NCTV Episode 55

Continuing with the series of bitesize health tip videos which can be found here on my YouTube Channel, this episode, includes:-

  • Knee pain and how to prevent it
  • Back pain and how to prevent it
  • Neck pain and how to prevent it
  • Iliotibial band pain and how to prevent it
  • Achilles tendon pain and how to prevent it


If you’d prefer to read the content within, rather than watch the video, then feel free to read the transcript, as follows:-

Hello and welcome to NCTV Episode 55 which is all about common cycling injuries and how you can avoid them.

Unless you fall off, cycling is actually a sport blessed by its body friendliness! In fact, riding big miles is more likely to get you fit than fractured. But, like any endurance sport, cycling can produce a catalogue of niggling aches and pains, which if left untreated can become more serious. To give your pain a name and point you down the right road to recovery, we’ll cover the 5 most common cycling ailments, their most likely causes, and how to go about fixing them.

There are two main types of cycling injury, those caused by falling off (which we won’t cover here) and the issues caused by overtraining, like biomechanical stresses – often due to muscle imbalances, and incorrect bike set-up. It is particularly important for the sake of future injury prevention to identify the root cause and address this ASAP.

1) So first up we have knee pain and one of the most common cyclist knee complaints is pain in the kneecap. This is most likely to be patellofemoral pain syndrome (PFPS). This is often worse when walking up and down hills/stairs or sitting for long periods of time. It may include wasting of the quadriceps (or thigh) muscles if the injury is an old one, and tight muscles around the knee joint. PFPS occurs when the patella (kneecap) rubs on the femur (thigh) bone underneath. It is believed that incorrect tracking (gliding) of the patella over the femur is a significant factor and results in damage to the cartilage underneath the patella. The cause may be from external factors like an increase in training, the seat being too low or riding too long in big gears. Internal factors such as poor patella tracking may result from excessive pronation (flat foot), rotation of the lower leg and tight or weak muscles around the thigh and pelvis.

To help avoid this try varying your pedalling rate or cadence – breaking up your training by pedalling in a high cadence (90 – 120 revs per minute) can help prevent injury. Raising the seat if it’s too low will reduce the amount of knee bend and utilise more of the hamstring and gluteal (buttock) muscles thereby off-loading the quadriceps muscle and patellar tendon. Also, if your foot rocks from side to side, use an insert to stabilise the rear of your foot, thereby reducing strain on the knee and increasing your efficiency.

2) Next is Back Pain. After knees, the back is probably one of the biggest causes of pain for cyclists, with lack of flexibility and bad posture generally the cause. Hunching forward on your bike, and probably also at work, places strain on your spine, loading structures for prolonged periods of time. Cyclists’ back pain is often due to mechanical factors so a first port of call is to have your bike properly fitted to your body. After that’s all sorted then it’s good to look at your body itself to see where you need adjusting. Lack of flexibility, such as excessive hamstring and hip flexor tightness can contribute to lower back pain. Differences in leg length are also common mechanical problems leading to imbalances in the spine. Core strength is very important to avoid lower back pain and this comes from strengthening a collection of deep muscles both big and small that work together to give you lumbar and pelvic stability.

A few more tips:- lower back pain can arise in cyclists that push big gears, especially while climbing. The angle of your back in relation to the bike can increase or decrease the strain on your back so consider alternating climbing positions by standing up or changing the angle of your back, especially during long rides or climbs, or talk to your osteopath or physio for example about a back rehabilitation programme to focus on strengthening your aforementioned core muscles.

3) Neck Pain. Neck pain from cycling usually stems from poor posture and weak muscles. Pain caused by neck hyperextension is made worse by positional issues on the bike, combined with a lack of flexibility. Just as you have core stabilisers around your lower back, you have stabiliser muscles called deep neck flexors around your neck to hold your head up. When your neck stabilisers are weak or fatigue quickly it is left to the trapezius muscle (that goes from the base of your skull to the shoulders and upper back) to support your head as you lean forward. And when these ‘stand-in’ muscles fatigue you can experience pain in the back and sides of your neck. You can restore balance by keeping your neck muscles loose and relaxed through a routine of strengthening and stretching exercises.

Other tips. Change your posture on the bike. If you’re reaching too far forwards, or your handlebars are too low, shorten the stem to shorten your reach. Raise your bars and riding more upright will reduce the strain you’re putting on your back and neck. Don’t forget to change your hand positions at regular intervals too, and sit up on the bike to stretch, straightening out your neck and back to vary the loads on the different muscle groups.

4) Iliotibial Band Pain – While it is more commonly known as “runner’s knee”, ITB syndrome is another common cycling injury. ITB pain is typically associated with prolonged, repetitive activity. Symptoms include pain on the outside of the knee, tenderness and sometimes swelling. In some cases, pain is felt simply walking or going up and down stairs. You may also feel stiff or tight after periods of inactivity. The ITB is a tendinous band of connective tissue that originates on the pelvis and attaches to the outside of the knee. As your knee bends and straightens repeatedly, the band can become inflamed by rubbing the over bony protuberances at the knee. Other contributing factors may include tightness of thigh, hip and buttock muscles as well as weak pelvic stabilising muscles.

To help prevent this, ensure that your seat is at the optimal height for your body. If you over pronate (or are flat footed) you may need orthotics or a wedge inside your cycling shoe to stop the leg and knee rotating inwards putting further tension on the ITB. Tucking the knees in too tight, to increase streamline, will also add tension and greater friction to the ITB.

5) Achilles Tendon Pain. The Achilles tendon is the tendon at the back of the ankle, connecting the calf muscle to the heel. If your Achilles is sore during or after riding you may have Achilles tendinopathy. Inflammation, micro-tears or compromised blood flow from overuse, can often cause this and subsequently put a stop to your riding season. There are a whole host of stretching and strengthening exercises you can do help and again, these are best tailored to you by your osteopath, physio or other therapist of choice.

In terms of advice to help your Achilles, having your saddle too high means your toes will be pointing down too much causing constant contraction of the calf muscles (how’s that for alliteration) and load on the tendon. Therefore, lowering your seat and making sure that your cleats aren’t pushed all the way forward towards the toes will help to even out the pressure on the muscles you’re using to pedal.

So there are your 5 main cycling injuries. Remember that these are predominantly overuse injuries and they can be prevented. Think A–B–C. A is for ALIGNMENT issues to be addressed such as muscle weaknesses, flexibility, leg length discrepancies and being flat-footed. Then B is for BIKE set up which you’ll need to check to see that everything is at the correct height and position for you to enable correct technique and cycling posture. Finally, C is to CONDITION yourself with appropriate strengthening and stretching exercises. Remember to progress your training moderately and always, always listen to your body!

That’s it for this week’s bitesize bit to help your health flourish! Bye bye for now.