Axis Sports Medicine | Breckenridge, Frisco, Silverthorne & Avon
KEY TAKEAWAYS
- Mountain biking injuries in Colorado are common — and highly treatable. Most riders don’t need surgery.
- The 5 injuries Axis PTs see most often: knee pain, wrist and hand pain, lower back pain, shoulder and collarbone injuries, and ankle/foot issues.
- Normal trail soreness fades in a day or two. Pain that lingers beyond 1–2 weeks, involves swelling, or gets worse with activity is your cue to see a PT.
- Colorado allows direct access to physical therapy — most riders can schedule an evaluation at Axis without a doctor’s referral.
- PT isn’t only for injuries. A post-season evaluation can identify weaknesses and help you ride stronger next year.
One of the best outdoor activities in Eagle and Summit County is mountain biking – and it makes sense, because so many of the trails here are world-class.
But the same terrain that makes rides so great can also lead to mountain biking injuries – many of which we often see in our clinic.
But the good news? The five injuries our PTs see most often are all highly treatable, and for most riders, surgery is not part of the equation.
Here’s what to look out for with mountain biking injuries, as well as what might be the culprit behind your pain.*
Injury #1: Why Does My Knee Hurt After Mountain Biking?
Of all the mountain biking injuries we treat in Summit and Eagle County, knee pain is the most common. And it almost always comes down to one of three things:
- Repetitive pedaling stress
- Poor bike fit
- The increased stress and pressures that come with long descents
While a full analysis can help identify exactly what is causing your knee discomfort and pain, the most common diagnoses include:
- Patellofemoral Pain Syndrome (PFPS) — this occurs when the kneecap isn’t tracking right under load, and causes pain behind or around the patella
- IT Band Syndrome (ITBS) — an outer knee pain that tends to flare on long descents – ITBS is extremely common on Summit County trails with sustained elevation drops
- Patellar Tendinopathy — an overuse injury that usually shows up mid-season as mileage starts to spike
How Does PT Help with Knee Pain?
The fix is rarely as simple as rest — it usually requires a combination of focused rehab treatments and adjustments. We’ll focus on hip strengthening, glute activation, manual therapy, and an adjustment to saddle height or cleat position.
This is why we offer our Axis Bike Fit service. If knee pain keeps coming back every season, your fit might be the reason.
Injury #2: Wrist and Hand Pain After a Mountain Biking Crash
Nobody wants to plan for a fall or crash, but the reality is that they happen. And your hands and wrists take the hit when you hit the ground.
Wrist and hand injuries fall into two categories: crash-related and chronic. Depending on the trauma and injury, your pain might come from one of these:
- FOOSH injuries (Fall On Outstretched Hand) — wrist fractures, scaphoid fractures from impact; the scaphoid in particular is easy to miss on initial imaging
- Handlebar Neuropathy — ulnar or median nerve compression from hours of grip pressure; causes numbness and tingling in the fingers
- De Quervain’s Tenosynovitis — thumb-side wrist pain from repetitive gripping and braking; more common than most riders expect
How Does PT Help with Wrist and Hand Pain?
Post-fracture wrist rehab needs specialist-level, hands-on care. Our therapists offer focused post-surgical and non-surgical rehab, as well as nerve mobilization for neuropathy. We can also help you get back on the bike faster with ergonomic handlebar adjustments (often in combination with a Bike Fit).
Injury #3: Lower Back Pain from Mountain Biking — Is This Normal?
No, it’s not normal. But don’t feel too bad, because it’s very common.
After all, spending hours in a forward-flexed position on a mountain bike places sustained stress on your lower back! The most common back pain culprit is muscle and ligament strain that comes from a sustained flexed posture that fatigues and strains the posterior chain.
In more severe cases, you may have disc irritation, where repeated vibration and impact loading can place stress on your spine.
Another potential issue is SI Joint Dysfunction, which can result from loading through corners and rough terrain, throwing off sacroiliac joint mechanics.
How Does PT Help Treat Lower Back Pain?
Some of the best PT you can do for back pain is core activation and posterior chain strengthening. We also offer manual therapy and spinal mobilization, as well as postural correction and riding position coaching.
Many riders are surprised by how quickly back pain resolves once the right muscles are doing their job under the right conditions!
Injury #4: Shoulder and Collarbone Injuries — When You Go Over the Bars
Going over the bars happens with mountain biking. And should it happen, your shoulder takes the force — and the results range from a sore rotator cuff to a fractured clavicle.
There’s also a second, less dramatic type of shoulder injury that builds over time from riding position.
Clavicle fractures are the most common traumatic injury in mountain biking, while AC joint separation and rotator cuff strains can also lead to acute and chronic pain.
How Does PT Help with Shoulder and Collarbone Injuries?
The timeline and approach are completely different for traumatic vs. overuse shoulder injuries.
Our PTs build progressive return-to-ride programs that include scapular stability work, rotator cuff strengthening, and functional testing before you’re back on technical terrain.
Injury #5: Ankle Sprains, Achilles Pain, and Foot Issues on the Trail
Ankle and foot injuries don’t get as much attention as knee or shoulder injuries, but they sideline a lot of riders — especially those who run clipless pedals or log high miles early in the season.
Some of the most common lower-body injuries we see include:
- Lateral Ankle Sprains — these can happen from clipless pedal mishaps and trail crashes
- Achilles Tendinopathy — saddle height issues and calf overload combine to stress the Achilles, which shows up as morning stiffness and pain at the back of the heel
- Plantar Fasciitis — particularly common in riders logging big miles in the early season before adequate conditioning
How Does PT Help with Ankle Sprains, Achilles Pain, and Foot Issues?
Balance and proprioception rehab is key to reducing and eliminating pain. Riding on uneven trail terrain requires more single-leg stability than most people train for.
We use eccentric loading protocols for the Achilles tendon, manual therapy for restricted ankle mobility, and footwear and cleat-position corrections (again, Bike Fit plays a role here).
How Do I Know If You Need Physical Therapy After a Mountain Biking Injury?
Normal trail soreness improves within a day or two and feels like general muscle fatigue.
An injury that needs attention usually lingers, worsens with activity, or involves swelling, sharp pain, or joint instability.
When in doubt, use this as a quick guide:
| What You’re Feeling | What It Might Mean |
| Pain that lingers more than a few days after a ride | Overuse injury — needs an evaluation |
| Swelling or bruising after a crash | May require imaging before starting PT |
| Sharp pain with every pedal stroke | Mechanical issue — bike fit + PT together |
| Numbness or tingling in hands or feet | Nerve involvement — don’t wait on this one |
| “It’s fine” pain you’ve had all season | Probably not fine — catch it before summer ends |
| Instability or a joint that “gives out” | Ligament or structural issue — get evaluated |
If you’re questioning it, get it evaluated. Most issues caught early resolve significantly faster than those that get ignored for the rest of the riding season.
Get Back on the Trail with Axis Sports Medicine
Axis Sports Medicine has been serving Summit and Eagle County riders since 2012 — and we’re proud to be a locally owned, therapist-operated practice built for mountain communities.
Each of our clinics is staffed by advanced-certified PTs who treat mountain athletes — and our team collaborates directly with local orthopedic surgeons and sports medicine physicians, including the Steadman Clinic in Vail, so we already know your post-op protocols when you walk in the door.
Want to learn more? Need to evaluate an injury? Reach out to our team or call your nearest clinic to schedule your evaluation today!
Frequently Asked Questions
What are the most common mountain biking injuries in Colorado?
The most common Colorado mountain biking injuries include knee pain, wrist and hand injuries from falls, lower back pain, shoulder and collarbone injuries, and ankle or Achilles issues. All are highly treatable with physical therapy, and many riders don’t need surgery when issues are caught early.
Do I need a doctor’s referral for physical therapy in Colorado after a mountain biking injury?
No — Colorado allows direct access to physical therapy, which means you can schedule an evaluation at Axis Sports Medicine without a physician referral. Some insurance plans, including Medicare and certain workers’ comp cases, may still require one. Contact Axis to confirm your coverage before your first visit.
How long does mountain biking knee pain recovery take with PT?
Recovery from mountain biking knee injuries like IT band syndrome or patellofemoral pain typically takes 4–8 weeks with consistent PT and appropriate activity modification. The timeline varies based on how long the issue has been present and whether a bike fit adjustment is also needed.
Can physical therapy help with a mountain biking crash injury like a broken wrist or collarbone?
Yes. PT is essential for recovering from mountain biking injuries like wrist fractures, clavicle fractures, and AC joint separations. Axis’s PTs handle post-surgical and non-surgical rehab, coordinating with local surgeons — including Steadman in Vail — to start your recovery from day one.
Is Axis Sports Medicine good for mountain biking injuries in Summit County?
Axis Sports Medicine has served mountain athletes in Eagle and Summit County since 2012, with clinics in Breckenridge, Frisco, Silverthorne, and Avon. Founded by Olympic ski trainers and staffed by advanced-certified PTs, the practice specializes in mountain sport injuries.
Should I keep riding if my knee or back hurts during mountain biking season?
Pain that persists during or after rides, involves swelling, joint instability, or worsens over weeks signals the need for attention. ‘Push through it’ isn’t advised. A PT evaluation clarifies the cause, severity, and next steps.
*This article is general information and is not a substitute for individualized physical therapy care. Contact Axis Sports Medicine to discuss your specific injury and treatment options.
