Have you experienced pain that ruins the pure enjoyment of riding your bike? Pain is debilitating at worst and frustrating at best.
When it comes to cycling, consistent and repetitive pain is a sign you shouldn’t ignore. But how do you separate pain from injury? How do you figure the cause and the seriousness? What’s more, who do you trust to give you answers?
Bike fitting is a growing profession and its common for riders to visit more than one fitter over the years. In fact, if you’re suffering from pain its likely you’ve chatted with a fellow rider who already referred you to a fitter.
Bike fitting is a science best approached with an understanding of biomechanics. Bikefit also requires a qualified team to address and ensure your best ergonomic setup. This involves appropriate components that are both mechanically sound and professionally installed. Most important is that a bike fitter be competent distinguishing pain from injury. Recognising the difference allows for correct referral to a medical specialist.
We often forget that contorting our bodies for hours spent on the bike, can have consequence. This is especially true for riders with bad alignment, neck extended, shoulders hunched. This prolonged position can accumulate into a series of problems. Significant pain points or sites of injury on the bike are part of the puzzle. Computer posture, improper bike fit, bad general posture, sleeping position also contribute.
tingling or numbness in hands
soreness in your back or neck
pain in your knees or underparts
Kenny Merlevede - Senior Physiotherapist, Ironman, runner, and born on a bike.
Bondi Junction, Physio K
Kenny understands the athlete psychology better than a general physiotherapist. As an accomplished Iron man, runner and swimmer, Kenny appreciates the need for riders to eliminate pain and get on the bike quickly. Thats why we're sharing the benefits of Kenny's practice as a first in our future line of interviews with favoured medical practitioners.
On my first meeting with Kenny I was in excruciating, heck, debilitated pain. Id been in tears for days and I could hardly move my head.
My introduction to Kenny began like many visits to physiotherapists. A consult to know what I was experiencing. What wasn’t expected was the total and near immediate relief I felt in that first visit. Alongside this was the relief of learning the culprit. While my bike position wasn’t a direct cause of this pain, ironically my dominant use of the bike as my only form of physical activity contributed.
What : I’ll say from the start, Ive had massage and needle work before. Nothing compares to the immediate change in my pain stemming from Kenny’s handiwork. In combination with his assessment, proficient massage and referred strength building exercises, Id rate him as a favourite physio to treat my acute pain.
Why : Being both an athlete and a highly experienced physiotherapist, Kenny immediately understood the cause was not in fact my neck, but a deep muscle called the pectoralis major. I wont bore your with details, no-one likes a complainer ... but important to note was Kenny’s immediate response and ability to alleviate the issue. Then to provide ongoing treatment to correct my postural problems. Recommendations led to pilates and to this point Ive not experienced the pain again.
The Interview :
Alison McGregor : Your treatment at Physio K is described as “holistic”. Can you describe what this means, and is there an example of a cyclist who benefited from this method ?
Kenny Merlevede : Holistic treatment means not just treating the symptoms but looking at the body as a ‘whole’. Your left ear is connected to your right small toe (and everything else of course) via fascia and connective tissue. Fascia is some kind of ‘skin’ that connects everything with each other. Also, muscles don't work in isolation, but rather in chains. Some muscles work together to create movement in a bigger area, rather than just over one segment. For these reasons, we need to look at the body as a whole. Let’s explain that with an easy example!
I recently saw a cyclist with knee pain and lower leg pain. The cause of this was a vertebrae (one of the bones in the spine) that was not moving well and associated muscle tightness in the pelvis. Because of these issues, the ITB (which is a thick band on the outside of your knee) was pulling on the knee and caused knee pain.
Alison McGregor : Yes, tight ITB’s seems quite common in cyclists, and is often related to what they do or don’t do "off the bike". You’ve a lot of experience treating specific low back pain, neck pain and headaches and I think the causes are quite relevant for many cyclists. Would you say the treatment with cyclists tends to be similar to general public, or are the causes for cyclists more individual requiring specific treatment plans?
Kenny Merlevede : There are definitely trends for cyclists as the position on the bike will be very similar for everyone. I’m yet to discover a good cyclist with extremely flexible hip flexors. This is the nature of the sport and is as common as short hamstrings in soccer players. This is not necessarily a bad thing though, as we can generate the most power with those hip flexors in a slightly shortened position.
Anyway, the most common issues we find in our clinic with cyclists would be, alongside shortness of some muscle groups: tightness or stiffness in the neck or back (due to the position on the bike), nerve irritation in the hands or headaches due to tightness in the sub occipital area (a region very high in the neck where small muscles can cause all sorts of issues). Even though there are trends and similarities in cyclists, we should, however, look at every case independently.
Every person is unique and will develop compensations in a different way. A specific assessment is key to determine the cause of the issues in every person.
Alison McGregor : Perfect. We certainly subscribe to analysing and catering to the individual rider, especially when it comes to customising a bike for them. It takes experience to successfully diagnose the origin of a patients problems, but sometimes we also can draw from our own sporting pursuits. How does your athletic background help with treatment?
Kenny Merlevede : I personally believe that, without passion, nothing very good has ever been accomplished. You need a personal interest in what you do and if you’ve never experienced those sports yourself, you’ll never fully understand the sports person.
Having done long distance running, cycling and an ironman definitely helped me become a better health practitioner in those fields and better understand the patients’ problems. Having had injuries and bike issues myself was the best thing that could happen to me as a physio.
Alison McGregor : The experiences on our bike also help us as riders relate to our clients. There are some really basic shared experiences we all go through when it comes to sports and pain. What are common problem areas you see typically associated with cycling, and would you say most clients’ pain is contributed by the bike itself?
Kenny Merlevede : That’s a very interesting question and it is something, I believe, physio’s like myself and bike mechanics like you, should work together on. When a bike is not set up properly, it can cause issues down the track. I’m not talking about major differences in position, even small changes in cycling posture can make a huge impact on the body if we do repetitive movements.
Everyone knows that, if we lift up a weight of 100 kg, we should do that with proper posture, otherwise we could get injured. But lifting up a weight of 1 kg a hundred times also has a big impact on the body, although we tend to banalise this a lot more. Cycling is a repetitive sport: how many times would we do a full rotation on a 50K or 100K ride?
So if you cycle frequently then the bike position is very important! If that’s not 100% correct, people will start compensating and injuries will follow for sure. If the bike was set up properly and injuries do occur, then the problem might be due to a variety of other things, e.g.: training schedule (too much too soon), muscle weakness resulting in compensation patterns OR a joint that did not move well before the bike was set up correctly and repetition caused injury because of that.
Bottom line: both the bike and the body have to be set up well and move well to prevent injury!
Alison McGregor : That combination of the right bike, correct position, perfect components creates a positive balance between the body, bike and terrain. It’s what we call unison and what we think as integral to creating a positive experience on the bike. A physio in my opinion is crucial to add to a training plan that requires correcting issues affecting their riding goals. But there are also riders who visit you for maintenance. How can a rider maintain their long term cycling health?
"It’s only when the bucket is overflowing that you’ll realise you have a problem, but it’s too late then!"
Kenny Merlevede : Cycling has a quite low impact on the body, definitely if you compare it with running, impact sports or exercises that require a lot of jumping and change of direction. Nevertheless, it is a repetitive sport and that can cause issues at some point.
The body is an incredible machine: we can do a lot with it and we often take that for granted. Our bodies are, however, not indestructible! We should take care of it, as it’s the only place we will have to live in forever. I always compare the movement system with a car or machine that needs maintenance. If you never change the oil, your car will break down at some point. This is also true with your body; and the more you ask from it, the more maintenance you will need.
Regular check ups from your physiotherapist will help prevent issues that are building up without you knowing it. Most issues are developing slowly: it’s like a bucket that’s slowly filling up with water. You won’t be aware of it, until it reaches a certain pain threshold. It’s only when the bucket is overflowing that you’ll realise you have a problem, but it’s too late then!
A check up with your regular physio will prevent that to happen and will keep you on the road for longer! Other things to consider, in particular for the riders to do themselves, is a good warm-up and cooling down. This seems obvious, but it often gets forgotten. Foam rolling and specific stretches will also help to maintain a good cycling health.
Alison McGregor : Yes. We get to see the result of pain building up to create injury. When it comes to helping a cyclist in this instance, is there a case where a cyclist has been treated with huge success?
Kenny Merlevede : There are numerous occasions where cyclists have had a turnaround after treatment, but I still remember 1 specific example of a treatment I did with a cyclist a few years ago.
A 30 year old woman came into my practice with upper leg pain after a fall a few months back. She did have massage and physio treatment in other clinics with mixed results, but the problem never really disappeared. She described her issue as ‘not having power in her right leg after about 50 to 60K of cycling’. She told me it was like a ‘weird grabbing sensation, in the middle of her quadriceps muscle’. I found out it was a trigger point in her vastus intermedius, a muscle of the quadriceps group, deep in the leg. 1 treatment with Dry Needling was sufficient to eliminate her problem and to give her the strength back.
Alison McGregor : Thats fantastic. I also had incredible results with your needling using techniques Id never encountered before. I have to admit, its not for the faint hearted. But it is for those who want or need results. Last question, what is the best part of your role at Physio K?
Kenny Merlevede : Getting people back to doing the things they love is the most rewarding part of our job and I feel privileged to help athletes in their journey to success and happiness!
Make a Booking at Physio K
Id like to extend a huge thanks to Kenny. We hope you also found Kennys advice informative and, should you like a consult for ongoing maintenance, injury prevention, or treatment, you can get in touch at Physio K. Efficient booking is found on their website. For further information please Email: Kenny@physiok.com.au
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