The BikeFit Physio

Next up in the case study series is Paul who presented with an interesting story and reason for his super conservative and upright bike set up. He was simply protecting his lower back because of requiring lumbar spine fusion surgery 7 years ago. This is where the problem lay. He also was wearing bike shoes that were too long, (Paul fell into the old pitfall of buying them long so that they are wide enough for your feet) plus his SMP Saddle was pointing down excessively and he was experiencing saddle sores. Current Right quad tendinopathy identified during the pre bike fit screening.

1) Interesting bike fit where we stripped back how conservative and protective your set up was due to your history of back surgery.
2) But that was 7 years ago and you are moving very well through your lumbar spine. So, we moved the saddle back and up to bring your knee angle into the recommended range and listened to your subjective feedback on your pedal stroke smoothness. This new saddle height will help your quad tendon also.
3) We then corrected the SMP saddle to the correct degree (it was at -5deg but these unique saddles should be set with the nose pointing up in order to support the pelvis the way that they are designed to) and in combination with swapping the stem for a 80mm at +6deg, we significantly improved your pelvic stability and position of your centre of pressure on the saddle. (Note the equal pressure on the saddle at the left and right sit bone when in the hoods compared to the pre bike fit pressure image with excessive pressure on the right side)
4) We ordered a pair of Lake wide Cx177 and when these arrive we will better position the cleat with the pedal compared to what we could manage with your current shoes that are too long. We fitted Paul with the wide Lakes a week later.
5) Your R quad tendinopathy will be happier with the higher and further back saddle position, but will still require the dedicated gradual progressive loading with the rehab exercises that I showed you.
5) Enjoy and safe cycling.

Case study series rocks on here with a gentleman who came in last week presenting with left hip ache and numb hands: On physio screening prior to his bike fit, we diagnosed the left sit bone pain that occurs on running as a long standing proximal hamstring tendinopathy. On assessing his ability to move through his left side in the single leg RDL and single leg step up, we saw some deficiencies here and steered him towards the correct rehab exercises for both prox hamstring tendon issue and general weakness around left hip.

Note the subtle changes to his pre and post images, but there were significant changes that are not visible.
1) We started with addressing the cleat position and also the saddle height in order to bring your knee angle into the recommended range and a suitable saddle height to still allow a smooth pedal stroke around the bottom of the stroke. We checked a height that was 3mm higher but it caused a negative change to your pelvic stability on the saddle, so we opted for this one.
2) We then addressed the reach as you tended to place your hands back from the hoods and not in the hoods. This along with the excessive weight force through your arms was causing the hand numbness.
3) We were able to move the saddle forward to bring your hands closer to the hoods and in doing so we didn't force more weight onto your arms and hands. In fact, we saw more weight force appear on the saddle detected by the saddle pressure mapping (see post bike fit saddle map image showing more sit bone pressure indicating more weight force through the saddle) and your ability to take your hands off the hoods and still hold your riding position (steve hogg test!)
4) We then optimised your foot/shoe/pedal contact point using the 3feet Sidas insole which perfectly matched your foots profile. This will lead to an improvement in the "connection" with your bike through improved neurological communication between the feet and the central nervous system.
P.s our client reports feeling that he is certainly riding better and with more comfort. He also mentioned the rehab for his hamstring tendon was working without hurting.

Continuing with our case study series, here is David who underwent complete metamorphosis from caterpillar to butterfly with this bike fit!!! He came in with a nice road bike that was set up like a Dutch commuter with its large bouncy saddle and upright stem! No surprise he presented with numb hands and some low back pain after cycling, with general discomfort in the form of saddle issues.

1) Night and Day!!
2) We sorted the cleats on the new shoes and then decided that the extra extra wide Dutch bike saddle had no place on your road bike so we swapped it for a GebioMized Valid saddle with a cutout. This saddle suits a rider who is not looking for an aggressive position like yourself.
3) We then started lifting the saddle higher and higher until we found the height that you felt you could maintain a smooth pedal stroke that also coincided with a very stable pelvis on the saddle pressure mapping data.
4) Due to the need to increase the saddle by a whopping 60mm, we advised you that should you feel any pain or discomfort behind the knees, you should lower the saddle and then slowly bring it back up to the post bike fit height.
5) We lowered the front end of your bike using your adjustable stem which brought it all together and allowed you to get into a conventional road bike position with a very manageable saddle to handlebar drop of 60mm.
6) Enjoy the drastically different and more efficient machine!!

Next up in the case study series is Ray who travelled from Galway for the Physio Bike Fit and VO2Max testing package. Lovely session where we got the test out of the way first, shared a coffee whilst mulling over the VO2max test data and then got stuck into the bike fit. He presented with L hand numbness, L foot pins and needles, saddle/ge***al numbness.

1) First step was and always is to correct the cleat position on the shoes in order to better distribute the pressure under the foot at this all important contact point and see if this will resolve your pins and needles sensation. The other point we raised here was that your foot would much prefer a wider shoe and you were happy to go with the Lake Cx242x to provide this and other benefits that go along with this shoe and especially in combination with the PUSH cycling specific footbeds.
2) We then sorted the saddle height to bring your knee angle into the recommended range according to the research and also in sync with your pedal smoothness feedback.
3) We noticed that you were not keeping your wrist in a neutral pos and this was stressing the joint/neural tissue and possibly a source to the left hand numbness. We also needed to reduce the overall weight force going through your arms and hands because hand numbness can come from lack of blood flow due to increased pressure/weight on the hands
4) Nice significant changes seen on your pressure mapping with regards to distribution of pressure on the saddle. Pre bike fit, too much pressure at the front of the saddle with your centre of pressure too far forward causing ge***al numbness. Post bike fit, centre of pressure moved back and now much less pressure at perineum area. This should resolve the ge***al numbness symptoms.
5) Enjoy the new set up and thanks for coming all the way from Galway.
Ray reported back on a phone call yesterday to say that his saddle numbness has completely resolved, his left hand numbness was significantly less and that his left foot numbness was the same. We shipped his Lake Cx242x wide shoes with PUSH insoles up to Ray in Galway the other day so will be keeping tabs on him to hear if the wider shoe will resolve the numbness.

Next up in the bike fit case study series is Lisa. She presented with ongoing Left frontal knee pain on cycling, walking and hill walking. She also described some low back muscle tension where she needs to bend her spine in order to improve it. She gets some foot numbness and some excessive hand pressure after 80-90km.
On pre bike fit screening, we found significant weakness around the lateral left hip muscles and Lisa was given rehab exercises to improve strength here to resolve her knee pain.

1) We started with the issue around the saddle in that you were really only using the very back section of it, (term called saddle overhang in the bikefitting world) ( see saddle pressure map on left side) and this was leading to poor pelvic stability on the saddle plus a big hint that you wanted to be further back in the bike.
2) We lifted the saddle only 5mm and also brought it back 5mm, in order to improve the knee angle at 6pm but more importantly to reduce the risk of further frontal left knee pain, as is the case with you. In doing this, we improved your centre of pressure position on the saddle (moved it further up the saddle) and also slightly improved your pelvic stability too.
3) We improved the cleat position on the shoe (pulled it back fully) which should also help with resolving your knee issue and will lead to greater pedal efficiency. In relation to your foot numbness, the new cleat pos should help, if it doesn't then I would suggest opting for cycling specific foot beds that match your foot’s profile and will increase contact of the foot in the shoe thereby reducing overall pressure under the ball of the foot and dispersing it across the ball and mid foot.
4) We then popped the stem adjuster tool on the bike and experimented with longer stems to allow you to feel out the most comfortable length. We landed on 110mm at -6deg.
5) Look forward to hearing back how this new set up feels after the first few spins and the famous Ring of Kerry!
As it happens, Lisa emailed this morning to say that she honestly believed that she wouldn’t have been able to complete the Ring of Kerry cycle had it not been for the bike fit!

Next up in the case study series is Patrick Hourihane who is fresh off the press!! He came in yesterday for his bike fit presenting with left knee pain towards the back of the knee where the hamstring tendon attaches to tib/fib joint. He also was troubled with Neck, shoulder and hand discomfort.
We found weakness at L hamstrings during the pre bike fit screening amongst other things!!

1) Nice session that started with the cleat position. You had them very far forward which was putting your shoe in a sub-optimal position at 3pm. We pulled the cleats back as far as they could go which unfortunately with fizik shoes, is not far enough!
We also spotted the left cleat was not aligned square on the shoe and was tilted inwards, this was stressing your left hamstring tendon attachment at the lateral knee along with the low saddle pos.
2) Due to the very very low saddle, you were way to squashed on the bike.
3) We moved to the saddle height and lifted it all of 29mm. The last 3mm of height sat well with you in terms of pedal smoothness around the bottom of the pedal stroke and we also saw improvements to saddle pressure mapping
4) We then moved the saddle back about 5mm in order to move you back with it so that we could reduce the weight force going through your arms and hands. This will lead to better bike handling and resolution of the neck, shoulder and hand discomfort.
5) We changed the tilt of the saddle from nose down of -2.8 to +0.6deg, this is so that we could flatten the surface where your sit bones are planted on the back of the T shape saddle and we didnt cause any frontal saddle pressure either.
6) We fitted you with category 2 PUSH insoles which did what they are supposed to do (improve comfort through reduced overall concentrated pressure at ball of the foot, improve "connection" with the bike through better proprioceptive input to the brain from the foot/shoe/pedal contact point). However, you rightfully stated that you would like to get more experience on the bike before upgrading.
7) Enjoy the new set up and safe cycling
P.s Patrick got back today to say that there’s been a significant improvement already. He’s set up now for the Ring of Kerry!

Next up in the case study series is Niall, who presented with a lot of hamstring tightness and hamstring tension in both legs, has a osteochondral defect in Left knee with many years but was getting Right knee pain and more than usual on Left

1) We started, like all bike fits should, with addressing the saddle height and using the camera angles and your feedback on pedal smoothness to land on this saddle height, 30mm higher than what you came in with. This new height will absolutely reduce load on your knees and also ease the hamstring tightness when cycling issue.
2) We then moved the saddle back, away from the handlebars, in order to lower your torso angle and get into a more powerful hip/pelvic position. We also found that this saddle aft adjustement improved the pelvic stability on the saddle (much less movement of your centre of pressure) but there was still more pressure towards the left side of your saddle so we looked at the foot/shoe/pedal contact point.
3) With your left lower limb, significantly weaker secondary to the long term knee diagnosis, this side required a little more help! We achieved this with two cleat wedges under the left cleat. You felt this improved the feeling at the left foot/shoe/pedal contact point and we saw improvements at the saddle pressure data, equal left and right pressure at nose of saddle when in the hoods, but not as good when in the drops.
4) The lower torso angle will mean more speed for the same power output and your power output will increase with the new saddle height and setback.
5) Enjoy and safe cycling. Stay in touch!
P.s Niall has since reported back with some good news re cycling pain free at the knees and no longer any hamstring tension!!
Bike fitting is real!

Case study series continues. This week we have Ed, who made the trek down from Cavan during the week with his wife for bike fitting and running gait analysis.
Ed was putting up with a lot of issues, including saddle discomfort, numb hands, neck pain, numb feet and recurring episodes of Low back pain
1) Lots to dismantle here, before we got anywhere near the bike, we started with addressing the abnormal movement patterns that Ed was clearly showing around his low back/pelvis region. He was avoiding movement of this area when moving into forward bending and this was a protective pattern learned after experiencing bad bouts of low back pain and muscle spasm over the past many years. (public warnings about the need to keep our backs straight! This is terrible advice and causes the recurrence of muscle spasm and painful flare ups. Spines are designed to bend, we need to bend them!)
2. We then worked on the seat height to bring it up to the required height to suit Ed. We then quickly realised that the saddle needed to change from a T-shape to a V shape one in order to allow him to roll his pelvis forward without discomfort. Ed is a good example of a rider who prefers a slight forward tilt/roll of the pelvis on the saddle, and this pelvis posture will typically struggle on a T shaped saddle where there is less surface to support the pelvis as it rolls forward. When we fitted the V shape GebioMized saddle with cutout, Ed said "I can feel my pelvic bones on the saddle for the first time”. This is what we were after, and it means that he is now allowing more weight through the saddle, which will immediately take the weight force from his arms, once the cockpit is set up correctly.
3) We moved our attention to the front of the bike where Ed was still putting a lot of weight down through your arms
4) By increasing the length of the stem, to Ed’s surprise, this allowed his arms to relax and his elbows to relax. This will lead to better bike handling & less tension around the neck and shoulders, resolving his neck pain and hand numbness.
5) The Lake CX242x will provide a wide platform to house your wide feet and resolve numbness!

Next up in the case study series is Kathrin who presented with left knee pain on the inside of the knee with cycling. Comes on after 60-70km and hangs around for a few days afterwards. Unable to cycle consecutive days.
What we did:
1) Once we got the right saddle height and saddle fore-aft position, we then focused our attention on the reasons for the medial knee pain,
2) We moved the left shoe closer to the bike to improve the knee alignment.
3) We then used a 1deg cleat wedge under the Left cleat which further improved knee alignment and you preferred it to 2 x cleat wedges.
4) After this, we needed to bring your awareness to how you were sitting on the saddle. i.e Not sitting centrally
5) We worked on correcting your midline awareness and after a few practice runs during the session, you were able to hold this and as a result your saddle pressure mapping greatly improved.

I have seen this a nice few times in my bike fitting history where the rider thinks they are sitting in the middle of the saddle and they subsequently feel off centre when they are positioned into the middle of the seat. There are some tricks of the trade to help here, using the stick from ice cream lollies to provide tactile feedback as to where the middle of the saddle is, being one of them.
Correcting this off centre pelvic position is important for comfort and also for knee alignment as you can imagine how sitting off centre could throw out the lower limb mechanics.
6) Enjoy and safe cycling

In keeping with the case study series, here is Culm Long in with a new bike and looking to get set up for both comfort (was getting saddle discomfort) and performance (racing in the first Gran Fondo to come to Ireland in Sligo at the end of the month)

1) First thing we needed to do was address the saddle position and we found that you were not using much of the saddle (looking at the pressure mapping and could also see that you had unequal pressure on the nose of the saddle)
2) We moved the saddle forward to allow you to sit back further into it, and in order to maintain pelvic stability we needed to drop the saddle to suit your level of hamstring flex and maintain pedal smoothness.
3) We then noticed that your contact at the foot/shoe was not optimal (used foot pressure mapping to assess this) even though you already had the Cat 3 PUSH insoles from our previous fit. We heated and moulded them to better contact your feet and this improved pelvic stability and pressure distribution on the saddle as a result.
4) Lastly, we lowered the front end of the bike to reduce torso angle and drag, increasing speed for same power output.
5) This did not negatively affect saddle mapping or comfort.
Enjoy and all the best in the Gran Fondo

Bike week is long gone now, but it’s not forgotten. On Friday 17th of May, I poured most, but not all of my bike fitting equipment into the cargo bike and headed into Penrose Dock in Cork city to set up camp and offer free bike fitting for commuters as part of the amazing Cork Bike week initiative brought by TFI and Cork Sports Partnership. It went very well and I must thank the buildings manager from Penrose for helping out by notifying the staff working within the two buildings. We helped people who commute to work by bike get set up properly. The ebike and hybrid bike sector is growing and it is most certainly a category of bike and cyclist who benefit from a bike fit. Just like a road bike, TT bike and mountain bike, position matters. I’ve set up a specialised Leisure bike fit and dedicated a page to it on the website. So, if you commute by hybrid or ebike and are just not satisfied with the level of comfort when cycling, get in touch.

TT bike fit Good example of footbeds improving saddle stability

1) Very interesting bike fit where we started with the seat height to bring your knee angle into the recommended range and also appropriate for your level of hamstring flexibility and feedback re smoothness around the bottom of the pedal stroke.
2) We then moved the saddle forward so that the rider could take on more of the saddle (move his centre of pressure back a little more into the saddle) and also get into an optimal TT pos. This also resulted in a slight increase in your hip angle at 12pm on the pedal stroke, meaning easier power production when pedaling.
3) Finally we paid attention to the saddle pressure mapping showing how he was not sitting in the middle of the saddle and by fitting you with Category 3 PUSH footbeds, your pelvic stability and saddle positioning improved with no other change to the bike fit.
Nice! A good example of how the communication between the feet and the brain can improve lower limb coordination, knee alignment and pelvic stability.
4) Enjoy and all the best in the season ahead.

Come one, come all. It’ll be all grand!

John Phelan, aka is inviting all who would like to join the first meet up group and connect with fellow adventuring folk.

The plan is to meet at the Life Fit Studio in Upper Ballygarvan, Cork, at 9am for coffee and chats. Then head to Garryduff woods for a group trail run.
Set for the 2nd of June at 9am.
No charge, just bring positive energy!

Send him an email at [email protected] to get involved.

Warm welcome to all who would like to join our first meet up and connect with fellow adventuring folk. Plan is to meet at the Life Fit Studio in Upper Ballygarvan at 9am for coffee and chats. Then head to Garryduff woods for a group trail run. The date is set for the Sunday 2nd of June, I know I know, same day as the Cork City Marathon! It’s ok though, this won’t be the first Adventure community meet up! Let’s try and gather some momentum and get something consistent going.
Send me an email at [email protected]
Look forward to welcoming you at the studio.
Many thanks,
John