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 Head Cx Thx Lx Shoulder Girdle Hip Upper extremity Lower extremity Traumatic 6.1%

• 8%

4% 34% 6% 16% 26% Overuse

• 5.7%

3.8% 15.1% 1.9% 3.8% 1.9% 67.9%

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

Priego Quesada et al, A retrospective international study on factors associated with injury, discomfort and pain perception among cyclists, PLOS One, 2019

739 cyclists 63.2% of respondents reported pain

RETROSPECTIVE STUDY AMONGST CLUB RIDERS

Priego Quesada et al, A retrospective international study on factors associated with injury, discomfort and pain perception among cyclists, PLOS One, 2019

Neck 23% Lower back 22% Knee 15% Hand 13% Genital area 11% Shoulder 11%

CLINICAL DIAGNOSIS OF THE OVERUSE INJURY

Mechanical LBP Cx Paraspinals Lx discopathy 13.5% 9.6% 3.8%

Spine 12.7%

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 syndromes poor postural habits off the bike dural tension sitting behind ischial tuberosities excessive reach/drop saddle nose up

NECK AND SHOULDER PAIN

Headaches Neck pain Burning between shoulder blades

OVERUSE INJURIES

NECK PAIN

common neck syndromes Thx kyphosis poor posture weak core weak neck extensors prolonged riding in drops

• r aero

excessive reach/drop

OVERUSE INJURIES

HAND NUMBNESS

Hx of ulnar neuropathy or Carpal Tunnel Syndrome infrequent change in position too much weight in hands lack of cushioning handlebars too low or too much reach handlebars at wrong angle saddle nose downwards

CHANGE IN BODY POSITION WITH INTENSITY

PERFORMANCE VARIABLES ASSOCIATED WITH BICYCLE CONFIGURATION AND FLEXIBILITY

THE APPOINTMENT

Structure Bike fit appointment not PT Good subjective then objective Not a once off 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
• ff 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!

OBSERVE RIDING

• What happens to their posture as

they ride?

• Are they shifting on the saddle?
• What happens as they increase

intensity?

• 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
• f 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

• bservations

Real time data collection Cyclists like data

SUMMARY POINTS

• 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

help?

• What can you do off the bike to

help?

• Progression of appointments, follow

ups?

• Referral?
• Feedback from client

THANK YOU! QUESTIONS?