Clinical Pearl: Physical Therapy and a Bike Fit—Back On The Saddle and Riding Pain Free

By Kristi Mason, MSPT

Many cyclists here on the East Coast have just finished the Pan-Mass Challenge, riding up 192 miles to help raise money for life-saving cancer research. For most of these cyclists, they have been training hard for this event since the winter. With the increased mileage and overall time spent on the bike during training, many of these cyclists utilize physical therapy to help them cross that finish line. The most common cyclist injuries I see in the clinic are hip pain, back pain, and knee pain. In most cases, these cyclists are back in the saddle and riding pain-free after 2-4 sessions. Usually, one session of dry needling followed up with corrective exercises and one session of a bike fit can do the trick.

Many of my cyclists are surprised that I do a bike fit. As physical therapists, we are experts in anatomy, bio-mechanics, and physiology, so I feel that, with training, we are the best resources for our clients. Every cyclist is unique, and I make sure their bike fits their body while also keeping in mind flexibility and strength limitations. If I am treating a runner, I like to do a gait analysis, so the same goes for my cyclists. I need to see what they look like on their bike. I want to know areas of weakness and inflexibility. Those restrictions often affect power and pedaling skills, leading to compensations that can cause pain and affect performance.

I analyze their pedal position, seat position, and handlebar position.

Once I know the areas they need to work on, I will design a program specifically for their imbalances. I will also adjust the bike to accommodate for those imbalances.

I make recommendations and adjustments to alleviate pain and increase performance. For most of my clients, a simple adjustment to their cleat position makes all the difference in the world.  A millimeter adjustment can go a long way towards bringing the client’s knee angle to the idle position in order to accommodate their hamstring length. This simple adjustment can decrease strain on the knee, hip, and low back. I often find that it is time for a new saddle for most of my clients. Similar to runners needing a new pair of shoes, cyclists place most of their wear on the saddle.  The saddle is where you bear most of your weight, so it makes sense that the more miles you do the faster your saddle wears out. As the saddle wears, it becomes too “squishy” which allows for increased movement at the hips, leading to wasted energy and increased strain on back and knees.

So, if you are experiencing pain on the bike, don’t ignore the signs; make an appointment with a physical therapist who is trained in bike fitting to get you back to riding pain-free.  Happy riding!