Blindspots & Shortcomings of the PT bike fit

What is a PT bike fit? I've held the belief for many years, and repeated it often, that a PT might be the person or profession best suited to performing your next bike fit. The extent to which body mechanics, kinesiology, tissue response and healing is drilled into us is fairly unique.  Additionally, we are in the rare position to establish a tremendous depth of "data points" through the hundreds or thousands of people we see in our practice because we are one of the few health professions that spends thirty minutes to an hour with each client and every visit involves assessing and retesting of movement patterns that then builds our "databank" of what normal movement looks like. (Incidentally, this is great for our clients and great for our knowledge base, but not as great for our pocket book. PTs could make a lot more money if they saw more clients per hour, and many do this to good effect, but as a profession we seem opposed to adopting the physician model of seeing a new client every 4-6 minutes, but this is another topic altogether).While I still believe this, I've also seen some issues over the years with the PT bike fit model and it usually stems from two main causes: occasional lack of bike or bike fit specific knowledge, and lack of technology. I think it's important to note that even with these two blindspots, I still feel that in most circumstances if you go see a PT for your bike fit issues you'll have better outcomes than if you visited your local bike shop.Sometimes a situation presents where a cyclist has an option to go visit their PT, who is a cyclist, but only has a small amount of bike fit training and no technology to speak of or to their local bike shop who might have invested heavily in bike fit technology and education, and this is where a gray area arises.  Would the cyclist be better off going to the shop with the technology and some bike fit specific training, or the PT with limited technology, a significant understanding of human movement but perhaps limited understanding of bike fit mechanics?

The Bike & Bike Fit Physics

Some PTs are cyclists, and many have some understanding about cycling, but most have only a shallow background in bike fitting itself.Other PTs know very little about bikes. There's nothing inherently wrong with this; we can't know everything about every sport. I know very little about lacrosse, so when I get a lacrosse player as a client I have to treat them as I would most team sports athletes, but I might be blind to a few of the deeper mechanical requirements of lacrosse as a sport. This may not be a tremendous road block, but I see in person or through social media many instances of PTs performing a bike fit and they missed a a number of areas where they could have benefited their client because they didn't understand the "bike fit physics" that goes on between the rider and their bike.Bike fit physics refers to all the small effects unique to cycling that certain changes will produce:What does moving the hips forward do to the balance of muscles working? the stresses at the knee? effect of weight on the handlebars?What about if we rotate the shifters into a flat position? what happens to the shoulders? how can this affect the pelvis on the seat? Cycling is unique because each change has a huge cascade of effects and each of these needs to be managed and tracked throughout all the changes being made.

Too Much PT?

Where I see many of these PTs getting into trouble is due to their limited knowledge of bikes or understanding of bike fit physics, they "over-PT" their bike fittings. More specifically, every person they do a bike fit on predominantly gets managed with some exercises or hands-on treatment to fix their bike specific issues. Don't get me wrong, this isn't a terrible thing. In fact, I believe that a good bike fit, from anyone, ought to have a component of working on the body so that it fits the bike better. This type of proactive thinking would be considered a correction-based approach - it involves fixing what is wrong with the rider in order to improve the situation. But the correction-based approach doesn't produce quick results as it can take weeks or months for a correction to be made and no athlete wants to hear that the solution is three months away but often this is the case in most situations related to managing sports injuries and movement issues.Bike fitting is unique, however because we're dealing with a complex interaction of human body with machine and there's much more to it than pain and injury management. There's efficiency, comfort, power output in addition to managing pain, injuries and aberrant movement. There are often many interventions that can be done right now with immediate effect. These small compensations require that we have very accurate dynamic measurements of the rider as they pedal, usually with dynamic infrared motion capture. Only with this information will we be able to see the changes to the rider's cycling mechanics in a very granular way which informs us as to what change is warranted and to what degree. These changes can't be accomplished by "eye-balling" them (the mechanics are just too fast), or doing them statically - higher level measurement technology is a requirement.So we have these two paths we can take in a bike fit - we can make the short-term compensations to the bike in order to improve the efficiency, power and comfort of the rider as well as tackling the long-term corrections of the rider themselves so that they continually coexist with their bike better. Bike fitting isn't an "either-or" proposition in regard to these two ideas. A good bike fit ought to include both short and long term solutions.Getting back to my original premise, I see many PTs opt predominantly for  the long term corrections because that's what they're trained in, but in most cases they're missing the small adjustments that can have a tremendous impact on their client's riding life right now.This further reinforces that a good bike fit needs a deep knowledge of human movement so that proper decision-making can take place to solve the biomechanical problems of the rider, but it also needs exquisitely accurate dynamic measurements with a good understanding of bike fit physics in order to track the small adjustments that are inevitably going to be necessary.So returning to my hypothetical rider trying to decide between the PT with basic bike knowledge and the bike shop with the technology, who should they see? I would still give the edge to the PT by a small margin and here's why:The PT will always be able to find useful areas for you to benefit your mechanics on the bike, even if they do "over-PT" the fitting. Further, the PT will be able to gain a better understanding of the bike fit physics just by simply doing more bike fittings; the shop fitter won't have the movement background to make these connections on their own. This is why when a PT does upgrade their bike fitting technology their skill will often improve at a much faster rate simply because of their movement "databank" that they can reference.What are your thoughts? Ever have a terrible bike fit experience and wonder why? Let me know in the comments below...