Common Cycling Aches and Pains

Do you remember the day the training wheels came off of your bike? Can you still feel the excitement and exhilaration? Now is a great time to pull the bike out of the garage, tune it up and take it for a ride. And now that we live in an era where a gallon of gasoline costs more than a grande nonfat latte, you can think about cycling your way to work a few times a week to help save a few dollars as you get your daily exercise. As with any other activity, I see more than my fair share of cycling injuries in my clinic. Below are a few precautions you can take to hopefully avoid any aches and pains.

Raise your seat! Most people ride with their bike seats too low and too far back. Low seats are generally responsible for achy knees, usually in the form of Patellofemoral pain syndrome.

If the seat is at the correct height, your knee should be almost straight when the pedal is at the bottom of the pedal stroke. A quick way to get your seat to the correct height is to raise the seat until your heel can barely touch the pedal at the bottom of the pedal stroke. While riding, the ball of your foot should be directly over the axle of the pedal. Any further back and your foot may slip off. Any further forward and you lose a lot of power production.

Slide your seat forward on the rails! Most of those low seats are also forward seats. By having your seat so far back it forces you to rotate your pelvis forward, placing more pressure on your perineum and lower back. The increased pressure on the perineum is the cause of numbness and discomfort that so many men experience with cycling. Part of the answer to this problem is a good seat, and the other part is proper positioning of that seat. The forward rotation of the pelvis also can place too much pressure on the lumbar facets. Known as facet syndrome, any prolonged extension can aggravate this condition.

With your cranks horizontal, a plumb line dropped from the bottom of the forward kneecap should run directly through the axle of the pedal. Time trial and triathlon bikes may be a little further forward than this and cruisers may be a little further back that this. You can adjust this measurement up to 2 centimeters based on your riding style.


Raise your handlebars! Well, maybe. If you ride a hybrid, city bike or a cruiser, then your bars can be several inches higher than your seat. With mountain bikes, the bars may be higher or lower depending on your flexibility and riding style. On road bikes and time trial bikes, the bar is very low, up to 5 inches lower than the top of the seat. Do not attempt this position unless you are physically ready for it. Handlebars that are too low force you to extend your neck, placing far too much pressure on the muscles that move and support your neck and head. One study of cyclists showed that the most common overuse injury report was to the neck, with almost half of the subjects reporting neck pain.


Get a good pair of gloves! Not only will they save you a lot of skin if you happen to crash, but they’ll protect a very delicate nerve that passes through your palm. Cyclist’s palsy, a condition where the ulnar nerve is impinged as it passes through the tunnel of Guyon, is often avoided by simply wearing well-padded gloves.

"Other" Approaches to Hypertension

It may seem strange that a column devoted to avoiding and treating musculoskeletal injuries would kick-off with a subject like hypertension. I am fascinated by hypertension (and diabetes) because they have become endemic to our society. Let's face it, while a quad strain may be a bummer because you can't run for a few weeks, at least it won't kill you. We are surrounded by people suffering from high blood pressure. With heart disease as this country's leading cause of death as of 2007, I hope this little bit of information will empower even a few people to take control of their life and body.

The National Institute of Health estimates ¼ of adults have high blood pressure, defined as pressure greater than 140/90mmHg. Because symptoms of high blood pressure may take decades to manifest, many of these people likely have no idea of the internal damage occurring in their bodies. For those interested in addressing high blood pressure through methods other than popping a pill every day, recent studies have found some simple and amazing methods to lower blood pressure.

There’s an old saying among dieticians and nutritionists: avoid anything white. That includes refined sugars, saturated fats, refined flour, white rice and white potatoes. Anyone who has ever washed and peeled a beet knows that beets are anything but white. The Journal of Hypertension helps to support that axiom. They found a daily serving of 500mL (that’s slightly over 2 cups) of beet juice lowered, on average, systolic pressure by 10.4mmHg and diastolic pressure by 8.1mmHg. Researchers theorize that beets’ high concentration of dietary nitrate (no, that is NOT the same evil substance that you find in hot dogs and processed meats) are responsible for the reduction in pressure. Maybe it’s time you dig that Jack LaLanne juicer out of the cabinet? To read the journal article in full, click HERE.

The DASH (Dietary Approach to Stop Hypertension) diet was created in conjunction with the US Department of Health and Human Services, the National Institutes of Health and the National Heart, Lung and Blood Institute to avoid developing and to treat high blood pressure. It is a fairly simple diet, characterized by low sodium and low dietary fat intake. The DASH diet now has two versions: the standard DASH diet and the lower sodium DASH diet. Both DASH diets aim to reduce the amount of sodium in your diet, but the lower sodium DASH diet encourages an even further reduction in the amount of sodium you eat. When followed, studies have shown a decrease of diastolic pressure by up to 14mmHg. To read more, click HERE.

Even chiropractic manipulation has been shown to reduce blood pressure. The results of a clinical trial showed a high level of efficacy with a chiropractic adjustment of the upper cervical spine. Compared to the control group who received a “sham” adjustment, those who received the “real” procedure saw an average 14mmHg greater drop in systolic blood pressure, and an average 8mmHg greater drop in diastolic blood pressure. To read more about this study, click HERE.

This Blog's Purpose

I chose to become a chiropractor because I am fascinated by biomechanics (my first love!), enjoy working one-on-one with patients to help them improve, and I have been treated by a lot of great chiropractors whom enabled me to continue training and racing despite my own obsessive training regime.

It was a visit to my brother-in-law, Dr Daniel Jacobsen, back in the early '90s that opened my eyes to what a chiropractor could do. At that time, I was running 80-90 mile weeks training for a marathon. My hip had been hurting so badly for a few weeks that, while I could still run, I could no longer stand without intense pain. It was my sister who convinced me to see Dr Dan (after I had already sought relief from my general practitioner, my running coach and a massage therapist). Prior to this, I had no idea what a chiropractor could or would do. After treating me twice that first day and teaching me a dozen stretches and exercises, I was able to run that evening pain-free! "WOW", I said.

So, my own journey to this profession took me to working for a major running shoe manufacturer (where I honed my observations on running biomechanics) to becoming a strength coach for professional athletes and weekend warriors alike.

Because of my history of athletics as well as the specialized knowledge that I've amassed, on a weekly basis I receive numerous requests for help from injured people all over the world. Despite the obvious limitations of email and telephone, I help however I can.

With this column, I hope to preemptively "attack" some of those requests for help. This blog is a combination of what's new in health and fitness, case reports (of both the mundane and not-so mundane type) and injury/illness avoidance advice. Please, if you have an injury or problem that you are concerned about, find a health care practitioner that can diagnose you.

I firmly believe that the type of provider is not important---whether he or she is a chiropractor, medical doctor, physical therapist, osteopath, nurse practitioner, acupuncturist, et al, the most important attribute is that the practitioner listen to you. Secondly, find a provider who "does" what you "do". Only a runner truly understands running injuries, and surfers best understand surfing injuries, etc.

I hope you find this helpful. I also hope to see you out there on the water, trails or roads sometime soon!
chiropractor chiropractic physical therapy orange county newport coast balboa irvine costa mesa newport beach laguna tustin huntington beach fountain valley turtle rock triathlete triathlon ironman 70.3 cycling mountain bike mountain biking paddleboard paddle board run running marathon injury rehabilitation rehab wellness active release technique art chiropractic chiropractor nsca cscs national strength and conditioning association certified strength and conditioning specialist strain sprain tendonitis tendinitis trauma surf surfing surfer sup