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Physiotherapy and bike fitting: The unique relationship

So, 2016 has been an exceptionally busy period here at Kernow Physio. Riders from all walks of life have paid a visit to the bike fitting studio. I’ve treated professional riders from Belgium and the UK, riders recovering from hip / knee surgery, and riders who purely are in pursuit of more free speed. So why should you have a bike fit with a Physiotherapist I hear you say? Let’s start off from the ground up and discuss foot biomechanics:

Every single foot is different. Some patients have two different feet, many have a rear foot or forefoot collapse / instability. Hence the word “individualised” is used at Kernow Physio. We all have grown up wearing shoes which unfortunately makes our feet lazy to a certain degree. Riders then expect to be pain free having strapped a pair of carbon soled shoes which are fixed to a bicycle. Many get away with this. Unfortunately many also develop problems in the ankle, knee and even lower back from an unstable foot. Here’s why.

Subtalar neutral (ankle joint in the right position). Your ankle can rotate inwards or outwards due to forefoot or rear foot collapse. Many patients develop this due to different leg lengths, favouring one foot during every day life, or have had a previous injury which causes the rider to protect an area which can cause increased foot instability. A second cause for ankle rotation can be due to hip and core instability. I’ve seen riders with excessive knee pain which was caused by weakness in both the ankle and hip, and individuals who have had knee surgery due to hip instability Rotation of the lower leg due to ankle and hip issues can have serious detrimental effects to the knee joint. So how is this assessed in a bike fit?

1: Assessment. Before the rider get’s on the bike, I am looking at how the rider moves. Where is their instability coming from? A repetitive single leg squat for example can show these areas of imbalance. Many individuals are unable to perform a single leg squat effectively in a controlled environment of a Physio clinic. Yet they expect to ride pain free for hours on end?

2: Forefoot measurement is recorded using a forefoot measuring device to identify how much forefoot movement is occurring using a forefoot goniometer. Riders can have up to 15 degrees of forefoot movement which needs addressing during the bike fit.

3: Rearfoot measurement: Where does the calcaneus or ankle bone sit during weight bearing and non weight bearing? How much movement is occurring here? Achilles tendinopathies, bursitis, and many other painful conditions can occur from rear foot instability.

4: Midfoot measurement: How much does the riders foot arch collapse in relation to forefoot and rear foot movement? Our feet need to have forefoot movement to allow our natural shock absorption properties. However, if the rear foot and mid foot is unstable this can further exacerbate instability on the bike. Making a calculated decision on this in my opinion is more about Physiotherapy than bike fitting.

5: A bike fit is not a 1 visit fix. At Kernow Physio we deliver a process over time to get the individual in an optimum position to prevent injury and maximise performance. The rider puts in some hours in the saddle and provides feedback and then returns for future alterations. Cleat wedges and custom made foot orthotics are then used to carefully position the ankle joint in the right position. Every rider is looking for marginal gains and foot measurement is one critical area of a bike fit. Get it wrong, and a riders health can take a serious downturn and cause patella femoral dysfunction, patella osteoarthritis, quadricep tendonitis, and even neural changes in the leg. In 2017 Kernow Physio will be offering pressure mapping analysis of the foot and saddle to further individualise the fit and maximise marginal gains both at professional and recreational cycling level.

So you can see, just measuring a riders feet in relation to their movement patterns takes up to an hour. It’s critical. I’ve worked as a Physiotherapist for nearly a decade in private practice now, and have been fortunate enough to work alongside some of the best health professionals in the World, gaining invaluable experience along the way. This allows me to make calculated decisions with a rider. Furthermore, I am constantly learning, adapting, and utilising up to date evidence based knowledge in my deliverance of a custom bike fit. Furthermore at Kernow Physio the recent addition of Hannah Hamley a fully qualified Podiatrist ensures each rider has happy feet. I see riders who buy a £2000 wheel set thinking it will make them the next Cavendish, buying the latest frame-set, riders going to great lengths paying through the earth for a gadget laden bike fit, riders paying a small fortune on power meters, and yet their position still causes pain or their position is still not optimal. The process at Kernow Physio doesn’t involve fancy gadgets or branding. You are paying for experience, paying for a bike fit with a Professional Physiotherapy cycling analyst who has dedicated his whole life to body geometry on a bike, and most importantly who is passionate about his work. So pop on down and invest in your body, rather than your bike for a change and enjoy cycling for many years to come.

Where we are

The Kernow Physio clinic is located in Nanstallon, near Bodmin

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