Common Cycling Injuries and How to Prevent Them: A Complete Guide

Numbness, weakness and pain in the wrists and hands are most often caused by the compression of either the ulnar or median nerves.

Ulnar nerve compression, often referred to as "handlebar palsy," is a common issue for cyclists. This condition occurs when excessive pressure is placed on the hands, leading to numbness or tingling in the ring and pinky fingers. 

Another common issue is carpal tunnel syndrome, where the median nerve is compressed, causing numbness and pain in the thumb, index, and middle fingers.

Prevention Strategies:

There are three categories of prevention strategies to consider here. 

• Decrease Weight on the Hands: Excessive weight distribution to the hands is a common contributor to nerve compression (and hand discomfort, in general). A properly dialed-in cycling position (fit) places more of the weight on the back half of the bike than the front half. A professional bike fit will help to rebalance the whole body of the bike. 
  
  
• Decrease Pressure on the Hands: Nerves that cross the wrist and hands do not tolerate prolonged pressure well, especially if that pressure is excessive.
  
  Wearing proper cycling gloves tremendously reduces pressure in the anatomical regions where nerves are most vulnerable. They also help the cyclist grip the bars with ease, reducing excessive gripping which can subsequently lead to more pressure on the nerves.
  
  It is also a good idea to sometimes alternate hand placement on the bars, distributing the pressure to different areas of the hand for a period of time.
  
  Some cyclists, especially those with small diameter bars, will benefit from thicker bar tape which will again help reduce the pressure. Some may even want to double up on the tape!
  
  The tilt of the bars and the positioning of the hoods also dictate how the pressure on the hands is distributed. If nerve injury is suspected, a competent bike fitter should have an idea of which nerve is involved and adjust the bars/hoods appropriately to redistribute the pressure off of the affected nerve.
  
    An excellent example of why searching for a bike fitter who is also a healthcare provider is a good idea. The same applies to the point below: 
  
  
• (Pro Tip!) Consider the Neck: Hand numbness, weakness, and pain can sometimes come from issues in the neck. This should be of no surprise, as the neck is placed in a straining position when you are on the bike, especially when you are in a particularly aggressive (aerodynamic) position.
  
  Consider my above suggestions with regard to “Neck & Shoulder Pain”. Also, consider what you are doing while off of the bike, that may contribute to neck and upper limb symptoms (i.e.: Are you straining over a desk all day?). When in doubt, see a trusted healthcare provider (one that cycles… bonus points if they are also a trained bike fitter) to help you figure this out. 



5.  Saddle Area Discomfort

Saddle area discomfort encompasses a number of ailments. It includes pain that may be localized to your sit bones or extend forward to the genital area. It may include numbness in the genitals. It may also include wounds, inflamed hair follicles and skin irritation (Saddle Sores). These issues are especially common during long rides or multi-day cycling events.

The general explanation is that all of the above-mentioned saddle area discomforts are usually related to excess rubbing or pressure in focal areas in the perineal region (the anatomical area between your sit bones and your genitals). 

Saddle area discomfort should be taken seriously. If left untreated, saddle sores can become infected and require medical attention.Extended pudendal or perineal nerve compression can lead to prolonged genital numbness, pain and potentially even erectile dysfunction. 

A poorly fitted saddle, inappropriate cycling shorts, or incorrect riding position are all factors that can increase the risk of developing issues in the saddle area. 

Prevention Strategies:

• Bike Fit: Improper positioning (fit) on the bike will impose greater pressure on the saddle and can accentuate movement of the pelvis. This can lead to saddle area discomfort.
  
  The saddle tilt is an important consideration. An improper saddle tilt can force you to sit in the wrong area of the saddle, and/or place pressure in all the wrong areas.
  
  HINT: lowering the nose of the saddle does not always relieve discomfort, and often makes it worse!
  
  The saddle width and shape characteristics are also important to consider. For example, a saddle that is too narrow will increase perineal pressure on the perineum, and will likely lead to excessive pelvic movement while pedaling. Also, a saddle designed with a high point along the centre of the saddle (Don’t ask me why they still make them like this!) will once again contribute to pressure in all the wrong anatomical areas.
  
  I often recommend a saddle that is relatively flat on the top (no central high point), with a sufficient cut-out that is surrounded by soft edges. In my practice, I always have a few NinetyK Line of saddles on hand to try, as they are designed and distributed by actual bike fitters.
  
  Be Warned! No matter how experienced your bike fitter is, and no matter what fancy gadgets they use, no one can perfectly match a specific saddle to your specific anatomy. This includes butt moulds and even pressure sensors.
  
  At the end of the day, sit-bone width measurements may be used as “guides” to help you determine a ballpark saddle width. A proper bike fit is paramount in helping you distribute the pressure on the bike’s touch points, including the saddle. Beyond that, it’s all about trying different saddles to find one that fits you best. 
  
  
• Wear Proper Cycling Shorts: High-quality, padded cycling shorts reduce friction and dampen pressure, helping to prevent saddle area discomfort.
  
  
• Use Chamois Cream: Applying chamois cream to areas that experience the most friction can reduce chafing and prevent sores. This is a must on longer rides!



6.  Foot Pain and Numbness

Cycling-related foot discomfort is usually caused by excessive pressure within the shoe which may cause pain (hot spot) and even numbness. Cyclists often experience this when their shoes are too tight or if the cleats are poorly positioned, especially when they ride for extended periods. 

Prevention Strategies:

• Wear Properly Fitted Shoes: I’ll be honest, more often than not, the cyclists I see come in with shoes that are far too narrow for their feet. Outdated notions that cycling shoes have to be tight persist heavily within the cycling community. Cycling shoes that are too narrow can excessively compress your forefoot and/or toes, leading to blisters, hot spots, and even numbness. Make sure your shoes fit well and allow for proper circulation.
  
  
• Adjust Cleat Position: If you use clipless pedals, ensure that your cleats are positioned correctly. Cleats that are too far forward can increase pressure on the balls of your feet and your toes. If you suspect this to be the case, consider moving them slightly back and then re-evaluate.
  
  
• Adjust the Cleat-Pedal Interface: Excessive pressure on one side of the foot can sometimes be alleviated with the properly placed wedges between the shoe and the cleat. However, you should delegate this task to a competent bike-fit professional.
  
  
• Specialized Insoles: While scientific support for this is essentially non-existent, it is possible that some cyclists will benefit from arch-supporting insoles. The over-the-counter options here are endless. If you choose to get fit for custom insoles (orthotics), you should get help from an orthotic provider who is aware of the needs of cyclists. There is only so much space in a cycling shoe! A standard orthotic is often too bulky for most cycling shoes. 



7.  Achilles Tendonitis

Achilles tendonitis is an overuse injury that affects the tendon connecting the calf muscles to the heel. This condition is relatively rare in cyclists, but it can occur from time to time. When it does it is often caused by either a poor bike fit or a calf that is not up for the job (or both).

A saddle that is too high causes excessive toe-pointing, over-engagement of the calves and therefore strain in the Achilles. On the other hand, a saddle that is too low may cause excessive heel drop, consequently exposing the Achilles to increased (and repetitive) stretch, leading to pain. Another bike-fit-related cause of Achilles tendon issues is poor cleat placement.

On the other hand, we must also consider that your Achilles is simply not conditioned for the repetitive strain that cycling places on the tendon, especially if you slam the pedals! This may be particularly true if you also participate in other activities that strain the tendon, like running for example.

Prevention Strategies:

• Adjust Saddle Height: If you feel you have to excessively point your toes, or drop your heel, it's likely your saddle height needs to be adjusted. 
  
  
• Adjust Cleat Placement: If your cleats look like they are slammed forward, try moving them back. Then, re-evaluate. 
  
  
• Strengthening and Stretching: Strengthening your calf muscles and incorporating stretches into your routine can prevent tendonitis by improving flexibility and resilience​.

Kudos to you for taking the time to educate yourself on the prevention of these, most common, cycling ailments. You have already done more than most cyclists! Sometimes applying all of this knowledge is difficult. But don’t worry, I’m here to help!

Discover and address training errors or biomechanical deficiencies early, before injury occurs

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