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					Bike Fit

  Marc Silberman, M.D.
            Gillette, NJ
•   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
Bicycle Exam
•   Comfort
•   Safety
•   Injury Prevention
•   Peak Performance

• Aerobic efficiency    Superman Position
  versus aerodynamics
Bicycle Anatomy

              Seat tube

              Top tube

              Seat tube angle
              72 - 74°
Crankset and Chainrings
                      Rider Height

                      60-64 inches

                      65-72 inches

                      72-74 inches
         53           74-76 inches
                            ER Burke
         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                2
   Saddle Tilt and Fore-Aft
   Re-check Saddle Height                3

3. Hands-Handlebar Interface
   Height, Reach, and Tilt           1
          1. Foot-Cleat-Pedal
• Ball of the foot is over the pedal spindle
• 1st metatarsal head
2. Saddle Height
                  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

Photo by Mike Spilker.
Saddle Height

Fabian Cancellara and Andy Pruitt
3. Saddle Fore-Aft-Tilt


                   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             Steeper Seat Tube
pedal spindle and 1st metatarsal 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


Top Tube

             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


 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 Sores
            Medical 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 Neuropathy
         On the Bike Treatment
•   Relieve pressure
•   Pad bars
•   New gloves (not gel)
•   Reposition often
•   Bars too far forward
•   Too low
•   Too much tilt
            Hand Neuropathy
            Medical Treatment
•   Massage
•   Cortisone
•   Night splint
•   Surgery

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

                    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 Syndrome
• 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
• Massage
• Assisted Stretching
• 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
    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 versus
  saddle to far back
• Manual Therapy, Strengthening Program
  Trigger point injections
        Training Periods of Pros
                     5%          15%
600                  15%                % in Zone 3
                                        > 90% HRmax
400                                                      km/week
        0%                       75%    % in Zone 2
                     80%                70 – 90% HRmax
200    10%
                                        % in Zone 1
       90%                              < 70% HRmax
      Nov - Dec    Dec - Feb   Mar - Oct

       Rest       Pre-Season   Competition
              Training Stimulus


                Training Volume/Intensity
•   Cyclists are notorious
•   Clinical history is most important
•   Many blood tests, not very helpful
•   Exclude organic disease
•   Profile of Mood States
•   Performance Testing Decrement
    – VO2, Lactate, HR, Watts, RPE relationship
                Laws of Training
1.    The race is won in the off season
2.    Train frequently, all year round
3.    Start gradually and gently
4.    Build a big base
5.    Go hard on the hard days, easy on the easy days
6.    Do not overtrain
7.    Avoid monotony
8.    Train with others
9.    Keep a logbook
10.   Take a break at the end of a season, stay active

                         Adapted from Tim Noakes in the Lore of Running
Marc Silberman, M.D.

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