Bike Fit 101: Your Pelvic Floor Will Thank You

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Transcript

Lindsey

My guest today is Desirae LeBlanc. She's an occupational therapist, a level one functional pelvic health practitioner and the owner of Cadence Pelvic Health and Wellness, a mobile and telehealth pelvic health OT practice in Southern Maine.

 An avid mountain and gravel biker herself, Desirae is passionate about working with cyclists who want to ride stronger and more comfortably by addressing pelvic floor symptoms that can show up both on and off the bike. Her goal is to empower riders to understand and improve their pelvic health so they can feel confident, capable and comfortable in and out of the saddle. I can't wait for you to hear today's episode.

Intro

New and seasoned OTs are finding their calling in pelvic health. After all, what's more ADL than sex, peeing, and poop? But here's the question. What does it take to become a successful, fulfilled, and thriving OT in pelvic health? How do you go from beginner to seasoned and everything in between? Those are the questions and this podcast will give you the answers. We are inspired OTs. We are out-of-the-box OTs. We are Pelvic Health OTs I'm your host, Lindsey Vestal, and welcome to the OTs in Pelvic Health podcast.

Lindsey Vestal

Desirae, I'm so excited to have you as a guest on the OTs for Pelvic Health podcast today, talking all things cycling and pelvic health.

Desirae

Oh, thank you, Lindsay. I'm so excited to talk to you about this. These are like two of my favorite things in the whole wide world so.

Lindsey Vestal

It's such an under-discussed topic and, you know, I'm thrilled to have you talking with us about it because you not only have our cyclists yourself, but you're really passionate about supporting other people who want to keep cycling and want to keep their public floors healthy.

So it's an honor. I know I had the privilege of supporting you and OT Pioneers in 2023. And so this is just like we had said before the recording got started, this is such a full circle moment.

So without further ado, I just wanted to say how excited I am to have you here.

Desirae

Oh, yes. I'm so excited. Yeah. Back when I learned about you and I heard you on a podcast, just now being on one with you is so crazy. So I just appreciate you having me here. And, you know, not only did I do the OT Pioneers in 2023, but also like the Level 1 functional health practitioner back in May finished that. So it's just been really cool to learn from you. And I'm so excited to talk more about this.

Lindsey Vestal

Oh, thank you. The honor is mine, Desiree.

So, alright, let's get into it. share a little bit, if you don't mind about your background as a cyclist and your work with other cyclists.

Desirae

Sure. So I you know didn't really grow up cycling or anything. I really kind of fell into it when I was about to graduate college and enter grad school. I started actually volunteering with an adaptive sports organization here in Maine called Maine Adaptive Sports and Recreation. And i just borrowed a bike from somebody and started, you know, cycling with others and helping others do it. And so that was kind of my first, you know, entry into, I guess, re-entry into biking because I really only biked when I was a kid.

And then also helping others do it. And I just loved it. And then fast forward to 2018, I bought a mountain bike off of a friend and ended up going biking with them and just kind of fell in love with mountain biking slowly.

Went off to do my field work out west in Arizona, actually, and met other really cool women who mountain biked and started biking.

you know, learning how to do it. And I really kind of fell in love with it through mountain biking. And then when I came back east to Maine, started biking with more friends and exploring what was around my area and just totally fell in love with biking, mountain biking, gravel biking, and just the bike community here.

And, you know, naturally that turned into like, okay, I love this so much. Like, how can i make this also my job? And, you know, when I took your course and just even hearing you say the pelvic floor is the bike seat muscles, I was like, whoa, wait a minute. Maybe this is something that I can do. And, you know, started talking to more people while i was, you know, biking with them and,

there, people were interested in like, how, what is pelvic health? And, you know, this does hurt when I bike or whatever. So I think there's just kind of a natural connection there.

Yeah, So now I just started working with, I honestly, it started with some friends who kind of were more expressing interest in, you know, talking more about pelvic health and bikes. And that's kind of my entry into starting to work with other cyclists too.

Lindsey Vestal

That is such a cool story. I think most people assume that, you know, if you meet a cyclist, they've been doing it, you know, since they were a kid.

And I just, I love how right before into grad school, you had that encounter that just propelled everything forward. And through your moves, that really enabled you to kind of like have a community, right there, ready to roll their sleeves next to you.

Like that's also really beautiful. And also i have to comment, like what's better than combining two passions? You know, like it's, you said like the way you said you're like, I literally found like my life's calling, you know, it's, it's just, it's really, it's really remarkable when those, when those aha moments come together like that. So that's amazing. Desiree, what do you wish more people knew about saddle sizing and its impact on pelvic comfort?

Desirae

Oh, so many things. So i think, you know, when I started really getting into biking, The saddle was something that I didn't know had anything to do with biking and how it can impact our comfort. And I just really wish people knew that there were, in general, different saddle sizes. Because when you buy a bike from a shop or online, you know, I don't know the exact percentage, but I would probably say 99% the time that saddle is not going to be the right fit for you.

And actually measuring your sit bones and measuring your saddle size is fairly simple. And you probably have all the things that you need to do that in or all the things you need to do that in your house right now. And it all just has to do with measuring the distance of your sit bones or ischial tuberosities.

And there's a couple different ways to do it. But you need a piece of tinfoil, a bath towel and some place to sit. And basically you just put the tinfoil on top of the bath towel, sit on the bath towel and bring your knees up, rock back and forth a little bit. And then when you stand up, you'll see two marks on the tinfoil and that's where your sit bones were. And you can put a little X on each one and then measure the distance between the two.

And then 20 in millimeters, I think is the best way to do it. And that will be your saddle size, which I just wish I had learned that a lot earlier in biking because I was riding the wrong saddle size for so long.

And I just hear that from so many people that, you know, I don't like biking because it's uncomfortable and like it hurts my butt or, you know, and I think that it's probably because 99% of the time the bike we bought doesn't actually fit us, fit us our saddle size.

Lindsey Vestal

Yeah. Wow. Like I love that.

How OT, you know, you need is tinfoil on a towel and the races with already enjoying cycling so much more.

Well, I'm so curious, like how obviously we've all felt that discomfort. Those of us, you know, have ridden bikes. And so, but thinking a little bit more about pelvic health, like pelvic floor pressure, pressure and things like that.

Can you talk to us a little bit more about how saddle angle, height, and all of that really influences pelvic pressure and even pelvic symptoms beyond us just saying, oh that,that was really uncomfortable.

Desirae

Absolutely, So really, there's three points of contact on the bike that we have, right? Our hands on the handlebars, our feet on the pedals, and then our sit bones and our pelvis on the saddle. And so those three points are really important to make sure that they're lined up because that's going to impact the pressure that it's putting on our pelvic floors.

So a good place to start is obviously like the height of the saddle. That's usually where most people start to make sure that they can get on and off the bike and that they're comfortable sitting on it.

So the height of the saddle, you want it to be at a point where when you're sitting on the saddle and you make a full pedal rotation and your foot is at that six o'clock position, that your knee is just slightly bent when it's fully, fully extended. So you don't want it all the way extended, but just slightly bent.

So that's going to be the height of your saddle. And then the angle is another piece of adjustment that you can make. And you ideally want the angle of your saddle to be neutral or slightly angled down.

If it's slightly angled up, it's going to increase pressure on your tissues. And it also, when you put it too far down, it's going to put a lot of pressure on your hands.

So, you don't, you kind of want it more in a neutral position.

you know, some people, if you know, you're someone who has a tendency to be in an anterior tilt, you can kind of use that to know, okay, so maybe I need to make sure that my saddle is more neutral.

I don't want it to be tilting too far down so that I'm putting myself in even more of an anterior tilt. And then also like the fore and aft of the saddle. So how far forward or backward is the saddle as it compares to your handlebars. So when your saddle is closer to your handlebars, you're going to be in a more upright position, that more neutral pelvis. And then if it's farther away, you might start getting into like a posterior tilt and your arms are going to be reaching, your back's going to be a little more arched.

So I think being an OT in this area is so cool because Where I'm not a professional bike fitter, I do know how to make those adjustments. And my dream is to be able to teach people how to do that. Like this is the Allen key that you need to turn that little bolt in order to adjust your saddle. And this is how you can do that to really empower people to get on the bike and try different things and see what feels comfortable and what doesn't. I think that's a really cool opportunity as an OT to just empower people to do that for themselves too.

Lindsey Vestal

Oh, absolutely. Because what you're describing, like, it's not super technical or complicated. course, like maybe you have a partner with you that can help, you know, stand away from you and see it with a little bit more objectivity.

But other than that, it's really already you're in tune with your posture and how you feel on the bike. And so it's just kind of like a list of best practices. Yeah, it is so OT.

And I love it, I love that you're leading this conversation. This is so cool.

Desirae

I will say also, I'm kind of the worst, but also best person to go on a bike ride with. Because if I'm behind you, I will be like, hey, your seat's not high enough. Like your knee is too far bent or it's too extended. and like, that's going to cause you pain later. Yeah.

Lindsey Vestal

Oh, I think most people welcome that. Please keep that up. What are some of the most common pelvic floor conditions that you see among cyclists?

Desirae

Yeah, so I'm in weird kind of world where I know a lot of cyclists, so they aren't necessarily coming to me because of biking in pain. They're coming to me because they're a cyclist and they might have symptoms that are affecting them in other parts of their life. But I had a client that actually said, you know have you ever read the book Everything is Tuberculosis by John Green? And it's essentially a book about how he sees the world through the lens of tuberculosis and that like everything that has happened is because of tuberculosis. And she was like, I think that's pelvic health. Like everything is pelvic health.

Like, yeah, pretty much like, you know, if you're having symptoms, you know, in your everyday life, like pain with sex or, you know, leaking or constipation,

you know, like that can carry over into pain on the bike and vice versa. Like if you're having pain on the bike, you know, sometimes the complaint is, oh, I'm having a lot of pain with sex or pain with orgasm and, you know, kind of more of those, like,  I guess, tight tissue issue.

Lindsey

So you've mentioned a professional bike fitter a couple times, and honestly, that's nothing I've ever heard of before. I may be completely in the dark ages there, but could you explain the role a professional bike fitter? Where could we find them? I know, like I purchased bikes at bike stores in the past. I my got bikes for my kids. I would assume it was the person selling me the bike, but they never talked to me about this. So yeah, tell us about professional bike fitters.

Desirae

Sure. So the bike fit certification that I'm aware of is by the Sirota International Cycling Institute or the SICI. And they offer level one, two, three, four. That can be for it can be healthcare workers, PTs, OTs, coaches, or people who work in retail. So that's like a pretty broad you know spectrum of people. But, you know,

So yes, you could find a bike fitter in a retail shop or there are a lot of PTs that are bike fitters. I don't know of any OTs in my area that are bike fitters, but  maybe coming soon because, you know, that's an area that I love and would be super interested in. But one certification at a time.

But you can you can just search, you know, bike fitter near me. And most of the time it is going to be like a physical therapist, a bike coach or yeah someone who's working in a bike shop. And essentially, you know, the difference between a professional bike fit and just, you know, learning how to adjust bike. your bike on your own would be that that person is specifically trained to get put your bike on a special trainer in order for them to measure all your different angles and your posture and your positioning based on your goals and the type of biking that you want to do. And then they fit that bike specifically to you.

Lindsey Vestal

Okay, thank you so much.

That's, that's cool.

So that you bring up a great point. Is there a difference between the advice you give recreational cyclists versus competitive ones?

Desirae

Yeah, I think it just depends on that person's goal and how much time they're spending on the bike. For me, you know, I have more experience working with mountain bikers and more gravel biking because I don't do a lot of road biking. And all the positions on all those types of bikes are completely different. You know, on a mountain bike, you're a little bit more upright. And on gravel and road bikes, you are a little bit more far forward. Those handlebars are a little bit lower. So you're in a little bit more of a forward leaning position.

So the pressure that your saddle and your body is going to put on your pelvic floor is going to be different for those different types of biking. So I would say the advice would probably be different based on the type of biking that the person's doing, not necessarily like competitive versus recreational, but more of like, what's the type of biking you're doing? How long are you biking? How many times a week are you biking? You know, are you doing slow group rides? Are you, You know, getting out there and just going as fast as you can and trying to get the KOM on the Strava segment. Like what, what kind of biking are we doing here? And, you know, what is the impact on your body and the pelvic floor

Lindsey Vestal

Desiree, how can breath work or core engagement strategies be integrated into cycling conversations?

Desirae

So I'll start with breathwork for the first part of this question. And I really think that education is key. Understanding what breathwork even is, what's a shallow breathing pattern versus what is a deep breathing pattern where we can engage our core as well as we're breathing.

And, you know, when we have better breathing patterns, we're going to perform better. We're not going to be as tired on the bike. We're not going to be in that shallow breathing pattern where we're breathing into our neck and shoulders, which again could cause pain because we're having to hold onto those handlebars. So I think that, you know, understanding how to take a nice deep breath off the bike and how does breathing and core go hand in hand off the bike then can translate on the bike. So I like to teach people 360 degree breathing.

How does that coordinate with your pelvic floor contraction relaxation? And then also, how are you activating your TAs, your transverse abdominus when you're taking that breath and then also then bringing that onto the bike? And and how is that going to support you on the bike?

Because i'll another thing that can contribute to the pressure on your pelvic floor on the bike and that discomfort in the saddle is having a weak core. And it can also contribute to back pain. We know weak core contributes to back pain, but weak core can also contribute to your position of your pelvis on your saddle.

So if we don't have good low ab engagement or you know, we're gripping with our upper abs and we're just putting all that pressure down, it can just create this like vicious cycle of discomfort on the bike. So going back to the doing things off the bike, like what are some low ab exercises that we can do? How can we learn to connect to our low abs so that they can support us better on the saddle and put us in a better position?

So things like really nice, easy, gentle dead bugs with just a focus on that low ab activation. And then, or like even grading that down more, you know, in that dead bug position, just doing heel slides, trying to activate the low abs.

And then also if we're having trouble with the breathing and taking deep breaths, we can work ah off the bike on back expansion, side expansion, rib expansion. Cyclists are in that hunched position on the bike and we need to do the opposite of that. We need to make sure that we're doing lots of rotation and extension to try to, you know, counteract the position that we're spending all of our time in.

Lindsey Vestal

Oh, that's lovely. Thank you so much that i can I can really start to see, you know, how all these things are brought full circle. And I love I love this approach of you taking it off the bike, putting it on the bike, making it so meaningful  for your clients. That's awesome.

What are some signs that someone's saddle or setup may be contributing to some of their pelvic floor issues?

Desirae

Yeah, I think the biggest thing is that you really should not have... pelvic floor pain on the bike. If you are, it's very common, but you shouldn't be. And there are ways that you can be comfortable. So big, I guess, red flag signs would be persistent numbness, you know pain that doesn't go away after a couple of rides. 

Because those initial first rides, you're going to have a little bit of soreness as you're you know getting your skin and muscles back in the groove of things and back on used to being on a bike and sitting in that way. getting saddle sores is another really common thing. Cysts is pretty common, especially in vulva owners. and then just chafing that's uncomfortable is like, is another sign that your setup's probably not optimal for you.

But Chamois or bike shorts that have padded bike shorts is they're really great for helping if you're just start like I like to wear my chamois when I just start biking again after, you know, I spent my winter season skiing and snowboarding.

Once I get back on the bike, I like to throw on padded bike shorts to kind of give myself a little bit of extra cushion on the bike. and I think that's something I would recommend to clients too, is, you know, let's beef up the cushion a little bit cause we're not used to this position. but if you're still having numbness or is chafing, even with, you know, a better saddle or better, ah bike shorts, you know, there, it probably is something else going on. So it would be, you know, important to, again, like look at the whole system yourself and what is the bike position, What's what's your position on the bike?

Lindsey Vestal

Awesome. Yeah, that's that's so helpful. What is one thing, Desiree, that you wish every cyclist knew about their body?

Desirae

You know, that you don't have to deal with pain on the bike. Like I like i kind of said, you know, it's kind of embarrassing to talk about. That discomfort, especially when you're like, my butt and my vulva hurts. like You don't want to complain about that on a bike ride.

I definitely did. But not everyone is comfortable with saying those things out loud to you know whoever you're biking with, whether it's a friend or not. And athletes are also known to push through pain. So I just wish that people knew that there are like pretty easy steps that you can take to increase your comfort on the bike. And, you know, it doesn't have to be overly complicated. You don't have to spend like thousands of dollars on a bike fitter or a new saddle or a new bike. You know, there's some pretty easy adjustments that you can make.

Lindsey Vestal

That's so cool.

We are in the part of the podcast where we're going to do some like rapid fire questions. Are you ready for them?

Desirae

I'm ready.

Lindsey Vestal

Do you prefer clip-in pedals or flat pedals?

Desirae

Flat pedals all the way. i have fallen way too many times in clip-in pedals. Although I do use clips on my gravel bike, not on a mountain bike. Learn the hard way.

Lindsey Vestal

What's your favorite post-ride snack?

Desirae

I love a salty, spicy pickle right after a long ride. 

Lindsey Vestal

That sounds so good right now.

Desirae

Oh yeah.

Lindsey Vestal

What is one cycling gear item that you can't live without?

Desirae

I'm going to take this one kind of literally and just say like a helmet, a helmet in my bike you gotta be safe on the bike.

Lindsey Vestal

That's right. That's perfect.

Desirae

Yeah.

Lindsey Vestal

Do you prefer a long solo ride or a group ride?

Desirae

I love both. I think there's a time and a place for both, but I'm definitely more of a group ride girl. I love getting a bunch of the girls together and going out on a women's ride. It's so empowering to bike with, learn from, and hang out with other women outside exploring trails.

Lindsey Vestal

Fantastic. What is your, my last one. What's your dream cycling destination?

Desirae

As I was telling you before, i first started biking, honestly, in Arizona, and I had no idea what I was doing when i was when I was biking out there. And I would love to go back to Arizona, Sedona, Flagstaff, and just you know see those trails through a different point of view now that I've been biking for a while. Yeah.

Lindsey Vestal

Oh, that's fantastic. Desiree, I can't thank you enough. This has been such a fun conversation. It's so clear how passionate you are about this topic. And as I said before, nothing's better than when we can combine two passions that fit so perfectly together. So thank you for all the contributions you make to the OTs and Pelvic Health Facebook group on this topic. And just thank you for like your genuine curiosity and passion for for everything that you do. It's been such a pleasure to support you and see your growth.

Desirae

Thank you so much, Lindsey. would absolutely not be here without you. And I am just so jazzed that we got to talk about this today.

Outro

Thanks for listening to another episode of OTs and Pelvic Health. If you haven't already, hop onto Facebook and join my group, OTs for Pelvic Health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and post it to IG, Facebook, wherever you post your stuff, and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic Health podcast.