Overcoming Cycling Challenges: A Case Study on Hip and Back Pain
- Jake Tay
- Feb 10
- 3 min read
Updated: Apr 6
Understanding the Impact of Perthes Disease on Cycling
As a 28-year-old male who enjoys cycling and weight lifting, I recently faced a challenge. I had to stop running due to persistent hip issues. While cycling, I experienced no pain in my hip or lower back. However, I did report discomfort in my neck and upper back, which limited my cycling to just one hour at a time.
Medical History and Current Condition
I have a history of Perthes disease, which has caused deformities in my hip bones. Specifically, the shape of my greater trochanters is squared rather than the normal ball shape. This condition has resulted in a limited range of motion in my hips, making it difficult for me to bend forward easily.
In the gym, I noticed hip pain when performing deadlifts and squats. This prompted me to seek physiotherapy to address my issues.
Physiotherapy Assessment
During my physiotherapy assessment, the following observations were made:
Shoulder Range of Motion: Full range with 5/5 power and good muscle bulk throughout.
Thoracic and Cervical Spine: Full range both actively and passively, with 5/5 power.
Lumbar Spine: Limited standing lumbar flexion, with most movement occurring in the thoracic spine.
Special Tests: Passive movement of lumbar vertebrae was stiff from L1 to L5, with pain rated at 3/5 during higher velocity movements.
Hip Joints: Notably, my left iliac crest was higher than the right. My range of motion was limited to 90 degrees of flexion and 30 degrees of internal and external rotation for both hips. This limited flexion made the top of the pedal stroke challenging.
Lower Limb Strength: Strength was equal at 5/5 for both legs, but flexibility was limited to 140 degrees of extension in the hamstrings.
Leg Length Discrepancy: My left femur is 9mm longer than my right.
Foot Posture: Both feet showed equal foot and toe length, but over-pronated when squatting.
Initial Bike Fit Assessment
During the initial bike fit assessment, I discovered that I was overreaching to the handlebars. This caused my arms, neck, and shoulders to overextend, leading to a curve in my spine due to the limited range of motion in my lumbar spine. Additionally, while pedalling, both of my knees tracked outward, presenting a bow-legged pedalling action due to the restricted movement in my hips.
Bike Fit Adjustments
To address these issues, I made several bike fit changes:
Saddle Height: I lowered my saddle by 9mm to optimise my quadriceps and hamstring function. However, my knees still tracked outward at the top of the pedal stroke due to limited hip range of motion.
Stem Length: By reducing my stem length from 100mm to 70mm, I was able to alleviate my neck and upper back pain.
Footwear: I fitted high arch insoles to correct my over-pronation while cycling.
Planned Follow-Up Bike Fit
For the follow-up bike fit, I plan to test my pedal stroke with an adjustable crank jig. I suspect that cranks of 155mm or shorter will be necessary to resolve the issue of my knees tracking outward. With a combination of shorter cranks and stem length, I should be able to pedal effectively despite my limited hip and lumbar spine mobility, thereby avoiding future injuries.
Once I have tested the shorter cranks, I will assess my 9mm leg length discrepancy. A 9mm shim could stabilise my pelvis, provided there are no secondary symptoms. Alternatively, a 5mm shim might be more tolerable. Once my knees are aligned with the pedal stroke, I can adjust my cleats for a more efficient foot posture. This adjustment will lead to a more effective pedalling style with greater power output.
I will update this blog with the results of the follow-up session. Additionally, I plan to post a video on Instagram and Facebook to showcase the results of these adjustments.
If you're facing similar challenges, remember that addressing your bike fit can significantly enhance your cycling experience. With the right adjustments, you can ride more comfortably and powerfully.
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