Beat the Pain Barrier

We show you how to diagnose and deal with the most common cycling ailments

Unless you fall off, cycling is a sport blessed by its body-friendliness, says Neil Pedoe. But just like any endurance sport, cycling can produce a catalogue of niggling aches and pains, which, unless properly treated can lead to something more serious.

The common-sense answer to any lasting pain is to stop what you’re doing and seek professional advice. But to point you down the road to recovery, with the help of Barry Edwards from Team Bath’s Physiotherapy & Sports Injuries Clinic, we’ve listed the most common ailments, their most likely causes and how to start fixing them.

Hand pain

Ulnar neuropathy causes a numbness or tingling sensation in the hands, commonly in the little and ring fingers, and often comes on after long rides when you’ve been keeping your hands in the same position for too long. It’s not just caused by the pressure from your weight but also the transmission of road buzz and vibration through the bars.

Try this
If you suffer from this, the first thing to address is your riding position, to take pressure off your hands and redistribute bodyweight more appropriately. “More often than not, the solution is to shorten your reach,” says Edwards. “That way more of your weight will be borne by the saddle.”

The problem can also be lessened by wearing gloves with gel padding over the ulnar area and by adding good padded tape to your bars, such as Bontrager’s Gel Cork Tape. There are even systems that put extra foam or gel padding along the bar tops under the tape to cushion the contact area, such as Specialized’s Body Geometry Bar Phat and Fizik’s Bar Gel.

Hip Pain

Piriformis Syndrome is known as wallet syndrome, because of where it hurts, and is often caused by overtraining, and specifically by overworking the gluteus maximus muscles in your buttocks. The piriformis itself is a small muscle that rotates the leg outwards. As this isn’t a movement that cyclists need to do much, the muscle can shorten and weaken. If overstressed, it can build in size to the point of putting pressure on the sciatic nerve, causing pain or numbness down the leg or in the hip – which is why it’s a common cause of sciatica.

If this injury has been caused by an imbalance between muscles, where the underused piriformis becomes weak, the solution is simple. By strengthening it, the tightness will ease off and often the pain too.

Try this
To stretch and strengthen your right piriformis muscle, lie on your back, bend both knees and cross your right leg over your left so that your right ankle rests on your left knee. Relax, breathe out, and then bring your left leg towards your chest by bending at the hip to stretch the piriformis. Deepen the stretch by grabbing your left thigh with both hands and gently pulling it, and the right foot resting on it. Repeat the stretch with the other leg.

Knee Pain

Although knee pain is one of the most common areas of complaint from cyclists – followed by back and then neck – it can be difficult to diagnose.

As a cyclist, there are several common knee injuries that you can probably rule out. “Meniscus tears, and damage to the anterior and posterior ligament, are rarely caused by cycling,” says Edwards. These injuries are more often the result of trauma, such as a heavy fall that causes the leg to bend unnaturally.

One of the most common cyclist knee complaints is pain in the kneecap. “This is likely to be the overuse injury patellofemoral pain syndrome or chondromalacia patellae,” says Edwards, “where the under surface of the patella becomes inflamed, usually because tightness or weakness in associated muscles moves the kneecap in a way it shouldn’t as you pedal.” If the kneecap rubs on the bones behind it, this can irritate and inflame the cartilage at the back of the kneecap. The same problem can be caused by your iliotibial (IT) band overtightening and pulling the kneecap out of line – again causing it to rub against bones.

Riding in a racing tuck on tri-bars or on the drops for long periods doesn’t help, and pulling the knees in towards the top tube can put even more tension on your IT band, causing it to tighten. Considering the repetitive nature of the pedalling action, up to 5,000 revolutions an hour – it’s no surprise a problem like this can quickly escalate into a clinical injury.

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If the pain is acute, the first course of action is to apply what the experts call RICE – rest, ice, compression and elevation – and then get yourself to one of those experts. “He or she will treat the swelling of the knee and release the IT band but most importantly get to the cause of the tightness that caused the problem so it doesn’t recur,” explains Edwards.

To stretch your own IT band, stand in a doorway with your right leg crossed in front of your left leg. Reach your left arm overhead towards the top right-hand corner of the doorway. Put your right hand on your right hip and push slightly to move your hips to the left, deepening the stretch. Hold for a few breaths, feeling the stretch along the outer torso, hip, upper thigh and knee of your left leg. Repeat on the other side.

Back pain

“The natural, neutral position for the human body is standing with all your muscles in balance,” says Edwards. “So, the minute you start reaching forward, you’re stretching some of those muscles more than they are used to, and potentially holding that stretch for hours at a time.” This overstretches the ligaments, causing them to overstrain, which can lead to localised lower back pain, though generally with no referral of pain into the legs, according to Edwards. This forward-bent position can also result in injuries to the trunk flexor and lumbar muscles and the sciatic nerve, while muscle groups not involved in the movement can become tight and shortened.

If you sit at a desk all day or drive a lot, you’re likely to have poor posture. “That makes you even more vulnerable to back injury from overstretching on the bike,” asserts Edwards, “putting too much pressure on the fibrous outer protective discs that protect your spinal vertebrae from shock. The result can be bulging discs, herniated or slipped discs, which in turn can cause sciatic nerve pain.

As with neck problems, the easiest way to avoid back pain from over-reaching is to change your riding position. Raising your bars by flipping your stem or adding spacers to your headset, or using a shorter stem, will let you ride more upright, as will simply moving your hands a lot.

Don’t sit for hours in the same position at your desk. “Every three-quarters of an hour, sit upright,” says Edwards, “and bend back on your chair to straighten out.”

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To release stress and tension from your neck and shoulders, lift your shoulders towards your ears, squeezing them hard. Hold for a couple of seconds and roll them back as you relax back down. Repeat eight to 10 times.

To improve posture and stretch all the muscles in your back, sides and arms, lace your fingers and stretch for the ceiling, breathing in deeply as you do so, then exhale and open your arms, sweeping them in a wide arc down to your sides.

Neck pain

Pain caused by neck hypertension is also normally exacerbated by positional issues on the bike, combined with lack of flexibility. “Just as you have core stabilisers around your middle,” says Edwards, “you have stabiliser muscles called deep neck flexors around your neck to hold your head up. When they become weak it is left to the trapezius muscle that goes from the base of your skull to the shoulder to support your head as you lean forward. It’s when these stand-in muscles get fatigued that you get the aches and pains in the back and sides of your neck.”

Try this
Lie on your back with your head on the floor, knees bent. Without moving your head at first, fix your focus on a point just above your knees, then follow your eyes with your head as if you’re nodding ‘yes', pulling your chin in towards your Adam’s apple without lifting your head off the ground. Hold the stretch for 10 seconds and gently return to the start. Repeat 10 times a day.

The easiest way to avoid neck pain is to change your posture on the bike so that you don’t have to crane your neck up so severely. “If you’re reaching too far, or your bar is too low,” says Edwards, “the first step is to use a shorter stem to shorten your reach. Turning it upside down will also raise your handlebar, so you can sit up more.”