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Preventing Common Bike Injuries

In this article, orthopedic surgeons review the most common causes of bike injuries to the lower extremities (legs). Proper bicycle design, size, and seat position are described. Training and technique needed to prevent injuries are also outlined.

The knee is the site of most bicycling injuries caused by overuse. Knee pain caused by patellofemoral syndrome (PFS) is also referred to as cyclist's knee. Pain of this type occurs along the bottom edge and underneath the patella (kneecap).

Pressure from the patella against the bone underneath is the most common cause of PFS. Hill climbing, riding in high gears, and a cadence that's too slow are some of the risk factors for this type of compression on the joint cartilage. Over time, shear and load cause damage to the cartilage behind the knee. This condition is called chondromalacia.

Other knee injuries include hip bursitis, patellar tendinitis, quadriceps tendinitis, or iliotibial band syndrome (ITBS). The ITB is a band of thick fibrous connective tissue. It begins at the pelvic crest and then crosses the hip and knee to its insertion point on the tibia (lower leg).

Injuries of the lower leg can also occur. Achilles tendinitis, compartment syndrome, and metatarsalgia are the most commonly reported lower leg injuries.

Compartment syndrome is a build-up of pressure inside the soft tissues in the front of the lower leg or in the calf. Metatarsalgia is pain across the ball of the foot. It is caused by repeated load during pedaling.

Many injuries occur as a result of malalignment of the patient's anatomy. But bicycle seat height, training intensity, poor foot position, and rigid shoes can contribute to these problems. Of course, unexpected trauma is another potential cause of cycling injuries.

The authors suggest it is possible to prevent predictable injuries due to repetitive motion. Each competitive cyclist should be evaluated for proper bicycle fit and alignment. Using the correct pedals and with proper technique is equally important. Rider position and the right training program can also help avoid injuries.

When nontraumatic injuries do occur, conservative care with rest and physical therapy are the first forms of treatment. Most repetitive, load, postural, and equipment-related injuries can be avoided or at least treated successfully without surgery.

References: Tony Wanich, MD, et al. Cycling Injuries of the Lower Extremity. In Journal of the American Academy of Orthopaedic Surgeons. December 2007. Vol. 15. No. 12. Pp. 748-756.

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