Yesterday a 60+ cyclist came to our Bioracer Service Center to get help for his saddle pain. After cycling for over 14 years (three times a week) without any problems, he started to develop saddle pain on the left side of his bottom. As the pain deteriorated over time, about nine months ago he sought medical help and a haematoma on his left Ischium was diagnosed. Although he received cortisone injection, the problem did not resolve, leading to complete cessation of his cycling activity.

When analyzing the cyclist’s movement using the Bioracer Motion system, the bike fitter immediately detected an extreme tilting of the cyclist’s upper body to the left. As shown in the symmetry report of the old position (see Figure 1), his wrist, elbow, shoulder and pelvis are all tilted to the left. The bars in Figure 1 show for every joint the average of the left and the right corresponding joint in comparison with the reference line (i.e. the bike). If the number is negative, the average joint position is situated more to the left, if positive, the average joint position is situated more to the right, compared to the bike. Most striking is his average shoulder position, which is more than 2 cm tilted to the left.

Fig 1. Symmetry report of the old position. The bars show for every joint the average of the left and the right corresponding joint in comparison with the reference line (i.e. the bike). Most striking is the average shoulder position, which is more than 2 cm tilted to the left.

Fig 1. Symmetry report of the old position. The bars show for every joint the average of the left and the right corresponding joint in comparison with the reference line (i.e. the bike). Most striking is the average shoulder position, which is more than 2 cm tilted to the left.

This left-oriented inclination of the upper body (including the pelvic area), which leads to excessive pressure on the left side of the saddle, might be the cause of the left Ischium haematoma. 

When having a closer look at the setup of the bike, the bike fitter noticed a nonconformity in the placement of the levers. The right lever was positioned more upright compared to the left lever. This different position of the levers forced the cyclist to bend over more extremely with his left side body, as he had to reach further to the lower positioned left lever.

Another aspect that might have contributed to the lack of symmetry, are the generic insoles that were used by the cyclist. Unfortunately, very few cycling shoe insoles are adapted to the individual needs of the cyclist’s feet. A solution for the problem are the personalized SIDAS insoles. These height-moulded insoles, that will seamlessly take the form of the foot under forefoot pressure, provide ideal support to the foot during pedalling.

After lifting the right lever to the same level as the left lever, and after creating personalised SIDAS insoles, the inclination to the left is reduced by 300% in the pelvic area, as shown in Figure 2.

Fig 2. The symmetry report after adaptation of the right lever and creation of personalised insoles. The left-oriented inclination of the pelvic area is lowered 3X compared to the first measurement (Figure 1).

Fig 2. The symmetry report after adaptation of the right lever and creation of personalised insoles. The left-oriented inclination of the pelvic area is lowered 3X compared to the first measurement (Figure 1).

The positive effect of these adaptations can also be seen in the back view of the knee movement. In the old position the trace of the left knee shows an opening between the downward and upward tracing, whereas the tracing after the adaptation shows a similar upward and downward tracing (see Figure 3).

Fig 3. After the adaptations to improve the symmetry of the cyclist the Bioracer Motion software shows improvement in the knee movement. Although the knee tracing is still skewed (outward movement when going up; probably caused by excessive abdominal mass) there is no longer an opening between the upward and downward tracing of the left knee; and the right and left knee tracings are much more similar.

Fig 3. After the adaptations to improve the symmetry of the cyclist the Bioracer Motion software shows improvement in the knee movement. Although the knee tracing is still skewed (outward movement when going up; probably caused by excessive abdominal mass) there is no longer an opening between the upward and downward tracing of the left knee; and the right and left knee tracings are much more similar.

When asking the cyclist how these adaptations made him feel on the bicycle, he answered ‘it feels like my brain tells me that my body is much more in balance on the bike’. 

Despite this improvement, there was another tracing that caught the eye of the bike fitter. The tracing of the ankles in the Bioracer Motion software shows a discrepancy between the left and the right ankle movement. Figure 4 shows the view from the left of the cyclist. When focusing on the ankle movement, the bike fitter noticed that the right ankle (blue tracing) is higher than the left ankle (black tracing). This tracing indicates that the cyclist pulls his right ankle higher than the left one in the upward movement of the pedal stroke before dropping it for the downward pushing phase. This causes a “skipping” movement while cycling with a poor stability of the pelvic area as a result (see Figure 5).

Fig 4. The upward movement of the right ankle (blue tracing) is higher than the left ankle (black tracing). 

Fig 5. poor stability in the pelvic area caused by a deviating ankle movement. The numbers show the movement volume of the joints of the upper body (in cm3) and the lateral movement of the joints of the lower body (in cm) .

Fig 5. poor stability in the pelvic area caused by a deviating ankle movement. The numbers show the movement volume of the joints of the upper body (in cm3) and the lateral movement of the joints of the lower body (in cm) .

To improve the stability of the pelvic area, the bike fitter moved the saddle 2 cm to the back and tilted both levers up to facilitate the reaching for the cyclist. Figure 6 shows that the left and right ankle tracing become more similar, leading to an improvement in the stability of the pelvic area (Figure 7).

Fig 6. the Bioracer Motion software shows more similar ankle tracing, when comparing left and right.

Fig 6. the Bioracer Motion software shows more similar ankle tracing, when comparing left and right.

Where the marker at the left and right pelvic joints had a movement volume of 11.65 and 9.61 cm3, these values were lowered to 4.85 cm3 and 6.00 cm3 respectively. This increased stability of the pelvic area will definitely lead to increased comfort at the saddle-bottom contact point.

Fig 7. the movement volume of the marker on the left and right pelvic joint lowered from 11.65 to 4.85 cm3  and from 9.61 to 6.00 cm3 respectively.

Fig 7. the movement volume of the marker on the left and right pelvic joint lowered from 11.65 to 4.85 cm3  and from 9.61 to 6.00 cm3 respectively.

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