Mr. D presented to our clinic for a fitting in April with an unusual set of problems. He had suffered a severe right elbow fracture some years before and had multiple surgical interventions which had left him with an elbow that was blocked out of the last 30 degrees of extension leaving him with an effectively shorter right arm. Added to this, his shoulder was heavily wasted from disuse and his scapular stabilising musculature had all but disappeared.
On the bike, his main discomfort was central lower back pain when riding more than 50 km as well as some minor left knee pain and left hand numbness. Mr. D is a serious social rider who is aiming to complete Gran Fondo and challenge events.
Examination revealed a sticky right sacro-iliac joint, tight left hip flexors, a 5 mm difference between feet in the position of his 1st metatarsal joints and a corresponding 5 mm foot length difference with the right being larger. He had a small pelvic tilt of around 10mm caused by a poor spatial awareness issue being driven by his right eye. There was no structural leg length difference and functionally, apart from his shoulder and elbow, he had reasonable flexibility although poor off-bike stability. Active trigger point formations were found in his left hip flexor, right gluteus medius and left calf.
Once I had resolved his pelvic tilt and spatial awareness issues using our proprietary techniques, I set up his cleat position at BOFOPA ( Ball Of Foot Over Pedal Axle) +15 mm (with a 5 mm difference in the apparent cleat position on the shoe sole owing to the differing proportions of his feet). On-bike assessment showed that Mr. D was sitting extremely high and far too far back. This led to him over-extending both legs severely, causing abnormal recruitment of the gluteal and hamstring complexes. He had a moderate right hip drop but his back pain was almost certainly from the poor pelvis position on seat; not much to do with the stiff elbow in the end! Still, some experimentation showed that to relieve his shoulder pain and hand numbness, we needed to shorten the reach to the right hand bar by some 70 mm (20 mm or so horizontally and 50 mm vertically) in order to get him sitting squarely.
Mr. D ended up with Sofsoles Neutral arch support modules and a single cleat wedge under his right foot as determined by our patented foot correction testing protocol. Addressing the arm extension issue was next on the agenda.
A bit of work was necessary. I fabricated an alloy bar extender and fixed it in to the bar with dowelling and high-grade epoxy resin.
The resulting piece was not pretty, but is extremely effective as the before and after pictures show below;
Seat height and setback were corrected simultaneously, and Mr. D has so far been very happy and since many pain-free rides under his belt, a MUCH improved front end feel. He feels more stable and solid on the bike with greater steering control and new found confidence in steering stability. I was a bit nervous about the effect of the arm length compensator on his steering geometry, but so far, Mr. D has been extremely happy with the result.
