Updated: May 2
Hip pain is common but needn’t stop you riding a bike. With a professional bike fit that takes into account your hip condition cycling can be a low impact way to stay fit or even race if you are so inclined. David Wadsworth has just published the first ever scientific paper on bike fitting for cyclists with hip pain, and in this blog he shares some of his expertise.
Hip pain due to overuse or biomechanical loading in cyclists (as opposed to trauma from a crash) is usually one of two types:
1. Joint pain from the hip socket (eg. inflamed or arthritic joint), or
2. Muscular pain from myofascial trigger points in the buttock muscles.
Pain from other sources is rarely caused by cycling, and pain due to traumatic hip injuries (ie crashes) is very different to overuse injuries of the hip. Professional care to work out your specific diagnosis is essential since treatment is completely different depending on the type of hip pain and its causes.
In terms of causes, hip pain can arise from a combination of:
1. Intrinsic causes, meaning something to do with the cyclists body such as poor flexibility, or a bony predisposition to hip pain, or
2. Extrinsic causes, meaning a poor bike fit that increases the risk of pain or overload (“too much too soon” in training).
Although a poor bike fit is the primary extrinsic cause of hip pain, this should not lead you to think that intrinsic risk factors are less important. For many cyclists failure to address the risk factors in their own bodies often results in failure to eliminate their symptoms despite a good bike fit.
One of the common causes of a “failed” bike fit in cyclists with hip pain is that the fitter fails to measure true hip joint angles when the cyclist is on their bike. In the paper I co-authored with Assoc. Professor Patrick Weinrauch, a specialist hip surgeon, I detail exactly how this should be done since no one has ever described this before. Ensuring that the position chosen for the cyclist doesn’t exceed this range of hip movement is essential in preventing both types (joint or muscular) hip pain. So how do we do this in a bike fit? I’ll illustrate with an example of a masters cyclist with a painful hip joint and limited hip flexion to 90°, which is also a common limitation if the athlete had received a hip replacement (and yes, I often fit cyclists to their bikes after hip replacement surgery and all other types of hip surgery – it can be a wonderful way to stay in shape even after surgery).
So our masters cyclist has a tight hip and that only bends to 90° (normal or ideal is 120-130°). On the bike, the top of the pedal stroke will challenge this range (see figure above - the cyclists leg requires a lot of flexion to get over the top of the pedal stroke). In order for him to be comfortable, and being comfortable and painless is essential for him to produce his best power output, there are some things that we can consider in his fit or positioning on the bike to minimise the impact on his sore hip. These include but are not limited to:
· Using a bike with higher frame stack (known as an endurance frame geometry);
· Using a shorter crank length;
· Using shoes / pedals with a lower stack height;
· Using a compact (ie short drop 120-130mm) modern handlebar of the correct size;
· Ensuring that the saddle is not set-back too far behind the bottom bracket (which forces the hip joint into excessive flexion);
· Ensuring that the saddle is not too low (again forcing the hip joint into excessive flexion);
· Ensuring that the drop and reach to the handlebars is not excessive (which both force the hip into excessive flexion)
If the hip is forced to operate beyond the cyclists’ functional musculoskeletal capacity, compensation will occur. This compensation may take many forms, such as knees moving outwards, pelvis rocking on the saddle, the lower back rounding over in the shape of the Sydney Harbour Bridge and so on. These compensations can result in pain in other areas such as the knee, low back or saddle sores.
Thus a bike fit for a cyclist with hip pain needs to not only accommodate the individual cyclists’ musculoskeletal capacity but also prevent transferring the problem to other areas. A common error seen clinically is changing the bike fit to micro-manage an individual problem that simply shifts the load and pain to another area – not a good outcome. The bike fit for a cyclist with hip pain still needs to comprehensively consider the function of the cyclists’ entire body and not simply micro-manage the hip.
If you have hip pain, a Physiotherapist whose expertise is cycling will help you to comprehensively sort things out:
1. Diagnose RIGHT
2. Treat RIGHT
3. Rehab RIGHT
4. Bike fit RIGHT
Leave one out and your pain may not resolve.
Reference: Wadsworth D & Weinrauch P (2019): The role of a Bike Fit in Cyclists with Hip Pain. A Clinical Commentary. International Journal of Sports Physical Therapy 14:468-486.