How to treat and prevent biking injuries
As a biker herself, sports medicine specialist Emily Levy, MD, sees her share of people who love biking but end up with knee injuries, clavicle (collarbone) fractures and other types of joint pain that may well have been prevented.
With biking season and cycling races going full speed ahead, Dr. Levy breaks down the two major types of injuries from biking (traumatic vs overuse), how to prevent these injuries, how to relieve your pain and more.
Traumatic injuries from biking
The single most important safety tip is always wearing a helmet. As Dr. Levy reminds us, "the brain is the most important muscle we have in the body!"
Dr. Levy also cautions bike riders to be safe on the roads and avoid car traffic areas as much as possible. Cars are bigger than bikes and even when there are bike lanes, you should always be aware of your surroundings.
One of the most common biking injuries she sees is a broken clavicle, usually from having been thrown off a bike by a car. While car-related biking injuries present the added risk of head trauma and more significant injuries, a broken clavicle may require surgery and approximately three months of recovery time.
What to do after a bicycle accident
A significant traumatic bike injury should be evaluated by a health care professional.
Make an appointment online with a sports medicine specialist
Seek immediate emergency medical care if you experience any of the following:
- Loss of consciousness
- Vomiting
- Severe headache
- Confusion
- Difficulty walking
- Vision changes
- Excessive drowsiness
- Dizziness or vertigo especially with sitting up or standing and walking
Overuse biking injuries
Any kind of biking can cause quadriceps tightness, stiffness and fatigue, which can then lead to common overuse injuries. For example, because quads attach to the kneecap, not stretching sufficiently can cause the muscle to tighten and pull on the kneecap. This causes the kneecap to sit where it's not supposed to sit. As a result of that “pull,” the cartilage underneath gets inflamed.
However, most nontraumatic bike injuries are due to either bike fit or doing what Dr. Levy refers to as “too much, too fast”:
- Injuries due to bike fit: A seat, also known as a saddle, that is too low puts too much pressure on the kneecap. Conversely, a saddle that is too high can overload your hamstrings.
- Injuries due to too much, too fast: Biking makes it easy to pick up speed faster than your muscles are ready for. As with most physical activity, if you're not properly warmed up or ready, you may be in pain for several days following your bike ride. Pushing too hard on hills or carrying extra weight on your bike can increase this pain.
How to prevent injury while cycling
When it comes to biking, the type of prevention you want to try may depend on the type of injury you are trying to prevent. But it's important to note that all of these tips can be beneficial to your whole body.
Preventing injuries due to:
- Bike fit: Bicycles can sometimes be complicated, but one of the easiest and most important things to evaluate is your seat height.
- Too much, too fast: Managing training load is important. Increasing mileage by 10–20% per week is a reasonable goal. Slowly increasing resistance or hills also helps. In addition, the cross-training recommended below for knee injuries can mitigate excessive stress on the body.
How to relieve pain after cycling
When someone has pain, adjusting the bike fit or backing off the mileage or hills can relieve pain. If pain persists despite these changes, having a formal bike fitting or going to physical therapy to work on biomechanics can resolve the issue.
When to talk to a specialist
If pain persists after these measures, it's important to follow up with an orthopaedist or sports medicine clinician.
They can provide personalized care for bikers, including:
- Identifying the root cause of your pain through examination and diagnostic imaging when needed
- Creating a customized treatment plan to relieve pain while maintaining your cycling routine whenever possible
- Preventing minor injuries early before they progress into long-term or severe conditions that could require more aggressive surgical or non-surgical approaches
What to do if you're prone to knee injuries
To relieve knee pain from biking, do quad stretches as the muscles recover. Or work different muscle groups with other types of exercise, rather than doing the same repetitive motion of cycling.
If you have an existing knee injury, and depending on the extent of that injury, aim to complete three different types of exercise every week:
- Aerobic exercise: Things like your existing biking routine or running or swimming to get your heart rate up
- Mobility exercise: Including stretching and flexibility training or yoga
- Strength training: Such as weightlifting to make your quadriceps and supporting muscles stronger
Most injuries come down to not having done these three things, which can really help preserve the knee and prevent re-injury.
How to treat knee pain from biking
The best way to deal with knee pain depends on the type of bike accident you had and how long your pain lasts.
If you have:
- Pain from a traumatic episode, such as falling and twisting your knee resulting in swelling or limping, see an orthopaedic clinician for an immediate evaluation
- Pain that persists three to four weeks after biking, also consult a health care professional
- Pain when squatting or pain that wakes you from sleeping without a known cause, talk with a sports medicine specialist to help identify and treat the underlying issue
Is the risk the same with spin class
With spinning in particular, people don't expect stationary biking to cause knee damage because there's less joint impact than riding a bike outdoors. However, spinning relies on many of the same muscle groups and repetitive movements as outdoor cycling.
People who take spin classes can also experience "too much, too fast" injuries. They may skip spin class then return and spin as hard as they can. Even in the confines of a gym, these peaks and valleys of strain can place extra stress on your body.
It's better to incorporate a variety of exercises into your training routine (not just spinning) and at consistent loads rather than trying to make up for inactivity by powering it out.
What about e-bike injuries
Since e-bikes can go much faster than pedal bikes, the risk of injury is greater. One of our trauma physicians shares tips she uses herself to prevent injury when she rides her e-bike. She also explains common injuries, battery risks, helmet safety and what to know before buying an e-bike or e-scooter.
Next steps
If you have ongoing or worsening pain while biking or spinning, a sports medicine physician can help you get a clear diagnosis and personalized treatment plan:
Make an appointment online with a sports medicine specialist
Learn more about Emily Levy, MD.
Learn more about orthopaedics and sports medicine at Main Line Health.
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