Fitting Your Bike

Author: Sierra Klotz, Licensed Physical Therapist & Athletic Trainer

It’s time to get that bike back on the road again! With all the new rail trails, it has gotten much easier to go biking here in Vermont. Are you ready to go out and enjoy this beautiful weather? These next posts will be dedicated to injury prevention with outdoor sports. A poor fitting bicycle will cause low back, neck and hip pain. It can also create friction in the hips that over time can turn into severe osteoarthritis and may necessitate a hip replacement. One of my favorite sayings is, “An ounce of prevention is worth a pound of cure.” As a Physical Therapist & Athletic Trainer, I specialize in injury prevention for athletes of all ages. To get us started, here are five tips to remember when adjusting and picking out a bicycle to find the perfect fit. These are simple recommendations, but may need to be altered if you already have hip or back pain. If you have pain and  feel that you need a more customized fit, we are happy to help you with this during a Physical Therapy session.

1. Find the Right Seat Height. This is the most important part of fitting your bicycle. Too low of a seat height will cause that degenerative hip osteoarthritis mentioned above because particularly while climbing up hills or going on long rides, there is constant grinding happening inside the hip joint if the seat is positioned too low. Research has also discovered that raising the height of your seat will decrease the compressive loads going through your knee. (M Erikson, “On the Biomechanics of Cycling. https://pubmed.ncbi.nlm.nih.gov/3468609/) This is an excellent article that details how to set your seat height in fairly easy to understand terms:https://www.bicycling.com/repair/a20022803/bike-fit-how-to-set-your-bike-seat-height/. A quick way to find out if your seat is at the right height is to place your bike on a stand or have someone hold your bike still while you sit on the bike seat. When your peddle is at the lowest position, your knee should be between 0-30deg or nearly completely extended. Make sure your knee is not hyperextended. In other words, there should be a slight bend to the knee at this maximal knee extension position.

2. Adjust Your handlebars. Once again, to adjust the handlebars to the best position, it is important to have someone hold the bike or place it on a stand. Now, place both your feet on the pedals and grasp the handlebars. It is most important how your body feels, so if there is strain on your back, shoulders, wrists, or neck, your handlebars will likely need to be adjusted. The handlebars need to be the lowest for mountain biking or sport/performance style bicycling at 5-10cm below the level of the bike seat. For commuting or riding around a city, the handlebars should be nearly level with your seat at 2.5cm above-2.5cm below. For bike touring or longer rides, the handlebars should be just below the seat or 2.5-5cm below the top of the saddle. However, it is very important that while grasping your handlebars in this position, your hips are not flexed to their maximum. Your back should feel comfortable and hips should be at a 100 degree angle or less. If there is back or hip discomfort or excessive hip flexion, raise up your handlebars.

3. Practice Optimal Foot Positioning. While the bike is held stable, place your foot flat on the pedal. The ball of your foot should be just in front of the pedal spindle. This is the part that attaches the pedal to the rest of the bike. The pedal should support the back half of the ball of your foot. Make sure your foot is not too far back on the pedal ie: your toes are not on the pedal. If this occurs, you are more likely to experience achilles pain and injuries. Again, in an ideal pedal position, your toes should be hanging off the front and the pedal should just be underneath the arch and back half of the ball of your foot.

4. Adjust the tilt of the saddle. It is recommended to start at no saddle tilt and based on the shape of the seat/saddle, the nose can be tilted downwards 1-6mm. There should not be any upward tilt to the saddle. This is very important for the comfort of the perineum or pelvic floor. Any upward tilt of the bike seat will increase your likelihood of saddle soreness. It is also important to avoid excessive downward tilt, as this will increase the amount of weight bearing into your arms, which may lead to nerve palsy, shoulder, wrist or elbow pain. 

5. Adjust the saddle forward/backward position. This is an important part of the bicycle fit that is often not given enough attention. A bike seat that is too far back will increase the angle of hip flexion needed and place greater loads on the hamstring and gluteal muscles (those muscles behind your thighs). A saddle that is excessively forward will increase the angle of knee flexion needed and place more stress on the quadriceps and hip flexors, (those muscles in the front of your thighs). An ideal forward/backward seat position will balance the amount of work required between your hamstrings, gluteals and quadriceps and share the joint loads evenly between the hip and knee. To find a general ideal forward/backward position, your knee should be directly over your ankle and your hips should be at approximately 100deg of flexion while sitting on the bicycle. This is typically neither all the way forward or backwards, but around halfway in between. If you have very tight muscles, your seat will need to be adjusted based on this and it is recommended that you have a private consultation.

When purchasing a new bicycle, it is also very important that the frame is a good fit for you. The assistant at the bike shop will likely be able to help you with this. However, it is also a good idea to research the bicycle model and make on-line to find what size a person at your height will require. Keep in mind that if your arm span is larger than your height, you will likely need to go one size up. Most bicycle models have a chart of what size is recommended for a person of your specific height. Just as important as investing in a good bicycle model is to invest in finding your perfect bicycle fit. 

Sources:
1. BIKE FIT. Physiopedia. https://www.physio-pedia.com/Bike_Fit

2. Wadsworth DJS, Weinrauch P. THE ROLE of a BIKE FIT in CYCLISTS with HIP PAIN. A CLINICAL COMMENTARY. Int J Sports Phys Ther. 2019;14(3):468‐486. doi:10.26603/ijspt20190468

How to lose (or not gain) The “Covid-19”

   Author: Sierra Klotz Athletic Trainer & Physical Therapist at Fit2Excel  

Have you heard of the “Covid-19”? This is similar to the “Freshman 15” you get when you first go to college and no longer have the healthy influence of your mother. In this case, it can be from no longer having the healthy influence or peer pressure of your co-workers, not being able to go to the gym and feeling like you need to eat all of the foods you stocked up on in the grocery store. Here are five healthy tips through diet and exercise to keep off the “Covid-19”:

1. Prioritize exercise into your daily routine.  Exercise can look like many different things and definitely should be fun. As the weather warms up, there are more and more modes of exercises including bicycling, hiking, jogging, playing tennis or kayaking. It is important to find something that you can do close to home and regularly, so as to avoid the hassle of packing up your car. Walking around the neighborhood can be a great avenue for this. If that feels too easy for you, turn it into a jog or bike ride. Make sure to take breaks as needed and do not walk or jog through injuries. The kind of injuries that develop while running or walking often will get worse if you try to push through. However, if these pains just started, you will likely only need a couple of sessions of sports rehab from Fit2Excel to get you back exercising pain-free.

2.  Cut the Carbs. A great way to lose that belly fat is to eat less carbohydrates. This will also improve your cardiovascular health, as carbohydrates contribute to inflammation and plaques within our arteries. (Deep Nutrition Catherine, Shanahan, MD.)  Dr. Cate cites her own clinical experience and recommendations of colleagues when she recommends no more than 100 calories from carbohydrates daily. Fruit, breads, rice and potatoes are all examples of carbohydrates. In simpler terms, the recommendation is no more than three large servings or six small servings of fruit, rice and breads combined. A wonderful way to limit these calories without feeling starved is to eat more healthy fats like eggs, yogurt and nuts. These foods are great for our brain and gut health. They also are highly satiating, meaning it will likely satisfy the food cravings. If this is still not doing it for you, it can be helpful to meet regularly with a certified nutritionist such as Fit2Excel’s Jess Voyer. You can find more information and contact Jess directly at: www.jessvoyerfitness.com 

 

3. Be Active. Make gardening, yard work, cooking, cleaning, playing music or doing art a part of your daily routine. As I sit on the computer typing this, I encourage you to limit that computer use and sitting time. Research has linked sitting for long periods of time to higher cholesterol levels, high blood sugar, high blood pressure and excessive body fat (Mayoclinic). It is no wonder, our bodies are made to move! I understand that it is hard when we need to be on the computer for our work. However, I encourage you to consider a sit-stand desk, take frequent breaks and keep regular hours for work, while taking time for yourself to do something active during the other parts of the day. Ok, now I am going to stand and take a stretch break. 

4. Use only Coconut, Olive, Sesame, Avocado Oil or Butter. Cook only with these oils! Other oils are hydrogenated and are linked to early onset Alzheimers, diabetes, post-concussion syndrome and yes, increased visceral fat. This type of fat not only makes us heavier on the scale, but leads to a bloated feeling and even risk of earlier death as it directly coats vital organs. The hydrogenated oils also cause inflammation and calcification of arterial walls. (Kumerow et al. The Negative Effects of Trans Fats and What to do about them. Pubmed.) Another name for this is arterial plaque formation which is what causes that silent heart attack. After injury, it is also critical that our arteries can dilate to flush out swelling and inflammatory mediators. This cannot  happen if you eat too much sunflower oils, safflower oils or fried foods in restaurants. Even salad dressings are loaded with these pro-inflammatory oils. How does this relate to concussions you ask? Concussions, or Mild Traumatic Brain Injuries involve a cascade of microtearing and inflammation of the small cells or “axons” in our brains. This cascade grows and grows with a pro-inflammatory environment of hydrogenated oils, but heals much quicker with a soothing brain environment from fish oils, and the healthier oils listed above. (Deep Nutrition Catherine, Shanahan, MD.) Nuts, eggs and fish are some of the best brain food with their high lipid profiles. Besides the book above, another great resource for cooking with less oils is the book, How Not To Die, by Gene Stone and Michael Greger.

 

5. Replace the snacks with a large glass of water or pot of tea. There is something about working at our home computers that make us crave a snack at our sides. Many of us know by now that sitting for long periods and snacking can be a deadly combination. By replacing the snack with a large glass of water or mug of tea, it is very soothing, relaxing and hydrating, which is what your body is really craving. 

Emerging with Strength: the Metamorphosis of Covid-19
Author: Sierra Klotz, Physical Therapist & Athletic Trainer

Many of the previous blog posts have shed light on how to emerge with strength: the previous post on how to change physically, the post before that on creating positive change within our community and Light at the end of the tunnel on healing if you become sick. This post will aim to tie all of these together to come out of this “tunnel” per se, a stronger, healthier person, so that hopefully we can emerge as a stronger, healthier world. We have often heard the saying that “one must go through darkness to see the light” so let this challenging time illuminate your way ahead.

1. Appreciate the simple beauties around you. Though we are in a scary time, many of us still have a lot to be grateful for. Take the time to call loved ones up on the phone and tell them how much you miss them or how you appreciate them. While you are walking, eating, or even brushing your teeth, slow down and appreciate what you have and often take for granted. If you are back out on the roads, take a couple of minutes to think in your head of at least three new things you are grateful for when first setting out. Gratitude boosts mental and physical health, improves relationships and enhances empathy while reducing aggression. Morin, Amy “7 Scientifically Proven Benefits of Gratitude.” Psychology Today 

2. Accept your Fear. It is very easy to get caught up in the fear. I often find myself while at the grocery store or listening to the radio, very fearful about our current situation. This fear is natural during this time and will only grow if you push it away. Instead, draw attention to where in your body you are feeling the fear. Are you feeling an ache in the pit of your stomach, a headache or tension in your shoulders? It is a natural response, to curl inwards and flex forwards when we are fearful. By bringing attention to this and accepting it, we can help the fear melt away and welcome in the next emotion. If the fear is long lasting, it can be very harmful to our overall health. I would encourage you to get professional help if this fear stays with you when you turn off the radio or leave the grocery store or public space. Psychological counseling is often needed, but physical therapy can also be helpful, as doing specific stretches and exercises can change your posture and help ease your fear from the outside in. At Injury To Excellence, we are currently offering telehealth services that can be scheduled at 802-871-5423 or [email protected]

 

3. Create a Supportive Environment. Our environment contributes largely to how we feel and how our bodies react. If you have boxes piled all over, you have a much higher fall risk than if your floor is clean and organized. This can be a great way to help your balance improve, but also presents a hazard for falling. If you have the space, this is a great time to dedicate a room of the house to pursue your passions. This could be making a fitness area with some small gym equipment or even just putting down a yoga mat for pilates and plyometrics. This might also be setting up a space for arts and crafts or planting a garden. There is no better way for positive behavioral change, than to make your environment conducive to it. 

4. Slow Down. As a whole, our typically fast-paced American culture has considerably slowed down. Many people are able to be home & spend quality time with their children or loved ones instead of everyone racing out the door. Though I am sure we all felt very challenged by this slower pace at first, many folks, myself included, are starting to appreciate this time we have to go outside, exercise and be creative. I have heard anecdotal evidence that babies are being born with less complications and higher birth rates during this time. Nurses are theorizing that it is because mothers are not having to work as hard and are able to slow down and rest. I encourage you to talk with your supervisors at work to see if working from home or changing your hours may be an option even after the quarantine is over. If you have not yet seen this viral video, The Great Realization by Tomfoolery, it highlights very well how us, as individuals and also our world are craving these changes.  https://www.youtube.com/watch?v=Nw5KQMXDiM4 To emerge from this stronger individually and as a nation, we must make permanent changes after this is all over. 

 

5. Remember to Smell the Hay! It is very important to take note of what is working for you during this time. So much about our daily lives is changing. If there are moments for you in which you feel light and at peace with your world, take note of that. What are you doing? How is this feeling? This may be cooking a creative dish, going for a run or playing outside with your children. To emerge as a stronger, happier individual, it will be important to keep the positive changes and do more of the enjoyable activities that you are now doing during this time of quarantine. It may also be helpful to keep a journal so that you can jot down each day what you did and how it felt. Don’t let yourself completely return to the old ways, but instead emerge as a healthier, happier you. 

Fitness for the Competitive Athlete
Author: Sierra Klotz, Physical Therapist & Athletic Trainer Fit To Excel

Amidst this crisis, it can be very challenging to maintain the competitive edge and find motivation to keep up the intensity of training. Here are five tips to stay in the game when the time comes that you can return to competition:

1. Participate in regular group fitness classes. It is recommended to do intense strength training 3x/week. This is best done through a class so that you have the motivation to keep it up and maintain the appropriate intensity. This exercise is meant to put your muscles into anaerobic respiration in which you feel the muscle burn. Because of this discomfort, it is recommended you do these training sessions through on-line group fitness classes. Fit2Excel is offering these classes at: https://www.fit2excelvt.com/classes/schedule/

 

2. Take advantage of nature. It is also very important to keep up your cardiorespiratory endurance by doing longer duration and lower intensity workouts. These can include bicycling or jogging. In Vermont, we are fortunate to have many hills and dirt roads which are perfect for jogging and bicycling… and you’ll never know what you might see! Make sure that you do this in a safe way and always wear a helmet when bicycling. To be ready for your sport, it is recommended that you do aerobic activity 5 days/week for at least 30 minutes. 

3. Train specifically for your sport. There is a principle in exercise physiology called SAID or Specific Adaptations to Imposed Demands. It is important that at least 3x/week, workouts include specific skills to your sport. For instance, if you are a gymnast, make sure that you are practicing somersaults, flips, pikes, V-ups and L-sits. If you are a soccer player, do sprints and find a large wall where you can practice shooting and passing the ball. I know it is very disappointing for all spring athletes who are missing your sports, but it will feel good to throw a ball with a family member if you are a baseball/softball player or to jump hurdles, sprint, throw the discus or train in whatever sport you compete in with track and field. By spending time in your specific sport training, you are keeping your muscles strong and fine-tuned for the demands of your sport. 

4. Keep your Mind Strong. The difference between winning and losing lies largely in how strong you are mentally. The more disciplined and determined you become, the easier it will be to train hard and get physically fit. Once you have the physical fitness and strength needed for your sport, you will likely be up against many opponents who have the same level of physical fitness. What will be your key to victory? When game day rolls around, your key will be the tenacity, focus and mental clarity of brain strength. There are many mental techniques and tips to have this competitive edge and many of these training skills can be practiced during this time of physical distancing. You can research mental training techniques and mindfulness techniques, some of which I have included in past blog postings. Another great option is to consult a trained professional such as Sheila Stawinski, sports psychologist for UVM Division 1 College teams and GMVS, a feeder program for the US Ski team. You can call 802-871-5423 or e-mail [email protected] to set up a consultation with Sheila. 

5. Sleep. Never underestimate the power of sleep. I have highlighted this in a couple previous blogs to recover from illness and keep your immune system strong to prevent getting sick. It is also very important for sport performance. Labron James averages 12 hours of sleep/day. (Forbes & ESPN) It is recommended that you get a baseline of eight hours of sleep/night with one hour added on for every hour of physical exercise that you get. For example, if you work out for two hours during the day, it is recommended that you get ten hours of sleep that night. During sleep, our muscles recharge, our bodies are flushed of harmful chemicals and our brains are re-booted for mental clarity and focus. Regenerative rest is just as important as the workouts that you plan into your day.

       Be The Change
    It feels like this week is one of hope, with Earth Day on Wednesday and the One World: Together At Home concert last Saturday. During this challenging time, it is very important that we collectively rise up stronger than when we went into this crisis. Here are some helpful tips to make a difference in your community and in the world. In times of crisis, it can often feel overwhelming, like nothing we do is ever enough. The best way to persevere, is to keep putting one foot in front of the other. I encourage you to choose one of the ways below to make a positive change. 

 

1. 1. Buy Gift Cards, CSA Shares or Donate to Local Non-Profits. Right now, many local businesses, small farms and non-profits are suffering with the hurting economy. If you have the means, it is a great idea to share the wealth. I just mailed out two checks today to my local yoga studio that is no longer in operation but has on-line videos and to a local farm for a summer CSA share. Buying a CSA is a safe way to ensure you are well-fed with fresh vegetables this summer. Some shares also include local milk and eggs. At pick-up time, you drive up and pick your box up from the farm, so it’s fast, easy and relatively safe. This also gives the farms money up front to help them cover the costs of growing and planting. 

 

• • • Stay Home & Be Still. I mentioned this in the first week’s post, but I want to reiterate that this is the perfect time to start a mindfulness practice. Being still is one of the best things we can do for our communities & the planet. You may be thinking, “Why is a Physical Therapist telling me to be still?” It is true that our bodies need to move to stay healthy. However, I want you to notice all the miniscule movements and changes happening within your body when you sit still. This means sit without any screens or books or entertainment in front of you. Cherish and explore the feelings inside of you. Exploring how our bodies change and different sensations that arise every moment will have profound effects on your life. It will help to develop your EQ or Emotional Intelligence, because you will become in better tune with your emotions and the emotions of others. It will also help you to realize your true needs more clearly. I have found that many positive changes including exercising more, doing less needless shopping and eating less sweets all came from being more in tune with my body. Even three-minutes, 3x/day of sitting still and exploring what arises inside of you will have a profound effect on your life and the planet. 

 

             2. Tune in to Virtual Earth Day. Earth Day is tomorrow, 4/22/20. This year, there are concerts, educational talks and    exciting action ideas that you can do from home. 

 

Here is the link to take part in this day of virtual earth celebration: https://www.earthdaylive2020.org/?source=email

We are All In This Together. At this time when all of our lives have been changed in some way, we can feel how fragile and interconnected our lives are with the earth. We depend on it to live, and taking part in this Earth Day can be a good way to gain inspiration and remain connected in the fight for a better future in good stewardship with the earth.