/back) and the type of pedal (platform/standard, toe clip or clipless). These will have an effect on your body position, the muscles that work and how hard they work – all of which will have a bearing on your risk of pain or injury. These factors will also influence how much power you can produce and your pedaling rate – which will impact how well you can ride. Internal factors include your fitness level and body alignment.

Different Strokes for Different Folks

When we talk about cycling, we need to consider the downstroke and the upstroke. When a cyclist is using standard pedals, they really only have access to the downstroke to produce power (pedal starts at the top and you push down), until the opposite side contributes with another downstroke. The advantage of toe clip or clipless pedals is the ability to produce power during the upstroke (pedal starts at the bottom and you pull up) as well. Both of these “strokes” allow you to use different muscles to contribute to power production.


The Downstroke

When using standard pedals, the downstroke is the main contributor to power production. During the downstroke, the knee extensor muscles (quads) are most active. Your calf and glute muscles will then start working pulling the leg back and allowing for recovery. Then the hamstrings and calf muscles work to bend the knee, bringing the leg back to the top position, ready for another powerful downstroke.


The Upstroke

When using toe clip or clipless pedals, the upstroke can also be used for positive power production. When this is the case, there is greater use of the rectus femoris (one of the quad muscles), hamstrings and shin muscles. If you are using standard pedals, the upstroke is pretty passive, meaning it happens as a result of the opposite side producing a downstroke, and there is little muscle activity contributing to the upstroke motion (other than just moving your leg to follow along).

Cycling: A Pain in the Butt?

Ever decided to take up cycling? If you have, you know it’s literally a pain in the butt. But what about actual pain and injuries that can happen? I’m a research person. So, when I have a question, I look to see what has been published in peer-reviewed literature to help answer it. Unfortunately, there isn’t a ton of research looking at common injuries in cyclists. If I were to talk to my parents, the main complaints I hear are knee pain (from my dad) and neck pain (from my mom – a relatively new road cyclist). Turns out they aren’t far from the norm, based on what research there is. The most frequent injury locations are the knee, neck, shoulder and low back. These injuries tend to be related to the muscle and overuse (versus traumatic).


Dad always says that the reason his one knee hurts, and not the other, is because the alignment of his one leg is “off”. His foot turns out more on that side, so when he clips his shoes in, it forces his leg in a position it doesn’t want to go in naturally. Mom says it’s the position of her head and neck during the long rides; to keep looking up when she is leaning forward on the handles of her road bike. Both of these things make logical sense to us. Some other factors that are thought to contribute to pain in cyclists include improper bike fit, unsound training, poor biomechanics (what dad is saying) and poor flexibility and/or strength (what mom is saying). 


When there isn’t research to tell you exactly what you want to know (like what leads to pain and injury in cyclists), that is when the understanding of basic science, biology and biomechanics comes in handy (thank you 12 years of school).


Bike Fit

The research out there is kind of here nor there with regards to the effect of bike fit. But again, it’s one of those logical things that make sense to us. Some research suggests that with a higher saddle height, there is more force across the front of the knee which can lead to knee pain around the knee cap. When the height of your saddle changes you completely change the orientation of your body in order to use the bike. Our muscles actually have ideal positions where they are more efficient and are able to produce force more effectively. When we change the position of our body, we are also changing the positions of these muscles. When we put our muscles in less optimal positions it requires them to work harder in a certain situation. So, let’s say you’re riding along and your bike fits you perfectly, your muscles only have to work at 50%. If you move your seat up or down into a less ideal position, your muscles may have to work at 60%. No, it doesn’t seem like a big difference. But don’t forget that you’re pedaling over and over and over again. And over time, that 10% difference adds up, and can lead to earlier fatigue. That can definitely have an impact on both pain and performance.


Let's Get Physical

When we talk about unsound training, poor biomechanics, flexibility or strength, we are talking about all the physical factors that may contribute to pain or injury. This is my wheelhouse.


Unsound training really means doing too much too fast. We have all been there… you start a new activity or exercise, and because you are super motivated on day 1, you decide to go all out. And then… you can’t walk for a week. When starting any new exercise, it is important to start low and increase incrementally, allowing your body to adapt, get stronger, and build stronger tissues. If you increase your mileage too fast, and don’t give yourself enough time to recover, your body doesn’t have enough time to make the muscles and tendons strong between rides. (Hint: recovery from a ride or workout doesn’t just come down to time, you should also consider other recovery strategies such as appropriate sleep and nutrition)


When it comes to cycling, most people recommend it because you aren’t weight-bearing, like you are when walking or running. People assume that because of this, you aren’t stressing your body as much, which in some ways is true. You aren’t putting your full body weight or more through each leg as you walk or run, however, strain can occur across a joint from the use of muscles. At higher intensities (when you produce more power), the strain across the knee cap (patellofemoral joint) can be similar to walking, jogging or stair-climbing. So, if you are considering cycling because of the lower strain on your joints, make sure to find out which joints are the problem and start at lower intensities, which produces less strain across joints.


The other thing to consider is the strength of the necessary muscles (the quads, calves and glutes). Because cycling is a very repetitive exercise, small imbalances or weaknesses across a joint get amplified with the number of times the action is repeated. These forces are generally controlled by the surrounding muscles, so it’s important to make sure the muscles are strong enough to support the joints equally. Muscles are the main stabilizers of a joint, not only do they work to move our bodies in space, they also reduce the forces that go through our bones and joints. If there are imbalances or weaknesses, it can cause abnormal movements or stresses across the joint, which might eventually lead to pain. Sure, a few times of abnormal movement might not result in anything bad, but do it 100 times, then you’ll feel it! This is true for pain in the front of the knee, a condition known as patellofemoral pain syndrome, as well as the outside of the knee, a condition called IT band syndrome.


What I’m essentially describing there is what dad says about his knee. “My foot turns out, so when I clip it into my bike, it forces my leg to turn in.” When your leg turns in, the forces across the knee (and likely hip and back) change too. These are the abnormal movements and stresses across the joint. This would be considered poor biomechanics, the abnormal function of the machine. Like I said before, do this a few times and it may not matter, but it’s the repetition that will hurt you in the end. Things that you can consider here is the alignment of the body, and how the constraint of the bike and clips may force you to adapt in a way that places abnormal stress on the joints, or causes your muscles to work in ways they aren’t used to or in a less optimal position.


Poor flexibility is related to this because it just adds an additional constraint to your body. Let’s say you can’t bend your knee all the way, or get your hip up to 90 degrees. These are movements that are required to ride a bike. Like I mentioned before, your body is smart, in the short term, it will find a way to ride a bike without those movements, or within the constraints that your body has to ride a bike. In the long-term, this will place additional stress on other joints or muscles, that are working to do a movement they aren’t supposed to do. This will lead to repetitive strain on the joints, which can be painful, or fatigue of the muscles, which also usually results in pain.

So, What Do I Do?

Firstly, I want to remind you that this information is in no way meant to replace an assessment by a regulated health professional. This is a reflection of published peer-reviewed literature and application of this information to potential clinical situations. If any of this resonates with you and you want to know how some of these components may impact your cycling, pain or injury, I highly encourage you to seek professional assessment and advice.


Secondly, we are all different. This is the first thing I tell dad when he sends me links to websites with “stretches for cyclists” or “exercises for cyclists to prevent injury”. Sure, you can spend the time to do the recommended stretches and exercises, but you can’t know for sure whether they are helpful to you in any way unless you know where your deficits are. Same as when you hear your car make a funny sound, it could be a bunch of things… you won’t know what the problem is until you get a mechanic to look at it.


If biomechanics are a concern, definitely follow-up with a healthcare professional who can assess your function, range of motion and coordination.


With those disclaimers out of the way, here are some things to consider:

  1. Getting a professional to fit your bike properly.

  2. Start slow and incrementally increase your volume or intensity (the rule of thumb is about 10% increase of volume or intensity per week).

  3. Start a complementary strengthening program that targets main muscles involved in cycling.

  4. I said it before, I’ll say it again. Get assessed and get recommendations that are specific to you and your weaknesses.

  5. If you want to get started on your own first, focus on stretching and strengthening the main muscles involved in cycling.

Give these a try and let me know how it goes! Questions, comments, concerns?

Send me a message!


Hold stretches for 1-2 minutes.

References

  1. Blake OM, Champoux Y, Wakeling JM. Muscle coordination patterns for efficient cycling. Med Sci Sports Exerc. 2012;44(5):926-938.

  2. Dahlquist M, Leisz MC, Finkelstein M. The club-level road cyclist: Injury, pain, and performance. Clin J Sport Med. 2015;25(2):88-94.

  3. Hug F, Dorel S. Electromyographic analysis of pedaling: A review. J Electromyogr Kinesiol. 2009;19(2):182-198.

  4. Johnston TE, Baskins TA, Koppel R V, Oliver SA, Stieber DJ, Hoglund LT. The influence of extrinsic factors on knee biomechanics during cycling: A systematic review of the literature. 2017;12(7):1023-1033.

  5. De Marchis C, Schmid M, Bibbo D, Bernabucci I, Conforto S. Inter-individual variability of forces and modular muscle coordination in cycling: A study on untrained subjects. Hum Mov Sci. 2013;32(6):1480-1494.

About The Author

Dr. Melissa Corso has an undergraduate degree in biomedical sciences and a Masters degree in human health and nutritional sciences from the University of Guelph and was a former Varsity soccer player. She graduated from the Canadian Memorial Chiropractic College (CMCC) in 2016 and completed the Sports Science residency in 2018. In 2019 she became a fellow of the Royal College of Chiropractic Sports Sciences (Canada). Dr. Corso is in private practice at an inter-disciplinary clinic in Richmond Hill, Ontario and a research associate at the Centre for Disability Prevention and Rehabilitation at Ontario Tech and CMCC. In her spare time, she enjoys working out, playing soccer and reading.

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Dr. Melissa Corso BSc, MSc, DC, FRCCSS(C)

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