Perspective

Biomechanical Considerations for

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Cycling Interventions in Rehabilitation
Therese E Johnston
TE Johnston, PT, PhD, MBA, is Re-
search Specialist, Shriners Hospitals
Individuals with physical disabilities may benefit from cycling interventions, which
for Children, 3551 N Broad St, Phil-
could address impairments while potentially minimizing stress on joints. Improve- adelphia, PA 19140 (USA). Address
ments in impairments may then have an impact on mobility, activity, and participa- all correspondence to Dr Johnston
tion. Cycling studies with adults and children who are healthy have shown that many at: tjohnston@shrinenet.org.
factors can influence the biomechanics of cycling. These factors include seat height, [Johnston TE. Biomechanical con-
crank arm length, foot position, cadence, and workload. Knowledge of these factors siderations for cycling interven-
is important for rehabilitation professionals who prescribe cycling as an intervention tions in rehabilitation. Phys Ther.
for individuals with disabilities, because changing these factors can potentially influ- 2007;87:1243–1252.]
ence the therapeutic outcomes. In addition, further research is needed to fully © 2007 American Physical Therapy
understand the effect of these factors on individuals with disabilities. Association

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September 2007 Volume 87 Number 9 Physical Therapy f 1243

Biomechanical Considerations for Cycling Interventions in Rehabilitation
I
ndividuals with physical disabili-
ties may benefit from cycling inter-
ventions, which could address im-
pairments such as decreased muscle
strength (force-producing capacity),
range of motion, and fitness while
potentially minimizing stress to
joints. Improvements in impairments
may then have an impact on mobil-
ity, activity, and participation. Many
factors, however, need to be consid-
ered in designing a cycling interven-
tion, and information learned from
studies examining cycling in adults
and children who are healthy as well
as in adults with disabilities can pro-
vide some insight into these factors.
The choice of the position in which
the individual cycles is important to
consider because the biomechanics
and efficiency of cycling in adults
have been shown to be affected by
seat height, crank arm length, and
foot position.1–11 Cadence (number
of revolutions per minute) and work-
load (resistance or power) also
have been shown to be important
factors.1,7–20 Careful consideration
needs to be given to these choices
for individuals with disabilities.
The purpose of this perspective is to
review the relevant literature on cy-
cling biomechanics in order to pro-
vide clinicians with information on
factors that may affect a cycling inter-
vention for individuals with disabili-
ties. This article will include infor-
mation on cycling biomechanics in
people with and without disability.
Cycling in People Without
Disabilities and
Implications for Individuals
With Disabilities
Numerous studies have examined
the biomechanics of cycling in adult
recreational and competitive cyclists
who are healthy. In these studies,
many biomechanical aspects of adult
cycling have been examined, in-
cluding joint kinematics,3– 6,10,11,21–25
kinetics,1– 4,7,9,10,18 –20,23,24,26 –31 muscle
1244 f Physical Therapy Volume 87
activity using electromyography
(EMG),8,22,25,27,29,31–33 energy expendi-
ture,6,12,13,32,34 –37 and the effects of dif-
ferent workloads,1,10 –12,14 –16,18,28,30,32
cycling cadences,1,7–9,12–14,17,19,20,22,30
and positioning of the subject on the
bicycle.1–11,27,38 The Table provides an
overview of the variables examined in
each study. These studies provide use-
ful information for physical therapists
who use cycling as an intervention.
Joint kinematics during cycling have
primarily been studied in the sagittal
plane. When cycling at a cadence of
60 rpm, a power output of 120 W, a
seat height based on 113% of the
distance between the ischial tuberos-
ity and the medial malleolus, and the
foot positioned with the ball of the
foot on the pedal surface, the lower
extremities of young men who were
healthy moved between 32 degrees
and 70 degrees of hip flexion, 46
degrees and 112 degrees of knee
flexion, and 2 degrees of dorsiflexion
and 22 degrees of plantar flexion.39
Although most studies have exam-
ined cycling in only 2 dimensions, it
has been suggested in the adult cy-
cling literature that 3-dimensional
(3D) motion analysis be performed
instead of 2-dimensional (2D) analy-
sis.23,40 Recent reports have indi-
cated that there is movement occur-
ring in both the frontal and
transverse planes and that excessive
motion in these planes around the
knee has a relationship with knee
pain experienced during cycling.23,40
Therefore, 3D motion assessment in
individuals with disabilities is even
more critical because of the disabili-
ty’s potential effects on lower-
extremity mechanics.
Likewise, analysis of joint moments
during cycling has primarily been
isolated to the sagittal plane.40 When
cycling at a cadence of 60 rpm, a
power output of 120 W, a seat height
based on the distance between the
ischial tuberosity and the medial mal-
leolus, and the foot positioned with
Number 9
the ball of the foot on the pedal sur-
face, young men who were healthy
with an average weight of 75.5 kg
had mean (⫾SD) hip flexion mo-
ments of 34.3⫾9.1 N䡠m, hip exten-
sion moments of 8.9⫾2.6 N䡠m, knee
flexion moments of 28.8⫾17.5 N䡠m,
knee extension moments of
11.9⫾2.6 N䡠m, and peak dorsiflexion
moments of 31.9 N䡠m (there were no
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plantar-flexion moments). All of
these moments were external mo-
ments.41 As with kinematics, 3D
analysis has the added benefit of pro-
viding information that may assist in
understanding the causes of knee
pain that may be due to external and
internal moments occurring during
cycling.40
The knee, however, is the only joint
that has been studied using 3D kinet-
ics. One study23 demonstrated that a
valgus moment was present at the
start of the extension phase (peak of
7 N䡠m) and a varus moment occurred
throughout most of the flexion
phase (peak of 7 N䡠m) when young
adults cycled at 225 W and 90 rpm.
Overall, the moment in the trans-
verse plane was internal throughout
most of the revolution with a peak
value of 1 N䡠m in each direction. The
authors did note great variability in
these measures. In individuals with
disabilities, knowledge of joint mo-
ments may provide clinicians with
information that could lead to meth-
ods designed to minimize joint
stress. For example, a patient who
has had knee ligament surgery may
need to minimize transverse and
varus/valgus force around the knee,
and cycling may be too stressful at
higher resistances and cadences. Fur-
ther research, however, is needed to
determine how these moments de-
crease at lower resistances and
cadences.
Many cycling studies with adults
have used EMG to gain a better un-
derstanding of how muscles function
during cycling.8,25,29,31,33 Figure 1
September 2007
 Biomechanical Considerations for Cycling Interventions in Rehabilitation

Table.
Selected Studies of Cycling Biomechanics and the Variables Examined

Authors Subjects Kinematics Kinetics EMGa Energy Workload Cadence Positioning

Expenditure
Brown et al21 11 adults who were X X X
healthy
Dore et al16 Males ages 8 to 20 years X
Duc et al 32 12 young male competitive X X X
cyclists

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Eisner et al25 6 young men and 6 young X X
women
Ericson et al33 11 young men X
Ericson et al 10 6 young men X X X
Ericson et al 24 6 young men X X
Ericson and Nisell1 6 young men X X
Ericson and Niselll1 6 young men X X X
Ericson 29 11 young men in EMG X X
study and 6 in power
study
Ericson and Nisell18 6 young men X X
Ericson30 7 young men X X X
Eston and Brodie34 19 young men X X
Gregersen and 15 competitive cyclists X X
Hull23
Gregersen et al27 15 competitive cyclists X X X
Hansen et al 12 9 young men X X X
Hansen et al 36 16 young men X X X
Hug et al35 12 young men: 7 trained, 5 X X
untrained
Hull and Gonzalez17 Computer simulation X X X
Inbar38 13 young male recreational X X
cyclists
Jorge et al8 6 experienced men X
Martin and Spirduso7 16 young trained cyclists X X X
Martin et al9 17 boys who were healthy, X X X
ages 8–11 years
McDaniel et al13 9 trained cyclists X X
Nielsen et al37 20 young men X X
Nordeen-Snyder 6 10 young women X X X
O’Kroy 28 23 college-aged men and X
women
Peirson-Carey et al2 16 recreational cyclists: 8 X X
women, 8 men
Prilutsky and 5 recreational cyclists: 3 X X
Gregory31 men, 2 women
Raasch and Zajac14 Computer simulation X X

(continued)

September 2007 Volume 87 Number 9 Physical Therapy f 1245

Biomechanical Considerations for Cycling Interventions in Rehabilitation

Table.
Continued

Authors Subjects Kinematics Kinetics EMGa Energy Workload Cadence Positioning

Expenditure
Redfield and Hull19 One experienced cyclist X X
Reiser et al15 28 young male recreational X X
cyclists
Reiser et al5 18 male recreational X X X
cyclists

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Reiser et al3 19 male recreational X X X
cyclists
Sanderson et al20 29 young men, X X
recreational and
competitive cyclists
Sanderson et al22 12 young adult cyclists X X X
Too and Landwer 4 11 young males who were X X X
healthy
a
EMG⫽electromyography.

shows an example of muscle activity

patterns during cycling. The general
weakness of these EMG studies is
that the criteria for determining the
onset and offset times for muscle ac-
tivity are inconsistent across studies,
making comparisons difficult. De-
spite this limitation, adults who are
healthy have been shown to co-
contract agonist and antagonist
groups during specific arcs of the
cycling revolution.8,40 It also has
been shown that adults who are
healthy have predictable patterns of
EMG activity in the uniarticulate
muscles during cycling.

Variability, however, has been re-

ported in the activity of the biarticu-
late muscles in adults who are
healthy, suggesting a different role
for these muscles. Often, the muscle
is shortening at one joint while
lengthening at the other joint during
cycling.40 Studies of complex mo-
Figure 1. tions such as cycling, running, and
An example of a polar plot representing muscle activity for adults who were healthy jumping have shown that the 1-joint
during recumbent cycling at 75 rpm and 250 W (adapted from Hakansson NA, Hull ML. muscles are primarily the power pro-
Functional roles of the leg muscles when pedaling in the recumbent versus the upright ducers, whereas the biarticulate
position. J Biomech Eng. 2005;127:301–310). Zero degrees occurs at bottom dead muscles function to transfer power
center (when the pedal is farthest from the seat and the leg is most extended).
1⫽gluteus maximus, 2⫽biceps femoris, 3⫽rectus femoris, 4⫽vastus lateralis, 5⫽semi- between the 2 joints.42 This informa-
membranosus, 6⫽anterior tibialis, 7⫽lateral gastrocnemius, and 8⫽soleus muscles, tion is important, because individu-
respectively. als with disabilities may display ex-

1246 f Physical Therapy Volume 87 Number 9 September 2007

 Biomechanical Considerations for Cycling Interventions in Rehabilitation
cessive co-contraction of agonist and
antagonist groups during functional
activities.43 In addition, biarticulate
muscles (gastrocnemius, hamstring,
and rectus femoris) in individuals
with disabilities may be shortened in
length,44 which could potentially
change the effectiveness of these
muscles.
Many studies with adults have exam-
ined the effects of changing the po-
sition of the rider on the cycle and
have shown that changes in the
length of the crank arm, the height
of the bicycle seat, and the position
of the foot on the pedal can have
significant effects on kinematics, ki-
netics, muscle activation, and energy
expenditure during cycling. The ef-
fects of different workloads and cy-
cling cadences also have been stud-
ied, and many studies have looked at
a combination of position, cadence,
or workloads and have attempted to
interrelate them.
Positioning on the Cycle
One area of debate has been on the
length of the crank arm, which is not
typically adjustable in bicycles. The
crank arm is the rotating bar to
which the pedal is attached, and the
length of the crank arm is measured
from the point of rotation of the
crank arm on the cycle to the point
of rotation of the pedal on the crank
arm (Fig. 2). Some studies have ex-
amined the effects of changing the
length of the crank arm of the cycle
on adults who are healthy4,7 and chil-
dren.9 Martin and Spirduso7 found
that crank length was optimal for
power (product of resistance and ca-
dence) production when the crank
arm was set at 20% of leg length
(standing height minus sitting
height) or 41% of tibia length (lateral
knee joint space to lateral malleolus)
in 16 trained young adult cyclists.
The pedaling cadence optimal for
power output was found to decrease
with increasing crank length.7 There-
fore, an increased crank length in-
September 2007
Figure 2.
The crank arm is the rotating bar to which
the pedal is attached, and the length of
the crank arm is measured from the point
of rotation of the crank arm on the cycle
to the point of rotation of the pedal on the
crank arm.
creases the lever arm, so the user
does not have to pedal as quickly to
achieve the desired power output. A
longer crank arm may be desirable
for power production for a patient
who is unable to achieve a high cy-
cling cadence.
Too and Landwer4 studied 11 young
adult male recreational cyclists and
reported that power output was op-
timal at 180 mm, a crank length 5
mm to 10 mm greater than the
length typically used for cycling.
These results somewhat conflict
with the results of Martin and Spir-
duso,7 who found that the optimal
crank length was related to leg
length. However, the range of the
crank lengths studied by Too and
Landwer4 was 100 to 265 mm, with
increments of at least 35 mm be-
tween successive crank arm lengths.
Perhaps the 180-mm length was op-
timal in their subjects due to these
large increments. Another study9 ex-
amined maximal power output in
children in relation to crank length at
2 settings—20% of leg length and
170 mm—and found no differences
in maximal power at either crank
length. However, pedaling cadence
at maximum power was 13% greater
with the crank length set at 20%
Volume 87
of leg length versus the standard
170-mm length, suggesting that
children could obtain higher pedal-
ing cadences at a crank arm length
set based on their anthropometric
measurements.
The height of the bicycle seat during
standard upright cycling has been
another area of investigation, with
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greater extension reported with in-
creasing seat height.6,39,45 Differ-
ences have been reported in excur-
sion at the hip, knee, and ankle with
seat heights identified as low (102%
of the distance between the ischial
tuberosity and the medial malleolus),
middle (113% of that distance), and
high (120% of that distance). With a
low seat height, excursions of move-
ment were from 40 degrees to 80
degrees of flexion at the hip, 65 de-
grees to 125 degrees of flexion at the
knee, and 5 degrees to 25 degrees of
plantar flexion at the ankle. As the
seat was shifted to the middle height,
these excursions changed to 32 de-
grees to 70 degrees at the hip, 46
degrees to 112 degrees at the knee,
and 2 degrees of dorsiflexion to 22
degrees of plantar flexion. As the
seat was shifted to the high height,
these excursions changed to 20 de-
grees to 65 degrees at the hip, 25
degrees to 105 degrees at the knee,
and 12 degrees of dorsiflexion to 20
degrees of plantar flexion.39
Another study6 showed a significant
difference in energy expenditure
across different seat heights in
adults, finding that a seat height set
at 100% of leg length (greater tro-
chanter to floor) was the most
energy-conserving compared with
one set at 105% of leg length. Finally,
it has been shown that young adult
cyclists who are healthy could obtain
greater ankle joint moments at a
higher seat height (120% of the dis-
tance from the ischial tuberosity to
the medial malleolus) rather than a
lower one (102% of that distance).10
Number 9 Physical Therapy f 1247
Biomechanical Considerations for Cycling Interventions in Rehabilitation
Based on the findings of these stud-
ies on seat height, it appears that the
specific goals for the individual
should guide the choice of seat
height. For example, if a patient has
a knee flexion contracture, a lower
seat height may be needed to allow
that individual to cycle. A lower seat
height also may be desirable in order
to minimize energy expenditure for
a patient with pulmonary or cardiac
concerns. If the desire is to
strengthen the calf muscles or to ob-
tain greater extension range of mo-
tion, a higher seat height may be the
better choice. A higher seat height
also may better challenge the cardio-
respiratory system during exercise,
potentially leading to exercise ef-
fects such as an improvement in
maximum oxygen consumption.
These are just a few examples of
how the information from biome-
chanical studies can be used to affect
patient care.
Researchers have reported on the ef-
fects of changing the position of the
foot on the pedal on ankle mo-
ments10,27 and tibiofemoral compres-
sive forces.11 Two reports10,11 were
based on the same study of 6 young
male recreational cyclists, in which 2
positions of the foot on the pedal
were studied: (1) an anterior posi-
tion where the head of the second
metatarsal was placed on the center
of the pedal and (2) a posterior po-
sition where the instep was placed
on the center of the pedal.
Ericson et al reported that ankle in-
ternal moments decreased when the
foot was in the posterior position on
the pedal compared with the ante-
rior position,10 indicating that the an-
kle muscles exerted less torque in
the posterior position. For example,
at a seat height based on 113% of the
distance between the ischial tuberos-
ity and medial malleolus, a power
output of 120 W, and a cadence of
60 rpm, the maximal plantar-flexion
moment was reported to be
1248 f Physical Therapy Volume 87
15.6⫾3.4 N䡠m with the foot in the
posterior position and 30.9⫾2.8 N䡠m
in the anterior position in young
men. Therefore, there is a greater
demand on the calf muscles and
greater potential strengthening ef-
fects on these muscles when cycling
with the foot in the anterior
position.10
In this study,10 seat height did have
an effect with greater ankle mo-
ments seen with higher seat heights.
Overall compressive forces at the an-
kle and knee also have been studied.
As the seat assumes a proportion of
the body weight, compressive forces
at the ankle were found to be ap-
proximately 29% of what is encoun-
tered during walking based on a 71.3
kg person.10 Tibiofemoral compres-
sive forces during cycling were
found to be approximately 0.3 to 2
times body weight depending on
workload, cadence, and saddle
height compared with tibiofemoral
compressive forces of 2 to 4 times
body weight during walking.11 At the
knee, no differences have been re-
ported in tibiofemoral compressive
or strain forces between the anterior
and posterior foot positions.11
In addition to the choice of the an-
terior or posterior foot position,
there is the choice to position the
foot in inversion or eversion on the
pedal, in cases when the pedal al-
lows this manipulation. Placing the
foot in 10 degrees of eversion has
been shown to decrease the varus
external moment by 55% and the
peak internal rotation moment by
53% during the extension phase
compared with cycling with the foot
in neutral inversion/eversion. The
moments were increased above val-
ues of the neutral positions when the
foot was in 10 degrees of inversion
(varus by 47%, internal rotation by
88%).27
Another positioning decision that
can be made for cycling involves the
Number 9
choice of an upright or a recumbent
cycle. In one study,46 lower-
extremity internal moments during
recumbent cycling in adults who
were healthy were compared with
values previously published for
adults who were healthy during up-
right cycling. It was found that the
knee extensor moment during the
extension phase of cycling while in
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the recumbent position was less and
that the hip extensor moment was
greater than those seen during up-
right cycling. In addition, a 90-
degree shift in the pattern of the gen-
eral muscle moments was seen at the
hip with both extensor and flexor
general muscle moments occurring
90 degrees later in the revolution
during recumbent cycling as com-
pared to upright cycling.46 The study
by Gregor et al46 suggests that re-
cumbent cycling may promote the
use of the hip extensors. An addi-
tional study examined differences in
knee loads when cycling in an up-
right or recumbent position and
found that anterior and posterior
shear forces were greater in the up-
right position. Therefore, a recum-
bent cycle may be a better choice for
individuals who have had an anterior
cruciate ligament reconstruction47
or with patients with anterior or pos-
terior knee instability.
Effects of Cadence and Workload
Cycling cadence has been shown to
have a relationship with joint mo-
ments,19 power output,19,20 EMG
patterns,48,49 and energy expendi-
ture.13,50 A general pattern of in-
creasing moments at the hip, knee,
and ankle and decreasing pedal force
moments has been reported as cy-
cling cadence increased in an expe-
rienced cyclist.19 In the study by
Redfield and Hull,19 the hip moment
was most significantly affected,
which the authors attributed to the
involvement of the hip in both accel-
eration and deceleration of the lower
extremity during cycling, with the
largest hip moment seen with decel-
September 2007
 Biomechanical Considerations for Cycling Interventions in Rehabilitation
eration during the transition from ex-
tension to flexion. This indicates that
higher cadences may demand more
work from the hip during the transi-
tions between flexion and exten-
sion. In contrast, however, another
study51 showed that an increased
workload led to an increase in the
moment at the hip and knee, but that
an increased cadence only led to an
increase in the moment at the hip.
A significant interaction between
power output and cadence was re-
ported in another study20 involving
young adult male recreational cy-
clists. In this study, increasing power
output with constant cadence led to
an increase in peak pedal force, in-
dicating that the leg was exerting
more force into the pedal. However,
increasing cadence while keeping
power output constant led to a de-
crease in peak pedal force. There-
fore, a lower resistance and in-
creased cadence may be indicated to
decrease loading across all joints.
Muscle activity also has been shown
to change with changes in cadence.
One study48 involving 10 young male
competitive cyclists showed that
muscles responded differently to in-
creases in cadence, with increased
activation in some muscles (gastroc-
nemius, hamstring, and vastus medi-
alis) but no change in activation in
other muscles (tibialis anterior and
rectus femoris) when cycling be-
tween 45 and 120 rpm at 250 W.
Interestingly, the gluteus maximus
and soleus muscles showed signifi-
cant trends with the lowest activa-
tion values when cycling at 90 rpm.
This study, therefore, showed that
the overall patterns of muscle activ-
ity during cycling could change with
changing cadences, indicating that
there may be different outcomes in
measures such as strength (force-
generating capacity of a muscle)
when cycling at different cadences.
Another study22 showed that increas-
ing cadence (50, 65, 80, 95, and 110
September 2007
rpm) led to greater activity of the
gastrocnemius muscle, but not the
soleus muscle, when cycling at a
power output of 200 W.
Finally, the relationship between ca-
dence and energy expenditure also
has been studied. One study13
showed that cadence did not signif-
icantly contribute to energy expen-
diture during submaximal cycling.
Pedal speed (cadence ⫻ crank
length ⫻ 2␲60), however, did signif-
icantly contribute, suggesting that
energy expenditure is higher with an
increased crank arm length when ca-
dence and workload are held con-
stant. In contrast, another study50
showed that a relationship existed
between cadence and energy expen-
diture with the trough of the curve at
60 or 75 rpm in athletic young adult
noncyclists when cycling to exhaus-
tion. Some of the differences seen
between these 2 studies may have
been due to the differences in test-
ing, because one test was submaxi-
mal13 and the other test was to ex-
haustion.50 A submaximal test may
be more energy conserving than a
test designed to achieve physical
exhaustion.
Workload has been shown to affect
compressive and strain forces at the
knee11 as well as the freely chosen
cycling cadence,12 the gross effi-
ciency of cycling,12 the ability to
reach peak power during an all-out
cycling test,16 and EMG patterns.49
An increasing workload has been
shown to increase the compressive
forces at the knee during cycling.11
For example, when cycling at 60
rpm, a mid-range seat position as de-
scribed earlier, and an anterior foot
position, the compressive force in-
creased from approximately 0.3
times body weight at 0 W to approx-
imately 2 times body weight at 240
W.11 This finding has implications
for treatment of patients in whom
high compressive forces may be
contraindicated.
Volume 87
In addition, freely chosen cycling ca-
dence has been shown to increase
with increasing load, and gross effi-
ciency (power output divided by
metabolic energy input) has been
shown to be lower at higher loads in
7 young men who were healthy.12
The low cycling loads studied were
9 to 36 kg/m2 and the high loads
ranged from 56 to 182 kg/m,2 which
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were set by using the high and low
gears of the cycle, respectively. Cy-
cling cadence and gross efficiency,
therefore, are inversely related,
with a higher cadence decreasing
efficiency.
In a pediatric study,16 prepubescent
boys also increased their cycling ca-
dence in response to increasing
loads. However, the highest loads
prevented the children from being
able to reach the peak power ob-
tained with lower loads during an
all-out cycling test because the chil-
dren became fatigued prior to reach-
ing a comparable peak power.16
These findings suggest that lower
loads may be more desirable to ob-
tain optimal measures of power, at
least in children. The authors re-
ported that a workload of 0.05 kg
per kg of body weight appeared op-
timal for their young subjects. If the
goal is to maximize power, there-
fore, a lower load may be desirable in
children.
Workload also has been shown to
affect EMG activity by altering the
onset and offset of muscle activity
during the revolution. Several mus-
cles have been shown to have earlier
onsets (gluteus maximus, rectus fem-
oris, biceps femoris, vastus lateralis,
anterior tibialis, and soleus) and ear-
lier offsets (gluteus maximus, rectus
femoris, biceps femoris, and vastus
lateralis) when the resistance de-
mand (in kilograms) was increased.49
In this study, the magnitude of
muscle activity also was shown to
change in the rectus femoris, vastus
lateralis, anterior tibialis, and gastroc-
Number 9 Physical Therapy f 1249
Biomechanical Considerations for Cycling Interventions in Rehabilitation
nemius muscles. Clinically, this find-
ing indicates potential for a greater
effect on these muscles when cy-
cling at greater loads. Another study,32
however, showed no change in mus-
cle activity levels when workload in-
creased by changing gears.
Cycling in Individuals With
Disability
There are a limited number of stud-
ies examining the biomechanics of
cycling in individuals with disability.
The available studies may provide in-
sight into potential biomechanical
differences in cycling when impair-
ments are present. In one study,52
subjects with diabetes (mean age
[⫾SD]⫽70⫾8 years) primarily used
a hip extensor moment during the
extension phase of recumbent cy-
cling, whereas subjects who were
healthy (mean age [⫾SD]⫽65⫾7
years) used more of a knee extensor
moment. During the flexion phase,
subjects with diabetes used more of
a knee flexor moment as opposed to
combination of knee and hip flexor
moments in the group without dia-
betes. There were no differences be-
tween groups in ankle muscle mo-
ments. Timing of some of the
moments at the different joints did
vary even though overall patterns of
activation were similar.
Similar findings were shown in an
earlier study53 in which subjects
who had a cerebrovascular accident
(CVA) also preferentially generated
power at the hip or the knee on the
involved side but not at both joints
while cycling. The involved limb of
these subjects also showed earlier ac-
tivation of ankle plantar flexor and
hip extensor moments. Overall,
these subjects displayed less power
generation at the ankle and knee and
increased power at the hip on the
involved side.
Although the subjects with diabetes
or who had a CVA in these stud-
ies52,53 do not represent all individu-
1250 f Physical Therapy Volume 87
als with disabilities, some of the im-
pairments that might contribute to
the difference in cycling moments
may be similar. Perell et al52 sug-
gested that decreased ankle mobility
in the subjects with diabetes possi-
bly led to some of the changes in the
extension phase, causing the sub-
jects to rely more on the hip. In ad-
dition, the subjects with diabetes52
or who had a CVA53 tended to dis-
play decreased ankle power during
walking, which might affect ankle
power during cycling as well. These
impairments also may be present in
individuals with other disorders.
Differences have been reported in
muscle activation patterns for indi-
viduals with chronic CVA. Coordina-
tion deficits have been shown in the
involved lower extremity, including
prolonged activity in the vastus me-
dialis muscle, increased activity in
the rectus femoris muscle during
flexion, and decreased activity in the
hamstring muscles during flexion.54
Increasing the workload for sub-
jects with chronic CVA did not in-
crease inappropriate muscle activi-
ty55 or movement asymmetry be-
tween sides.56
Finally, altered muscle activation pat-
terns during cycling have been re-
ported in children with cerebral
palsy (CP) and include prolonged pe-
riods of muscle activity and in-
creased co-contraction compared
with children with typical develop-
ment.57,58 Children with CP also
have increased movement in the
transverse and frontal planes during
cycling and decreased cycling effi-
ciency.58 These altered movement
patterns for children with CP as well
as for adults who have had a CVA are
likely related to strength and motor
control deficits, impairments that of-
ten are seen in patients with neuro-
logical disorders.
Number 9
Conclusion
As stated earlier, individuals with dis-
abilities may potentially benefit from
a cycling intervention, which ad-
dresses impairments (eg, decreased
muscle strength, range of motion,
and fitness), while minimizing stress
to joints that often deteriorate with
aging. Improvements in impairments
then may affect mobility, activity,
Downloaded from https://academic.oup.com/ptj/article-abstract/87/9/1243/2742447 by guest on 02 August 2019
and participation. However, consid-
eration needs to be given to the
many components of cycling that
may affect the biomechanics and,
therefore, the potential outcomes of
a cycling intervention. The knowl-
edge gained from studies of cycling
in adults with and without disabili-
ties and children can provide knowl-
edge about the potential manipula-
tions of positioning on the bicycle,
workloads, and cadences that may
be able to target specific impair-
ments in individuals with disabilities
as well as provide an understanding
of cycling biomechanics.
Further research is needed to exam-
ine the effects of manipulating the
positioning, cadence, and workload
during cycling for individuals with
disabilities to gain a better under-
standing of manipulations that may
lead to improvements in impair-
ments specific to the needs of each
person. Based on the literature from
other populations, a recumbent po-
sition may encourage the use of the
hip extensors, and a higher seat
height and placing the ball of the
foot on the pedal may encourage the
use of the plantar flexors. Moments
around the hip, knee, and ankle may
increase with increases in cadence,
and moments at the hip and knee
may increase with increasing work-
loads. These increases in load mo-
ments and thus forces through the
lower extremities may be desirable
to increase bone density but may not
be desirable for individuals with
joint pain. Finally, the cardiovascular
system may be challenged to a
greater extent by increasing the seat
September 2007
 Biomechanical Considerations for Cycling Interventions in Rehabilitation
height and increasing the pedal
speed. All of these possible effects
warrant further study in order to op-
timize the potential benefits of cy-
cling for individuals with disabilities.
However, the extensive literature on
cycling in adults who are healthy can
serve as a guide for choosing more
appropriate cycling interventions for
individuals with disabilities.
This article was received July 28, 2006, and
was accepted April 9, 2007.
DOI: 10.2522/ptj.20060210
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September 2007