Bike Fitting Basics: Keep Riding, Reduce Your Injury Risk

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By Michael Joseph, DPT Student

In my three years working as a professional bicycle fitter I have done fits for every level of cyclist, from individuals who were purchasing their first road bike to professional level cyclists and national team members. A properly fit road bike is imperative to ensure the frame and components are the right size for the rider.  The purpose of professional fitting is to reduce pain, increase comfort and maximize speed and efficiency. The following article will cover basics of fit measurements, positioning, and reasons why riders may be experiencing pain or discomfort on the bike. The bulk of this content is based on my professional experience as a bicycle fitter and the training I received from GURU Cycling.

Saddle Height 

Saddle height is measured with the rider seated on the saddle with his or her foot at the 6 o’clock position. The rider’s pelvis should be level on the saddle and there should be 40 degrees of knee flexion (plus/minus 5 degrees). Measure both legs to ensure no there are no imbalances. Common symptoms of a saddle that is too high include IT band syndrome, posterior knee pain, and hip or low back pain. Common symptoms of a saddle that is too low is anterior knee pain from stress on the quadriceps and patellar tendons.

Saddle Setback

Saddle setback refers to the fore and aft position of the saddle. When the foot is in the 3 o’clock position, the front surface of the knee should be directly over the pedal spindle. This can be measured using a plumb bob or laser. The rider should feel like they are pushing the pedal straight down, not in front of them or behind them; the pedal stroke should feel powerful and efficient. If the saddle is set too far back, it can irritate the IT band and hamstrings tendons. If it is too far forward, it may put excessive pressure on the quadriceps and patellar tendons.

Type of saddle  

Saddle selection is highly subjective. Every manufacturer seems to develop their own way of fitting a saddle to a rider. This can include basing it on width of the pelvis, sit bone pressure points, or spinal flexibility. However, the best way to determine the which type of saddle to use is to test ride it. Saddle selection is all about finding the saddle that fits the rider’s body type.

Cleats  bike 7

Cleat fitting might warrant an entire article all on its own, but here are some basics.

The fore aft position of the cleat on the shoe should align the ball of the foot with the pedal spindle. The medial/lateral position of the cleat should position the knee directly over the foot. The rotational position of the cleat should position the foot so it is facing directly forward. Knee pain can be caused by improper foot and cleat positioning. If a rider has knee pain and the saddle height and setback are positioned correctly, cleat positioning may be the culprit.

Handlebar Reach

Handlebar reach is defined as the distance from the saddle to the handlebar and is measured from the front tip of the saddle to the center of the tubing of the handlebar. When fitting reach, the rider should place his or her hands on the brake hoods. The reach should be as long as possible, while still feeling comfortable. A longer reach allows for a longer stem, which makes the front of the bike more stable and makes steering more responsive. However, in this position the shoulder should not exceed 90 degrees of flexion. There should also be about 15 degrees of elbow flexion. If the reach is too long, the rider may experience elbow pain, tension in the neck and shoulders, and back pain.

Handlebar Drop

Handlebar drop is defined as the difference in height between the saddle and the handlebar. Increasing the drop makes the rider position more aggressive and aerodynamic. This may be ideal for a rider participating in stage or criterium racing. However, for a leisure rider, a more upright position will likely be more comfortable. If the drop is too low, the rider will experience symptoms in the hands and wrists, such as pain from too much weight on the hands. This can also cause nerve irritation; riders may experience numbness, tingling, and burning sensations in the hands.   

FullSizeRender 15 Blog Post written by Michael Joseph, DPT Student at Mount Saint Mary’s University. Michael is currently in his final Clinical Rotation with me at Catz Physical Therapy Institute.

Sources:

  1. www.gurucycling.com
  2. Asplund, Chad, St. Pierre, Patrick. Knee Pain and Bicycling: Fitting Concepts for Clinicians. The Physician and Sports Medicine. April 2004. 32(3).

What are Shin Splints?

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By Michael Joseph, DPT Student

Definition and Risk Factors:

Medial Tibial Stress Syndrome (MTSS), better known as shin splints, is a common athletic injury caused by repetitive stress to the tibia. MTSS is more prevalent in activities involving a great deal of running and jumping, like distance running, sprinting, basketball, tennis, gymnastics, and dancing; it is also common in military personnel. MTSS can be caused by many factors stressing the tibia, including: periostitis (inflammation of connective tissue surrounding bone), periosteal remodeling, tendinopathy, and dysfunction of muscles surrounding the tibia, like the tibialis posterior, tibialis anterior, flexor digitorum longus, and soleus muscles. Risk factors for MTSS include flat feet and/or over-pronation, repetitive running and jumping, excessive hip range of motion, smaller calf girth, and a body mass index above 20.2.

Symptoms:

Symptoms include pain of the middle and lower thirds of the medial shin. Individuals may experience pain during and/or after physical activity. During the early onset of MTSS, symptoms may be felt at the beginning of exercise, but may subside as activity continues. As MTSS progresses, pain may be felt throughout exercise and may linger afterwards.

Diagnosis:

A thorough physical therapy subjective and objective exam is usually sufficient to diagnose MTSS. However, patients may require further imaging or work up to rule out pathologies like stress fractures, exertional compartment syndrome, or peripheral vascular disease.

Management of Shin Splints:

Acute Phase:

The goal of physical therapy in the acute phase is to reduce pain and inflammation. This can be done through stretching, manual therapy of the injured tissue, taping, icing, and rest. For many athletes prolonged rest from their sport is not ideal. MTSS management may require “relative” rest, meaning their activity level may need to be adjusted but not stopped completely. This depends on the activity and severity of the pathology.

Subacute Phase:

The goal of physical therapy in the subacute phase is to modify training regimens and correct biomechanical abnormalities. According to Galbraith et al, reducing weekly training frequency and intensity by 50% will likely improve symptoms without completely stopping training. However, this depends on each patient’s case and may need to be adjusted. Training can also be augmented with low impact exercises, like swimming or cycling, to help maintain strength and cardiovascular endurance.


Create a Physical Change in Your Body and Movement

Another treatment of MTSS is to strengthen the arch of the foot and hip, and increase core stability; this will help to improve jumping and landing mechanics, as well as single leg stability. Specifically, strengthening the tibialis posterior and intrinsic foot musculature will help increase arch support and prevent excessive pronation. Improving hip extensor and abductor strength can help improve lower extremity mechanics. Stretching and eccentric strengthening of the calf has also been shown to be beneficial by decreasing muscle fatigue with running and jumping.

Changing running biomechanics may also be beneficial. A study from Leiberman et al, found that heel first strike during initial contact, when running, creates an impact transient equal to nearly three times the individual’s body weight. Not only is this incredibly inefficient, but this creates a large force traveling directly up through the tibia with each step. The impact transient with forefoot first strike during initial contact is seven times lower than with a heel strike. This evidence suggests forefoot running is more efficient and less injurious. 

FullSizeRender 15Blog Post written by Michael Joseph, DPT Student at Mount Saint Mary’s University. Michael is currently in his final Clinical Rotation with me at Catz Physical Therapy Institute.

Sources:

  1. Budde, Kari Brown. Physical Therapist’s Guide to Shin Splints (Medial Tibial Stress Syndrome). http://www.moveforwardpt.com. Accessed May 11, 2017.
  2. Galbraith, R. Michael, Lavelle, Mark E. Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2009 Sep; 2(3):127-133.
  3. Lieberman, Daniel E., Venkadesan, Madhusudhan, Werbel, William A., Daoud, Adam I., D’Andrea, Susan, Davis, Irene S., Mang’Eni, Robert Ojiambo, Pitsiladis, Yannis. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010 Jan; 463:531-535.
  4. Moen, Maarten Hendrik, Holtslag, Lenoor, Bakker, Eric, Barten, Carl, Weir, Adam, Tol, Johannes L., Backx, Frank. The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. Sports Med Arthrosc Rehabil Ther Technol. 2012 Mar; 4(12).

What is Platelet Rich Plasma?

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By Meggie Morley, DPT Student

In recent years the use of platelet rich plasma has been on the rise as a means of promoting healing in soft tissue structures such as tendons, muscles, ligaments and joints. With professional athletes such as Tiger Woods and Steph Curry receiving the injections as a method to promote healing, it may be useful to take a closer look at the possible effects and uses of PRP injections.

How it Works

Platelets are a component of the blood with the main function of promoting blood clotting. They also release numerous growth factors, including Platelet Derived Growth Factor (PDGF), which is a protein that helps regulate cell growth and division. PRP is made by collecting a blood sample from the patient, then centrifuging the blood to separate out the platelets.  The platelet rich plasma is then treated and injected into the patient, often with the use of ultrasound to guide the placement of the injection. PRP is made from the patient’s own blood, so there are very few side effects associated with the injections, however it is recommended to stop taking anti inflammatory medications before and after the injectionPRP 2

Article Review

In an article by Pandey et al., the effects of PRP were examined in patients who underwent arthroscopic rotator cuff repairs compared to subjects that underwent the same procedure without PRP.  The effectiveness of the treatment was measured by four different clinical scores and by ultrasound to view if there was a re-tear and the general vascularity of the rotator cuff. The results found that three of the four clinical scores demonstrated significantly better outcomes in the PRP group versus the control group at various follow up times. The other score (The American Shoulder and Elbow Surgeons Score) was comparable between the PRP and the control group at all follow-up visits. The incidence of re-tears was significantly lower in the PRP group, but only for large tears. The ultrasound also showed that there was significant vascularity at the repair site three months post operatively.

While this article showed positive outcomes for patients who received PRP, overall the evidence for the use of PRP in human subjects is still lacking. As with any medical procedure it is important to be informed and discuss your options with your physician.

FullSizeRender 9 Blog Post written by Meggie Morley, DPT.  At the time of posting Meggie was in her final clinical rotation with me at Catz Physical Therapy Institute.

References

Boswell SG, Cole BJ, Sundman EA, Karas V, Fortier LA. Platelet-rich plasma: a milieu of bioactive factors. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2012 Mar 31;28(3):429-39.

Kohen R, Warren R, Rodeo S. (2010, October 5). Platelet Rich Plasma (PRP) Treatment: An Overview. Retrieved from https://www.hss.edu/conditions_platelet-rich-plasma-prp.asp

Pandey V, Bandi A, Madi S, Agarwal L, Acharya KK, Maddukuri S, Sambhaji C, Willems WJ. Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2016 Aug 31;25(8):1312-22.

Filardo G, Di Matteo B, Kon E, Merli G, Marcacci M. Platelet-rich plasma in tendon-related disorders: results and indications. Knee Surgery, Sports Traumatology, Arthroscopy. 2016:1-6.

High Intensity Interval Training vs. Steady State Cardio

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By Darelle Noel

Whether you use cardio workouts to improve your health or performance in sports, one common goal of cardio training is to improve the function and capacity of your energy system. Many people decide the intensity of their workouts based on what they’re looking to accomplish during training. Some prefer steady state cardio (Aerobic) while others prefer high intensity interval training (Anaerobic).  Both yield great cardiovascular results so neither is a wrong way to go.

Slow steady state cardio or aerobic activity is when an exercise is performed at one FullSizeRender 20steady pace for an extended period of time, maintaining a relatively constant intensity level or heartrate.

High Intensity Interval Training or anaerobic training is a technique that alternates between short intense activity with a maximum recovery period. This technique varies the heartrate expeditiously improving your work to rest ratio (Energy System Capacity).

A blend of both could be an even better option. Instead of slow, plodding workouts, try a combination of utilizing both energy systems. This will have your muscle groups, nervous system, and hormones acting synergistically to help your body work as efficiently as possible. All these benefits result from time-efficient workouts that are much shorter than your average lower-intensity cardio session. The program you choose should reflect a balance of strengthening your weaknesses and challenging your strengths.FullSizeRender 19

Begin by improving your overall aerobic threshold, some great exercises are:

◾Outdoors: Paced walking, walking up hills, biking, rowing

◾Indoors: Biking, treadmill climbing/walking, elliptical trainer

Using the aerobic zone will improve your cardiovascular system and prepare your muscles for the greater speeds.

FullSizeRender 18Next try to move into a little more intensity levels, At this level you’ll ride, run, or climb as hard as possible for between 10-30 seconds with maximum levels of recovery.. In order to get the most out you’ll need to pack as much power and energy into these segments as possible.

Some of the best activities for this are:

◾Sprinting (flat or uphill)

◾Shuttle runs (5 yards and back, 10 yards and back, 15 yards and back)

◾Bicycle intervals

◾Tredmill Sprints

◾Rowing for speed. FullSizeRender 17

A balanced training program should use different combinations of these exercises and different intensity levels to create varied and personalized workout that will develop both energy thresholds. You can spend more time in aerobic level initially and progress to performing intervals in which you spend more time in higher-intensity zones to improve your overall endurance, strength, and power.

FullSizeRender 21Blog Post written by Darelle Noel, Athletic Gaines Performance Specialist.  I have had the good fortune to work with him at Catz Physical Therapy/Athletic Gaines Pasadena.

Straight Bar Deadlifts vs. Hex Bar Deadlifts

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By Michael Joseph, DPT Student

The deadlift is one of the most effective and widely used exercises to build raw strength. There are many variations of the deadlift, including conventional deadlifts, sumo deadlifts, stiff leg deadlifts, Romanian deadlifts, and the popular hex bar deadlift (HBD). As opposed to a straight bar deadlift (SBD), where the bar is sitting in front of the body, this bar allows the lifter to stand within a hexagon-shaped frame and lift the weight from the ground. But, what is the difference between a straight bar and a hex bar? And why would you use one instead of the other?

Research

In a study by Swinton et al, a group of competitive powerlifters were recruited to compare the biomechanical differences between the SBD and HDB. Subjects tested their 1 rep max and submaximal lifts on both bars. 3-D motion analysis was used to measure body position and velocity and acceleration of the bar. The study found the powerlifters were able to lift an average of 45 lbs. more using the hex bar, compared to the straight bar. In addition, across submaximal loads deadlifts using the hex bar produced greater peak force, peak velocity, and peak power compared to the straight bar. This suggests that the HBD is a more effective exercise due to the greater mechanical stimulus produced during submaximal loads. IMG_9047

A follow up study was done by Camara et al, comparing electromyography, force, velocity, and power characteristics between the two bars. Surface EMGs were placed on the vastus lateralis (quadriceps), biceps femoris (hamstrings), and erector spinae (low back) muscles. Force, velocity, and power were measured by attaching a velocity transducer to the barbells. This study also measured subjects’ 1 rep max and submaximal loads. EMG results found greater quadriceps activation during the HBD, but greater hamstrings and low back activation during the SBD. However, there was not a significant difference in the 1 rep max lifts. This study also confirmed higher peak velocity, peak force, and peak power with the HBD than the straight bar deadlift.

Clinical Application

Both studies confirm the SBD puts greater stress on the hamstrings and low back, while the HBD distributes loads more equally, putting greater stress on the quads. For individuals with low back pain or who are rehabilitating a low back injury, using a hex bar to deadlift may be a safer alternative to using a straight bar. Similarly, for a patient who may not be ready to perform a loaded squat, the HBD may be used as an effective alternative to strengthen the quadriceps.  IMG_9044

Both studies also agree that the HBD produced greater peak force, velocity, acceleration, and power. This suggests the HBD is a better exercise for overall strength training. The HBD may be a more beneficial deadlift variation than the SBD for athletes because it is more effective for improving overall strength, while putting them at less risk of a low back injury. So when should the SBD be used for patients and athletes? If the goal is to strengthen hamstrings and low back extensors specifically, the SBD will be more effective. Similarly, if the SBD is specific to the athlete’s sport, (for example, powerlifting or CrossFit) training the SBD may be more beneficial.

FullSizeRender 15Blog Post written by Michael Joseph, DPT Student at Mount Saint Mary’s University.  Michael is currently in his final Clinical Rotation with me at Catz Physical Therapy Institute.

References

  1. Swinton PA, Stewart A, Agouris I, Keogh JW, Lloyd R. A biomechanical analysis of straight and hexagonal barbell deadlifts using submaximal loads. J Strength Cond Res. 2011;25(7):2000-9.
  2. Camara KD, Coburn JW, Dunnick DD, Brown LE, Galpin AJ, Costa PB. An Examination of Muscle Activation and Power Characteristics While Performing the Deadlift Exercise With Straight and Hexagonal Barbells. J Strength Cond Res. 2016;30(5):1183-8.