CYCLING HEALTH
Robert H. Sheinberg, DPM

There aren't many exercises other than cycling where you complete 90 repetitions per minute  If you multiply those repetitions out to a one, two or three hour bike ride, that's a lot of repetitive motion.

With that repetitive motion is a lot of potential for injury. Unlike running and other highly repetitive sports, preparing an athlete to meet the physical demands of a road race or mountain biking competition is only half the challenge. The bike and additional equipment allows the athlete to maintain a healthy body position and long-term health. Cyclists who aren't in top shape or use equipment that's "off," risk tendonitis, patellofemoral pain and other repetitive stress injuries (RSIs) of the upper and lower extremities.

The Right Fit
For this reason, cyclists at the professional and club levels may need cycling evaluations before a competition or event. Some of clients are cyclists in the market for a completely new bike, so they want a few ideas as far as frame size and the bike angles. But the majority are an athlete who're changing equipment, whether that's bike cleats or a more aerodynamic handlebar. Cyclists should bring their new equipment in so the fit can be assessed and adjustments recommended if necessary

The main considerations are:

Bike Frame: Obviously, cyclists should clear the top tube by 2 to 3 inches when standing over the bike. As a general rule, mountain bikes should have a smaller frame than road bikes to allow for jumping and riding on uneven, rocky terrain.

Seat Positioning: Proper seat height for a rider is predominantly a function of their foot size and leg length. The seat should be positioned so that the rider's knees are flexed 22 degrees to 30 degrees with the pedal in the lowest position.

Handlebar Height: The stem that holds the handlebars should be set slightly lower than the nose of the saddle, based on the rider's needs and the event he'll be competing in.

Cyclists should be assessed while they're using bike shoes, pedals, saddles and other accessories that could affect positioning on the bike. You also need to have clients out on the road riding because the riding done on a stationary bike isn't what is encountered on the road or trail, working up hills or into a headwind.

As important as a proper fit is, however, cyclists who aren't in riding shape and those who use bad riding technique still run a risk of injury. For example, one client may present with complaints of knee pain that he thought was the result of poor cleat alignment. After watching this patient ride on a training stand, however, the knee pain was traced back to an ankle injury that was suffered during a mountain bike race. Because of a severe sprain that this patient didn't treat, he had tightness in the subtalar joint that caused an abnormal foot position on the pedal. With some joint mobilization, a custom-molded orthotic and specific stretching activities we were able to treat the patient better than if we immediately started adjusting the bike.

Clinicians conducting a cycling evaluation take a thorough history and put patients through many of the same functional tests used in other settings; for example, watching the patient walk, squat, balance and transfer from sitting to standing, and checking for signs of scoliosis or other structural dysfunction. Areas that are particularly relevant to cycling include hip flexibility and motion in all planes (flexion, extension, abduction and external rotation), lumbopelvic orientation and motion, and ankle dorsiflexion and ROM.

There's usually less stress on head, neck, wrist and arms, so we're looking more at stability from the spine through the shoulder girdle. If the rider needs to get into an aerodynamic position for a triathlon or a time trial trunk flexibility and stability become more of an issue than if they're sitting upright on a mountain bike or going for a casual ride.

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