Ari Baquet: If a person is having bike-related issues, when is it my body versus when is it my bike? Even on the clinician end that can be pretty hard to tell, some of the time. If somebody were to come in and ask you that question, what would be your thoughts?

Brian Bonilla: I’ll usually ask someone if they have prior injuries or things that give them discomfort off the bike, and see what affects them off the bike. Let’s say their hands keep going to sleep, when generally that doesn’t happen, or they feel a lot of pressure in their perineal area [while riding] whereas sitting on a bench or chair there are no issues, that’s when I’ll think the saddle height might be too high or the handlebars are pushing up against your hands cutting off circulation or creating hand numbness. So it’s more of a person-to-person type of thing. But generally speaking, I’ll ask questions about injuries or discomforts and I’ll go based off of that.

Ari: So it sounds like if it’s something they experience only on the bike but not in other parts of their life, that’s when you wonder if the bike is the problem?

Brian: Yes, that’s how I’d sort it out. And generally, if you’re active on a bike whether you’re recreational or racing, getting a general saddle height is key, to make sure you won’t get discomfort, whether it be knee-wise or low back discomfort.

Ari: If somebody then were to ask, “I just started riding, I don’t think I have any issues, should I get a fit done?”, how would you talk them through that?

Brian: Generally what I would say is if you just got into riding and you think you don’t need a fit done, I would say get something called a “bike sizing”, where you get your saddle height and handlebar in the right place. When you buy something that moves, be it roller blades, or snowboard, or even a bike, it’s like getting something your general size – like a suit – and then getting it tailored to you. You might have a shorter torso and longer legs, so you might need a shorter stem, or vice-versa where you have hardly any inseam and need a low saddle height and further-out handlebars. So I generally tell people getting a bike is like getting a suit. You get your general size, and then the bike would get adjusted to you. Something that took me a long time to learn is that the bike works for you, you don’t work for the bike. So we should be able to manipulate the bike to have as much comfort and not as much discomfort. 

Ari: I feel like that’s quote of the day right there.

Brian: Yeah, it was after my coach told me that, where he saw me super-stiff on the bike one day before a race, and told me “Remember, the bike works for you”. 

Ari: What are the most common injuries or discomforts you see in either new riders or riders who may have been just a little off in their fit?

Brian: One of the biggest things would be IT bands, where people are really stiff or don’t stretch before riding and might have a saddle height that’s too high, so once they’re riding they’re [effectively] over-stretching. Another major thing where I feel bad for people is if they’re new to the sport, and they just start riding clipped-in (where one’s feet are fixed to the pedals -Ari), and don’t get their cleats set up, it can cause a lot of knee discomfort. Riding with a clipped-in shoe puts your lower extremities in a fixed position, and if you have [trouble with your] knees, it locks it in and doesn’t allow your leg or knee to float around. So that’s one of the biggest issues, is cleat placement, on knee issues and toe numbness as well.

Ari: How does the toe numbness thing tie into cleat placement?

Brian: Toe numbness and cleat placement can work where, let’s say, if the metatarsal of your foot and center of your cleat are badly aligned, it can put more pressure on certain parts of your toes, and can affect blood flow through the foot. From there, when I set up cleats, I make sure everything is neutral for your body and not simply straight for the bike, and also look at how the cleats place relative to the arch of your foot. If it’s too far forward, your arch can collapse and that causes your knees to buckle in toward the frame, which will affect from the foot all the way up the legs. Finding good arch support and setting up cleats properly can affect toe numbness and help all the way up through your knees.

Ari: That makes sense, but I would never have thought of it in terms of a blood flow standpoint. If someone comes to you and you’re seeing them for the first time like a blank slate, broadly speaking what does your assessment consist of?

Brian: Good question. I have them do a couple of stretches before they even hop on the bike, while barefoot. I see how the hip flows in relation to the hip, knee, ankle, and arch of the foot. I try to see what sticks out. For example, when someone does a knee bend, does their hip shoot out to the right? From there, a couple of shoulder stretches, because when on the bike you are kind of stretched out to the handlebars, so I look toward the neck as well to see what it naturally looks like with your arms out. I feel the back as well, and adjust accordingly to that. I have about a ten-step set of things I look at before we hop on the bike. 

Ari: How do you tie that into what you’re seeing on the bike? Do you immediately adjust for it, or is it just good context?

Brian: It’s good context. I’ve seen it all the time where people are really stiff and don’t have the most mobility off the bike, but once they’re on the bike, their whole body changes. I’m myself a great example of that. I have the worst posture ever. But once I’m on the bike, I have a nice flat back, and stable hips, but if you see me just standing my shoulders are hunched and I don’t have the nicest gait walking. But on the bike it’s very different.

Ari: Are bike fits something that change over time? Or is it a set-it-and-forget-it kind of thing where once it’s dialed, you’re good?

Brian: I usually tell people to get a fit check-up every six months to a year and a half, just because the body changes dramatically in a month and a half. Where you might not have the most mobility when we meet up the first time, when we do the follow-up, someone might say “Hey Brian, I’ve been stretching more, doing more yoga, and have lost some weight”, that can also affect their ability to get lower and more aggressive on the bike to get more efficient. But if they get a bike fit and then don’t really ride for the first six months, it can be that the handlebar height has to be up a little more since they don’t have the flexibility anymore, and saddle position might have to be lower and further back. So I generally tell people to get a check-up every year. 

Ari: What else should I be asking you? What else would you want someone to know?

Brian: Saddle selection. What works for someone won’t work for someone else. Everyone has to feel well-supported without too much pressure in the crotch area, where it’s nice and neutral. If you’re on too wide of a seat you can get saddle sores; if you’re on too narrow of a saddle your hips will be rocking everywhere and you won’t be as stable and efficient. So that’s a key portion. Something else is that sometimes as we do the fit I put wedges and shims inside cleats and shoes, to adjust for leg length discrepancies or arch drop, small things individual to the person. 

Ari would like to express his gratitude to Brian for his time and thoughtfulness throughout this interview. Please contact MOTI Physiotherapy or The Cub House with questions.

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HISTORY OF PHYSICAL THERAPY 

The physical therapy profession came to the forefront during World War I, when Marguerite Sanderson and Mary McMillan trained people to care for individuals that were wounded during the war; those trained individuals became known as “reconstruction aides”.  At that time, there were more than 700 reconstruction aides, the majority women, who cared for nearly half of the 125,000 Americans that were disabled during World War I. Following the events of World War I, another turning point in history occurred during the 1920’s and the 1930’s; the poliomyelitis epidemic. Physical therapists played an important role by incorporating treatment that consisted of exercises, massages, hydrotherapeutic modalities, heat/light modalities, and the use of assistive/adaptive equipment. Fast forward to present day, physical therapists continue to play a vital role in improving the way people move in order to transform society by optimizing movement to improve the human experience.[1]  

DID YOU KNOW? 

• Physical therapists are movement experts that improve your health and quality of life through prescribed exercise, hands-on care, and patient education that are individualized for each patient. Physical therapists can help you… [2,3] 
  • Prevent an improve chronic conditions  
  • Manage pain, avoid surgery, and minimize use of prescription drugs 
  • Recover from and prevent injuries 
  • Improve your movement and fitness 

• According to the American Physical Therapy Association’s (APTA) Physical Therapy Workforce Analysis done in 2019, there are over 223,751 physical therapists in the United States with the numbers growing every year [4] 

• In order to become a physical therapist in the United States, a person must go through an accredited physical therapy program to obtain a Doctorate in Physical Therapy  
  • All of our MOTI Physiotherapy physical therapists are Doctors in Physical Therapy and are licensed to practice as a physical therapist in the state of California 

• Physical therapists can work in various settings which include but are not limited to:  
  • Outpatient Clinics 
  • Hospitals 
  • Schools 
  • Nursing Homes 
  • Factories 
  • Sports and Fitness Facilities 

• Physical Therapy Specialties 
  • Geriatrics 
  • Neurology 
  • Oncology 
  • Orthopedics 
  • Pediatrics 
  • Sports 
  • Women’s Health 
  • Wound Management 

MOTI Physiotherapy has many clinicians who have various backgrounds of specialities and subspecialties that include orthopedics, sports, pelvic health, and women’s health. 

THANK YOU 

MOTI Physiotherapy would not be what it is today without the support of all our staff members. A big shoutout goes to our owners, Dr. Nick Cutri and Katie Schaar Cutri, our administrative team, clinic directors, assistant clinic directors, patient coordinators, physical therapists/occupational therapist, and physical therapy aides. Thank you for all that you do. 

#ChoosePT #PTMonth 

References 

1. Moffat M. The history of Physical Therapy Practice in the United States. Journal of Physical Therapy Education. 2003;17(3):15-25. doi:10.1097/00001416-200310000-00003. 

2. American Physical Therapy Association. Becoming a PT. American Physical therapy Association. https://www.apta.org/your-career/careers-in-physical-therapy/becoming-a-pt. October 2021. 

3. Choose Physical Therapy. American Physical Therapy Association. https://www.choosept.com/. October 2021. 

4. American Physical Therapy Association. APTA Physical Therapy Workforce Analysis. https://www.apta.org/your-career/careers-in-physical-therapy/workforce-data/apta-physical-therapy-workforce-analysis. December 2020. October 2021. 

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Sitting does not directly lead to low back or neck pain but can be an associated risk factor and contributing element to chronic neck and low back pain. The average occupational desk worker sits for over 8 hours a day. The sustained static and awkward seated postures contribute to increased spinal load and shear forces at both the cervical (neck) and lumbar (back) spine. It has been reported that 21-51% off office workers that sit for an extended period of time suffer low back pain. [4]

In this blog post I will be discussing the effects of a slumped seated posture has on the cervical and lumbar spine, standing desk set up and exercises that can help support your spine and posture to improve your endurance with sitting and standing postures.

“When we sit, there is an increase in the forces that travel to the disc and place greater stress on these and other lumbar spine structures. By focusing on trunk stability, active exercise, and time under tension we can create a natural brace that helps to decrease the forces that can cause injury. These tips and exercises should not only be thought of as treatment for an injury, but also as prevention for problems that may arise due to prolonged sitting. I applaud Dr. Megan O’Linn and MOTI for the recommendations and instructions to help prevent problems before they arise.”

Dr. Gene Tekmyster

Slumped Seated Posture effects on the Cervical and Lumbar Spine

The anterior to posterior reaction force at the lower neck and back was highest in the slumped position while sitting. Sitting with a forward head position and rounded low back places more demand on the extensor muscles to hold up the head and maintain an upright posture. It also impacts the joint space and creates more pressure on the disc which can lead to pain and inflammation from joint pain and muscle fatigue. [4]

Standing Desk Set Up 

In the below video I will walk you through step by step standing desk set up, monitor and keyboard position and work cycle settings for standing and sitting work periods.

Key take aways:

Monitor: Eye level or slightly below

Keyboard: wrists neutral, elbows slightly extended past 90 degrees and arms in line with your body; use a detachable key board if you are working on a laptop to allow for proper screen height

Lower body set up: standing- feet hip width apart, standing about a foot away from the computer. Sitting– hips higher than knees, knees at 90-degree bend and feet slightly wider than hip width apart.

Work Cycle: Change positions every 30 minutes, take a 10-15 minute work break after 3-4 work cycles

Exercises to help improve postural strength and endurance for the work day

1. Chin tuck for deep neck flexor endurance 
Perform: 3×10, with 10 second hold each repetition
Form: lay on back, pillow under head and knees bent. Nod your head downward by gazing your eyes over your knees and hold, then return head to midline looking at ceiling. Head should remain on pillow at all times and shoulders relaxed on ground.

2. Trunk Stabilization and breathing
Integrated spinal stabilization is the coactivation of the deep cervical flexors, diaphragm, pelvic floor, all sections of the abdominals and deep spinal stabilizers to provide spinal elongation and postural stabilization

         Perform: 4 rounds of 10 repetitions [1 second inhale: 2 second exhale]

Form: same set up as exercise 1, lightly draw rib cage in towards abdomen, belly button drawn down and lower abdominals engaging outward into pelvic bones. Bring legs up into table top position – knees over hips, slight external rotation of hips with heels inward        but not touching and toes pointing upwards towards your nose. Do not let low back or head arch. Abdomen should feel flat without doming. Breathing is in/out through the nose.

3. Standing T
Perform 3×10
Form: Hold the band in each hand, maintain abdominal activation and chin tuck from exercises 1 and 2, thumbs pointing back and arms in a 120-degree angle. Pull band back slightly, then return to midline while keeping shoulders out of ears. Do not let head drop or back arch when pulling band. Should feel muscles at center and lower shoulder blades.

• 

• 

4. Standing Y
Perform 3×10
Form: Hold the band in each hand, maintain abdominal activation and chin tuck from exercises 1 and 2, thumbs pointing back and arms in a 90 angle out to side. Pull band back slightly, then return to midline while keeping shoulders out of ears. Do not let head drop or back arch when pulling band. Should feel muscles at center and lower shoulder blades.

• 

• 

Perform each exercise 2x/day. Adherence to a 6-week program can lead to improved strength and endurance to maintain upright posture and reduce incidence of low back and neck pain. [5,6,7,8]

If you have any further questions or have been struggling with neck or low back pain, please contact MOTI Physiotherapy at either our Los Feliz, (323) 912-9166, or Highland Park, (323) 503-1414, locations. We would love to get you scheduled for a personalized evaluation with one of Doctors of Physical therapy that are movement experts and will help you achieve your goals! 

By: Dr. Megan O’Linn, PT, DPT, OCS, CSCS
Clinic Director MOTI Physiotherapy Los Feliz
Megan@motipt.com

References: 

1. Bontrup, C., Taylor, W., Fliesser, M., et al. 2019. Low back pain and its relationship with sitting behavior among sedentary office workers. Institute of Biomehcanics. Applied Ergonomics. 81.
2. Lis, AM., Black, KM., Korn, H. 2007. Association between sitting and occupational LBP. Eur Spine J. 16:283-298.
3. Mahmoud, NF., Hassan, KA., Abdelmajeed, SF., et al. 2019. The Relationship between forward head posture and neck pain: a systematic review and meta-analysis. Current Reviews in Musculoskeletal Medicine. 12:562-577.
4. Kwon, Y., Kim, JW., Heo, JH., et al. 2018. The effect of sitting Posture on the loads at cervico-thoracic and lumbosacral joints. Technology and Health Care. 26:S409-S418.
5. Falla, D., Jull, G., Russell, T., et al. 2007. Effect of Neck Exercises on sitting posture in patients with chronic neck pain. Physical Therapy Journal. 87:408-417.
6. Ekstrom, RA., Donatelli, RA., Soderberg, GL. 2003. Surface Electromyographic Analysis of Exercises for the Trapezius and Serratus Anterior Muscles. Journal of Orthopedic Sports Physical Therapy. 33: 247-258.
7. Rahimi, NM., Mahdavinejad, R. Hosseini, S., Negahban, H. 2019. Research Paper: Effect of Dynamic Neuromuscular stabilization breathing exercises on some spirometry indices of sedentary students with poor posture. Physical Treatments. Vol 9. Number3. 170-176.
8. Frank, C., Kobesova, A., Kolar, P. 2013. Clinical Commentary Dynamic Neuromuscular Stabilization and Sports Rehabilitation. The International Journal of Sports Physical therapy. Vol 8, Number 1. 62-73.

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