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Bike path to success
Monday October 1, 2012


Today Erik Moen, PT, is a national authority on the treatment of bicycle injuries, but his rise in this field began with his own personal struggle with pain.

Moen, an avid cyclist since he was a teen, was increasing his hours on the bike to train for collegiate road racing in the early 1990s, when he had to cut his training short as a result of pain in his low back, ankles and feet. During discussions with musculoskeletal experts about his problems, he first learned about the concept of "bicycle fitting" — altering equipment position to accommodate the body.

Moen, owner of Corpore Sano physical therapy in Kenmore, Wash., started poring over books about pedaling biomechanics and the pathomechanics of cycling injuries. His conclusions laid the foundation for a practice visited by more than 1,000 cyclists per year who seek Moenís help to rehabilitate from their injuries and return to their passion.

"In the past, people used formulas to determine the correct bike settings, but itís critical to take into account a cyclistís goals, flexibility, strength and coordination," Moen said. "That is why the physical therapist is uniquely qualified to help this group."

The first success story

For Moen, the discovery that bike fit was not a formula was particularly encouraging because he was born with a club foot. After multiple tendon-lengthening and tendon-transfer surgeries as a teen, his condition improved, but his right foot still is three sizes smaller than his left. His right leg is more than half an inch shorter than the left.

Moen initially experimented on himself. He added a spacer between his right cleat and shoe, and lowered his bikeís saddle to meet the needs of the shorter leg. He also adjusted the placement of the foot clips based on the strength in each leg. After these adjustments, he was able to resume his training and ratchet up his hours and intensity on the bike.

"These little, tiny millimeter differences in things like the seat height, handlebar position and cleat placement make huge changes in how cyclists weight-bear and posture themselves on the bike," Moen explained.

After performing a musculoskeletal evaluation, Moen asks patients to pedal on their own bikes, which are positioned on a stationary resistance trainer. "When people are injured, it is not effective treatment unless you look at them while they are on their own bikes," he said.

One of the most common injuries he treats is anterior knee pain, which often is caused by a saddle position that is too low, irregular cleat placement, or a low cadence as a result of a gear that is too low.

Moen is adamant that PTs need specific training to treat cyclists effectively, and he teaches weekend continuing education courses to PTs about bicycle biomechanics, bike fit concepts and common bicycling injuries.

Muscle weakness can be a culprit for pain

Although bike fit changes can eliminate pain in many cases, another common source of injury is muscle weakness, said Jerry Durham, MPT, owner of San Francisco Sport and Spine Physical Therapy in California. "The hip mechanics affect just about every diagnosis from the hip down," he said. "Ten years ago, people focused on the foot and the ankle to treat injuries in those areas, but now I know to start at the hip. This approach can solve just about any diagnosis below the hip you can come up with."

Durham said that he commonly sees cyclists whose knee and foot injuries are linked to weakness in the gluteus maximus, gluteus medius and deep hip external rotators. He prescribes strengthening exercises for these muscles, and this usually mitigates the pain.

For patients suffering from neck pain, he works with them to strengthen their shoulders, biceps and triceps, which helps cyclists maintain good posture and support the head properly. He also encourages cyclists to "look through their eyelids," or look at the road ahead without constantly lifting the chin. This decreases the pressure on the lower cervical spine.

Getting the word out

Although PTs like Moen and Durham are having noticeable success in treating pain among cycling clients — the majority of cycling patients are back on the road with significantly less or no pain after one to three sessions — many cyclists are not aware PTs can help them, said Matt Lee, PT, DPT, OCS, of Kentucky Orthopedic Rehab Team Physical Therapy in Lexington.

"Iíve been an avid cyclist for 10 years, and I see many people who think that a massage therapist, bike shop or chiropractor is the answer," Lee said. "But physical therapists are the experts in handling the biomechanics of cycling."

For Lee, one of the turning points in garnering more business came after he successfully treated a well-known masterís racer in his 50s who had tried numerous other solutions with no success. The man had suffered a left leg injury after falling a year earlier. Although his injury had healed, he struggled to keep up with his peers and noticed his speed decreasing. He also was experiencing new pain in the Achilles region and popliteal area. He tried resting, exercising at the gym and seeing his physician, but nothing helped. He attributed his declining performance to aging.

A friend gave the cyclist Leeís contact information, and Lee performed a detailed musculoskeletal exam and watched the man pedal on his bike. During the exam, Lee identified that the man was suffering from weakness in his left hamstring and gluteal muscles.

"The previous injury had caused the muscle weakness, but he did not realize this," Lee said. "The more he rode, the greater his problems were in other areas due to the weakness." Lee prescribed exercises focused on developing proper motor control of the gluteus maximus, gluteus medius and hamstrings.

"I also helped him relearn how to distribute his weight and pedal in a smooth circular pattern, utilizing his newly found strength and control of his body," Lee said. "Within a few weeks, he was back to cycling and increasing his speed again. Once his teammates saw him getting stronger, it opened the floodgates and word starting spreading that physical therapy can help."

Lee printed KORT bike jerseys this summer and started visiting local bike shops to teach owners about the benefits of physical therapy. "They are highly motivated, fun people who are very interested in the body," Lee said. "They enjoy being educated about the problem as well as the solution, and thatís rewarding for the physical therapist." •

Heather Stringer is a freelance writer.

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Monday October 1, 2012
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