Cyclone: Festival of Cycling preparation, tips and advice.
June 25, 2018
The sport of road cycling in the UK has grown substantially the past 10 years. Whether cycling for leisure or competition, it is an easy way to carry out low-impact exercise, whilst keeping fit and healthy. The low-impact nature of road cycling makes is a great rehabilitation tool for lower limb strength, endurance, and stability. With that being said, due to the repetitive motion in the sport, clinically we often treat cycling-related lower limb overuse injuries.
Prevention of common lower limb overuse related road cycling injuries can seem quite daunting at first considering the ever-evolving equipment choices, advice, and technological advances; however, the core essentials continue to be relatively constant. In clinic, the most common lower limb overuse cycling injuries that we treat are located in the hip, knee, and Achilles tendon.
In this this blog, we will help you tackle the basics in prevention and rehabilitation of cycling-related overuse lower limb injuries and become injury free!
TIP #1 Sometimes It Is about the Bike!
First of all, the most important tip is to pay for a professional bike fit-your body will thank you. For an expert bike fitting, you can expect to pay between £150-£300 in the UK. This may seem a bit steep, but if we consider the amount of hours spent in the saddle at one time, alongside the repetitive and unnatural position, a poor bike fitting can increase the risk of developing or exacerbating pre-existing aches and pains.
The expert should begin with a comprehensive interview asking you about your riding experience/style, needs and goals, alongside you getting to know their experience in the sport. This is followed by an anatomical off-the-bike assessment, evaluating height, posture, foot positioning, range of motion of the ankle, knees, hips, and lumbar spine, and upper and lower limb lengths. All of which will help guide the on-the-bike assessment, providing guidance on cycling technique, and selection of the bike type and frame size, type of shoe support, crank length, seat height, and handle bar type/height that suits you best.
TIP #2 Cycling Related Knee Pain, Why Me?
Although cycling is considered to be low-impact exercise, the repetitive motion of pedaling can lead to a variety of overuse knee injuries. Clinically, Anterior Knee Pain (frontal knee pain) is one of the most common lower limb compliant of cyclists.
How Does It Happen?
Anterior knee pain is thought to involve mechanical changes resulting in an increased or abnormal contact point of the patella (kneecap). The condition is an umbrella term for common conditions such as patellofemoral pain syndrome (PFPS), chondromalacia patellae, and patellar & quadriceps tendinosis (tendinitis). This condition may stem from a suboptimal bike fit, increased training volume or intensity, poor cycling technique, using heavier gearing/lower pedaling cadence, or excessive hill climbing.
Saddle Height & Angle?
If the saddle height is too low, this can cause excess stress on the on the front of the knee, whilst the posterior chain of muscles (hamstrings, calves) are not lengthened enough for an optimal contraction whilst performing the up-stroke portion of the pedal cycle.
Alternatively, if the saddle height is too high, power is reduced because lower limb muscles must work beyond their optimal length (over-stretched). Furthermore, this may cause over- extension of the hip on the pedaling down-stroke, disturbing the stability of the hips and lower back.
If the saddle if too far forward or tilted forward, or excessively long cranks, this causes excess stress on the front of the knee as it is more flexed (bent), alongside the hip flexors (muscles that bring the knee towards chest) and the posterior chain will not be at the optimal length and tension for force production. Conversely, if the saddle is too far back, the hamstrings and gluteal muscles will be lengthened too much for optimal force production.
With that being said, the most notorious culprit of anterior knee pain seen in clinic is poor alignment from the foot on the pedal to the knee, or knee to the hip, or all three together.
TIP #3 This Achilles Pain Is Getting Me Down!
Firstly, Let’s Look at the Foot & Ankle Complex
It is very important that the cyclist chooses a shoe that is stiff and supportive because the foot becomes a rigid lever for power transfer from the thigh muscles to the pedal. During normal cycling motion, the foot supinates (inside arch of the foot or medial rolls towards the outside) and pronates (medial arch of the foot rolls towards the inside) in order to stabilise and transfer force on and off of the foot during weight bearing activities.
However, some cyclists overpronate (medial arch of the foot excessively rolls inwards) either due to intrinsic foot weakness or poorly supported shoes, or both. Usually, this occurs during the down-stroke, causing the shin bone (tibia) to roll inwards as well. If performed repeatedly, this may overload the knee, contributing to mechanical knee pain.
In the same manner, the Achilles tendon is a common source of pain often related to repetitive overpronation. Repetitive collapsing of the medial arch may contribute to this condition because the line of pull from the beginning of the tendon to the insertion into the calcaneus (heel bone) is not linear. Thus, this may cause excessive tendon overload and pain.
Achilles pain can also develop if the saddle position is too low or cleat positioning on the shoe is positioned too far anteriorly (forward). This may overload the tendon due to increased ankle dorsiflexion (toes brought closer to the shin) at the bottom of the pedal stroke (tendon is overstretched). However, if the saddle is too high this may produce increased plantarflexion (toes brought away from the shin) on the down-stroke, thereby overloading the tendon by repetitive over-contraction of the calf muscles.
Whether due to overpronation, tendon overload, or an improper bike fitting or cycling technique, have a go at the exercises below (for at least 1-3 months) or seek physiotherapist advice for a progressive foot and ankle strength and stability program. It is also recommended to consider scaling back the frequency, intensity or time of training sessions to give you a window of opportunity to offload and get stronger.
In addition, you may want to consider seeing a local podiatrist who specialises in cyclist orthoses (shoe inserts that support the medial arch) or an expert bike-fitter who can advise you on supportive shoes or special cleat wedges.
TIP #4 Beef Up The Hips And Knees!
Now, Let’s Look at the Hip & Knee Complex
Anterior knee pain can be associated with an excessive medial (inward) angle measured from the front of the hips to the middle of the knee, also known as the “Q-Angle”. An excessive Q-Angle is frequency associated with the knee moving medially (inwards) during the down-stroke of cycling. It is proposed that this may be a primary indicator for either hip or knee weakness, or both, contributing to knee pain via repetitive mechanical overload.
In the same way, other common pathologies associated with hip and knee weakness are lateral hip conditions (outside of the hip) such as gluteus medius (hip abductor) tendinosis, trochanteric bursitis (bursitis), and Iliotibial Band Syndrome (a band of tissue on the outside of the thigh attaching from the hip to the knee).
Luckily, for the most part, these conditions can easily be self-managed with a progressive hip and knee strength and stability program.
These exercises focus on strengthening the major hip and knee stabilisers such as the hip abductors (Gluteus Medius/Minimus), hip extensors (Gluteus Maximus and Hamstrings) and knee extensors (Quadriceps, more specifically the Vastus Medialis Obliquus). It is suggested that by improving hip and knee stability, this will reduce your risk of hip and knee repetitive strain injuries.
Try our hip and knee exercises below for yourself! Give it a shot for at least 1-3 months. As previously discussed, consider adjusting the intensity, frequency or time of training sessions to give yourself time to recover and become more resilient. But, if in doubt, seek physiotherapist advice; we’re here to help!
TIP #5 Be Nice To Your Body!
Rest & Recover
Lastly, listen to your body. If you’re going to train hard, it is essential that you incorporate ways to rest and recover-this includes both mentally and physically! Rests days are essential (at least 2 days per week) for your body and mind to repair, replenish, and come back even stronger! Considering the sport of cycling is very linear in nature, yoga is a perfect way to mobilise and stretch dynamically, keeping all the muscles, tendons, and joints supple and efficient. At the very least, you should include a gentle stretch at the end of each of your training sessions (minimum of 10 minutes) and consider myofascial release exercises with a foam roller (5 minutes). Below are some of our “go-to” exercises to help encourage resiliency from injury.
Whilst there are many potential reasons for overuse lower limb injuries seen in cyclists, hopefully our readers have gained some insight and “know-how” on preventing and self-managing their conditions. Please see If you are unsure or have any questions, feel free to get in touch with us via phone, email, or pop into one of our local clinics for an assessment.
Happy training and best of luck! See you at the finish line!