+100. Former yoga teacher here. You really need to be working with a professional PT, as laid out by Luke for all the reasons he mentions.
Thanks! I’ll see if anyone works near me. Closest I come to you regularly is DC. The piriformis + sciatic nerve bit is PM&R diagnosis from a local, well-regarded university hospital system. So I trust the foundation. The ideas I laid on top of it are conjecture, and I will gladly follow a smart idea diligently… unless it’s just more clamshells, having followed that particular road to a very dead end over a few years.
Yup! I have what I’ve understood to be a minor leg length discrepancy on the order of 1cm. However, no one with a professional background has watch/filmed me pedaling to see if there is a subtle dip or similar that would only show up under a watchful eye. I don’t perceive rocking and buddies riding behind me don’t see it, but that doesn’t mean it isn’t happening. That’s why my next stop is a local bike fitter who is also a PT. If the leg length thing is a or the major contributing issue, I reckon she will have a keen eye for it.
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Feel free to tell your PT that about the clamshells too. Any good PT should be fine with that. Though this is a cycling issue, maybe consider someone with running expertise too since you suspect it’s a gait thing at root. Just because it happens on the bike doesn’t mean it’s cause by the bike, necessarily.
You may do well by aiming at a PT who works out of a gym or at least has a squat rack or similar in their photos, that would probably be more your style than a traditional clinic structure.
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Thanks. That running-focused idea is great. In fact, it’s pretty to me clear given how long I’ve taken off the bike that whatever this is, much of it is not caused strictly by the bike.
I had a similar issue and my PT found a leg- length discrepancy. He recommended a bike fitter who was also a PT. He added a shim to the bottom of my shoe on the short leg and it has helped a lot.
One clue that was overlooked was that my previous bike fitter had a hard time getting my seat hight correct. The hight for one leg was too high for the other. He split the difference for the two legs and that didn’t work so well.
Good luck getting to the root cause of your problem!
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I haven’t worked with her before myself, but it’s worth emailing Sarah Rice: About – Pedaltailor – professional bike fitting in Chicago she’s a bike fitter and PT, located in Chicago. She will have a backlog though, she’s currently racing trans am.
Hey Aryeh - late to this conversation but I have one suggestion I haven’t seen made that might be useful: find a pelvic therapist, specifically. A good general PT can be a lot of help, but a doctor of PT might have some extra insight to offer that goes past even a high-quality general PT’s level of knowledge. There’s a bit of a myth around pelvic therapy that it’s mostly focused on women, but good pelvic therapy practices see plenty of men too, often for issues around prostate surgery. This might be a bit outside their usual patient profile but a first session might give you an idea of whether they can help. But of all the folks who will take you seriously and could potentially offer something new, a pelvic therapist would be at the top of my list.
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@Aryeh_Jacobsohn, can you do a single leg heel raise (touching for balance) on that side and keep the weight mostly pressed down on the big toe side?
Yes. I can do this on both sides. The calf hurts a little more on the left when I do it. Can’t tell if it’s simply that the right calf is more developed (it is), or something else.
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I have similar problems. I went to redeye bike fitter in golden earlier today strangely enough and i was really happy with how thorough he was. I am turned to my ride by default, and working out of that, but in the meantime I am happy to be fit to accommodate the asymmetries vs. fight my body into try to being perfectly symmetric. lot of adjustments to cleats and different insoles on each shoe to try to get my pelvis to be square.
Edit: I’ve been to a ton of PTs, Chiro, doctors, etc after a bad knee injury. I think the time injured is what mostly got me out of whack. Pelvic PTs were helpful, but this bike fitter seemed to have the understandings of this stuff applied to the bike very well.
If you haven’t already tried this, I would recommend doing a couple of weeks/months on heel raises:
- Seated and standing.
- Heel raise machine, smith machine are good options for resistance when ready. Dumbbells ok if that’s all you’ve got.
- Progress to a slightly heel dropped starting position, e.g. with a small wedge.
- Ensure you’re keeping the base of the big toe pressed in through the top of the range of motion.
- 2+ sets of 5-10 reps 2-3x per week
Also every now and then when walking remind yourself to push off through your big toe.
Rationale: a few of things you’re mentioning make sense if your foot/ankle isn’t dealing with loading (possibly a mix of calf and peroneus longus). Worst case you end up with stronger ankles than before.
I don’t believe a 1cm leg length discrepancy is meaningful unless your bike fit is way off, and that wouldn’t explain why you also notice issues with running.
Hey Aryeh,
Really interesting post, thank you for sharing. Lots of useful replies here!
I’ve been having hip issues recently too, and I started doing regular yoga and I’m already beginning to see real positive differences. I’m subscribed to Abi Carver’s Yoga15, and she recently wrote an article about piriformis which you can read here - https://yoga15.com/article/yoga-for-piriformis-syndrome/
Abi outlines some useful yoga moves to carry out in the article which you can copy without subscribing, although I would recommend subscribing because she has some great yoga plans aimed directly at athletes. I’m finding it very beneficial in reducing some pains and weak spots I have, and also helping me become generally stronger.
Yikes, it sounds unpleasant. I am also not a doctor, but I do have personal experience with hip pain. I did PT last year and suffered from gluteus medius weakness. Initially, I had severe one sided back pain but the problem was in the hips. PT gave me stretches which helped a bit and so electrolysis treatment but single leg exercises with resistance bands were the ultimate solution. The muscles needed to be evened out in both tightness and strength. It turned out the troublesome glute was the opposite side that I expected. It’s all connected and needs to be balanced. Single leg exercises: standing lifting the leg in sets of 10 front, back and side helped enormously. I also got assiomo duo power meter pedals and found a big left/right imbalance. Initially, 65/35. With continued resistance work I have it down to 53/47. Best wishes, it’s a frustrating situation. I think I had been compensating for years without realizing. The glute was asleep and I had no idea. When I finally figured it out it was because side leg lifts with a resistance band on my right leg relieved the sharp pain on my left side. Strengthening the right glute eventually rebalanced my hips and I suddenly found I had a core that I could finally push power to the pedals from. Good luck!
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In addition to others folks have said, I would make sure you keep your eye on your overall movement off the bike and your daily posture. I developed functional scoliosis and bad postural habits from my other injuries and it was largely missed by everyone. This had the effect of largely negating some of the hard activation and strengthening work that I was doing in the gym that should have otherwise been effective. Also, partially because we don’t have any cycling specific PT’s where I live and improving overall, everyday movement became the primary goal, I was able to find a local running specific PT who was able to help a lot. He really understood and was able to seea lot of things that were inhibiting my cycling. Good luck!
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65/35 power balance is wild. I’d suggest verifying that with a second PM. although - you do say you’ve reduced it to near even balance which suggest it might have been real. sorry - a bit off topic. I’ve never heard of such a wild imbalance.
Ha, yeah it was extreme. To be clear, that was on a trainer in a lot of pain at the very beginning of the process. I wasn’t riding outside at that point and I had just resolved a related lateral shift in my lumbar spine with PT. I was effectively on one leg at that point trying to see if it was possible to be on the bike at all.
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Several years ago I saw a pelvic specialist physiotherapist for an extreme and debilitating occurrence of piriformus syndrome. She told me that cyclists constituted close to 40% of her male piriformus syndrome patients. Her treatment was very effective and I wholeheartedly endorse your recommendation . Unfortunately she is in Melbourne (Aus) so isn’t much use to the OP, but I’m sure there will be one near him.
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I have wanted to visit Melbourne since my wife was lucky enough for work to fly her there about ten years ago, but this strikes me as a “months not days” situation. Someday!
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I’m not qualified to help but can’t see any mention of nerve flossing in the thread. Might be worth a try.
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