By Patricia Staszak, PT

Cycling is an excellent form of cardiovascular exercise that can be performed by people of all ages. It is primarily a non weight bearing exercise that is easier on the knees than running, walking and even the elliptical trainer.  However, as with any sport, due to the repetitive nature of the movement during cycling, overuse injuries are common.  Proper bike fit and cycling technique can reduce the incidence of these injuries. The purpose of this article is to discuss common cycling injures and the bike adjustments that may help improve the symptoms of these injuries.
Lower Body:  Pain at the Achilles tendon can develop for two reasons: moving your ankle too much while riding, or from the seat being too high or the cleats too far forward so you have to pedal more with your toes.  Numbness at the forefoot can result from wearing soft-soled shoes.   This occurs because the force from pushing  your foot through the pedal is absorbed in just the front of the shoe, instead of the whole shoe when a stiff cycling shoe is used. Shoes that are too tight also can cause compression at the ball of the foot and will sometimes cause numbness. 
Pain at the anterior knee could be a result of compression at the patellofemoral joint and may be a result of the seat being too low or too far forward.  Patellofemoral and ITB pain can also occur from a foot that pronates too much or too much toeing in with the cleat.  This can cause the knee to move in and out while pedaling, which can cause increased stress through the knee. Patellar tendonitis causes pain just beneath the kneecap and occurs as a result of cycling in too high a gear or riding on a lot of hills.  Pain at the back of the knee, hamstrings or upper calf muscles can result from the seat being too high.  
Trunk and Upper Body: Low back and neck pain are often related to poor posture on the bike. Low back pain may occur because of excessive rounding at the low back.  Riders tend to round because of an uncomfortable saddle that causes  them to tuck their pelvis under, instead of having pelvis tilted forward; tight low back or hamstring muscles can also cause this.  An uncomfortable saddle can be remedied by purchasing a saddle with a center cut out to unload the pubic area.   Low back pain can also be caused by excessive stress through your joints in your lower back.  This can occur from sitting and too much arch (or extension) in the low back, or with a seat that is too high and causes the hips to rock from side to side while riding.
Excessive rounding at the low back can also cause too much rounding at the mid back, which can contribute to compression through the neck and increased stress through shoulders.  A helmet that is too low in the front and causes a rider to keep the head tilted upward to see the road can also cause compression at the neck.
Shoulder and wrist pain can be caused by a seat that is tilted down at the front.  This causes the rider to slip forward and put more weight through the hands and arms.  Neck, shoulder, and wrist pain can also be caused by a variety of cockpit issues; handlebars that are too high or too low, a stem that is too long or two short or uneven hoods.