Cycling/Injuries

Injury Modifications

4 injury guides

Guidelines for safely modifying workouts when dealing with common injuries. Always consult a healthcare professional for specific medical advice.

Hand Numbness

Hand numbness and tingling are very common in cyclists, affecting up to 70% of long-distance riders. The sustained pressure on the hands combined with vibration and gripping can compress the nerves in the palm. Two main conditions: - Ulnar neuropathy (handlebar palsy): Affects ring and pinky fingers - Median neuropathy (carpal tunnel): Affects thumb, index, middle fingers Both are usually reversible with proper management but can become permanent if ignored over time.

Warning Signs

  • ⚠Symptoms occurring earlier in rides
  • ⚠Symptoms lasting longer after rides
  • ⚠Weakness developing
  • ⚠Symptoms during daily activities
  • ⚠Difficulty with fine motor tasks (buttons, typing)

Red Flags - Seek Immediate Care

  • ●Muscle wasting visible in hand (thenar or hypothenar atrophy) - nerve damage, seek evaluation
  • ●Significant weakness affecting grip - may indicate nerve damage
  • ●Symptoms progressing despite rest - seek evaluation
  • ●Symptoms not improving after 2-4 weeks of rest

When to Seek Professional Care

  • →Any red flag symptoms
  • →Weakness in hand
  • →Symptoms persisting days after riding
  • →Symptoms during daily activities not related to cycling
  • →Previous carpal tunnel or nerve issues

General Principles

  • •Hand position variety is essential - never stay in one position for long
  • •Padded gloves help but don't fix underlying position issues
  • •Wrist should be neutral, not hyperextended
  • •Pressure should be on the base of the palm, not the wrist
  • •Grip loosely - death grip increases pressure

Contraindicated Movements

Prolonged same hand position (all levels)Hyperextended wrist positionExcessive vibration without dampingDeath grip on handlebars

Recommended Exercises

Wrist flexor stretches

3 sets × reps

Reduces tension at carpal tunnel

Nerve gliding exercises (ulnar)

3 sets × 10 reps

Gentle nerve mobilization for ulnar nerve

Nerve gliding exercises (median)

3 sets × 10 reps

Gentle nerve mobilization for median nerve

Grip strengthening (putty or ball)

3 sets × 15 reps

Maintains hand strength during recovery

Finger spreading against band

3 sets × 15 reps

Strengthens intrinsic hand muscles

Return to Full Training

Criteria:

  • ✓No numbness during daily activities
  • ✓Can complete 60 min ride without symptoms
  • ✓No weakness in grip
  • ✓Position modifications implemented

Progression:

  1. 1.Week 1-2: Short rides (30-45 min) with frequent position changes
  2. 2.Week 3-4: Gradually extend duration, monitor symptoms
  3. 3.Week 5-6: Return to normal duration
  4. 4.Ongoing: Maintain position variety habits

Knee

Warning Signs

  • ⚠Pain increasing during ride (stop)
  • ⚠Swelling after rides
  • ⚠Clicking or catching sensation
  • ⚠Pain at rest or walking

When to Seek Professional Care

  • →Pain persists despite fit adjustments
  • →Swelling, redness, or warmth
  • →Locking or giving way
  • →No improvement after 2-3 weeks

General Principles

  • •Cycling is generally knee-friendly due to low impact
  • •Most cycling knee pain relates to bike fit, not the activity
  • •Saddle height and cleat position are critical factors
  • •Higher cadence (90-100 rpm) reduces knee stress
  • •Avoid big gear grinding, especially when fatigued

Contraindicated Movements

Low cadence grinding (<70 rpm) especially uphillHeavy gear starts from standstillDeep flexion (saddle too low)Sprint efforts with poor form

Recommended Exercises

Professional bike fit

1 sets × 1 reps

Essential - most cycling knee pain relates to bike fit, not the activity

Quad and IT band foam rolling

1 sets × 5 reps

Releases tension that can affect knee tracking

VMO (inner quad) strengthening

3 sets × 15 reps

Strengthens inner quad for better patellar tracking

Hip strengthening exercises

3 sets × 12 reps

Hip stability reduces knee strain during pedaling

Return to Full Training

Criteria:

  • ✓Pain-free at endurance pace for 1 week
  • ✓Bike fit verified by professional
  • ✓Can increase cadence without pain
  • ✓No pain after rides or next morning

Progression:

  1. 1.Week 1: Easy spinning only, high cadence
  2. 2.Week 2: Gradual duration increase, still easy
  3. 3.Week 3: Introduce tempo if pain-free
  4. 4.Week 4+: Gradually return to full training

Lower Back

Lower back pain is extremely common in cyclists, affecting up to 60% of riders. The sustained flexed posture on the bike, combined with repetitive pedaling motion and prolonged static loading, creates unique stresses on the lumbar spine. Causes include: - Poor bike fit (especially stack/reach issues) - Weak core stability - Hip flexor tightness - Excessive time in aero position - Inadequate position variation during rides

Warning Signs

  • ⚠Pain worsening during rides
  • ⚠Pain lasting longer after rides
  • ⚠Radiating leg pain
  • ⚠Numbness or tingling in legs
  • ⚠Difficulty finding comfortable position

Red Flags - Seek Immediate Care

  • ●Saddle anesthesia (numbness in groin/inner thighs) - cauda equina syndrome, go to ER immediately
  • ●Bladder or bowel dysfunction with back pain - cauda equina syndrome, go to ER immediately
  • ●Bilateral leg weakness - go to ER immediately
  • ●Progressive neurological symptoms (numbness, weakness getting worse)
  • ●Severe back pain with fever - possible infection

When to Seek Professional Care

  • →Any red flag symptoms
  • →Radiating leg pain (sciatica)
  • →No improvement after 4 weeks of modification and core work
  • →Pain affecting daily activities despite rest
  • →Need professional bike fit assessment

General Principles

  • •Bike fit is the most important factor - get a professional fit
  • •Core stability protects the spine during sustained flexion
  • •Position variation is essential - no single position for hours
  • •Hip flexor flexibility affects lumbar spine position
  • •Aero position increases spinal load significantly

Contraindicated Movements

Extended time in aggressive aero position (moderate and severe)Long rides without position breaks (all levels)Riding through significant painSit-ups and crunches (all levels)

Recommended Exercises

McGill Big 3 (bird dog, side plank, curl-up)

3 sets × 10 reps

Evidence-based core stability without spinal flexion

Dead bugs

3 sets × 10 reps

Core stability maintaining neutral spine

Hip flexor stretching

2 sets × reps

Tight hip flexors pull lumbar spine into flexion

Glute bridges

3 sets × 15 reps

Hip extension strength to balance flexor dominance

Cat-cow mobility

2 sets × 10 reps

Spinal mobility after sustained position

Thoracic spine rotation

2 sets × 10 reps

Upper back mobility reduces lower back compensation

Return to Full Training

Criteria:

  • ✓Pain-free during daily activities
  • ✓Can complete 60 min ride without pain
  • ✓Core stability exercises pain-free
  • ✓Bike fit optimized

Progression:

  1. 1.Week 1-2: Short easy rides (30-45 min), frequent position changes
  2. 2.Week 3-4: Gradually extend duration
  3. 3.Week 5-6: Add intensity, avoid prolonged aero
  4. 4.Week 7+: Return to normal with ongoing core work

Saddle Issues

Saddle-related issues are among the most common complaints in cycling, affecting comfort, performance, and in some cases, long-term health. Issues range from minor skin irritation to nerve compression causing numbness. Conditions covered: - Saddle sores: skin irritation, folliculitis, abscesses - Perineal numbness: compression of pudendal nerve/artery - Chafing and skin breakdown Proper saddle fit, hygiene, and riding technique are essential.

Warning Signs

  • ⚠Numbness not resolving with standing
  • ⚠Recurring saddle sores in same location
  • ⚠Sores becoming more painful or swollen
  • ⚠Urinary symptoms
  • ⚠Erectile dysfunction

Red Flags - Seek Immediate Care

  • ●Persistent genital numbness (off the bike) - possible nerve damage, seek evaluation
  • ●Erectile dysfunction - may indicate vascular/nerve issue, seek medical care
  • ●Urinary symptoms with saddle issues - seek medical evaluation
  • ●Fever with saddle sore - possible abscess/infection requiring medical care
  • ●Large, painful, fluctuant mass - abscess requiring drainage

When to Seek Professional Care

  • →Any red flag symptoms
  • →Saddle sore that's red, hot, swollen, or has discharge
  • →Persistent numbness off the bike
  • →Urinary or sexual dysfunction
  • →Sores not healing within 1-2 weeks
  • →Need for abscess drainage

General Principles

  • •Saddle fit is individual - what works for others may not work for you
  • •Numbness is never normal and should be addressed immediately
  • •Good hygiene prevents most saddle sores
  • •Stand periodically to relieve pressure (every 10-15 minutes)
  • •Weight should be on sit bones, not soft tissue

Contraindicated Movements

Riding through significant numbnessRiding with infected saddle soresLong trainer sessions without standing breaksIgnoring persistent symptoms

Recommended Exercises

Standing intervals during rides

1 sets × reps

Relieves perineal pressure and restores blood flow

Core strengthening

3 sets × 15 reps

Stable core reduces rocking and friction

Return to Full Training

Criteria:

  • ✓No active saddle sores
  • ✓No numbness during rides
  • ✓Can complete normal ride duration comfortably
  • ✓Proper saddle fit confirmed

Progression:

  1. 1.Start with short rides (30-45 min)
  2. 2.Gradually extend duration
  3. 3.Monitor for recurrence
  4. 4.Adjust saddle as needed