When the Foot hits the Pedal and Proper Bike Fit

By Beth Mason
Physical Therapist & Retul Fit Professional

“The knee bone’s connected to the leg bone. The leg bone’s connected to the anklebone. The anklebone’s connected to the foot bone and the foot bone’s connected to the toe bone!”

The campfire song above is a good illustration of what some Physical Therapists know as “Regional Interdependence”.  With respect to musculoskeletal problems, regional interdependence refers to the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint (Wainer, JOSPT 2001).  What does this mean to the cyclist?  The pain you feel at your knee, your hip, your low back, could very likely be attributed to how your foot is contacting the pedal.

After about a year of performing a zillion bike fits (okay, a few less than that), and really thinking very hard about what I am seeing, this is what I have found:

1. Many cyclists have what appears to be a “short” leg
2. Many cyclists have what appears to be a “windswept” posture (a little rotated on the saddle)
3. The “short” side is often the side that presents with problems, low back pain, knee pain, etc.
4. The “long” side can also have its share of issues as well (achilles tendinitis, hamstring pain).

So what is the fix?  The ultimate fix, tends to be in addressing movement patterns that we have developed over years of being lazy standers and sitters in “real life”.

Consider this.  Consider that when you stand to talk to someone, you stand like this:

 

I can tell you for certain that when I look at you on the bike you will not be symmetrical.  You will likely be rotated. You will probably need wedging, more on one side than the other.  If you were my husband Jeff (the grim looking guy pictured above), your right shoulder would appear to be higher, and your right leg would appear to be shorter when evaluated closer.  Structurally, neither of those things would likely be true (although neither could be verified without an xray or MRI), but functionally, this is how your body would function due to many months or years of functional muscular shortening, lengthening, tightening and weakening (dependent upon the location).  On the bike, you would look slightly rotated to the left.  Your right knee (and maybe the left too) would dive toward the top tube when pedaling), and your hip on that side would turn inward as well.   If you suffer from low back pain, this would be the side you would have it on. 

There are quick fixes to this problem that include primarily wedging under the cleat as a first choice (inside the shoe as a second choice), and more definitive fixes that involve some postural exercises over a two to three weeks (and then maybe once a week for maintenance).  If you come to see me for a bike fit, it is very feasible that I can fix the low back pain or the knee pain that you experience on the bike by wedging the appropriate amount under the appropriate cleat. The foot bone is connected to the ankle bone, the ankle bone is connected to the leg bone, the leg bone is connected to the thigh bone….

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Beth Mason, PT is a SICI certified bike fitter who employs the Retul technology with her bike fits, and draws from her 13 years as a licensed Physical Therapist and board certified Orthopedic Clinical Specialist to assist in her complete assessment of the cyclist.  In addition to her work as a professional bike fitter, Beth is also currently completing her doctorate in Sports Medicine Physical Therapy.  See www.bethbikes.com for details, or email Beth for inquiries regarding her next visit to the DC metro area.