Portland’s cycling culture is built on repetitive motion—a low-impact, high-volume activity that, without proper form and fit, inevitably translates into overuse injuries. The common aches cyclists face—persistent knee clicking, radiating low back stiffness, and locked-up shoulders—are rarely just "part of the ride." They are mechanical signals demanding attention. Let’s look at the biomechanical relationship between your body and your bike, and how chiropractic, massage, and acupuncture are great tools for cyclists.
1. Three points of contact: The bike as an extension of the body
Your body interfaces with the bike at three points: The saddle, the pedals (cleats), and the handlebars. Small errors in any of these areas create cumulative stress on the joints.
Decoding Knee Pain: Location is the Clue
Knee pain is the most reported complaint among cyclists. Its exact location tells us precisely what needs adjustment on the bike or strengthening in the body.
Front of the knee (Patellar Tendinitis)
Saddle too low or too far forward. This increases knee flexion and compressive forces on the kneecap.
Quad dominance and weak glutes/hamstrings (the pedal stroke is driven entirely by the front of the thigh).
Back of the knee (posterior pain/hamstring strain)
Saddle too high or too far back. This forces the leg into overextension at the bottom of the pedal stroke.
Overstretched hamstrings and tight calves compensating for the reach.
Outside of the knee (IT Band Syndrome)
Improper cleat rotation (feet are fixed in an unnatural angle).
Weak hip abductors (glutes) and tight Iliotibial Band causing the knee to track laterally.
2. Advanced adjustments: Cleat float and saddle setback
The "quick fixes" for knee pain often revolve around two key settings that require careful attention:
Saddle height and setback: As saddle that is too low causes pain at the front (quad compression). A saddle that is too high causes pain at the back (hamstring overextension). Experiment with moving the saddle forward or backward (setback) to shift the load distribution: Forward loads the quads, backward loads the hamstrings/glutes.
Cleat rotational float: Cleats hold your foot fixed, but your knee naturally wants a few degrees of rotational freedom, called float. If your cleat offers too little float, or is positioned incorrectly, it forces the knee joint to absorb the rotational strain from the hips, leading to collateral ligament stress and IT Band Syndrome. Always ensure your cleats allow your foot to align naturally.
3. Stability is key
Low back pain in cyclists is often a stability problem, not just a flexibility problem.
Hip flexor tightness: Long periods in the flexed (forward-bent) cycling posture shorten the hip flexors (psoas). When you get off the bike, these tight muscles tilt your pelvis forward (anterior pelvic tilt), causing constant compressive load on the lumbar spine.
Weak core: Cycling primarily uses the muscles that generate movement (prime movers) but neglects the anti-rotation and stability muscles of the core. A weak core allows the pelvis to rock or tilt on the saddle, creating subtle but powerful shearing forces on the low back over thousands of pedal strokes.
4. Why professional assessment is critical
Everyday cyclists need to prioritize recovery and address the imbalances caused by high-volume, repetitive movement. However, the cause of pain is often a biomechanical issue that requires professional eyes and hands.
Massage therapy (targeted release): Licenced massage therapists can target the over-active hip flexors and the tight IT Band, directly addressing the source of low back and lateral knee pain. This releases the tension that prevents your body from recovering its neutral alignment.
Chiropractic (alignment and assessment): Chiropractic care focuses on restoring the structural integrity of the pelvis and lumbar spine and assessing functional leg length differences or glute firing patterns that contribute to knee and low back pain.
Acupuncture (inflammation control): Acupuncture is highly effective for reducing the chronic, localized inflammation associated with overuse injuries like Patellar Tendinitis or IT Band Syndrome, speeding up the recovery process.
If simple adjustments don't resolve the pain within two weeks, seek professional care. Your body needs to be assessed off the bike to ensure it's structurally capable of handling the demands on the bike.
The video below explains common overuse injuries in cycling and why evaluation of bike fit adjustments is key for treatment and prevention.
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