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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.
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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
Balance • Comfort • Safety • Injury Prevention • Peak Performance • Aerobic efficiency versus aerodynamics Superman Position
Bicycle Anatomy Seat tube Top tube Seat tube angle 72 - 74°
Crankset and Chainrings Rider Height 60-64 inches 165–167.5mm 65-72 inches 170mm 72-74 inches 172.5mm 74-76 inches 175mm ER Burke 39 53
Cycling Clock Diagram Myth: Clipless pedals allow the rider to pull up during steady state US National Rider 300W and 90RPM The limb is lifted but Not as fast as the pedal Is rising Broker and Gregor 1996
Order of Fit 1. Foot-Cleat-Pedal Interface 2. Pelvis-Saddle Interface Saddle Height Saddle Tilt and Fore-Aft Re-check Saddle Height 3. Hands-Handlebar Interface Height, Reach, and Tilt 2 3 1
1. Foot-Cleat-Pedal • Ball of the foot is over the pedal spindle • 1st metatarsal head
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
Saddle Height Lemond-Guimard Method. Saddle Height = Inseam in cm X .883
2. Saddle Height Knee flexed 25-30 degrees with pedal in 6 o’clock position. 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 Plumb bob falls over pedal spindle and 1st metatarsal Steeper Seat Tube More Forward Position Higher Saddle
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 Size 10 –12 cm Tops Hoods Top Tube Drops
4. Stem Extension Torso flexes about 60 degrees with the hands in the drops. Torso flexes about 45 degrees with the hands on the hoods. Photo by Mike Spilker.
4. Stem Extension Andre Steensen, neck and lower back pain, shortened stem 1cm
Contact Overuse Neuropathy Saddle Sore Morton’s Neuroma
‘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 Greater Troch Pre-patella and MCL bursa 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 Patella Femoral ITB 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 Adjustment Location Cause Solution Anterior Saddle too low Raise saddle Saddle too far forward Move saddle back Cranks too long Shorten cranks Posterior Saddle too high Lower saddle Saddle too far back Move forward Medial Toes point out Point in Feet too far apart Move closer Tight pedal tension Lower tension Lateral Toes point in Point out Feet too close Move apart Arnie Baker 1998 Bicycle Medicine
Strain Cervical Thoracic 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