Bike Fit Guidelines For PTs: 4 Key Aspects Every Physical Therapist Should Check.
Cyclists often present with low back and neck pain, hip discomfort, or sciatica. Adding a few basic bike fit checks to your clinical assessment can help you identify when pain is reinforced by equipment setup. It’s easy to get some video footage of your cyclist next time they’re on a ride to quickly evaluate these four bike fit aspects that affect pain on the bike.
1. Saddle Height
Too high → hip rocking, hamstring over-lengthening, lumbar compensation.
Too low → posterior pelvic tilt, quad inefficiency, lumbar extensors overstretched.
PT Check: Knee angle ~145–155° at bottom of stroke, heel angle less than 20°.
2. Saddle Fore/Aft Position
Too far forward → quad overload, lumbar flexion stress.
Too far back → hamstring and lumbar overwork.
PT Check: Knee roughly aligned over pedal spindle when it’s parallel to the ground.
3. Handlebar Reach & Drop
Excessive reach/drop → demands high core endurance, often beyond the rider's capacity.
Too short reach/drop → can result in too much pressure on the hands and numbness or tingling.
PT Check: Watch for thoracolumbar collapse or excessive cervical extension.
****Note***- the image below is in regards to a road bike fit. There are some considerations that change when fitting a mountain bike. Download my Ultimate Bike Fit Checklist here to learn more about what a mountain bike fit should look like and the different considerations with road bikes vs. mountain bikes.
4. Saddle Tilt/Angle
Too nose-down → rider slides forward, resulting increased soft tissue friction, extra load on quad and increased lumbar strain.
Too nose-up → increased perineal pressure, posterior pelvic tilt, and lumbar strain.
PT Check: Start level. Adjust slightly (a few degrees) based on comfort and symptom response. Most saddle angles should fall between -1 to 1 degree.
If your patient has pain on the bike or after a ride, assessing bike fit should be an essential part of your treatment plan. Use these four checkpoints to start helping your patients feel better on the bike and make your physical therapy plan even more effective.
Next Steps:
Looking for a little deeper dive into bike fits, or for a reference for patients and clients? Download my Ultimate Bike Fit Checklist below👇
If you’re looking for a fully personalized, in-depth bike fit for yourself or your patients, I offer online bike fits! Click here for the Virtual Bike Fit Rx, a top-to-bottom bike fit that utilizes top end tech and clinical reasoning to provide bike fits to cyclists, wherever they may be.
