A Guide to
Cycling Related Injuries

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Most people are familiar with many of the benefits of exercising, like improving muscle strength and endurance, reducing the risk of heart disease and stroke, and preventing obesity. While non-weight-bearing activities like cycling do not increase bone density, they are excellent for strengthening our muscles and keeping our heart and lungs fit.

Particularly for those with Musculoskeletal Health Conditions like Arthritis that prevent you from taking part in weight-bearing activities; Cycling can be a great way to keep fit, if done correctly..

Upper Limb Injuries:

Bruises and minor cuts are usually the leading injuries caused by cycling, followed by fractures, muscle strains, and sprains. However, serious injuries can occur. Certain chronic injuries or conditions can develop because of the prolonged awkward position required when road biking.


These can be categorised into tendon, bone, joint and nerve-related problems.


Tendinitis, involving the inflammation of hand tendons, can be aggravated by gripping the handlebars and using the brake or gear pedals.
Other chronic conditions such as lateral epicondylitis (tennis elbows), inflammation of your shoulder (rotator cuff) tendons and bursitis often are caused by excessive cycling.


Falling on outstretched hands can cause tendon and ligament injuries in the elbow or shoulder. More subtle injuries to the wrist include ligament tears between the small carpal bones, which requires a thorough examination by a specialist to establish a diagnosis.

Nerve Related Injuries:

A nerve related problem can be carpal tunnel syndrome, a compression neuropathy of the median nerve at the wrist. This could happen due to the prolonged hyperextension posture of the wrist while cycling. 

Joint Related Injuries:

Osteoarthritis, which more often impacts the base of the thumb, is aggravated by hand positioning during cycling. Cyclists can also experience an exacerbation of shoulder arthritis, especially those with poor posture or poor cycling techniques.

Bone Related Injuries:

The most common fracture caused by cycling is the fracture of the clavicle, i.e your collarbone. This fracture happens when the rider falls over the handlebars, and the resulting impact on the arm and shoulder girdle leads to a break in the bone. Fortunately, most clavicle fractures are treated non-surgically with a sling. However, fixing these fractures has become increasingly common to achieve the best result.
Wrist fractures are common too, particularly in the distal radius. The radius is one of the two forearm bones located on the side of your thumb: the part of the radius that is connected to the wrist joint is called the distal radius.

The most common fracture of the distal radius seen within adults would be the spongy bone portion of the forearm, where it meets the hand. Other injuries involving the wrist include the common scaphoid fracture.

Additionally, the smaller bones in the hand can also experience trauma from a fall, including phalangeal and metacarpal fractures, but these tend to be less common. Complex elbow and shoulder fractures can also happen, with large variations in the fracture patterns.

Surgical vs Non-Surgical Treatments

Our arms serve many purposes in our ability to function. They help us eat, dress, write, earn a living, create art, and much more.In order to function, our hands require sensation and movement in the shoulder and elbow joints, tendons, and muscles.

When something goes wrong in the arm, care must be provided to all the different tissues that are involved in the hand’s functioning.

We tend to manage these injuries sustained while cycling through different modalities. These include non-surgical and surgical treatments.Conservative treatment usually suffices to heal tendonitis and bursitis, including injections and physiotherapy. If non-surgical options fail, key-hole or minimally invasive surgery can be pursued.

More recently, new fixation methods have worked to revolutionise the treatment of fractures. With almost no long-term deficit, it involves an anatomic correction of the displaced bone followed by the placement of a plate and screws to allow for rapid recovery of function.

Surgical Options

Due to advancements in surgical techniques introducing less invasive procedures, there are now more options for treating cycling-related injuries.

While each of the methods available has its advantages and disadvantages, all have the same end goal of getting you back to your pre-injury self. The type of surgery performed depends on various factors which include your surgeon’s experience and familiarity with a particular procedure, what the problem is, the anatomy, as well as tissue and bone quality.

The three reconstructive techniques most common for upper limb procedures include traditional open surgery, arthroscopic repair, and mini-open repair. Some joint replacement options are available too

All-Arthroscopic (Key-hole) Repair

Nowadays, we choose to undertake all-arthroscopic (key-hole) repair for most upper limb problems.

During arthroscopy, your surgeon inserts a small camera called an arthroscope into your joint. The camera will display pictures on a television screen, which are used to guide miniature surgical instruments.

Because the arthroscope and surgical instruments are thin, your surgeon can use tiny incisions (cuts) rather than the larger incision needed for a standard, open surgery.

All-arthroscopic (key-hole) repair is usually a day case procedure and the least invasive method while also being associated with quick recovery.

Open Repair

If the injury is large, complex or if surgery is required outside the joint, a traditional open surgical incision (several centimetres long) is often required.

Mini-Open Repair

The mini-open repair uses newer technology and instruments to perform a repair through a small incision. The incision is typically 3 to 5 cm long.

Complete Joint Replacement

In replacement surgery, damaged parts of the joint are removed and replaced with artificial components, called a prosthesis.

The treatment options involve either replacing just one part of the joint (e.g. the head of the humerus bone, also known as the ball) or both sides of the joint, like replacing the ball and the socket (glenoid).

Severe fractures that are hard to reconstruct is a common reason people have replacements. When the head of the upper arm bone is shattered, it may be complicated for a doctor to put the pieces of bone back into place.

Further to this, the blood supply to the bone pieces can also be interrupted. In this scenario, your surgeon may recommend a shoulder replacement.Older patients with osteoporosis and patients with fractures involving arthritic joints are most at risk for severe shoulder fractures.

What You Can Do To Prevent Injuries

To minimise your risk of injury while riding a bicycle:

Wear a helmet

Half the admissions of cyclists to an emergency department are for head and facial injuries.

Protective gear is not practical for the upper limb since hand, wrist and elbow mobility is critical to performing the complex functions needed to manoeuvre a bicycle. Studies show that wearing a bike helmet reduces the risk of severe head and brain injury by 85%.

  • Ensure the helmet fits snugly but comfortably and does not obstruct your vision.
  • It should have a chin strap and buckles that are securely fastened.

Follow the rules of the road

  • Familiarise yourself with all of the cyclist related rules of the road.
  • Ride in the direction of traffic.
  • Follow traffic signs and lights.
  • Signal your turns and intentions so that drivers can anticipate your actions.
  • If you are riding with others, ride single file.
  • Ride defensively

    Be aware that drivers often do not see cyclists, so you must be fully aware of your surroundings and ready to act in order to avoid a collision.

    Be careful when riding next to parked cars to avoid being hit by an opening door.

    Choose bike routes wisely

    Avoid riding on high traffic roads.

    The most direct way to your destination is often not the safest option because vehicles will most likely take that route, so choose streets with fewer and slower cars.

    Whenever possible, choose roads with designated bicycle lanes.

    When a street lane is too narrow for a vehicle and bicycle to ride side-by-side safely, or if there are several parked cars on the street, you will need to join traffic and ride toward the centre of the road.

    If this causes traffic behind you to jam, or if cars are switching lanes trying to pass you, it is safest to find another quieter street.

    Avoid distracted cycling

    Do not listen to loud music with headphones, talk on your phone, text, or do anything else that can obstruct your hearing and/or vision while riding

    Take extra precautions while riding at night

    Wear bright fluorescent colours and make sure to have rear reflectors.

    Your working tail light and headlight should be visible from 500 feet away.

    No drugs or alcohol

    Never ride a bicycle while under the influence of drugs or alcohol.

    Never underestimate road conditions

    Be cautious of uneven or slippery surfaces

    Maintain your bicycle

    Be sure to check your bicycle’s mechanical components regularly (brakes, tires, gears, etc.), just like you would for a car.

    If your bike is not in good condition, do not ride it.

    Dress appropriately

    Avoid loose clothing and wear appropriate footwear. Never wear flip flops.

    For longer rides, wear padded gloves and use properly padded cycling shorts.

    If you commute on your bike, carry your belongings in a bag with close fitting straps.

    Pace yourself

    Cycling can be vigorous exercise, so it’s important to ensure you are fit enough to participate before you start pedaling.

    In addition, make sure you understand how to use the gear systems on your bike to help control your physical exertion level.

    Change riding positions

    Slight variations in your position can reduce stress on pressure points on your body and avoid overstressing muscles.

    Hydrate

    Be sure to carry water and food on longer rides. Drink a full water bottle for each hour you spend on the bike.

    As we get older, we tend to drink less water. Our bodies need eight 8-ounce glasses of water each day.

    Caffeinated beverages, such as coffee and tea do not count as hydration, but in fact act as a diuretic and remove water from the body.

    Supervise younger riders at all times

    It is recommended that younger children only ride in enclosed areas — away from moving vehicles and traffic.

    Stretching

    Cyclists are often pressed to fit workouts into their busy schedules which results in the act of stretching becoming neglected. This common mistake can reduce the effectiveness of exercise because better flexibility leads to better fitness.

    By becoming more flexible, you can improve your ability to move around. Any muscle tension you’re experiencing will reduce, and your posture will likely improve. Most importantly, stretching after each workout reduces your risk of injury.

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    The Pinnacle Global Health Manchester clinic offers a comfortable and inviting atmosphere for patients. The latest equipment such as MRI scanning technology and other diagnostic tools are available for patient convenience, as well as friendly nurses and staff to offer help and support at all times.

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