Mediclinic and ER24 understand that participating in and completing an event such as the Absa Cape Epic can be a lifetime achievement. We understand the investment and time that goes into preparing for the event.

Our aim is to ensure that each rider who starts the event, crosses the finish line happy and healthy. Over our nearly 20 years of supporting the event, we have noted that small things make the biggest difference in a multi-stage event. This is why ensuring you have the best possible bike fit it essential.
We chatted to Daisyway Coaching Systems to understand how the small things can impact the big things – like a successful endurance event.

“You can have the most amazing and perfect training plan or access to bike training, however, if your bike is not set up optimally, and your pedal stroke is not efficient, you will never be riding to your full potential – and quite possibly picking up a niggle somewhere,” explains Erica Green, double MTB Olympian and Founder of Daisyway Coaching Systems (1999) and UCI Level 3 Cycling Coach.

What is the best method for bike fit?

First off, after years of experience, we have definitely noticed that lasers and lights are most certainly not the complete answer to a proper bike fit. Foot size is the first point of contact on the bike, and so foot size should matter (in addition to riding style and goals.  Yes, there are many cyclists out there with the normal foot size, but what about the smaller or very long feet?

What impact does this have on where you set the cleats, or the fore-and-aft position of the saddle. Foot size is a fundamental in how the femur functions as part of the very sensitive pedaling action. Cycling is a very abnormal action for the human body – one where our center of gravity is articulated in an upright, standing position.  Not sitting, and leaning forwards, pulling on handlebars, and pushing down on the pedals, often at a high intensity.

According to Erica, the most important elements for correct bike fit are:

  • Foot size
  • Cleat rotation
  • Cleat fore-and-aft
  • Saddle height
  • Saddle fore-and-aft
  • Saddle position and general comfort
  • Reach of handlebars
  • Width of handlebars
  • Suspension

Foot types, alignment and biomechanics:

Pronate vs supinate.  Toe-in vs toe-out.  Cleat fore-and-aft.

The above is paramount to ortho-medicine.  It is best not to fiddle too much with biomechanics, except for 3 important aspects:

  • Cleat fore-and-aft AND alignment
  • Saddle height
  • Pedal stroke

There are wonderful tools to help with this. The first one being a clever tool that, without forcing the foot into a fixed position, it follows each rider’s specific pedal stroke range of motion and the cleats are then adjusted to ensure a neutral rotation of the cleat.

The further forward the cleat is, the more the rider is pedaling “on their toes”.  For a track sprinter, this would be optimal, however, for a mountain biker, being able to push down during the “power phase” of the pedal stroke, the position of the cleat should be further back (between the inner and outer meta). 

There are a few devices out there that assist with establishing: roundness of pedal stroke and optimal fore-and-aft/saddle height.  If the pedal stroke is showing a “peanut” shape graph, this means that the rider is essentially only using the downward push on the pedals (and using predominantly only the quadriceps).  This also means that the quads are going to fatigue sooner, as well as the rider not using all muscles available to form part of the pedal stroke.

Common cycling related pedaling injuries

Dr Darren Green, Mediclinic Race Doctor to the Absa Cape Epic explains, “When we look at the injury risks in cycling the profile differs greatly across the various sub-disciplines. Factors such as duration, loading and posture maintenance all play a significant role. Mountain bikers present with both acute and overuse injuries.

Overuse injuries can be ascribed to extrinsic factors such as bike position, shoe and pedal setup or intrinsic factors such as anatomic anomalies, poor cycling technique or reduced neuromuscular control.

Some of the most common related medical issues we see popping up at our clinic during racing events range from nerve palsies of the hands and fingers, neck and back pain, ITB issues as well as lower limb strain injuries around both the knee and ankle joints.

Knee pain is the most common overuse injury among cyclists of all levels. The majority of knee pathology is associated with the patellofemoral joint, however, the differential to keep in mind includes diagnoses such us ITBS (Iliotibial band syndrome, infrapatellar fat pad impingement, medial plica irritations and medial patellofemoral ligament strains as well as tendinopathy.

What about riders that need arch support and suffer from alignment issues? If you feel the need to put inserts into your shoes, it is advised to consult with a podiatrist or orthopedic specialist

Other common complaints include lower back pain. This is also linked to “over-use” – riding for many hours (and usually with a lot of climbing), and/or riding much harder than your body is accustomed or trained to. 

The complexity of movement and optimizing posture and positioning is crucial – an understanding of how the biokinetic chain is connected from the head to the toe is vital when doing the necessary analytics for setup.

Cycling is thus a very unnatural position, where “sitting straddled on a surface smaller than a shoe box, leaning forwards and pushing down really hard on the pedals.  This action is going to offset our natural muscular use and cause different tensegrity forces, that, if not sufficiently supported (core stability, muscular strength, fitness and conditioning, elimination of “old injury muscular imbalances”), the body is too clever and will find a way to let you know very quickly it cannot cope.  Usually, in cycling, the root cause of the issue is not necessarily where the pain is located.  For example, back and gluteus muscle issues are often a result of previous shoulder issues.

Handlebars and reach

According to Erica, once you have the foot and saddle position in an optimal range and position, the “easy” part is setting the handlebars. It’s important to note here, that before we set about doing a set up, it is vital to understand some history about the rider:

How long have they been riding for?

What type of riding do they do?


This is the final part of a bike fit - not many bike fit centers consider this aspect – it is usually only suspension specialists that have the appropriate experience with setting up suspension. This also takes time to properly understand.  Riding with the correct suspension settings is crucial to, not only comfort but also, safety and cycling ability!

Once again, considerations when setting suspension:

  • Bike type: Short travel, stiff and light cross country, slacker and softer longer travel, gravel road riding, flat trail riding, very bumpy and technical riding
  • Type and style of riding: Racing snake, weekend warrior, new to cycling, body type/male/female, lightweight and stiff head-angle vs slacker, softer fork angles etc.
  • Comfort: suspension (type of riding, type of bike, style of riding) optimize ride of cyclists as well as safety

If you have had a bike fit done and get a new bike, it’s sadly not possible to transfer the measurements over to the new bike, as each year, bike geometry changes and improves.  It is always recommended to trust what you feel on the bike – if you feel uncomfortable or feel like you’d like to change something ….. you’re probably right.

Seek the advice of a person who has a long history in cycling and has loads of experience.

Enjoy your cycling!!