Physical Therapy or Bike Fitting?

Physical Therapy or Bike Fitting?

Physical Therapy for Bike Fitting?

It’s increasingly common for orthopedic facilities to provide on-site “Bike Fitting” with a physical therapist, which is enticing because is it covered by insurance in most cases. In truth, here is no CPT code for “Bike Fit”, and the closest alternative allocates only a fraction of the time required to conduct a comprehensive fitting.

I see at minimum 5-clients each year with exhausted health care spending accounts from 3-12-months of physical therapy who are not difficult cases.

In my opinion there is a disconnect between what constitutes proper anatomical function and proper cycling function, which might explain why I have never seen a positive outcome for bike-fit or bike-related issues resolved exclusively with physical therapy in Minnesota.

Ironically, the majority of these folks required only the most simple adjustments for complete symptom-resolution when cycling.

What do I consider a “simple” solution?

Bike fit related issues that can be resolved by consulting “Google.”

  Moving the cleats back to reduce foot numbness or knee strain is probably the most popular, but rotated-saddles, staggered-cleats, handlebars that aren’t straight, two-insoles in one-shoe, etc., are also common.  Other cases have required modifying the shoe/pedal interface, stem, saddle, cleats, seat-post offset, saddle-angle, cockpit., etc.,  with 100% positive results when the symptoms occur only when cycling.

Aside from what I perceive as a dis-connect between bipedal and quadruped activities (walking vs. riding),  physical therapists typically do not have access to stems, seat-posts, shoes, cleats, pedals, and other components required to conduct professional bike fitting.  If a bike can not be properly adjusted using these resources, the causative agents are shifted from bike to body.

How does one discern between a Bike an Body problem?

Fit-related symptoms occur only when riding a bicycle, and are entirely resolved with a competent bike-fit.

Body-related symptoms occur on- and off- bike, and are NOT entirely resolved with competent bike fitting, though symptoms might be reduced significantly with accommodating modifications.


Requirements for PT Bike Fitting (1.5-2.5-hrs)

1. The cycling assessment must occor on the bicycle producing symptoms.  It is virtually impossible to identify and treat bike-related issues without inspecting componentry and bike fit.  If a PT claims otherwise, find another PT. 2. The PT MUST be a cyclist, and have experience riding a variety of bikes — TT, cyclocross, mountain, road, etc.    3.  He/she must demonstrate mechanical competency and provide  handlebar installation and taping, appropriate torque settings, cable replacement/routing, gear and brake adjustments when necessary.    4.  An inventory assortment of stems, saddles, handlebars, cleats and pedals are necessary to produce positive outcomes —  because nothing changes if nothing changes.  Installation shold be included with the fitting.   5.  A positive outcome guarantee for the complete resolution of  symptoms that occur ONLY when cycling.  If the problems persist, see a reputable fitter who can provide documentation for the intervention and improvements so you can get a refund. 6. Documentation of component specifications and contact points.

There are, of course, extremely qualified PT Fitters in the US.

Two of my favorite are  Brian Adams or Curtis Cramblett