Top 3 Overuse Injuries in Colorado Road & Gravel Cyclists — And How Physical Therapy Can Keep You Riding Strong

Colorado is a cyclist’s dream. From the smooth tarmac of mountain passes to the rugged challenge of gravel routes like the Colorado Trail or the Unbound Gravel race scene, our state’s roads and trails invite epic rides.

But epic mileage and challenging terrain come at a cost: overuse injuries. Unlike traumatic crashes, these injuries develop gradually from repetitive mechanical stress, subtle movement faults, and muscle imbalances that are compounded over thousands of pedal strokes.

At Rise Rehabilitation & Sport Performance (Rise RSP), we see these patterns every riding season. The good news? With the right evaluation, targeted strength work, and proper bike fit adjustments, most of these problems are completely reversible — and preventable.

Below, we break down the top three overuse injuries we see in Colorado road and gravel cyclists, explain the anatomy and physiology behind them, and share exactly how we approach treatment using objective muscle strength measurement — so you’re not just guessing what to fix.

1. Knee Pain — Patellofemoral Pain Syndrome (PFPS) & Patellar Tendinopathy

What’s Happening in the Knee

The knee joint functions like a hinge but is influenced by forces from above (hip and pelvis) and below (ankle and foot). The patellofemoral joint is where the kneecap (patella) glides in a groove on the femur (trochlear groove) as you bend and straighten your leg. In cycling, this movement happens 80–100 times per minute for hours on end.

• PFPS: Pain occurs when the patella doesn’t track smoothly, leading to increased pressure on the cartilage and surrounding tissues.

• Patellar Tendinopathy: Repetitive high-force loading (like sprinting, climbing, or grinding big gears) stresses the patellar tendon fibers, causing microscopic tearing and degenerative change.

Why Colorado Cyclists Are at Risk

• Long climbs with sustained knee flexion angles of 60–90° increase patellofemoral compressive forces.

• Gravel and rough terrain require higher torque at lower cadences, stressing the patellar tendon.

• Poor bike fit (too low saddle height, excessive forward seat position) shifts load toward the anterior knee.

Physiological Mechanisms

When the quadriceps isn’t firing effectively, the patella can drift laterally, increasing joint shear forces. At the tendon level, collagen fibers lose alignment and the tendon’s ability to store and release elastic energy decreases, making it more injury-prone.

How We Treat It at Rise RSP

We don’t guess which muscle group is weak — we measure it. Using digital muscle dynamometry, we compare quadriceps, hamstrings, and glute strength side-to-side and against normative data.

If quad strength is deficient → targeted eccentric and isometric loading protocols are prescribed. If glute activation is poor → hip abductor and extensor strength work is prioritized to reduce knee stress.

PT Plan Includes:

• Saddle height and setback adjustments to achieve ~25–30° knee extension at bottom dead center.

• Quad activation drills (terminal knee extensions, step-downs).

• Eccentric decline squats for tendon loading.

• Soft tissue mobilization for quads, hip flexors, and IT band.

2. Iliotibial Band Syndrome (ITBS)

What’s Happening Anatomically

The iliotibial band is a thick band of fascia running from the tensor fasciae latae (TFL) and gluteus maximus at the hip down to the lateral condyle of the tibia. It stabilizes the knee laterally during movement.

In cycling, the repetitive flexion-extension causes the IT band to rub over the lateral femoral epicondyle, especially between 20–30° knee flexion — the range where most pedal strokes pass thousands of times per ride.

Why Colorado Cyclists Are at Risk

• Long days in the saddle over mixed surfaces mean more lateral pelvic drop if hip abductors are weak.

• Climbs encourage pulling through the top of the pedal stroke, which can overwork the TFL and underuse the glutes.

• Slight cleat misalignment (“toed-in” position) increases IT band tension.

Physiological Mechanisms

Weakness in the gluteus medius leads to poor pelvic control, increasing the side-to-side sway of the femur and stretching the IT band. Over time, the friction causes localized inflammation of the underlying bursa or compression of richly innervated tissue — which explains the sharp, pinpoint pain cyclists feel on the outside of the knee.

How We Treat It at Rise RSP

First, we measure hip abduction strength using our force-measurement tools. If it’s deficient, your knee pain isn’t going away until your glutes are stronger.

PT Plan Includes:

• Cleat and pedal alignment check.

• Progressive strengthening of gluteus medius and minimus (side planks with abduction, monster walks, single-leg deadlifts).

• Neuromuscular re-education to shift load from TFL to posterior glute fibers.

• Myofascial release for the TFL and quads — not to “stretch” the IT band (which doesn’t really stretch), but to reduce surrounding tissue tension.

3. Neck & Lower Back Pain

What’s Happening in the Spine

Cyclists spend hours in a flexed spine posture with cervical extension (neck craned up to see the road). This combination loads the cervical facet joints, strains the levator scapulae and upper trapezius, and puts the lumbar paraspinals under constant isometric tension.

Gravel riding amplifies the problem — small vibrations travel up from the handlebars, fatiguing stabilizing muscles and irritating facet joints.

Why Colorado Cyclists Are at Risk

• Extended climbs and descents require sustained postural endurance.

• Gravel surfaces create low-frequency, high-volume vibration exposure, fatiguing spinal stabilizers faster.

• Aggressive aero positions on road bikes demand more neck extension.

Physiological Mechanisms

Prolonged static contraction in spinal extensors leads to reduced blood flow (ischemia), triggering muscle fatigue and pain. In the cervical spine, the deep neck flexors often become inhibited, leaving superficial muscles to overwork — a common source of stiffness and tension headaches.

How We Treat It at Rise RSP

We start by assessing isometric endurance of neck flexors and trunk stabilizers using timed holds and force output tests.

PT Plan Includes:

• Handlebar height and reach adjustments to reduce spinal strain.

• Deep neck flexor activation (chin tucks with pressure biofeedback).

• Thoracic mobility drills (cat-cow, thread-the-needle).

• Core stability work (pallof press, bird dog, dead bug) to maintain neutral lumbar position.

• Education on micro-breaks: standing on pedals every 10–15 minutes, frequent hand position changes.

The Rise RSP Advantage — Precision Over Guesswork

Many cyclists try generic stretching or strength routines and wonder why they don’t get better. At Rise RSP, our philosophy is simple: Don’t guess. Test.

We use muscle dynamometry, range-of-motion sensors, and movement analysis to pinpoint:

• Which muscles are actually weak.

• Whether mobility or strength is the limiting factor.

• How your pedal stroke and bike fit are influencing your symptoms.

By knowing exactly what’s off, we can create a plan that gets you back to pain-free riding faster — and keeps you there.

When to Seek Help

If pain persists for more than a week, worsens with riding, or changes your pedal mechanics, it’s time to get evaluated. Overuse injuries rarely “just go away” — and continuing to ride through pain often makes recovery longer.

Final Word

Colorado’s road and gravel routes will push your endurance, your strength, and your bike handling — but they shouldn’t push your body into chronic pain. With the right evaluation and targeted treatment, you can keep riding the high passes, gravel grinders, and weekend group rides without being sidelined by overuse injuries.

Ready to fix your pain and ride stronger? Call us at (720) 248-4386 to schedule your free discovery call and get back in the saddle pain free!