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Troubleshooting Pain^1,2,11,12,13

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PROBLEM	BIOMECHANICAL FACTORS	SUGGESTED BICYCLE ADJUSTMENTS/TREATMENTS
Neck	Cervical strains due to holding the head up with the body in horizontal position (hyperextension). Compounded by weight of helmet and turning the neck to look back.	Rest, stretching, and anti-inflammatory medicines. If problem persists, consider use of hybrid or recumbent bicycle encouraging more upright position of the body.
Shoulders	Muscle tension due to elevated and forward shoulders.	Try lengthening handlebar stem to avoid hunched position. Tilt head side to side while riding to prevent stiffening.
Back	Lower back strains due to curved back.	Try shortening handlebar reach, raise stem. Back must be flat. Stretch frequently.
Hand and wrist pain/numbness	Ulnar nerve and median nerve compression injuries.	Handlebars too low. Body weight on arms should not exceed 10%. Change hand position often, keep elbows flexed, and keep wrists straight, not bent! Increase handlebar padding and wear padded gloves. Use wider tires, lower inflation pressure and consider adding or adjusting front suspension. If problem persists, consider use of hybrid or recumbent bicycle which reduces weight borne on arms.
Groin, pubic area, buttocks	Butt soreness, pelvic aching. Urethral, vulval, rectal, trauma, numbness, and fractures. Impotence.	Ensure correct seat height and angle. Wear padded bike shorts and try a different saddle. Cutout saddles may help. Use lubricating ointments or talcum powders for chafing. Stand up periodically. With impotence, cease cycling. May take weeks or months to resolve.

PROBLEM	BIOMECHANICAL FACTORS	SUGGESTED BICYCLE ADJUSTMENTS/TREATMENTS	ILLUSTRATION
Hip	Usually trochanteric bursitis.	Try lowering saddle a bit. Iliotibial band stretching, ice, and anti-inflammatories.
Hamstrings	Leg-length discrepancies.	See advise for ankle/foot problems.
Knee pain, quadiceps tendinitis	General: usually due to patellofemoral pain syndrome or incorrect foot position.¹ Toe-in or toe-out positions of the foot. Tendon on inside knee painful: pes anserine bursitis. Forefoot varus: foot pronated inward. Causes stresses on the kneecap due to internal rotation of the lower leg. Forefoot valgus: foot inverted outward. Causes stresses on the kneecap due to external rotation of the lower leg.	Saddle too low or too far forward. Use rigid orthoses in shoes or medial wedge between shoe and cleat. Use rigid orthoses in cycling shoe or medial wedge between shoe and cleat. Add threaded spacer between crankarm and pedal.
Foot/ankle	Achilles tendonitis Metatarsalgia	Leg length discrepancies (also a cause of hamstring tendinitis and pes anserine bursitis). Correct overpronation, if present. Fit bike to the longer leg. On the shorter leg, if the thigh length of the leg is short, use a shorter crank on that side. If the lower leg is short, lift the shoe. Correct shoe position and use cushioning insoles.