Tour de France Special - top cycling related injuries we see in physiotherapy

Tour de France Special

So the Tour de France is nearly upon us! It is arguably the biggest cycling event of the year and many pro riders spend not only the season preparing themselves for this race, but often their career.

Watching cycling as a spectator might seem all glamour, but unless you live the life of a pro it’s difficult to understand all the hard work and sacrifice that comes with it, as well as coping with injuries and setbacks. Geraint Thomas (Team Sky) famously rode the 2013 Tour with a broken pelvis!

Whereas there are many crashes and trauma related injuries on the pro circuit, amateurs tend to be more affected by “overuse” or position related injuries. These are some of the top cycling related injuries we see in physiotherapy:


Knees are probably the most commonly affected area in cyclists and are particularly vulnerable if there are pre-existing pathologies e.g. patellofemoral disorders. Most background causes are poor cleat set-up, saddle too low/too far forward, sudden increase in training volume, insufficient pedalling technique (e.g. “mashing” the gears) and poor flexibility of the quadriceps/hip flexors.


Common causes

Management plan

Anterior knee pain

Poor cleat set up

Saddle too low/far forward

Sudden increase in volume

Patella mal-tracking

Optimise cleats

Check saddle height/alignment

Improve flexibility and strength

Posterior knee pain

Saddle too high

Saddle too high back

Overuse of hamstrings e.g. pedalling technique

Lower back pain – referred

Check saddle set up

Glutes strengthening

Lateral knee pain

Saddle too high

Poor cleat set up

Weak glutes

Optimise cleats

Let irritation settle

Medial knee pain

Overpronation at feet

Feet positioned too wide

Saddle too low


Optimise cleat and saddle set up


There are many things apart from bike set up that can improve your knee pain. In order to tailor this it is important to have a thorough physical assessment by a qualified practitioner.

Low Back Pain

Low back pain (LBP) is probably the second most common injury amongst cyclists.  People tend to accept LBP as an inevitable symptom when riding.  LBP can be positional but is also often due to weak core stability – simply our spinal muscles fatigue the longer they have to work.  Pilates and various strengthening exercises for the pelvis and shoulder girdle can help to reduce the severity and onset of LBP, as can a gradual build in cycling distance and volume.

Finding a good sturdy saddle to sit on, and getting the correct saddle position will also provide the optimum position for your spinal and leg muscles to work in which will help prevent fatigue related LBP.

Numb hands

Numb hands are another complaint that a lot of riders shrug off as a normal part of cycling. This does not have to be the case! Cycling can cause a lot of compression of the nerves in the hands, due to hand position, how much weight is going through the arms, and shock from the riding surface. Again correct bike set up can help prevent these symptoms.


Common causes for numb hands

Saddle too high or too far forward

Poor saddle choice i.e. not wide enough to properly sit on

Bars too low or too far away

Bars too wide

Poor brake hood set up

Small bar diameter/aluminium bars


Essentially many cycling related problems can be created because of similar problems:

  1. Incorrect bike set up
  2. Sudden increase in training volume/load
  3. Acute change in bike set up with insufficient time to adapt
  4. Underlying biomechanical problems and pre existing injuries


If you have a complaint (or multiple areas of complaint!) then it is advisable to see a qualified physiotherapist who has a special interest in cycling related injuries and/or bike fit skills.

Bianca Broadbent - Physiotherapist, Retul Bike Fitter and Triathlete is available for appointments at Perform Birmingham, Spire Little Aston Hospital.  Call 0121 580 7131 today to make an appointment to see her.

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