UPPER BODY EVALUATION AND INTERVENTION: ON AND OFF THE BIKE Dr - PowerPoint PPT Presentation

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?