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Cycling Injuries and the Benefits of a Bike Fit - A Physiotherapist's perspective

Cycling Injuries and the Benefits of a Bike Fit - A Physiotherapist's perspective

Cycling Injuries and the Benefits of a Bike Fit – A physiotherapist’s perspective

Toni Keech- August 2014

Thanks to the success of British cyclists over the past 10 years there has been a positive increase in cycling participation. As cycling grows as a sport, cycling injury incidence has also risen accordingly. From a Physiotherapist’s point of view, this has led to an increased importance of understanding optimal cycling positions, how the body interacts with the bike, training principles and the effective management of cycling related injuries.

My personal interest in the physiotherapy management of cycling injuries has developed since attending a course in 2012 directed by Dr Michael Callaghan who has worked within British Cycling over the past 20 years. With detailed knowledge gained from the course and reviewing the extensive literature available on the subject in addition to the hands on experience from treating numerous cyclists over the past four and a half years at Physiokinetic, I have devised a ‘Bike Fit’ service.  It is designed to eliminate cycling injuries associated with the bike, prevent injury (especially if buying a new bike) and may well have some performance benefits through optomised positioning.

Bikes have a complex anatomy and there are several possibilities for a bike set up. You may have done some research online or received some advice when you bought your bike but this advice does not consider one very important factor- YOU! Your own personal anatomy, flexibility and strength, previous injury history, training goals and type of bike will affect your optimal position which is not the same for everyone. Every single bike fit can be treated as a puzzle to be solved, focusing on the specific needs of the individual rider.

The physical assessment section of the bike fit is important in identifying any biomechanical problems that may affect your cycling and as a Physiotherapist I have experience in assessing these areas. As well as making adjustments to the bike as required following static and dynamic cycling analysis, I will advise on how to optimise your personal biomechanics to help prevent cycling related pain, overuse injuries developing and enhance your cycling performance.

A large percentage of the injuries that I treat amongst cyclists fall in the overuse category. There is a broad spectrum of contributing factors which can lead to these injuries. Although cycling is considered a knee sparing exercise because it does not require impact with the ground, the repetitive technique of cycling can lead to a variety of overuse injuries. In one hour of cycling, there can be over 5000 pedal revolutions. Repeated activity fatigues specific structures, such as tendon or bone and without adequate recovery, cumulative micro-trauma will stimulate an inflammatory response and subsequent symptoms can develop. In chronic cases, continued activity produces degenerative changes that lead to weakness, reduced range of movement and chronic pain.

Research suggests that the most common sites of overuse injury are the knee, lower back, perineum, hand and foot. The knee has been reported as the most common site for overuse injuries (Silberman, 2012) affecting an estimated 40-60% of all regular and elite cyclists (Wanich et al, 2007). Overuse injuries classically occur when an athlete changes intensity or duration of training, often early in the cycling season. In one recreational long distance bicycling tour, 65% of all riders reported knee pain (Dannenberg et al, 1996). Another study of more than 500 recreational cyclists indicated that almost 42% of all riders experienced overuse knee pain (Wilber et al, 1995).

Sanner et al, 2000 found patello-femoral pain syndrome to be the most common overuse knee problem in cyclists, shortly followed by ITB syndrome and patellar tendinosis. Excessive pressure across the patello-femoral joint is caused by cycling in high gears, hill climbing and too slow a cadence. Causes of abnormal tracking include improper saddle height, saddle position and problems at the shoe/pedal interface (Bini et al,2011). This includes pronation and improper foot position. Even slight inaccuracies can drastically change a cyclist’s biomechanics.

Inflexibility of the quadriceps, hamstrings or ITB may restrict range of movement around the knee and are likely to increase the forces on the knee. Weakness in the leg muscles may lead to fatigue-induced alterations of pedalling technique which will also alter forces on the knee. Leg length discrepancies can also be a contributing factor.  All of these factors and more are assessed within the Physiokinetic Bike Fit to minimise your injury risk and offload any current symptoms.

The key principles in the successful management of cycling injuries rely on establishing an anatomical and pathological diagnosis of the injury initially. Secondly, identifying the underlying intrinsic and extrinsic risk factors associated with the injury. Treatment generally consists of two phases, treatment of the symptoms and correction of the underlying cause.

Cycling injuries are a broad and fascinating speciality within Physiotherapy and I am looking to continue to develop my own knowledge base in this field. I will be attending the two day Retul Cycling Specific Injury Management Workshop course in October 2014 at the home of British Cycling in Manchester. Run by ‘some of the world’s best minds in cycling science’ I hope to fine tune my bike fit data collection precision and mechanical correction skills to alleviate injury. I look forward to letting you know how I get on!


Bini, R., Hume, P., & Croft, J. (2011) Effects of bicycle saddle height on knee injury risk and cycling performance, Sports Medicine, 41(6)463-476

Dannnberg, A., Needle, S., Mullady, D. (1996) Predictors of injury among 1638 riders in a recreational long distance bicycle tour: Cycle Across Mryland. Am J Sports Med. 24 (6): 747-753

Sanner, WH., & O’Halloran, WD. (2000) The biomechanics, etiology, and treatment of cycling injuries, Journal of the American Podiatric Medical Association, 90(7):354-376

Silberman, MR. (2012) Bicycling injuries, Current Sports Medicine Reports, 12(5):337-345

Wanich, T., Hodgkins, C., Columbier, J.A., et al., (2007) Cycling injuries of the lower extremity, Journal of the American Academy of Orthopaedic Surgeons, 15:748-756

Wilber, C., Holland, G., Madison, R. (1995) An epidemiological analysis of overuse injuries amongst recreational cyclists. Int J Sports Medicine. 16(3):201-206


Testimonial from Martyn Riesner- Summer 2013

Toni spent nearly two hours with me on Wednesday analysing my position and posture on the bike. The session began with Toni chatting through what exactly I do on the bike. This may sound trivial, but a cyclist comes in many forms: commuter, mountain biker, road racer, triathlete…..  The bike I had come along with is used for Sportives and triathlons. 

Toni asked about any previous injuries and any current discomforts I was feeling whilst riding. I know that bike fits can be done in many different ways, with people from different backgrounds. A physio though, offers a unique perspective on the bike fit: thinking beyond comfort. 

Once on the bike, Toni immediately pointed out some obvious issues in my positioning. She began measuring and marking me: noting down angles and lengths. She then explained that there are optimum measurements to work towards and we set about making adjustments. Looking in the mirrors I could immediately see that there massive improvements in my positioning taking place. I couldn't believe I hadn’t been able to do this before: believe me I have tried!

Once Toni was happy that we had achieved the best positioning possible, she set me off on the turbo recording my cycling on a camcorder. Watching this footage identified a small 'flick' in my right pedal stroke. Minor adjustment of the cleat later and the problem was sorted.

After leaving, I couldn’t resist a quick cycle session. Result: I felt more relaxed and powerful on the bike.


I've got a 150 mile ride coming up next month, so I will update you with the result. That will probably equate to around 8 hours plus in the saddle: a good test for my new positioning.

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TASS WCCC University of Birmingham Sport