Although there have been increased efforts to improve road safety in the UK, cyclists remain one of the most vulnerable groups on the road. Department for Transport (DfT) data reveals, 91 fatalities concerning cyclists in 2022, alongside over 4,000 ‘serious injuries’ and 11,546 ‘slight injuries’.
The number of cyclists on the road has also increased, with the majority of accidents occurring during peak hours from Monday to Friday, (7am-1pm and 4pm-7pm) or mid-morning (10am-12pm) during the weekend.
The most common cycling injuries in the UK remain wide-ranging, from everyday strains, sprains, and muscle pains to more serious injuries resulting from an accident or a collision.
Top Five Factors Contributing to a Fatal or Serious Collision with a Cyclist
Let’s delve into some of the most common cycling mishaps, plus the steps to mitigate future injuries and how a bespoke Bike Fit at Pure Sports Medicine can make sure that both you, and your bike are fit for the road ahead.
Head, neck, and shoulder injuries #
Whether riding on city roads or in rural areas, head, neck and shoulder injuries remain one of the most common risks for cyclists, with many cycling injuries resulting from poor bike posture:
- Are you reaching forward on your bike excessively? Cyclists craning to view the road ahead with the neck hyperextended, will start to notice a dull ache in the base of the skull and neck. If exacerbated, the upper body will also be placed under strain, effecting the tendons in the shoulder blades.
- Placing too much weight on your handlebars? Leaning your bodyweight on the arms, hands and wrists can lead discomfort in these areas as well as the back, neck and shoulders.
“We are starting to see a lot more cycling clients present with neck and shoulder pain, which could be due to the fact that some bikes now have more of an integrated stem/handlebar and possibly less ability to modify the reach from the front end,” commented Physiotherapist, Sam Sieguien.
To mitigate the risk of future injury, an experienced Physiotherapist can help strengthen the head, neck and shoulders, while an Osteopath can help to realign the spine to improve mobility and alleviate pain in the joints.
Upper and lower back pain #
Upper and lower back pain are a common complaint for both amateur and experienced cyclists. While there is not sole cause, common cycling back injuries often result from:
- Improper bike fit
- Poor posture
- A low level of physical fitness
- Lack of mobility, impacting the affected muscles
- Past injuries, such as a slipped disc or trapped nerve (sciatica)
- Chronic conditions, such as arthritis or osteoarthritis.
While upper back pain can feel like an aching or radiating pain across the shoulders and neck, lower back pain is usually felt in the lower torso and lumbar region. Adopting the correct posture and ensuring your bike it set up for your body is paramount for a pain-free ride.
Receiving a proper bike fit will provide an additional layer of support, while customised Back Pain Programmes can help to strengthen the muscles in the back and shoulders to improve mobility.
Arm, hand, and wrist injuries #
Cyclists can place their hands in a range of positions during a ride. This includes the top of the handlebars or dropbars, squeezing the top of the brake hoods, or positioning the hands at the hooks or ramps to maintain stability. However, when putting the feet into the cleats or pedals to power a bike uphill, or standing upright, increased pressure is placed in the hands and wrists.
“Since the start of 2024, most injuries to cyclists can be put down to ill-fitting bikes or cleats that have been set up inappropriately for their unique proportions. These are often new bikes, or bikes not used over the winter,” explained Sam.
“For new or intermittent riders with ill-fitted bikes, the ride can result in a mixture of pins and needles into hands alongside knee pain whilst riding, and even subsequent neck and lower back pain, particularly after longer rides.”
Common conditions for cyclists include the following:
- Handlebar palsy (cyclists’ palsy): increased pressure through the hands can result in compression of the ulnar nerve, resulting in numbness and tingling.
- Carpal tunnel syndrome: increased weight on the hands can compress the median nerve at the wrist, causing weakness in the hands and fingers.
To counteract this, cyclists should vary their grip positions throughout their ride, bring their seat forward, and keep their forearms relaxed and elbows slightly bent. Wrists should also be kept in a neutral position to reduce pressure within the hands and wrists.
For injuries affecting the hands and wrists, such as strains, fractures, torn ligaments or tendons, visiting a Hand and Wrist specialist is recommended.
Knee and leg pain
#
A healthy knee joint is essential in gaining significant momentum on the road or trail.
When sitting on the bike, cyclists should measure the angle of their knee extension when the leg is at its straightest point. The ideal range is between 25 – 30 degrees to reduce risk of injury.
Cycling over a long period of time will place increased pressure on the muscles surrounding the knee joint and can result in a knee and lower leg injury.
Common knee and leg injuries from cycling include:
- Cyclists knee (patellofemoral pain syndrome): pain at the front of the kneecap (known as the anterior) is often caused from a sudden increase in your physical activity or overtraining
- Patellar tendinopathy: pain located below the kneecap; patellar tendinopathy can result from overuse of the surrounding tendons
- Iliotibial band syndrome: commonly known as ‘runners’ knee’, the iliotibial band is a large band of tissue located on the outer thigh and runs across the thighbone (femur) and down towards the shinbone (tibia). As the leg extends to facilitate movement, pain can radiate through the leg, resulting in inflammation.
Although leg and knee pain from cycling can often go away on its own, if reoccurring, it is vital to receive treatment.
Physiotherapy and Soft Tissue Therapy can help to restore affected muscles, tendons and ligaments, with recovery taking approximately 6 – 8 weeks.
Further support can include taping, which can offer effective pain relief. This can be complemented by strength and conditioning training to support recovery of the glutes, quads and hamstrings.
For more specialised care, bespoke knee pain programmes can also offer a tailored service that meets your specific needs and requirements.
Ankle and feet pain #
From ill-fitting shoes, poor bike posture or increasing your cycling range too soon, there are several common ankle and foot injuries resulting from placing significant stress on muscles and tendons. This can result in numbness, tingling, swelling and inflammation. Common concerns include:
- Hot feet: riding over an extended period may cause swelling of the feet as they get ‘hot’ in cycling shoes. Pressing down on the cleats, combined with nerve compression in the feet, can result in numbness, a tingling or a burning sensation at the ball of the feet
- Achilles tendonitis: the large tendon which runs down the back of the leg, linking to the calf muscle and down towards the ankles, the Achilles tendon can become inflamed due to overuse, as well as poor bike posture. Cyclists may experience an aching in the back of the leg, stiffness, or ongoing pain that won’t go away. Without regular stretching, cyclists could be at increased risk of an Achilles tendon rupture
- Plantar fasciitis: affecting the plantar fascia ligament, which connects to the Achilles tendon and the underside of the foot, plantar fasciitis can result in a sharp pain at the arch of the feet, and can result from overtraining, poor choice of footwear, poor bike positioning or tightness across the ankles and feet
- Tarsal tunnel syndrome: affecting the tibial nerve which runs down the back of the leg and into the feet, the tibial nerve also connects to the sciatic nerve down towards the ankle and through the tarsal tunnel inside the ankle. Increased pressure over an extended period can result in pins and needles, tingling, or ongoing pain.
- Metatarsalgia: cyclists may end up with shooting pain or inflammation at the ball of the foot due to wearing ill-fitting shoes or muscle overuse. The pain is located under the five metatarsal heads, the long bones in the mid-section of the feet that connect to your toes.
If you are experiencing ankle or feet pain, a podiatrist can provide a comprehensive assessment and diagnosis, and develop a personalised management strategy to ensure that you can keep cycling without pain.
Hip and pelvic pain #
Cyclists will need to ensure sufficient hip rotation to engage core muscles, distribute weight evenly and fully utilise larger muscle groups throughout their ride.
For both beginner and experienced cyclists, poor bike posture, an uncomfortable saddle or being fixed in one position can all contribute to sore buttocks after riding a bike, or lead to increased pressure in the glutes, hamstrings, hip flexors and genital nerves.
To ensure a comfortable seated position, the UCI have advised for the peak of a saddle to be a minimum of 5cm, while the length can range from 24cm-30cm, with a 5mm tolerance. Angling the saddle at 0 – 4 degrees, rather than having a flat saddle, can also provide further relief, but this will be dependent on the individual.
Common cycling injuries concerning the hip and pelvis include:
- Hip impingement: affecting the hip flexor muscles that support the hips and knees, an impingement of the hip can lead to pain in the hip joint and groin, whereas weak hip joints can result in lower back pain.
- Tight hamstrings: the hamstrings and quadriceps are used when pedalling, but tired or underactive glute muscles can result in hamstring injuries as they work twice as hard to help maintain momentum.
- Pudendal neuralgia: the compression of the pudendal nerve could result in pudendal neuralgia in cyclists, which can lead to severe, sharp pain or genital numbness.
- Piriformis syndrome: weak glute muscles and tired hip adductors can result in pressure on the piriformis muscle, which helps to mobilise the hip joint. However, this will result in irritation of the sciatic nerve, leading to pins and needs down the back of the leg, or pain in the groin and buttocks.
- Hip bursitis: hip bursas are fluid filled sacs that are situated at the side of the hip become inflamed due to competitive cycling, leading to groin pain.
- Saddle sores: riding for an extended period can often result in added sweat and friction which can result in saddle sores causing discomfort where your body comes into contact with the saddle. Saddle sores will look like a sore or pimple and will likely be an infected hair follicle or boil. While a small sore will heal without treatment, a boil will require treatment from a health professional.
To counteract this, a Bike Fitter can check your positioning and overall posture as you ride, as well as the overall mechanics to ensure your bike is fit for purpose.
Preventative measures #
To reduce the risk of injury when cycling, there are several preventative management strategies that can be adopted, or support your rehabilitation.
Improve your mobility #
To maintain a strong body and mitigate the risk of injury, cyclists should focus on exercises that enhance your core mobility. This includes exercises such as yoga for injury prevention and recovery, as well as Pilates to improve balance, coordination and posture.
Through a range of stretching exercises, cyclists can reduce stiffness, improve the strength of the glute muscles, mobilise the joints and mitigate risk of injury.
Additionally, Strength and Conditioning should also be incorporated into your routine to help improve your range of motion.
Attend Soft Tissue Therapy #
Cyclists should regularly attend Soft Tissue Therapy to support the musculoskeletal system, alleviate general aches and pains, and offer effective rehabilitation to ensure you can get back to doing what you love.
Additionally, Platelet-Rich Plasma injections (PRP) can aid in repairing injured muscles and soft tissues.
Arrange a Bike Fit Assessment #
A Bike Fit Assessment is an essential part of getting prepared for any type of cycling and will help you to get the most out of your ride.
At Pure Sports Medicine, our team of experienced Bike Fitters can examine your current bike setup, the height of your frame, stem, saddle position and cleat placement to ensure optimal positioning.
A Bike Fitting can help to identify issues that might cause pain and negatively affect the muscles, tendons, ligaments, and soft tissues.
Our experienced team can also adjust the position of your handlebars to reduce the need to overreach, sit too upright, or place excessive weight forwards, reducing the impact on your hands and wrists.
Whether you are looking to get the most of your bike, improve your performance or speed or mitigate future injury, our experts can examine your cycling technique, help to identify any aches or pains that you may be experiencing, and help you to reach your long-term goals.
Book a Bike Fitting
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