Physical Therapy for Cyclists: A Clinician’s Guide to Treating Riders Better (and Smarter)

Why Treating Cyclists Requires a Different Clinical Lens

If you treat endurance athletes long enough, cyclists will eventually make up a significant portion of your caseload. And when they do, you’ll notice a pattern: highly motivated patients, impressive aerobic capacity… and stubborn, recurring complaints that don’t fully resolve with traditional rehab approaches.

That’s because physical therapy for cyclists isn’t just about pain management or generic strengthening. Cycling is a closed, repetitive, constrained movement pattern performed for thousands of repetitions in a single position. If we don’t account for how the athlete interfaces with the bike, we risk missing the real driver of symptoms as clinicians.

So if you’re a PT who works with (or wants to work with) cyclists; let’s dive into how you can confidently treat cyclists, improve outcomes, and differentiate your practice beyond basic sports rehab.

1. Cycling Biomechanics Are Unique. Assess the Sport, Not Just the Symptoms

Cycling is not gait. It’s not squatting. And it’s definitely not “just cardio.”

Key biomechanical realities every PT should account for:

• The rider operates in a fixed sagittal plane with minimal variability

• Hip flexion is relatively sustained, not transient

• The diaphragm needs to be able to function from a disadvantaged position

Clinical implication: traditional strength or mobility screens may look “normal,” while the athlete continues to break down on the bike.

What to assess differently:

• Hip and trunk control in sustained hip flexion

• Movement quality under fatigue

• Ability of the thoracic spine and lumbar spine to work together in flexion

• Coordination across the entire pedal stroke, not isolated peak force

Treating cyclists in PT practice means zooming out from isolated impairments and evaluating efficiency, timing, and tolerance.

2. Stop Saying Cyclists “Need Stronger Glutes”

Let’s retire this blanket statement.

Most cyclists do not lack glute strength in a traditional sense. In fact, many will look quite strong in glute-focused exercises like hip thrusts or deadlifts. What they lack is the ability to use their glutes in a lengthened position over a long period of time.

Cyclists don’t lack glute strength; they lack hip stability (think the muscles deep to the glutes: piriformis, gemelli, obturator internus, and quadratus femoris). These muscles create the stability that the glutes need to work off of. Without them, it’s like trying to shoot a cannonball out of a canoe.

What their glutes do lack is the ability to put out significant power in a lengthened period of time for a long period of time. This changes the length-tension curve and requires the glutes to work at a more disadvantaged position.

What we commonly see:

• Adequate glute recruitment in upright or shortened ranges when glute max is tested, but poor force generation in a flexed hip position

• Decent MMT in external and internal rotation

• Back pain due to the paraspinals constantly having to counteract a hypertonic glute

Clinical takeaway:
Your goal isn’t maximal glute strength—it’s context‑specific glute function.

That means programming:

• Lengthened‑range hip extension work

• Exercises that bias coordination of hip stability over load

• Positions that mirror cycling posture

This reframing alone often changes outcomes dramatically for cyclists with knee, hip, or low‑back complaints.

3. Bike Fit Is a Clinical Tool—Not an Optional Add‑On

In physical therapy for cyclists, bike fit is not separate from rehab—it’s part of the intervention.

You don’t need to be a professional fitter to make meaningful impact. Even basic observations can uncover drivers of symptoms:

• Saddle height influencing knee and hip load

• Excessive reach increasing lumbar or cervical strain

• Cleat position affecting knee tracking and calf demand

Why PTs are uniquely positioned here:

• We understand joint mechanics, tissue tolerance, and motor control

• We can relate positional changes directly to symptom behavior

• We can reassess movement after making changes

When treating cyclists in PT practice, think of the bike as an extension of the kinetic chain—because functionally, it is.

👉Not sure where to start? Download my Ultimate Bike Fit Checklist for a guide that you can use in-clinic to assess patients’ bike fits.

4. Change the Quality of the Movement Before You Load It

Cyclists already accumulate enormous training volume. Adding more load without improving movement quality often backfires.

Effective rehab and performance support focuses on:

• Lumbopelvic control and coordination in sustained postures

• Ribcage mobility for breathing and force transfer

• Scapular stability for long‑duration weight bearing - the serratus anterior muscle is an incredibly important muscle for sustained posture on the bike.

This is not anti‑strength. It’s pro‑specificity.

Ask yourself:

• Does this exercise improve how the athlete rides?

• Does it translate to better tolerance at their pain point?

• Does it reduce compensatory strategies under fatigue?

If the answer is no, it may be strong—but not useful.

5. Screening for Cyclists Is Injury Prevention in Disguise

Many cycling injuries don’t start with pain—they start with subtle efficiency losses.

Incorporate cyclist‑specific screening into your evaluation:

• Hip coordination vs straight glute MMT strength

• Single‑leg control

• Fatigue‑based breakdowns rather than max effort tests

Early identification allows you to:

• Modify training before symptoms escalate

• Educate athletes on load management

• Position yourself as a long‑term performance partner, not just a rehab provider

This is where cycling injury prevention through physical therapy truly lives.

Final Thoughts: Treat the Rider, the Bike, and the System

Cyclists don’t need cookie‑cutter rehab. They need clinicians who understand the demands of their sport and can translate movement science into meaningful change on the bike.

When physical therapists approach cycling with intention—integrating biomechanics, positioning, and neuromuscular control; we don’t just resolve pain.

We help athletes ride better.

And that’s what keeps them performing on the road and on the trail.

👉Want to Treat Cyclists With More Confidence (and Better Results)?

If you’re a physical therapist who wants to work with cyclists, but feels like you’re not sure how to provide long-lasting and successful outcomes, book a Clinician Consultation now for an hour-long, one-on-one, deep-dive in how to become your area’s go-to physical therapist for cyclists.

My mentorship is designed for PTs who want a guidance and clarity for treating cyclists:

• How to assess cyclists differently

• How to integrate bike fit into your PT evaluation

• How to program strength and movement work that actually carries over to riding

This isn’t about becoming a fitter or chasing certifications. This is one-on-one mentorship and advice from someone who has treated hundreds of cyclists and gotten them back on the bike pain-free.

Sign up here and learn how to get the results you want for your patients on the bike today.