University of Virginia

Clinical Bike Fit
Jay Dicharry, MPT University of Virginia Center for Endurance Sport Dept of Physical Medicine and Rehab

University of Virginia

University of Virginia

Quick tip for patients ! Seat height •!level pelvis •!crank arm parallel to the seat tube •!Heel on pedal •!Knee should be straight

University of Virginia

Quick tip for patients ! Seat height

University of Virginia

Anterior knee pain?

Raise seat to minimize excessive compressive forces on patella femoral joint

Lateral Knee pain?

Lower seat to avoid friction of the Illiotibial band across the femoral condyle

University of Virginia For more information: “Bike Right.. Bike Fit!” -APTA The End! …….or is it the beginning! .

University of Virginia •!Aim to be efficient •!Course demands play a role in their position •!Individual factors affect fit .

and technique that need to be addressed to reach desired position – clinical experience guides this just as it does in any functional training Make the bike reflective of the rider Proper bike fit is a process . What needs to be altered to be able to seek desired position? !!fit rider to bike !!Identify issues in ROM.University of Virginia Bike Fit for the clinician…… today and beyond 1. stability.! How do I use their body in front of me today? !!fit bike to rider a)! Our evaluation defines constraints of each individual b)! Apply these limits in ROM and stability to that day’s fit 2.

University of Virginia .

and you don’t .University of Virginia Why doesn’t every cyclist look like one of these two guys? Endless supply of resources Event specific fit Technique stability They are different than you! flexibility Daily optimization of position They have a closed course with a pace car in front of them and a coach in their ear piece telling them How many feet till the next turn .

2. Going forward and up will help to " drag. The wind tunnel numbers don’t lie. but when does the change in joint angles result in a " power output? .! it IS possible to get almost as aero as standard draft legal positions using an ITU legal position if you manipulate the body correctly. Busted Reason 1.University of Virginia You must go down and forward for better time trial and triathlon performance.

University of Virginia You run faster off the bike leg if you are in a forward. Guess what . 2. they can’t run a sub-30 min 10K Off the bike. Hard to control.! For every study I’ve read that says one thing. aero position. another study says another. do me a favor and tell the ITU guys and gals (who are in restricted positions) that sorry. Inconclusive Reason 1.they are!!! .

work to improve dynamic limitations 2.University of Virginia So how do we begin the fit process? Key Principles: 1.! Orient the rider in the correct location above the bottom bracket and contact points .! Accommodate for structure.

severe hip flexor limitation.3 yr focus on TT Mild/moderate low back pain after 30 min on TT bike Musculoskeletal Exam Highlights: Severe limited lumbar flexion.University of Virginia Case Study: Rider X Top 10 VA state TT championships Goal: win state TT 5 yrs riding history . severe hamstring restriction bilaterally. protracted shoulders •!Fit emphasis on rolling the hips forward to minimize strain on lumbar spine and open the hip angle throughout the stroke •!Location over the bottom bracket established through course profiles and soft tissue and stability limitations •!Exercises given to increase hamstring and hip flexor mobility and increase scapular stability to prevent excessive protraction in aerobars .

3. Top 5 @ Nats Verdict: he is pleased .we can do better!!!” Engineer does NOT perform or take into consideration any biomechanical analysis that is unique to the rider. ……………. Rider calls me after 3 months of trying to adapt to this position: 1.University of Virginia Results: Back pain reduced following fit to complete resolution in 3 weeks Over the course of the year. Both depart happily.! Has not placed in top 10 in any race since he altered position. thinks fit is a big part of his success Fast forward….! Back pain has returned. Power outputs remain normal on his road bike.! Power outputs on all workouts have objectively reduced 40-50 watts at all given intensity.Rider finishes residency and is now making a salary Goes to wind tunnel for analysis Engineer in tunnel says “You won the state TT in that position?!?!? . but improves drag by 32%. 2. rider saw significant improvements in power and placing at races: VA state TT champ.calls me constantly. Do you think Rider X reached the tipping point??? .

! Bar drop 5.University of Virginia So how do we begin the fit process? ..! Set Seat height 3..! Bar width Seat tube Seat tube angle Bottom bracket .! Fore / Aft position 4.by addressing points of contact 1...! Cleat position 2.

!fore/aft b.! Cleat position a. rotation c. width .University of Virginia 1.

to shim or not to shim……and where Cycling is not running •!Foot deformation due to " shock is not necessary as part of pedal cycle •!Structure does influence how the foot interfaces with the shoe foot bed Cleat wedge Forefoot wedge insole Ar •!Alter position of entire foot •!intervention at the ankle •!Alter surface contact on foot..! Cleat position Shim…….University of Virginia 1.proprioception •!Possible to alter torsional position of foot .

foot interface – Step 1 – arch height Plug the hole With an insole! Ar .University of Virginia 1.! Cleat position .

University of Virginia 1.! Cleat position .foot interface – Step 2 – forefoot alignment Fill the gap Ar .

check pelvis to see if pattern is acquired or compensatory . Seat Height Knee angles: angle at the knee when the pedal is the furthest distance away from the hip joint •! this is not always parallel with the seat tube with some more radical frame designs •! 25-40 deg depending on rider history and ankling pattern •! Wide range to take into account what happens under load •! If Excessive pelvic rock or excessive toe down.University of Virginia 2.

direct effect on knee angle •! Achieved through measuring knee angle (angle between greater troch and fibular maleolus) •! Using a goniometer.University of Virginia 2. so try to move seat back to maintain relative distance from bottom bracket . knee flexion angle should be between 25-40 deg when the pedal is the furthest distance from the acetabulum ( parallel to the seat tube) •! Mountain bikers can go slightly lower for lower COG. Seat Height •! Observe rider first to check ankle position .

Tibial tuberosity over pedal spindle 3. Fibular head over pedal spindle 2.University of Virginia 3. Patella over pedal spindle . Fore / Aft This can be objectively referenced using either: a)! the bike (seat tube angle) •! 1 cm = ~1 deg of STA b)! the rider (using anatomical landmarks on the rider’s body). •! KOPS! 1.

Fore / Aft Rider anterior Fibular Head neutral Tibial tuberosity Rider posterior Patella .University of Virginia 3.

why would we depart? Anthropometric differences Course profiles Aero goals If the desire is to go low.University of Virginia Fore-aft position •! •! •! If tibial tubercle is neutral. you’ve got to get forward. But you also get closer to the tipping point .

Bars !! Comfort !! Handling 1.! Bar width •!Bar height should take constraints of the rider into the equation .University of Virginia 4.! Bar drop 2.

What happens on the way down? .

! ROM in hamstrings and L spine 2.! Stabilization Critical for bar drop & reach! .Posterior tilt Can’t get low Vertical Middle road Anterior tilt Low long Ability to roll pelvis limited by: 1.

University of Virginia J-Bar Test •!to establish an aerobar drop that is specific to the dynamic mobility of each rider •! allows a functional quantification of a rider’s mobility that is reflective of the amount of soft tissue tension it sees in a riding position. .

c. While keeping the knees in their 30 bend. Have the rider stand against a wall and record their inseam (cycling shoes on) b. Instruct the rider to bend their knees approximately 30 deg d. and back of the head. ask the rider to bend from the hips until the point at which they feel any tension at all in the hamstrings or low back . Rider to places a dowel along the back of the body so that it is held in contact with the sacrum.University of Virginia J-Bar Test Instructions: a. They will be standing sideways to the wall so that it is on their right or left. thoracic spine.

and back of the head.University of Virginia J-Bar Test Instructions: a. They will be standing sideways to the wall so that it is on their right or left. While keeping the knees in their 30 bend. ask the rider to bend from the hips until the point at which they feel any tension at all in the hamstrings or low back . Have the rider stand in bare feet against a wall and record their inseam (in shoes) b. c. thoracic spine. Rider to places a dowel along the back of the body so that it is held in contact with the sacrum. Instruct the rider to bend their knees approximately 30 deg d.

Have the rider stand in bare feet against a wall and record their inseam (in shoes) b. and back of the head.University of Virginia J-Bar Test Instructions: a. While keeping the knees in their 30 bend. c. thoracic spine. They will be standing sideways to the wall so that it is on their right or left. Rider to places a dowel along the back of the body so that it is held in contact with the sacrum. ask the rider to bend from the hips until the point at which they feel any tension at all in the hamstrings or low back . Instruct the rider to bend their knees approximately 30 deg d.

This will serve as the High Point. Have the rider stand in bare feet against a wall and record their inseam (in shoes) b. ask the rider to bend from the hips until the point at which they feel any tension at all in the hamstrings or low back. They will be standing sideways to the wall so that it is on their right or left. While keeping the knees in their 30 bend. c. Instruct the rider to bend their knees approximately 30 deg d. Measure the height of the elbow above the ground. and back of the head.University of Virginia J-Bar Test Instructions: a. thoracic spine. Rider to places a dowel along the back of the body so that it is held in contact with the sacrum. .

High Point . Rider to places a dowel along the back of the body so that it is held in contact with the sacrum. ask the rider to bend from the hips until the point at which they feel any tension at all in the hamstrings or low back. thoracic spine. Instruct the rider to bend their knees approximately 30 deg d. While keeping the knees in their 30 bend. c. This will serve as the High Point. Measure the height of the elbow above the ground. They will be standing sideways to the wall so that it is on their right or left. Have the rider stand in bare feet against a wall and record their inseam (in shoes) b. and back of the head.University of Virginia J-Bar Test Instructions: a.

f. and goals. Once this measure is recorded. Again the height of this position above the ground is recorded as the Low Point.Low Point = lowest point that bars can be below saddle based on their flexibility Where to place bars in the range is now a combintion of evaluation. time in aero position. ask them to continue flexing from the hip to the point where they feel a light to moderate stretch in the hamstrings. .University of Virginia J-Bar Test e. Plug numbers into the following formula: Inseam – High Point = high point from which we begin bar drop from saddle Inseam .

Plug numbers into the following formula: Inseam – High Point = high point from which we begin bar drop from saddle Inseam . Low Point . and goals. Again the height of this position above the ground is recorded as the Low Point. Once this measure is recorded. f. time in aero position.Low Point = lowest point that bars can be below saddle based on their flexibility Where to place bars in the range is now a combintion of evaluation. ask them to continue flexing from the hip to the point where they feel a light to moderate stretch in the hamstrings.University of Virginia J-Bar Test e.

Formula: Inseam – High Point = high point from which we begin bar drop from saddle Inseam .University of Virginia J-Bar Test f. and goals.Low Point = lowest point that bars can be below saddle based on their flexibility Example: 82 cm inseam High Point = 84 cm . time in aero position. . Low Point = 74 cm 82inseam – 84 high = +2 cm ! bar 2cm above seat 82inseam – 74 low = -6 cm ! bar 6cm below seat Where to place bars in the range is now a combintion of evaluation.

•!Good starting point is a slight downward tilt to spread the weight of the upper body equally through the forearms and hands .University of Virginia Bar Fore/aft and Tilt •! Shoulder is perpendicular (approximately 90 Degrees) to the torso. •!Too high of a tilt also tends to put too much weight on the elbows •!Too low of a tilt will create additional upper body strain. •! Excessive reach for the bars (flexing the shoulder) will increase muscle activity in the upper body ! plank Tilt bars up helps aerodynamic drag but limits the amount the rider can pull on the bars when climbing. •! The elbow pads should be adjusted 2-4in distal to the elbow.

•!Goal is to maintain shoulder blades flat along the body Wide Better breathing More comfort More stability Narrow Impaired breathing Compensatory scapula (shoulder blade) position increasing neck strain Poor handling (how technical is course?) . breathing room. and stable handling.University of Virginia Bar width •!“Stacking” the rider over the contact points provides stability.

University of Virginia Bar type /bike type influences elbow position and muscular effort required to hold position Standard Aerobar + + Road bike = = Shoulder angle Too flexed (too far reach) Shoulder angle @90 -proper Weight distribution Shorty Aerobar Road bike .

Assessment 1.! Have rider spin for 4-5 min and settle in on seat position LISTEN-do you hear a smooth spin or choppy stroke.! elbow angle d. toe down or heel drop-due to compensation or correction? Where does knee track over foot when looking from behind? (knees should follow the structural alignment you saw during your eval – excess frontal and transverse plane ROM can be addressed through cueing and therapeutic intervention) Seat height via knee angle Fore/aft via KOPS method Gather info on upper body position a.! .! scapular orientation e.University of Virginia Fit Flowsheet .! shoulder angle c.! 3.! bar drop b.! 4. what does pelvis look like (wobble or tilt).! cervical spine position 2.

! 5.keep height in check Observe alterations in pedal stroke Continue to adjust bars according to criteria presented Adjust for abnormalities using Table 1 Check Table 2 for specific complaints 3. If they lack ham and/or lumbar mobility.! Set cleats according to static evaluation Instruct on how to sit on bike a.! J-Bar test uses the functional relationship of the ROM in the hamstrings and lumbar spine to help guide expectations. but be realistic about room for improvement.Intervention 1.! changes orientation of hip center to affect all lower body measures b.! 7.! 8. Can be improved. 4.University of Virginia Fit Flowsheet .! .! torso length to affect reach and drop c.! 2.! 6. they have to go up and forward Seat height @ 25 -40 deg knee flexion angle Set fore/aft according to KOPS .

and safety Positives of slack Spreads out the total work demand of lower body muscles more evenly Allows for more efficient position climbing More comfortable since there is more room to move around Puts less restriction on the hip joint (more open throughout the revolution) Negatives of slack less aero rider with limited hamstring/lumbar mobility will not be able to achieve a slacker position without making interventions to their flexibility and alignment . vision.University of Virginia Positives of steep Allows a more aerodynamic position Necessary for riders with limited mobility – we further compensate their position on the bike due to their lack of mobility Negatives of steep can decrease power production places increased work demand on the quads Places additional compressive forces on the patella-femoral joint Can impair low rpm hill climbing Can affect bike handling.

Bridge the gap ? From the clinic to the bike .

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University of Virginia How do I sit on a bike? .Broomstick Drill •!Rotate through pelvis – not spine •!Seat tilt can be your friend to cue pelvic tilt •!Ready Position! .

University of Virginia Posture .

If core stability in functional task is so important. why not do it on the bike? .

Left arm off .

Right arm off .

Left leg off .

Left arm off Contra-lateral leg off .

Deficient Force-Couple .

Global muscles provide external loading and spinal orientation Move the bucket around Local muscles provide segmental control Increase the segmental stiffness Progress is made by incorporating functional skill into light tasks (supine bridges) and progressing to heavier load functional task (climbing a 14% grade at 350 watts) Adding core drills on the bike is an essential to Ensure that this learned skill transfers into their Riding position. .University of Virginia Organization of trunk muscles is impaired in chronic LBP and posture dysfunction. often the source of poor stabilization of the entire lower extremity.

University of Virginia .

University of Virginia The End…… And the start of the road ahead .

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