Hello! 42yo uk-based male cyclist here. I’ve just had a bike fit from a pretty reputable guy in the UK who is also a consultant physiotherapist, and an Ironman athlete. As someone with a colourful physiological history (OA in hips, AnkSpond, Femoroacetabular Impingement in both hips, right side operated with arthoscopy, DHS after femoral fracture in right leg), I wanted someone with proper physio knowledge to fit my newish bike (Canyon Ultimate SLX) with the aim of reducing pain (knees, hips, lower back) and allowing me to finally get back into some proper training.
The fitter moved my saddle up and forward 2cm (back pain) and narrowed my stance by moving the cleats outwards. The new cleat position meant my knees were tracking straight and in-line with the pedal, thereby stopping the knee issues. This felt great in the bike fit session - more power, no pain - and felt good for a few short/easy rides. However, after a turbo session in which I deigned to sprint for 20 seconds, the next day I experienced a deep pain in my groin on the left side.
This was 2 weeks ago and, while not agonising, is lingering still, exaccerbated by cycling. It feels like impingment pain (which I’ve already experienced on the right side and had operated on via arthoscopy). I’ve done my own deep dive into others’ experience of riding with FAI, and the impact of q-factor / stance width / cleat position, and the consensus seems to be that, in order to avoid impingement, more is better. SO it would make sense to move the cleats back inwards and/or add some pedal washers, thereby undoing some of the fitter’s efforts to reduce knee pain.
I am speaking with the fitter to get his input before I change anything, but am keen to get anyone else’s feedback/ideas on what to do here, as it seems to me that my options are to choose between knee pain or hip impingement, a choice I am not a huge fan of. And I am not enamoured with the idea of going under the knife again anytime soon, as the right side arthoscopy was pretty traumatic and involved a very lengthy recovery, though i accept that this option may be inevitable at some point.
TL; DR Optimal stance width for cycling with hip impingement.
I’m sure this won’t be news to your bike fitter (or you if your living with FAI!) … But general impingement related pain is exacerbated by deep hip flexion and/or internal rotation of the hip. Raising and moving saddle forward should help with the flexion component. And can’t imagine too much internal rotation of the hip happens in a cycling position?
But given your history of various injuries etc I imagine your fit will be highly individual and will take a bit of trail and error with your fitter to get right!
I have FAI but rarely have have any symptoms these days. However, I did have a bike fit at its worst and my fitter (also a physiotherapist) actually recommended a wider stance.
It didn’t work for me as pedal/stance is the one thing that does trigger discomfort when I’ve tried to change it…I get immediate adductor tightness and hip pain (btw best way to relieve this I found is resting my inner thigh on a kettlebell handle!)
It would help enormously if you could work out if the FAI pain is triggered by flexion or internal rotation (or both). If flexion, then maybe try shorter cranks. If rotation then try a wider Q-factor. Ditto for the knee pain - is it due to increased knee flexion (which raising the saddle/shorter cranks will help with) or a side-to-side alignment issue (Q-factor). The tricky part is if they’re both triggered by the same set-up but in opposite directions, then you’ll just have to find a happy medium.
Also, are you sure it’s a proper FAI? Is there a chance it’s just a muscle/soft tissue sprain, which may settle down with time/rest/therapy?
It’s tempting to use pathophysiology (knowing what tissue is potentially messed up) to drive bike fit - however everyone is an N = 1 and I think your fitter is doing what is necessary - go based off of your symptom provocation based on setting up your fit.
So don’t change things because “most” people have pain with FLEX or IR of the hip - because I have had patients whose impingement was driving by external rotation of the hip based on where the labral tear or impingement is (if they have a femoral neck deformity).
Keep seeing the fitter - be patient, and don’t be afraid to mess around with things until you find what works.
Glad to hear you aren’t suffering with the FAI too badly! I’ve also been fairly ok with it since surgery in 2017 (until this latest thing anyway). I use a metal pole to role out the tight muscles around the top of the thigh and a lacrosse ball in the psoas area - seems to help.
Thanks - yes i have been using 165mm cranks for years, as a result of FAI diagnosis. I’m 191cm, so this took a while to get used to!
It’s impossible to say 100% that this pain is FAI-related, but having experienced very similar pain on the right side that subsequently resulted in a hip arthroscopy, I’m concerned that this is a similar issue.
I shifted the cleats 2mm inwards, widening my stance slightly, which seems to have helped, though have only ridden 2 x 1hr rides with this new setup. Bit converned that the setup is triggering knee/hip issues in opposite directions, as you say. Physio/strengthening/rest days should help.
Might be worth it to double check all the measurements to make sure nothing shifted/slipped/moved after you left the shop. Good fitter also needs to be a good mechanic (ie, did he use a torque wrench to set everything?)