Bike Fitting Will Come Out From the Shadows and Into Rehab Armamentarium

By Happy Freedman

Many readers may not have heard of it yet, but by the time LER turns 20, I predict it will be a common prescription…at least I hope it will be. I’m talking about bike fitting, of course.

The number of individuals choosing cycling as transportation, hobby, sport, or community activity—whether it’s competitive or recreational—is increasing annually—up from around 43 million in 2014 to 47.5 million in 2017.¹ Indeed, nearly $580 million was spent on bicycles in 2017¹ and the market for e-bikes (bikes with electric motors, very common for commuters) grew eightfold between 2014 and 2017, the last year for which numbers are available.²

Cycling as part of a prescribed and/or preferred rehabilitation program after injury is also growing as the number of Baby Boomers moves into their senior years and seeks lower impact exercise options. Bicycling, while low impact, still builds muscle which can help reduce falls, making it a logical alternative to running.

And just like running, many factors can influence the biomechanics of cycling, such as seat height, crank arm length, foot positioning, cadence, and workload. Bike fitting is about fitting the biomechanics of the bike to the biomechanics of the cyclist. In other words, bike fits are not one-size fits all. They are a snapshot in time. Fit the cyclist first, then adapt the bike.

Bike fitting has been around the bicycle industry for about 30 years. In its infancy, fitting was viewed as a kind of black art: its practitioners used a blend of eyeballing and “feel” and the really sophisticated fitters had a plumb bob. There were no teachers. There wasn’t even a name for it. Today there are schools that teach fitting at its most basic levels, sizing people for retail sales. As in many professions, skill levels very greatly, as does the knowledge base of its practitioners. In fact, most of the training today is done in schools run by major manufacturers.

Clinical bike fitting is hard to define as there are no evidence-based protocols. Many fitters start with the foot, based on the theory that the foot is the foundation and you build up, a theory that originated in the Serotta School. More advanced techniques start with the airway—diaphragmatic and intercostal breathing—and look at the whole body. In my opinion, hands-on bike fitters generally have better knowledge of anatomy and cycling as well as physiology. More technocratic peers tend to lean toward computer software and apparatus to measure and determine proper size and position.

Clinical bike fitters typically include physical and occupational therapists, many of whom are expert cyclists themselves. Non-clinically trained bike fitters typically have gone beyond a retail environment and gotten additional training for custom frame building. Both groups tend to deal with more complicated fittings that address the dynamics of individual cyclists including injury asymmetries and specific applications they want their bike to be able to do. Bike fitting may also involve the team approach, with several different professionals of various expertise working with a cyclist and may involve exercise components, rehabilitation, and strength training, and even teaching altered riding skills. Research on the benefits of bike fitting is just beginning. At some point, aspects of bike fitting may even be covered by insurance as a component of rehab.

Cycling be an exercise, a form of transportation, a leisurely ride, a grueling competitive endurance challenge, or a ride at the beach…its what each cyclist makes it. Keeping that cyclist riding injury free is the promise of bike fitting. I predict more patients will be asking for it as cycling becomes ever more popular.

A cycling coach, innovator, and internationally recognized expert in the field of bike fit, Happy Freedman helped develop the first multi-disciplinary hospital-based state-of-the-art Bike Fit Lab, to be used for performance, clinical bike fit evaluations, and research at the Hospital for the Special Surgery (HSS) in New York City. His professional experience covers a range of related areas and his current position in Prosthetics and Orthotics in the HSS Rehabilitation Department allows him to work in close cooperation with physical therapists and investigators in the motion lab.

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