By Connor McKay B.A Physiotherapy
Connor is a full-time physiotherapist and an elite level age group triathlete. He worked in a bike shop whilst at university, igniting a love for bike fitting. This passion has only expanded as a professional, utilising his skills and knowledge as a physiotherapist in conjunction with his own impressive experiences in cycling and triathlon, to begin treating patients with cycling-related issues through bike fitting and customised rehab programs. He shares his recent experience travelling to Amsterdam to undertake Australian physiotherapist Paul Visentini’s “Science of Cycling” course as part of his ongoing development as a dedicated physiotherapist.
What is bike fitting, and why is it so important? Essentially to “fit a bike” involves matching a person’s equipment to their own personal capabilities with the goal of improving performance, comfort, efficiency and reducing injury rates. As a physiotherapist, my goal is to create the perfect symphony between a clinical, biomechanical and aerodynamic approach. This requires an in-depth approach that incorporates body assessment including mobility and strength, an on-bike assessment, hands-on therapy and where required, a supplementary exercise program. This is then assessed through dynamic analysis – looking at power and heart rate while riding in their initial position and the final position to see if there is a measureable change.
Rewind to July and my eagerness for learning lead me to Amsterdam, where 12 physiotherapists convened to learn more about the art of bike fitting, cyclist assessment, treatment and rehabilitation from Paul Visentini. Also attending were a number of highly skilled physiotherapists, PhD candidates, pro cyclists Niki Terpstra’s physiotherapist, and a bike fitter for a number of professional teams working out of Geneva. I saw this as a great opportunity to not only learn the evidence behind our treatment methods, but also gain some experiential knowledge from these great minds.
The three-day intensive course was truly a valuable experience to learn more about motor patterns, strength training and how the bike can be modified in so many ways to make the body more comfortable, efficient and aerodynamic. My main lessons in relation to evidence (disclaimer – this doesn’t include experiential evidence, purely what the research currently shows):
- Most cycling injuries are related to the lower back BUT the knee is the area which causes the most time off the bike
- There is moderate evidence for a link between saddle height and knee pain (i.e. saddle too low can cause knee pain), and minimal evidence for saddle fore/aft in knee pain (i.e. position of saddle in relation to the bottom bracket)
- 7% of cyclists surveyed in one study (Dahlquist, 2015) had pain while cycling, and 65.1% of those had that injury for longer than 1 year
- There is also moderate evidence for a link between increased lower back flexion (i.e. larger drop to the handlebars) and lower back pain
An interesting take home point from the course was there was only moderate evidence for supporting the many expensive bike fitting machines and the parameters these machines work off and significantly helping with pain/injury. Alternatively, there is great evidence for professional bike fitting with positive outcomes and pain relief. So regardless of the methods used, whether it be the $20,000 machines or a windtrainer, the message to coaches and athletes alike is to ensure the fitter is experienced and knowledgeable in the bike fitting; it is both an art and a science.
These outcomes emphasise the need to analyse the body more than the bike, looking at strength, mobility, muscle activation and kinematics. This is where health professionals become key. I certainly am biased towards physiotherapists, but have met myotherapists, osteopaths, sports scientists and biomechanists who also perform fantastic bike fits. If you are experiencing pain, why not seek someone who is an expert in pain relief?
For coaches/athletes, here are some quick evidence-based things to look out for which might be contributing to your pain:
- Back pain: too much lumbar flexion i.e. bending too far, reaching too far to the handlebars
- Knee pain: saddle too low
- Saddle pain: cut out in the saddle to assist with relief of anterior perineal structures
…and some experiential-based (those garnered from the groups years in the industry) things to look out for:
- Foot pain: is there a rigid base in the shoe? Is cleat position correct/even?
- Toe numbness: cleat position is critical, saddle fore/aft also a factor
- Hand numbness: bars too low
- Neck pain: reaching too far or too low
Since arriving back in Australia I find myself assessing everyone’s position now whenever I am riding past! My new focus is to help my clients by focussing on helping the body be comfortable in the position it wants to be in on the bike, rather than making a body suit a position it is not used to. Comfort is a huge player in speed. As a triathlete, I have had comfort-related bike fits and also have had aerodynamic-related bike fits myself, but a combination of these leads to the most ideal outcome. Aerodynamics are important (everyone wants to go faster), but comfort is also key in maintaining the perfect time trial position for 20, 40, 90 or 180 kilometres.
TOP TIPS FOR CYCLING COMFORTABLY:
- Make sure you are riding the right size bike – collaboration between your physiotherapist/allied health professional and local bike shop can make sure your dream bike is the right size.
- Relax! The main thing I see contributing to people’s pain is that they are too tense on the road. 70% of the pressure should be going through your feet, 20% through the saddle and 10% through your hands, so relax your upper body.
- Make sure that not ALL of your riding is hard – 90% of your riding should be easy and long, with the remaining 10% being hard work. Monitor your load levels.
- Make sure your body stays ‘fit’ for your dream bike – maintain condition by doing the rehab/prehab/recovery and training specifically set by your health professional and/or coach.
- Recovery is key – post ride, ensure you have had enough nutrition and fluids on board, stretch/foam roll (for pain relief, not injury management) and continue with your conditioning work. As they say, it’s not all about the bike!