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

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

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
60-64 inches
165–167.5mm
65-72 inches
170mm
72-74 inches
172.5mm
74-76 inches
175mm
ER Burke 39 53

9. 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

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 2 3 1

11. 1. Foot-Cleat-Pedal Ball of the foot is over the pedal spindle
1st 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. Saddle Height Lemond-Guimard Method.
Saddle Height = Inseam in cm X .883

15. 2. Saddle Height Knee flexed 25-30 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
Plumb bob falls over
pedal spindle and 1st metatarsal
Steeper Seat Tube
More Forward Position
Higher Saddle

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
Tops
Hoods
Top Tube
Drops

24. 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.

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

26. OVERUSE INJURIES

27. Contact Overuse
Neuropathy
Saddle Sore
Morton’s Neuroma

28. ‘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

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
Greater Troch
Pre-patella and
MCL bursa
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
Patella Femoral
ITB
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
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

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
10% 5%
15%
15%
% in Zone 3
> 90% HRmax
% in Zone 2
70 – 90% HRmax
% in Zone 1
< 70% HRmax 0%
10%
75%
80%
90%
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
Record at Mt. Evans set a month after a rider had taken 10 days off bike

55. Laws of Training 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
One can look at lactate, watts, speed, intervals, daily workouts but if you don’t see the bigger picture you will never understand training – these are so simple too understand but so difficult to follow – keep a copy on the refridge
Adapted from Tim Noakes in the Lore of Running

56. Marc Silberman, M.D. drbicycle@njsportsmed.com