BIKE-FIT BREAK THROUGHS

Can ad­just­ing bike set-up re­ally solve long-term prob­lems and get side­lined cy­clists back in the sad­dle? Michelle Arthurs-bren­nan speaks to four rid­ers mirac­u­lously fixed by a bike-fit

Cycling Weekly - - Fitness -

Bike-fit­ting has come a long way since the days when a vet­eran racer would squint in your di­rec­tion, slam your stem and send you on your way. These days, when in­jury rears its ugly, frus­trat­ing head, bik­e­fit­ting ex­perts with a deep un­der­stand­ing of the hu­man body seek to find solutions us­ing tech­niques far more ad­vanced than mir­ror, plumb line and ad­vi­sory an­gles.

“The dif­fi­cult thing in a bike-fit is un­der­stand­ing the hu­man body — that’s where the real skill is,” says Lee Prescott of Warwickshire-based Velo Atelier. “You’ve got these or­ganic, asym­met­ric bod­ies that you are try­ing to mate to a per­fectly sym­met­ri­cal en­gi­neered piece of ma­chin­ery.”

A fit­ter must make al­lowances for in­di­vid­ual phys­i­cal quirks, whether nat­u­ral or the re­sult of in­jury.

“Un­der­stand­ing how that per­son’s body moves, you can see whether the bike is forc­ing them to move in an un­nat­u­ral way, and what you can do about that,” says Prescott, who has worked with Par­a­lympians. “If an in­jury is ap­proached in­tel­li­gently and sym­pa­thet­i­cally, there’s nearly al­ways some sort of an­swer to get you to your goal.”

For some prob­lems, ad­just­ments to the bike put a band-aid on the prob­lem, al­low­ing the rider to go away and con­tinue with re­hab, typ­i­cally work­ing on strength or flex­i­bil­ity to help them hold their op­ti­mal po­si­tion.

“I can move the bike around to make a rider safe and com­fort­able and in­crease their per­for­mance. But quite of­ten the thing hold­ing them back is a phys­i­cal prob­lem, and at that point we’ll rec­om­mend a physio, os­teopath or ex­er­cises to help them,” Prescott says.

There is no re­li­ably pos­i­tive correlation between the num­ber of mag­i­cal-look­ing lasers and the ex­per­tise of the bike-fit wizard us­ing them. Some fit­ting sys­tems cal­cu­late the ideal po­si­tion for a rider based on an al­go­rithm, but a true ex­pert takes notes, then ap­plies as­sess­ment of the in­di­vid­ual, their history, con­di­tion and goals.

“Data is great,” says Phil Burt, for­mer chief physio at Bri­tish Cy­cling, “but it’s not the data that makes you knowl­edge­able, it’s the anal­y­sis of it.”

Burt re­cently set up his own bik­e­fit­ting clinic, Phil Burt In­no­va­tion, where he aims to bring his knowl­edge to the masses. At his stu­dio within the Manch­ester Health and Per­for­mance Cen­tre, he has ac­cess to a wealth of cut­ting-edge equip­ment — but em­pha­sises the vi­tal im­por­tance of get­ting the basics right too.

Burt be­lieves in the “three pil­lars of bike fit”, where fit can be tai­lored to­wards com­fort and sus­tain­abil­ity, per­for­mance, or aero­dy­nam­ics.

“It’s im­por­tant to spend time dis­cov­er­ing what peo­ple’s goals are at the be­gin­ning of a bike-fit,” he says. “The world I lived in was about get­ting an Olympic gold… but some­one might say to me, ‘Get rid of my knee pain and I’ll be re­ally happy,’ so we skew ev­ery­thing to­wards that.”

Fix­ing a three-year ache

Mau­rice Bren­nan broke his col­lar­bone rid­ing a moun­tain bike in his early 20s, and went on to com­pete in road races and time tri­alling, be­fore knee pain al­most ended his love of cy­cling al­to­gether. Now 34, he is seek­ing a long-term so­lu­tion from spe­cial­ist Phil Burt.

“After a num­ber of years of cy­cling fairly heav­ily, pro­gress­ing from cross­coun­try moun­tain bike rac­ing to road rac­ing and time tri­als, my right knee be­came a con­sis­tent weak point, al­ways need­ing a lit­tle man­age­ment and tender lov­ing care,” he says.

“A light win­ter fol­lowed by a Ma­jor­can train­ing camp was the straw that broke the camel’s back, with ten­donitis flar­ing up badly in the quadri­ceps mus­cles. For years I strug­gled to fully rid my­self of the prob­lem. Dur­ing this time, I saw sev­eral spe­cial­ists, all with vary­ing in­cor­rect di­ag­noses, un­til a sur­geon aided by an MRI scan iden­ti­fied the is­sue and pre­scribed a platelet-rich plasma (PRP) in­jec­tion. Though this seemed to help, I could still feel some­thing wasn’t right while ped­alling.

“I was los­ing faith in the med­i­cal in­dus­try’s abil­ity to fix the prob­lem, and re­signed my­self to it. See­ing Phil [Burt] was a re­lief — hav­ing al­ready seen my med­i­cal history, he noted that I hadn’t been pre­scribed any ex­er­cises to fix the un­der­ly­ing is­sue. With his vast ex­pe­ri­ence both as a phys­io­ther­a­pist and bike-fit­ter, Phil was able to al­ter my bike-fit to pro­vide a plat­form for treat­ing the con­di­tion, and pre­scribe the ex­er­cises to fix it.

“Since my ses­sion in Manch­ester, I have found my resid­ual knee pain re­duc­ing, and it’s much eas­ier to ap­ply force while rid­ing seated. A three-yearold con­di­tion will never right it­self overnight, but with the new fit, the Spe­cial­ized shoes he rec­om­mended and hav­ing in­cor­po­rated the sug­gested ex­er­cises into my rou­tine, I can feel a real im­prove­ment in the way I’m ped­alling and no longer have to hold back on hills for fear of the after-ef­fects. The

“The bike-fit has been has been the miss­ing link to my prob­lem”

bike fit has been has been the miss­ing link to my prob­lem.”

Phil Burt says…

“Mau­rice came to me hav­ing been di­ag­nosed with tendinopa­thy, but he hadn’t been prop­erly treated. The is­sue may have arisen from an old col­lar­bone break, which had left him with a dropped right shoul­der, man­i­fest­ing it­self as a twist at the pelvis.

“First we ad­justed the bike to make sure that it wasn’t ex­ac­er­bat­ing the prob­lem. Mau­rice’s sad­dle was too low and too far back for op­ti­mal knee biome­chan­ics, so I ad­justed this and also tilted the nose down. I also ad­vised Spe­cial­ized S-works shoes with a twoplus in­sole — the com­bi­na­tion of which in my ex­pe­ri­ence de­creases the load­ing on the knee.

“Hav­ing es­tab­lished the op­ti­mal po­si­tion to ride, the real work be­gan: we needed to turn around his tendinopa­thy with off-bike re­hab. I pre­scribed iso­met­ric holds, foam rolling, and ec­cen­tric ex­er­cises — body weight squats and knee ex­ten­sions. Iso­met­rics make him fire his quads bet­ter in a very safe way, foam rolling makes sure the lat­eral fas­cial plane is al­low­ing his knee to move in the way he wants it to, and the ec­centrics ba­si­cally put the stim­u­lus in there — re­search shows they turn bad ten­dons into good healthy ten­dons.”

From hob­bling to na­tional tt champs top 10

Mar­ket­ing man­ager Chris Hall, 28, went into July’s Na­tional 24-hour time trial not know­ing what to ex­pect. After seek­ing help from bike-fit­ter Tim Allen (soigneur.co.uk) for chronic lower-leg pain, he took three weeks off and gam­bled on a last-minute en­try.

“I’m a prob­lem child,” he says. “I used to play rugby, and I dis­lo­cated my knees ‘the wrong way’ when I was 19. Since then, I’ve had feet that point out­wards. I’ve been see­ing a phys­io­ther­a­pist on and off for 10 years, I’ve ba­si­cally had to re-learn to walk. It’s caused prob­lems for years, and I never re­ally fig­ured it out, just dealt with it.

“Lead­ing up to the Na­tional 24, I rode to the Lake Dis­trict off-road, quite spon­ta­neously. When I came back, I had pain in my knees, in my shins, and in the soles of my feet. Ev­ery­thing hurt. I checked in for a fit with Tim Allen a week be­fore the event, and he added metatarsal pads to my shoes. I took three pairs, be­cause I al­ways get burn­ing foot

pain and I ex­pected to need to change them a lot. Mak­ing changes so close to the event wasn’t ideal, but I’d not have been able to do it with­out the in­ter­ven­tion, so I didn’t have an­other op­tion.

“I went into the event just want­ing to fin­ish, but the re­sult was in­cred­i­ble. I ac­tu­ally felt stronger as the race went on. I fin­ished eighth, which was pretty nuts. I didn’t need to change my shoes once. Get­ting off a time trial bike after 24 hours and feel­ing OK is an achieve­ment in it­self — to ac­tu­ally be com­fort­able was ex­tra­or­di­nary. I couldn’t have done it with­out Tim’s help.”

Tim Allen says ...

“Chris came to me with three pairs of shoes, ask­ing me to set them all up ‘about the same’. But I could see that the shoes were not the prob­lem. As Chris was load­ing his feet, the metatarsals were col­laps­ing and spread­ing the toes, cre­at­ing pres­sure on the side of the foot, and also pos­si­bly caus­ing him to com­pen­sate, col­laps­ing off to one side, and caus­ing an ir­ri­ta­tion of the nerve.

“It’s likely that the prob­lems Chris was hav­ing in the lead-up to the time trial were re­lated to his pre­vi­ous knee trauma. The metatarsal pad is a small squishy pad that sits in the mid­dle of the in­sole and stops the col­lapse, which stops the foot spread­ing. We also slightly ad­justed his sad­dle, and changed the el­bow pads that he used, al­low­ing him to set­tle into the time trial po­si­tion, keep­ing his up­per body locked in and sta­ble.”

From hip op stop to can-do cannes

So­lic­i­tor Sara Ec­cle­stone, 50, is a for­mer run­ner who un­der­went a hip op­er­a­tion last sum­mer, where­upon she switched to cy­cling. Suf­fer­ing pain and swelling after the op­er­a­tion, Sara checked in for a bike-fit with Lee Prescott (veloate­lier.co.uk) — and in May 2018 rode 670 miles from Paris to Cannes.

“I used to cy­cle as part of my run­ning train­ing, but not se­ri­ously,” she says. “After the op­er­a­tion, I was ad­vised that the high-im­pact na­ture of run­ning was not ideal for my body, so I started to get more into cy­cling.

“Lee made a lot of changes in my bike-fit as I re­cov­ered from the op­er­a­tion. You get a lot of swelling after the pro­ce­dure, and of­ten a leg-length dis­crep­ancy as your mus­cles get used to mov­ing dif­fer­ently. Lee helped me to mon­i­tor it over time, and to grad­u­ally ad­just the set-up through re­cov­ery.

“First it was all about com­fort, but as I’ve got stronger, it’s been more about per­for­mance and how to get the most from the bike. You can’t run two sit­u­a­tions in par­al­lel [hy­po­thet­i­cal and ac­tual], so you don’t re­ally know, but I gen­uinely don’t think I would have made the pro­gres­sion I have with­out the bik­e­fits and ad­just­ment over time.

“We rode from Paris to Nice in May; it was up to 86 miles a day, and be­ing in pain would have ru­ined the whole ex­pe­ri­ence. Be­com­ing a cy­clist has been a big ad­just­ment, but if I’m to­tally hon­est, I think I’m ac­tu­ally a bet­ter cy­clist than I was a run­ner.”

Lee Prescott saysé

“When I first saw Sara, she was strug­gling to ride her bike in any sort of com­fort, even for short dis­tances. To try and al­le­vi­ate her dis­com­fort, she had low­ered her sad­dle and was us­ing flat bars to give a more up­right po­si­tion. On closer in­spec­tion, I found that she was un­der-ex­tend­ing the leg, and much of her dis­com­fort was due to the up­right po­si­tion not al­low­ing her pelvis to sta­bilise on the sad­dle.

“Ini­tially I al­tered her sad­dle height and low­ered the bars, to help her ro­tate her pelvis for­ward, dis­tribut­ing her weight more evenly across her pu­bic rami [base of pelvis]. This helped her pelvis to sta­bilise and pro­vide a good base for her glutes to work against. It also made it eas­ier for her core to en­gage, sup­port­ing her weight, taking ef­fort away from the arms and shoul­ders. These ini­tial steps got Sara out and about on her bike

in more com­fort.

“Ini­tially, Sara’s left leg was around 10mm shorter than her right — mostly as a re­sult of tight­ness caused by the pro­ce­dure. I could have added a shim to one side, but as she was in re­cov­ery, I erred away from ‘lock­ing in’. We worked on ped­alling dy­nam­ics and ba­si­cally re-taught her mus­cles to pedal sym­met­ri­cally. Her dis­crep­ancy is now slowly re­duc­ing and I would like to think that if she keeps up her re­hab, it will soon be greatly re­duced.”

Sooth­ing with a Stem and Sad­dle

Su­sanne Koch has been on two wheels all her life, en­joy­ing moun­tain bik­ing, com­mut­ing and tour­ing, but on switch­ing to road cy­cling she found her­self strug­gling with lower back pain. The 46-year-old op­er­a­tions man­ager checked her­self in with physio Ni­chola Roberts (velo­physio.co.uk).

“I only started road cy­cling this year,” she says. “I fit­ted a shorter stem be­cause I felt too stretched on the bike and ex­pe­ri­enced some dis­com­fort in my el­bows. The lower back pain started on a 177km ride in the Lake Dis­trict, the long­est ride I’d ever done. After that, it ap­peared even on shorter rides.

“I checked in at Velo Physio on a friend’s rec­om­men­da­tion. I had the Ride­lon­don-sur­rey 100 sportive com­ing up and wanted to make sure that I would be com­fort­able rid­ing it with­out pain and with the best power out­come too. We changed the stem back to a 90mm, raised the seat height a lit­tle, and ex­changed the sad­dle for one with a cut-out. I’m re­ally happy with the sad­dle swap; it meant that I didn’t ex­pe­ri­ence dis­com­fort when stretch­ing out more and go­ing into a ‘proper’ rid­ing po­si­tion.

“We also swapped my 40cm han­dle­bars with a 38cm bar to give me bet­ter sta­bil­ity, as my shoul­ders were not wide enough for the orig­i­nal set-up. My bike now feels so dif­fer­ent, and so much more com­fort­able. The lower back pain has gone, and I can ride for hours with­out any dis­com­fort. I did not have any back pain at all dur­ing Ride­lon­don and even en­joyed it de­spite rid­ing in the rain and wind.”

Ni­chola Roberts says…

“Su­sanne was strug­gling with lower back pain after 30-40km of rid­ing. She had been back to the bike shop twice and they had tried short­en­ing the stem. How­ever, I found that due to the sad­dle, which did not suit her, her pelvis was in a poor po­si­tion on the bike. This was af­fect­ing her spinal po­si­tion, caus­ing her to be sit­ting more up­right, then hav­ing to bend through the up­per back and ex­tend her el­bows in or­der to reach the han­dle­bars.

“The po­si­tion of the pelvis also af­fects core and glute ac­ti­va­tion, which in turn help to sup­port the back when cy­cling. With­out ad­e­quate sup­port and poor pelvic po­si­tion, back pain can en­sue. When we al­tered the pelvic po­si­tion on the sad­dle, her spinal po­si­tion greatly im­proved. How­ever, the sad­dle be­came very un­com­fort­able and she was un­able to main­tain the po­si­tion.

“I rec­om­mended an al­ter­na­tive sad­dle, and a re­turn to the orig­i­nal stem. Hav­ing made these changes, she re­turned, adopt­ing a good po­si­tion. Su­sanne had above-aver­age flex­i­bil­ity, but her core strength needed work­ing on. I sug­gested some core ex­er­cises to help main­tain her new po­si­tion.”

“Su­sanne had above-aver­age flex­i­bil­ity, but her core strength needed work”

A bike-fit can di­ag­nose and treat many cy­cling-re­lated in­juries

Sad­dle ad­just­ment and ex­er­cises healed Bren­nan’s tendinopa­thy

Metatarsal pads fixed Hall’s knee, shin and foot pain

Surgery left Ec­cle­stone with a leg-length dis­crep­ancy

Koch’s sad­dle was caus­ing back pain

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