Cycling and osteopathy — Sydney
Quick answer (60 sec read) Most cycling-related musculoskeletal presentations — neck and upper-back pain, lower-back pain, anterior knee pain — trace back to the interaction between riding position, riding load, and the body's current capacity. Max assesses all three together and builds a plan that usually keeps you riding in modified form. Three Sydney clinics. AHPRA OST0004003860.
Max sees road, gravel, and indoor-trainer riders across all three clinics — particularly from the Inner West (Bay Run loop and surrounding cycling routes) and CBD commuter riders. The common thread is sustained position plus repetitive load: hours in flexion loading the neck, lower back, and knees in a way few other sports do. Assessment looks at the rider, the load, and the position — in that order.
What cyclists see Max for
The most common cycling presentations across the three clinics:
- Neck and upper-back pain — the cervical extensors work hard holding the head up in a drop or aero position; long rides and aggressive setups commonly outrun their endurance. Indoor-trainer blocks in winter often trigger it. See neck pain →
- Lower-back pain — sustained flexion plus high pedalling load; often felt late in long rides or after step-ups in volume. See low back pain →
- Anterior knee pain — patellofemoral load from saddle height or cleat position changes, big-gear work, or rapid volume increases. See runner's knee (patellofemoral pain) →
- Achilles and calf complaints — most often after cleat or saddle changes that alter ankle load. See Achilles tendinopathy →
- Hand or wrist numbness — sustained pressure on the bars; usually position-related, referred for further assessment if it persists or progresses
What a cycling assessment involves
An initial cycling assessment is 60 minutes. It typically includes:
- Load history — weekly hours, terrain, indoor/outdoor mix, recent changes in volume, intensity, or equipment (new bike, new saddle, new cleats)
- Position factors — saddle height and setback, reach, stem and bar drop, cleat setup — screened as contributors, not as a substitute for a professional bike fit
- Movement assessment — hip and trunk mobility, cervical and scapular endurance, single-leg control, and strength testing relevant to the presentation
- Site-specific examination — palpation, joint range, and load tests as relevant
- Discussion of findings — what's been found, what it likely means, and what management would look like
- Initial treatment — hands-on management where clinically appropriate on the day
Where the position itself is the main driver, Max will say so and recommend a professional bike fit alongside the rehabilitation plan.
How Max approaches cycling load
Management focuses on matching riding load to current tissue capacity — most riders keep riding through rehabilitation at adjusted volume, intensity, or position. Off-bike strength work (cervical and scapular endurance for the neck, trunk and hip strength for the back, graduated knee loading) rebuilds the capacity side, guided by the same load-management principles used across running and return-to-sport care.
Modalities used in cycling presentations
- Manual osteopathy — primary hands-on tool for cervical, thoracic, lumbar, and hip contributors
- Dry needling — selective use for muscle-tension components (e.g., cervical extensors, quadriceps, calf)
- Exercise prescription — central to every plan; endurance and strength work matched to riding demands
See how Max works for detail on each modality.
Initial consultation $160 (60 min) · Follow-up $130 (45 min) · HICAPS available
See also:
Max Bellaiche · AHPRA OST0004003860 · Master of Osteopathic Medicine
Educational content, not medical advice. In an emergency, call 000.