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Preventing Cycling’s Most Common Injuries, with Dr. Andy Pruitt

Dr. Andy Pruitt dissects some of the most common cycling injuries and how to approach prevention so you can stay healthy.

Dr. Andrew Pruitt Fast Talk Podcast

Pain, injuries, sores—they are an unfortunate but nearly inevitable part of cycling. If you want to be among the best, you need to wear them with pride. And if you believe that, then get out of the 1980s. Yes, this is a sport for the tough man or woman. But save being tough for that 20 percent climb, not for the aches, pains, and saddle sores you don’t need to suffer through.

In this day and age, most of the common overuse injuries in cycling can be addressed and prevented. It just requires the proper precautions—such as getting regular bike fits and doing off-the-bike strength work. (Here are our five favorite workouts.)

Today we’ll talk about the most common over-use problems and how to address them, including:

  1. What used to be the most common over-use injury—knee problems—why they are no longer the most common problem, and how it’s possible for most of us to go through the rest of our cycling careers without one.
  2. Back problems—these have eclipsed knee issues as the most common cycling complaint. Unfortunately, the cycling position is not kind to the lower back, but there are still things we can do to prevent pain.
  3. Saddle sores, numbness, and pressure issues, and how with the right saddle and fit most of these issues can be addressed.
  4. Just like the back, the cycling position can be tough on the neck. We’ll discuss.
  5. Feet and hands—many of us think that numbness is just part of riding a bike. But the truth is that if you’re experiencing numbness, something is wrong, and it can generally be solved.
  6. Finally, for those of you still clinging to that 1980s mindset, we’ll talk about just how bad it was then and why you want to get with the 2000s.

Our primary guest today is Dr. Andy Pruitt who has over 40 years of experience in cycling medicine and ergonomics. He is a bike fit guru who invented the Body Geometry fit system and continues to design ergonomic products for Specialized. He has seen every cycling injury in the book and, because of that, has literally written the book. It’s called “Andy Pruitt’s Complete Medical Guide for Cyclists.”

In addition, we speak with Evan Huffman of Rally Cycling, who shares some quick thoughts on the injuries he’s seen on his team, and what the team’s staff does to make that a short list.

Finally, we speak with Colby Pearce, a regular on our show. As a coach, fitter, and elite athlete, Pearce shares his thoughts on the common injuries he sees and what he does to address them. Colby zeroes in on one of the most important aspects of the bike — saddle choice and saddle position.

Primary Guests
Dr. Andy Pruitt: Fit guru and Specialized product designer

Secondary Guests
Evan Huffman: Pro cyclist
Colby Pearce: Elite coach

Episode Transcript

Intro  00:00

Welcome to Fast Talk, the Velonews podcast with everything you need to know to ride like a pro.


Chris Case  00:13

Hello and welcome to Fast Talk. I’m your host Chris Case managing editor of Velonews, joined as always by Coach Trevor Connor, whose ailements keep piling up. Pain, injuries, sores, they are an unfortunate but nearly inevitable part of cycling. If you want to be among the best, you need to wear them with pride. And if you believe that then get out of the 1980’s. Yes, this is a sport for the tough man or woman. But save being tough for that 20% climb, not for the aches or pains, saddle sores you don’t need to suffer through. In this day and age, most of the common overuse injuries in cycling can be addressed and prevented. Just requires taking the proper precautions; getting a regular bike fit, doing off the bike strength work.


Chris Case  00:13

Today, we will talk about the most common overuse problems and how to address them, including, number one, what used to be the most common overuse injury, knee problems. Why they’re no longer the most common problem and how it’s possible for most of us to go through the rest of our cycling careers without number two back problems. These have eclipsed knee issues as the most common cycling complaint. Unfortunately, the cycling position is not kind to the lower back. But there’s still things we can do to prevent the pain. Number three, saddle sores, numbness and pressure issues. And how would the right saddle and fit most of these issues can be addressed. Number four, just like the back of the cycling position can be tough on the neck, we’ll discuss number five feet and hands. Many of us think that numbness is just part of riding a bike. But the truth is that if you’re experiencing numbness, something is wrong, and it can generally be soft. Six and finally, for those of you still clinging to that 1980s mindset, we’ll talk about just how bad it was then, and why you want to get with the 2000s. Our primary guest today is an icon in the sport Dr. Andy Pruitt. He has over 40 years of experience in cycling, medicine and ergonomics. He has a bike fit guru. He invented the body geometry fit system continues to design ergonomic products for specialized. He has seen every cycling injury in the book and because of that has literally written the book. It’s called any Pruitt’s complete medical guide for cyclists check it out. In addition, we speak with Evan Huffman of rally cycling, who shares some quick thoughts on the injuries he’s seen on his team and what the team staff does to make that a very short list. Finally, we speak with Colby Pearce a regular on our show. As a coach fitter and elite athlete Pearce shares his thoughts on the common injuries he sees and what he does to address them. Colby in on one of the most important aspects of the bike, settled choice and saddle position. So put on your favorite gym. Relax your hands, your feet, your back. Let’s make you fast.

Trevor Connor  03:24

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Intro  04:05

We are sitting down today in the Specialized Boulder experience Center and home of Retool in Boulder, Colorado. The new campus that just opened up to the public. And we’re sitting here with Dr. Andy Pruitt. Many of you out there probably know him. He’s been in the industry in the science of ergonomics really for 40 plus years. He’s retired from clinical practice at this point, but he’s still working closely with specialized designing products and innovating in the ergonomic realm.


Dr. Andy Pruitt  04:40



Chris Case  04:41

So thank you for joining us.


Dr. Andy Pruitt  04:43

Happy to be here. Happy to be here.


Intro  04:45

Yeah, and today’s episode really is about those common cycling injuries that people get frustrated with that take some of the joy and beauty out of this sport that we all love. I think we’re here today to really say those don’t usually have to be part of this sport. Some people might think, oh, if my butt doesn’t hurt, I’m not riding hard, or I’m not a hard man. But that’s not true at all.


How to Avoid Knee Injuries, Some Advice From the Pros and Experts

Dr. Andy Pruitt  05:14

Right? I think that most likely injuries don’t have to happen. Right? They don’t have to happen if we do things right. But they still do happen.


Chris Case  05:22



Trevor Connor  05:22

So I think the one thing I have to add to this, this was an article when the first article articles I ever wrote for Velonews. And then Dr. Pruitt you actually did an interview for this article, was about knee injuries. And since I always have a couple people that interview for an article, so I interviewed a friend who was a massage therapist, and so in Europe for several pro tour teams thinking he would have all sorts of stories about dealing with knee injuries with-with top cyclists to that level. So I asked him, “What do you guys do about knee injuries?” And he said, “Nothing.” To which I replied. So you just let them have a knee injury, you don’t help them. He goes, “No, we don’t have guys with knee injuries, you don’t get to this level if you haven’t figured that out yet.” And then he gave me this good talk about the fact that none of this stuff is necessary. This is not an inevitability of cycling. And actually, if you’re having knee injuries, it’s because or other issues, so often, because you’re not doing the right things. And he said, “To get to the pro tour level, you have to figure those things out, you have to find those solutions.”


Dr. Andy Pruitt  06:28

I would comment that I still see a lot of pro tour riders with knee pain. I’m not sure if that guy was really, really lucky. Or because you can be a biomechanical 10 on your bicycle, you’d be perfectly fit. And you can still get what we would call an extrinsic injury, meaning that it occurred because of too much training too much terrian change, you know, too much power too much watt output. So you can get a screaming case of tendinitis. Being perfectly fit on your bike just by doing too much too soon, or iliotibial band is one of the most common, you know too much too soon kind of things. I would love to have a discussion with your soigneur, your friend.


Trevor Connor  07:07

So I will mention that his pastime is he goes and does dead lifting contest. So I really didn’t want to argue with him.


Dr. Andy Pruitt  07:15

Okay, then maybe we should do it on the phone.


Evan Huffman’s Pro Experience About How to Avoid Injuries

Trevor Connor  07:19

I caught up with Evan Huffman, a pro rider with rally cycling at a past winner of the Tour of the Gila, and the best climbers jersey at the Tour of California. We talked briefly about injuries at the pro level. Are there any injuries that you see on your team that seemed to be pretty common? Particularly I’m not talking about crashing injuries but more overuse injuries?


Evan Huffman  07:40

Not really. It’s a pretty healthy bunch. Actually. I think Mateo has some knee problems from time to time. I don’t know a lot about his process of I know he that was why he skipped Utah last year, he’s having some kind of knee issues. That’s kind of the only person I think it’s had problems.


Trevor Connor  08:00

So what do you guys do to avoid overuse injuries, because obviously, you’re on the bike a lot.


Evan Huffman  08:06

Our team is very unique in that we don’t have a shoe or saddle sponsor, which I think is really awesome. Because those are obviously three out of the five contact points on the bike and it can cause a lot of problems for people. So it can be a little more stressful to kind of find your own sponsor or buy stuff but I think in the end, it allows everybody the freedom to find a shoe and saddle it’s comfortable for them. I think that is a big part of it for sure, is just having a good fit on the bike and being in a position and getting the shoes and saddle setup just perfect so that you’re not going to create problems for yourself. I think stretching and massage helps a lot as well. Correct imbalances and just recover faster. Which is definitely a part of the pro lifestyle perk is getting massage during races. It’s really beneficial. But yeah, even at home or burning buddy stretching, core work is really good as well. Don’t have to go crazy and get like a 90 minute massage every week or a couple times a week. I think just you can just set aside 15 minutes after most workouts to stretch. I think that helps a lot. I can tell when I don’t do it. I feel a lot tighter on the bike the next day it takes longer to warm up.


Trevor Connor  09:29

Alright, let’s get back to the show.


The Most Common Cycling Injury

Chris Case  09:31

Well, why don’t we get into and you have a little story thing I think for us at this point about what is the most common cycling injury out there. I guess there in the past has been some debate but maybe maybe you have a story for-


Dr. Andy Pruitt  09:47

Well, if you were to ask me what the most common cycling injury is, asked me that question 30 years ago, it would have been blatantly knee, right? No question. No doubt in my mind would have been the knee was the center of the injury universe but if you think about 30 years ago and 40 years ago, the equipment changes were happening so rapidly that a lot of things especially medicine couldn’t keep up with them. So if you think about the invention of the clipless pedal, first the black look cleat, actually, Gianelli made the first clipless pedal, but nobody remembers that one. It was a manual lock, it was, think about the last bolt on your door, and you do that manually to each foot. So maybe those never-


Chris Case  10:27

That’s kind of scary.


Dr. Andy Pruitt  10:27

-they were not a marketing success. But the black look cleat was in 1983 and 84. And it created an epidemic of knee injuries. The same engineer that had developed the black look system felt so badly about what he had actually done right in creating these knee injuries. He switched companies with the time and created the time system, which eliminated many of the injuries that the look system had started. But it created its own set of injuries, we actually begin to nickname injuries after which pedal system that people were writing and then other pedal systems have had I don’t want to call those two out as bad because they’re not. But they did create a whole epidemic of knee injuries. So if you were to ask me this question, those decades ago, it would been blatantly the knee. But the advances actually, another little caveat was that we were actually inventing and creating surgical techniques to treat the knee injuries created by these pedal systems. Those surgical techniques today, if you ask a young orthopedic surgeon, he’s never heard of them. Because we really eliminated much of the knee issues with fitting solutions and understanding the real biomechanics of what happens when we actually fastened somebody to a bicycle. So interesting enough, I was asked that same question by somebody from the UK last week. And the question was asked to me and Todd Carver, one of the founders protege of mine, one of the founders of Retool, they asked us both the same question and I habitually said knee, and Todd said “I think it’s back if you look back at a chapter you and I wrote for the Olympic Committee about the epidemiology of cycling injuries gee low back was the number one thing listed.” So um-


Chris Case  11:54

It’s just habit that you say knee.


Dr. Andy Pruitt  12:07

It was yeah you know they say with Alzheimer’s you last thing you lose your your old memories, so I ever still remember 30 years ago. Anyone I don’t want to make fun of Alzheimer’s but the there’s been a significant seismic shift in cycling injuries for sure. Especially the overuse the overuse kind and I would tell you that fit and fit solutions, pedal system choices, cleat choices, cleat, wedging arch support are ergonomically designed shoes, saddles, oh my gosh saddles have changed the way people sit on bicycles significantly. So there’s been a lot of solutions created by the industry that have eliminated a lot of what we used to think of as common cycling injuries.


Chris Case  12:50

Now, that’s not to say you’ve eliminated knee injuries in the sport, what what types of knee injuries are you still seeing?


Dr. Andy Pruitt  12:56

Well, the number one athletic knee complaint regardless of sport, is some kind of patellofemoral you know, pain behind your kneecap. Patellafemoral, malfunction dysfunction. Some people call it chondromalacia, depends on how old the orthopedist is that wants to name it for you, but it’s really a dysfunction compressive or mouth tracking dysfunction of the patella on the front of the knee. And it is again, a running injury, i’s a jumping injury, it’s a cycling injury. It’s really the weak link in the knee design, if you will. The ACL aside, that’s a whole nother kind of knee injury that doesn’t happen in cycling, but the patellofemoral joint is the achilles heel of, of that particular job.


Chris Case  13:40

Why do you say it’s a design flaw, so to speak, what what’s going on?


Dr. Andy Pruitt  13:45

The the knee is a very interesting design as a very complicated joint. Most people think of it as a perfect hinge joint, but it’s not. It swivels as it bends. The patella is the fulcrum in this lever system. It is so the compressive forces of the patella are really what help you create the power that you that you lay down on the pedal. So it is a compressive force and a shearing force, right. So as the quadricep and all the other muscles contract to push down the pedal, the kneecap is pressed into the front of the femur. The femur is moving behind the kneecaps, we get the shearing forces. So it’s a combination of compressive and shearing forces. Now, those articular cartilages are absolutely designed for those combinations of forces. The flaw annoyment primarily comes at the joint above and below the knee right? So the knee is the victim. The culprit is could be the fit, the foot or the hip, right. So the knee is trapped in the middle. We’re strapped down fasten to the pedal and if you sit on your saddle, right, you’re fairly attached to it as well. So he is in the middle trying to produce all this, all this policy.


Trevor Connor  14:55

That is one of my favorite expressions that you gave me that I used in that article. Which is the knee is a victim.


Dr. Andy Pruitt  15:02



Trevor Connor  15:02

So unless you get hit by a car in the knee, usually the problem doesn’t start at the knee, it starts elsewhere and spreads.


Dr. Andy Pruitt  15:09

Correct, the solution is elsewhere.


Trevor Connor  15:11



Dr. Andy Pruitt  15:12

Right. The solution is elsewhere.


How to Avoid Common Injuries

Chris Case  15:13

Yeah, let’s, let’s talk about that solution.


Dr. Andy Pruitt  15:15

Sure. So if the if the knee is tracking well, so if you were looking at a rider coming at you in a slow motion video, the perfect knee tracking is that knee is tracking vertical, right? It’s moving up and down in a vertical plane. But even if you watch the tour on TV, and you see some of these guys with the knees moving in a figure eight or excessive moving media laterally, I guarantee you, we can help them and we can improve their power transfer by getting that need to move more more linear. So that’s how the cartilages are designed to work. And the muscles and ligaments and structures around the patella, are all trying to maintain it in its groove. Right. So I talk to people about the muscles and tendons and connective tissues around the knees is like the reins of a horse bridle. So if you pull on the right rein, the horse’s head moves to the right, you put on the left, right and move to the left. Well, if we don’t have our tissues in balance, then that patella is going to move right or left inside that groove. And those lateral stresses are really what not was what the patella is not designed to absorb. So it’s designed to absorb vertical, and shear and compressive not lateral movement. So by using shoe, pedal, cleat, and arch remedies, but we strive to get that knee tracking as linear as possible.


Chris Case  16:41

Are there other things like physical therapy and exercises people can do to and bike bit to help with these issues?


Things to Help You Recover From Your Knee Injury

Trevor Connor  16:49

Just going to share a quick story because I had an athlete this winter that had that issue with it. He was getting a huge amount of pain behind his patella. He had flown out here to do a training camp with me. So we were we were riding here in Boulder and on the second day, his knee started hurting so bad. He thought he had to quit. He was upset because he had flown out here he wanted to do a camp in Boulder and didn’t think he could continue and asked him to describe the pain and just said, “aye I think you you put your saddle too low after you rebuilt it from the plane.” He’s like “No, I put it in exact same spot.” I’m like,” Look, just raise it two millimeters” and said, “tonight really stretch your quads really stretch your hip flexors.” He did all that he didn’t believe it. He didn’t think he’d ride the next day goes out the next day. He’s like, “It’s not so bad.” The day after that. No pain.


Dr. Andy Pruitt  17:35

Yep, yep. So the answer to the question, there’s yes, there are mechanical solutions, static solutions, such as an arch support or pleat wedge or appropriate shoe, whatever. And then there are more dramatic or more dynamic solutions, which would be stretching, right to get those tissues in balance. Espeically when your stretching, you’re stretching your quads, stretching your hamstrings, tight hamstrings, you think about where they attach around the knee tight hamstring actually pulls the tissues on the front of the knee more and more tightly. Right? So yes, stretching, hamstring, stretching your, your quadriceps, all those things very important. Strengthening. So depends on what sport you came to cycling from, you may have developed a set of muscles that were great for inline skating, but not so great for vertical pedaling of a bicycle. So you may have developed the lateral quad versus the medial quad. So getting those getting your strength and balance around the knees is crucial. Bike fit, wow. Yes, saddle height and saddle for aft can dramatically change the compressive forces at the knee. Absolutely. So I used to say that with a handheld goniometer that about 30-


Chris Case  18:49

Explain what a goniometer is for those out there..


Colby Pearce  18:52

That’s an old Egyptian tool, like a plumbob that measures joint angles. Handheld, you know, like a protractor, if you will, that’s a different way to look at it. But 35 degrees of knee flexion at dead bottom center would give us adequate safety around the knee. And then you go look at the pro tour guys and they’re riding closer to 40. And you’re looking at some older people with patellofemoral pain or arthritic knees are running closer to 20 degrees at dead bottom center. So that that sweet spot is somewhere between 20 and 40. I remember going to a orthopedic meeting when I was in practice. And there was a pamphlet about bike fit, written by a bunch of orthopedic surgeons, I thought well this will be interesting. And they said that the appropriate saddle height was to be set where the knee was at 20 degrees of knee flexs on dead bottom center. And it was obviously aimed at patellofemoral arthritic sufferers, because the patella really is no longer in contact with the femur at 20 degrees, right. The patella becomes free floating. If you take, you straighten out your leg, you can take your kneecap and move it all over the place. So it’s about 30 degrees before it really begins to settle into its groove. There’s a fat pad behind it to protect it. So I would tell you that if we tried to set a serious cyclist saddle at 20 degrees of knee flex at dead bottom center, he’d have saddle sores, he’d have hamstring pain, and he’d have no power. Because the patella is no is an ineffective fulcrum at that height. So professional bike fit is exactly what has eliminated and diminished many of the knee injuries that we knew in the past.


How Important Getting a Bike Fit Is

Trevor Connor  20:26

So this is nothing. For us, nothing new that we’ve been saying all the way along we’ve had you on the show for this before is, when you’re looking at best places to spend your money, go get a good bike fit. And I think that’s we’re gonna go through all these injuries. And I can tell you right now the answer to almost every single one is going to be bike fit.


Dr. Andy Pruitt  20:46

But the bike that’s a big, big thing, it’s not just your saddle height and your settle for often where your handlebars are. So bike fit, to me, it has to be done in all three planes. If you think about the side view, right, that’s the X & Y plane. And that is what bike that was historically, before it got scientific, it was all on the side view, the Z plane is where we really eliminate that’s the front or back view, that’s where we really eliminate hip knee ankle stresses. When we get to talking about low back pain, that really, that can be an X, Y solution. But it’s also a Z solution. So if you’ve got some issue at the foot, or at the saddle, which is causing you to sit slightly crooked on your bike, right, that’s gonna create back pain, that won’t be seen from the side view. That’s gonna be back pain that’s solved from the X, from the Z plane from the front view, or the rear view, looking at how that pelvis is actually sitting on the saddle.


Chris Case  21:44

That brings a question up in my mind about breaking bad habits. And I’m sure you’ve dealt with a lot of people that have had bad habits, if they could just change them, they’d be fine on the bike, do- have you come up with any good ways to persuade people?


How to Break a Bad Habit on the Bike

Dr. Andy Pruitt  21:59

So bad habit habits are tough to break, right? Sure, easy to develop hard to break. I developed a bike that philosophy, which was to make the bike look like you that day, there’s a reason you came to see me. Crotch pain, back pain, knee, whatever it is. So we want to solve that issue. We’re going to make the bike supportive of you that day, and carry on. And then the physical therapy world kind of said, No, no, no, no, we need to correct all these things. So you don’t need that wedge in your shoe. With, the truth of matter is it’s really ought to be a progressive process, right? So you make your initial bike fit to solve those issues. So they can continue to ride, identify those issues, and then their address them off the bike. If it’s hamstring flexibility issue, and they’re asymmetrical, right so that we can fix that with bike fit, to make you comfortable on your bike. But we also should address it off the bike so that you can get symmetrical flexibility. And then does that cleat change we made? Does it go away? Sometimes, yes.  Sometimes no. So I totally agree there, that off the bike issues need to be addressed not just bike fit.


Chris Case  23:14

And that’s another reason why and this isn’t just to make more money, but you want to get not just one bike fit in your life, but like fits repeatedly.


Dr. Andy Pruitt  23:24

Well, yeah, I mean, that’s it’s such a hard sell. I don’t know why I’ve been doing this for two years. And I’m still baffled while why bike fitting at the highest level is such a hard sell. So I was developing this big philosophy and teaching it in schools and thousand bike fit students a year globally. And we did the research and finally realized we were reaching about 7% of cyclists.


Trevor Connor  23:48



Dr. Andy Pruitt’s Push to Educate Athletes on Bike Fit

Dr. Andy Pruitt  23:48

With that level of fit. So my whole pendulum has swung to doing things creating product or techniques or philosophies to engage 90% of cyclists. And so I used to have this philosophy that never do a partial fit, right? Because how do you stop somebody say, “Well, I want number two on your menu and it’s just gonna be an X-Y fit. I don’t want to I don’t want that z plane thing that’s expensive.” And but you’re looking at them going, “Well, I can’t fix X&Y if I don’t scoot around into the front and look at the Z.” So but my my whole pendulum has swung and I don’t want to do a plug here. But with Retool. One thing we’re driving for is people to be able to walk into a bike shop and very accurately know starting saddle height, the bike size, stem length, shoe size, arch height needs very quickly and very easily. So that maybe they’ll get-


Chris Case  24:45

Inexpensively I suppose.


Dr. Andy Pruitt  24:47

Inexpensively if not free. So if they get a taste of what scientific data bike fit can afford them, then hopefully they’ll come back, right. So and come back and get the rest of it addressed. If they can see what a saddle choice difference can make to them, maybe then they’ll be interested in what their shoe choice, arch choice, stem length, all those different solutions that we have that are in our, at our disposal, what can be done. And so that whole pendulum swung from all in all, or nothing bit fit, to, let’s do some simple pieces of it first. Make more people on bikes happier. So maybe 90% of people have actually had at least a part of their bike fit solved.


Chris Case  25:33

That’s a lofty goal.


Dr. Andy Pruitt  25:34

It is.


Chris Case  25:36

That’s how you that’s how you operate though right?


Dr. Andy Pruitt  25:39

It has been most of my-yeah, yeah.


Trevor Connor  25:41

So one of the neatest stories I’ve personally seen is that athlete who I had here in Boulder in the winter, part of it was to bring him into having bike fit.


Dr. Andy Pruitt  25:50



Trevor’s Own Injury Experience With His Athletes

Trevor Connor  25:51

And do all the testing on him. And they ran a he had had an issue that we could not solve that when he was in a race, he kept getting popped in races where there was a lot of tacking, and he had to keep standing up and keep standing up that he would just all of a sudden he would have no power, they would ride away from them. And then he would sit down and time trail at 320 watts and and keep pace with them. But he couldn’t handle the attacks. And we were trying to figure out with is training. When we brought them in, they did a glycogen scan on and discovered his one, I think it was his left hamstring, was just chronically glycogen depleted. And when they talked to him about it, he had broken that leg about three years ago. And it hadn’t quite healed, right that was affecting his fit. And without I’m trying to remember all the details. But basically, this was causing them to constantly be glycogen depleted in the hamstrings. And when you stand up to sprint, you recruit your hamstrings a lot more, he just didn’t have strength. So that was actually we were able to do things with his bike fit and his training once they realized that to solve that issue, and now he doesn’t that hasn’t happened to him in races, and you would never think fit for something like that.


Dr. Andy Pruitt  26:59

Oh, I think that every time. So I mean, I yeah, um, I think that every time somebody has a complaint. So you know, nutrition, hydration, fit training, they all interplay on each other, I’m convinced.


The Second Leading Bike Injury: Lower Back

Chris Case  27:13

Is that a good place to jump to lower back pain? Because I think that is the other major, and perhaps the current leader of common bike injuries.


Trevor Connor  27:25

As Dr. Pruitt stares at me.


Chris Case  27:28

Yeah, well, your back is a whole different subject. That’s a chapter in and of itself.


Trevor Connor  27:33

I still remember you did an MRI on my back. And I said, “So how does it look?” And you just said, “You look like you’re in your 40’s Trevor.”


Dr. Andy Pruitt  27:40

That was probably a compliment at the time. That back looked a little older than that. But, so let’s talk about healthy backs. That hurt when you ride a bike.


Trevor Connor  27:52

Okay. I need to go to the bathroom, call me when-


Dr. Andy Pruitt  27:56

No, I mean, so even the healthiest of backs can be so uncomfortable on a bicycle, right? So your saddle height plays a huge role in back pain. So if your saddles too high and you’re kind of waddling on the saddle, somebody has set your saddle at a place that looks safe for the knee, but maybe too high for you causing you to rock or to waddle. We’ve all seen them on group rides, that can be a very healthy back that gets muscular back pain from that position. Or the same guy has, he wants his bicycle to look like his heroes, right? So if you look at the tour, all there’s rarely a stem that has a spacer under it.


Chris Case  28:37

They’re slammed.


Dr. Andy Pruitt  28:37

They’re slammed, but you gotta remember that maybe that’s a custom head tube for that guy. So-


Chris Case  28:43



Dr. Andy Pruitt  28:43

If he bought his bike in the store, it may have one or two or more spacers. So, handlebar drop and reach, combined with saddle position, are really going to be the easy solutions to solving back pain. The thing about vax is, is that they’re meant to curve in opposite direction than we lean on a bicycle. So the low back is actually curved in what we call lordosis. Right? So it’s kind of the arch in your back. And what do we want to do on a bicycle? We want to flex forward as far as we can, it really puts a stress on those tissues that really want to be the other direction. If we’re thinking about historical equipment changes, again, we have now designed saddles that don’t necessarily feel like two by fours that you’re sitting on or a fence rail. So we used to sit on a saddle, it was probably too narrow for us. And the reaction to that to avoid pressure on your genitalia is to rock your pelvis back even farther. And then you’re still trying to reach the handlebars. And that combination puts us in a reversed curvature of the low back. So most low back pain on a bike in a healthy individual is tissue stress is because the tissue is being placed in a position of which they’re unaccustomed. And over time on the bike, things begin to tighten up and become uncomfortable for you. So then you’ve got the individual who has some degenerative disc disease, right, so just some aging discs in the low back. So that vertebrae or these bony legos that snap together at these little facettes, these little faces in between the bony legos are jelly filled doughnuts. And the jelly filled donut is actually hyper inflated, right? So you get 10 pounds of jelly and a five pound donut, right? So it’s overinflated and that’s what gives the disc life, gives it dynamic life. But if we, form that disk by forward flexing on the bicycle, that is like popping a pimple, that disc material is gonna move to the back part of that disc.


Chris Case  30:48

Your grossing me out with doughnuts and pimple talk.


Sylvain Chavanel’s Back Recovery Story

Dr. Andy Pruitt  30:51

But do you see it in your mind? So how many people are listening to this have ever gotten off their bike and had trouble standing up? Because the back just won’t stand up. And what’s happened is that the disk has deformed to acclimate to that cycling position, that disc has changed its shape. And now you want to stand up and you’re gonna you’re forcing that disk to reshape into its normal mold, extended periods of time where that disk is being forced out of its normal shape, it might actually begin to leak. Right? And that’s so that’s kind of what happens with disc disease is that is the discs begin to donut cracks begins to leak out the the substance or the jelly. So that aging back or that even even 20 year olds can have disc disease. That’s that’s a slightly different story than the healthy back that just needs a quick backup. So that degenerative back needs physical therapy. Absolutely. 100%, and he needs a close eye on bike position. Absolutely. So there were, were very kind of different things. So my great, dic story was  Sylvain Chavanel, when he was riding for Quickstep, we were at the November camp. Sylvain showed up 10 days after diskectomy and he comes to his bike fit session ready to rock and roll. 10 days post diskectomy and he couldn’t touch his toes. He could barely touch his knees. I mean, this guy was he still had steri tapes on, his stitches were just out. And I said so on your your back patient said I am a professional. I cannot ride the bicycle with four centimeters of spacers. I cannot do it. As, we had a piracetam, four centimeters of spacers. And that’s the only place he was comfortable in his current state, right. If I said you’re not a professional today, you are a post operative back patient today. I gave him four physical therapy goals to reach with every goal he reached, he could take out a spacer. Okay, so he liked this right. He had goal, right. The bottom story is is that in November, this happened and in March, he won the three days of DuPont. And he wanted the last day in the penultimate time trial. So here’s a guy who has known this disease. And we put him in a corrective position made the bike look like him that day. And then as he reached his physical therapy goals, he was able to acclimate back to his original professional position right.


Chris Case  33:22

Hardman position.


Dr. Andy Pruitt  33:23

At Hardman position. And you know, here we are, what, 60,90 days later, he wins a really hard stage race, but he wins it in the TT position. So I my reasoning for that story is there are times when your bike position needs to change. And hopefully that’s temporary.


Chris Case  33:41



Dr. Andy Pruitt  33:41

Whether that’s saddle goes up because of patellofemoral pain, saddle goes down because of a hamstring injury, handlebars come up, stem gets shorter, whatever it is to accommodate for a backer shoulder, and then with the right work, you can gravitate back to that pro-position.


Chris Case  33:56

You can put your ego aside for the short term for-for long term gains.


Dr. Andy Pruitt  34:00

Hard to do


Chris Case  34:01

Hard to do.


Dr. Andy Pruitt  34:03

I’ve had a lot I’ve got lots of stories I can tell. But Sylvain’s was public. That’s why I can use his name and tell you that story. His was, that battle was very public.


Is the Solution to a Back Problem Stretching?

Trevor Connor  34:12

So one thing I will add in terms of dealing with a back problem from a lot of experience is I do see athletes who think the solution is to do a lot of stretching. And I personally think that can be a mistake because often those muscles are tight because they’re protecting the back.


Dr. Andy Pruitt  34:28

So, flexibility and strength need to go hand in hand.


Trevor Connor  34:32



Dr. Andy Pruitt  34:32

So I thought another story? We were just introducing professional bike fit to the pro tour with the Saxo Bank Team. And Cancellara was the world time trial champion at the time, we thought what a great poster boy this will be right? So I put him through the whole body geometry fit process of time. And his preferred assessment showed us that the guy is so flexible. He’s like a gymnast like Gumby. And we go through the whole fit process. He looks great on his bike and kind of talking to look, you don’t have to lock your elbows out this new position you can settle in, and everybody’s happy. He moved to the next room where they’re gonna do a photoshoot with him about bike fit. And we kept on working with our athletes so we weren’t monitoring what he looked like to the photoshoot. So in the photoshoot, he immediately reverted back to his locked elbows. His core strength was so weak. He the reason he could, he’s so flexible, he can fold himself up into that TT position. But he doesn’t have the structural strength. Right. So he depended on the forearm pads and those things to hold him in place on the road bike in a relaxed position, he’s totally elbows locked out holding himself up without the so bike fit didn’t solve his flex over flexibility, lack of core strength solution. So Trevor, you’re right on the money.


Trevor Connor  35:52

Yeah,I do. I used to do a lot of stretching. I still like to stretch it, but it’s much more work on the core that my back is bugging me, I go to the core work, not the flexibility work.


Dr. Andy Pruitt  36:03

And so when you think about core work on a bicycle, we’re not talking about six pack abs here.


Trevor Connor  36:08



Dr. Andy Pruitt  36:08

Right. It’s not the torso flexion muscles that we’re after the torso extension muscles we are after. So it’s so it’s plank, side plank. If a cyclist didn’t do any else, anything other off the bike plank and side plank. They don’t do anything else off the bike plank and side plank.


Trevor Connor  36:26

Yep. And I know when my back goes out, I tried to do a plank I can’t last 20 seconds.


Dr. Andy Pruitt  36:31

Pain is amazing strength dissolver.


Chris Case  36:40

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Chris Case  37:12

The next topic that we might want to dive into is a, one that gets talked about a lot. It’s one that I think is well associated with cycling because of that hardman attitude that a lot of people have and it’s saddled pain and all the issues that go along with that. Should we talk-


Chris Case  37:32



Chris Case  37:32

Saddle sores?


Saddle Sores and Other Cycling Injuries

Dr. Andy Pruitt  37:34

Well, so there are saddle sores, which is to me is a skin eruption of some kind, right? So the skin eruption can happen at a hair follicle. So with all the friction and today’s grooming techniques, the hair can get sheared off at the skin, and then we add it add friction to it and bacteria. So we can get a actually an infected hair follicle. So that’s a that’s a skin issue. That’s treat, treat it like acne, if you will, and works works pretty well. We also get pressure sores. So when we pressurize skin, we devoid of capillary blood flow and it’ll get a little necrotic or little dead and it’ll create an ulcer. So you can get it you can actually get an ulcer like like a bedsore, right and you get a bedsore on the back of your heel. If you’re hospitalized too long, or in your bottom. We can get an ulcer in the in the crotch from from saddle pressure. That’s definitely hard man disease. I’ve seen some of those as big as dimes and quarters that that in the middle of Grand Tours that-


Chris Case  38:37

Yeah, we don’t we don’t need you to spear the story.


Dr. Andy Pruitt  38:39

Ya know what, I got him on my phone, you want see- no.


Trevor Connor  38:42

I’m gonna post this on the website. He really wants to look at.


Chris Case  38:46

Here’s my grandchild. Oh, there’s a saddle sore. There’s my-


Dr. Andy Pruitt  38:49

So true. Anyway. So, so the hair follicle is one that you treated much like acne the ulcer is treated like an open wound. So you may be off your bike a bit for either one of those or divert the pressure. Sometimes I’ve had people wear a double chamois and cut a hole and the chamois closest to you like a doughnut around the saddle sore. When you do that you’ve effectively changed your saddle height. So you have to lower your saddle a few millimeters to take up for that extra chamois. The worst injuries are going to be really to some kind of sexual dysfunction, erectile dysfunction or genital numbness, that’s those are just issues that that are right, but they can be solved. And again, like the historical knee injury story 20 years ago, a erectile dysfunction, male erectile dysfunction was, according some urologist epidemic, and some urologists said the cycling was dangerous for men of the breeding age. And saddles technology changed with the minkow wedge, the original body geometry saddle Roger Minkow designed the saddle to alleviate pressure on the penile arteries and nerves. And if you were to ask a young urologist today he’ll tell you that there’s no association with cycling, erectile dysfunction, you ask one that was in practice 20 years ago, he will tell you there is right? So that’s been the shift. So, in the technology, the the industry has evolved significantly in saddle design. So if you were to say, isn’t there just one saddle that could work for everybody? The answer is no. There’s so many saddles on the market, because there’s that many different size shapes bottoms out there that want to ride a bicycle. So never just assume that the bike you bought has the right saddle for you. And if you’re a woman, don’t assume that your husband’s old saddle-


Chris Case  40:35



Dr. Andy Pruitt  40:35

-is right for you, you know, women, the, the discussion is becoming more and more popular now more and more open about women’s issues. So 51% of the human race are women, and about 15% of cyclists are women. So there’s a huge disconnect there. And I think the saddle is the primary reason for that disconnect. So we’re working really hard at designing female specific saddle designs that I think are hopefully gonna eliminate a lot of these issues and bring people back. So erectile dysfunction, I think can be solved 99% of the time with saddle choice and fitting. But if you get into some kind of urinary issue, bladders, infections, urethritis, those kinds of things, all of our soft tissues are slightly different. So our, our nerves, arteries and hollow structures, like urethras, in most people they’re well protected in soft tissue. But the skinnier we get, the less protected again. So people want to ride a soft saddle. I mean the foam, the softness is not all it’s cracked up to be in a saddle that-that foam wants to go somewhere when it’s pressurized. A nice firm sitting area when you’re sitting on the right structures, such as the bony structures is far safer and more comfortable in the long run, if you will. I mean, I could I could talk for hours on the different diagnoses that come from men’s and women’s cycling at the saddle. But those aren’t the common ones. Right. So saddle sores, pressure related hair follicle related, those are the ones that are most common.


Intro  42:05

I feel like of all the issues that cyclists face, especially people trying to get into the sport,  this saddle choice is the hardest thing that people go through. And it takes they they’ll come to people that are experienced cyclists and they’ll say, “What saddle should I ride this that?” You’ve seen this 1000 to 10,000 times? What is your process? What are your top five tips? What can you tell people out there that are struggling with this issue?


How to Help Cyclists Pick out the Best Saddle

Dr. Andy Pruitt  42:34

Well, a good interview, right? I want to know where their pressure where they’re sore is? What does it look like necessarily, so a good interview is crucial there.


Trevor Connor  42:41

Well, you have a an actual pad that you put on the saddle that shows all the pressure spots.


Dr. Andy Pruitt  42:46

I’m getting there. So but not all fit studios have a pressure map. So it really comes down to that interview, and the willingness of the fitter and the rider to experiment with different sizes and shapes. So it wasn’t that long ago that saddles came in one size, and they were 130 millimeters wide at the widest part. And we did a huge study measuring the distance between the sit bones. We don’t rarely do we actually sit on our sit bones on a bicycle saddle. But that’s the only one we can measure that we’ve seen on the Buick Rami. But then did this huge study, and the variant in males and females, there’s a lot there’s more overlap than there is difference between males and females as far as that part of the pelvis is concerned. We now make saddles rarely at the 130, they are now variable 140 and 170 millimeters wide. And these are all races-


Chris Case  43:39

You talking edge to edge or?


Dr. Andy Pruitt  43:40

Outside edge to edge at the widest part the available seating area then is dictated by the dome or the shape of the saddle. So the flatter the saddle, the more available seating area has, but it may not be comfortable to you.


Chris Case  43:52



Dr. Andy Pruitt  43:52

Then they they come in varieties of shapes and domes to find that right one for your particular pelvis and your particular soft tissue shape and girth. So yes, there are a lot of saddles on the market for a very good reason because it takes that many to find. So-so my advice to the listener is, don’t be satisfied with first choice. Unless it is so comfortable. When you go on a bike ride and you don’t really think about your saddle, you’ve got the right one. If you’re on a on a bike ride and, in an hour, you’re wondering how you can get off soon. And then you stop to go to the restroom get something to eat. If it was uncomfortable at that hour, it’s going to be really be comfortable if you try to remount, right? And that’s a pretty common scenario. So I would suggest that you use a shop and a fitter that allows for test saddles, exchange saddles. The number of people that won’t change this out because it’s the color that matches their-right? It’s so true.


Chris Case  44:48

Yeah, I bet. I bet.


Dr. Andy Pruitt  44:50

It’s so true, but it looks so good. I mean, if you’re sitting on it, nobody can see it. Right. So if you’re sitting on it means you’re riding it. So yeah, find a shop that allows for-for a good fitting experience, saddle choices, and-and that you can try them return them. Yeah.


Chris Case  45:05

And if somebody eventually does find that perfect saddle, they should switch?


Dr. Andy Pruitt  45:10

They should not switch.


Trevor Connor  45:12

This is why you see pros with all new gear, brand new bikes, and some duct taped seven year old saddle.


Dr. Andy Pruitt  45:19



Chris Case  45:20

On branded.


Trevor Connor  45:20

On that bike.


Dr. Andy Pruitt  45:21

Yep, it’s true. It’s true.


Chris Case  45:23

I believe I’ve heard stories about people in the past that would carry their saddle in a little suitcase with them, or they would go to races so they could put it on to their bike, is that, you’ve ever seen that?


Dr. Andy Pruitt  45:32

Yup, absolutley, absolutely. Well, now, of course, the teams that I work with are so well sponsored that they’re, they’ve got hundreds of saddles, they do break then crashes, etc. So they’re there, we have developed protocols to remount a new saddle and the exact same place that that other one that just broke came off of whatever so I think as a as a Masters athlete, probably my pedals, my shoes, and my saddle would go in my backpack, and my bikes underneath the plane, then those things are gonna be with me in the cabin. Yep.


Trevor Connor  46:08

Which brings up a really good point. Once you have a good saddle and a good fit,  don’t mess with it. Don’t be raising and lowering your saddle. Don’t let your kids or significant other get on your bike and change it unless you mark the height, you mark the position so you can get it right back in the right spot.


Dr. Andy Pruitt  46:24

So let’s tell the Eddie Merckx story then, right?


Chris Case  46:27



Eddie Merckx’s Story

Dr. Andy Pruitt  46:27

So Eddie Merckx was famous-


Chris Case  46:29

Or the Chris Froome story. Turns out he’s an adjuster as well.


Dr. Andy Pruitt  46:34

That’s a, we’ve had this discussion a different day. So Eddie Merckx was known for always having a five millimeter key in his back pocket and in the middle of a train ride, he would change his saddle position. During the middle of the race, he put up with the car, the mechanic would change his saddle position, which tells me if you’re a fiddler on a daily or weekly basis, there’s something wrong with your fit. There’s something that has not been recognized about your body. So long pages turned, calendar passes. And Eddie actually brings Axel his son to see me as a patient, because Axel was experiencing much of these same issues that his dad had. And he was a fiddler. So Eddie brings Axel to see me and in Denver at the time as early 90s, probably, and do the whole exam. It was pretty obvious to me that that actual had a femoral thigh bone, leg length inequality. And x-rays prove that out, we adjusted his bike, several kind of a recipe of things, a cleat shift and a lift and some things, Axel went on to be a very successful rider. And he today still uses all of those solutions. So they don’t have to fiddle with his bike fit. And and Eddie, his comment was, where were you when I was young. So-


Trevor Connor  47:54

I was gonna say, that was probably the issues trying to find the right height, but it’s always gonna be right for one leg not the other.


Dr. Andy Pruitt  47:59

Exactly, so he would exhaust a position he would become unhappy, and he would change this a little bit and everything was happy again. And so this went on-


Chris Case  48:05

Back and forth, back and forth.


Dr. Andy Pruitt  48:06

-for his entire his entire career.


“Micro Adjuster” and “Macro Absorber”

Chris Case  48:08

Yeah, what, how much better would he have been? How many instead of 525 victories? Have you heard the terms micro adjuster and macro absorber?


Dr. Andy Pruitt  48:18

Totally, yeah, know, the guy that made the quote.


Chris Case  48:20

Is it? And you believe that, that is true about people and that certain people fall into those categories?


Dr. Andy Pruitt  48:25

Oh wow, you bet. Hockey, I’m not going to think of the guy’s name on Bora. He got a teammates bike in the middle stage. Totally wrong size bike. He went on to win the stage, right? I mean, and he’d had no idea that the bike didn’t fit him, he couldn’t have cared less, the guy could ride anything. And then there’s those who have to have a teammate who’s their clone, who can keep up with them in case their bike goes bad so he can take their bike right? Their bike positions are that close to each other. I do believe there are princesses in the pea. And that no, every wrinkle in their short, every wrinkle on their sock, and they give us great kinesthetic feedback during a exam or fit great, kinesthetic. Then there are other people who are so disconnected from themselves that they really give us terrible or non-feedback, right? How does that change feel? Well, I’m not sure. And there’s the guy. How’s that change feel? Oh, wow. Yeah, that went, “Was that more than a millimeter.” So yeah-


Chris Case  49:22

There’s no right or wrong here.


Chris Case  49:23

No, no, no.


Chris Case  49:24

It’s just some people have that sense. And other people don’t.


Dr. Andy Pruitt  49:27

Absolutely. Absolutely.


Trevor Connor  49:29

Well only easier for the fitter if they have that sense because you get better feedback.


Dr. Andy Pruitt  49:32

To a point.


Chris Case  49:33

To a point yeah right.


Trevor Connor  49:34

They are really picky.


Dr. Andy Pruitt  49:35

That, that, that yeah picky, oversensitive, pain in the butt, whatever you wanna call them. That, that, that guy is gonna be um, fiddler, that micro adjuster. They exsist no doubt about it.


Chris Case  49:53

And sometimes, I guess, like in Merckx’s case, there’s a good reason for that. And other times, it’s maybe just they have that sensitivity.


Dr. Andy Pruitt  50:00

You know, he was a macro adjuster, that guy.


Chris Case  50:02



Dr. Andy Pruitt  50:03

He was making adjustments on a daily basis but they were not small necessarily. He would do five millimeters in a whack with no problem. We never never examined. I have to tell you I never examined Eddie we all assumed that Axel had it, so did Eddie, right. But Axle’s, femoral leg lengthening call. It’s pretty significant, it’s over a centimeter. So they were Eddie was making big adjustments.


Chris Case  50:25



Dr. Andy Pruitt  50:26

He would let, that’s his story he tells me he was making big adjustments.


Chris Case  50:28

Sure, sure.


The Injuries Colby Pearce Sees In His Fit Studio

Trevor Connor  50:30

Colby Pearce, a respected coach bike fitter, now a world champion at, and regular on the show talked with us briefly about cycling injuries he sees in his fit studio. Well, every fitter has their own solutions, you’ll notice several common themes with what we’ve already been discussing.


Colby Pearce  50:46

Well, what I see is a lot of athletes come to me with saddles that are probably optimistically high. I don’t know what it is about bike racers. But they, for some reason, many cyclists, not all but many biker’s assume that when you raise your saddle they’re, you’re going to find that missing 10th of a point of VO2 or extra 20 watts somewhere. And there’s always more is always better. Not always, but very often. And so I see saddles that are just really high. And what’s interesting about the human body is that it doesn’t necessarily end up in the same place. You see the same symptoms, the saddles too high, the hip is dropping down on one side of the bottom stroke, they’ve got horrible pelvic stability as a result. And then where that goes from there depends on the athlete. It can be chronic, IT band pain on the opposite side, it can be chronic IT band pain on the side that the hip is dropping, it can be chronic lumbar pain in the lower back on either side. More commonly, if the right side hip is dropping, it’d be on the left. It can end up in the shoulder because the torso has to be stabilized during all those pedaling motions can end up in chronic stuff in the knee. But the common denominator not for all of them, but a lot of them is a saddle is too high. So where the human sort of deals with it, or where it ends up where the pain refers to is a different location every time but that’s kind of the denominator. So it doesn’t really answer your question. Overuse stuff. I mean, the typical list of the most common complaints I get in my fitting lab are I get shoes, and it’s almost always lateral pressure on the fifth metatarsal heads because the tailboxes are too narrow, almost always, and I get a lot of saddle discomfort problems. A lot of people are dealing with saddle pain. And I’ll tell you, it’s what year is it? 2018. Man we’ve come a long way in saddle technology. It used to be a hard man’s perspective where you were like to get fit on a bike, I have to go out ride 100k a day and my 39:21 and I have to deal with neck pain and back pain and leg pain and lung pain and crotch pain. It’s not the case anymore. Now we have far better fitting bicycles than we ever have had. And we solve a lot of hip problems. So that means you can focus more on your leg pain and your lung pain and deal with those things that actually make you faster. It’s not as much of a be a tough guy and go out and just drill your crotch into oblivion. Can I say that for three months?


Chris Case  52:56

You can. I-


Trevor Connor  52:58

I’m still trying to understand what the issue is here. But go ahead.


Colby Pearce  53:01

It’s, there people who are still stuck in 1984 land come and see me on concor saddles, and those things are just disasters apparently.


Chris Case  53:09

I know that.


Trevor Connor  53:10

Yeah. I’m sorry. What’s the issue?


Dr. Andy Pruitt  53:13

Your riding concor?


Trevor Connor  53:13

What was our topic here?


Chris Case  53:14

Trevor isn’t married. I know that you work with SMP saddles quite a bit. And that to the layperson is a totally odd looking saddle. And what is that thing? And that’s goofy. And but what’s the philosophy there? And why do you why, why is it attractive to you?


Colby Pearce  53:36

To a traditional eye, it’s a very unusual looking saddle. Most people complain about the the “beak nose”. I don’t know why people are so hung up on that to me, I don’t even notice it. Well, first of all, if the thing works amazingly well, who cares what it looks like? We’ll figure that out later, right?


Chris Case  53:49



The Myth Behind Crotch Pain When Riding Bikes

Colby Pearce  53:50

Function first. But the philosophy is, from what I’ve seen, and I’ve seen a lot of saddles on the market, no other saddle has the combination of as big of a perineal cutout or pressure relief cut out and as nice deep of a curve when viewed from the side. So if you picture like a horse saddle, it’s kind of curved from the side and what we want to do is support the bony ishim and the ishim. Guess what? They’re kind of curved like rocking chair feet, they’re wider in the back, and then they get narrower as you come towards the front. They’ve got a nice curved angle to them, or curved section to them. And that fits right into that channel, that SMP so it locks people in place, it gives them a lot of support. And I’ve had many clients get on those saddles and just have their minds blown. They’re literally like, I never knew a saddle could disappear like this under me. It doesn’t work for every client. But for an overwhelming majority of my clients, they walk out the door with an SMP and they love it, never turn back. And that was exactly-


Chris Case  54:41

Which is not the experience, you as you were alluding to with a lot of other people they think that their crotch was supposed to hurt when they ride a bike.


Colby Pearce  54:50

They think it’s part of riding a bike that they have to endure some sort of discomfort and that’s really not the case for the vast majority of riders. We have saddles that should literally disappear under you. You should be able to ride for four or five hours and never think about it. That’s a saddle that fits well. There are lots of hurdles in doing that because people don’t want to buy a saddle and try it and then realize it sucks. And so-


Chris Case  55:08



Colby Pearce  55:08

Manufacturers start to figure that out. There’s more test saddles, available ect, ect. But-


Trevor Connor  55:12

I don’t like this direction. Now, you’re going to tell me that you don’t even bother to duct tape your shorts to the saddles?


Trevor’s Technique: Duct Taping the Handle Bars

Colby Pearce  55:18

Velcro, duct tape.


Chris Case  55:21

You use duct tape for bar tape, right Trevor?


Trevor Connor  55:27

I actually, so where I learned how to ride to give you the idea of the mindset, and nobody believes me until they end up in that part of upstate New York and actually see this. I used to get made fun of because I had handlebar tape. And a lot of the people there felt that handlebar tape wasn’t necessary. Why would you use it?


Colby Pearce  55:45



Trevor Connor  55:46

That’s where I come from.


Colby Pearce  55:47

You guys have really nice roads up there.


Trevor Connor  55:49



Chris Case  55:50

You wear gloves a lot of the time.


Trevor Connor  55:51

Yeah, yeah.


Chris Case  55:53

Thick gloves.


Colby Pearce  55:53

Your always wearing ski gloves that’s the conclusion I’ve come to. Yes, handlebar tape is unnecessary. Do they realize that metal is more conductive than if you wrap it with some nice rubbery stuff and it’s gonna be colder?


Trevor Connor  56:03

That is completely irrelevant.


Colby Pearce  56:04

Totally irrevlevant. Okay, alright.


Chris Case  56:06

Oh boy.


Why you MUST Clean Your Chamios Religiously

Trevor Connor  56:08

And I wonder why Dr. Pruitt uses me as a case study of things to do. Let’s get back to our conversation with him and the right way of doing things. So I think the the only thing I would add to all this is clean your chamois because you brought up the whole fact that these issues there’s bacteria involved?


Dr. Andy Pruitt  56:26

You bet.


Trevor Connor  56:27

And when I talk to athletes who are constantly getting saddle sores on the questions asked how often do you wash your chamois? Oh, i’ll do three or four rides before I clean it. There’s part of your issue.


Chris Case  56:38



Trevor Connor  56:39

Keep it clean.


Chris Case  56:40

Keep it clean.


Dr. Andy Pruitt  56:41

So yes, I think chamois is like shoes, like saddles, like all other technologies, chamois technology is changing so rapidly right now. I mean, I can even at this moment in this building chamois technology is changing. So it needs to be machine or sink washed, hand washed, and needs to be air dried. That is the best medicine to preserve your chamois if you want to kill bacteria, the dryer so if you get your chamois free, wash and dry them. If you don’t get your shampoo for free, then I would air dry them because that’s going to add life to the life to the garment. Get out of your chamois ASAP spend no longer in your chamois then you have to.


Chris Case  57:22

Yeah chamois time does not equal-


Trevor Connor  57:22

But then the ride isn’t that long.


Chris Case  57:25

-does not equal training time.


Dr. Andy Pruitt  57:27

Always cracks me up when I do a Ride the Rockies or some other you know big multi-day event and they’re standing in the food line at nine o’clock at night and they’re still in their shorts. And I’m afraid they’re gonna wear that same short again tomorrow, they may sleep in them I don’t know. But but get out of your short and use an astringent I like like a an acne wipe or something to clean your skin if you don’t have access to an immediate shower. Let things dry, boxers for men, commando let-let things dry out in there as best as possible. If you need a lubricant, I hope you’re not sponsored by chamois cream. If you need chronic lubricant, there’s something wrong with your saddle choice or your bike fit. Now that said in a week long tour, you’re probably going to get some issues even if all is perfect. So there is a place for chamois cream. I like a mixture of one part vaseline and one part, triple antibiotic ointment. Mix those two together, I’m sure there’s some petroleum jelly is out there that come already mixed with some antibiotic in them. That’s really what you’re after. So you’ve got a little antibiotic got a lubricant it’s there at the end of the ride. It’s not water soluble, doesn’t wash away or sweat away. But it does make chamois care much harder. And also makes skin care harder because it can clog up the pores. So for every good thing, there’s some, some negatives, but-but skincare crotch care crucial. Women, women bring some other issues to the sport, and that their urethra is only a couple centimeters long. So there is urinary leakage. There’s vaginal discharge, there are some things that really add to the petri dish in the chamois. So women have to be far more careful with chamois and crotch care than men do.


How Long Should Chamois Last?

Chris Case  59:14

Is there any guideline on how long a chamois should last?


Dr. Andy Pruitt  59:18

I don’t know that. I think if I’ll be vary-


Chris Case  59:20

Probably not a decade though.


Dr. Andy Pruitt  59:21



Chris Case  59:22

But I know that there are a lot of people out there riding old, old shorts.


Dr. Andy Pruitt  59:26

I love to go on a big group ride and I don’t know everybody and I can see through the lycra. You know how old that short is right?


Trevor Connor  59:33

Which, that was gonna be my one little tip. If you do put your chamois in the dryer, don’t use dryer sheets.


Dr. Andy Pruitt  59:39

Yeah, yeah, yeah.


Trevor Connor  59:40

Because your shorts transparent.


Dr. Andy Pruitt  59:43



Trevor Connor  59:43

It’s a little embarrassing from experience.


Dr. Andy Pruitt  59:47

So there you have it. We’ve talked about saddle sores, saddle issues, knees, backs. We’ve left out a lot of body parts.


Chris Case  59:55

Well yeah.


Trevor Connor  59:55

We left out the neck.


Chris Case  59:56

Feet, hands, and neck. Feet, hands, and neck.


Dr. Andy Pruitt  1:00:00

Where do you want to start?


Chris Case  1:00:02

You’ve got a lot of experience with all of them. But do you have a feet is let’s start with feet.


Feet Cycling Injuries

Dr. Andy Pruitt  1:00:07

Feet are as individual as faces. So shoe manufacturers try to build a shoe that meets that bell shaped curve. So there’s always going to be outliers, right? But getting a shoe that fits. When I was a young, stupid racer, we bought our cycling shoes one size too small. We soak them in water overnight. We lace- stuffed our foot in next morning, laced them up as tight as we could and went on a hot summer ride dry, hot hot summer ride. And they the shoe would dry over our foot during that time and we had a custom-


Chris Case  1:00:38

Keep molding.


Dr. Andy Pruitt  1:00:38

We had a custom upper, we had a custom upper. The shoes aren’t leather anymore. The soles aren’t wooden anymore. So those opportunities are behind us. Finding a shoe soul that that works well for you, a soul plate that works well for you. An upper that works well for you. Obviously, I’m fond of specialized because we do believe ours are the only biomechanically designed shoe on the market. But even that said, they need to be adaptable for arch height, and and cushion and, forefoot width and all those things. Most pain in the foot, we do here by cyclin hotfoot, right. So that’s a form of ischemia, again, we talked about ischemia and the skin where we sit on something and pressurize it. So the ball the foot under constant load, we’re going to push all the capillary blood out of that tissue and it becomes ischemic and begins to feel like hot, feels like heat, it feels like pressure. That’s just the first signs of tissue starvation, if you will, in this ischemic spot. So the way we’ve solved that a lot is by moving the foot forward on the pedal, putting the axle the pedal just behind the ball the foot to disperse much of that focal pressure. So that’s a really an easy solution. If you’ve if you’ve got hot foot out there in radio land view got hot foot, move your foot forward on the pedal that’s cleat back, foot forward. Tery two or three millimeters at a time until you solve the solution. So you solve,  till you solve the problem. Saddle, each time you make that adjustment and it can’t be just on the painful foot, it has to be on both feet. Each time you make that adjustment, you need to lower the saddle that same distance because you’re actually shortening the whole lever system by moving the foot forward. So that, so good our support, good shoe upper choice, and changing that cleat position, are the easy, less the low hanging fruit for solving foot thing.


Trevor Connor  1:02:30

And you actually brought up something we should have mentioned right from the beginning, that is really important. If you make any adjustments to your position. Remember, one adjustments affects everything else. Don’t slam your cleats back and then go well now I’m fine.


Dr. Andy Pruitt  1:02:44



Trevor Connor  1:02:44

Don’t raise your saddle and go okay, now everything’s fine. You have to adjust everywhere.


Dr. Andy Pruitt  1:02:49

When you lower your saddle, that equals also taking it back. So reach has gotten longer, when you lower your saddle. A millimeter to have saddle adjustment up and down, I wouldn’t worry about my reach. But if you make a significant change in saddle height, your reach will be affected by that. So up equals back, down equals forward. You got, there’s there’s no free lunch, right? If you change something, you’re gonna affect it someplace else. For sure.


Hand Cycling Injuries

Trevor Connor  1:03:14



Dr. Andy Pruitt  1:03:15

There is some discussion in the elite fit world right now about the distribution of pressures. Is the saddle 50% than the feet? Depending on your watt output, 40 and hands 10. I mean, really, is it 60-40 front wheel, back wheel. There’s a lot of discussion in that right now around bike handling. But if you’ve got hand pain, one of the best places for a fit sale to begin is that the glove rack. If you’re in there buying big fat padded gloves, there’s something wrong with your equipment, right. Glove design has changed as bar design has changed. So if we think back when I was again, a young racer, all the bars were metal, all the bars were small and round. So we all wanted a lot of padding on the heel of our hand to pad that unforgiving, small round bar. As the bars have gotten bigger, and they become different materials-


Chris Case  1:04:08

Better bar tape even.


Dr. Andy Pruitt  1:04:09

-better bar tape and more ergonomic placement and design of the brake hoods. So hand issues have diminished along with knees and everything else with technological improvement. So if you’ve got a significant hand issue that you only have on the bike, you don’t have it at work, at play, at sleep. It’s a bike position thing. If you have hand issues off the bike, then you probably have a pathology of some kind you need to have examined and addressed right? I know of people that have carpal tunnel disease that had it so minimally off the bike that it wasn’t an issue. But the bike was exacerbated. So the bike really brought their carpal tunnel to a focus that had to be addressed surgically. We did everything we could bike fit wise. But I do, should we wear gloves? I think that if your bike fit’s perfect, you could go for an hour bike ride and not wear gloves and not miss them. If your bike fit isn’t right, I think your hands are gonna be uncomfortable pretty quickly into that hour, and you’re going to be looking for a glove. There are some ergonomically designed gloves to improve blood flow. There are some ergonomically design gloves that are the pad around the nerves. I think, it’s like your shoe and your saddle choice. It takes a good fitter and some good advice. Don’t buy gloves off the glove rack without advice. That’d be my-


Chris Case  1:05:29

Or because of the color.


Dr. Andy Pruitt  1:05:30

-or because of the color. Wait, wait for them to come back in order and get off backorder and get the bright yellow gloves that you that you so desire. But I think that the bar design, hood placement, hood design, bar tape, all those things have really improved the hand issues. I’ve been riding my bike chronically for 50 years. I’ve got arthritic wrists, not from my bike. Alright, I got it from work, play, uh crashes. So I’m pretty careful about my hand position. But I wear a minimalist glove, I cannot stand a lot of glove in my hand, I want to be able to feel the handle bar.


Chris Case  1:06:08



Trevor Connor  1:06:09

So this might be a little old school and you said that they’re debating this now. But I was always told if you have a really good bike fit. When you’re in your position on the bike, you should be able to lift your hands off the handlebars without falling forward.


Dr. Andy Pruitt  1:06:23

If your core strength is adequate, I still, I think you should be able to be riding along in the hoods and take your hands off the hood and have your torso position not change. That’s perfection. Not everybody can do it. But that’s perfection. That tells me that your core strength, your tipping point, you’re right at your balance point, right. So your torso angle is at a place where your core strength and handle it. Your bar position, hood position, stem length etc. are at a place that mat- match that absolutely. So I do I still do believe in that.


Neck Cycling Injuries

Trevor Connor  1:06:58

Okay neck. And do we talk about RAAM and taping your helmet to your back?


Dr. Andy Pruitt  1:07:03

Shermer’s neck? So the neck is just part of the spine, so we go back to those lego blocks with the jelly donut in between them. There’re is smaller, we have similar curvature in our neck as we do in our spine. So the cervical curvature is also lordotic. The disc, if we place them at risk right under load, such as an aggressive position where you’re having to look down the road, that disc is going to deform. Looking down the road tends to deform the disc anteriorly. We’re in the low back the disc for choose posteriorly because we’re turning the spine the opposite direction. So handlebar position, reach, ect. are really crucial in protecting the neck or treating the neck. So there are cyclists who have had disc disease from a really aggressive position that disc disease is then addressed. Physical Therapy, cortisone injection, surgery, whatever it is, we put them in a more conservative upright position until things heal. Just like the Sylvain Chavanel’s story, gradually can bring them back down to wherever they’re asymptomatic, as low as low as they can go and still stay asymptomatic. So neck pain, the bad ones are disc related. The not so bad ones are muscular. You’re holding up this 15 pound pumpkin using somewhat up right, it’s a balancing act, right. So there’s this like guy wires and a tent and the wind holding up our head when we’re upright. As soon as we put ourselves in a bike position we’re having to hold our our head up using the erector muscles at the back of the back of the shoulder and back in the neck and they just are going to fatigue, especially if you’re a novice, or you going from a cruiser to a gravel bike, that’s training. A lot of that is training to get yourself strong enough to hold yourself up. Now the Race Across America, you mentioned RAAM injuries, the schermer is neck. Wow. So that guy, he rode so long in the arrow position, he fatigued his entire system could not hold his head up. So he actually taped his helmet, you know, to his back to that and they placed a low a bar and a platform for his chin to continue the race. That is not a bike fit solution that I would use.


Chris Case  1:09:12

That’s a psychological issue at that point.


Trevor Connor  1:09:16

That’s where you start going, this might not be the healthiest cycling activity, you can do.


Dr. Andy Pruitt  1:09:20

Well no, so he was trying to be aero for 20 hours a day. And that’s probably not, I fit a lot of the RAAM guys and you try to find a place, a conservative place where they can be comfortable for those number of hours like a day. And then you put some arrow bars on there. And they actually refer to them as resting bars. It’s just another position so that they can move around on the bike a little bit so they can rest in that arrow postion, the resting bars.


Chris Case  1:09:46

The resting bars.


Dr. Andy Pruitt  1:09:49

But if you have hand numbness, tingling, upper extremity tingling after cycling, you’ve got a nerve root that is being irritated. So I would I’d be careful with that, that transient tingling or numbness in hands that are associated with cycling. That’s, that’s a kind of a red flag.


Chris Case  1:10:06

So I know you’ve worked with a lot of pro riders over the years and had to do some minor tweaks to for some and major tweaks for others. And it’s fascinating to me that even the best cyclists in the world benefit from-


Dr. Andy Pruitt  1:10:21



Chris Case  1:10:22

-bike fits, and I’m not, I’m sorry to admit this, I’ve only had one bike fit in my life.


Dr. Andy Pruitt  1:10:27

We’re gonna, we’re gonna fix that.


How Beneficial Bike Fits Can Be For Novices and Professionals

Chris Case  1:10:28

I know, but, but I’m a macro absorber, I think. I just want to understand, from your perspective, how influential how beneficial, this bike fit process can be for the novice to the professional.


Dr. Andy Pruitt  1:10:46

So I think you’re alluding to Peter Sagan, you know, here’s a guy with gigantic motor, gigantic talent. And if you’ve ever watched his core strengthening routine on YouTube, he’s got amazing flexibility and amazing strength. But all of us have something, either an injury that’s created a weakness, or there’s something about us that’s that’s not perfect. And with modern bike fit technologies and solutions, we can we can really represent those and support those. So everybody, I mean, everybody deserves bike fit, and there’s not a professional team that doesn’t have a professional bike fit consultant these days. Every professional team has that. Does that mean they deserve it, and the lady who wants to do her first Ragbrai doesn’t deserve it? I think the lady one who wants to do her first Ragbrai probably deserves and needs it more than the super athlete. Everybody should consider true bike fitting, I don’t mean a sizing, right? I don’t mean what to do to buy a new bike, you want to make sure you’re on the right size. That does not mean that that manufacturer guessed exactly what stem length you need or what stem angle you need what bar with you. They do the best job they can a fitting this big bell shaped curve of humanity. But I don’t care if it’s a $500 bike or $1,000 bike. I’ve known people who’ve spent more on their bike fit than they did on their bike. People may think I’m trying to pad my own nest, but it is the best money spent. If you want to ride a bicycle comfortably.


Chris Case  1:12:22

And powerfully.


Dr. Andy Pruitt  1:12:23

And powerfully. No doubt about it. There’s a direct connection, truly.


Chris Case  1:12:26

Comfort and performance go together.


Trevor Connor  1:12:28



Chris Case  1:12:29

All right Trevor. You’re up first this week. You’re on the clock one minute, what are your best tips for cycling, preventing cycling injuries and fitting in general?


Trevor’s Take Home Message

Trevor Connor  1:12:44

So this is just a something I want to add a long time ago, you gave me a list of six exercises that you said, “Every cyclists should do these.” They because something like 70% of cycling injuries can be prevented by doing these six exercises. I put that into a routine I gave it to all my athletes. And so really my take home is we will post those six exercises, so it’s clamshells and bridge, your planks exercises like that. We’ll post it on the website. And I can say is do that four or five times a week takes 10 minutes.


Dr. Andy Pruitt  1:13:20

Yep. It’s like brushing your teeth, right like flossing.


Chris Case  1:13:23

And once you get into the routine, it just becomes it’s a good habit. It’s one of those good habits. So Dr. Pruitt, you’ve got you got one minute.


Dr. Pruitt’s Take Home Message

Dr. Andy Pruitt  1:13:31

Learn the difference between the pain of injury and the pain of exertion. Pain of injury doesn’t go away when the efforts over or when the rides over. The pain of exertion lets up when you let up. And a lot of people have trouble discerning the difference between the two. So the way you’ll avoid injury is by recognizing that was a pain that didn’t go away as soon as I stopped. I should I should address that. So that I think that’s my, my kind of underlying tip that goes along with the exercises I gave Trevor. You want to send me that program Trevor? No. But I still budget I still recommend the same six exercises because they’ve been useful over time. But that differentiating between the pain of physical exertion and the pain of injury. I think that if you really can dial into those two different things, you won’t get injured, and you can hit it off at the past. Bike fit, wow. We have eliminated a dozen different surgeries that were designed to address cyclists with bike fit technology and bike fit solutions. And that saddles, that’s knees, that’s please know everybody deserves professional bike fitter.


Trevor Connor  1:14:43

But just that add to that for some of you out there, bike fit doesn’t mean just aerodynamics.


Chris Case  1:14:49



Trevor Connor  1:14:50

That is very old school.


Chris’s Take Home Message

Chris Case  1:14:52

My one minute would start off with don’t ignore it. If there is a problem, there’s a problem. Don’t take that hard man mentality. Biking, riding a bike does not have to hurt. It’s supposed to be joyful. That, that would be my 30 second tip, just don’t ignore the pain if there is pain and to go back to your, there’s there’s different types of pain but if there’s a real problem address it. And don’t think that you have to have this hard man mentality when being on a bike.


Dr. Andy Pruitt  1:15:24

But I like the hard man mentality.


Chris Case  1:15:26

Well so does Trevor.


Dr. Andy Pruitt  1:15:28

I know if it doesn’t, so I think Peters Sagan is the hardest man I’ve ever met. And I would like to assure people he’s got a great bike fit. But he is a hard guy. I think our-


Chris Case  1:15:38

Don’t be stubborn.


Dr. Andy Pruitt  1:15:39

There you go.


Chris Case  1:15:40

Don’t be stubborn about these things.


Trevor Connor  1:15:42

Again, what’s your issue here?


Chris Case  1:15:45

If you can’t sit on your saddle for more than an hour, there is a certain, there is a problem that needs to be addressed.


Dr. Andy Pruitt  1:15:49

Absolutey. So ignore penile numbness. That is not hard man, that is dumb man.


Chris Case  1:15:54

That is stupid, that is plain stupid.


Dr. Andy Pruitt  1:15:56



Trevor Connor  1:15:59

Oh, no, we’re including that. He said-


Chris Case  1:16:02

If you can’t have a hard penis and then you aren’t a hard man.


Trevor Connor  1:16:05

This is true, and with that-


Dr. Andy Pruitt  1:16:10

God, awesome.


Chris Case  1:16:12

Thank you. That was another episode of Fast Talk. As always, we love your feedback. Email us at Subscribe to Fast Talk on iTunes, Stitcher, SoundCloud and Google Play. And please be sure to leave us a rating and a comment. The more people that leave comments and rate us on iTunes that more people we’ll reach. While you’re there, check out our sister podcast though Velonews podcast. Become a fan of Fast Talk on Facebook at and on Twitter at Fast Talk is a joint production between Velonews and Connor Coaching. The thoughts and opinions expressed on Fast Talk are those of the individual for Andy Pruitt, Evan Huffman, Colby Pearce, Trevor Connor. I’m Chris Case. Thanks for listening!