15 Common Cycling Injuries and How to Prevent Them

Published by Dr. C.J. DeFabio, D.C. | September 17, 2018

Top 15 Cycling Injuries and How to Avoid Them

If you ride in Chicago, whether it’s along the lakefront, commuting through Andersonville, or putting in long weekend miles, you’ve probably had something start to feel “off” at some point. Maybe your knee started bothering you halfway through a ride. Maybe your hands went numb. Or your lower back just kept getting tighter the longer you stayed on the bike. Here’s what most cyclists don’t realize at first:  Cycling injuries usually don’t happen all at once; they build slowly over time.  And because they come on gradually, they’re easy to ignore until they start affecting how you ride or whether you can ride at all.

At Ravenswood Chiropractic & Wellness Center in Andersonville, we work with cyclists across Chicago dealing with exactly these issues. The good news is that most cycling injuries are very manageable and often preventable when you understand what’s causing them.

Why Cycling Injuries Happen: It’s Not Just Overuse

Cycling is low-impact, but it’s highly repetitive.  What we see clinically isn’t just “overuse,” it’s usually a combination of:

• Small bike fit or positioning issues
• Mobility restrictions
• Muscle imbalances or poor motor control

Over time, those small things add up.  That’s why in our clinic, we look beyond where it hurts and evaluate the following because if those aren’t addressed, the same injury tends to come back. 

• Joint mobility
• Tissue flexibility
• Movement patterns

The Most Common Cycling Injuries We See in Our Clinic

Deep Glute Pain or Piriformis Syndrome

Piriformis syndrome happens when trauma to the gluteal muscles (buttocks) occurs, mainly from prolonged sitting and cycling. Piriformis syndrome is usually characterized by pain and instability in the hip, coccyx, buttock, groin, or distal part of the leg. The piriformis muscle helps to externally rotate and abduct the thigh, which is why many cyclists complain about a literal pain in their buttock or even something that travels down the leg.  This often develops from prolonged sitting and repetitive motion. But what we see clinically is that it’s not just overuse, it’s how that muscle is being loaded over time.

Instead of just stretching, we focus on:

• Improving hip mechanics
• Reducing overload
• Restoring balance between muscle groups

Treatment typically focuses on reducing irritation in the gluteal region and improving hip function. This may include Class IV Laser Therapy to calm irritated tissue, along with targeted physical therapy to restore balance between the hip flexors and glutes and improve movement control.

Pain on the Outside of the Knee or IT Band Syndrome

The iliotibial band is located on the outside of the thigh. It runs from your knee into the hip joint. The cause of ITB syndrome can be three-fold: weak musculature, overuse of a specific muscle group, and excessive cycling.  This one tends to sneak up on cyclists.  Everything feels fine at the beginning of the ride, and then somewhere along the way, you start to notice a sharp or burning pain on the outside of the knee. The longer you ride, the more it builds.  Overuse and muscle weakness are contributors, and that’s absolutely part of it. But what we see in the clinic is that IT Band Syndrome is rarely just about tightness.

More often, it’s coming from:

• The hip is not stabilizing well during the pedal stroke
• Subtle tracking issues at the knee
• Or the load is being distributed unevenly over time

That’s why foam rolling or stretching the outside of the leg might feel good temporarily, but it doesn’t actually solve the problem.

What we often find clinically is that the issue isn’t just the IT band itself.  It’s the muscles that control tension through it.  In many cyclists, there’s underlying tightness and restriction in the glute max and tensor fascia lata (TFL). When those muscles aren’t functioning well, they increase tension through the IT band, which then shows up as pain on the outside of the knee.  In more persistent cases, these areas can develop adhesions that don’t respond well to stretching alone. That’s where treatments like shockwave therapy can be helpful to address the muscle tissue directly, while Class IV Laser Therapy is often used at the knee to help calm irritation locally.

If the pain:

• Shows up earlier and earlier into rides
• Starts lingering after you’re done
• Or changes how you pedal

It’s a sign that the tissue is getting overloaded and not recovering well. That’s usually the point where it’s worth taking a closer look rather than trying to push through.

Front-of-Hip Pain or Hip Flexor / Iliopsoas Issues

Cycling puts your hips in constant flexion.  Iliopsoas tendonitis is an inflammation of your hip flexor tendon (Iliopsoas) and, or, the area surrounding it. Its notable characteristic is the harmless snapping sound when moving your legs. Two of the most common causes of iliopsoas tendonitis is damage to the tendon and overuse resulting from repetitive hip flexion. This is the exact movement during cycling.

Over time, that can lead to:

• Tightness
• Reduced mobility
• Changes in how power is generated

This is one that a lot of cyclists feel but don’t always know how to describe to me. It usually presents as a tight, pinching, or even sharp discomfort in the front of the hip. Some people notice it while riding; others feel it more when they get off the bike or after longer efforts.  Overuse and repetitive hip flexion are contributors, But what we tend to see clinically is that it’s not just about overuse, it’s about imbalance.

More often than not:

• The hip flexors are doing more work than they should
• The glutes aren’t contributing enough
• And the system becomes inefficient over time

That’s when the front of the hip starts to get irritated.  A lot of people try to stretch it aggressively, which can help temporarily, but if the underlying imbalance isn’t addressed, it tends to come right back.

What works better is:

• Restoring balance between the hip flexors and glutes
• Improving how the hip moves under load
• And reducing irritation so the tissue can recover

If you notice:

• Tightness that builds the longer you ride
• A pinching feeling when bringing the knee up
• Or discomfort that lingers after cycling

It’s usually a sign that the hip flexor is being overloaded.  And like a lot of cycling injuries, it’s much easier to address early than after it becomes persistent.

Care is centered on restoring balance across the hip by reducing overactivity of the hip flexors and improving glute and core function. This may include laser therapy to reduce irritation, combined with movement-based physical therapy to improve how force is generated and absorbed during activity.

Pain Around the Kneecap or Patellofemoral Pain

This is one where cyclists will point very specifically to me and say, “It’s right here,” just below the kneecap.  It usually starts as a mild ache, often during harder efforts like climbing or pushing heavier gears, but over time, it can become more noticeable and linger after rides.  Repetitive motion and seat height can be contributing factors. Still, clinically, we see this is less about inflammation and more about how much load the tendon is being asked to handle.  When that load exceeds the tendon’s tolerance, especially without adequate recovery, it becomes irritated. That’s why simply resting for a few days might help temporarily, but the pain often returns once you resume the same intensity.

If you notice:

• Pain during harder efforts
• Discomfort that lingers after rides
• Or increasing sensitivity in that same spot

It’s usually a sign that the tendon isn’t adapting well to the current workload.  In these cases, we often focus on gradually restoring load tolerance and calming irritation, sometimes using Class IV Laser Therapy or shockwave therapy alongside targeted strengthening.

Cartilage Irritation Under the Kneecap or Chondromalacia

This one builds more gradually and can feel harder to pinpoint at first.

Cyclists often describe:

• A dull ache behind the kneecap
• A grinding or “off” feeling
• Or discomfort that worsens with longer rides

Typically, this is a cartilage breakdown due to poor alignment of the kneecap. What we see clinically is that the kneecap isn’t tracking smoothly, which over time creates uneven pressure. Instead of being a single moment of injury, it’s more of a repetitive stress issue that slowly builds.

If you notice:

• Pain that gradually worsens with mileage
• Stiffness after riding
• Or discomfort with stairs or sitting

It’s usually a sign that joint mechanics need to be addressed.  Treatment typically focuses on improving alignment and movement patterns, often supported by laser therapy and physical therapy to reduce irritation and improve tracking.

Low Back Tightness or Pain

This is one of the most common complaints we hear from cyclists in Chicago. It often starts as tightness that builds the longer you ride, but over time, it can become more persistent or even show up off the bike. Cycling puts you in a sustained forward position, and if your body doesn’t tolerate that well, the lower back ends up doing more work than it should.

What we usually find is:

• Limited hip mobility
• Reduced core endurance
• Or uneven load distribution

Posture-related strain is a big part of it, but it’s how your body handles that position that really determines whether pain develops.

If you notice:

• Tightness that builds during rides
• Pain that lingers afterward
• Or symptoms that start traveling into the hip or leg

It’s worth taking a closer look. When the spine is involved, care may include non-surgical spinal decompression, laser therapy, and movement-based physical therapy depending on the underlying cause.

Neck and Upper Back Pain

Neck and upper back pain are often due to prolonged riding posture and handlebar positioning. When the upper back isn’t moving well, the neck compensates. This is one that many cyclists assume is just part of riding.  It usually shows up as stiffness or fatigue in the neck and upper back, especially on longer rides.  Handlebar reach and prolonged extension are key contributors, and what we often see is that when the upper back isn’t moving well, the neck has to compensate.

Over time, that leads to:

• Muscle fatigue
• Stiffness
• And sometimes headaches

If you notice:

• Persistent tightness
• Reduced ability to turn your head comfortably
• Or the tension that builds with longer rides

It could be a sign that the load isn’t being distributed efficiently.  Treatment typically focuses on restoring upper back mobility and reducing strain, often supported by cervical spinal decompression, class IV laser therapy, chiropractic care, and targeted physical therapy when appropriate.

Hand Numbness or Handlebar Palsy

Handlebar palsy is when there is ulnar nerve compression at the tunnel of Guyon. It’s often a result of placing your hands on the hoods or the area where the brake lever attaches to the handlebars. Failing to make the necessary bicycle adjustments to fit the rider’s size and anatomical characteristics may also increase the likelihood of handlebar palsy.  Handlebar palsy usually responds to rest, and you can rest this injury a little by using padded gloves, changing hand positions on the handlebars frequently, and using aero bars to rest your forearms on pads.

Cyclists often notice:

• Tingling
• Numbness
• Needing to shake hands out

This is one of those symptoms that shows up mid-ride and is easy to ignore.  It is usually due to pressure on the ulnar nerve . The longer that pressure is applied, the more irritated the nerve becomes.

If symptoms:

• Appear earlier in rides
• Last longer afterward
• Or become more consistent

It’s time to address it.  In more persistent cases, we focus on reducing nerve irritation and improving positioning, often combined with laser therapy and movement correction.

Heel Pain or Plantar Fasciitis

In cyclists, Plantar fasciitis is generally caused by the constant pressure of the foot against the pedal. Ill-fitting shoes or cleats are often blamed. The most significant characteristic of plantar fasciitis that you will hear is that the bottom of your foot, and in particular your heel, is painful upon rising, especially the first steps out of bed. The pain may be severe enough to prevent the athlete from walking barefoot in a normal heel-toe gait.  This is one that often surprises cyclists.

At our clinic, we often see additional contributing factors such as

• Tight calves
• Limited ankle mobility
• And repetitive load through the foot

If it begins to:

• Affect walking
• Persist between rides
• Or worsen over time

It’s no longer just a minor issue, and it’s time to get it checked out.  This is one of the conditions where shockwave therapy combined with Class IV Laser Therapy can be especially effective for stubborn cases.

Burning Foot or “Hot Foot” / Metatarsalgia

Metatarsalgia, also known as Hot Foot, is caused by compression and inflammation of nerves and joint tissue at the metatarsal heads, the area just above a well-placed pedal spindle. It is characterized by pain, burning, and numbness and usually occurs mid-ride.

Often related to:

• Pressure
• Nerve irritation
• Footwear

Treatment focuses on reducing pressure and irritation in the forefoot while improving load distribution during cycling. This may include addressing foot mechanics and, in more persistent cases, using shockwave therapy or Class IV Laser Therapy to calm nerve irritation and support tissue recovery.

Achilles Tendon Pain

The Achilles tendon’s purpose is to push and stabilize the gastrocnemius (calf) muscle. Most common injuries to the Achilles tendon occur when you overextend your heels for too long a period. This begins to tear the tendon fibers, which, in turn, become inflamed.  You may prevent Achilles tendonitis by strengthening your calf muscles with resistance exercises such as calf raises. You may also take a few minutes before cycling to stretch the ankle and surrounding tendons. Achilles tendonitis usually starts as tightness and progresses to pain.  This is a classic load management issue. 

Cyclists may notice:

• Stiffness early on
• Then soreness
• Then the pain that lingers after the activity

This is generally an overuse and strain issue , which aligns with what we see clinically.  Over time, the tendon becomes less tolerant to load. Treatment focuses on restoring load tolerance, sometimes supported by laser therapy or shockwave therapy, depending on severity.

When Cycling Pain Isn’t Normal

If something:

• Keeps coming back
• Gets worse with riding
• Or changes how you move

It’s worth getting checked out because early treatment is almost always better than waiting.

How We Help Cyclists in Chicago

At Ravenswood Chiropractic & Wellness Center in Chicago, we don’t just treat pain we look at why it’s happening. Your care plan may include:

Class IV Laser Therapy

Helps reduce inflammation and support healing.

Shockwave Therapy

Used for stubborn tendon and muscle conditions.

Non-Surgical Spinal Decompression

For disc-related neck, back pain, and nerve symptoms.

Chiropractic and Physical Therapy

To restore movement and prevent recurrence.

How to Prevent Cycling Injuries

What actually works:

• Gradual training progression
• Proper bike fit
• Strength training (hips + core)
• Mobility work
• Addressing symptoms early

Cycling Injury Treatment in Chicago

If you’re riding in:

• Andersonville
• Ravenswood
• Lakeview
• Lincoln Square
• Uptown
• Edgewater

And something doesn’t feel right, it’s worth getting it looked at early.   Schedule a Free Consultation.

FAQs

What is the most common cycling injury?

Knee pain is the most common due to repetitive stress and positioning.

Should I ride through pain?

If it persists more than a few days or worsens, it should be evaluated.

Can cycling cause nerve issues?

Yes, prolonged pressure can irritate nerves in the hands or pelvis.

How do I prevent cycling injuries?

Proper fit, strength training, and early intervention are key.

Where can I get treated in Chicago?

Ravenswood Chiropractic & Wellness Center in Andersonville specializes in cycling injuries.

Ready to Ride Pain-Free Again?

If something feels off, your body is telling you something. Schedule an evaluation at Ravenswood Chiropractic & Wellness Center, Ravenswood Ave, Andersonville in Chicago.  Call or Text us at 773.878.7330