Biomechanics and Bike Fitting: Getting Low (Flexibility)

Biomechanics and Bike Fitting: Getting Low


The Flexibility Problem

The Internal Problem

The Hidden Problem

The Solution

Other Positional Changes That Might Help

Further Information

The Flexibility Problem

A cyclist will often feel unable to get into a low position on the bike comfortably. This will mean that the lowest hand position available (in the ‘drops’) will feel uncomfortable and only able to be used for short periods, if at all. The result of this is that the rider will be sitting upright more than necessary and creating more drag, meaning they have to put out more power to attain any given speed. In a sport where “aero is everything”, even non racers will benefit from reducing wind resistance. Bike fit can help to enable a rider to get lower but if the rider has intrinsic flexibility issues preventing them from comfortably using the lower positions for extended periods of time they are missing out on these benefits.

The Internal Problem

The issue that will stop most people from getting low on a bike is that it feels uncomfortable to get to, or stay in, the position. People will say that they feel their hamstrings, lower back or some other area is too tight to be able to comfortably drop down to a low position on the bike. To fix this, various stretches of hamstrings, hips, back etc. are often used to try to get more flexiblity in order to ride in a lower position for longer.

A common test of hamstring flexibility is called the Straight Leg Raise (SLR) test. This test is very simple – lie on your back and lift your leg (keeping it straight) and see how many degrees of movement you can achieve. As a guideline for cyclists, I like to see at least 70 degrees and would prefer closer to 90 degrees.

Wiggins great flexibility and biomechanics on a bike

Wiggo getting low!

As you can see from the picture of Wiggo above, in the low position he is pictured at the bottom of the pedal stroke his leg will be close to straight with a leg angle of close to 90 degrees from his torso. Therefore the goal should be to increase the range of motion in the SLR test, which would seem to be helped by stretching the muscles in the back of the leg and hip, right?

The Hidden Problem

However, often the problem is not what it seems! People who say they have tight hamstrings often have another issue that is causing it, which doesn’t get much attention in traditional approaches. As Biomechanics Coaches we will check the whole system to see if there are any issues and/or patterns that may be missed by standard muscle length or functional movement testing. The particular common issue that can affect a forward bending position such as the one we are discussing here is a tightness or tethering or the sciatic nerve. This nerve runs from the head all the way down the back of the body and if it is shortened or tethered (compressed or trapped somehow) it will cause a reflexive tension of the muscles when trying to stretch into a flexed position (such as touching the toes)

Here is a simple exercise to show that a feeling that is often mistaken for ‘tight hamstrings’ is actually a stretch in the sciatic nerve: Sit in a chair, then tuck the chin to the chest and collapse the chest, rounding the upper back. From here, straighten one leg until you feel the start of a stretch sensation in the back of the leg. Holding the leg at this point of a very mild stretch, now look up and lift the chest. You should find that the stretch in the leg either lessens or goes away. This proves that the sensation of stretch you felt when extending the leg was not a tightness in the hamstring, as the position of this muscle has not changed.

The Solution

slump test mobilisation sciatic nerve biomechanics flexibility

There can be a few reasons why the sciatic nerve is short or tethered, and it may not be the only issue that is causing problems – but if the stretch in the test above felt familiar it should help to mobilise the nerve. Often flexibility gains in a SLR (Straight Leg Raise) test of ten or more degrees are seen just by mobilising the sciatic nerve, and without stretching any muscles.

To mobilise the sciatic nerve, we perform the slump mobilisation. This is done by slumping forward as in the test above, moving the leg to the very first point of a stretch sensation and then returning the leg to the start position. Perform 12-15 repetitions on each leg, and repeat the whole thing 3x each side. DO NOT hold the stretch as this can cause irritation and damage to the nerve, potentially causing pain/tingling/numbness that can last for days!

Once the sciatic nerve has been mobilised you should find that the legs can move more freely, feeling less heavy and tight and you may notice comfortable pedalling cadence increases and the legs turn over nicely.

Other Positional Changes That Can Help

Due to the fact that the sciatic nerve goes all the way up the spine, we can help take some of the tension off the leg in the tucked position by arching the back. Think about pushing the chest towards the bars and getting long in the spine. This may require stretching or mobilisation of the ribcage area to be able to do comfortably. It may also require a change in bike geometry.

It also helps to slightly raise the chin, being careful not to hyperextend the neck. As a general guide, even in your low position on the bike you should be able to lift the head a further inch or two from your normal position and not be locked into end range of motion.

If You Need Further Information

As you can probably guess, this article only skims the surface of the long process of getting comfortable being in a low position on a bike. The process should start with the basics such as the mobilisation above, looking at all the joints and muscles in the body and ensuring everything is correctly aligned. The next stage would be to look at your position on the bike and adjust things based on your current physical condition and riding goals.

For a great start to getting optimal function, a Biomechanics Screen will help – with over 25 tests for muscles, joints and nerves throughout the body it gives a unique picture of where you have dysfunction and how to go about correcting it. For more details contact me today and start down the path of riding faster and more comfortably!

pec minor spasm posture biomechanics

Pec Minor Biomechanics

Pec Minor Biomechanics

This muscle can have large effects on the body, causing shoulder pain, poor posture and can even affect other areas. I have personally seen a leg length difference change after only working on the Pec Minor!

The Pec Minor when tight or in spasm pulls the shoulder forward and down, causing poor posture. This is common in people who do a lot of weight training, and also those who work at a desk.

A shortened Pec Minor puts the shoulder joint in a compromised position and cause cause tightness and a lack of mobility. Overhead lifting is certainly a bad idea unless the Pec Minor biomechanics function is normalised first.


pec minor spasm - active biomechanics london

A Simple Test

A simple test you can do is to lie on your back with your hands palm down on your stomach and elbows on the floor. From here you can either look at both shoulders one at a time, or (even better) take a photo from above your head to see the position of each shoulder. If one shoulder is noticeably further forward than the other, the Pec Minor is suspected of being the cause.

A Simple Solution!

If you notice one side is high on the previous test, you can try an anti-spasm technique to reset the pec minor muscle to its optimal state. Stand near a doorway in the position in the attached picture, and allow the arm to be gently pulled backwards - not into a stretch, just as far as it will easily go.

From here press the elbow gently into the door frame (use around 20% of your maximum strength) and hold this for 20 seconds. Release, then repeat 2-3 more times. If the pec minor was in spasm this will often be enough to reset it's tone and regain optimal length.

If there is no change, there are three basic possibilities:

  • The pec minor is short and needs stretching
  • Another related muscle is the actual problem
  • The problem is being caused by something elsewhere in the body.

If you are trying to self-treat at this stage, I suggest attempting to stretch the pecs. If this does not improve the issue, it may be worth getting checked out by someone!

Please contact me if you would like more information, or to book an assessment which will check not only pec minor biomechanics, but 20-30 more of the most common areas that cause dysfunction in the body, contact me today!

[ Pec Minor picture: "Pectoralis minor muscle and shoulder blade" by Anatomography - Anatomography (setting page of this image.). Licensed under CC BY-SA 2.1 jp via Commons -…/File:Pectoralis_minor_muscl… ]

Biomechanics and Bike Fitting: Leg Length Discrepancy

Biomechanics and Bike Fitting: Leg Length Discrepancy


The Problem

The Bike Fitter’s Solution

The Biomechanics Coach’s Solution

Why Do People Have Different Leg Lengths?

How Can I Fix A Functional LLD?

The Problem

A common problem amongst cyclists is that the pedal stroke feels uneven, one leg feels stronger, the pedal feels closer on one side or whichever way the individual expresses the problem verbally. The root of this feeling is often decided to be that one leg is longer than the other, meaning that either the shorter leg has to overreach or the longer leg doesn’t achieve a full pedal stroke. This Leg Length Discrepancy (LLD) may only be a matter of millimetres, but cycling is a sport of millimetres. The reason for this is that on a bike you are fairly locked into a certain position and doing the same movement pattern over and over – even a short ride of 2 hours will generally use somewhere in the region of 8-10,000 pedal revolutions – and therefore any imperfection in the position will become quickly apparent.

The Bike Fitter’s Solution

The solution to the problem of one leg being longer than the other is generally corrected by bike fitters by putting a shim (a thin piece of plastic or similar) under the sole of the shoe of the short leg, which essentially makes the short leg longer and corrects the problem.

bike fit wedges

This is a great solution from a bike fitting/extrinsic biomechanics (i.e. looking at how the body moves from the outside) point of view and sometimes can be exactly what the individual needs. A less hi-tech solution that can also be used is to lower the seat to the point where the shorter leg is no longer over-reaching, however this is less than ideal as it leaves the body being unevenly loaded on every pedal stroke. Many people would be able to tolerate this for short to medium distances though, and may never realise a problem exists.

The Biomechanics Coach’s Solution

A Biomechanics Coach will always start from the beginning so no matter what the problem is basic function will be checked. In this case, the Biomechanics Coach will not start by seeing one leg longer than the other and go from there looking for solutions. The BC will see one leg longer than the other and ask “Is this leg structurally longer than the other or just functionally longer, and if the latter can it be fixed?”

biomechanics LLD and bike fitting

As you can see from the image above, it is possible to have one leg longer than the other one minute, and reduce or eliminate the Leg Length Discrepancy (LLD) the next. The two images that are side-by-side above were taken 10 seconds apart. If the assumption had been made that the situation in the first picture was permanent, an unnecessary shim of around 3mm would have been added. This client may be able to eliminate the LLD in time once the function in the hip is corrected.

Why Do People Have Different Leg Lengths?

There can be many reasons for an LLD, only a minority are due to the fact that the bones in one leg are actually longer than the other. Most times where this is the case it is due to breaking a leg and the bone not setting in the original position. A more common problem is a rotation of the pelvis (which the legs are obviously connected to) causing one leg to seem shorter than the other. Ideally, every time we lift our leg there should be a small movement of the pelvis which helps the hip joint perform the movement without jamming up. If tightness, spasm or another issue prevents the pelvic movement not only will the leg seem a different length at rest but the movement pattern will be altered, possibly causing issues above or below the hip.

How Can I Fix a Functional LLD?

The good news is that a Biomechanics Coach will have a few tools available to address the issues that commonly cause problems in the pelvis leading to an LLD and often these problems can be completely fixed. Due to the fact that this basic realigning of the body (called the ‘Normalise’ phase in the Biomechanics Coaching system) is the first step in the correction of any problems – see here for an explanation of the basic system – I would always recommend a cyclist looking to feel more comfortable on his or her bike to see a Biomechanics Coach and get normalised before getting a bike fit and addressing the specific problems you have on a bike. If the body doesn’t function off the bike it is highly unlikely to function on the bike, and if apparent issues that are actually only temporary are treated with a permanent solution in a bike fit you may end up feeling less comfortable on the bike or even getting injured.


To arrange a Biomechanics screening, please see the contact page.

For a map of Biomechanics Coaches throughout the country, please see the ‘Find a Coach’ page on the Biomechanics Education site here


sports massage on recovery

The Effect of Massage on Recovery

The Effect of Massage on Recovery

This article is about the impact of massage on recovery, as measured by the Omegawave system ( The Omegawave takes an ECG standard reading of the heart activity and tracks heart rate variability and a host of other things. It then gives you a series of readings for Cardiac Stress, Recovery Pattern, Adaptive Reserves and more. The newer model will also track Central Nervous System activity through electrodes attached to the head and arm.

Omegawave measurement

The omegawave in action!


I and many of my clients use the Omegawave system to give feedback on the effects of everyday life and training stresses. This enables us to better adapt the training plan to take into account how the body is responding to the imposed stressors, both short and long term. Many things can make the various readings worse – a bad night’s sleep, a reduced calorie intake, a very hard training session or even the onset of illness.

Using the Omegawave means we don’t have to wait weeks or even months to see if our training is having a beneficial or a negative effect. This means we can make changes earlier and spend less time fighting against nature. Instead, we can work with the body and do hard training sessions when readiness is high and easier training sessions when things are less ideal.

This approach generally works well and enables us to miss fewer training sessions due to illness, injury or tiredness. However, in the example I am going to talk about in this article, a simple ‘do an easier training session’ or ‘eat a bit more’ approach did not solve the problem.

A Real Life Example:

A client of mine, Cindy, had done a week of cycling every day. She had then taken a few days off to recover and then done another couple of hard days on the bike. After a day off she took another reading, expecting to be recovered as usual. However, her readings still showed extreme fatigue, with an elevated heart rate and cardiac stress as well as a very bad recovery pattern. I am not sure the reason for the readings staying low – perhaps she hadn’t eaten enough, or maybe muscle soreness was playing a larger factor for her. Either way, I advised a day off training to help recover.

cardiac readiness before adaptive reserves before

Cindy later did a reading that showed a slight improvement, so she decided to train anyway at a very low intensity. However she found even this very easy (on paper) workout to be almost impossible to do without her heart rate shooting up, so she cut it short. A reading after the workout showed that her assessments had returned to ‘very poor’.

At this stage I decided to try alternative forms of recovery, rather than relying on just rest and food. I told Cindy that I thought a massage may be beneficial. I set up the massage table to do a relaxing form of massage therapy. I used techniques more suited to relaxation than my usual sports massage approach, using lots of long flowing strokes and only moderate pressure. I would classify this as more of a general massage that pumps blood and lymph around rather than a specific targeted treatment aiming at releasing certain muscles. This was the effect of the massage on recovery immediately after the treatment.

cardiac readiness effects massage on recoveryadaptive reserves effect massage on recovery


Cindy then got plenty of good quality food – lots of vegetables, high carbohydrate and protein with some good fats – and had an early night, and woke up in the morning with the following readings.

cardiac readiness next morning adaptive reserves next morning


And here are screenshots of the daily overview, showing the measurements throughout the day, after training and after the massage on the 6th, and the continued improvement on the morning of the 7th.

overview 6thoverview 7thomegawave readings of effect of massage on recovery

During the time after this event, Cindy resumed training at a slightly lower intensity and was able to recover adequately from this. However the next weekend she did a longer, higher intensity ride and the numbers dropped more than expected, showing that the recovery process was still ongoing and she was not back to 100% readiness. This time round, a day off and a slightly higher calorie intake was all that was needed to return her to a good Omegawave score.


I feel this shows the effectiveness of massage on recovery, as well as the need for correct nutrition and sleep for recovery from stress. Remember that stress can be caused by things other than training. Also, it is better to remove a cause of stress rather than be forced to do lots of extra things to recover from it. However, in extreme cases like this or after a big ride/run/game etc, massage can be used very effectively to return the body to a state where training is possible and beneficial.

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To book sports massage or biomechanics coaching services yourself in West London or Surrrey, contact me today by clicking the link: Contact Me

Great results with Rugby players in 1st Biomechanics Coaching session

In the last week I’ve done a lot of work with Rugby players of various levels, here are some of the highlights!

– Around 50% of the people got to totally clear on the basic screen within 1 hour, indicating that all basic dysfunctions have been fixed.

– One guy who had problems/pain with his shoulder and failed 4 out of 4 of the shoulder tests ended up passing all the shoulder tests….after 10 minutes of self-releases on his hip!

– Another guy who started with one leg over 10mm longer than the other walked out at the end of the session with no difference in his leg length and much less dysfunction and tightness in the hips.

– A girl who had back pain ended up pain free by the end of the first session, her hamstring flexibility also drastically improved.

These type of results are not out of the ordinary for one hour of Biomechanics Coaching, and unlike most other types of rehab/injury prevention approach you are given the tools to fix the problems yourself. All the above results were achieved without massage, without joint manipulation and without me even touching the person!

The next step on anyone that gets to the stage where they are passing the vast majority of the basic tests is to make sure that the results ‘stick’ and start building stability to support the new alignment of the various joints. The end result is a stronger, faster, pain free athlete who is able to perform consistently and efficiently!

If you are interested in getting a Biomechanics screen, please get in touch via the contact page and you too could be the next to get great results like the ones above.

Who Can Benefit From Biomechanics Coaching?

Recently a few people have asked me variations on the question of “I’m not injured, can Biomechanics Coaching benefit me?”

The answer is – yes, in fact that is the perfect situation! Here’s why…

The Biomechanics Coaching system is not about immediate pain relief (although some of the techniques can give great results for this too!) but it is about looking at the body as a whole and noticing and correcting patterns that are causing inefficient or faulty movement patterns. This will mean that the athlete is in a better position to be able to display strength, speed, fitness etc.

Let’s use a theoretical example – for instance, a rugby player who has problems with his  hamstrings. They always feel tight and he sometimes pulls a hamstring, but is generally recovered well enough to train again within a couple of weeks. This situation is far from ideal, but can be managed. However, if and when the injury is more severe he will be out for a much longer period, and find it harder to get back to peak levels.  In this case an ideal situation would be for him to consult with a Biomechanics Coach as soon as he notices there is something not right (regular tightness and minor tweaks in this case would be signs that something is not right). The Biomechanics Coach would then do a full screen on the player, finding any problems and giving him the tools to correct them with simple exercises he can do anywhere. In this example, he may just have tight hamstrings….or he may have problems with the sciatic nerve that runs down the back of the leg, or a tightness or weakness in the hip that is causing the hamstring to work harder than it should, or a spine stability problem…..and so on. Whatever the case, the player will have the information about the cause of the tightness and a proven way to improve the situation.

Another example might be a girl who plays tennis. Perhaps she is having shoulder problems, mainly on the backhand. She has seen a physio and got some shoulder strengthening exercises but still hasn’t got 100% pain free. If this person came to see me, as a Biomechanics Coach, I would not only look at the shoulder but also the feet, knees, hips and spine as well. The reason for this is that there could be many problems elsewhere on the body that could cause shoulder pain, and looking at the shoulder only may not get to the root of the problem. In fact it is often the case that a shoulder problem has its origins lower down the body, for instance in the hips (especially in a sporting environment where the legs are always involved as well).

The most shocking example I have heard along these lines is of a tennis player who had multiple surgeries to a painful shoulder with only minor improvements. He ended up visiting a Biomechanics Coach and becoming pain free within a few sessions by working on his….opposite leg! In this case, as with many that I see on a daily basis, the pain was not an indication of the root of the problem but rather just where the weak link in the chain happened to be.

Often as Biomechanics Coaches when starting to work with someone we have to go backwards to go forwards – meaning that the person wanting to be able to perform better in their chosen sport may be looking for a harder exercise or training program to get to the next level, when often the answer is to fix something seemingly minor that may be causing problems with every movement they make. To give you a visual idea of this, here is a ‘performance pyramid’ that Biomechanics Coaches use:

Here we can see that where we want to be improving is ‘Global Muscle Performance’. However, if there is a problem in ‘Core Stability’ our performance will be affected as we will not be able to get into position/stay tight/output as much power as possible with the global muscles. And further down the line, if we have problems with (for instance) muscle spasm, we may not be able to get optimal firing patterns to stabilise the core and/or perform at the higher levels. This may mean that to improve a skill such as sprinting for instance we have to go all the way to the bottom of the pyramid and reduce a muscle spasm or mobility issue in the hip, then build on top of the larger base our pyramid has.  In this way peak performance can be reached safely.

Biomechanics of the Knee and Common Knee Injuries

Knee Biomechanics


Knee Anatomy

What Can Effect Knee Biomechanics

– Incorrect Hip Function

– Incorrect Foot Function

– Weak Muscles In The Hip

– Imbalances Between The Muscles Of The Leg



A common place to have problems in the body, ranging from aches and pains to more serious injuries is the knee. These injuries can be sudden and seemingly come from nowhere like an ACL tear, or they can be wear and tear problems such as the wearing down of the cartilage inside the joint. But why do these problems occur and how can we help prevent them, or recover from them once they happen?


Knee Anatomy

The picture above shows the structure of the knee. If you’re mechanically minded, you will see it’s primarily a hinge joint, with potential for a bit of rotation, and some clever person has designed it with a nice pair strong strap down each side to keep it stable whilst allowing free movement. So what causes problems with it?

Knees. Vulnerable, especially to arrows…

The knee is effectively a passenger – no matter what it wants to do, it’s stuck in the middle of the leg between the hip and the foot and it pretty much has to go where they tell it to. The knee biomechanics are often dictated by other joints. This is fine if everything is working right, but what about it either the foot or the hip is in the wrong place, or even worse if both the hip and foot are trying to get the knee to do opposite things? Contrary to what you may think, knee pain is often not an issue of a problem with the knee joint. Long term injuries such as wearing away of cartilage are of course problems located within the knee, but even these are often a symptom of bad alignment of the knee for years. Most of the muscles connecting near the knee are concerned with flexing and extending, but when it comes to rotation and lateral movement the knee is often at the whim of the hip and the foot.

“Stuck between a hip, and a foot place”
(the other option for this picture was some kind of ‘stuck in the middle with shoe’ gag, so think yourself lucky)

What Can Effect The Knee Biomechanics

So now we’re seeing that the knee is often a downtrodden victim, bowing to the whims of the foot and hip, let’s see what commonly goes wrong with those areas. Here’s a quick list:

  • Incorrect hip function
  • Incorrect foot function
  • Weak muscles in the and hip
  • Imbalance between muscles of the leg

Incorrect Hip Function

The hip can often cause problems with the knee due to incorrect function causing the knee to be put in the wrong position, twisting and torquing which can cause excessive wear and tear or in extreme cases sudden snapping of the ligaments holding the knee stable.

The Piriformis muscle

The muscle to look at first for hip function is the piriformis. This little blighter sits right in the centre of the body, and can often protest about it’s tough working conditions by going into spasm. This can cause all sorts of problems within the body, but affecting the knee biomechanics specifically it can cause problems by transmitting stress that should be taken up in the bigger, stronger hip joint down into the knee. This type of problem will be all the more obvious if you perform repetitive impactful exercise such as running. To reduce spasm in the piriformis anti-spasm exercises, massage and stretching can be beneficial (usually in that order in terms of effectiveness)

Another major contributor to incorrect knee biomechanics and knee pain/injuries is if the foot is not working properly. The knee is delicately balanced on top of a stack of bones consisting of the shin (tibia/fibula), then the talus and calcaneus (ankle and heel), with a whole host of other bones in the foot held together by tendons, ligaments and muscle. The way it should work is that the weight is mostly supported on the heel when standing, and the toes are like controls, steering which way the whole unit further up. If there is a problem with the foot (collapsed arch etc.) the issue doesn’t just affect the foot but is transferred up the body. In this way a foot problem can be known to cause a neck problem in extreme cases! In some cases the foot may need support from orthotics or the ankle may need to be mobilised, but sometimes the foot function is affected by the strain of carrying too much weight. This is usually an issue of a hip weakness.

Weak Muscles In The Hip

As suggested in the previous paragraph, weakness in the hip can cause problems further down. The hip has some of the biggest and strongest muscles in the body, and has a large part in the side-to-side and rotational movement of the knee. These movements in turn can put more or less stress on the knee and foot.

Glute Max & Medius

The most commonly weak muscle in the hip is the Gluteus Medius. This muscle runs down the outside of the hip and when contracted in a side-lying position lifts the leg out sideways from the body. However this is not the major function in normal life. When walking, running or jumping, every time the foot hits the ground the Gluteus Medius (amongst other muscles) must work to stabilise the knee and prevent it from collapsing inwards. This is a very common problem for women especially, due to their wider pelvis causing a mechanical disadvantage for the gluteus medius. This ‘falling in’ of the knee puts a pressure on the surfaces of the bone that rub over each other, and can wear away the cartilage and cause arthritis in the long term.

Knee falling in due to weak glutes

The best ways to strengthen the gluteus medius are generally standing exercises such as squatting with a band around the knees providing something to push against, standing abduction of the leg (i.e. pushing the leg out to the side) against cable or band resistance, and various single leg stability exercises such as squats, reaches, deadlifts etc. I also like using more simple exercises such as clamshells (lying on your side and pushing your knees apart with band resistance) and glute bridges with a band (lying on back and pushing the hips in the air) in the warm-up in order to activate the glutes and get the mind-muscle link working. A stability band is ideal for this type of work.

Imbalances Between The Muscles Of The Leg

The last common problem that can affect knee biomechanics that I will mention is an imbalance between the muscles of the leg. This is less common that some of the others but can certainly cause or contribute to knee pain. The basic story is this – the muscles in the front of the leg attach to the front of the shin, the muscles in the back of the leg attach to the back of the shin. Therefore, is the muscles on one side are stronger or tighter than the muscles on the other side, they are able to create a pulling force on the knee which can move it out of optimal position. This means, similarly to the last point, that there is more stress on certain areas of the knee that are designed to rub together.

Great image showing how the muscles of the leg affect the knee

The solution to this is to strengthen the muscles that are weak and/or stretch the muscles that are tight. Again, I prefer to use as ‘functional’ a movement as possible for this so would prefer a front squat or a lunge to strengthen the quads as opposed to a leg extension, but some people could benefit from isolation exercises at certain times.

In Closing…

I hope this article has given you some ideas as to the wide range of factors that can affect the knee biomechanics and cause pain and injuries. As you can see it is a complex subject and this has only really scratched the surface, but the main take-home point is that it is often not just a problem at the knee. Often I see people running or playing sports wearing knee supports whilst still having incorrect biomechanics and movement patterns – this will not solve the problem long term and could even make things worse by making you reliant on outside aids to perform without pain. Please comment or ask questions below!

Hip Rotation Deficits And Lower Back Pain

Hip Rotation and Lower Back Pain

Here is an interesting study I found regarding lower back pain being related to problems at the hip. Read at least the bolded bits, and see underneath for my comments! :

Low back pain (LBP) is arguably one of the most common diagnoses treated by rehabilitation specialists. LBP constitutes a perplexing problem that can exact enormous human and societal costs, and whose successful evaluation and treatment continue to elude the efforts of those who care for these patients. A myriad of potential causes of low back pain exists, but evidence is mounting to support the possibility that low back pain may be a result of hip rotation deficits. Several investigators have reported that LBP may be related to hip pain secondary to limited range of motion in the hip.

Ellison et al sought to determine the prevalence of passive hip rotation deficits in healthy subjects (n=100) and those with low back pain (n=50). Researchers suggested that there was an association between those with hip rotation ROM imbalance and the presence of LBP. 48% of subjects with LBP had increased lateral rotation than medial rotation of the hip.

Vad and others investigated hip rotation deficits in a group of professional golfers to determine if these deficits correlated to LBP. LBP is the most common musculoskeletal complaint experiences by both amateur and professional players. Forty-two male, professional golfers were categorized as having no history of back pain or those with a history of low back pain greater than two weeks affecting play within the past year. 33% of golfers had previously experienced LBP. Researchers found that a statistically significant correlation was observed between a history of LBP and decreased lead hip internal rotation and FABER’s position distance, and lumbar extension loss.

Cibulka and coworkers investigated rotation deficits of the hip with those experiencing signs/symptoms suggestive of sacroiliac joint (SIJ) dysfunction. In one-hundred male and female patients with low back pain, unilateral hip rotation deficits were found to correlate with SIJ dysfunction. In those with LBP but without evidence of SIJ dysfunction, significantly greater hip external rotation than internal rotation bilaterally, whereas those with LBP and signs suggesting SIJ dysfunction had significantly more external rotation than internal rotation unilaterally. Specifically, the deficit was observed on the side of the posterior innominate.

In a case study, Cibulka describes the treatment of a patient who had signs/symptoms of a sacroiliac component of LBP. The patient described right low back pain and evaluation of this patient found excessive right hip lateral rotation and limited right hip internal rotation. Of note, the patient frequently crossed his right leg over his left leg. After restoring hip rotation and SIJ dysfunction via manual therapy techniques, the patient no longer complained of LBP. The case suggests that hip rotation asymmetry may contribute to the SI component of LBP.

Finally, Warren also described a patient case with SIJ dysfunction and concomitant asymmetrical hip rotation deficits. After six physical therapy visits focusing on stretching, manual therapy, and postural education, hip rotation ROM was restored and the patient resumed full-time work and golf without back pain.

Based on this summary of relevant research, it appears that evidence supports the relation of deficits in hip rotation to both LBP and SIJ pain. Specifically, it appears that a loss of internal rotation is implicated in these cases. Biomechanically, this finding in the physical examination is plausible. Using gait as an example, a decrease in hip internal rotation will not allow the pelvis to rotate over the stance limb, thereby limiting the coupling mechanics (a whole other discussion!!) of the sacrum and lumbar spine. Additionally, muscles in the low back, like the multifidus, will not achieve their normal length-tension relationships. Potentially, that could also be a source of low back pain. The lack of motion in the sacrum and low back may lead to degenerative changes and excessive compression of the facets on one side. The clinical significance then is that the therapist must screen every patient for hip rotation deficits in cases of SIJ or LBP.


Porterfield JA, DeRosa C. Mechanical low back pain: Perspectives in functional anatomy. 2nd ed. Philadelphia: WB Saunders, 1998.
Ellison JB, Rose SJ, Sahrmann SA. Patterns of hip rotation range of motion: a comparison between healthy subjects and patients with low back pain. Phys Ther. 1990; 70(9): 537-541.
Chesworth BM, Padfield BJ, Helewa A, et al. A comparison of hip mobility in patients with low back pain and matched healthy subjects. Physiotherapy Canada. 1994; 46: 267-74.
Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine. 1983; 8: 643-51.
Mellin G. Correlation of hip mobility with degree of back pain and lumbar spinal mobility in chronic low back pain patients. Spine. 1988; 13: 668-670.
Offierski CM, MacNab I. Hip-spine syndrome. Spine. 1983; 8: 316-321.
Vad VB, Bhat AL, Basrai D, et al. Low back pain in professional golfers: the role of associated hip and low back range of motion deficits. Am J Sports Med. 2004; 32(2): 494-497.
Batt ME. Golfig injuries: an overview. Sports Med. 1993; 16: 64-71.
Cibulka MT, Sinacore DR, Cromer GS, Delitto A. Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain. Spine. 1998; 23: 1009-1015.
Cibulka MT. The treatment of the sacroiliac component to low back pain: a case report. Phys Ther. 1992; 72: 917-922.
Warren PH. Management of a patient with sacroiliac joint dysfunction: a correlation of hip range of motion asymmetry with sitting and standing postural habits. J Man Manip Ther. 2003; 11: 153-159.
Ellison JB, Rose SJ, Sahrmann SA (1990). Patterns of hip rotation range of motion: a comparison between healthy subjects and patients with low back pain Phys Ther DOI: 2144050

Source: Low Back Pain and Hip Motion Correlation ~

This is one of the major issues that a biomechanics screen deals with, looking specifically at piriformis. To give a short background, the biomechanics screening process came about as Martin Haines (who’s been doing physio work for years with the likes of Arsenal and UK Athletics) noticed that the same problems were coming up again and again. Over time and through trial and error he also found the things that most commonly caused problems and also what worked to resolve those problems. This is a very powerful tool, to have a screen and then a specific technique related to that screen that has been statistically proven to have good results in improving the results of that screen. This means that it is possible to use the system and do a lot less fumbling in the dark with the majority of problems.

Anyway, two tests on the basic screen specifically test Piriformis/Hip Rotation, which is linked with pain and disfunction throughout the body if not working correctly. We don’t test so much for range of motion as per the study above, but more if the hip is able to function correctly or if there is muscle spasm. Another common symptom of the hip not working correctly is that it ends up stuck in a certain position, which can end up with one of the legs looking longer than the other. A lot of people prescribe orthotics for this ‘problem’, seemingly without knowing or looking into the fact that the leg length can be changed within minutes by releasing piriformis. In one of the pictures on the Biomechanics page you can see the difference in leg lengths achieved in 2 minutes by using anti-spasm exercises. This was using no massage or stretching.

How Back Pain Can Be Helped By Biomechanics Coaching

Back pain is never something expected or welcomed – instead it tends to sneak up unannounced – one day you’re going about your day, and the next thing you know you have constant pain to deal with. Perhaps you were at the gym, or work, or simply reaching for something or trying to put your shoes on at home and ‘BAM!’ – as they say in the world of pro wrestling, you’re in ‘a world of hurt’!

How back pain happens

I’ll start with my story…One day I was in the gym doing deadlifts (a great exercise for the back and legs, but one which can put a lot of stress on the spine). I was using a weight that was only 5 kilos heavier than last week, since I believed in trying to beat my previous workout every time….but that 5 kilos made all the difference!

Deadlifts – great exercise but use correct form!

I was due to do 5 sets of 5 repetitions, and even the first set was tough. After the first set I had a dull ache in my back which was fairly common for deadlift day, a sign that the muscles were being worked hard. After set two the ache had got worse and after set three I had to lie on the floor to be able to stop the pain, which was getting worse. Of course like all young and apparently invincible guys, I waited until I was able to stand with ‘not much’ pain and then proceeded to do another set! I had a target in my head and stubbornly pushed on until I’d hit it…..however, my workout was now over and I was barely able to stand – even sitting caused considerable pain.

I quickly learned a position that I would become very familiar with over the next few months (lying on my back with my legs on a chair) was pretty much the only position where I could be comfortable. Needless to say, this put my training sessions for the future somewhat on the back burner while I spent time and money trying to get pain-free in my back again!

The end result of this was that I was unable to train with weights for around 6 months, and it took well over a year to get back to my previous strength levels. The upside is that the research that I did during this time started me down the path to becoming interested in injury prevention/rehabilitation, but the downside is that it was likely entirely avoidable.

Lesson – If the hips are wrong, the back is under more strain

The hip and lower back

When I first saw the osteopath after my injury he found my pelvis was out of place. This is a common finding amongst people with back pain. One of the reasons for this is because the spine sits on top of the pelvis, with gravity (and whatever weight you are lifting if and when you lift weights) pushing down on it. Therefore if the pelvis is not correctly aligned, the spine will also be incorrectly aligned. There has to be some form of compensation higher up the chain in order to maintain weight distribution and balance. The good news is that it often it is possible to realign the pelvis by releasing tight muscles, and only in extreme cases will you need to be ‘cracked’ by an osteopath or chiropractor (see below for a common release for the hips)

Another common problem is that the hips are aligned properly at rest, but do not move as intended when walking/running/cycling/lifting weights/etc. The pelvis is designed to move a small amount as the hip flexes or rotates, and if this movement is restricted extra stress will be sent up and down the body in order to compensate for this. For example, the pelvis is meant to rotate as the leg is lifted in front of the body and if this rotation is limited the body will find another way to gain this motion. This additional motion will generally come from the lower back, putting strain on the soft tissue and disks in the area. Considering the virtually every activity involves lifting the leg in front of the body (running, cycling, jumping and many weight training exercises, for example) it is a high priority to correct this movement problem before performing exercise, especially at high intensities or prolonged durations.

Action – A simple release for the hips that can help back pain

As a Biomechanics Coach, one of the most common exercises I use to release the hips is called ‘4 sign’, a simple self-release exercise intended to release spasm in the piriformis and hip rotators. This will help the hips to move more freely, putting less strain through the lower back.

To perform the 4 sign exercise, sit in a normal chair and cross one leg over the other putting the ankle joint of the lifted leg on top of the knee of the leg that is still on the floor. Sit tall and in good posture and then put your hand/forearm on the knee of the crossed-over leg. Do not push the leg into a stretch, just let it fall to where it naturally falls to and then put the hand on top of the knee to hold it there. From this position, push the outside of the crossed-over leg’s ankle into the knee of the leg touching the floor at 20% of your maximal strength (in other words, a very small effort). Hold this contraction for 20 seconds and then release, drop the leg down, shake it out and relax, then repeat (or switch sides). Perform this exercise 3-4 times each side and you may find that the knee will now drop closer to the floor when the legs are crossed, which is a good sign!

See the picture below for a demonstration of the 4 sign exercise:


4 sign exercise


If you have back pain that doesn’t respond to the simple release above, there may be another cause and/or other treatment needed – to book in for a full Biomechanics assessment please visit the contact page

hoy pendleton cycling biomechanics

Biomechanics are essential, says GB Cycling Performance Director

It was great to hear in the news the other day that the Performance Director of the most successful cycling team that Great Britain has had in recent memory included Biomechanics as one of his fundamental considerations for success!

hoy pendleton cycling biomechanics

Here is an excerpt from the interview:

‘We have a small group led by Chris Boardman who look for the latest innovations in other industries and apply them to cycling.

‘You start by analysing the event that you want to win and then you give yourself priorities because you can’t win everything.

‘We look at the gap between where we are and where we have to be to win and then we create a plan and execute it.

‘If you break down everything that you need and improve every little aspect by 1 per cent then that can make a difference. Some things are essential – fitness, biomechanics, etc – others are less essential but can make the difference such as posture when you sleep, using the right kind of pillow.

‘Hygiene is extremely important because you are going to get ill a little bit less. If you put all these little things together you are going to improve.’

Read more: Londonicle-2184824/London-2012-Olympics-Victoria-Pendleton-event-sad-day–Dave-Brailsford.html#ixzz23AjitMVi

He echoes what I and other Biomechanics Coaches always say – the foundation of any training program, whether it is for a housewife looking to get fit or an olympic athlete going for gold is correct movement first. One should worry about correcting Biomechanics, exercise form etc early in the training/season in order to more safely and effectively perform at higher intensities. Whilst it is certainly possible to reach a high level of sporting achievement with incorrect and inefficient biomechanics, eventually the cumulative effects are premature wear and tear of joints, injuries and performance drop-off.