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My story: Getting back on the bike after knee problems

Posted by on January 21st, 2015 at 12:20 pm

Getting fit with Seth Hosmer-1

Dr. Hosmer measuring things out.
(Photos J. Maus/BikePortland)

This is the time of year when many Portlanders are putting in serious miles in hopes of having good form for the upcoming racing season — or to complete whatever epic bike adventures await. Last year I was one of those people. I was so eager and focused on racing cyclocross that I crashed and burned, and learned some important lessons about training, injury, and recovery along the way.

In hopes of sharing some great local resources, and maybe even helping others who might face a similar situation, I want to share my story…

I raced intensely for 4-5 years back in the mid to late 1990s. And after that I continued riding both mountain and road bikes regularly and seriously for several years. But I took a long hiatus from any sustained training or racing until the summer of 2013. Thanks to a new road bike that re-kindled my love of riding, I was back in the saddle again and putting in miles just like the old days. By the time 2014 began, I was totally focused on the cyclocross season. With a move up to Category A (the “Masters” class) I was motivated to ride and train and much as I could fit into my schedule.

Everything was going well. By summer of last year I was in great shape; but there was nagging knee pain hanging around. As someone with five knee surgeries in their past (thanks high school basketball!), I figured it was just old aches and pains and I thought pain and occasional swelling was something I’d just have to live with. But by the end of June it became too much to bear.

shortrack

A week after this photo was taken, I was sidelined with sore knees.

One week I was winning a local “short track” mountain bike race, and the next week I was off the bike completely. After months of focus and countless hours in the saddle, I found myself down and out. At that point I turned Google for research and asked friends for advice on what to do with my ailing knees.

To make a long story short, I over-trained. I did all the classic things you’re not supposed to do: Rode too much too soon; didn’t stretch and recover enough; did too much climbing; sat at a desk all day, and so on. I realize now that I applied my 20-year old training mentality to my 39-year old body. I should have known better. It was destined to fail.

Luckily I got help.

I turned to Dr. Seth Hosmer, a local chiropractor who specializes in cycling injuries and performance. Hosmer is the guy behind Hosmer Chiropractic Clinic in the Pearl District (NW 10th and Marshall) and he offers both physical therapy and bicycle fitting.

At my first appointment Hosmer just listened to my story. Once we ruled out any major injuries or problems with my knees (X-rays from an orthopedic surgeon also helped allay my fears), he began some basic treatments and prescribed stretching exercises. Hosmer’s clinic is full of smart trainers who have all the latest secrets and equipment at their disposal.

We focused on deep stretches of my quads, calves, and hamstrings. Before this happened, I never realized how the condition of my leg muscles could dramatically impact the health of my knees. (If I had to pick a diagnosis I would say I had a case of patellafemoral syndrome.) Hosmer helped me understand that if my muscles weren’t fully loose and recovered between workouts, my kneecap would not “track” properly when I pedaled and the result would be swelling and pain. Knowing this, I started to take stretching — before and after a ride — much more seriously.

The other piece of putting my cycling puzzle back together was to make sure my bike actually fit me. Similar to how I jumped into serious training with only a vague sense of what I was doing (and then paid the price), I also just assumed my biomechanics and fit was on target. It wasn’t.

Getting fit with Seth Hosmer-4

Getting fit with Seth Hosmer-3

Getting fit with Seth Hosmer-6

Technology is awesome.

When I showed up for my fit, Hosmer invited me to the upstairs loft at his clinic. We set my bike in a trainer and he pulled out his tools of the trade: a level, a lead weight attached to fishing line, a measuring tape, and an iPad.

Hosmer recorded measurements of my saddle set-back, the stack and reach of my handlebars, the height of my top tube relative to the bottom bracket, and so on. Once we had the existing numbers, he had me hop on the bike. Hosmer then took more measurements to see where my body was lining up. (Turns out I sit slightly crooked with my left hip slightly up which pushes my left leg a full centimeter in front of my right.) Then he filmed me with his iPad and a very nifty video-analysis app called Dartfish. Hosmer had me pedal at different cadences and had me focus on lowering my heel.

Then, using the Dartfish software, Hosmer slowed down the video and replayed it to analyze my movements. He noticed a wave and a hop in my back with each pedal stroke. Then, simply by drawing with his finger on the screen across my leg, the software calculated the angles in my pedal rotation. Hosmer used this analysis to make adjustments to my saddle height and give me some tips to correct my pedaling style.

At the end of the day Hosmer made significant changes to my saddle height and I agreed to drop my heels more during my pedal stroke. It felt strange, but I trusted him.

I’m happy to say that my knees are fine now and it’s been ages since I’ve had this much confident in them. My racing season was full of ups-and-downs, but Hosmer’s help and insights were key to getting my health back and getting my knee issues under control.

I can’t wait for all the great riding I’ve got planned for this year!

Portland to Astoria Ride-5

Ready to ride.

If you are starting to ramp up the miles for whatever cycling goal you’re working toward, I’d highly recommend getting help from a physical therapy clinic and professional bike fit. Check out the links below for more great local spots to get yourself healthy, strong, and dialed-in for a great season:

North Lake Physical Therapy & Rehabilitation
Upper Echelon Fitness
Hosmer Chiropractic Clinic
Pedal PT
Bicycle Fitting Services
*Note: Nearly every major local bike shops has expert bike fitters on staff. Inquire within.

NOTE: We love your comments and work hard to ensure they are productive, considerate, and welcoming of all perspectives. Disagreements are encouraged, but only if done with tact and respect. If you see a mean or inappropriate comment, please contact us and we'll take a look at it right away. Thank you — Jonathan

42 Comments
  • Esther January 21, 2015 at 1:10 pm

    I was sidelined by knee pain in september after a long bike tour that I was illl prepared for and unfortunately have continued to have knee pain since then, including being completely bike-free for the last 4 months despite having been bike-dependent/primarily-car-free for the last 18 years. (Let’s just put it this way: trimet is not the best thing ever.)

    Kids, Jonathan is not joking: Get your bike fitted and for the love of god STRETCH!

    For what it’s worth, if anyone has insurance that covers services through Portland Clinic (I have Kaiser and it covers Portland Clinic), I was approved for physical therapy, and was able to have a bike fitting covered by my Kaiser insurance as it was done by a Physical Therapist at the Washington Square Location who specializes in bike fitting. I really liked her (better than my other PT actually) and she noticed some of the same issues as you have with sitting crooked (which proper stretching helps correct). It turns out I had moved my saddle WAY too far back and was riding with my legs too elongated.

    So the process to have that done was: go to a regular doctor (primary/family care) with complaints about my knee pain, get approved for 6 PT visits, choose the PT at the Washington Square Mall location.

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    • Alex Reed January 22, 2015 at 9:00 am

      Wow, thanks for the info Esther! This is wonderful to hear for those of us with Kaiser insurance!

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  • John Lascurettes January 21, 2015 at 1:13 pm

    “a lead weight attached to fishing line” a.k.a. a plumb line.

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  • Todd Hudson January 21, 2015 at 1:22 pm

    Ah, Patellofemoral Pain Syndrome!

    “I never realized how the condition of my leg muscles could dramatically impact the health of my knees.”

    I had pretty bad knee pain until a phsyical therapist gave me some hip-strengthening exercises. As long as I do the exercises, the knee is not a problem!

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  • Amy January 21, 2015 at 2:04 pm

    Speedy recovery, Jonathan! I recommend Paul at Peak Condition (peakconditionpdx.com) to get and keep you in cycling shape while avoiding injury.

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  • Adam H. January 21, 2015 at 2:07 pm

    Chiropractic is pseudoscience. I’d recommend seeing a physical therapist instead.

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    • Pete January 21, 2015 at 2:56 pm

      I’m a former client of Dr. Seth Hosmer and have nothing but praise for his work. The guy knows maybe just a little about cycling…
      https://www.facebook.com/NWEliteCycling

      And I’ve been through some really useless physical therapy in my life too. It’s not the certificate that makes the professional.

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      • Champs January 21, 2015 at 4:13 pm

        Being impressed with neither, I’ll reference Sturgeon’s Law: 90% of everything is crap.

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    • pdx2wheeler January 21, 2015 at 3:32 pm

      When I was 16 a chiropractor was able to correct a scoliotic curve that had developed in my back. I was experiencing terrible low back pain, my shoulders were oddly tilted, and you could clearly see a curve in the x-rays of my spine. It took about 1 month, maybe 10 visits. 25 years later… the curve has never come back, and I never went to a physical therapist once.

      Speaking from my own personal life experience, I wouldn’t be so quick to discount a chiropractor’s unique skill-set. Side note, I studied physical therapy for 4 years and worked full-time in a PT clinic for several more.

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    • spencer January 21, 2015 at 3:58 pm

      @ Jonathon Maus. By law and definition, Chiropractors are not able to provide Physical Therapy in the State of Oregon. Its a protected term by the profession. You’re reporting is inaccurate and misleading to laypeople. Please correct your story ASAP.
      Chiropractors provide chiropractic care and it is NOT the same as Physical Therapy. Chiropractic is NOT an allied health profession because it is NOT based/substantiated by the scientific process.

      If you’d like more information feel free to contact me privately or I’d suggest you contact the Oregon Physical Therapy Licensing Board for clarification.
      If one wishes for Physical Therapy, one should see a Physical Therapist.

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    • Todd Hudson January 21, 2015 at 4:20 pm

      Not all of them. Just the ones who claim to cure cancer and tell people that vaccines are the boogeyman.

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    • El Biciclero January 21, 2015 at 4:33 pm

      pudproofding. Heh—get it?

      If a client sees positive results from chiropractic treatment, does it work?

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  • Aaron January 21, 2015 at 2:09 pm

    I’d also say, do some research on fitters. I went to a prominent fitter in town and came out with a bike that I hated. Everybody has different philosophies, some may work for you and others wont.

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  • soren January 21, 2015 at 2:09 pm

    If doing something works for you then by all means continue to do it.

    Nevertheless, as someone who strongly believes medical advice should be evidence-based I feel the need to comment.

    Evidence that stretching reduces injury (or improves performance) is uniformly very poor:
    http://www.ncbi.nlm.nih.gov/pubmed/?term=24370993
    http://www.ncbi.nlm.nih.gov/pubmed/15782063

    Harriet Hall of Science-based medicine has a good summary of how chiropractic manipulation is based on a flawed understanding of anatomy:
    http://www.sciencebasedmedicine.org/the-end-of-chiropractic/
    (The comments from clinicians and chiropracters also make for good reading too.)

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    • Adam Herstein January 21, 2015 at 2:58 pm

      Chiropractic was based on the idea that improper spinal alignment causes most diseases, and this can be fixed using spinal manipulation. It’s not only an inherently flawed practice, it’s potentially dangerous. Chiropractic is widely considered to be pseudoscience by the general evidence-based medical community.

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      • RoZa January 22, 2015 at 8:28 am

        Umm….no. Has nothing to do with disease(s). It is about proper alignment eliminating pain caused by subluxation (basically a feedback loop caused by improper alignment) no matter what online dictionaries say. I have never had a chiropractor say they could treat diseases, just mechanical issues.

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      • Mabsf January 26, 2015 at 7:27 am

        I agree that chiropractic doesn’t heal diseases, but when a structures is out of plumb it will not function well… I feel the same way about my skeleton…

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    • Pete January 21, 2015 at 3:13 pm

      Agreed. I’ve had much better luck with myofascial release (foam rollers and tennis balls) in general than stretching. I’ve also had good experience supplementing strength and endurance training with yoga (to reduce pains/cramps/injuries). We have a hot tub and I used to soak in it after rides, but last year I switched to soaking in it before rides as a warmup and sometimes do cold baths after particularly hard rides. What a difference!

      I too believe medical advice should be evidence-based – as well as experience-based. Always good to try stuff!

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  • Dwaine Dibbly January 21, 2015 at 6:14 pm

    Here’s wishing you a speedy and lasting recovery! Take it slowly. It sucks getting older, but going slow is a lot better than re-injuring yourself. Keep your mileage and intensity fairly low. Once you start feeling better, mix in some intervals, but still without pushing the intensity. You’ll get there!

    Agree with Pete about evidence-based medicine, but I’m inexperienced in chiropractic, so I’m not going to try to dissuade anyone who feels as though they’re getting benefit from it.

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  • The Odd Duck January 21, 2015 at 7:28 pm

    You did the classic mistake that we all do. You try to put a twenty year old attitude into a forty year old body. I do it all the time with a sixty plus year old body. One thing I saw I am thinking about get is a simple exercises bike. It nothing more a seat with peddles, something you can sit an watch TV and peddle then fold up and put away. It something to think about.

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  • daisy January 21, 2015 at 8:48 pm

    So I had been thinking about getting a bike fitting, but I was pretty intimidated by the whole process. Gladys Bicycles started posting about fit services they were providing with Natalie Ramsland of Sweetpea Bicycles. I set up a time for that, and it was fantastic. I really recommend it, even if you’re not a racer. My bike became so much more comfortable, and lots of little weirdnesses went away with a few adjustments. If you are a woman cyclist who feels a bit intimidated by the whole fit, I strongly suggest working with Natalie through Gladys Bikes.

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  • Randy January 21, 2015 at 9:12 pm

    Jonathan, Glad to hear you got the help you needed to improve your overall health. Life is too short for evidenced-based mudslinging… Whatever works for you, works for you.

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  • reader January 21, 2015 at 10:09 pm

    When I told a bike shop employee just last week that I needed some help figuring out why my neck and shoulders get so tired when I ride, he suggested it would be a good idea to get a bike fitting.

    Sounds obvious, but so far I have not followed up on the advice due to the price.

    I recently had an electric bass professionally set up by a great luthier in town and when I got it back and it felt like a new instrument, I instantly forgot about the cost of the work. Maybe a professional bike fitting would be the same way.

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  • Jim Lee January 22, 2015 at 9:25 am

    Seth Hosmer holds the hour record at Alpenrose velodrome.

    Could not have done that on an ill-fitting bike.

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  • davemess January 22, 2015 at 12:31 pm

    If people are really focusing on cross, going really long in January might be a bit much (still 7-8 months away from the season). The beauty of cross racing is that you get to do your base at some of then best weather time of the year (late spring into summer), at least if you’re not racing mountain or road.

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    • Jonathan Maus (Publisher/Editor) January 22, 2015 at 12:40 pm

      that’s a great point davemess. And I agree.

      in fact that’s another thing I did wrong last season. I applied my old type of training plan — from collegiate road racing days when we built big base in winter — to ‘cross. So dumb in hindsight but that’s all I knew! Definitely taking a different approach this year.

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  • Jimmy January 22, 2015 at 12:39 pm

    I took part in massive physical therapy after a broken femural head and the addition of a half dozen screws and plates in my hip. After 3 years of continual PT, chronic pain and a severe limp that affected walking which is a large part of my profession, the medical advice I was given was to commit to prescription narcotics. Dr. Hosmer corrected my physical issues to be more manageable on my own inside of a year. Chiropractic care is part of whole body health and well being.

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  • Seth Hosmer January 22, 2015 at 2:15 pm

    Thanks for the write up on the process Jonathan, and good to hear that you are feeling good on the bike again.

    I wanted to clarify a few things about the profession, and the process we use at Hosmer Chiropractic.

    Regarding the origins of Chiropractic, most newer graduates do not believe or subscribe to the outdated vitalistic theories, and instead apply a biomechanical and evidence-based approach to treatment. In addition, there are a lot more methods that we use to help patients beyond Chiropractic adjustments. And yes, Physical Therapy is part of the scope of practice in Oregon, as all graduates of UWS here in Portland study for and pass the Physiotherapy National Board Exam. In the state of Oregon, we are licensed as primary care physicians, and do not need a referral from a PCP.

    Our approach to treatment at Hosmer Chiropractic centers on finding and correcting joint problems if they are present, finding and correcting soft tissue problems if present, and teaching rehabilitation exercises. In a nutshell, we are working with each patient to restore normal movement and function. We also have some unique treatment approaches for cyclists, as I have raced bikes since 1996 and have had or treated just about every injury common to cycling. First-hand experience counts for a lot. It is one thing to say you are a sports oriented Chiropractor, it is another entirely to be an active participant in the sport.

    Regarding the articles above about stretching – I would agree, stretching has not been shown to decrease the incidence of injury happening. However, there is a big difference when you are dealing with somebody that is already injured – generally the soft tissues shorten in response to injury, and will not function normally if they continue to be tight. We find that doing some form of myofascial release first, then stretching second, is the best routine for most of our patients. We have an extensive video section of our website if you are interested in finding out more about these types of things.

    Ultimately, results speak for themselves, and we pride ourselves on running a top notch clinic using cutting edge and modern approaches to treatment.

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    • Chris I January 22, 2015 at 7:48 pm

      Are you saying that you practice physical therapy? I don’t see anyone on your staff with a DPT.

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      • spencer January 23, 2015 at 6:20 am

        I concur. Passing a standardized test does not make a Physical Therapist, the education does.
        If ANYONE on your staff holds a license as a Physical Therapist, it would state so right after their “DC” on their name. Your use of the term, and profession, is fraudulent (however eloquently stated).

        I’d like to point out to everyone reading that Mr Hosmer does NOT advertise Physical Therapy on his site or in his business because it is ILLEGAL to do so.

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      • Seth Hosmer January 23, 2015 at 8:26 am

        No, we are not stating that we are a practicing Physical Therapist.

        An MD practices pharmacology, but is not a pharmacologist. Both Chiropractors and PTs generally do some sort of soft tissue manipulation that to the layperson might be thought of as massage, but neither is a licensed massage therapist. Some PTs even do Joint Manipulations or Joint Mobilizations, but cannot state that they are doing Chiropractic Adjustments.

        Strictly speaking, when we discuss this type of thing with patients, we generally use the term “rehabilitation exercises” or similar, and avoid the use of the term Physical Therapy because it is a protected and special term reserved for those that are licensed to practice Physical Therapy.

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  • Kevin @ Pedal PT January 22, 2015 at 5:26 pm

    Thanks Jonathan- So glad to hear you’re feeling better- A professional Bike Fitting (preferably by a healthcare practitioner) can make a world of difference for all levels of cycling, from the commuter, to the everyday rider and racer alike.

    However I digress, and will reiterate what someone posted earlier, in that the term “Physical Therapy” is not to be used loosely, and can only be delivered by a Licensed Physical Therapist, who graduated from an accredited PT school.

    If one were to: 1) pass the NPTE and 2) graduate an accredited PT school, their name would be listed in this Oregon PT License verification database: https://hrlb.oregon.gov/ptlb/licenseelookup/ –Searching for “Seth Hosmer” produces no results. Thus, if you have no PT License, you cannot use the term “Physical Therapy”, end of discussion.

    My fellow PTs and I have worked way too hard for anyone to throw this term around sparingly- Jonathan, I’d really appreciate if you would remove that portion form the article. Thanks!

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    • Kevin @ Pedal PT January 23, 2015 at 11:49 am

      OK, let’s put this to rest, as we’re all in it for the right reasons.

      I have the utmost respect for Dr Hosmer (and many other Chiros for that matter)—- AND after speaking with the Oregon PT board (they called me), I found out a DC really CAN use the term “Physical Therapy”- (I know, I’m as surprised as anyone!) –it’s part of the practice act in Oregon, however not in many other states, which is probably where the confusion came about.

      I just wanted to follow-up and clarify for everyone: If PTs want to have rights to this term, it has to go through the ‘political machine’ in Salem– If you are passionate about this topic, as we all seem to be, please contact your elected officials!

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  • elpenguino January 23, 2015 at 6:57 am

    yeah, I would say the evidence based model has PLENTY of weaknesses. It is all about who has the funding to create the evidence. Just because there is no evidence doesn’t mean it is some hack trying to trick you into to paying them. As someone who is a health care professional (allied health), I have seen people’s health outcomes severely limited by the closed minded evidence based approach. But, it is a tool and framework to use and helps folks in health care not get sued. If something makes someone have a net gain in their health, meaning more good than harm, than who are we to tell them they are experiencing the fake results of pseudoscience…

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  • Peter R January 23, 2015 at 9:32 am

    As some one who has known Seth since high school…circa 1990 or so, I can tell you he is a bright, well educated guy with no intentions of pretending to be something he is not. He’s a top notch athlete too, who has tons of experience with cycling related fit issues.
    I’m the son of a pharmacist and nurse too, I can tell you just because something works for one person, doesn’t mean it will work for everyone. So, according to Jonathan, this process worked for him. It may not work for you, but you’re not Jonathan.
    Chiropractic may work for you, it may not. But unless you have firsthand knowledge, all you’re doing is throwing out junk information yourself.

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  • Scott January 23, 2015 at 10:09 am

    I have had nothing but great experiences at hch
    Seth and his staff took a wholistic approach to my bike fit and really found the causes of the problems.
    Not only am I riding faster and further pain free.
    He added 20 yards to my golf driving distance.
    Thanks hch!

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  • Terry January 23, 2015 at 4:21 pm

    I broke a rib right before cx season a couple years ago and was certain I’d not be able to race. Dr. Seth got me back on track and I started 22 races that season. That non physical therapy pseudoscience he practices sure works.

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  • Stephen Bedford January 23, 2015 at 9:35 pm

    I am an elite cyclist who has won several state titles as well as a national road racing championship. Reaching the peak form it takes to accomplish these achievements requires serious volume and maximum intensity. Needless to say this is very hard on my leg muscles and joints. I have indeed experienced knee pain as a result of my training and I utilized Seth’s services with undeniable results. I should add that I am someone who practices skepticism, and am not an easy sell with anything. However, I believe in empirical results and that”s what I experienced. Coming from a professional freeskier background, and having fractured more bones in my back and hips than I have fingers to count them, I have extensive experience with MD’s/PT’s. Given my experience, I would not advocate that one type of practitioner is categorically better than another, but rather, treatment should be based on an individual’s specific needs. Hosmer Chiropractic Health has improved my physical condition as well as improved my performance on the bike and I will always put results before process classification.

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  • David January 24, 2015 at 9:21 am

    Bicycles have substantial bilateral symmetry. Humans, not so much; we just look that way.

    Well fit, a bicycle like a good pair of shoes, you don’t notice and go all day. Poorly fit, you notice

    If the fitter doesn’t squat down and watch you from all angles, at least from the four sides, go somewhere else. A good fitting takes more than one session.

    Fitting has gone through three major approaches:

    Anatomical, measurement, bio-geometric, formula] measure lengths: the rider’s arm, leg, torso; do some math; adjust the bicycle. Epitomized by FitKit, important at the time. Improved by a goniometer to measure angles: knee, torso, arm. All static measurements. Few humans fit well any set of numbers.

    Bio-mechanical, dynamic] measure movement, usually with motion capture. Informed by sports-med. Improvement over bio-geometric. Still limited by an idea of correct position. Exemplified by Andy Pruitt. (Andy does good work but his book disappoints). This approach comes with a lot of technology and theater.

    Neuromuscular] adjust bicycle to rider’s current ability. Measure the rider’s range of motion off the bike, especially noting asymmetries of flexibility and strength. Adjust leg extension based on velocity of knee. Adjust handlebars based on strength and flexibility of back. Adjust torso position to improve cardiovascular performance. And many more details. Epitomised by Steve Hogg.

    Good fitting starts at the feet.

    Mindfulness makes the biggest difference. Every so often, for a few minutes out of every half-hour, pay attention to how you ride, how you feel, how you move, how the bike feels under you.

    (Steve Hogg has a somewhat different analysis and goes into much greater detail, highly recommend you read him: http://www.stevehoggbikefitting.com/bikefit/2011/09/perspectives-on-fitting/ )

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  • spencer January 26, 2015 at 7:13 am

    To Seth Hosmer DC,

    I regret that I was unable to formulate a response for bikeportland.org this past Friday. I know that my intent was question your validity in providing Physical Therapy services. However, after clarification with the Oregon Physical Therapy Licensing Board, I’ve been made aware of the legal issues regarding the protected use of the term “Physical Therapy”. I was mistaken in my belief that Physical Therapists and Physicians (MD) were the only health professionals legally allowed to practice Physical Therapy in the State of Oregon. I apologize for my confusion and for fueling this debate.

    We all know your accolades and history of treating the athletic community, speaks loudly. I look forward to seeing you out on the road.

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  • Matt January 26, 2015 at 6:25 pm

    Being one of those lazy people that likes immediate gratification I have pretty much done everything wrong when it comes to training. No stretching, no warm-up, no bike fit, no off season, lousy diet, too much too soon, etc., etc. I now find myself dealing with severe tendonitis in both knees. Am really hoping this is not a premature end to my bike racing days but after finally paying up for a pro fit and 3 months of PT the situation is improving. Still, I would welcome the opportunity to travel back in time and slap some sense into my younger self.

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