Six Common Cycling Issues – How I Diagnose and Treat Them

Orthopaedic & Spine Center

Boyd W. Haynes III, MD

Bicycling is a wonderful exercise for anyone who wants to stay fit, be outdoors and it can be as competitive or as laid back as you want it to be.  You can race with others in your age bracket in a ranked sporting event or you can take your cruiser down the boardwalk for a laid-back day at Virginia Beach.  As with any sport, cycling has its share of injuries to discuss.  Today, we are not going to talk about what happens when you fall off the bike or get in a crash – we’re going to focus on the aches and pains that happen when you stay ON the bike!

Hot Foot – That’s right – it doesn’t just happen when you are walking on coals, this is a common ailment for cyclists.  The symptoms are a burning sensation that occurs at the ball of the foot and heads towards the toes.  It usually is a result of 1) too tight shoes in the summer as your feet swell; 2) too thick socks constricting the foot in the winter; 3) un-supportive shoes; 4) plantar fasciitis.  The first three can be remedied by the rider without a lot of trouble, however, if those actions fail to provide relief, you may wish to get checked out by an orthopaedic physician if foot pain persists.  Plantar Fasciitis is best tackled early on before it becomes chronic with a regimen of deep stretching, relative rest, night bracing, oral or injected steroids and Physical Therapy to address deep inflammation while working on strength and mobility.

Knee Pain – The legs propel the bicycle forward and the knees are reported as the number one body part that is injured by overuse in cycling.  Most injuries involve the knee joint, kneecap, and the tendons and ligaments surrounding the joint and each will need to be diagnosed and treated by an orthopaedist.  Treatment typically will involve Physical Therapy, relative rest, a modified cycling schedule, NSAIDs, potentially oral or injected steroids, the use of ice after cycling and changes to cycling shoes, cleats and possibly shoe wedges may be recommended.  If things don’t improve with conservative treatment, I may recommend an MR scan to see if something more involved is going on in the knee that our initial x-rays did not expose.

Neck or Back Complaints – Because of the forward positioning of a cyclist’s body toward the handlebars, I hear about neck or back issues from time to time.  First, the rider should ensure that their handlebars are at the proper height for riding.  Handlebars that are too low can cause the rider to round their back causing neck and back strain.  Tight hip flexors and hamstrings can cause riders to arch the back abnormally which in turn can cause the neck to hyperextend.  The neck can become stiff if the rider stays in one position for too long, so it is important that they shift position regularly while riding.  Its also recommended that cyclists do stretches while riding, such as shoulder shrugs, and neck stretches to keep the neck from tightening up.  Stretching is very important before, during and after your ride to keep neck and back problems at bay.  Physical Therapy may help with persistent issues.

Wrist and Forearm Problems – Bicycling can cause two issues for riders that affect the wrists, forearms, hands and fingers – Cyclist’s Palsy and Carpal Tunnel Syndrome.  These problems are caused when riders don’t keep their elbows bent when riding to act as shock absorbers and instead keep their arms rigid and straight, rarely change hand positions on the handlebars, or keep their wrists bent below the handlebars for long periods while riding.  Both can cause pain, numbness tingling, weakness and numbness in the wrist, forearm, hand and fingers, although the symptom pattern will be different for each malady, as the nerve compressed is also different. 

Diagnosis consists of a physical exam and x-rays.  I also want to rule out other issues, such as Ganglion cysts or fatty lipomas that may be compressing the nerve.  Treatment typically involves bracing, activity modification, ergonomic changes to the bike, rest, anti-inflammatory medications and Physical Therapy.  More difficult cases may need surgery to decompress the nerve.