Case Study 2 – Congenital Issues

ISSUE: In some instances during the course of physical assessment and by way of asking relevant questions it becomes apparent that a client has a congenital ‘body factor’ that needs careful consideration.


Sport/Exercise History: 2nd/3rd year triathlete. Always ‘sporty’/physically active. Purchasing TT bike for middle to long distance triathlon. Back pain when riding for long periods. Problematic tight hamstrings.

Riding Goals: Working towards Ironman.


 Kamil Klamann spine curvature 2  Kamil Klamann spine curvature
  • Unusually short hamstrings at the knee and more unusually, also at the hips in and otherwise flexible and mobile body.
  • Congenital scoliosis (S curvature with rotation of the spine) – identified by forward flexion test and then revealed by further questioning and childhood medical history (the rider was told in adolescence that orthopaedic surgery to correct this may be an option)
  • Asymmetrical pelvic tilt when seated in the saddle, worsened as the saddle went up.
  • Using the standard body proportion assessment (see Case Study #1) is the starting point from which to modify his position to take account of the issues above.


  • The rider needs to focus the time he has for stretching on an intensive program for his hamstrings and the results need to be reassessed.
  • Bike set up needs to minimize the asymmetry in pelvic tilt to reduce onset of back pain.
  • A non-standard bike set up in terms of conventional saddle height, seat tube angle and drop is warranted in this instance.
  • The position will be continually refined over months depending on the rider’s development with the stretching program.


Kamil Klamann spine curvature 3


  • A personalized stretch program was provided
  • Saddle height was set conservatively low as this reduced the asymmetry in pelvic tilt at current hamstring range of motion
  • We need to be selective with the frame geometry to find a model which has sufficient head tube length to offer a cockpit at a sufficient height so as not to aggravate the pelvic disturbance due to an aggressive drop position.  (Most TT frames have very short head tubes for what we need here.  Moving up a frame size would be too long in the reach).
  • Two settings available for seat tube angle – the softer position was selected as again pelvic tilt measures and knee alignment relationships were more favourable particularly with a ‘lower’ saddle.


This is an example where very individual issues require a non-standard approach to final set up.

We have explained to the client what underlying issues are affecting his performance as a bike rider.  He can now be confident in taking remedial steps to address the issues with a structured plan. He has been given a tailored stretching solution and bike set up.  He now has shed some light on his past comfort anxieties and has taken back some control.

Fitting is the combination of ‘Body+Bike’.

Le Beau Velo

Ground Floor 2-8 Scrutton Street
t: 0203 239 2311

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