UPPER BODY EVALUATION AND INTERVENTION: ON AND OFF THE BIKE Dr Wendy Holliday BSc Physical Therapy, PhD Exercise Science
DISCLOSURE I have no relevant financial relationships with any companies related to the content of this course
WHY IT IS IMPORTANT TO ADDRESS THE UPPER BODY
Anatomical area Traumatic Overuse 6.1% - Head - 5.7% Cx 8% 3.8% Thx 4% 15.1% Lx 34% 1.9% Shoulder Girdle 6% 3.8% Hip 16% 1.9% Upper extremity 26% 67.9% Lower extremity Bernardo et al. Incidence and risk for traumatic and overuse injuries in top-level road cyclists. Journal of Sports Sciences. 2016
RETROSPECTIVE STUDY AMONGST CLUB RIDERS 739 cyclists 63.2% of respondents reported pain Priego Quesada et al, A retrospective international study on factors associated with injury, discomfort and pain perception among cyclists, PLOS One, 2019
RETROSPECTIVE STUDY AMONGST CLUB RIDERS Neck 23% Lower back 22% Knee 15% Hand 13% Genital area 11% Shoulder 11% Priego Quesada et al, A retrospective international study on factors associated with injury, discomfort and pain perception among cyclists, PLOS One, 2019
CLINICAL DIAGNOSIS OF THE OVERUSE INJURY Spine 12.7% Mechanical LBP 13.5% Cx Paraspinals 9.6% Lx discopathy 3.8% Bernardo et al. Incidence and risk for traumatic and overuse injuries in top-level road cyclists. Journal of Sports Sciences. 2016
LOW BACK PAIN � Deep ache � Constant moving to stretch � Stiffness
OVERUSE INJURIES LOW BACK PAIN � common LBP ischial reach/drop syndromes tuberosities � saddle nose � poor postural up habits off the bike � dural tension � sitting behind � excessive
NECK AND SHOULDER PAIN � Headaches � Neck pain � Burning between shoulder blades
OVERUSE INJURIES NECK PAIN � common neck � prolonged � excessive syndromes riding in drops reach/drop or aero � Thx kyphosis � poor posture � weak core � weak neck extensors
OVERUSE INJURIES HAND NUMBNESS � Hx of ulnar � too much weight � saddle nose neuropathy or in hands downwards Carpal Tunnel � lack of Syndrome cushioning � handlebars too � infrequent low or too much change in reach position � handlebars at wrong angle
CHANGE IN BODY POSITION WITH INTENSITY
PERFORMANCE VARIABLES ASSOCIATED WITH BICYCLE CONFIGURATION AND FLEXIBILITY
THE Structure Bike fit appointment not PT APPOINTMENT Good subjective Not a once off then objective appointment
QUESTIONS TO ASK IN THE SUBJECTIVE • Why are they here? • What is their main complaint? • Secondary complaints? • When do they get the pain/discomfort? • How long does it last? Does it limit them from riding? • What do they do to ease it? • Strength work? • Job? • Rating of discomfort or pain
PRACTICAL
OFF THE BIKE EVALUATION
STANDING POSTURE • Systematic • From the feet up • Anterior, lateral and posterior
ARM MOVEMENTS • Standing • Quick screening
SCAPULA MOVEMENT • Sitting on plinth
SPINAL MOVEMENTS • Cervical • Thoracic • Lumbar • Quick screening
LUMBAR-PELVIC DISSOCIATION • Sitting and standing
SIT AND REACH TEST • More than just a hamstring test • Where is the movement coming from?
KNEE EXTENSION ANGLE TEST Golden standard test for hamstring extensibility
FINGERTIP TO FLOOR TEST • Observe where the movement is coming from
4 POINT KNEELING
UPPER BODY ROTATIONAL STRETCH • Compare left and right • Where is the movement coming from?
CHECKING FOR TRAFFIC • Break down the movement off the bike • Where is the limitation coming from?
DEEP BREATHING • Particularly after a crash
UPPER LIMB NEURAL TESTS • Only to be done if you have the qualifications • Can easily flare neural pain
GRIP STRENGTH • In applicable hand position for type of riding
SLUMP TEST • Neural test
VERTEBRAL ARTERY TEST • If applicable • If positive, do you have a referral system?
TEST FOR BAR WIDTH • Purely anecdotal, not scientific
COMFORT OF KIT
ON THE BIKE EVALUATION
BIKE OBSERVATION • Wear and tear • General configuration
POSITION ON THE BIKE • General observation
TIME TO STAND UP AND MOVE!
• What happens to their posture as they ride? • Are they shifting on the saddle? • What happens as they increase intensity? OBSERVE RIDING • Increased/decreased plantarflexion? • Knee alignment? • Pelvis rocking? • Rounded back? • Head and shoulders?
MEASURE JOINT ANGLES • Have a standard method • What tools do you use?
CHECKING FOR TRAFFIC
ON BIKE TASKS • Reaching for water bottle • Getting something out of back pocket • Observe control of movement
ON THE BIKE INTERVENTION
POSTURAL AWARENESS • Simple cues
CHANGE BICYCLE CONFIGURATION • Saddle height • Saddle setback • Saddle tilt • Handlebar reach • Handlebar drop • Handlebar tilt • Levers
TASK BREAKDOWN • Practice each component of a task whilst on the bike
OFF THE BIKE INTERVENTION
STANDING DOUBLE ROW • Postural endurance exercise • Not about the resistance
STANDING SINGLE ARM ROW • Control of movement
MOUNTAIN CLIMBERS
4 POINT KNEELING
PIKE
UPPER BODY ROTATION STRETCH
HAMSTRING STRETCH
CLOCK EXERCISE
ONE ARM DUMBBELL ROW
SEATED CABLE ROW
BACK EXTENSION
STABILITY BALL & LIGHT DUMBBELLS
HIP HINGE
HOW AND WHEN TO INTEGRATE TECH INTO THE BIKE FIT Gives numbers to Real time data Cyclists like data observations collection
• What is clients’ main complaint? • What is the sauce of the complaint? • Is it bike or body related, or both? • What can you do on the bike to SUMMARY POINTS help? • What can you do off the bike to help? • Progression of appointments, follow ups? • Referral? • Feedback from client
THANK YOU! QUESTIONS?
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