History of a problem is often the key! When did it start? What changed around that time? This information is critical to a therapist’s understanding the origin a patient’s problem.

One of our patients suffered a fall that resulted in repairs to his bike. Soon after receiving his bike back he reported pain in the back of his knee when riding. After 3-4 months of physical therapy care at another physical therapy clinic, he returned to biking. His knee pain returned immediately.

At Apex, we performed a physical therapy evaluation and found calf weakness and some tightness in his hip (calf-and-hamstring-strain), an obvious possible diagnosis. But we didn’t stop there. Further evaluation involved observing him on a bike trainer Apex. This provided a completely different explanation for his pain. His bike seat was too high, perhaps as a result of the repairs after his fall.

The observed seat setting left his knee fully extended at the bottom of his spin. The muscles crossing the knee could not generate enough force to protect the knee. Generally you want a 25 degree bend at your knee at the bottom of the spin.

The same problem often shows up in elbows—try holding a gallon of milk with your arm locked straight instead of slightly bent next to your body!

Poor Knee Position

Before- Poor Knee Position

Correct Knee Position

After- Correct Knee Position


Take a look at the position of his knee before and after our adjustment to his seat post height.

We followed up with our patient. He reported completing a 16mile bike ride without any pain– with his seat in the new position.

Make sure you inform your physical therapist about any changes in your routine or events that may have caused adjustments to your equipment or position while exercising. History is key!


Apex Orthopedic Rehabilitation located in the Gabriel Realty Buidling at One East Ridgewood Avenue in Paramus, NJ provides orthopedic and sports physical therapy services for the greater Ridgewood, Paramus, and Bergen County region.  This blog is intended for informational purposes only and should not be used for diagnostic or prescriptive purposes. The views expressed here are the author’s views and should be taken as suggestions. Always consult your doctor or healthcare practitioner before engaging in a orthopedic or sports physical therapy rehabilitation program.