Top 10 Chronic Mountain Bike Injuries

Top 10 Chronic Mountain Bike Injuries

Mountain biking is a dangerous sport. When the average person hears that I am a mountain biker I think they imagine me in a full-face helmet going over gnarly drops and risking life and limb. This is only half true.  As a cross-country rider I’m subject to two different types of injuries: acute and chronic. While the average person might look me up and down as if assessing, how many broken bones I’ve had in my life, they are forgetting a whole different type of injury that we risk every time we saddle up to ride. 

While the catastrophic and acute injuries create the best stories to tell your buddies over a beer, it’s often the slow stalking type of injuries that really limit an individual’s ability to enjoy this sport. Insidious injuries, or injuries with a gradual onset can sometimes be the most difficult to diagnose because there is no one clear moment that caused the pain to begin. Sometimes these injuries are due to overuse or repetitive microtraumatic stress on a specific body structure. These injuries often inspire statements like, “It’s felt like this forever.” “I don’t know how it started, it just did.” “It feels like it has just gotten worse and worse overtime.” From a sport’s medicine standpoint, these injuries when lasting for several weeks or months are usually considered chronic.

Chronic injuries can end up being some of the most dangerous. They nag and they hurt, but not always enough to seek medical help. The injuries can sneak up on you and before you know it you’ve been living with pain for months. I’ve complied my list of Top 10 mountain bike chronic injuries. (Not from personal experience, thankfully).

Photo: J Vargus

Knee: Knee pain might be one of the most common injuries among cyclists. According to some sources, up to 65% of cyclists experience knee pain at one point or another. Not all knee pain is created equal though. What are you experiencing?

IT Band Friction Syndrome: This injury generally occurs due to overuse and is common in cyclists and runners. Pain is described when the leg is bent slightly (about 30 degrees). On average, how many times per ride do you think you straighten and bend your knee? At this point, the fibrous IT band shifts across a bony prominence, which can cause pain and inflammation.  The pain is generally described on the outside of the knee and is often treated or avoided with hip strengthening.

Patellar Tendonopathy: This pain will often occur in the lower portion of the knee due to small micro-tearing of the tendon that connects the shin and the knee cap. This can occur by creating a malaligned mechanism within the knee. In other words, your cleat position or seat height might be off. It can also be exasperated by pushing too high of a gear.

Patellofemoral Pain Syndrome:  This injury is usually diagnosed by ruling out other options. Pain will be spread throughout the front of the knee and often be associated with clicking or popping. Females are nearly 2x as likely to have to deal with this injury than men. Despite being such a general injury, it can drastically affect your ability to ride. To help avoid this injury, increase your training load gradually, never increasing more than 12% in volume each week.

Hip:  The hip is a very complicated array of structures. It’s a difficult portion of the body to navigate and diagnose. While your hip pain could be caused by any number of factors, here are my top two that I have seen on the bike.

Piriformis Syndrome: An individual with piriformis syndrome will experience burning, pain, and numbness in the hip region. The sciatic nerve runs just below the piriformis muscle and becomes trapped when the piriformis is over-activated. This athlete should implement a strengthening and stretching routine into their daily workout plan (yes, even if it takes away from ride time.)       

Snapping Hip Syndrome: This injury is exactly what it sounds like, literally. If you have this injury, you will hear an audible snap when your hip bends and extends. The cause may be from your hip flexor or the dreaded IT Band.  The repetitive nature of cycling can cause overuse of the hip flexor and lead to snapping hip syndrome.

Back: I hear a lot of people complain of back pain while riding their bike. Most of the time it is just a muscle spasm from the difficult and bumpy trails that we ride. Sometimes, though, the pain is from something deeper which causes a pain-spasm- pain cycling. The body feels pain so the muscles spasm to guard the pain, then the muscle spasm causes pain and so on and so on.

Facet Join Dysfunction: When the vertebrae stack on each other, a small joint forms on the sides of the vertebra. Facet joint dysfunction involves these small joints being misaligned, stiff, or otherwise compromised. This can cause pain when bending backward or to the side. The first thing you should do if you think that you might have this condition is limit muscle spasm with rest, ice, and stretching.

Elbow: This is probably one of least common chronic injuries on the bike, although I have heard of cyclists complaining of elbow pain. On the mountain bike, our elbows give us a 2nd set of suspension to our fork. They allow us to cushion extra bumps and drops, unless of course they are in too much pain.

Tennis Elbow: This certainly isn’t just for tennis players out on the court. This injury involves an overuse of the tendons and muscles on the outside of your elbow.  If bending the back of your hand toward the back of your forearm causes you pain, you might be suffering from this condition. When riding, focus on keeping your wrists neutral, elbows bent, and grip as loose as possible. You should also re-evaluate the height and width of your bars.

Hand: While hand injuries sometimes seem more like inconveniences than actual injuries, your ability to hold onto the bars is imperative to your comfort and your safety.

Carpal Tunnel Syndroe: Ok, you’re right, this is not a usual mountain bike injury. However, carpal tunnel involves the compression of the median nerve causing pain. With the perfect storm of predisposing factors, this injury is often seen in activities that create repetitive vibrations such as jackhammering.  I’m sure that all mountain bikers would agree that when riding particularly rough terrain it does in fact feel like you are holding onto a jackhammer.

Ulnar Nerve Palsy: Contrary to the last injury, this one is specific to cycling. In fact, it is often called “handlebar palsy.” The ulnar nerve runs right under a small bony projection on the pinky side of the palm of your hand. When gripping the handlebars tightly, cyclists have reported the feeling of their pinky going numb. This is due to the compression of that small portion of the ulnar nerve. Next time you ride, focus on loosening your grip and change the angle of your handlebars if necessary.

            Injuries are always difficult to deal with. They can cause an athlete to doubt all of their hard earned work or simply take the fun away from shredding trails. Sometimes, though, just understanding what the injury is makes you feel better. If not, I’m a huge advocate for bike fits. While they can cost a decent chunk of change you are paying for your comfort and health in the saddle. And, as always, if an injury progresses or is causing considerable discomfort follow up with a doctor to receive professional treatment.  Ride lots, ride fast, and ride healthy!


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