Tingly hands

Lauren, a 26 year old female, new to cycling 2 years ago, but an accomplished runner, calls me about her preparations for this years upcoming triathlon season.”You know, I really want to do better at the Montauk Triathlon”, an Olympic distance event, ” but my numb hands stop me spending enough time on the bike to train for the longer distance”.. To this point, she had just been racing sprint distance events. She had also been a patient of mine for some right lateral hip pain, mostly resolved, but still present when sitting for long periods of time, in the car, but also on the bike. I suggested a bike-fitting session and review of her biomechanics using a combination of PT problem solving and Retul technology.

Lauren likes her new bike, an upgrade from riding her husbands old bike, but is uncomfortable. Her initial choice of hand position is on the tops, and when actually on the hoods, feels “too stretched out” with more pressure on her bars, increasing her numbness. Her hip pain also bothers her within 10′ warm up @ 100 watts.

Hypothesis: Laurens residual G. Medius tendinopathy was still an issue, and strength testing with a microFET dynamometer indicated 20% strength deficits in her G. Medius, G. Max and Iliopsoas on the affected side. She had reduced core strength with poor neutral pelvic spine position control, thus tended to roll into a posterior pelvic tilt on the bike. This combined with the too-low seat position, effectively increased her “reach” and forcing her to assume the “tops” of the bar position to shorten her cockpit, instead of using the hoods. As a novice cyclist, since she was unable to reach the brakes and gears from this position, she was understandably rather nervous on the road.

Changes: Shoe cleats were moved aft 1.5cms closer to the backside of the metatarsal heads: this immediately resulted in increased knee extension and a less compressed position in her hips. In conjunction with this, her seat height was increased 3cms, gradually to increase knee extension angle to 40degrees, from a compressed and squashed 49 degrees. Saddle was slid slightly forward, to compensate for increased height, and 0.5cms felt best, any further and she felt the familiar pressure build on the hands again. Stem was tweaked using the Salsa Size-o-matic: 85mm flat stem swapped for 60cm with 7 degree incline. Hey Presto! No more hip pain, no numb hands after 15′ in the saddle, and “oh, I forgot to tell you that my feet are usually numb by now”, so no numb feet either.

Lauren continues to work on her hip strength, and flexibility but has been able to get training with increasing mileage and no return of symptoms. We will do a review fit before tri-season starts, to get her clip-on bars correctly positioned, and work on her aero-position.

Lauren after: actually increased her shoulder / wrist angle from 68 to 80 degrees, but she felt it was now more comfortable since her weight was happier in its distribution.  Pelvis more rotated forward, shoulders more relaxed, and the smile.. says it all!

Keep the rubber side down, and consider a bike-fit before you need a bike-fit! sinead@bikefitplus.com

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About sineadpt

physical therapist, PhD candidate, bike fiend, swim nut, run loony, multisport athlete, bike fitter, coach, general life enthusiast
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