Scoliosis Surgery and Cycling: A Comprehensive Guide to Bike Fit and Physiotherapy

Understanding the Impact of Scoliosis on Cycling

Scoliosis can significantly affect a person's physical activities, especially cycling. For a 30-something female who underwent scoliosis surgery in 2008, the challenges can be multifaceted. In addition to scoliosis, she has experienced issues such as a torn ACL in her left knee and a labral tear in her left hip, which has led to bursitis and hip pain while cycling. Furthermore, saddle sores and overall discomfort during longer rides have become common concerns.

This blog post explores the assessment and bike fitting process that can help alleviate these issues, ensuring a more comfortable and enjoyable cycling experience.

Part 1: Physiotherapy Assessment

During the physiotherapy assessment, it was observed that her pelvic alignment was lower on the left side while standing. This misalignment is likely a result of her scoliosis. Despite this, there was no obvious weakness in her lower limbs. She demonstrated good range of motion in her hamstrings and hip flexors, and testing confirmed equal leg length.

The left knee and hip joints exhibited functional movement, despite her injury history. However, when pressure was applied during flexion, pain was provoked. This is an important consideration, as a closed hip position on the bike could lead to pain and reduced power at the top of the pedal stroke.

Part 2: Bike Fit

Upon assessing her bike fit, it was noted that her left hip dropped and rolled forward at the top of the pedal stroke. Additionally, her left foot was positioned with the heel out and toe in. To address this, the saddle was lowered by 3mm, moved forward by 3mm, and set to a horizontal position. These adjustments helped to level her pelvis, improving pelvic symmetry further with a shim placed under the right cleat.

The right hip was also higher the bike

To further assess stability, saddle pressure mapping was conducted. This revealed 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 handlebar and stem positions, we determined that changing from an 8cm to a 6cm stem, with an increased angle from 6 to 17 degrees, was optimal. This adjustment improved her hip angle and helped resolve her hip pain. Additionally, changing her handlebars from 40cm to 36cm further stabilised her back and pelvis, enhancing comfort and control.

The feedback from the client was overwhelmingly positive. She reported hip-free cycling with no saddle sores, a fantastic outcome from what initially appeared to be a complex case study.

Conclusion

In conclusion, addressing the challenges faced by cyclists with scoliosis and related injuries requires a comprehensive approach. Physiotherapy assessments and precise bike fitting can significantly enhance comfort and performance. By making targeted adjustments, cyclists can enjoy their rides without discomfort or pain.

For those experiencing similar issues, seeking professional advice can lead to significant improvements in cycling experience. Remember, every cyclist deserves to ride comfortably and confidently, regardless of their physical challenges.