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The day my bike went to the doctor

author : alicefoeller

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I took my bike to physical therapy and got great results

As part of my current Ironman journey as a middle-aged athlete, I've been working hard on my form. After 20 years in triathlon, it's no longer smart to push through discomfort or to think that any discomfort is going to magically improve as the miles pile on.

In addition to strength-based physical therapy, I also signed up for a professional running gait analysis, which is when I learned I could get a bike fit from a physical therapist. I've had a bike fit at a bike store before, including one by a FIST-certified fitter who ended up swapping out parts on my bike to improve my power and comfort. I've had laser scans to confirm my inseam measurement. I've seen new fangled bike saddle fit technology that measures sit bones and matches them to available saddles.

But I didn't know I could take my bike to the doctor.

On a Tuesday morning, I wheeled my Felt DA through the lobby, past the lab services and neurology departments, past obstetrics, and back to the physical therapy department. Were the other patients staring at me? Sure.

Having paid cash for a certified bike fit at a triathlon store a number of years ago, I had some idea of what to expect, but I was pleasantly surprised at how much more I received at the physical therapist, covered by my insurance:

Evaluation and objective measurement of hip flexibility and hamstring flexibility on an exam table (I didn't get that at the bike store!)

Multiple measurements of the same angle (knee flexion angle at the top of the pedal stroke, for example) to eliminate measurement errors

A check of the "float" in my pedals, to allow my knees some movement as my foot (and shoe and cleat and pedal) move through the pedal stroke

Knowledge of which parts of the knee (outside, inside, front of patella) would be tight or painful as a result of various bike geometry problems

And after all of that, the physical therapist pulled a torque wrench out of her bag and began adjusting my seat height (with my permission, and after marking the original height with tape).

How to get a medical bike fit

This didn't all come together easily, by walking into a sports medicine place with my bike.

First I networked with a functional movement specialist I know in California to find the professional associations he trusts, and managed to find one single doctor here in my city who was affiliated.

I couldn't get an appointment with that doctor without a referral, so I made an appointment with my primary care doc. (He might have given me one over the phone, but I had not visited in more than a year due to Covid, so I had to wait for that appointment, go in, and deal with people faxing paperwork to other people.) Naturally I needed to complain of some pain or discomfort, which was pretty easy, since I'm 44 and training 15 hours a week.

A few weeks later, I had an initial consultation with the physical therapist I wanted to see, and he mentioned that I could schedule a gait analysis and a bike fit with another doctor at the facility.

In all, it took almost three months to get it set up and covered by insurance.

What to bring to the bike fitting

I brought my bike (with a trainer tire on the back), my bike shoes, and an old pair of bike shoes and cleats that I suspected was the source of the original knee pain.

I pumped up the back tire before leaving home.

I also removed as much "junk" as I could conveniently remove from the bike frame so she could see to measure and make adjustments. I removed my bento box and toolbag, but I left my aerobottle on.

I wore the normal triathlon shorts I wear most frequently. She advised me that the padding in bike shorts can make a difference of a half a centimeter or so, which is a big difference.

What I learned

I'm always looking for imbalances or explanations, because I have two symmetrical sides of my body, but they don't hurt the same. So something must be going on.

For me, the area where the doctor found my measurements were most outside of the recommended range was at the top of the pedal stroke. My knee was too flexed. That seemed like it would impact both knees equally, but as we talked about it, I realized that I ALWAYS coast with my left pedal down. Which means I always start up against a lot of resistance with my right foot at the top of the pedal stroke, pushing hard, putting pressure on my right knee. We raised my seat 1.5 cm (which is a LOT! I think I may not have tightened it enough and perhaps it slipped down over time). The 1.5 cm adjustment resulted in 8 fewer degrees of knee flexion at the top of the pedal stroke. It also put me in the proper range for my knee being aligned with the pedal spindle. I had anticipated it would make the 90-degree angle at my elbow higher, since moving the seat up on a tri bike also moves it back a little. But my elbows stayed exactly as far in front of my shoulders as they had been. The drop from my seat to the aerobars increased, of course, by the amount we raised the seat. However my reach distance (seat to elbows) only increased by 0.5 cm.

Of course this is all specific to me, and would be completely different for someone else. But it's helpful to share. If you submit to a bike fitting like this, you'll receive different adjustments, different advice, different recommendations, and a different outcome. I was relieved she didn't recommend a different bike altogether.

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