Training with an injury: what you can keep doing and what to stop

An injury rarely takes away all of your training. It takes away a part of it, and the part it leaves is usually enough to keep most of your fitness if you use it well. The question to ask is not "can I train?" but "what, specifically, is off the table, and what is still on it?" This post works through that question for the injuries cyclists actually get, with the caveat that a physiotherapist or doctor who has looked at you outranks anything written here.

What you stand to lose, and how fast

The reason to keep training at all is that fitness leaves quicker than it arrived. Coyle's group followed well-trained endurance athletes who stopped completely: VO₂max fell by roughly 7% in the first three weeks and continued down to about 16% below baseline by twelve weeks, with blood volume and stroke volume going first and muscle enzyme activity following. The general pattern is that the cardiovascular side drops within weeks and the muscular side over months. We cover the timeline in full in detraining: how fast you lose fitness.

The useful finding for an injured rider comes from Hickson's group. Their subjects trained hard for ten weeks and then, for a further fifteen, kept riding the same sessions at a third or two-thirds of the intensity. VO₂max fell and short-duration endurance went with it, even though the amount of riding had not changed. Spiering's 2021 review of minimal-dose training pulls together that study and its companions, where intensity was kept and frequency or duration cut instead, and concludes that endurance can be held for months on a fraction of the usual volume as long as the hard work stays in. If you have to give something up, give up volume, not intensity.

The injuries cyclists actually get

Clarsen, Krosshaug and Bahr surveyed professional road cyclists about overuse problems over a season. Lower-back pain was the most common complaint, affecting close to half of them in a year, and anterior knee pain was the one most likely to need time off the bike. Neck, hand and hip problems were further down the list. Traumatic injuries, meaning crashes, are a separate category with their own logic: collarbones, wrists, ribs, road rash and head injuries. Most of what follows applies to the overuse group, because that is where "what can I keep doing?" has an interesting answer. Crash injuries are mostly about waiting for bone to heal.

Knee pain

The default advice for a sore knee is the one most riders resist: reduce the load on the knee, not the load on the heart. The common patterns, patellofemoral pain at the front and patellar tendon or iliotibial band pain at the sides, are almost always load-related, and a long ride in a big gear is exactly the wrong medicine. What is usually still available:

• Higher cadence, lower force. The same power at 95 rpm puts less force through each pedal stroke than at 70. If a session hurts at 75 rpm and does not at 95, ride at 95.
• Shorter, flatter, indoors. A trainer lets you hold cadence steady and stop the instant something changes. Intensity is fine if the knee tolerates it; grinding is not.
• A bike-fit check. Saddle height and cleat position are the usual suspects and the fix is often ten minutes. See knee pain from cycling for the specifics.

Tendon problems in particular do not respond to rest alone. Malliaras's review of loading programmes for Achilles and patellar tendinopathy finds that progressive, tolerated loading, not avoidance, is what rebuilds the tendon. The practical translation is to find the amount of riding that produces mild, settling discomfort rather than none, and hold it there while it improves.

Lower back

Back pain on the bike usually comes from a position held too long, not from the pedalling itself, which is why it is so common in the professional survey. Almost everything stays available: shorter rides, a more upright bar position for a few weeks, standing up regularly, and intervals rather than four-hour days. We would keep the intensity in and cut the longest ride first. Core and hip work is the long-term answer; lower back pain on the bike and core strength for cyclists cover it.

Collarbone, wrist, ribs

A fractured clavicle or scaphoid takes you off the road until it is stable, but it does not take you off a trainer for long. Once the pain allows you to sit upright with the injured arm supported, indoor riding is usually possible well before outdoor riding is, and this is the point where Hickson's finding matters most: short, hard sessions on the trainer will preserve far more than easy spinning. ERG mode helps because you do not need to shift or steer. The Indoor app can run a workout with a heart-rate strap and a trainer alone, no bars required beyond something to rest on. Do not do this against medical advice, and do not do it if a fall from the trainer would be a disaster for the fracture, which for the first fortnight it might be.

Head injuries

Concussion is the one injury where "what can I keep doing?" has a short answer for the first couple of days: nothing hard. The Amsterdam consensus on concussion in sport recommends relative rest for 24 to 48 hours, then a stepwise return to light aerobic activity that stays below the level that worsens symptoms, and a graded progression back to full training only once symptoms have resolved at each step. Riding a bike outdoors during that progression carries an obvious extra risk, since a second impact before recovery is the thing everyone is trying to avoid. A trainer session at conversational intensity is a reasonable early step; a group ride is not.

Keeping the muscle you have

A leg in a cast or a period of genuine rest costs muscle quickly. Tipton's review of nutrition for injured athletes describes measurable losses of muscle mass and strength within the first weeks of immobilisation, fastest at the start. Two things blunt it. One is any loading of the limb that the injury allows, however small. The other is food: the same review argues against the instinct to eat much less because you are training less, since a large energy deficit accelerates muscle loss, and recommends keeping protein intake at the upper end of the athletic range, spread across the day. Cutting calories to avoid gaining weight during an injury is the most common way to come back weaker than necessary.

What to stop, without negotiation

• Anything a clinician has told you to stop. They have seen the injury. We have not.
• Riding through pain that is getting worse. Mild, stable discomfort that settles within a day is often acceptable for tendon and back problems; pain that ratchets up session to session is a signal, not a challenge.
• Outdoor riding with an unstable fracture or an unresolved concussion. The problem is not the pedalling. It is the crash you cannot afford.
• Racing before you can train. The Bern return-to-sport consensus makes the point that return to sport is a continuum, from participation to full training to competition, and that each step should be earned. Skipping the middle is how re-injury happens.

Coming back

The mistake on the way back is to restart at the volume you left. The Bern consensus recommends a graded, criteria-based return rather than a calendar-based one: you move to the next step because the current one is tolerated, not because a week has passed. For a rider that means starting with the sessions the injury tolerated during the layoff, adding duration before adding intensity if intensity was the thing that was off the table, and holding each new level for a few sessions before the next. Our guide to the general case is getting back on the bike after a break.

In Moveee the plan wizard has a "blocked dates" setting: mark the days you cannot ride and the engine plans nothing on them rather than stacking the missed work into the days around them. When you are back, the adaptive plan eases the next hard day after a ride that comes in well above what was planned, which is worth having when your judgement of "fine" is a fortnight out of date. A fresh plan from the wizard with honest hours is usually better than resuming the old one.

The short version

Find what the injury still allows and keep the intensity in it, because intensity is what holds fitness and volume is what you can spare. Load tendons, do not rest them. Eat properly. Rest fully for a concussion and for the first days of a fracture. Come back by criteria, not by the calendar.