The New Year is upon us. New years resolutions are likely rampant. Some of you may have gotten a new bike for Christmas. New bike or not, if you are a cyclist, you may be thinking of goals you would like to meet in the new year. Perhaps youíd like to complete your first Century (100 mile) ride. Or maybe your goal is just to get out and ride for cardiovascular conditioning. On occasion, there are some barriers that may prevent a cyclist of any level in completing his goals. This article will mention just a few problem areas that often keep cyclists off their bikes along with possible solutions to get them outside riding.

Knee Pain

Knee pain may be one of those barriers. Knee pain is not uncommon to cyclists and may result from overuse phenomena, various inflammatory syndromes or muscle strains. While cycling is not considered a high impact activity, the forces imparted to the knee cap and Achilles tendon have been reported more than body weight while cycling. Further, intermittent bursts of hill climbing and short sprints can generate forces of up to 3 times bodyweight to the pedals. The topography, where a cyclist does the majority of his cycling, may determine the chance of having a knee problem. For example, someone who cycles more in mountainous regions or even in rolling hills may have an increased incidence of knee pain as compared to someone who cycles in a flatland area.

Professional cyclists or even serious recreational cyclists may perform an intensive study of variables which may play a role pedaling efficiency. After all, for some it is about going as fast and as efficiently as possible. These multivariable factors include, but are not limited to the following: cadence (pedaling speed), crank arm length, frame design/geometry, seat height, foot position relative to pedal and pedal design.

Most of the articles I have read on cycling examine efficiency in bicycle design regarding energy output. However, findings regarding cycling, knee pain and factors that may affect the knee are limited. Most cyclists are non-competitive. One might assume that the chance of knee pain is greater in a recreational cyclist. However, to date there is minimal support for this assumption in research. So anyone may have this problem.

One of the most rewarding aspects of my job as a physical therapist is to guide a patient back to activities of enjoyment that has been missed because of some musculoskeletal issue. In my own experience I have found a number of patients through the years, from competitive to recreational, who gave up on cycling because of knee pain. So, it goes without saying that I will examine variables that I can control between the patient/cyclist and the bike in order to lead them back to this activity.

I will occasionally have a patient bring their bike in and put it on a trainer. A trainer is a stable apparatus designed to hold a bicycle in place and allow the cyclist to exercise, using his own bike. The back tire of the bicycle is affixed to a roller. With the bike fixed in place, I can observe the patient/cyclist while cycling and attempt to identify variables that may be modified in order to help alleviate the cyclistís problem. (special note: Trainers typically use a weighted wheel, fan, or magnets to allow resistance to simulate riding on the road.).

The first thing I look for when a cyclist complains of anterior knee pain is the seat height. More often than not, the seat is too low. If so, raising the seat alone may allow decreased forces on the patella (knee cap) as the knee will be in a more extended position during the down-stroke of the pedal cycle. By simply raising the seat as little as 1 cm, some cyclists report immediate relief in the anterior knee.

Neck Pain, Wrist pain, Numbness in the Hands

Neck and wrist pain as well as numbness in the hands while cycling are other common complaints reported. These particular problems may be associated with the following: the bike frameís top tube being too long and/ or the bike seat being positioned too high or too far back. Often times, it is possible the cyclist was not properly fit to the bike prior to the purchase.

Most unfortunate for the sport of cycling is that some cyclists who are not properly fit in a bike may just assume that biking is not supposed to be comfortable. So they just put up with pain until either they stop cycling or figure out how to make changes to the bike that will allow for a more comfortable ride.

I remember as a 19 year old, I had just gotten a brand new road bike. I loved that bike, but I absolutely hated the seat. That seat killed my backside. I never considered changing the seat. I didnít know that you could do that. But you can and you should if you are not comfortable with it. The point is that cycling is not supposed to be painful. There are modifications that can be made that, in turn, will allow increased comfort while cycling.

If the frame is a bit too long you may try, ever so slightly, rotating your handlebars back. This will shorten the distance from the bikes saddle to the hoods (top of the brakes where most cyclists place their hands while riding a road bike). By making this adjustment, the cyclist will sit more upright. That adjustment will also help the neck and at the same time take extra weight off the hands; possibly reducing neck pain and hand numbness often reported by unhappy cyclists.

It that is not enough, you can shorten the stem (the part that holds the handlebar to the frame). Your bike shop can help with this. Be careful though. Shortening the stem can make for quicker steering and a twitchy ride.

Anytime you make adjustment on your bike, you have to make sure the new components match yours regarding measurements or the modifications will not work. Sadly, if the bike frame does not fit you, the only way to modify it is to purchase a new one.

The Bike Frame

I have had, over the years, a number of patients who had just spent thousands of dollars on a brand new bike only to find that since the purchase they are now having some sort of pain issue in the hands, neck, back, shoulders or knee while riding. A few questions I ask during the initial evaluation are: what is the frame size, what method did they used to determine the appropriate size of the frame, who is the manufacture of the frame and what is the type of the bike frame they have (road bike or mountain bike).

It is a hard pill to swallow to think you just spent $4,500.00 on a bike to find the bike frame doesnít fit your body! Ouch! Buyers beware: a good deal on a bike during an end of year sale should be secondary to proper fit. You should speak to your local bike dealer or research online to get a ball park idea of how your inseam size matches to a particular frame size.

Donít make the assumption that you need a 58 cm frame on company Bís bike just because company Aís bike fit you in a 58 cm frame. The reason for the difference in frame size is that bike manufactures landmarks for measuring frames are not standard. The lesson here: try it before you buy it. And regarding your inseam size, donít base this on your pant size. Get an individual at the bike shop who knows how to measure this take the measurement. Then you can be more confident in the purchase.

With that being said, you can have a custom frame made. Some of the local bike shops in the area can take specific measurements and then put you in touch with the manufacture who will ask you a few questions about the type of riding you do to determine how to build your frame. The bike will feel so good; youíll almost forget you just spent nearly $3600.00 for a custom frame.

Winter riding

Some of you may be thinking that cycling is an activity for a warmer season. However, the fact is, avid cyclists ride all year round. How do they do it? They know how to dress. Obviously, cold weather may discourage you to stay off your bike. In reality though, it is possible to ride throughout the winter; with the proper attire.

If you have ever been snow skiing you may have experienced overheating as a result of overdressing. You actually generate quite a bit of heat while exercising. When the heat gets trapped from over dressing you decided to shed a jacket; realizing you can actually be very comfortable with just a few layers of clothing. When you get back on the ski lift you may begin to notice yourself getting cold. This is because you stopped exercising and your body begins to cools down.

Interestingly, in cross country skiing, the skier expends a tremendous amount of calories because the skier is continuously moving. Therefore, the skier can get away with wearing less; wear a polypropylene bottom, synthetic tee-shirt and polyester pile or even wool sweater. If it is windy the skier may wear a shell to serve as a windbreak.

Winter cycling, is much like cross country skiing in the wind. Just remember a few rules and you should be fine.

You must never wear cotton. Cotton breathes well, but it also absorbs water. This will most likely leave you wet and cold.

For the initial base layer touching the skin, you will need to wear a synthetic/polyester blend. This type of material will serve as a functional under layer, conforming to the skin. The second layer should be just bit thicker and also synthetic; perhaps thin polyester pile.

Since you will be riding a bike you will have to deal with the wind. Therefore, you will need some kind of nylon outer shell. Some of these come in the form of a vest which is solid in the front to break the wind and is more open in the back with a net like design so not to allow overheating. Other designs offer full coverage of arms and back.

Finally, youíll need gloves, ear protection from cold and cycling glasses. Your bike helmet will most likely be vented. So if it is really cold you will need a head cap of some sort. Cycling gloves come with cut out finger for summer and full fingers for winter. Cycling glasses are a must; not just to look cool, but to protect your eyes from the wind and debris.

Finally, if you enjoy cycling but have pain issues that keep you from doing it, this article may help you process just a few of the many possible changes you may make to get you back on your bike. As always, discuss any pain issues with your physician. It is possible he/she may even recommend physical therapy to help you work through your problem. Happy riding!

Todd Ketron, PT, DPT is a physical therapist with Sullivan Center Physical Therapy and works on site at Eastman Chemical Company; providing physical therapy services for Eastman employees.
This article was originally published in the Kingsport Times-News' Wellness magazine on January 26, 2011

Last updated February 03, 2011