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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.

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Presentation on theme: "Bike Fit Marc Silberman, M.D. Gillette, NJ. Supplies Bicycle trainer Stadiometer or measuring tape Text book Measuring tape Goniometer Plumb line Allen."— Presentation transcript:

1 Bike Fit Marc Silberman, M.D. Gillette, NJ

2 Supplies Bicycle trainer Stadiometer or measuring tape Text book Measuring tape Goniometer Plumb line Allen wrench set Video Camera, Tripod, Computer/TV

3

4 Pro Bike Fit Fabian Cancellara, Andy Pruit, Scott Holz, Bobby Julich

5 Bicycle Exam

6 Balance Comfort Safety Injury Prevention Peak Performance Aerobic efficiency versus aerodynamics Superman Position

7 Bicycle Anatomy Seat tube Top tube Seat tube angle °

8 Crankset and Chainrings Rider Height inches 165–167.5mm inches 170mm inches 172.5mm inches 175mm ER Burke

9 Cycling Clock Diagram Broker and Gregor 1996 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

10 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 1 2 3

11 1. Foot-Cleat-Pedal Ball of the foot is over the pedal spindle 1 st metatarsal head

12 2. Saddle Height

13 Saddle Height Most important bicycle position setting Inseam measurement method (LeMond) –Saddle Height = 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

14 Lemond-Guimard Method. Saddle Height = Inseam in cm X.883 Saddle Height

15 2. Saddle Height Knee flexed degrees with pedal in 6 o’clock position. Photo by Mike Spilker.

16 Saddle Height Fabian Cancellara and Andy Pruitt

17 3. Saddle Fore-Aft-Tilt Tilt Fore-Aft

18 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.

19 Road vs. Time Trial Position Steeper Seat Tube More Forward Position Higher Saddle Plumb bob falls over pedal spindle and 1 st metatarsal

20 Frank Schleck TT Position Raised Goal: more power

21 4. Stem Height 1 to 3 inches

22 4. Stem Height Stem raised 1cm, rider actually became lower, more aero

23 4. Stem Extension Stem Size 10 –12 cm Top Tube Tops Hoods Drops

24 4. Stem Extension Torso flexes about 60 degrees with the hands in the drops. Photo by Mike Spilker. Torso flexes about 45 degrees with the hands on the hoods.

25 4. Stem Extension Andre Steensen, neck and lower back pain, shortened stem 1cm

26 OVERUSE INJURIES

27 Contact Overuse Saddle Sore Morton’s Neuroma Neuropathy

28 ‘Morton’s Neuroma’ Burning pain and numbness Impingement of interdigital nerves See riders shaking foot out of pedals Chronic inflammatory mass Between 3 rd and 4 th metatarsal classically

29 ‘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

30 ‘Morton’s Neuroma’ Medical Treatment Cortisone Massage Shoe inserts Surgery

31 Saddle Sores Moisture + Pressure + Friction Chafing Ulceration Folliculitis Abcess Subcutaneous nodules

32 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

33 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

34 Hand Neuropathy Cyclist’s Palsy (Ulnar Neuropathy) Carpal Tunnel Syndrome Worse after long rides Worse on rough terrain EMG reversible changes May become permanent

35 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

36 Hand Neuropathy Medical Treatment Massage Cortisone Night splint Surgery

37 Bursitis Pre-patella and MCL bursa Greater Troch Ischial Tuberosity

38 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

39 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

40 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

41 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

42 Most Common ITB Patella Femoral Patella Tendon

43 Patella Femoral Pain Syndrome Pain under the patella from excessive load –Hill climb –Wind –Big gear –Time trialing –Weight training

44 Patella Femoral Pain Syndrome Tender patella facets Tender patella compression Unable to do one legged squat No effusion

45 Patella Femoral Pain Syndrome Treatment 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

46 ITB Syndrome Distal Anterolateral pain Burning or snapping Climbing, pushing big gears Wind Stationary Trainer

47 ITB Massage Assisted Stretching OMT Physical Therapy Leg length evaluation Address training and bike fit Not Rest, NSAIDs, injection, or surgery

48 Knee Pain and Adjustment LocationCauseSolution AnteriorSaddle too lowRaise saddle Saddle too far forwardMove saddle back Cranks too longShorten cranks PosteriorSaddle too highLower saddle Saddle too far backMove forward MedialToes point outPoint in Feet too far apartMove closer Tight pedal tensionLower tension LateralToes point inPoint out Feet too closeMove apart Arnie Baker 1998 Bicycle Medicine

49 Strain Cervical Thoracic Lumbar

50 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

51 TRAINING

52 Training Periods of Pros 90% 0% 10% 80% 15% 5% 75% 15% 10% % in Zone 3 > 90% HRmax % in Zone 2 70 – 90% HRmax % in Zone 1 < 70% HRmax Rest Pre-Season Competition

53 Training Stimulus Performance Training Volume/Intensity

54 Overtraining 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

55 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

56 Marc Silberman, M.D.


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