PRACTICAL MANAGEMENT

Road Bicycle Fit

Marc R. Silberman, MD,* David Webner, MD, Steven Collina, MD, and Brian J. Shiple, DO

(Clin J Sport Med 2005;15:271276)

roper bicycle t is essential for comfort, safety, injury prevention, and peak performance. The goal is to balance all of the issues at hand, optimize power and aerobic efciency, and avoid injury. At an average of 80 revolutions per minute, a cyclist may complete over 5400 revolutions during an hour ride, up to 30,000 revolutions over a 100-mile course, and 81,000 revolutions in the span of 1 week. Compounded over a season, one can see how overuse injuries develop. If properly tted, the majority of cyclists training correctly will remain injury-free. Bicycle t consists of static (measurements at rest) or dynamic (measurements while riding) evaluation. Dynamic t also involves video analysis with concomitant heart rate, wattage, and pedal torque readings. There are 3 contact areas a rider makes with the bicycle, addressed in the following order (Fig. 1): 1. Shoe-cleat-pedal interface 2. Pelvis-saddle interface 3. Hands-handlebar interface Whether a weekend warrior or elite Olympic hopeful, all cyclists are positioned the same, with the exception of the hands-handlebar interface. A recreational rider may prefer to be positioned more upright.

should be corrected. If a rider has excessive malalignment of the lower extremity, canted shims or wedges can be used. Heel lifts and most orthotics are not sufcient for cycling as the driving force is through the metatarsal heads.2

Saddle Height
Historical studies on formulas to determine saddle height have been discussed previously by De Vey Mestdagh.3 These formulas are designed to t a rider in the highest seated position to produce the most power at a minimal aerobic cost without placing undue stress on the lower extremity. The basic position is that of an almost fully extended leg when at the bottom of the pedal stroke. A formula endorsed by 3-time Tour de France champion Greg LeMond and his coach, Cyrille Guimard, takes the riders inseam length in centimeters and multiplies it by 0.883 to equal the saddle height, measured from the center of the bottom bracket to the top of the saddle4 (Fig. 3). An alternative method is to use knee angle measurements. The knee should be exed 25 to 30 from full extension, with the pedal in the 6-oclock position5,6 (Fig. 4). Cyclists who tend to pedal on their toes can tolerate a higher saddle height, whereas those who pedal by driving through and dropping their heels will prefer a lower position. Achilles tendinopathy can result from excessive stretch if the position is too high or from excessive force in the downstroke if the saddle is too low.1

STATIC FIT Shoe-Cleat-Pedal Interface

For maximal power and injury prevention, the cleat should be positioned so the rst metatarsal head lies directly over the pedal axle (Table 1; Figs. 1, 2). For leg length discrepancy, the shoe-pedal interface can be adjusted in 1 of 3 ways. Shims can be inserted between the cleat and the shoe on the shorter leg, custom orthotics may be tried, or the cleat may be moved back slightly on the longer leg. A true discrepancy of greater than 6 mm is considered signicant in the cyclist, with some athletes unable to tolerate a difference of 3 mm.1 One third to half of the difference
Received for publication January 2005; accepted May 2005. From the *New Jersey Sports Medicine and Performance Center LLC, Gillette, NJ; Sports Medicine, Department of Family Medicine and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA; and Crozer-Keystones Healthplex Sports Medicine Institute, Springeld, PA. Reprints: Marc R. Silberman, MD, Director, New Jersey Sports Medicine and Performance Center LLC, 689 Valley Road, Suite 104, Gillette, NJ 07933. (e-mail: www.njsportsmed.com, drbicycle@njsportsmed.com). Copyright 2005 by Lippincott Williams & Wilkins

Saddle Fore-Aft Position

When the pedal is positioned at 3 oclock (forward and parallel to the ground), a plumb line dropped from the inferior pole of the patella should hang directly over the pedal axle (Fig. 5). Sprinters and time-trialists will adjust their saddle so the plumb line falls slightly in front of the axle to get on top of the gear in a more forward position. Moving the saddle forward lowers saddle height, whereas moving it backward elevates the saddle. To compete in a time trial with clip-on aero-bars, a rider with one bike may move the saddle slightly forward and higher from the usual road racing position.

Saddle Tilt
Saddle tilt should be close to level or parallel to the ground. About 60% of body weight can be centered on the narrow saddle. Saddle sores (skin wounds secondary to bacteria, moisture, pressure, and friction), perineal pain and numbness, or impotence may result if the saddle is not wide enough to support the ischial tuberosities or set to a correct height and angle. Time-trialists, who ride on aero-bars in a more forward

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TABLE 1. Static Fit: Order of Adjustments and Recommended Neutral Position

1. Foot-shoe-cleat-pedal interface First metatarsal head lies over pedal spindle 2. Saddle height A. Knee angle exed 25 to 30 short of full extension when the pedal is at the bottom of the downstroke B. Saddle height, measured from center of bottom bracket to the top of saddle, equal to the riders inseam length in centimeters multiplied by 0.883 C. Leg extended fully and comfortably (without any pelvis rocking) with heel resting on back of pedal at the bottom of the downstroke (6-oclock position) 3. Saddle fore-aft Plumb bob dropped from the inferior pole of the patella should fall directly over the pedal spindle, with the cranks positioned forward and parallel to the ground (9-oclock position) Note: Recheck saddle height after making fore-aft adjustment 4. Saddle tilt Level to the ground 5. Stem height 0 to 3 inches below the height of the saddle With the hands on the brake hoods and the arms slightly exed, the torso should ex to 45 in relation to the top tube With the hands in the drops, the torso and top tube angle should be about 30 6. Stem length or extension With a rider comfortably in the drops with the elbows exed about 20 degrees, and the knees at their maximal height and forward position, the distance between the elbows and knees should be a small distance, up to 2 inches (make sure rider can stand and climb without hitting knees against bars) With the hands in the drops, looking down, the front hub should be obscured by the transverse part of the handlebars

exed position, prefer a slight downward tilt to decrease saddle pressure on the perineum.

Stem and Handlebar Height

Stem height is more of a subjective measurement, but is extremely important in terms of aerodynamics, power production, comfort, and injury prevention. With the hands on the brake hoods and the arms slightly exed, the torso should ex to about 45 in relation to a nonsloping top tube7 (Fig. 5). When the hands are in the drops, the torso should ex 60 (Fig. 1). The vertical distance between the top of the saddle and the top of the stem or bars should be 1 to 3 inches (58 cm) below the saddle, depending on the athletes exibility4,8 (Fig. 3). A recreational rider may prefer to sit more upright, with a shorter reach and higher placed handle-

bars, for a more comfortable position at the expense of aerodynamics. The rider accounts for 65% to 80% of the total aerodynamic drag.9 The lower the stem, the more aerodynamic a rider can be, though at the expense of comfort and power. An average size male cyclist can decrease his frontal area by about 30% by moving from the upright touring position to a racing position in the drops. If forward-exed excessively, maximal sustainable power is often reduced due to diminished crank torque through the top of the pedal cycle.9 Miguel Indurain (5-time Tour de France champion) and Lance Armstrong (6-time champion) are two notable cyclists with an upright time-trial position despite the total aerodynamic resistance. Handlebar tilt is a personal preference, but most cyclists prefer the lower curve and brake hoods to be slightly elevated. Too often, the bars are tilted downward or the hoods are rotated low, forcing the athlete to overreach. This may result in overuse strain, increased pressure on the hands, and loss of power through the core.1

Stem Length or Extension

Equally important in the t of a cyclist is that of upper body position or extension. The athletes core musculature is extremely vital to performance. Too short a top tube plus stem length (Fig. 4) and the rider will be too bunched up. Too long, and the rider will be too stretched out. When the rider looks down with the arms slightly bent and the hands in the drops, the front hub should be obscured by the transverse part of the handlebars. Also, when the rider is comfortably in the drops with the elbows exed 60 to 70 and the knees are at their maximal height and forward position, the distance between the elbows and knees should be small, 1 to 2 inches (25 cm). The adjustment of upper body extension is achieved through changing the stem length. If the frame was properly tted, the top tube length will allow an optimum position to be achieved with the use of a 10 to 12 cm stem.
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FIGURE 1. Order of the three contact areas to address in a bike t. Torso exes 60 degrees with hands in the drops. Photo by Mike Spilker.

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FIGURE 2. Cleat is positioned so rst metatarsal head lies directly over pedal spindle.

DYNAMIC FIT
A cyclists performance capacity is determined by three components: the athletes metabolism, biomechanics, and aerodynamics. A dynamic evaluation assesses all three of these parameters. Whereas the ofce examination of the athlete and bicycle is well suited for measuring geometric values, no laboratory investigation can simulate the real-world performance, balance, and aerodynamic issues that confront the athlete out on the road. Video analysis, measurement of wattage, heart rate, and pedal torque comprise a dynamic bike t.10 Any adjustments to position can then be re-evaluated in terms of objective rider physiological measurements. If a stem is lowered to provide a more aerodynamic position, but the rider is now too exed to produce power effectively (demonstrated by lower wattage, higher heart rate, and/or ineffective pedal torque numbers or pattern), then the position change was ineffective.

Pedal Torque and Spin Analysis

Muscles involved in the power phase drive the crank downward in an effort to rotate the crank, whereas the muscles

that are active in the recovery phase are ring primarily to reduce resistance versus the contralateral propulsive limb. Although most athletes believe they pull up on the pedals while cycling, this is rare in road cycling during steady-state efforts and is not essential to an efcient seated pedal stroke.9 Studies on elite cyclists during steady-state cycling have shown that even on the upstroke, the vector of forces is downward in the opposite direction of the pedal motion.11,12 The leg in the recovery phase is not lifted as fast as the crank is rotating. The elite cyclist, however, exhibits reduced negative force during the upstroke, in addition to decreased time in producing these forces.13 There are commercially available tools to evaluate pedal torque. Spin Scan (Racermate) provides net torque, a multicolor graphic depiction of one 360 pedal revolution broken down into 15 segments based on the riders pedaling technique. An efcient or optimal pedal stroke pattern is felt to be one with a atter or more even bar graph.10 An examination of national team riders demonstrated that maximal torque during the downstroke is what differentiated elite athletes from the recreational rider.13

FIGURE 3. Lemond-Guimard method of determining saddle height. Saddle height = 0.883 3 inseam length in cm. Inseam measured by placing a book between legs to simulate saddle and measuring line to mark on wall. q 2005 Lippincott Williams & Wilkins

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FIGURE 4. Saddle height set so knee angle is 2530 degrees with pedal in 6 oclock or dead bottom center position. Bert Webster performing bike t. Photo by Mike Spilker.

In terms of bike t, pedal torque appears most useful when evaluating injured cyclists and implementing drastic position changes for those riding with aero-bars. Further research needs to be conducted before a pedal torque examination can be universally recommended.

INJURIES AND AILMENTS

De Vey Mestdagh3 has described cycling posture based on posture height and posture length. Complaints related to the lower extremity may be addressed by adjusting the saddle (posture height), whereas complaints related to the upper extremities, neck, and back may be addressed by adjusting the handlebars (posture length). The genital, pelvic, and lumbosacral region all fall in an intermediate area. Knee injuries are

the most common, and by localizing where the knee hurts, sometimes all that is needed for correction is a small bicycle adjustment (Tables 2, 3). Posterior neck pain and scapular discomfort may be caused by an elongated reach and can be remedied by placing a rider in a more upright position. Ulnar neuropathy or cyclists palsy, a common ailment, results from excessive pressure on the handlebars. Contributing factors may be bars positioned too low or a saddle too far forward or tilted downward. Hand symptoms may be rectied by increasing handlebar padding, changing hand position frequently, adjusting handlebar tilt and/or height, and rechecking the saddle height. Low back pain may occur in riders who are overstretched on the bike. Riding more upright, raising stem height, and shortening stem length may resolve back discomfort (Table 2). A saddle too high may lead to lower leg symptoms, tibialis anterior, or Achilles tendinopathy. A saddle too low, with excessive heel drop at the bottom of the pedal stroke, may also cause Achilles pain. Correcting saddle height may address these problems. Mortons neuroma or foot neuropathy is common in cyclists and may be due to cleat position, shoe tightness, or shoe-sole irregularities (worn sole with cleat bolts pushing through; Table 2). Knee pain is the most common ailment of cyclists and may be due to training error, poor bike t, or both. Anterior knee discomfort may be due to a saddle position too low or too far forward in addition to excessive climbing, use of big gears, or too long a crank arm. Adjusting saddle position and modifying training can improve conditions such as patellar tendinosis and patellofemoral pain. Posterior knee pain may occur if the saddle is too high or too far back. Saddle adjustment as well as limiting pedal oat can eliminate the discomfort. Medial knee pain can develop from outward pointing toes and/or excessive oat in the pedals and can be addressed

FIGURE 5. Saddle fore-aft. When pedal is in the 3 oclock position, plumb line dropped from inferior pole of patella falls directly over pedal spindle. Bert Webster performing bike t. Photos by Mike Spilker.

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TABLE 2. Overuse Injuries, Contributing Bicycle Posture, and Bicycle Adjustments

Ailment Posterior neck pain, scapular pain for clarity Contributing Position Too great of a reach, handlebars too low, too stretched out Bicycle Adjustment 1. Ride more upright, shorten reach 2. Raise stem height 3. Shorten stem length 4. Ride with hands on hoods or tops of bars 1. Increase padding on bars and gloves 2. Avoid prolonged pressure, change hand position often 3. Raise stem height 4. Move saddle back if too far forward 5. If saddle is tilted down, position it level 1. Ride more upright, shorten reach 2. Raise stem height 3. Shorten stem length Lower saddle height Lower saddle height Raise saddle height Usually, move cleat back, but may be forward Check sole for inner wear or cleat bolts pressing inward Wider shoes, loosen Velcro straps/shoe buckle Lower saddle height Adjust angle closer to level with the ground

Hand neuropathy (cyclists palsy, ulnar nerve)

Too much pressure on bars, handle bars too low, saddle too far forward, excessive downward saddle tilt

Low back pain

Too stretched out

Tibialis anterior tendonopathy Achilles tendonopathy

Mortons neuroma/foot pain/numbness

Perineal numbness

Saddle height too high Saddle height too high (excessive stretch) Saddle height too low (with concomitant dropping of heel to generate more power) Cleat position Irregular sole Shoes too tight Saddle too high Tilt angle excessively up or down

by changing cleat position and limiting oat. Lateral knee pain and iliotibial band symptoms may be seen with toes pointing in and/or excessive oat in the pedals. Appropriate cleat and pedal modications can eliminate lateral pain (Table 3).

Perineal neuropathy is seen with saddles set too high, tilted excessively downward or upward, or too narrow to support the ischial tuberosities. Saddle height and tilt may be reduced (Table 2). The sooner the overuse ailment is addressed through evaluation and modication of training and bike t, the greater chance of rapid recovery.

TABLE 3. Bicycle Adjustment Based on the Location of Knee Pain

Location Anterior Causes Seat too low Seat too far forward Climbing too much Big gears, low rpm Cranks too long Cleats: toes point out Floating pedals Exiting clipless pedals Feet too far apart Bicycle Adjustment Raise seat Move seat back Reduce climbing Spin more Shorten cranks Modify cleat position: toe in Consider oating pedals Limit oat to 5 Lower tension Modify cleat position: move closer Shorten bottom bracket axle Use cranks with less offset Modify cleat: toe out Consider oating pedals Limit oat to 5 Modify cleat position: apart Longer bottom bracket axle Use cranks with more offset Shim pedal on crank 2 mm Lower saddle Move saddle forward Limit oat to 5

CONCLUSIONS
Proper bike t is essential for peak performance, comfort, safety, and injury prevention. There is no one set of guidelines or geometric measurements scientically validated to t an athlete properly. Each athlete must be tted individually. Changes should be made during the off-season, one change at a time, in small increments. The goal is to balance all of the issues at hand: injury prevention, aerodynamics, comfort, and performance. The use of video analysis in conjunction with objective physiological measurements such as heart rate, power output and pedal torque has added science to the art of bicycle t. Whether caring for an elite cyclist or the weekend warrior, the knowledge and skill to t a cyclist are useful training tools. REFERENCES
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Medial

Lateral

Cleats: toes point in Floating pedals Feet too close

Posterior

Saddle too high Saddle too far back Floating pedals

Reprinted with permission.14

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injuries: prevention and management. Philadelphia, PA: Saunders; 1994: 187206. 7. Hughes J. Dr. Andy Pruitt on Bike Fit. Available at: http://www. ultracycling.com/equipment/biket.html. Reprinted from Ultra Cycling, About Ultracycling Magazine. 8. Armstrong L, Carmichael C. The Lance Armstrong Performance Program. Emmaus: Rodale Press; 2000:3536. 9. Gregor RJ, Conconi F, Broker JP. Biomechanics of road cycling. In Gregor RJ, Conconi F, eds. Road Cycling. Oxford, United Kingdom: Blackwell Sciences Ltd; 2000:1839.

10. Drake S. Dynamic Bike Fit With the CompuTrainers Spin Scan Takes the Guesswork out of Positioning. Available at: http://www.computrainer. com/html/coaching_corner/dynbiket-example.htm. 11. Faria IE, Cavanagh PR. The Physiology and Biomechanics of Cycling. New York: Wiley; 1978. 12. Broker JP, Gregor RJ. Cycling biomechanics. In Burke ER, ed. High Tech Cycling. Champaign, IL: Human Kinetics; 1996:145146. 13. Broker JP. Cycling biomechanics: road and mountain. In Burke ER, ed. High Tech Cycling. Champaign, IL: Human Kinetics; 2003. 14. Baker A. Bicycling Medicine. New York : Fireside, Simon and Schuster, 1998.

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