Frequency of Overuse Injuries and Associated Risk Factors in Competitive Road and Off-road Cyclists: A Narrative Review

Purpose: Competitive road and off-road cyclists train hard and participate in many races in the same season, decreasing rest periods and increasing the risk of overuse injuries. Hence, this study aimed to investigate the major overuse injuries in competitive road and off-road cyclists and to identify potential associated risk factors. Methods: We searched PubMed, Web of Science, and Google Scholar databases to identify English-language sources using the following terms: “overuse injury” AND “competitive road cyclists” OR “competitive off-road cyclists”; “risk factors” AND “overuse injuries in cyclists”. Studies investigating overuse injuries in recreational cyclists and triathletes were excluded. Results: Although the characteristics and performance patterns of the two cycling disciplines are very different, the main overuse injuries observed in competitive road and off-road cyclists were knee pain, low back pain, and buttock pain. Possible risk factors that emerged were bike fitting, training volume associated with low cadence, a rapidly increasing training load, prolonged lumbar flexion, anterior pelvic tilt, a weakness of abdominal and lumbar muscles and overweight or underweight conditions. Conclusions: This study describes the overuse injuries and the associated risk factors that competitive road and off-road cyclists might experience. These findings could help coaches and athletes prevent the occurrence of these injuries.