The Most Common Cycling Injuries and How to Prevent Them

In this interview with Jeff Greenwald, Kevin R. Stone, MD shares what he sees most often in his office with injured cyclists and discusses how to avoid those types of injuries while out on your bike. 

Cycling Injury Prevention Tips

Spring is here, and—with the price of fuel rising—bicycling is more popular than ever. So what are the main types of injuries faced by cyclists? 

Dr. Stone: Many of the injuries we see from cycling are simple ones—such as iliotibial band tendonitis, presenting as pain on the side of the knee or side of the hip. We see this most commonly from either technique error, or from bike fit issues: cases where the bike is not set up properly and fitted for the rider. 

The next most prevalent injuries we see from cycling are injuries from falls: breaking the clavicle, tearing the rotator cuff, or falling on an outstretched hand. All of these—as well as road rash on the sides of the hip and legs—are trauma injuries that occur as a result of the skin-meeting-the-pavement falls.

In cycling, as in every other sport, we see that the number one cause of trauma injuries is mental error. The injury occurs when you're just not paying attention; not noticing the pothole ahead, not paying attention to the traffic, not paying attention to the rider in front of you. Falling, in cycling, is most commonly due to a mental error—and that's true in high-level, competitive racing as well as in recreational cycling. 

Are there certain exercises to strengthen the parts of the body that are prone to repetitive motion injury or anything besides a fall? 
Dr. Stone: Among cyclists, one thing that we find is that their core muscles and their back muscles are weak—mostly because their belly is hanging down, their back is curved, and they're taking the jostling of the road. When we look at cyclists’ core strength, it’s often surprisingly weak. Unfortunately so is their bone density, if they don’t cross-train with resistance exercises. The small, repetitive oscillations for the road bumps do not provide strong enough resistance to build bone throughout the cyclist’s body. So it's important for cyclists to weightlift, hike, and cross-train if they want to cycle forever.

Are there some tell-tale signs that can help a cyclist proactively avoid an injury?

Dr. Stone: To avoid tendonitis and joint pain caused by poor form, or poor bike fit, it pays to have a professional fit you to your bike. A modern bike helmet reduces head trauma. Bike gloves keep you warm, reduce hand impact, and protect the skin when landing on dirt or cement. Glasses shield the eyes. While these may seem obvious, it is always surprising how many injuries could have been avoided with a little protection.

How do eBikes fit into the cycling injury equation?

Dr. Stone: One thing to be aware of with eBikes is that they are permitting people to go at higher than usual speeds—speeds we previously saw mainly with motorcycles or mopeds—and carry children, dogs, and groceries all at the same time. And some eBikers are riding without any protection at all, on surfaces— such as sidewalks and bike lanes—that were not designed for motorized vehicles. So yes, the motorization of bikes is going to lead to a whole other class of injuries due to their speed, impacts with other cyclists, and lack of protection. eBikes are essentially underpowered, underregulated, accessible motorcycles. 
Seems to be an argument for getting a bell installed on your bike!
Dr. Stone: Well, yes… But some of these people are going as fast as 40 miles per hour in a bike lane! Often with a child on the back and a child on the front. A truck airhorn would be more appropriate.

So it does seem like one of the primary tips for cyclists is to be aware of their speed and not overdo it?

Dr. Stone: Correct. One thing I like to tell people is, if you are riding for pleasure don't pedal faster than you can daydream. So much of the time, when people are riding, they're riding aggressively or they're riding competitively, or they're riding with a goal in mind. If you look at many riders on the road, very few have smiles on their faces. I think that's a tragedy because it's a wonderful sport that permits you to let your mind float even while paying attention. If you can get into a zone where you're safe and you've got the open road ahead of you, let your mind run. Enjoy the mental freedom of cycling and free-thinking and you may be surprised by the creativity it unleashes.

Medically authored by
Kevin R. Stone, MD
Orthopaedic surgeon, clinician, scientist, inventor, and founder of multiple companies. Dr. Stone was trained at Harvard University in internal medicine and orthopaedic surgery and at Stanford University in general surgery.