Bicycling Health: Pain-Free and Fancy-Free!

Vera-Ellen rides a bike; courtesy

Springtime biking! Two words that bring a rush of happiness to many a Portlander’s heart. Whether you’re a seasoned year-round biker, a weekend warrior, or a pleasure rider, biking can both create a huge improvement in quality of life and occasionally introduce some aches and pains. So in order to address bicycle injuries, aches and pains, we’re writing a short series about health and bicycling in Portland.

Part 1: Accurate Structural Assessment and Preventive Care

One often-cited survey from California State University found that over 85% of recreational cyclists develop an overuse injury, with females nearly twice as likely as males to suffer from neck and shoulder pain due to cycling (1). Only 36% of respondents sought medical treatment for their pain. This shows that many people just passively associate biking with some kind of unavoidable pain. We are here to remind you that pain is not an unavoidable component of bike riding!

Are you riding with pain and ignoring it?

First of all, if you are having pain, treating the injured tissues is the first priority. This may seem obvious, but many people choose to ignore pain, especially if the pain only lasts during the bike ride itself. However, if the tissue continues to sustain damage, whether it’s a joint capsule, nerve, ligament, or muscle, your body will compensate in some way that will become more and more complicated to reverse over time. Seeking chiropractic, massage and acupuncture care constitutes an excellent first step in stopping the tissue damage and starting to reverse it.

What is the most efficient way to eliminate pain and restore function?

At Hawthorne Chiropractic we have found that the fastest and most effective way to treat pain is by smoothly combining a set of therapies which can be used simultaneously. Here is the general order of care for assessing and treating bike injuries and pain:

  1. Chiropractors will perform a detailed structural assessment to learn how your muscles, nerves, and joints are working together, identifying chronic strains and tensions that set off chain reactions of weakness and pain in other areas of the body. The chiropractor will give you stretches and exercises to help re-balance your body at home, while treatments in office will heal areas that can’t be changed by stretching and exercising alone.
  2. Hawthorne Chiropractic’s massage therapists are also chiropractic assistants and work closely with them to maintain a targeted treatment approach. Massage will help alter structural function and patterns of tension, allowing your home exercises to be more effective and helping you feel greater ease of movement.
  3. Acupuncture is used to gently and painlessly release trigger points and reduce inflammation and scar tissue within joints and around tendons. Our acupuncturist may also prescribe herbal soaks and compresses for home use to help heal and relax the tissues directly, using transdermal martial arts recovery formulas.These three therapies dovetail wonderfully to create a full plan of wellness which is surprisingly relaxing and fun to implement. The treatments are tailored to speed recovery time, so you can also be confident that you’re using a targeted approach for a shorter recovery period.

    Excellent posture. Now to gain some speed…

Now that pain is reduced or eliminated, how do you prevent it from coming back?

Once the more urgent pain issues have been identified and a plan of action created, the next step (and arguably the most important one) is to identify and correct the underlying mechanical imbalances on the bike. The most effective way to do this is to visit an experienced physical therapist who has been trained specifically for bike fitting. And yes, even if you have been using the same bike for years and it was already fitted to your body, it’s still imperative to get a re-assessment as bodies and bikes both change over time. There is also a wide range of skill and effectiveness in the bike fitting world, so getting a second opinion is not a bad option anyway.

Why should I see a Physical Therapist for bike fitting?

Many bike shops advertise bike fitting services using imaging technology, but the bike fitters in this sense are learning about bike fit from the perspective of the bike, not the body. A physical therapist can analyze how your various muscle groups are firing, how relatively restricted various tissues are, and can pair that knowledge with the physics of how the bike fits your body. We work closely with Kevin Schmidt, PT, the owner of PedalPT. For a more in-depth interview with him, please see our upcoming bike fitting article.

What can I do at home or outside of a treatment setting to maintain optimal cycling health?

Yoga, foam rolling, and regular muscle-relaxing baths are three of our top recommendations for maintaining a pain-free cycling routine. We promote any exercise or activity that allows the spine to gently extend back (rather than hunch forward), rotate the torso and open the hips, and allow the neck and shoulders to move more freely (such as swimming, playing soccer, dancing, even just pushups).

Here at Hawthorne Chiropractic we teach each patient the best ways to use foam rolling for maintaining muscle and tendon health. While foam rolling is highly beneficial when performed correctly, it can be ineffective when performed without personalized instructions. Contact our chiropractors for a foam rolling consultation for maximum effectiveness.

Yoga classes for bicyclists are springing up all over Portland, but in this case one must be careful as well. Some classes can be too intense for those with previous injuries or chronic complaints, so we recommend working with yoga instructors in a physical therapy environment, such as PedalPT, where they host weekly small yoga classes for bicyclists Wednesday mornings and Monday evenings.

You may also check out the book Pedal, Stretch, Breathe: The Yoga of Bicycling by Kelli Refer. This book details “relaxed yoga sequences to do before riding or while stopped at lights, post-ride stretches to keep your knees and hips limber, breathing tips to get you up any hill, a quick guide to the muscles you use while cycling, the basics of yoga philosophy to apply to your ride, and more.”

Lastly, our Acupuncturist Beth Griffing, LAc recommends an herbal bath soak using household spices to relax muscles and ease pain post-commute or post-workout. You may also use this bath prior to foam rolling for greater effectiveness! If you would like a stronger bath with a personalized Chinese Herbal external soak formula for treating more severe cramping and pain, contact Beth for a consultation.

Portland Biker Bath Soak


2 tablespoons grated fresh ginger

1 cup fresh or dried rosemary

2 tablespoons wine (preferably white or pink wine but anything will do)

3 cups water


Boil 3 cups water; add ginger and rosemary; turn off heat immediately. Let steep 5-10 minutes. Strain into bath water; add 2 tablespoons of white wine to bath water to facilitate transdermal movement of beneficial herbal compounds and further relax muscles. Optional: sea salts or epsom salts may also be added to the bath but are not necessary.

Soak 15-20 minutes; rinse with cool or cold water briefly, dry off by vigorously rubbing skin with a rough towel to promote circulation, and feel completely refreshed!


More Questions? We are just beginning the seriesPart II will introduce a few case studies from our clinic, detailing the treatment of some common biking injuries and bicycle – motor vehicle accidents. We will go into more detail about neck, knee, shoulder, and groin pain from biking. In the meantime, try out a few of the suggestions and let us know how they work for you!


1. Wilber CA, Holland GJ, Madison RE, et al. “An Epidemiologic Analysis of Overuse Injuries Among Recreational Cyclists.” International Journal of Sports Medicine. 1995: 16: 201-6.