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1 These notes are a preview. Slides are limited. Be sure to convert to your own time zone at PHYSIOTHERAPY AND CYCLING THE INTERACTION BETWEEN BODY AND BIKE CAMERON ELLIOTT 1

2 CYCLING IN AUSTRALIA CYCLING IN AUSTRALIA 2

3 CYCLING AT OLYMPIC/ ELITE LEVEL Olympic Games cycling medal tally 14 Gold, 18 Silver, 17 Bronze Most successful Olympic Games 2004 (6 Gold, 2 Silver, 2 Bronze) Most gold won by Australia in cycling at a single Olympic Games 6 (2004) WHATS THE DIFFERENCE BETWEEN THEIR CYCLING AND OURS? 3

4 MANAGING (BIKE FIT) INJURIES IS THIS A CYCLIST ISSUE OR A BIKE ISSUE (OR BOTH!) These notes are a preview. Patello-femoral pain Slides are limited. Low back pain (NSLBP) Shoulder and Neck pain Achillies Tendinopathy Foot/ Hand irritations THE RIGHT COMBINATION FOR THE RIGHT PERSON IT NOT JUST ABOUT THE BIKE 4

5 BIKE FIT ORIGINS Pre 1970 s little formal documentation 1970 S Italian Olympic Committee 1980 s Anthropometric calculations (Cyrille Guimard) On bike analysis (static and motion analysis) THE 3 PILLARS OF BIKE-FIT (with thanks to Phil Burt) 1- AERODYNAMICS (reduce frontal area calculations, wind tunnel testing) These notes are a preview. Slides are limited. 2- COMFORT/ SUSTANIBILITY (rider comfort and injury incidence) 3- POWER (Watt bike or cycle computer) 5

6 THE PILLARS CHANGE IN BALANCE FOR US ALL HENCE THE FIRST PART OF THE BIKE FIT INVOLVES.TAKING A HISTORY! RIDING RESUME: Years on bikes, style of bike, equipment used (eg: flat pedals, cleats), usual riding habits (commuting, weekend rides), previous injury history, current aches/ pains, future plans for riding and any goals from the fit. 6

7 MICRO ADJUSTERS and MACROABSORBERS (with thanks to Phil Burt) These notes are a preview. These notes are a preview. Slides are limited. Slides are limited. During your history try to determine if your patient is a micro-adjustor or a macroabsorber. This will also influence your planning for the bike fit and your advice about adopting new positions PHYSICAL ASSESSMENT off bike Do the basics, they still have to move in ADL s! ROM The details of ideal ranges will depend on the goals of the fit, key areas include hip mobility, hamstring and hip flexor flexibility. For more aggressive fits upper body screening may also be useful. Strength Appropriate to say that it should be symmetrical but is also context specific. Motor Patterns Activation is large focus for developing cyclists in the NSWIS program and can also be useful. Lumbo-pelvic-hip associations/ dissociations are of particular focus. 7

8 THE BIKE FIT JOINT ANGLES & MEASURING THE BIKE FIT MOVEMENT ANGLES Best to consider a min & max range of recommendation rather than a single position. The micro-adjuster will feel likely have a smaller range, a macroabsorber will likely have a greater range as they are more robust and can handle changes relatively well. These notes are a preview. Slides are limited. Only 3 contact points between the rider and the bike (pedals, seat and bars) so all fitting is an Full adjustment notes available process after of purchase one or all from of these points to achieve the goal outcome. As our bodies change, so may the fit recommendations. EG: 12 weeks of dedicated stretching, a week in-front of a computer with poor posture, returning from injury. 8

9 SEAT HEIGHT- THE NUMBER 1 PRIORITY Different static methods: of Inseam length 2 Knee extension at BDC of approx degrees off full extension for recreational riders and degrees for competitive riders SEAT HEIGHT - continued Considerations include: The bike and riding purpose: a time trial bike rider might want more aero and hence may require a higher seat position. A key physical competency here is hamstring flexibility which if not present can pull the pelvis posteriorly and result in many overuse injuries in the knee, leg or pelvis/ back areas. These people may be able to handle knee angles of as low as 25 degrees. Pedalling habits: this will influence your knee angle measurements, get the person to ride the bike on a trainer for a few minutes (or ride to your clinic) so they are warmed up and settled on the bike. Ensure when you stop them to measure that they keep foot/ ankle position unchanged. Remember Micro and Macro some people will always be fiddling it their height from one ride to the next 9

10 SEAT HEIGHT DYNAMIC MEASURE Probably the best measure requires a high speed camera setup on a bike trainer or a professional fit with joint markers (3D Vicon or RETUL) SEAT FORE/ AFT the second measure Best to always measure and adjust AFTER setting desired seat height. Determined by position of the kneecap at horizontal crank position, measure with a plumbbob (on tibial tuberosity) or spirit level (front surface of patella) Tibial tuberosity should These be inline notes with pedal are a spindle, preview. knee cap should be just in front This will influence the balance Slides and handling are limited. of the bike as well as knee loading 10

11 SEAT FORE/ AFT - CONTINUED This rule (Knee Over Pedal Spindle) will fit the vast majority of bikes you see, however some highly specialised fits may break this rule. These fits should be done by an experienced fitter. Also be aware of saddle comfort and angle when setting this. Saddle comfort is determined by the design of the saddle the rider is using (varies a lot). Saddle angle should be horizontal or max. of 2 degrees down..never pointing up! SADDLES AND SADDLE ANGLES 11

12 HANDLEBARS Ideal that handlebar width reflects either comfort or aerodynamic pillars Handlebar shape is usually left to rider preference (many variations) Handlebar position will help determine the position of the upper body and the reach of the upper limbs HANDLEBARS - WIDTH For most riders, measure distance between A/C joints and set bar width to same measure. These notes are a preview. Slides are limited. More narrow bars may be chosen for better aero 12

13 HANDLEBARS - REACH Most comfortable range is a body angle of approx degrees More aerodynamic positions are degrees Feel like just a bit more weight on the seat than on the bars Arm to trunk angle is often set at 90 deg for best comfort. SOME EXAMPLES 13

14 HANDLEBARS - BRAKES Calculate reach to the part of the bars the rider most usually holds onto. Don t be afraid to move brake lever to suit your setup PEDALS Will leave the choice of the brand/ design to the individual Toe straps or no cleats are easy to use, comfort is the key These notes are a preview. Slides are limited. Cleats are the choice of most riders eventually Fit for these is important for comfort and performance 14

15 PEDAL POSITION Usually look to align to the space between the 5 th MET and the 1 st MET The smaller the foot the further towards the 5 th MET, the larger the foot the further towards the 1 st MET can be considered PEDAL FLOAT Float is the description to the amount of rotational movement the pedal cleats will allow. FIXED PEDALS: Have no float, fitting the foot to these pedals requires much precision as no room for cyclist adjustment is allowed. One advantage is that it is a very stable platform for transfer of power to the pedal from the foot. FLOAT PEDALS: Have a system for rotational movement at the ball of the foot, this can reduce the stress on other areas that may wiggle when riding. Most pedals will allow for float adjustments of between about 5 15 degrees. Having some amount of float is recommended for virtually all of the cyclists you will do a fit for. Usually the finer points of this adjustment should be done by an experienced bike fitter. 15

16 MOUNTAIN BIKES Setup position is not too different from road riding for many long distance riders on MTB. Specialised MTBs are These designed notes and are a fitted preview. for a single purpose (egg: downhill bikes) efficient pedalling Slides is less are of a limited. focus for these bikes and that changes the usual goals of the fit. Stability and steering is a much greater focus in these bikes ITS NOT JUST ABOUT THE BIKE!! Human related problems can contribute to a poor bike fit as well. Your usual physiotherapy physical examination will help uncover these problems. The following are areas of particular focus. 16

17 Hamstrings Need to be flexible to allow for reach to pedals esp. in fits with a lot of aero as the pelvis will be rotated further. Often look at Straight Leg Raise, Active Knee Extension and Slump to assess this. SLR 0 deg. AKE 0 deg SLR- 90 deg Hip flexors/ Knee Extensors Cyclists almost always have tight quads, if muscular tightness appears to be disturbing joint mobility/ motor patterning then problems may arise These notes are a preview. Slides are limited. Muscles may tighten from cycling (eg: long or frequent rides) but lifestyle factors (gym, prolonged Full notes available sitting etc.) after may purchase also be from an issue. Remember to consider all angles as to why a person has tight muscles and how that effects their current riding position Thomas Test is usually sufficient to assess this neutral hip and over 50 deg of knee flexion is ok 17

18 HIP ROTATION ROM Useful to use in your overall hip assessment, esp. for riders who are doing other forms of training (eg: gym based programs) or those in aggressive fit positions. Will give you an indication (with other tests) how tight a persons hips are which is information which can be combined to the current/ desired bike fit position to see if the bike should be adjusted to fit the person/ or the person needs to do some exercises to be able to fit the bike My preference is to do this passively but you can also consider active testing if you wish. Prone: IR -Over 35 deg Supine: IR Over 35 deg ER Over 45 deg HIP FLEXION ROM Usually limited by tight glutes A useful test when viewed in light of the other hip ROM tests Best when compared to on bike analysis but as a rule of thumb over 130 deg or until thigh reaches their torso is ok 18

19 UPPER BODY Particuarly useful for aggressive bike fits or people who do other forms of training (eg: Gym programs). Assessment of general scapula control (Kibler test) thoracic cage movement These notes (Extension, are a preview. Rotation etc.). Also be aware of previous injuries when taking Slides a history are limited. (eg: look for previous clavicle fractures or shoulder dislocations being an origin for altered shoulder function). Trunk/ Core Stability Many different ways to test. The standard we use is pressure cuff testing with leg raise/ lowers. Goal is to keep neutral spine at all times. Often good to test low load stability (pressure cuff) and high load stability (FMS) and look at results in light of each other. Biering-Sorensen Test is also helpful to get picture of low back strength. 19

20 FUNCTIONAL MOVEMENT SCREENING A useful screening test to add strength/ movement quality information to your ROM testing. You may not decide to do all tests every time (depends on your time allowance and the persons history/ goals). Also single leg decline squat can be a useful test. Look for whole trunk control/ hip control and drive/ leg strength. SUMMARY A good bike fit is one that will reduce the risk of injury and will meet the personal goals of the cyclist. A useful framework for These this notes is to consider are a preview. a balance between rider comfort, aerodynamics and power Slides output. are The limited. balance of this can be established at the history taking stage and fine tuned throughout the fit process. Consider both intrinsic and extrinsic measures (do I fit the person to the bike of the bike to the person), be aware that they can change over time (injury). Record the measures and changes made for future reference 20

21 THANK YOU! 21