I was hoping for your thoughts on a client that I'm left scratching my head over. SOrry for lengthy post as hoping to present decent case study for those fitters longer in the business to perhaps supply some direction. I really want to solve this one.
30 year old male road cyclist with left sided ischial ramus pressure, which he describes like "skin pinching and rolling", basically on the inner lip of anterior ramus, as far as I can determine ( I don't own pressure mapping systems) Has had a reputable fitter spend the last 8 months trialliing different positions and saddles galore, bike shorts and material to no avail. + 2 good physical therapists. Both the fitter and therapists have concluded that his pelvis is not assymetrical on the bike- right hip lower or left hip higher- whichever way you look at it. I however, don't really see a massive pelvis assymetry when viewed from rear.
-Functionally "short" right leg but now no obvious dip in right pelvis or high left ilac crest when pedalling (previously been wedged and shimmed to address R foot varus and the leg length difference by previous fitter).
-I have followed a FIST protocol as per my training, looked at foot pedal interface and got it as best I can- still medial deviation of both knees through pedal stroke, despite lateral cleat placement to the max and forefoot and heel wedging.Can't get feet any further below knee as then he would be hitting chain stays
-likes a fair degree of upward nose tilt on saddle (+ 2 deg) which I find a little curious- perhaps he's searching for more stability rearwards on saddle??
-using the handy saddle changer- I've tried a multitude of saddles in quick succession on my Purely custom fit bike- narrowed it down to Pro Stealth, Cobb San Remo and the Bi Saddle (very expensive!) as better options within studio , however once riding on road- same issues with saddle discomfort- pain is no where else.
-really interesting thing is that he is a professional classical guitarist spending big chunks of day with torso rotated largely to L (anticlockwise)...is his left pelvis rotating to R on bike (not visually obvious) to counteract this and square body to bars and hence contact LEFT ramus more? HOw woudl I solve this on bike-----? turn nose of saddle slightly to R? Haven't done this one before but realise some have....
-another interesting fact - doesn't get his pain when riding indoors doing trainer road sessions on Wahoo kickr core. I've checked with Wahoo and their trainers axle at rear is exactly level with through axles for 700cc wheels at front (ie. not an upward tilt on bike). My thought was that he was slightly more posterior pelvis tilted indoors and therefore unweighting ramus? probably not
-my final thought and where I will go next is to visit is house and wathi him on his trainer and then outdoors to compare. I'm wondering if when outdoors he canterlevers his bike and hence saddle contacts those bony bits, whereas inside the bike is "held" in place by trainer.?
Again, sorry for loads of questions and lengthy written thoughts..any help would be much appreciated :)