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Thread: Bike fit to accomodate injury

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    Default Bike fit to accomodate injury

    Hey everyone, I'd like to get the groups thoughts on bike fit to address injury issues.
    (I realize bike fit via internet is fraught with issues. I'm seeking general advice as a starting point. I'm going to enlist the help of professionals post 'Rona.)
    Due to traumatic injury, I'm left with a right ankle having nearly zero range of motion. (neutral to 10 deg plantarflexion)
    Up until a few months ago, I was unable to put any load through the ball of my right foot either walking or riding.
    I'm fortunate enough to be the new owner of a high end AFO device which has made normal life and work on foot so much better.
    Without getting into the weeds, think Oscar Pistorias type carbon fiber energy return spring like function. I still have both legs / feet.

    I'm now looking to address some ongoing bike fit issues in hopes that I can get back to something approaching pre-injury cycling life.
    My device uses a toe down orientation to pre-load the brace to store and release energy for walking.

    Any thoughts on general adjustments to accommodate asymmetry? I'm thinking along the lines of different length crank arms, cleat position, saddle height and fore / aft, etc.
    I'm working on core strength and PT type things to overcome years of wonky gait, atrophy, and sitting crooked on the bike.

    Thanks in advance

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    Default Re: Bike fit to accomodate injury

    Quote Originally Posted by Kev inc. View Post
    Hey everyone, I'd like to get the groups thoughts on bike fit to address injury issues.
    (I realize bike fit via internet is fraught with issues. I'm seeking general advice as a starting point. I'm going to enlist the help of professionals post 'Rona.)
    Due to traumatic injury, I'm left with a right ankle having nearly zero range of motion. (neutral to 10 deg plantarflexion)
    Up until a few months ago, I was unable to put any load through the ball of my right foot either walking or riding.
    I'm fortunate enough to be the new owner of a high end AFO device which has made normal life and work on foot so much better.
    Without getting into the weeds, think Oscar Pistorias type carbon fiber energy return spring like function. I still have both legs / feet.

    I'm now looking to address some ongoing bike fit issues in hopes that I can get back to something approaching pre-injury cycling life.
    My device uses a toe down orientation to pre-load the brace to store and release energy for walking.

    Any thoughts on general adjustments to accommodate asymmetry? I'm thinking along the lines of different length crank arms, cleat position, saddle height and fore / aft, etc.
    I'm working on core strength and PT type things to overcome years of wonky gait, atrophy, and sitting crooked on the bike.

    Thanks in advance
    145 cranks with custom shoes drilled mid-foot will reduce ankle plantarflexion/dorsiflexion to a minimum
    Got this answer from someone I trust who fits para-olympians.

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    Default Re: Bike fit to accomodate injury

    When flexed is your (flexed) foot at the same height as your unaffected foot? In other words, when standing upright in bare feet with your appliance are your hips level? I'm guessing the answer is yes.
    I'd start with flat pedals and no changes to the bicycle otherwise.
    Need to hear more to take a few more amateur guesses. LOL in reality I've fit a ton of people with leg length discrepancies, some actual others were "assumed" and we can get into that later.
    Anywho, congrats on your resolve to get your butt out there and ride the bike.
    Last edited by Too Tall; 02-08-2021 at 11:43 AM.

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    Default Re: Bike fit to accomodate injury

    Yes, my device keeps me in a loaded stance that results in level hips.
    The brace requires a heel wedge in street shoes but not in cycling shoes.
    I've got myself confused trying to decide if a longer or shorter DS crank would help.
    Probably a good start to not change anything and just get some saddle time.

    Thanks

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    Default Re: Bike fit to accomodate injury

    Quote Originally Posted by Kev inc. View Post
    Yes, my device keeps me in a loaded stance that results in level hips.
    The brace requires a heel wedge in street shoes but not in cycling shoes.
    I've got myself confused trying to decide if a longer or shorter DS crank would help.
    Probably a good start to not change anything and just get some saddle time.

    Thanks
    Good call. Would dig hearing about your progress.

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    Default Re: Bike fit to accomodate injury

    Quote Originally Posted by Kev inc. View Post
    Yes, my device keeps me in a loaded stance that results in level hips.
    The brace requires a heel wedge in street shoes but not in cycling shoes.
    I've got myself confused trying to decide if a longer or shorter DS crank would help.
    Probably a good start to not change anything and just get some saddle time.

    Thanks
    Makes sense. FWIW, I kept my standard length crankset but moved cleats as far back as they would go (and adjusted saddle height accordingly) last year when I was coming back from a full achilles tendon rupture and had very limited plantar and dorsiflection

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    Default Re: Bike fit to accomodate injury

    How much control / strength do you have over / in the ankle muscles?
    Were you a heel down type of rider prior?
    Do you need the AFO on the bike?
    Pain any?
    I’m with TT to leave the crank length untouched and have somebody video you (slo mo on iphone) and see what is going on.

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    Default Re: Bike fit to accomodate injury

    I'd suggest skipping the 'net and going straight to a good bike fitter. I know little about medicine but I would think that good fit from the beginning is important to avoid the body learning bad habits as it adjusts to the revised physical capabilities. Poor motion gets ingrained and causes long-term additional problems as it is difficult to unlearn bad habits. Where do you live? Maybe the vSalon group can suggest a good DPT/fitter.

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    Default Re: Bike fit to accomodate injury

    Thanks for all the replies.
    I do have control over my calf, however there isn't much there. I've had to train myself to not fire those muscles in my device.
    I do everything in my brace except sleep and shower. Brace is needed on the bike.
    This helps with retraining muscles and unlearning gas pedaling which is counter to the AFOs design, as well as pain prevention.
    After injury and multiple surgeries, my daily pain level ranged from 2-8. After receiving my device, pain is mostly gone. Unless I do something dumb)
    Before my injury, I was a heel down rider with a smooth higher cadence. Couldn't stand on the pedals due to pain.
    My first ride when I got home with my brace was a revelation as to how bad things got.
    I was able to put power into my right crank instead of my right foot just ticking around following my left. I could stand on the pedals, jump, sprint, etc
    I still have a long way to go to correct my core and posterior chain imbalance, but change is happening.

    I'm interested in fitter recommendations. LBS do Serotta fit, some whizbang Trek fit, and a variant of Fit Kit.
    They all seem to not understand my asymmetries and how to correct.
    I'm in SW Michigan. Occasionally in the Detroit area for family and work.
    I'm also open to travel (someday) if options exist further away.
    Thoughts on Steve Hogg fitters in USA? Hospital for Special Surgery?

    I appreciate all the thoughts so far.

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    Default Re: Bike fit to accomodate injury

    I think you need a university athletic performance center, not a bike shop. I know UC Davis out here could help, I don’t know if MSU’s Spartan performance center has folks who would know, but might be worth a call. Even though you have your foot, I can’t help but to think someone with experience with adaptive equipment for amputees is the right person. They would probably open up the options for creative fit and interface crafting.

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    Default Re: Bike fit to accomodate injury

    You may want to approach University of Michigan Orthotics and Prosthetics Center in Ann Arbor. UMOPC has a range of services including research and is part of UMHS. It is a benefit if insurance can cover all of this.

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    Default Re: Bike fit to accomodate injury

    Quote Originally Posted by vertical_doug View Post
    You may want to approach University of Michigan Orthotics and Prosthetics Center in Ann Arbor. UMOPC has a range of services including research and is part of UMHS. It is a benefit if insurance can cover all of this.
    While I'm closer to MSU and have been there for sports injuries and foot orthotics, UMOPC has a strong group. Friend that has retired from there and still consults a bit, she's a cyclist but an upper limb person. LMK if you'd like me to query her re recommendation of someone in lower limb that's an active cyclist. The person in management there was a challenge to work for and some staff have left.

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    Default Re: Bike fit to accomodate injury

    There is a wealth of knowledge within the handicapped military cycling community when it comes to adaptations to bikes etc.
    I would research that for expertise in your area.

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    Default Re: Bike fit to accomodate injury

    I used to ride and race with a PT who specializes in bike fit. he works at a rehab hospital now. maybe a worthwhile resource:

    https://spauldingrehab.org/condition...dicine-program

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