Bike Fit

Marc Silberman, M.D. Gillette, NJ

Supplies

• Bicycle trainer

• Stadiometer or measuring tape

• Text book

• Measuring tape

• Goniometer

• Plumb line

• Allen wrench set

• Video Camera, Tripod, Computer/TV

Pro Bike Fit

Fabian Cancellara, Andy Pruit, Scott Holz, Bobby Julich

Bicycle Exam

Balance

• Comfort• Safety• Injury Prevention• Peak Performance

• Aerobic efficiency versus aerodynamics

Superman Position

Bicycle Anatomy

Seat tube

Top tube

Seat tube angle72 - 74°

Crankset and Chainrings

53

39

Rider Height

60-64 inches165–167.5mm

65-72 inches170mm

72-74 inches172.5mm

74-76 inches175mm ER Burke

Cycling Clock Diagram

Broker and Gregor 1996

Myth: Clipless pedalsallow the rider to pull upduring steady state

US National Rider300W and 90RPM

The limb is lifted butNot as fast as the pedalIs rising

Order of Fit

1. Foot-Cleat-Pedal Interface

2. Pelvis-Saddle InterfaceSaddle HeightSaddle Tilt and Fore-AftRe-check Saddle Height

3. Hands-Handlebar InterfaceHeight, Reach, and Tilt 1

2

3

1. Foot-Cleat-Pedal

• Ball of the foot is over the pedal spindle

• 1st metatarsal head

2. Saddle Height

Saddle Height

Most important bicycle position setting

• Inseam measurement method (LeMond)– Saddle Height = 0.883 X inseam in cm

• Knee angle measurement (Pruitt, Burke)– 25 to 30 degrees knee flexion at 6 o’clock position

• Heel to back of pedal method– Leg almost fully extended with no hip rocking

Lemond-Guimard Method.

Saddle Height = Inseam in cm X .883

Saddle Height

2. Saddle Height

Knee flexed 25-30 degreeswith pedal in 6 o’clockposition.

Photo by Mike Spilker.

Saddle Height

Fabian Cancellara and Andy Pruitt

3. Saddle Fore-Aft-Tilt

Tilt

Fore-Aft

3. Saddle Fore-Aft

When pedal is in the 3 o’clock position, plumb line dropped from inferior pole of patella falls directly over pedal spindle.Bert Webster performing bike fit. Photos by Mike Spilker.

Road vs. Time Trial Position

Steeper Seat TubeMore Forward PositionHigher Saddle

Plumb bob falls overpedal spindle and 1st metatarsal

Frank Schleck

TT Position Raised

Goal: more power

4. Stem Height

1 to 3 inches

4. Stem Height

Stem raised 1cm, rider actually became lower, more aero

4. Stem Extension

Stem Size10 –12 cm

Top Tube

Tops

Hoods

Drops

4. Stem Extension

Torso flexes about 60degrees with the handsin the drops.

Photo by Mike Spilker.

Torso flexes about 45degrees with the handson the hoods.

4. Stem Extension

Andre Steensen, neck and lower back pain, shortened stem 1cm

OVERUSE INJURIES

Contact Overuse

Saddle Sore

Morton’s Neuroma

Neuropathy

‘Morton’s Neuroma’

• Burning pain and numbness

• Impingement of interdigital nerves

• See riders shaking foot out of pedals

• Chronic inflammatory mass

• Between 3rd and 4th metatarsal classically

‘Morton’s Neuroma’ On the Bike Treatment

• Adjust cleat position, usually further back

• Check inside shoe for cleat bolts

• Change shoes to wider toe box

• Shoe inserts may help

‘Morton’s Neuroma’Medical Treatment

• Cortisone

• Massage

• Shoe inserts

• Surgery

Saddle Sores

• Moisture + Pressure + Friction

• Chafing

• Ulceration

• Folliculitis

• Abcess

• Subcutaneous nodules

Saddle Sores On the Bike Treatment

• Change saddle

• Cut a hole in the saddle

• Check saddle height and tilt

• Clean chamois, no seams, keep dry

• Don’t sit around in your kit after riding

• Emollients

Saddle SoresMedical Treatment

• Prevention– Keep dry, clean, chamois, avoid shaving high

• Medical Treatment– Warm soaks– Topical cortisone, anti-fungal, anti-bacterial– Oral antibiotics– Surgical incision and drainage– Surgery

Hand Neuropathy

• Cyclist’s Palsy (Ulnar Neuropathy)

• Carpal Tunnel Syndrome

• Worse after long rides

• Worse on rough terrain

• EMG reversible changes

• May become permanent

Hand NeuropathyOn the Bike Treatment

• Relieve pressure

• Pad bars

• New gloves (not gel)

• Reposition often

• Bars too far forward

• Too low

• Too much tilt

Hand NeuropathyMedical Treatment

• Massage

• Cortisone

• Night splint

• Surgery

Bursitis

Pre-patella andMCL bursa

Greater Troch

Ischial Tuberosity

Ischial Tuberosity ‘Bursitis’

• ‘Sits Bones’ sore

• Cold weather, early season, time trialing

• Rest, Massage, Cortisone

• On the Bike:– Change saddle– Check saddle height and tilt– New chamois

Greater Trochanteric ‘Bursitis’

• Proximal ITB Syndrome

• Pain with lying on side at night

• Physical Therapy

• Massage, OMT, Cortisone

• On the bike:– Check saddle height– Check cycling form

Pre-Patellar Bursitis

• Aspiration and fluid analysis• Cortisone• RICE and massage• On the bike:

– Check cleat and position– Check saddle height and fore-aft– Check pedal technique– Check crank arm length

MCL ‘Bursitis’

• Pain and tenderness over MCL• MRI if suspicious for meniscal tear• Massage• Cortisone• On the bike:

– Check cleat– Check saddle height and fore-aft– Check pedal technique

Most Common

ITB

Patella Femoral

Patella Tendon

Patella Femoral Pain Syndrome

• Pain under the patella from excessive load– Hill climb– Wind– Big gear– Time trialing– Weight training

Patella Femoral Pain Syndrome

• Tender patella facets

• Tender patella compression

• Unable to do one legged squat

• No effusion

Patella Femoral Pain SyndromeTreatment

• Off the Bike– Massage

– Cortisone or viscosupplementation

– Physical Therapy

– Surgery for removal of medial plica

• On the Bike– Check if saddle is too low or forward

– Check if cranks are too long

– Relative rest, supple spinning

ITB Syndrome Distal

• Anterolateral pain

• Burning or snapping

• Climbing, pushing big gears

• Wind

• Stationary Trainer

ITB

• Massage• Assisted Stretching• OMT• Physical Therapy• Leg length evaluation• Address training and

bike fit• Not Rest, NSAIDs,

injection, or surgery

Knee Pain and AdjustmentLocation Cause Solution

Anterior Saddle too low Raise saddleSaddle too far forward Move saddle

back Cranks too long Shorten cranksPosterior Saddle too high Lower saddle

Saddle too far back Move forwardMedial Toes point out Point in

Feet too far apart Move closerTight pedal tension Lower tension

Lateral Toes point in Point outFeet too close Move apart

Arnie Baker 1998 Bicycle Medicine

Strain

CervicalThoracic

Lumbar

Thoracic Strain/Cervical Strain

• Upper trapezius

• Levator scapula

• Trigger points and spasm

• Do not need to be folded in half

• Bars too low or too far forward versussaddle to far back

• Manual Therapy, Strengthening Program Trigger point injections

TRAINING

Training Periods of Pros

0

200

400

600

800

Nov - Dec Dec - Feb Mar - Oct

km/week

90%

0%10%

80%

15%5%

75%

15%10%

% in Zone 3> 90% HRmax

% in Zone 270 – 90% HRmax

% in Zone 1< 70% HRmax

Rest Pre-Season Competition

Training Stimulus

Performance

Training Volume/Intensity

Overtraining

• Cyclists are notorious

• Clinical history is most important

• Many blood tests, not very helpful

• Exclude organic disease

• Profile of Mood States

• Performance Testing Decrement– VO2, Lactate, HR, Watts, RPE relationship

Laws of Training

1. The race is won in the off season2. Train frequently, all year round3. Start gradually and gently4. Build a big base5. Go hard on the hard days, easy on the easy days6. Do not overtrain7. Avoid monotony8. Train with others9. Keep a logbook10. Take a break at the end of a season, stay active

Adapted from Tim Noakes in the Lore of Running

Marc Silberman, M.D. drbicycle@njsportsmed.com