admin

First things first: you run pretty well! Surprisingly well, in fact!! With that stated, there are certainly areas you can and should address. While there are things we cannot help (namely, your knees), there is much still that can be done: eliminate the right lean, increase left hip extension, increase lateral strength.

Given your background, I’m sure it’s redundant to write this, but I’ll do so nonetheless. Think of the pelvis as a pulley…or better yet, as an orb (basketball, soccer ball, whatever your choice). Now picture that ball floating on the surface of a calm pool. If I push down on the right side of the ball, the left side rotates up. If I pull up on the back side, the front rotates down. Muscle imbalances around the pelvis have the same effect. Either tightness or weakness can force/allow the pelvis to shift right, left, forward, back, rotate right, left, forward or back. Or any combo of the aforementioned.

Based on what I see on video, these imbalances are definitely causing the asymmetry in your gait and most likely are causing the right foot 5th styloid pain (or at least continuing the pain after the narrow shoes let the genie out of the bottle).

To help with your gait, we need to address the muscles that rotate about the z-axis (the torso and hip lateral flexors), about the y-axis (hip rotators, int and ext obliques, lower traps) and for the most part ignore the rotators about the x-axis (quads are a no-no, but hopefully glute max and psoas can be addressed).

First things first, here are your run videos:

 

Anterior View

***NOTE: I intended to mesh the anterior and posterior on one screen, but the pausing did not sync. The best way to view these is to open two windows and pause manually to keep them in sync (sorry it turned out this way…I only discovered my error once I had completed and to fix it would mean keeping you waiting another day).

 

Posterior View

 

Lateral View

***NOTE: Upon reviewing this video, I see I erred in marking the hip extension measurement. The left side of the screen (measuring the right hip) is correct at 174 degrees. The right side of the screen (measuring the left hip) is incorrect (I inverted the angle). Instead of 179 degrees, it should read 181 degrees. In other words, your left hip actually extends past neutral, while your right hip does not.

 

 

EXERCISES:

 

 
QL STRETCH (to address high right hip, perform 20-30 seconds post work out and as needed)

 
ITB STRETCH (to address high right hip, perform 20-30 seconds post work out and as needed)

 
QUADRIPED (to address lateral strength, perform 10-20 reps, 2-4 sets daily or as tolerated)

 
SIDE BRIDGE (to address lateral strength, peform 10-20 reps, 2-4 sets daily or as tolerated)

 
GLUTE AND PIRIFORMIS STRETCH (to address hip extension, peform 20-30 seconds post workout and as needed)

 
STANDING PSOAS STRETCH (to address hip extension, peform 20-30 seconds post workout and as needed)

 
TURKISH GET UP (a fantastic and difficult exercise to address rotational and extension strength, perform 10-15, 1-2 reps per side with very VERY light weight…and study the video for proper form!)

 
MYRTL ROUTINE (a GREAT all around hip strengthener and mobilizer routine, BUTTTTTTT the athlete in this video performs these exercises WAAAAAAAAAAY to fast, perform up to 10 reps of each in a slow and controlled manner; eliminate any segment that causes pain)

 
LEG CROSS OVER STRETCH (to address torso rotation, perform 20-30 seconds post workout and as needed)

 

Hi Dori

First, about the pre and post measurements on the video—all of the numbers are just theoretical. There is a saying in medicine: if you put three orthopedists in the room, you’ll get four opinions. The same holds true for “ideal” fit and positioning on the bike. I don’t subscribe to any one fit method, but try to use a combination of what I know and a mean value from all of the experts out there. So, if my notations state that you are slightly inside or outside of a normal value, do not take that as an absolute.

In fact, my greatest concern is comfort. If you aren’t comfortable, you’ll never be powerful. My goal with your fit was the most comfort that you are capable of currently. Hopefully with time (and the right combination of strengthening and stretching), you will be able to achieve different positioning on the bike.

First, the functional testing: what areas need to be addressed? You have a lack of pelvic rotation about the Z-axis (think swaying up and down like a hula dance); you are asymmetrical with pelvic rotation about the Y-axis (twisting motion); you lack extension of the thoracic spine both from mid and lower trapezius strength and from spinal “stiffness”; you have an asymmetry in ilio-psoas length.

I don’t want to just complain: your glute strength is fantastic; calf range of motion is ideal; and quad and hamstring strength are perfect.

And now from the bike fit. We made good changes. I would like to have done more, though I think right now the changes were as much as your body could handle. You still are a bit too high and too far back (you will see a decreased degree–though still too much–of vertical hip motion with each pedal stroke), but at least the movement was in the right direction. I am very pleased with the new shoulder/neck position and think the “pre” was at least one component of your neck pain.

I did not note this in the video (though we did discuss it in the office), but your right ankle still lacks the motion of the left ankle (you ride toe-down on the right whereas you have much better dorsi and plantar flexion of the left ankle). I think the best solution to this–in addition to addressing all of the pelvic imbalances–is gaining calf strength. Single leg calf raises should suffice for this.

Enough of my writing….on to your videos. For the two squat exercises, use whatever weight you feel comfortable using. I am happy with just body weight, but I would like you to use a bar of some sort (a flat 45 pound weightlifting bar, a broomstick, 5-6 feet of PVC pipe, etc.). As for repetitions and sets, challenge yourself. Make the exercises seem at least a little bit tiring or difficult. The strength exercises should be performed several times per week (2-4 times) and the flexibility exercises should be daily (preferably post workout). Obviously, if any of these exercises causes pain, stop it! And let me know!! Otherwise, I’m pretty confident that this is the right combination of “stuff” for you.

If you have any questions whatsoever, don’t hesitate to ask.

Your Bike Fit Pre and Post Video

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Pelvic Rotation about the Z-axis



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Pelvic/Lumbar Rotation about the Y-axis

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Thoracic Spine Extension



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Mid and Lower Trapezius Strengthening

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Psoas Stretching

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Calf Strengthening