Bicycle suspension systems have been designed to improve bicycle comfort and handling by dissipating terrain-induced energy. However, they may also dissipate the cyclist's energy through small oscillatory movements, often termed 'bobbing', that are generated by the pedalling movements. This phenomenon is a major concern for competitive cyclists engaged in events where most of the time is spent climbing, e.g. off-road cross-country races. An acceptable method to assess the overall efficacy of suspension systems would be to evaluate energy consumed by cyclists using different types of suspension systems. It could be assumed that any system that reduces metabolic expenditure for the cyclist would automatically lead to performance improvement. Unfortunately, only a limited number of studies have been conducted on that subject. Moreover, the conclusions that can be drawn from most of them are limited due to unsatisfactory statistical power, experimental protocols, measuring techniques and equipment. This review presents and discusses the most relevant results of studies that focused on mechanical simulations as well as on energy expenditure in relation to off-road bicycle suspension systems. Evidence in the literature suggests that cyclist-generated power that is dissipated by suspensions is minimal and probably negligible on most terrains. However, the scarce studies on the topic as well as the limitations in the conclusions that can be drawn from most of them indicate that we should remain cautious before supporting the use of dual suspension bicycles on all course types and for all cyclists. For example, it should be kept in mind that most cross-country racers still use front suspension bicycles. This might be explained by excessive cyclist-generated power dissipation at the high mechanical powers developed by elite cross-country cyclists that have not been studied in the literature. Finally, suspended bicycles are more comfortable. Moreover, the fact that suspension systems may significantly reduce physical stress should not be overlooked, especially in very long events and for recreational cyclists.