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Saddle Height and Knee Injuries

27 Mar 2015
Randall Cooper
Cycling and knee injuries go hand in hand. Pain in the front of the knee will occur in 25% of the population at some point in their life, and anterior knee pain is one of the most common overuse injuries for cyclists. Cycling is also usually recommended for knee rehabilitation purposes, being advocated for people following ACL reconstruction, patellofemoral pain, and meniscal issues. Incorrect bicycle configuration, in particular saddle height, can contribute to knee pain for both cycling populations, and in this article I will give a brief overview of the different methods and evidence around getting the seat height correct.

Various methods have been described and used for determining seat height based on lower limb length. A quick summary of these are as follows;

  • Hamley and Thomas Method: 109% of inseam (top of inner leg) to floor length 
  • Trochanteric: 100% of trochanteric to floor length
  • Ischial Tuberosity: 113% of ischial tuberosity to floor length
  • Greg LeMond Method: top of saddle to centre of bottom bracket - 88.3% of inseam length
  • Heel Method: cyclist is seated on the bike, the knee is fully extended with the heel on the pedal and crank in line with the seat tube
  • Holmes Method: knee flexion angle of between 25° and 35° with cyclist seated on bike and pedal at bottom dead centre
  • Howard Method: a variation of the Holmes Method, with the knee at 30° and the ankle in neutral

Research has been performed on most of the methods above mainly into cycling performance parameters such as time to exhaustion, energy expenditure/VO2, power output and pedal force. However for the purpose of this article, studies that looked at the relationship between saddle height and knee injury risk are of most interest.

A number of these knee related studies demonstrate that a small change in seat height can cause a major change in knee joint stresses. A 5% change in saddle height affected knee joint kinematics by 35% and joint moments/forces by 16%. However changes of less than 4% from preferred height do not result in changes to knee injury risk or performance. Forces in the patellofemoral joint (knee cap) are inversely related to saddle height. Cycling backwards results in more patella compression than cycling forwards.

In a review study by Bini and colleagues in 2011, the authors reported conflicting evidence between studies that analysed saddle height and knee injury risk, however it was their recommendation that a knee flexion angle method should be employed (25° to 30°). My thought is that this is too simplistic for the serious or competitive cyclist, and obviously many other configuration factors need to be considered. For the higher-level cyclist, a professional and experienced bike fitter is needed to get your set up right. However, for a quick and easy method for the early stage rehabilitation patient or novice rider the Howard Method with a knee flexion angle of 25° to 30° may be the way to go. Make sure any set up changes are made gradually.

 

References:

  1. Asplund C, St. Pierre P (2004) Knee pain and bicycling. Phys Sportsmed 32 (4): 23-30
  2. Ward SR, TerkMR, Powers CM (2005) Influence of patella alta on knee extensor mechanics. J Biomech; 38 (12): 2415-22
  3. Fleming BC, Beynnon BD, Renstrom PA, Peura GD, Nichols CE, Johnson RJ (1998) The strain behavior of the anterior cruciate ligament during bicycling. An in vivo study.  American Journal of Sports Medicine 26 (1):109-118.
  4. Ericson MO, Nisell R (1987) Patellofemoral joint forces during ergometric cycling. Physical Therapy 67 (9):1365-1369. 
  5. Kutzner I, Heinlein B, Graichen F, Rohlmann A, Halder AM, Beier A, Bergmann G (2012) Loading of the knee joint during ergometer cycling: telemetric in vivo data. Journal of Orthopaedic Sports Physical Therapy 42 (12):1032-1038. 
  6. Hamley EJ, Thomas V (1967) Physiological and postural factors in the calibration of the bicycle ergometer. J Physiol; 191 (2): 55-6P
  7. Nordeen-Snyder KS (1977) The effect of bicycle seat height variation upon oxygen consumption and lower limb kinematics. Med Sci Sports Exerc; 9 (2): 113-7
  8. Shennum PL, DeVries HA (1976) The effect of saddle height on oxygen consumption during bicycle ergometer work. Med Sci Sports Exerc; 8 (2): 119-21
  9. Burke ER. Perfect positioning (2002) In: Burke ER, editor. Serious cycling. Champaign (IL): Human Kinetics: 235-45
  10. Holmes JC, Pruitt AL, Whalen NJ (1994) Lower extremity overuse in bicycling. Clin Sports Med; 13 (1): 187-203
  11. Bini R, Hume PA, Croft JL (2011) Effects of bicycle saddle height on knee injury risk and cycling performance. Sports Med. Jun 1;41(6):463-76. 



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