Bike Fitting at Endurance Physio

WHY IS BIKE FITTING IMPORTANT?

Bike fitting is a process where your physical therapist performs a comprehensive evaluation of YOU and makes sure your bike is going to fit your body. There are often bike accommodations that can be made to help a bike fit to your body, but the process should never be the other way around of fitting a person to a bike. Pain while cycling can be due to a number of things such as a person’s position and or movement, training or the bike itself. Cycling is a repetitive motion. Poor cycling mechanics with high repetition over time adds up. Part of bike fitting is also teaching you how to make adjustments on your bike. Fitting is dynamic and as you get stronger cycling and/or with your exercises, you may need to make subtle adjustments to your fit.

HOW DO CYCLING INJURIES OCCUR?

• Training error- increasing mileage or intensity faster than the body can keep up with. The repetitive stress breaks down body tissue at a higher rate than the body can repair the tissue

• Musculoskeletal imbalance- Sometimes certain muscles become overdeveloped, while others become underdeveloped. This can often lead to movement patterns that overload certain tissues

• Mobility deficits- Cycling requires a certain amount of mobility at each joint. If one or more joints is lacking this mobility, cycling mechanics will be affected, causing another avenue for tissue overload

• Weakness- Cycling with proper mechanics requires adequate strength. If you are not strong enough to use the correct muscles you will compensate often causing poor alignment and/or increased stress on other tissues.

• Improper bike fit- Sometimes it is as simple as an adjustment to the bike, the saddle, or cleats that will alleviate symptoms and make for pain free riding.

HOW DO WE REHABILITATE CYCLING INJURIES AND PREVENT THEM FROM REOCCURRING?

COMPREHENSIVE SUBJECTIVE AND PHYSICAL ASSESSMENT

In order to treat a cycling injury, your physical therapist must first understand why it occurred in the first place. We will spend as much time as necessary to understand your training habits, bike selection, cleat selection, shoe selection, and personal cycling goals. We will then perform a comprehensive physical exam in order to determine any musculoskeletal imbalances, mobility deficits, weaknesses, or coordination deficits that may be contributing to your injury. The exam will include:

• Functional movement assessment

• Functional strength assessment

• Formal manual muscle testing

• Functional mobility assessment

• Special tests to aid in proper diagnosis

• Palpation for identification of painful structures involved

CYCLING ANALYSIS

Your physical therapist will perform a video cycling assessment in order to capture your cycling pattern. This may help identify movement patterns that contributed to your injury and may also reveal areas where you may be able to improve efficiency and performance quality. At Endurance Physio, we use a 2D video assessment tool and lasers to help us analyze your cycling mechanics:

• Saddle height

• Saddle fore/aft

• Proper reach

• Proper hand and wrist positioning

• Proper pelvic position

• Spinal alignment

• Side to side symmetry

TREATMENT APPROACHES

Your physical therapist will educate you on any impairments found in the initial exam including training error, relative imbalances, mobility deficits, weaknesses, and cycling mechanic abnormalities. You and your PT will discuss treatment options and devise a plan to address the relative issues in the least amount of visits with the most amount of success. In general, treatment consists of the following:

• Education on training, cross training, and relative rest

• Muscle activation and strengthening therapeutic exercise and neuromuscular rehabilitation

• Movement retraining. Your physical therapist will teach you how to break down the pedal stroke and proper body position into smaller pieces, break any faulty movement patterns, rebuild correct movement patterns, and then apply this back to your cycling.

• Pedal stroke and cycling posture retraining. If it is indicated, your physical therapist may provide cuing to alter your body position and or/pedal stroke to decrease pain, decrease loading of injured tissue, and improve cycling tolerance.

  • 2D video analysis

  • Cuing to alter pedal stroke when needed

• Education on home exercise program. At Endurance Physio, we highly value your treatment success. In order for you to overcome your injury, we will work with you to develop a plan so you may perform as many exercises and drills on your own as you feel able to do and as we see relevant and safe for you to do. It often takes a lot of work to retrain movement patterns and strengthen underdeveloped muscle groups. It is imperative that you perform the exercises properly and we are here to help assure that you do so.

• Guidance on proper loading with cycling training. Your physical therapist will help you come up with a plan to get you back on the trails/roads as quickly as possible without risking re-injury.

• Manual therapy. In order to aide in pain relief, improve mobility, improve muscle activation, or down-train muscles (decreasing activation to overactive muscle groups), you may receive any of the following manual therapy treatments if needed:

  • Functional Dry Needling

  • Instrument Assisted Soft Tissue Mobilization and Soft Tissue Mobilization

  • Muscle Energy Techniques (MET)

  • Joint Mobilization

• Taping, shims, education on ideal cycling footwear and/or orthoses. Your physical therapist may use taping techniques to improve alignment, offload injured tissues, and decrease pain. You may also be educated on change in shoes, cleats, shims in cycling shoes and use of foot orthoses if appropriate.