Cycling is a means of both exercise and transportation across the globe. As with any form of exercise, the cardiovascular and overall fitness benefits usually outweigh the risks. However, clinicians should still be aware of both sides of the equation in order to provide optimal care for their patients.

Injury risks

Cycling is a common cause of exercise-related injury, with up to 85% of all recreational cyclists citing an overuse injury.

Lee A, Breyer BN. Bicycle riding: good or bad for men’s health? Urology Times Journal. 2020;48(3).

Anatomic regions most often affected by cycling include the neck, wrists, hands, lower back, knees, and perineum, consequent to the uneven pressure distribution experienced while on a bicycle.

In men, cycling has been closely linked to an increased rate of genital numbness, but this did not appear statistically significant with respect to the outcome of erectile dysfunction (ED) in a study conducted by Dr. Breyer, one of the Urology Times authors.

Baradaran N, Awad M, Gaither TW, et al. The association of bicycle-related genital numbness and Sexual Health Inventory for Men (SHIM) score: results from a large, multinational, cross-sectional study. BJU Int. 2019;124(2):336–341.

“These findings suggest that increased cycling may increase risk of inducing perineal numbness, but that itself may not necessarily translate into worsened sexual function.”

Baradaran N, Awad M, Gaither TW, et al. The association of bicycle-related genital numbness and Sexual Health Inventory for Men (SHIM) score: results from a large, multinational, cross-sectional study. BJU Int. 2019;124(2):336–341.

In women, Dr. Breyer’s research group found that “women cyclists were no more likely to report sexual dysfunction or urinary symptoms than swimmers or runners.”

Gaither TW, Awad MA, Murphy GP, et al. Cycling and female sexual and urinary function: results from a large, multinational, cross-sectional study. J Sex Med. 2018;15(4):510–518.

Of greater concern are road-related incidents consistent with motor vehicle collisions, with one expert noting that “concussions are common in cyclists.”

Greve M. Acute cycling injuries. Phys Med Rehabil Clin N Am. 2022;33(1):135–158.

Traumatic brain injury (TBI) is the leading cause of death due to cycling injuries, while road rash is the most common injury overall in outdoor cyclists.

Indoor spinning

A particular health concern has arisen from extreme indoor spinning: The risk of exertional rhabdomyolysis. 

The most common symptoms in those presenting with rhabdomyolysis were myalgia, dark urine, and thigh muscle weakness.

Health benefits of cycling

While there are certain risks, cycling also offers health benefits. As noted by authors writing in Urology Times, “Cycling reduces the incidence of cerebrovascular accidents, coronary artery disease, hypertension, dyslipidemia, obesity, and diabetes mellitus.”

Lee A, Breyer BN. Bicycle riding: good or bad for men’s health? Urology Times Journal. 2020;48(3).

While cycling offers substantial health benefits, clinicians should be aware of potential risks and be prepared to address cycling-related injuries and conditions. Encouraging patients to cycle safely, use appropriate protective gear, and gradually increase exercise intensity can help maximize the benefits while minimizing the risks.