At DMO we are blessed to be located close to the stunning Surrey Hills, which are a cyclist’s paradise! Cycling is beneficial in many ways…

It can be an adventure, getting out on trails and exploring new areas, taking in beautiful views and the fresh air.

It is an eco-friendly way to get from A to B. Opting to ride a bike keeps emissions at zero. You may spot our principal Osteopath Dominic commuting on two wheels!

It is an extremely effective form of low weight-bearing cardio exercise. This type of exercise is very body friendly, with minimal impact on joints. It is great mixed in to a varied regime that includes some weight-bearing activity like walking or running where possible, which is important for maintaining good bone health. 

Cycling can be enjoyed alone or as a social activity in a group, creating opportunities for forming new friendships and building communities. (Dominic’s wife can be tempted out on her bike if it involves a coffee and cake stop with friends on route!)

For those of us with a competitive streak, there are plenty of opportunities to put ourselves to the test, with a huge range of long and short distance competitions, charity events, and multi-sport challenges like triathlons. This brings the added satisfaction of giving us physical goals and challenges to work towards.

But most of all its fun and it makes you happy, thanks to the endorphins which are released when you exercise.


8 most common cycling injuries

However, cycling injuries are an unfortunate downside to the sport. Most occur as a direct result of the repetitive nature of cycling, overtraining, biomechanical stresses (often due to muscle imbalances) and incorrect bike set-up.

Musculoskeletal tissues including muscle, tendon and bone are constantly evolving and with appropriate loading (training) and adequate recovery time, the tissue gets stronger and develops better stamina. Over-loading our bodies can cause a breakdown in tissues, tissue fatigue, and pain. Hence, cumulative stress or load that’s above the capacity of the tissues, can cause overuse injury. This makes monitoring your training load, giving your body time to adapt, and increasing the volume and intensity of your training gradually is an essential component of staying injury free when cycling. 

Like any repetitive motion sports, cycling can produce a catalogue of niggling aches and pains, which if left untreated can become more serious. We explore the 8 most common injuries below:

  • Burning feet (metatarsalgia) 
  • Achilles tendon pain
  • Knee pain
  • Iliotibial band pain
  • Hip pain
  • Back pain
  • Hand pain
  • Neck pain

Neck Pain

You have stabiliser muscles called deep neck flexors around your neck to hold your head up. When these are weak or fatigue quickly it is left to the trapezius muscle (that goes from the base of your skull to the tip of the shoulder) to support your head as you lean forward. When these ‘stand-in’ muscles fatigue you can experience pain in the back and sides of your neck.

You can restore balance by keeping the neck muscles loose and relaxed through a routine of strengthening and stretching exercises (read on for some examples).

Back Pain

Lack of flexibility, such as excessive hamstring and hip flexor tightness and bad posture can contribute to low back pain. Hunching forward on your bike, and probably also at work, places strain on your spine, loading structures for prolonged periods of time.

Core strength is very important to avoid low back pain. See the resources section for some core exercises that are super for cyclists.

Knee Pain

The most common knee pain in cycling is as a result of patellofemoral pain syndrome, which occurs when the patella (kneecap) rubs on the femur bone underneath. The causes can be from:

  • external factors e.g. increase in training, the seat being too low or riding too long in big gears; or
  • internal factors e.g. poor patella tracking resulting from
    excessive pronation (fat foot), rotation of the
    lower leg and tight or weak muscles around
    the thigh and pelvis.

Hand Pain

‘Handlebar Palsy’ is the condition suffered by cyclists caused by compression of the ulnar nerve at the wrist against the handlebar. It often comes on after long rides, and is not just due to the pressure from your weight but also the transmission of road ‘buzz’ and vibration through the bars.

Symptoms include numbness, tingling and weakness over the outside of the hand.

Hip Pain

Possible causes of hip pain in cyclists include bursitis, snapping hip syndrome, impingement syndrome, labral tears or piriformis syndrome. Although the diagnoses may vary, the causes of cycling hip injuries are usually similar and involve over-training, pushing excessively high gears and muscle imbalances.

The key is to address the underlying muscle imbalances; by strengthening a muscle the tightness will ease off and often the pain will disappear too. Gear back and increase your cadence to take pressure off your hips.

Illiotibial (ITB) Pain

While it is more commonly known as “runner’s knee”, ITB syndrome is another common cycling injury.
Symptoms include pain on the outside of the knee, tenderness and sometimes swelling. You may feel stiff or tight after periods of inactivity.

Factors that can contribute to ITB pain include tightness of thigh, hip and buttock muscles as well as weak pelvic stabilising muscles.

Achilles Pain

The Achilles tendon is the tendon at the back of the ankle, connecting the gastrocnemius (calf) muscle to the heel. Soreness during or after riding may be indicative of Achilles tendinopathy. This is where the Achilles tendon gets inflamed, has micro-tears or blood flow to the tendon is compromised, often as a result of overuse.




Painful burning of the ball of the foot (a.k.a. “hot foot” or metatarsalgia) is usually caused by pressure pinching the nerves in one or both feet. Hot weather and poorly fitting shoes exacerbate the symptoms.


What can I do about these common complaints?

Many cycling overuse injuries can be prevented by remembering A–B–C.

Be assessed by osteopaths or physiotherapists for underlying ALIGNMENT issues such
as muscle weaknesses, flexibility, leg length discrepancies and being flat-footed.

Then check you have the correct BIKE set up, correct technique and cycling posture.

Finally, CONDITION yourself with appropriate strengthening and stretching exercises and progress your training moderately and always, always listen to your body! Some great exercises for cyclists are included below.




As ever, if you like the information we are providing in these blog posts then you can also follow us on Facebook at Dominic Malone Osteopathy and Instagram at @dm_osteopathy for additional titbits of advice and guidance.