Cycling injury physio in London: assessment, treatment and your return-to-riding plan

By Geoff Scott, Founder & Senior Physiotherapist, Hauora

By Geoff Scott, Senior Physiotherapist and founder of Hauora, former Head of Medicine and Performance at Tottenham Hotspur. Reviewed by Jason Oliveira, Senior Physiotherapist, shoulder specialist and Hauora’s concussion expert. Last updated 14 November 2026.

Quick answer: most cycling injuries are either overuse problems, such as knee, back, neck or hand pain from hours in the same position, or crash injuries, such as a broken collarbone, a shoulder injury or concussion. Both recover best with an accurate diagnosis, a plan that keeps you riding where it’s safe, and a staged return to the bike based on tests you pass. At Hauora, our physiotherapy clinic in Primrose Hill, London, every cyclist gets a thorough assessment, a written treatment plan and a clear return-to-riding pathway.

Cycling injuries at a glance

The knee is the most common site of overuse injury in cyclists. Studies report knee pain in roughly 40% to 60% of recreational riders.
Pain at the front of the knee is the most common type, often from patellofemoral pain or tendon overload. Pain on the outside of the knee is often the iliotibial band (ITB).
Lower back, neck and shoulder pain are also common, especially in recreational riders who are less used to long hours in a riding position.
Bike fit matters, but it’s rarely the whole story. Research hasn’t found strong evidence linking any single bike-fit measurement to injury, so how much and how hard you ride, and how strong you are off the bike, matter just as much.
Crashes commonly cause collarbone, shoulder, wrist and hip injuries, and concussion.

Cycling injuries we treat

Knee pain: pain at the front of the knee, patellar and quadriceps tendon pain, and ITB pain on the outside. See our knee pain page.
Back and neck pain from long rides and aggressive positions. See our guide to back and neck pain.
Hip, buttock and hamstring pain, including hamstring injuries
Achilles and foot pain, including hot spots and numbness
Numb or tingling hands from pressure on the nerves at the wrist
Crash injuries: broken collarbones, shoulder injuries, wrist and hip injuries, and rehab after surgery
Concussion after a fall, with a staged return to riding. See our guide to concussion assessment.

What happens in a cycling injury assessment at Hauora

Your first appointment is with a senior physiotherapist and lasts 45 minutes. For riders who want the fullest picture, our 90-minute Hauora+ athlete session adds more testing and a longer planning conversation.

Your riding story. What you ride, how often and how hard, recent changes to your training, bike, saddle, cleats or shoes, and what you’re aiming for, from a commute to a sportive or a race. Your Strava, Garmin or power data is useful if you have it.
A clear diagnosis. A hands-on examination to find what’s irritated and why, and a check for anything that needs a scan, a surgeon or a doctor.
Strength and mobility testing. Quads, hamstrings, glutes, calves and trunk, compared side to side, plus the hip, back and neck mobility a riding position needs.
Your position on the bike. Photos or video of you on your bike are useful, and we’re happy to work with your bike fitter on any changes.
Your plan. A written treatment plan with clear stages, the tests you’ll need to pass, and how much riding you can safely keep doing.

Your treatment plan

Riding load first. Adjusting how long, how hard and how hilly you ride is often the quickest way to settle an overuse injury. Easier gears and a higher cadence usually take pressure off the knees.
Strength off the bike. Cycling builds endurance but not much maximum strength. Targeted gym work makes the knees, hips, back and neck more robust.
Small, careful bike changes. Saddle height, saddle position or cleat adjustments made one at a time, ideally with your bike fitter, so we know what helped.
Hands-on treatment where it helps, always alongside exercise.
Fuelling for long rides with our performance nutritionist, Dr Emma Tester, if it’s part of the picture.

Our return-to-riding pathway

You move to the next stage when you pass its tests, not when a date arrives. After a crash, we follow your surgeon’s guidance on any fracture or operation.

Settle and protect. Calm the pain, protect any healing injury and start the strength and mobility work you can do safely.
Indoor riding. Short, easy sessions on a turbo trainer, where there’s no risk of falling, building time before effort.
Ready-to-ride tests. Pain-free easy riding, enough strength and control in the injured area, and, after an upper-body injury, the ability to grip, brake, steer and support your weight on the bars safely.
Back on the road. Short, flat outdoor rides, then longer rides, then climbs and intervals, adding one thing at a time.
Group rides, sportives and racing. Once you’ve handled full training without symptoms.
Staying there. A maintenance strength routine and a plan for your next build-up.

After a crash: concussion and head injuries

If you hit your head, even with a helmet on, stop riding. UK guidelines say you shouldn’t ride a bike, drive or drink alcohol for 24 hours after a suspected concussion, and you should be assessed by a healthcare professional or call NHS 111 within 24 hours. Call 999 for warning signs such as being knocked out, repeated vomiting, a worsening headache, confusion or neck pain after a heavy impact. Jason Oliveira, our concussion expert, manages every part of a cyclist’s concussion recovery, from assessment to a staged return to the road, and arranges onward referral if you need it.

Why cyclists choose Hauora

Senior physiotherapists only. Geoff Scott spent two decades leading medicine and performance at Tottenham Hotspur and Nottingham Forest. Jason Oliveira, our shoulder specialist and concussion expert, spent seven years as a senior physio at Saracens.
Measured, criteria-based rehab, so you always know where you stand and what’s next.
Physio, strength coaching and nutrition under one roof, working from the same plan.
Close to where London rides. We’re in Primrose Hill, minutes from the Regent’s Park Outer Circle and close to the climbs of Highgate and Hampstead. Open Monday to Saturday, with same-day appointments often available.

Frequently asked questions

Why does my knee hurt when I cycle?

Pain at the front of the knee usually comes from overload, such as a jump in hills, big gears or mileage, sometimes combined with saddle position. Pain on the outside of the knee is often the iliotibial band. A physio assessment finds which it is and why.

Will a bike fit fix my injury?

It can help, but it’s rarely the whole answer. Research hasn’t found strong evidence linking any single bike-fit measurement to injury, so we look at your riding load and strength too, and work alongside your bike fitter.

When can I ride again after a broken collarbone?

It depends on how the fracture was treated and how it’s healing, so follow your surgeon’s advice. Indoor riding usually comes first. Riding outdoors waits until you can grip, brake, steer and react to a fall safely.

When can I cycle after a concussion?

Not within 24 hours of a suspected concussion. After that, follow a staged return, starting with gentle indoor riding. For amateur competition, UK guidelines say there should be no return to competition before 21 days from the injury.

Why do my hands go numb on the bike?

Usually from pressure on the nerves at the wrist. Changing hand positions often, padded gloves or bar tape, and a check of your reach and bar height often help. Get it assessed if numbness or weakness lasts after rides.

Can I keep cycling while I recover from a running injury?

Often, yes. Cycling is a useful way to keep your fitness during rehab for many running injuries. Read our guide to running injury physio.

Do I need a referral?

No, you can book directly. If you’re claiming on health insurance, check with your insurer first, as some ask for a GP or specialist referral.

Book a cycling injury assessment

Book at Hauora, At The Core, 44 Gloucester Avenue, Primrose Hill, London NW1 8JD. A 45-minute physiotherapy assessment is £155, and a 90-minute Hauora+ athlete session is £250. See all our fees, book online at hauora.com/book or call 020 4541 8924.

Finding us: Hauora is based inside the At The Core building, but we’re a separate business from At The Core. We share the building and the phone number, so when you call, please ask for Hauora.

This article is general information, not a diagnosis. If you’re injured or unwell, see a doctor or physiotherapist. After any head injury, get medical advice straight away.