Why cyclists get hurt

WHO counts cyclists among vulnerable road users, along with pedestrians and motorcyclists, and identifies helmets as an effective way to reduce serious head injury. The benefits of regular cycling for heart and metabolic health far outweigh the risks for most people, according to WHO's physical activity guidance. Many overuse problems come from a saddle height or reach that does not suit the rider, or from a sudden jump in mileage.

01Road crashes and head injuries

Collisions at junctions, car doors opening, and falls on poor surfaces are common causes of injury. Head injuries are among the most serious, and the NHS advises getting medical help after any head injury with worrying symptoms.

What helps

  • Wear a correctly fitted helmet on every ride.
  • Use front and rear lights and bright or reflective clothing, day and night.
  • Ride assertively away from parked car doors and make eye contact at junctions.
  • Plan routes that use cycle lanes and quieter roads.

02Knee pain

Pain at the front of the knee is often linked to a saddle that is too low or set back incorrectly, or to pushing big gears. Pain at the side or back of the knee can relate to cleat position or a saddle that is too high. The NHS notes that most knee pain improves with rest and adjustments.

What helps

  • Get a bike fit or check saddle height, setback and cleat position.
  • Spin at a higher cadence in easier gears rather than grinding.
  • Increase distance gradually.
  • Strengthen hips and thighs off the bike.

03Back and neck pain

A long or low reach to the handlebars and long hours in a fixed position strain the lower back and neck. Core strength and position changes help.

What helps

  • Adjust reach and handlebar height so you are not overstretched.
  • Change hand position and stand on the pedals regularly on long rides.
  • Do core and back strengthening twice a week.
  • Build up long rides gradually.

Weekly checklist for cyclists

  • Check lights, brakes and tyres before each ride.
  • Wear your helmet on every ride, however short.
  • Vary ride intensity through the week.
  • Do two short strength sessions off the bike.
  • Check bike fit after any change of bike, saddle or shoes.
  • Increase weekly distance gradually.

When to see a professional

  • Any head injury with headache, vomiting, confusion or drowsiness.
  • Knee pain that persists despite fit changes and rest.
  • Numbness in the hands or groin that does not settle.
  • Back pain with leg pain, numbness or weakness.

After a crash, call emergency services for loss of consciousness, a seizure, repeated vomiting, worsening headache or suspected neck or spine injury. Do not move someone with possible neck injury unless they are in danger.

Where ONU fits

ONU brings your activity, sleep and recovery trends together, so you can see how big riding weeks affect your sleep and recovery. It does not detect injuries or assess bike fit.

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Common questions

What is the right saddle height?

With the pedal at its lowest point, your knee should be slightly bent, not locked straight. A professional bike fit can fine-tune this.

Do bike helmets work?

WHO and road safety bodies identify correctly worn helmets as an effective way to reduce the risk of serious head injury in a crash.

Is cycling in traffic worth the health risk?

For most people, the health benefits of regular cycling outweigh the injury and pollution risks. Choosing quieter routes reduces both.

Sources and further reading

Educational information drawn from the public-health sources listed on this page. It is not a diagnosis, a treatment plan or a guarantee that you will avoid an illness or injury. ONU does not diagnose, treat or prevent disease. Speak to a qualified professional about anything that concerns you, and follow the rules of your employer, sport or local health service.