Bicycling is a growing competitive and recreational sport. There was a 64% increase in cyclists traveling to work from 2000-2012 (NHTSA.gov). This is beneficial to improve health, reduce fossil fuel emissions, and contribute to more livable communities.
Unfortunately, new and veteran bicyclists alike are prone to overuse injuries. The prevalence of non-traumatic bicycle injuries are about 88%.2 Cyclists may experience discomfort in their neck, back, hand/wrist, hip, buttock/perineal, knee, and foot/ankle.2 These are usually a function of sustained irregular positions, and are remedied via bike fit. As Chicagoans gear up for spring, this is a great time and way to ensure a healthy and successful cycling season.
Bike fit is adjusting a bicycle to meet individual needs at both a musculoskeletal and goal-specific level. It allows for efficient pedaling and safe use of the bicycle. Though bike shops offer adjustments to the bicycle itself, physical therapists are better positioned to match the rider’s strength, flexibility, and coordination to the machine.
When addressing cycling overuse injuries, the physical therapist or healthcare provider should first perform bike-specific evaluation. This includes gathering subjective information about onset of injury and cycling experience to address training errors. Then a thorough objective evaluation of range of motion and strength should be performed, before dynamic evaluation of pedaling mechanics and posture with the patient on their bike.
The treatment plan should address intrinsic impairments, and a bike fit should address extrinsic deficits. These extrinsic areas of focus include: frame, wheels, handlebars, stems, brakehoods, seatposts, saddles, and cranks. All of these may be adjusted or adapted to meet the individual needs of the rider. The sheer volume and variety of equipment and adjustments is incredible, so a certified bike fitter (e.g. http://bikept.com/location/illinois/) better handles more complex cases.
There are some simple adjustments to establish saddle and handlebar position that may have a big impact. This includes the following:
- Shoe fore/aft on pedal = 1st MT head just forward of pedal spindle
- Knee over pedal at 3-o-clock
- Knee angle at point of greatest extension = 32-40 deg
- Trunk angle = 35-45 deg
- Shoulder angle = 90 deg
- Elbow angle = 20-40 deg
- Width of stance = 2nd MT under center of hip
With proper bike fit, posture, stretching, and strengthening, sports medicine physicians and physical therapists are well positioned to help patients avoid overuse injuries for more enjoyable bicycling. This will help individuals achieve a more efficient and effective ride, and pursue biking as a clean and healthy alternative to transportation.
- Moen E. How to get an overuse injury: common mistakes in endurance bicycling. BikePT. 2011. Available at: http://bikept.com/bike-fit/how-to-get-an-overuse-injury-common-mistakes-in-endurance-bicycling/. Accessed March 7, 2016.
- Van der Walt A, Janse van Rensburg DC, Fletcher L, Grant CC, & van der Walt AJ. Non-traumatic injury profile of amateur cyclists. South African J of Sports Med, 2014;26(4):119-122.
- Moen E. Physical therapists offer tips for proper bike fit. APTA News Releases. 2009. Available at: http://www.apta.org/Media/Releases/Consumer/2009/5/13/. Accessed March 8, 2016.
Britta Gauthier, PT, DPT