Heal the pain: One writer’s insight into dealing with some of cycling’s common aches and injuries

On my second morning of pedaling, I decided my bike seat felt just a little too low. A low seat position causes a cyclist's knees to bend more than necessary with each pedal stroke—a recipe for pain in cycling's lynchpin joint. In 2006, I'd suffered a knee injury that stalled me for two weeks as I cycled from Spain to Greece, and I did not want to risk a repeat out here in the wild mountains of Bulgaria. So, I made a quick adjustment, raising the seat post about a quarter inch.

It was a mistake that has plagued me ever since.

Within hours, a deep, gnawing ache had set into the rear of my leg, three inches above the heel. My Achilles tendon was injured—the well-known result among physical therapists of a seat post set too high.

I spent a week in a hostel in the old city of Plovdiv, with my leg elevated and a pack of frozen peas rubber-banded to my tendon. The inflammation eventually settled down, and for the next six weeks as I cycled through Turkey, the pain didn't return.

Five years later, however, and the injury is still with me. Every few months, my Achilles flares up again, and physical therapy, basic stretching and yoga are only marginally effective at staving off the pain.

I've experienced other cycling injuries, too, and so I am at once bewildered and encouraged by the late cycling guru Sheldon Brown's mantra, which he repeated frequently on his blog: Riding a bicycle should not hurt.

UC Davis cycling coach Judd Van Sickle tells athletes the same thing at the beginning of seminars and lectures: Cycling should be pain-free. Van Sickle, who cycled competitively for several years, explains the logic.

“With cycling, you don't have the impact of running that's going to increase your potential for overuse injuries, and you can find fairly neutral positions on a bicycle so that you aren't placing unusual stresses on your body,” Van Sickle says.

It's very true. Unlike running, cycling is a smooth and low-stress activity. Adjustable gears allow us to tackle long ascents without increasing load on the body while obtaining the benefits of intense cardiovascular training. Indeed, physical therapists often recommend cycling as an alternative exercise for injured runners

Trouble is, cycling can and does hurt. While cycling's great virtue as an exercise form is its minimal impact on the joints, its chief flaw may be that it's so repetitive and homogenous.

“Cycling is a very constrained motion activity,” Van Sickle says.

If a person's only considerable form of exercise is cycling, imbalances in muscle and tendon strength will probably develop, leading to pain or injuries. The quadriceps—those muscle slabs on top of your thighs—tend to get overworked by pedaling while the muscle directly opposing them, the hamstrings, get underused, Van Sickle says.

Since the quadriceps muscles attache via a tendon to the kneecap, imbalances in this muscle's strength can pull the kneecap off its proper line of motion, leading to rubbing between it and the femur and pain in the front of the knee. This is called Patellofemoral Pain Syndrome, and trust me—it's not good. I had a bout with it in 2010 that lasted for three months. It started during a 50-mile December bike ride in cold and rain. When the tissues in a joint get cold, they work less efficiently—and pain follows.

The discomfort that comes with Patellofemoral Pain Syndrome may be crippling—a dull, scraping ache that can be intolerable when riding uphill or even off the bike, while descending stairs. You don't want it.

A preventative trick to avoiding pain in the front of the knee, says Van Sickle, is to strengthen and stretch, not too much of either, and with a focus on all major leg muscle groups. That means squats for the quads, back bridges for the butt, Jane Fonda-style clamshell leg lifts and complementary stretching for all of these muscles. It also pays to keep the knees warm while cycling. Wear knee warmers, or fashion one by cutting a hole at the toe of a tube sock and hiking it up over your kneecap.

One of the more feared injuries among competitive cyclists are those involving the IT band, and even for casual amateurs, it can put one on public transit for weeks or months. Formally known as the iliotibial band, this large tendon runs parallel to the femur on the outside of the leg. It connects at the hip and at the outside of the knee. When this band becomes tight through imbalances in strength and flexibility, pain can develop on the outside of the knee so hot and searing that one must quit cycling for weeks or months before the symptoms cool down. I've experienced it multiple times on both legs, and it's no fun.

Van Sickle says weakness in the pelvic stabilizer muscles often causes IT band issues.

“Everything tightens up to try and protect them, and then you get more tension on the IT band, and you get friction down around your knee,” he says.

To stave off inflammation, stretch the glute muscles. Do this by lying on your back, hugging the knee toward your chest and creating a tight pull on the outside of the butt. If left unaddressed, the problem may become chronic, resurfacing repeatedly through the years.

Still, it's an injury to the Achilles tendon that's almost mythical in its capacity to hobble a person and sideline athletes for months. Fortunately for cyclists, avoiding Achilles injuries is simple. Van Sickle says incorrect riding posture is generally at fault. When the seat post is too high, for example, one's toe must extend at the bottom of each pedal stroke, placing repetitive stress on the Achilles. Poorly placed cleats—for those who ride with cycling shoes that clip into pedals—also impact the Achilles tendon. Cleats that are set too far forward increase the toeing action of the foot, which directly stresses the Achilles. Van Sickle suggests moving the cleats back toward the heel so that your foot extends further over the pedal. If you ride in casual footwear on flat, platform pedals, making this adjustment is very easy.

With the exception of injuries obtained in crashes and collisions, cycling injuries are generally of the overuse sort. That is, muscles and tendons that may tear or snap when subjected to the explosive forces of other sports—like running or gymnastics—may simply become irritated through cycling. A physical therapist recently told me, for example, that my Achilles, no matter how inflamed it becomes, will at least not rupture. Many runners and basketball players, on the other hand, are familiar with the excruciating torture of a snapped Achilles tendon.

Still, cycling injuries are scary because they tend to creep up on us slowly. Avoiding them means staying vigilant and listening closely to your body. Aches—especially in the places discussed here—should be taken seriously. Ease off the pedaling as needed. You may also want to have a professional fit you to your bike. This will involve a brief physical exam followed by a fine-tuning of nearly every adjustable dimension on your bicycle.

Brown told us that cycling shouldn't hurt. It's ironic that his mantra is most often remembered by those of us who have become injured through cycling, learning the hard way that riding a bike can and often does hurt—even if it shouldn't.