Biking Biomechanics And Injuries
As biking surges in popularity, one finds specific bike-related
injuries. The most common injuries are as follows: Road rash or
abrasion, head injuries, anterior knee pain, tendinitis, neck pain,
clavicle fracture, low back pain, saddle sores, and nerve
The focus of this article would be to describe biomechanical factors
that can lead to musculoskeletal problems as they relate to biking
ANTERIOR KNEE PAIN
Anterior knee pain is a common symptom of biking in all age groups.
Chondromalacia patella is a common problem that creates chronic
anterior knee pain in bicyclists. The most common cause of
chondromalacia patella is improper-fitting bicycle where the saddle
position may be too far forward or too low, or the cranks too long,
knock-kneed or leg-length discrepancy. Additionally, improper
positioning of the cleats, either being toe-in or toe-out may
predispose to malalignment of lower extremity resulting in anterior
Another cause of anterior knee pain results from strain of the
quadriceps muscle from using excessively large gear.
Treatment of anterior knee pain due to biomechanical causes should
assess one’s bicycle equipment and positioning. Raising or moving
the saddle back should be assessed to decrease the knee angle at
maximal loads. Shorter crank can decrease the leverage and result in
less force on the knee. Adjusting the cleat position positions into
neutral position reduces sideways force. Orthotics can also help
avoid leg length discrepancies or excessive pronation or supination.
Tendinitis is defined as inflammation of the tendon. In bicycling,
the most susceptible area is in the knee with inflammation commonly
occurring within the patella, quadriceps tendon, hamstrings tendon,
iliotibial band, tibialis anterior muscle, Achilles tendon, or the
pes anserine bursa.
Improper bike fitting, pedaling mechanics, or muscle pathology may
result in improper biomechanics that also lead to tendinitis.
Assessment of improper bike fitting should be evaluated for saddle
positions being either too high, too far back, too low, or too
forward. Additionally, one should assess the position of the shoes
as well as the cleats ensuring that they remain in the neutral
Neck pain was frequently reported by cyclists in the area of the
base of the neck and in the area of the base of the skull. The most
common causes of neck pain were found to be due to improper neck
postures, improper bike fitting, underlying muscle or joint
pathology, as well as inadequate conditioning and training.
Common problems of improper fitting bicycles found that the
handlebars may have been too low, the stems too long, or too forward
of a tilted seat saddle.
LOW BACK PAIN
Cyclists frequently experience low back pain that were result of
poor posture, improper-fitting bicycle, poor training technique, as
well as underlining muscle and joint pathology.
Improper bike fitting may result in low back pain if the saddle
position is too low or tilted forward, the stem being too long or
the handlebars being too low.
The cyclist’s musculoskeletal system should also be evaluated for
muscular tightness, specifically the hip flexors and hamstrings.
Cyclists should regularly undergo stretching of the iliopsoas and
hamstrings on a regular basis as well as performing the stretch in
the post-ride routine. Core-stability exercises targeting the
abdominal, back extensors, or hips would also be recommended.
In regards to correct imperfections in problems of fitting, one
should focus on these aspects: The saddle should be leveled and the
stem should be adjusted to avoid long or low reach to the
The most common nerve compression in cycling involves the ulnar and
median nerves of the hand. Ulnar nerve compression results in
numbness of the ring and fourth finger, whereas the median nerve
compressions commonly are called carpal tunnel syndrome with
numbness in the finger, index, middle, and half of the ring finger.
Nerve compression can be caused from poor-fitting bicycles as well
as poor training techniques.
Improper bike fitting may cause nerve compression when the seat is
too forward, tilted as there will be an excessive need for forward
reaching resulting in improper positioning of the handlebars and
Improper biking techniques such as riding on rough ground or
over-gripping the bars may also create compression of the wrist
compartment affecting the median nerve.
Saddle sores are pressure areas of the buttocks and the groin, which
are common sites of pressure-sore development. During riding, heat
and moistness creates an ideal bacterial environment for growth
resulting in underlying skin infections.
Improper fitting of the saddle height, tilt, and type is a critical
element for reducing focal pressure areas. Wearing clean shorts and
utilizing appropriate padding in bicyclists reduces friction and
helps prevent secondary saddle sores and infections.
Other injuries in biking include head injuries and clavicle
fractures. Head injuries are most common cause of death and serious
injury in bicycling. Highway Safety Insurance Institute survey shows
that 95% of the bicyclists that were killed were not wearing
Most common fractures in a bicycle crash are the clavicle or the
collarbone. This bone is usually fractured when the bicyclist falls
with outstretched arms trying to break the fall. Healing is
approximately six weeks since surgeries are rarely indicated. During
the time of recovery, bicycling should be avoided; however, one can
maintain conditioning by riding a stationary bicycle during the six
weeks of healing time.
Taras V. Kochno, M.D.
Board Certified in Physical Medicine & Rehabilitation