Bike Fit
Marc Silberman, M.D.
Gillette, NJ
Supplies
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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
Balance
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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
39
53
72-74 inches
172.5mm
74-76 inches
175mm
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
Saddle Tilt and Fore-Aft
Re-check Saddle Height
3. Hands-Handlebar Interface
Height, Reach, and Tilt
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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
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Inseam measurement method (LeMond)
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Knee angle measurement (Pruitt, Burke)
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Saddle Height = 0.883 X inseam in cm
25 to 30 degrees knee flexion at 6 o’clock position
Heel to back of pedal method
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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
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
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
OVERUSE INJURIES
Contact Overuse
Neuropathy
Saddle Sore
Morton’s Neuroma
‘Morton’s Neuroma’
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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
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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
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Cortisone
Massage
Shoe inserts
Surgery
Saddle Sores
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Moisture + Pressure + Friction
Chafing
Ulceration
Folliculitis
Abcess
Subcutaneous nodules
Saddle Sores
On the Bike Treatment
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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
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Warm soaks
Topical cortisone, anti-fungal, anti-bacterial
Oral antibiotics
Surgical incision and drainage
Surgery
Hand Neuropathy
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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
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Relieve pressure
Pad bars
New gloves (not gel)
Reposition often
Bars too far forward
Too low
Too much tilt
Hand Neuropathy
Medical Treatment
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Massage
Cortisone
Night splint
Surgery
Bursitis
Greater Troch
Pre-patella and
MCL bursa
Ischial Tuberosity
Ischial Tuberosity ‘Bursitis’
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‘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’
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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
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Aspiration and fluid analysis
Cortisone
RICE and massage
On the bike:
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Check cleat and position
Check saddle height and fore-aft
Check pedal technique
Check crank arm length
MCL ‘Bursitis’
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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
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Hill climb
Wind
Big gear
Time trialing
Weight training
Patella Femoral Pain Syndrome
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Tender patella facets
Tender patella compression
Unable to do one legged squat
No effusion
Patella Femoral Pain Syndrome
Treatment
• Off the Bike
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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
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Anterolateral pain
Burning or snapping
Climbing, pushing big gears
Wind
Stationary Trainer
ITB
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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
Saddle too far forward
Cranks too long
Saddle too high
Saddle too far back
Toes point out
Feet too far apart
Tight pedal tension
Toes point in
Feet too close
Raise saddle
Move saddle back
Shorten cranks
Lower saddle
Move forward
Point in
Move closer
Lower tension
Point out
Move apart
Posterior
Medial
Lateral
Arnie Baker 1998 Bicycle Medicine
Strain
Cervical
Thoracic
Lumbar
Thoracic Strain/Cervical Strain
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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
Training Periods of Pros
800
5%
600
15%
10%
15%
% in Zone 3
> 90% HRmax
km/week
400
200
0
0%
10%
80%
Rest
% in Zone 2
70 – 90% HRmax
% in Zone 1
< 70% HRmax
90%
Nov - Dec
75%
Dec - Feb
Pre-Season
Mar - Oct
Competition
Training Stimulus
Performance
Training Volume/Intensity
Overtraining
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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
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The race is won in the off season
Train frequently, all year round
Start gradually and gently
Build a big base
Go hard on the hard days, easy on the easy days
Do not overtrain
Avoid monotony
Train with others
Keep a logbook
Take a break at the end of a season, stay active
Adapted from Tim Noakes in the Lore of Running
Marc Silberman, M.D.
drbicycle@njsportsmed.com