The Art of Cycling
Monday August 20, 2007
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Erik Moen, PT, CSCS, could sympathize with his patient’s predicament. A longtime cyclist himself, Moen understood the frustration of sustaining an injury at the peak of the training season. His patient, a regional and national elite amateur cyclist, was in so much agony from patellofemoral pain syndrome that any riding was uncomfortable.
Luckily, the 20-year-old rider had come to the right place. Moen, a Seattle-based bike racer and coach, is a nationally recognized expert when it comes to physical therapy for cyclists.
Moen improved the cyclist’s bike fit and worked to increase tissue mobility and hamstring flexibility. Once the cyclist’s pain was under control, he slowly worked up to riding three to four hours at a time. Several months later Moen’s patient went on to break away from the other riders and win the Snohomish Road Race in Washington — a significant accomplishment in the cycling world.
According to Moen, success stories like this are not uncommon among patients with cycling injuries. Unlike most sport-related injuries, many cyclists experience significant improvements if they see physical therapists who know how to properly fit the bicycle to the patient. A good bike fit coupled with flexibility and strengthening exercises often leads to noticeable results.
“Day after day, I hear people say ‘I can’t believe how much more comfortable this is. I’m riding faster and more comfortably,’” Moen says.
Luckily, the 20-year-old rider had come to the right place. Moen, a Seattle-based bike racer and coach, is a nationally recognized expert when it comes to physical therapy for cyclists.
Moen improved the cyclist’s bike fit and worked to increase tissue mobility and hamstring flexibility. Once the cyclist’s pain was under control, he slowly worked up to riding three to four hours at a time. Several months later Moen’s patient went on to break away from the other riders and win the Snohomish Road Race in Washington — a significant accomplishment in the cycling world.
According to Moen, success stories like this are not uncommon among patients with cycling injuries. Unlike most sport-related injuries, many cyclists experience significant improvements if they see physical therapists who know how to properly fit the bicycle to the patient. A good bike fit coupled with flexibility and strengthening exercises often leads to noticeable results.
“Day after day, I hear people say ‘I can’t believe how much more comfortable this is. I’m riding faster and more comfortably,’” Moen says.
Top three injuries
During the peak cycling season in the summer, about 90% of Moen’s patients are riders. The most common injury he treats among this patient population is patellofemoral pain syndrome. The majority of these injuries are caused by a saddle that is too low or poor cleat position, he says.
In some cases this injury also can be traced to a lower pedaling cadence, or riders who choose higher gears, says Moen, who owns a private practice called Corpore Sano LLC.
“When you look at the act of pedaling, it’s not simple,” he says. “People who are fairly new to the sport, and even some more experienced cyclists, sometimes select lower cadences of 60 to 70 rpm, which can create irregular compression of the knee.” The preferred cadence is 80 to 90 rpm because this minimizes compressive forces within the knee, Moen explains.
Another common cause of patellofemoral pain is a pedal stroke that is “quad biased,” or one that emphasizes the downward push of the pedal. He teaches these cyclists to focus on the other half of the pedal stroke. “It’s about working the entire circumference of the pedal stroke,” he says. “When you think about the entire pedal stroke, you start to realize it is a skilled event.”
After anterior knee pain, the second most common injury Moen treats among cyclists is neck or back pain. This is usually caused by a poor bike fit, such as a low saddle, downward tipped handlebars, or handlebars that are too close or too far from the seat.
Tied for third as far as frequency of injuries are hamstrings tendonitis and iliotibial band friction syndrome (IT band syndrome). These conditions can be caused by a saddle that is too high, an irregularly placed cleat, poor flexibility in the hamstrings, or improper pedaling technique.
During the peak cycling season in the summer, about 90% of Moen’s patients are riders. The most common injury he treats among this patient population is patellofemoral pain syndrome. The majority of these injuries are caused by a saddle that is too low or poor cleat position, he says.
In some cases this injury also can be traced to a lower pedaling cadence, or riders who choose higher gears, says Moen, who owns a private practice called Corpore Sano LLC.
“When you look at the act of pedaling, it’s not simple,” he says. “People who are fairly new to the sport, and even some more experienced cyclists, sometimes select lower cadences of 60 to 70 rpm, which can create irregular compression of the knee.” The preferred cadence is 80 to 90 rpm because this minimizes compressive forces within the knee, Moen explains.
Another common cause of patellofemoral pain is a pedal stroke that is “quad biased,” or one that emphasizes the downward push of the pedal. He teaches these cyclists to focus on the other half of the pedal stroke. “It’s about working the entire circumference of the pedal stroke,” he says. “When you think about the entire pedal stroke, you start to realize it is a skilled event.”
After anterior knee pain, the second most common injury Moen treats among cyclists is neck or back pain. This is usually caused by a poor bike fit, such as a low saddle, downward tipped handlebars, or handlebars that are too close or too far from the seat.
Tied for third as far as frequency of injuries are hamstrings tendonitis and iliotibial band friction syndrome (IT band syndrome). These conditions can be caused by a saddle that is too high, an irregularly placed cleat, poor flexibility in the hamstrings, or improper pedaling technique.
Solving the puzzle
When cyclists with any type of injury meet with Moen, he looks for clues that point to the cause of their pain. He starts by asking some thorough questions to obtain a complete history, such as how long they have been cycling, recent crashes, their training routines, and cycling goals.
Then he conducts a musculoskeletal exam to pinpoint any other clues. He examines the cyclist’s flexibility in the hamstrings, gluteals, and quadriceps. He also looks for asymmetry in the body, such as one leg that may be longer than the other. Additionally, he assesses strength in areas such as the back, hamstrings, and lateral hip stabilizers.
After examining the patient, Moen turns to the bike and inspects it while it is in a stationary position. He checks the saddle tilt, the distance between the handlebars and the saddle, cleat position, and any asymmetry.
Within his comprehensive gait evaluation, Moen has the cyclist ride the bicycle while it is mounted on a stationary resistance trainer. He then measures the knee angle in the most extended position, as well as the saddle height, trunk angle, and shoulder angle.
Although bike shops can provide bike fits, Moen believes PTs have the training to best fine-tune bike fit to the rider rather than following general rules of thumb.
“The wonderful thing that PTs have is their musculoskeletal training,” Moen says. “If a person has really tight hamstrings, we will not put them in a Lance Armstrong performance position. Or if someone is newer on the bicycle, we may not put them in the optimal position because it will not be comfortable.”
He also has learned that swimmers who transition to biking typically have a difficult time assuming competitive biking positions because they do not have the needed muscular development.
He usually starts swimmers with a less-extended position so they do not have to reach as far for the handlebars.
As his clients gain strength and flexibility through home exercises and more time on the bike, Moen often modifies the fit to accommodate their improved abilities.
When cyclists with any type of injury meet with Moen, he looks for clues that point to the cause of their pain. He starts by asking some thorough questions to obtain a complete history, such as how long they have been cycling, recent crashes, their training routines, and cycling goals.
Then he conducts a musculoskeletal exam to pinpoint any other clues. He examines the cyclist’s flexibility in the hamstrings, gluteals, and quadriceps. He also looks for asymmetry in the body, such as one leg that may be longer than the other. Additionally, he assesses strength in areas such as the back, hamstrings, and lateral hip stabilizers.
After examining the patient, Moen turns to the bike and inspects it while it is in a stationary position. He checks the saddle tilt, the distance between the handlebars and the saddle, cleat position, and any asymmetry.
Within his comprehensive gait evaluation, Moen has the cyclist ride the bicycle while it is mounted on a stationary resistance trainer. He then measures the knee angle in the most extended position, as well as the saddle height, trunk angle, and shoulder angle.
Although bike shops can provide bike fits, Moen believes PTs have the training to best fine-tune bike fit to the rider rather than following general rules of thumb.
“The wonderful thing that PTs have is their musculoskeletal training,” Moen says. “If a person has really tight hamstrings, we will not put them in a Lance Armstrong performance position. Or if someone is newer on the bicycle, we may not put them in the optimal position because it will not be comfortable.”
He also has learned that swimmers who transition to biking typically have a difficult time assuming competitive biking positions because they do not have the needed muscular development.
He usually starts swimmers with a less-extended position so they do not have to reach as far for the handlebars.
As his clients gain strength and flexibility through home exercises and more time on the bike, Moen often modifies the fit to accommodate their improved abilities.
High-tech bike fitting
Tami Dick, PT, CSCS, specializes in treating cyclists at the Boulder Center for Sports Medicine in Colorado. Like Moen, she preaches the power of bike fit. Cyclists from throughout the nation come to the Center for Sports Medicine, where PTs have access to a three-dimensional motion analysis computer for bike fitting. The system uses six infrared cameras to analyze motion. The PTs place reflective markers on certain anatomic landmarks to assess cycling gait. Dick says she spends about half of her day doing bike fits.
“I like doing bike fits because it is a puzzle,” she says. “People may fly in to see us, and I have to assess them and solve the puzzle of their bike fit in a couple of hours.”
Although a proper bike fit is critical for preventing injuries, Dick is the first to admit that this is not a cure-all. Dick, who started bike racing when she was 30, started suffering from IT band syndrome several years ago when she trained too aggressively. She trained minimally during the winter and felt like time was running out before the racing season. In an attempt to make up for lost time, she started doing vigorous hill intervals. A few weeks later she started having IT band pain, and had to take a couple of months off from cycling.
“I became a patient in the clinic and started swimming and doing stretches and self-massage,” Dick recalls. “I learned that you can’t get fit this week. You have to increase your training time and intensity gradually and listen to your body.”
Tami Dick, PT, CSCS, specializes in treating cyclists at the Boulder Center for Sports Medicine in Colorado. Like Moen, she preaches the power of bike fit. Cyclists from throughout the nation come to the Center for Sports Medicine, where PTs have access to a three-dimensional motion analysis computer for bike fitting. The system uses six infrared cameras to analyze motion. The PTs place reflective markers on certain anatomic landmarks to assess cycling gait. Dick says she spends about half of her day doing bike fits.
“I like doing bike fits because it is a puzzle,” she says. “People may fly in to see us, and I have to assess them and solve the puzzle of their bike fit in a couple of hours.”
Although a proper bike fit is critical for preventing injuries, Dick is the first to admit that this is not a cure-all. Dick, who started bike racing when she was 30, started suffering from IT band syndrome several years ago when she trained too aggressively. She trained minimally during the winter and felt like time was running out before the racing season. In an attempt to make up for lost time, she started doing vigorous hill intervals. A few weeks later she started having IT band pain, and had to take a couple of months off from cycling.
“I became a patient in the clinic and started swimming and doing stretches and self-massage,” Dick recalls. “I learned that you can’t get fit this week. You have to increase your training time and intensity gradually and listen to your body.”
Benefits of strength
Jerry Durham, PT, of San Francisco Sport and Spine Physical Therapy, combines bike fit with core strengthening to help many of his cyclist patients. In his experience, novice riders who start cycling for events such as Team in Training often see him for neck and shoulder complaints.
“They are not used to bearing weight on their hands for long periods of time,” he says. “They go from sitting or standing all day at work to sitting on a seat during training.”
For these clients, Durham suggests exercises that strengthen both their lower and upper core muscles, which includes muscles such as the hip external rotators, gluteus medius and maximus, cervical spine stabilizers, and middle and lower trapezius.
Dick also believes that many cyclists can benefit from core strengthening exercises. When patients ask her why she is suggesting these types of exercises to heal a knee problem, she explains that when the core is strong, the hips and legs can do the work of pedaling and this takes stress off the whole system. She uses the following analogy to help patients understand the value of core strengthening:
“I tell them to think about how much work it is to throw a ball when standing on the ground versus when treading water. If you do not have any ground to stand on, then you don’t have a good foundation. Without a good foundation, you have to work harder to throw that ball,” Dick notes.
In Moen’s opinion, the most critical muscles to strengthen are the back muscles: “I can’t overemphasize the importance of the back muscles. Back strength is the foundation from which you push off while pedaling and posturing yourself while cycling.”
For Moen, Dick, and Durham, their suggestions for cyclists — whether bike fit alterations or strengthening exercises — have been tested personally. All three are avid cyclists who draw from years of experience on the bike.
“I love the sport of cycling,” Moen says. “I race, I coach, and I work with kids. It’s a passion of mine, and I understand the sport at a high level. I feel like I can provide great solutions and outcomes so cyclists can better understand the sport and function at a higher level.”
Jerry Durham, PT, of San Francisco Sport and Spine Physical Therapy, combines bike fit with core strengthening to help many of his cyclist patients. In his experience, novice riders who start cycling for events such as Team in Training often see him for neck and shoulder complaints.
“They are not used to bearing weight on their hands for long periods of time,” he says. “They go from sitting or standing all day at work to sitting on a seat during training.”
For these clients, Durham suggests exercises that strengthen both their lower and upper core muscles, which includes muscles such as the hip external rotators, gluteus medius and maximus, cervical spine stabilizers, and middle and lower trapezius.
Dick also believes that many cyclists can benefit from core strengthening exercises. When patients ask her why she is suggesting these types of exercises to heal a knee problem, she explains that when the core is strong, the hips and legs can do the work of pedaling and this takes stress off the whole system. She uses the following analogy to help patients understand the value of core strengthening:
“I tell them to think about how much work it is to throw a ball when standing on the ground versus when treading water. If you do not have any ground to stand on, then you don’t have a good foundation. Without a good foundation, you have to work harder to throw that ball,” Dick notes.
In Moen’s opinion, the most critical muscles to strengthen are the back muscles: “I can’t overemphasize the importance of the back muscles. Back strength is the foundation from which you push off while pedaling and posturing yourself while cycling.”
For Moen, Dick, and Durham, their suggestions for cyclists — whether bike fit alterations or strengthening exercises — have been tested personally. All three are avid cyclists who draw from years of experience on the bike.
“I love the sport of cycling,” Moen says. “I race, I coach, and I work with kids. It’s a passion of mine, and I understand the sport at a high level. I feel like I can provide great solutions and outcomes so cyclists can better understand the sport and function at a higher level.”
Heather Stringer is a medical writer for Today in PT. To comment on this story, send e-mail to pteditor@gannetthg.com.
Monday August 20, 2007