With the Silver Comet Trail in our backyard, the Atlanta Beltline making plans to connect, and bike friendly areas north of the city, there has been an influx of recreational and avid cyclists in the Atlanta Metro Area.  Organizations like the Atlanta Bicycle Coalition and the PATH Foundation have made strides to increase mileage of bike lanes in the city as well as off-road trail availability. As the number of bicyclists has grown, so has the incidence of injuries due to cycling.

Although cycling is a mode of exercise with low joint stress, improper bike fit and/or improper training lay risk for postural pain and overuse injuries. According to Wilbert and colleagues (1995), recreational cyclists reported the most common sites of pain as neck (48.8%), knees, groin/buttock (41.7%), hands (31.1%), and back (30%). Tour cyclists more commonly reported pain in knees (65.2%), hands (40%), and low back (14.6%)1. The differences in injury sites experienced by tour level cyclists may be due to a poor training design that may not allow for enough recovery or include excessive hill training rather than a poor bike fit2.  Whether poor training or improper bike fit, physical therapists can play a significant role in the treatment of overuse injuries in cyclists and all athletes alike.

The Selective Functional Movement Assessment™ (SFMA) is a tool used by the physical therapists at One on One Physical Therapy to assess movement patterns in patients with known injury. The SFMA evaluates global movement patterns instead of assessing movement solely at the injury site, as it is widely documented that pain plays a role in the alteration of movement3. Impairments may not be localized to just injury sites and their residual effects may become sources of future problems4. The SFMA utilizes ten movement patterns to determine if a movement dysfunction is driven by decreased tissue extensibility, reduced joint mobility, or a stability and motor control dysfunction. Knowledge of the injured cyclists’ global movement impairments will help direct an individualized treatment plan, not only to treat the symptoms, but also to address the cause of pain and/or dysfunction.


Once the diagnosis and corresponding impairments are determined, physical therapists use their clinical knowledge of movement, palpation, and tools like the SMFA to direct treatment of the overuse injuries experienced by athletes. Plans of care are developed to address the muscle imbalances, loss of tissue extensibility, decreased strength, and reduced joint mobility to promote the athlete’s return to sport. Recommendations of a home exercise program by the physical therapist, an appropriate bike fit, and training protocols will help cyclists to prevent future injuries. If you or someone you know is experiencing pain related to bicycling, call our office today to schedule an evaluation with one of our specialized clinicians.

This is the beginning of a series of posts dedicated to the prevention and treatment of injuries experienced by cyclists.

Alexis Lowery, PT, DPT is a doctor of physical therapy that treats orthopedic conditions. She is a graduate of the University of North Carolina at Chapel Hill and Emory University, where she received her Doctorate of Physical Therapy. As an avid recreational cyclist, Alexis has pursued advanced knowledge in the injury prevention and treatment of cyclists.

  1. Wilber, C.A. et al. An epidemiological analysis of overuse injuries among recreational cyclists. Int. J. Sport Med, 1995;16(3):201-206.
  2. Cipriani, D. et al. The triathlon and the multisport athlete. Literature Review. J. Orthop Sports Phys Ther, 1998;27(1):43-50.
  3. Hodges, P, Tucker, K. Moving differently in pain: a new theory to explain the adaption to pain. Literature Review. Pain, 2011;152(3): 90-98.
  4. Glaws, K. et al. Intra and interrater reliability of the selective functional movement assessment. Int J. Sport Med, 2014; 9(2): 195-207.