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Bicycling shouldn't be painful--as long as you're properly fitted to your bike.
That's why patients who complain of pain associated with cycling likely haven't had a proper bike fit. Physical therapists trained in bike fitting can minimize a patient's discomfort, increase efficiency and help prevent cycling injuries.
ADVANCE spoke with Jerry Durham, MPT, a licensed competitive cyclist who specializes in treating cycling injuries at San Francisco Sport and Spine Physical Therapy, about proper bike fit for patients.
ADVANCE: Do many cyclists think of going to a PT for a proper bike fit or cycling pain?
Durham: It's a rare day when I get a cyclist who says, 'I have pain that started last week.' Everybody tries to work through their own pain. Usually, I'm farther down the list-if on the list all. As far as bike fits go, unless I get the word out there that I do bike fits, people aren't seeking me out. You've got to educate people that you are the expert. I will not argue with any bike shop that they are experts in bicycles, but I know the human body and I know it well. Developing a relationship with a bike shop is a very good idea because most everybody is going to go to the bike shop and ask where they should go for pain.
ADVANCE: What is the advantage of having a PT fit a cyclist's bike?
Durham: The way I see it, we're experts in movement and biomechanics. We know the body, we know physiology, we know anatomy. We know how muscles are supposed to work and what muscles are supposed to be working at certain times when we look at a cyclist. Because of that, physical therapists are better at fitting cyclists than someone who hasn't been trained in that manner.
ADVANCE: Do PTs need to be trained to fit bikes?
Durham: Yes. Physical therapists need to be trained properly. If a PT has never worked with cyclists, then they're not going to be able to fit someone on the bike. There's some great bicycling courses out there for physical therapists who want to learn more about fitting bikes and cycling.
ADVANCE: What measurements should PTs consider when fitting a bike?
Durham: The number one thing you check is the seat height. The second is called the seat fore/aft. (That means how far forward or how far back the seat is set.) Then you check out all other things, such as how far they have to reach the handlebars and how high up the stem is. A huge mistake people make is sliding the seat forward to accommodate reaching too far to the handlebars. If changes need to be made for the handlebars or the stem you make them there, not at the seat.
ADVANCE: What factors contribute to a cyclist's knee pain?
Durham: Cyclists have their foot fixed on the pedal, so in a lot of ways you can take research of someone just walking and standing and apply it to people on the bicycle. You also have to evaluate what is going on at the hip and that's a very different approach. In the past, people spent a lot of time looking at the foot on the bike, but you have to go up even higher to that hip. Usually, when someone comes in to see me for knee pain on the bike, they are going to have problems at that hip. When there is a lot of weakness at the hip, it lets the knee go towards the top tube and almost hit that top tube.
ADVANCE: Does foot position affect knee pain?
Durham: Yes. When you clip your foot into the pedal, if that clip itself is off line or if it's rotated and pulls your heel out, that's going to make your knee drop in towards the top tube. You want to keep that knee out from the top tube and if your cleat is pulling your knee in, your pedal is not going to allow you to get it straight. That's where the bike fit component comes in.
ADVANCE: "Handlebar palsy" or ulnar neuropathy is when the nerve that runs along the length of the arm to the hand becomes inflamed after absorbing vibration. Do you see that a lot
Durham: No, I don't personally. But I do know it happens. I see people riding in positions that would bring on handlebar palsy, and they're usually riding in these positions because they're not set up properly. They lock their elbows out and then they let their shoulders slide up towards their ears so they're leaning on that nerve more. That could be either a bike fit or a strength issue of your upper body. You should be riding with your wrists neutral, your elbows slightly bent and the shoulder blades down away from your ears.
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