Hello,

I am hoping I can tap into the expertise on this forum, as I have just started doing bike fits and getting more questions than answers.

I recently did a fit for a female triathlete on a road bike (Specialized Dolce) and was struggling to make the correct decision on medial/lateral placement of cleats or use of spacers.

The lady in question has a large q-angle: very broad hips and thighs deviate medially. Legs are straight. With a laser beam on the second ray it's near the ASIS but the knee tracked within the beam and medially on the power phase of the pedal stroke.

Left leg: On moving the cleats back (for other reasons) the knee, at TDC was on the laser line then moved in medially on the power phase. Does that mean no more action needs to be taken and alignment achieved? No mention of this scenario in Paul Swift's excellent "When the Foot Meets the Pedal…" manual.

Right leg: Knee was closer to the main frame of bike at start, though no indication of hip rotation on saddle. Cleats also moved back (for other reasons) but no real change to initial tracking. Moving cleat outward would possibly make the knee hit top tube of bike. Also rider getting lateral knee pain, location above knee joint indicative of ITB friction syndrome. So moving foot in would make this worse. Rider has very hypertonic glut medius and minimus making her lateral hip very sensitive to touch (receiving sport massage therapy put not from me). It was a lot easier to palpate for the greater trochanter on the right possibly suggesting internal rotation at the hips? ITB is tight too, so could be just because of this. What intervention, if any, would any of you consider? (ps: no LLD, no need for wedges, SOLE insoles used).

Your thoughts and ideas would be greatly appreciated.

Thanks,
Alexander

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Serotta Advanced and Advanced Triathlon
Retul Certified in 2011
Qualified sports massage therapists