It Takes Two to Cycle

Your bike-fit is often blamed for the way you feel – but is it really the bike or is it you? Cycling Chiropractor Dr David Stapleton examines this common dilemma.I was out riding in a bunch recently when I overheard one of the riders complaining bitterly about the fact that he had yet again paid ‘good money’ to be set up on his bike and still continued to be plagued by low back pain and severe knee aggravation.I’d love a dollar for every time I’ve heard that. Same old thing, only the names and faces change.The sad part is that more often than not, the guy who set him up is quite unfairly blamed for not fixing his pain and ends up having both his skills and integrity questioned. No doubt like everything else in life some bike-fits are done more skillfully than others, but generally speaking I’m sure they’re all done with the best of intentions. It’s not an easy job and there’s certainly more to it than meets the eye. And that’s exactly my point.As a chiropractor with a special interest in the musculo-skeletal and biomechanical aspects of cycling, I’ve seen some weird and wonderful bodies that people expect, without question, to casually put on a bike seat and instantly ride off into the sunset.Riders also naively take the view that just because they mortgaged their house for the most expensive bike on the market they should be automatically exempt from any of the aches, pains and wear and tear mechanisms typical to cycling. For others, it’s common just to get on the DIY bike-fit merry-go-round where they spend copious amounts of time and money changing things depending on the intensity of pain and areas of aggravation. Just like putting out spot fires, one week it’s changing saddle height, next it’s resuming saddle height and changing head-stem length and so on. The circle just continues to go around.People don’t come in rack sizes and more importantly what you see on the outside is by no means what exists on the inside. There is a huge variation of imbalances and asymmetries simply because human skeletal frames are certainly not perfect. And other complexities arising from things such as injury, postural anomalies and other seemingly normal day-to-day imperfections tend to make us all somewhat different.For every single rider who buys a bike and is comfortably set up on it, there are many others who continue to be plagued by a myriad of performance-inhibiting problems, despite trying everything in the book. Neck and shoulder pain, low back pain, pins and needles to the arms, saddle soreness and knee pain are not what you want for a great day on the bike.My advice to the guy in the bunch was to temporarily forget about the bike and get himself checked. That’s right, of course get your bike set up properly in the first place, but if after a time you have ongoing difficulties then maybe it’s prudent to look at yourself. Remember it takes two to cycle – the bike and you.From a biomechanical perspective, cycling is very different to other sports. At least with football, basketball or tennis there is a considerable latitude for multidirectional movement allowing the many postural and skeletal differences of the individual human body to be absorbed by the varying postural demands of the game.However the goal posts change dramatically when you take the human skeleton, sit it on a static bike frame, in a semi-extended position, attach the feet to pedals and turn repetitiously in a perfect circle over long periods of time. It will certainly seek out the weak spots in a hurry. And it does, in fact very often, in more ways than one.

Clinical Case

Here is such a case: See if you can relate to this?This rider is a 34-year-old male who averages between 200-300kms per week and has oscillated from time to time between A and B grade competition. He complains of constant back pain, neck pain with restriction in range of motion, often with accompanying headaches. Lately, he also has right hip and right hamstring pain extending down to the back of his knee.He has been cycling competitively since his early teens with a history of only a few minor injuries and no major accidents. His current symptoms were originally noticed approximately two to three years ago but have continued to oscillate in both intensity and frequency until about 12 months ago when his training schedule suddenly increased. Currently his low back and neck pain are both moderate and manageable on a daily basis but are easily exacerbated after approximately an hour on the bike. He complains more recently of a noticeable loss of power transfer and a rapid irritation of pain in the right knee and hamstring when climbing or sprinting demands an out of saddle position.Post ride soreness and restricted range of motion in both the low back and neck is now rapidly becoming a problem. As a result he’s had several reviews of his bike set-up with varying results, all of which gave only temporary relief but also ended up creating a few new problems in the process. In desperation he had another bikefit approximately two months ago, which this time in particular, has made very little difference.In a moment of total frustration he too started to question the worth of his bike-fit. Ironically, my view was that whoever did the job was particularly talented in dealing with the skeletal anomalies they had to work with and perhaps it was time to put the bike aside and look at himself.

Investigation

It wasn’t until he took some advice and started to look at his own skeletal structure that the mystery started to unravel. Just from a routine postural assessment it was evident that there was more to the problem than just the bike. Further clinical testing of his posture, his range of motion and spinal mobility continued to reveal a number of issues that certainly made a lot of sense in terms of the difficulties he was experiencing on the bike. X-ray analysis clearly showed a biomechanical instability within the lower back, right hip and pelvis. In other words one of the three bones making up the pelvis was not sitting correctly creating a considerable instability in terms of the bony and muscular foundation of his entire low back. Remember, virtually everything else is reliant on this structure in some form or another, whether it be the driving and supportive muscles of the legs or the supportive soft tissue structure in the low back and abdominal areas. In cycling, it is absolutely imperative that all of these work together harmoniously otherwise they become both counter-productive and antagonistic to each other. Serious wear and tear type of degeneration is a typical result.

Silent Destruction

But here’s the irony. Very often this type of spinal misalignment, muscular compensation and pelvic instability at some stage of their degenerative development have absolutely no pain. That’s right, no pain. Just the same way as, at any given time, you could well develop tooth decay but have no pain. In fact, any heart specialist will tell you that all too often the onset of heart disease has no pain attached to it either.Always remember these two things when dealing with musculoskeletal issues:

• Symptoms (or lack of) very often misrepresent the true state of your health;
• Very seldom do we ever find the cause of the problem at the site of the pain.

Sadly, over time, the wear and tear factors together with an acquiescing of muscular and soft tissue degeneration all take their toll in the form of unwanted muscular compensation together with a myriad of other aggravating factors. The referral of pain to a seemingly unrelated area is one of them. Don’t be fooled. Very often riders complain of upper back pain, shoulder and neck soreness and pain to the arms, which all too commonly can be related to instabilities within the low back and pelvic structure. A good example of this is illustrated in Figure 1.

Figure 1

This is a random example of an X-ray showing the spine and the two ‘wings’ that make up the pelvis. See how one wing of the pelvis has ‘dropped’ on the right? Also, see how the ball joint of the right leg has had no alternative but to drop on the right as well? Clearly, the larger supportive muscles on one side of the back have, over time, started to tighten in an attempt to compensate which has ultimately created a ‘short leg’. That is, the leg is not anatomically short, (if you measured them they would be the same length) but only appears short due to the change in the pelvic position.Studies have shown convincingly that abnormal stresses and strains on the human frame resulting from differences in leg length have been closely associated with degenerative conditions elsewhere. In other words, as one area yields to the gravitational forces, so too must others. In this particular case the mechanisms of the leg and knee are very much at risk and have already shown significant signs of aggravation and loss of power. As a result of hours on the bike and constant repetition in an adverse biomechanical position, the angle of the pelvis has altered the position of the major driving and supportive muscles of the leg. Consequently, over time, the knee and ankle have had no alternative but to create their own wear pattern and in turn distort the surrounding connective tissue and ligaments. And so it goes.However, it doesn’t stop there. Here’s another random example of an X-ray showing the pelvis and the mid thoracic spine and neck. Take a look at Figure 2.

Figure 2

Can you see how this spine has had no choice but to ‘compensate’ a little higher up in the mid back area? As a result the upper back, shoulder and neck areas are also at risk. The neck is now forced in a very similar way to compensate, which it does by placing a significant amount of stress on the major muscles of the lower neck and shoulders.Just like the sciatic nerve is to the lower back, the upper spine also is governed by a very large and powerful nerve network, which when aggravated often refers pain to the neck, arms, wrists and hands. Another ‘three-card trick’ is that in this type of case, people are invariably attracted to target just the area that hurts in terms of treatment. When in fact, quite often, the actual cause may well be coming from a totally different area. Always keep this in mind.

Performance Implications

Proper positioning on the bike should have the rider’s weight evenly distributed over the saddle, pedals and handlebars so that the entire skeletal structure bears the weight instead of just a few muscles in the back and arms.Misalignment of the bones of the spine, soft tissue problems and structural compensation can all have significant effects on performance in one way or another. Spinal misalignment in particular can very often reduce the neurological impulses necessary for firing messages from your brain to the rest of your body much in the same way as a dimmer switch on the wall can reduce power to ultimately dim your lights. Structural compensation is also an all too common result of spinal misalignment.Ultimately all of these, either individually or as a complexity, result in a loss of power, premature fatigue and the generation of new injuries as well as the exacerbation of old ones. Sadly, these effects are often camouflaged by the fact that characteristically they oscillate. That is, they may well be a noticeable problem one day and they’re gone the next only to reappear in a slightly different format a short time later and so on. A common complaint very often noticed before anything else is the loss of power transfer in a sprinting effort or hard climb. Always be aware of this. Premature fatigue is also another common element and like so many of these types of symptoms is both hard to measure and difficult to monitor.Research from the Olympic training centre in the USA suggests that riders properly positioned on their bikes could reduce their average oxygen consumption by between 8 to 14%. This, in real terms, is certainly not to be sneezed at. It can mean a significant difference in race results if you’re a serious competitor and the difference between a great day on the bike and an ordinary one if you’re not.Remember also that the ‘performance’ we’re talking about is not just about the effort required for winning races it’s also about your body working to the absolute best ability at all times.

Tell Tale Signs

Once again, keep in mind that very often, postural changes are gradual and so symptoms may tend to oscillate rather than come on full force immediately. Monitor yourself closely on a ride-to-ride basis and be aware of any changes no matter how subtle they may appear to be: Here are some of the most typical signs you should be aware of:

• An unexplainable loss of your usualfitness on the bike.
• Loss of general comfort when riding.
• The development of sore spots oruncharacteristic areas of pain.
• The development of pins and needles, e.g.arms, neck.
• Unusually cold feet, pins and needles,cramps in the calves.
• A sudden difference or feel in the sitbones.
• Loss of power in one or both legs.
• A feeling that you are dominant on oneside.
• Sudden appearance of pain, e.g. low back,between shoulder blades, neck etc.
• Premature fatigue.
• Poor recovery.
• Unexplainable post-ride soreness.
• Post ride headache.

If you’re still having ongoing trouble with comfort or performance on your bike or are just in doubt, your chiropractor has the technology to assess your posture, and evaluate the health of your spine and skeletal structure. Once a clear understanding of your individual problem is established and a treatment strategy is in place, it’s a great opportunity to have your chiropractor work closely with any other health professionals who may be able to contribute to your success. Physiotherapy, podiatry and massage therapy can all provide additional support to get you back on track as quickly as possible. Once you begin to make the satisfactory structural changes, your chiropractor will want to work closely with your bike-fit professional so that micro-adjustments can be made to your bike relative to the ongoing changes to your skeletal structure.Photography by Tim De Waele