Is Pain Normal?
Is pain normal when it comes to biking? Is it something we should just expect and “deal with?” The short answer is no. There are many adjustable components on your bicycle, and proper positioning of those components can go a long way in eliminating and preventing pain while enjoying cycling. There are well-researched ideal angles of movement and positioning for the ankle, knee, hip, and shoulder joints, and poorly positioned bicycle components can change these for the worst.
Starting at the bottom, and working our way up, the foot position on the pedal is the first thing we look at. If your cleat is positioned too far forward or backward, too far laterally or medially, or with any rotation on your shoe, it changes a number of things. The foot’s position on the pedal is the most obvious thing affected, but the amount and direction of ankle, knee, and hip motions are also altered.
Additionally, seat height can change how much knee flexion is used as well as where the knee aligns over the toes during different parts of the pedal stroke. The seat, or saddle, of a bicycle can also be moved forward or backward on the post offering further changes in not only angles and positions of the legs, but also the trunk and shoulders. Adjustments to cleats and the seat are often quite helpful in addressing conditions such as hot foot, knee pain, and hip pain commonly suffered with cycling.
The stem, the portion of the bicycle that attaches the handlebars to the frame, can be altered in both length and angle in most cases. Adjustments here can be used to improve body angles and address neck and back pain commonly suffered with cycling. Adjustment of one component affects all other components, so it is important that the changes be made in a logical order by someone who fully understands the process. In cases of pain or dysfunction with cycling, the person making these adjustments should not only understand the adjustability of the bicycle, but also the kinetics and kinematics of the human body, and that is where the expertise of a physical therapist plays an important role in keeping you on the bike.
Why You Might Need a PT to Customize Your Fit
When a rider is having knee pain, the therapist may observe poor tracking of the knee during 2D analysis of pedaling in that the knee leaves the plane of the hip and ankle and wobbles side-to-side. This can be addressed by changing cleat or saddle position, but it may require more than that. For example, a limitation in ankle ROM or weakness in certain hip muscles can both create this same deviation. Neck pain can be addressed by altering the bicycle components to create a more upright position of the rider, however this may also require something more. For example, a limitation in mobility in the joints of the spine may be present, or the rider may also have nerve root involvement where they are having symptoms down into his/her arm. A physical therapist will be able to take you off of the bike and look for these musculoskeletal components and develop an appropriate and skilled treatment plan including corrective exercises and manual therapy, something that would not happen at a bike shop.