Scoliosis Bike Fit Case Study

30 something female. Scoliosis surgery (2008). Left knee torn ACL (no surgery) and Left hip labral tear/bursitis causing hip pain when cycling. Experiencing saddle sores as well. Some overall discomfort on longer rides which I'd like to sort out.

Scoliosis causing pelvic mis alignment and the right hip higher than the left

Part 1 Physiotherapy Assessment

Off the bike her pelvic alignment was lower on the left in standing I suspect from the scoliosis. There was no obvious weakness in her lower limbs strength with good range in her hamstrings and hip flexors. She has equal leg length on testing. The left knee and hip joints showed functional range of movement despite the history of injury. Although with over pressure into flexion there was some pain provocation which is worth considering when a closed hip position on the bike could cause pain and or reduced power at the top of the pedal stroke.

Part 2 Bike Fit

On the bike her left hip was dropping and rolling forward at the top of the pedal stroke. Her left foot was heel out/toe in . By lowering the saddle 3mm, bringing it forward 3mm and setting it to horizontal your pelvis started to level up. Her pelvic symmetry improved further with a shim under the right cleat.

The right hip was also higher the bike

I then assessed the stability of her pelvis further with saddle pressure mapping which found equal contact points through the left and right sit bones both when her hands were on the hoods and drops.

Saddle Pressure Mapping showed improved stability through her sit bones after the bike fit change

By testing various positions with the handlebar and stem jig we found the optimum reach was to change from an 8cm to 6cm stem with a big increase in angle from 6 to 17 degrees. This was needed to improve her hip angle and resolve her hip pain. In addition this will also take the load off her spine. I changed her handlebars from 40cm to 36cm handlebars to further stabilise her back and pelvis and improved comfort and control.

The feedback from the client was hip free cycling with no saddle sores which was a great result from what initially looked like a complex case study.