Category Archives: Orthopedic

Finding a Good Bike Fit for You

A proper bike fit will allow you to enjoy cycling while decreasing the chance of injury. The American Physical Therapy Association (APTA) makes the following recommendations for posture & fit:

Trunk Position & Shoulder Angle

  • For the recreational rider, trunk position should be 40-80° from horizontal and shoulder angle should be between 80-90°
  • For the road cyclist, trunk position should be between 30-40° and shoulder angle should be between 90-100°


Handlebar position will affect your hand, shoulder, neck and back comfort as well as overall handling.

  • For the recreational rider, the width should allow hands to be slightly wider than shoulders
  • For the road cyclist, hands should be approximately 2 cm wider than the shoulders

Knee to Pedal

The closer the angle is to 35°, the better the function and less stress on knee

  • For the recreational rider, the angle should be between 35-45°
  • For the road cyclist, the angle should be between 30-35°

Foot to Pedal

  • Position the ball of your foot over the pedal spindle for the best leverage, comfort & efficiency
  • A stiff soled shoe is best for comfort & performance

The Saddle

  • The saddle on your bike should be level – if the saddle tips downward, pressure will be placed on your hands & lower back
  • The saddle should also be a comfortable distance from the handlebars – too close, and extra weight will be placed on your mid-back and arms; too far away, and you may put extra strain on your lower back and neck


Plantar Fasciitis

What is Plantar Fasciitis?

Simply put, it is inflammation of the fascia on the bottom of the foot. There can also be changes in the fascia as a result of inflammation that cause the tissue to thicken and become gritty with less flexibility of the tissue to stretch. Plantar fasciitis typically presents as heel pain from the inflammation and increased tension and/or shortening of the fascia. It can also present as pain in the arch of the foot. The fascia spans from the heel, spreading out in a fan shape, attaching into the base of each toe. The onset of pain can be slow and progressive or come on quickly without warning and not necessarily related to specific trauma. Many people wake in the morning and complain of foot pain as they stand up and first put weight on their feet. In many cases, the pain can improve as you walk and muscles and fascia loosen up after rising in the morning but if it has progressed too far, the pain may limit the ability to tolerate walking and/or standing throughout daily activities.

What causes this?

The fascia on the bottom of the foot not only supports the arch of the foot but it has to stretch and allow movement as you bear weight on your feet to stand, walk, run, etc. If a muscle imbalance/weakness, joint or soft tissue restriction and/or altered dynamic from normal lower body mechanics has developed, this can put increased strain on the fascia of the foot as it tries to control the landing of the foot on the ground. Then the additional, repeated tension and load on the fascia creates an inflammatory reaction leading to pain and possible changes in the quality of the fascial tissue. The cause is typically multi-factorial and the treatment involves identifying the possible causes and implementing the appropriate treatment techniques to resolve the identified areas of need.

What are possible treatment options?

  • Rest/Activity modification
  • Stretching
  • Ice
  • Night splints
  • Taping
  • Soft tissue and joint mobilization
  • Instrument assisted soft tissue mobilization-GRASTON TECHNIQUE
  • Strengthening and balance training
  • Muscular/Movement re-training
  • Shoe wear changes
  • Shoe inserts (over-the-counter/custom)
  • Patient education and home programs

Skilled Physical Therapy intervention for plantar fasciitis is invaluable to identify the cause of inflammation and dysfunction and design an individualized treatment plan to resolve the problem.

Foot pain does not have to be a barrier to an active lifestyle!

An Overview of Graston Technique

To address restrictions and improve tissue mobility, the therapists at DTS are now trained to incorporate Graston Techniques along with traditional hands-on therapy and specific, individualized exercise programs. Graston incorporates specialized hand guided stainless instruments to specific areas to assist in pain relief and tissue recovery. Research has demonstrated a more rapid return to desired activities with the use of the Graston Technique.

Graston may be indicated in many inflammatory and overuse conditions such as Achilles tendonosis/itis, carpal tunnel syndrome, cervical sprain/strain (neck pain), lateral epicondylosis/itis (tennis elbow), medial epicondylitis (golfer’s elbow), lumbar strain/ pain (low back pain), patella-femoral pain/ disorders (knee pain), plantar fasciitis (foot pain), shoulder pain and disorders, shin splints, scar tissue, and women’s health issues.

Contact DTS for further information!