Sports Medicine and Rehabilitation Bradenton FL & Parrish FL - Sports Medicine physician Florida USA

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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 compression.


The focus of this article would be to describe biomechanical factors that can lead to musculoskeletal problems as they relate to biking or cycling.




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 knee pain.


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 position.





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.




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 handlebars.




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 brake handle.


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 helmets.


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






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