Vol. 17 •Issue 19 • Page 8
'Fitness on Wheels'

With proper training, physical therapists can be a valuable asset to the cycling community

By Beth Puliti

Erik Moen, PT, CSCS, fell in love with bicycling as a child-and has been smitten with the sport ever since.

"I've ridden bicycles since I was a kid when I would ride to 7-11 on a BMX bike to get a Slurpee during the summer," he recalled.

In high school, his interest shifted toward triathlons and later in college, he started road and mountain bike racing. Since then, Moen has also raced competitively in cyclocross and track cycling.

Now an "elite level" coach with USA Cycling, he treats cyclists in one of the few specialty clinics in the country.

Related to Gait
Moen is well-known in the Seattle, WA, area for treating more than his fair share of cycling overuse injuries. These types of injuries occur as a result of the highly repetitive, prolonged and forceful nature of the motion of bicycling, he explained.

According to Moen, cyclists can potentially get injured in five ways: improper bike fit, flexibility (too flexible or not flexible enough), strength (weak hamstrings or back), skills (poor climbing, cornering or peddling) and training (how far and strong a cyclist should ride).

PTs can help prevent overuse injuries by applying their knowledge of the musculoskeletal system to cyclists. When looking at the biomechanics of bicyclists, Moen believes PTs prove especially valuable because of their expertise in gait.

"Physical therapists have been trained to perform gait analysis. Watching a person ride a bicycle is gait analysis. Analyzing bicycle gait will require a transfer of gait paradigms to figure what is appropriate and inappropriate motion," he explained.

Physical therapists can develop flexibility and strength programs and perform bike fits to rectify inappropriate motion.

Jerry Durham, MPT, is a licensed competitive cyclist and specializes in treating cycling injuries at San Francisco Sport and Spine Physical Therapy. He agreed with Moen that physical therapists' knowledge of gait is useful when evaluating cyclists.

"Cyclists have their feet fixed on the pedals. So in a lot of ways, you can take the research of someone just walking and standing and apply it to people on the bicycle," he said.

Durham takes a unique approach when he is presented with a cyclist who has knee pain.

"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 the hip," he explained. "Ninety-nine out of 100 times when someone comes in to see me for knee pain on the bike, they are going to have a lot of weakness at the hip."

The knee cap slides up and down in a groove on the femur when the knee is in line with the hip and foot. But a weak hip will cause the knee to veer toward-and almost hit-the top tube on a cyclist's bike, losing its alignment with the foot and hip.

Though knee pain is a very common ailment among cyclists, neck, wrist and back pain are also examples of cycling overuse injuries. Durham believes all overuse injuries occur primarily for two reasons: lack of bike fit and lack of flexibility or strength.

"A cyclist can prevent these injuries by getting a proper bike fit. I preach that all the time. You have to find someone to do a bike fit when you buy your bicycle," he said. He also mentioned that cyclists should practice specific bicycle stretching and strengthening exercises. "Those two things go together. You can't do one without the other."

The Perfect Fit
Durham suggested cyclists first have a general bike fit at the bike shop upon purchase and then see a physical therapist, properly trained in cycling, for a more thorough bike fit.

"[Physical therapists] are experts in movement and biomechanics. We know the body; we know physiology; we know anatomy; we know how muscles are supposed to work," he said.  

When performing a bike fit, the first thing Durham checks is the seat height and fore/aft (how far forward or how far back the seat is set). From there, he determines how far the cyclist has to reach to the handlebars or how high up the stem is.

A big mistake many people make is adjusting the seat to relieve neck pain when changes should actually be made to the handlebars or stem.

"If [cyclists] try to [set] their head and arm position by sliding their seat forward, then they're setting themselves up for other problems," warned Durham.

Neck pain is one of the most common complaints Durham treats in riders. He noted that not having enough strength in the arms, shoulders and upper back area to support oneself on the bike can cause neck pain.

"I don't know of anybody who works in a job who actually has his hands weight-bearing all day long. Because we do that on the bicycle, we need to train our bodies for that," he explained. 

The neck can be the root of a problem too. Hand numbness is likely to stem from the neck. Durham evaluates cyclists who present with hand numbness or tingling by checking their neck first to see if it is the source of their symptoms.

Bicycling shouldn't be uncomfortable as long as a person is fitted to the bike, Moen stated. He described a bike fit as being partially about comfort, partially about avoiding injury and partially about performance.

"It's not like everyone has to look and perform like Lance Armstrong on their bike. Everyone can appreciate their bicycling experience at a higher level if their bicycle can handle well. There are many other reasons why bike fit is important other than just avoiding injury," said Moen.

Catering to Clients
In any given day Moen treats a diverse group of riders. "The other day the gamut ran from a century rider to an Ironman triathlete to an advanced century rider to someone who hopes to start riding his hybrid bike an hour a week," he said.

Though he treats many competitive racers, Moen pointed out that the majority of bicyclists a PT would potentially see would be recreational. PTs can help this population by simply making them feel comfortable on their bikes so they enjoy riding.

"You should know how to treat beginning bicyclists as well as those with advanced capabilities.  A physical therapist should understand and appreciate the different demands of bicycling.  Effective care of the bicyclist will make them happy," he said.

Physical therapists who are interested in treating competitive cyclists should first understand the flexibility, strength and coordination that is required for endurance bicycling, Moen suggested. Then the therapist can focus on conditioning the cyclist.

In general, endurance sports involve periodized training, and cycling is no exception. This type of intentional training of the individual allows for periods of overreaching and periods of recovery.

"Periodized training allows for recovery but yet creates stimuli that allow a person to move up to a higher level of activity. Physical therapists should already be using periodized training programs for strength and coordination," said Moen.

He noted that endurance athletics have addictive physiological attributes, and upper level cyclists have made mental, physical and financial investments in the sport. PTs interested in treating competitive cyclists should learn about the sport itself, Moen recommended. In order to gain credibility with bicyclists, you have to be able to talk the language.

"You can't just try to get away with 'PT speak.' You have to be able to talk about and understand what bicycling is. You have to appreciate what one does to train for bicycling," he said.

'Talking the Talk'
Even though it seems physical therapists would rank high among the cycling community, Durham admitted they are farther down the list-if on the list all.

"It's a rare day when I get a cyclist who says 'I have pain that just started last week.' Everybody tries to work through his own pain," he said.

PTs need to educate cyclists about what they can offer in order to become more well-known in the community. Durham advised developing a relationship with a local bike shop. When cyclists need changes made to their bikes, he refers them to the bike shop and bike shop customers are referred to Durham when they ask where to go for pain problems.

"I'm not going to argue bike mechanics with [a bike shop employee], but I'm not going to let him tell me how the quads and the hamstrings and the nervous system all work together," he said. "A bike expert and a body expert are the perfect combination."

Bicycle shop employees are increasing their knowledge in the bicycle fit arena through industry-based initiatives. In general, they have a better understanding of bicycling mechanics. However, they do not have the musculoskeletal training that the physical therapist does, he said. 

Consumers will start to recognize PTs as a great source of bicycle fit when the PT can demonstrate their knowledge in bicycling biomechanics, specific/effective injury intervention, and knowledge of bicycle components.

Recently, Moen partnered with the APTA to promote seeing a PT for a proper bike fit during National Physical Therapy Month. APTA has taken an active role in trying to reach out to more active populations, but they shouldn't be responsible for letting the entire world know about the relationship between physical therapy and bicycling, he stated.

"If you look at other countries, bicycling is definitely not going away. It's a mode of exercise and transportation," said Moen. "If PTs can talk the talk and understand the activity, then they can start applying what they know about musculoskeletal health and function to the sport of bicycling."

Beth Puliti is editorial assistant at ADVANCE. She can be reached at epuliti@merion.com