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Complete Medical Guide for Cyclists

Author: Pruitt A, Matheny F
Category: Sports Medicine
Audience: Consumer
Length: 200 pages
Publisher: Velo Press
  Year Published: 2006
List Price: $18.95® Rating: Good

The Complete Medical Guide for Cyclists is a great resource for those who do a lot of cycling.

• Recommended for:  weekend warriors as well as elite cyclists.


• Andrew L. Pruitt, EdD is the director of the Boulder Center for Sports Medicine (BCSM), in Boulder, CO.  He is an internationally known athletic trainer, physician assistant, and educator.  He is an expert on bike fitting and cycling injuries.  Pruitt headed the US Cycling Federation's sports medicine program and was the Chief Medical Officer for US Cycling at the 1996 Olympics in Atlanta.  At BCSM, Pruitt uses 3-D computer technology to determine proper bike fit for cyclists.  Even though he lost part of his right leg in a hunting accident at age 14, he still won 12 varsity high school letters.  In addition to being an elite cyclist, he is also an expert downhill skier.

• Fred Matheny is an English major who has written about cycling for nearly 30 years.  He is the former editor of Bicycling magazine.  Matheny and Pruitt have ridden together and have published dozens of papers together.


The 200-page book is organized as follows:


  • Chapter 1:  Bike Fit Rules
  • Chapter 2:  Saddle Position
  • Chapter 3:  Handlebar Position
  • Chapter 4:  Pedals and Cleats
  • Chapter 5:  Knees
  • Chapter 6:  Back and Neck
  • Chapter 7:  Foot and Ankle
  • Chapter 8:  Hands, Arms, and Shoulders
  • Chapter 9:  Crotch and Skin
  • Chapter 10:  Eyes and Head
  • Chapter 11:  Overtraining and Recovery
  • Chapter 12:  Weight Loss
  • Chapter 13:  Physiological Testing
  • Chapter 14:  Developing a Personal Training Program
  • Chapter 15:  Health Maintenance
  • Chapter 16:  Aging and the Cyclist
  • Chapter 17:  Comfort and Performance -- You Can Have Both
  • Chapter 18:  The Biomechanics of Cycling
  • Chapter 19:  Stretching and Rehabilitation
  • Chapter 20:  What We Don't Know (But Wish I Did!)


The book opens with an impressive Foreword by Chris Carmichael that serves as a testimonial to how effective Andy Pruitt is at addressing problems cyclists encounter.  After reading this Foreword, you'll want to buy this book!

Part I is excellent.  It summarizes the details that go into obtaining the best bike fit for each cyclist.  These 42 pages illustrate why Andy Pruitt is an expert on this topic.  If you can't travel to Boulder, CO to have him provide a personalized bike-fitting session, carefully following these guidelines may suffice.

Pruitt reveals his wisdom in statements like:
  • the seat "set back" position (ie., fore vs. aft) is just as important as seat height
  • riders with "long" feet may need a higher seat height
  • poor (rider) flexibility requires a different approach to bike fitting
  • the discussion of Greg Lemond's femur length in relation to his torso was revealing
This section is also supported with good black-and-white photos demonstrating how to perform some of the assessments.  (Most of these were shot in a studio; it would have been interesting to see photos of actual cyclists being evaluated at the Boulder Clinic.)

As Pruitt points out, at 90 revolutions per minute, a rider pedals over 32,000 times during a 6-hr race.  Now, most people don't ride like that, but, you get the point:  cycling is hard on the knees and legs.

So, it's appropriate that Part II addresses cycling injuries.  These 55 pages review dozens of sports medicine topics (ie., the treatment of medical issues that occur during long-distance cycling).

Most of the information in this section is helpful, however, I had several concerns:

• NSAIDs:  The use of NSAIDs (drugs like ibuprofen) are recommended liberally throughout Part II.  Unfortunately, each recommendation is followed with "take with food".  It's true that these drugs can cause gastritis, however, because the effect is a pharmacologic one and not a local effect, taking them with food does not prevent this.  More importantly, there is growing concern that use of NSAIDs during endurance exercise, combined with consumption of free water, can increase the risk for developing hyponatremia, a serious medical condition.  Considering that, this issue should have been included in this section.

• DOMS:  DOMS (delayed-onset muscle soreness) can occur in any skeletal muscle that is overworked.  I couldn't find a discussion of this important topic anywhere in this book.  This is a major omission.

• Recovery Drinks:  Rapid recovery is important not only for Tour de France cyclists, but, also for people participating in cross-country bike rides.  "Recovery" drinks are not discussed in this book (though post-ride consumption of carbs and protein in a 4:1 ratio is discussed on p. 107).  This is another major omission, in my opinion.  Even if the authors don't recommend these products, readers of this book are likely to want this information.

Curiously, the issue of pelvic problems and their relationship to saddle design appears in Part III (ie., as opposed to Part II).  Unfortunately, only 3 pages are devoted to this topic and the information that is provided isn't very helpful:
  • what is the optimum saddle width for lowering perineal pressure?
  • does a saddle with a groove down the center help?
  • what is the relationship between either hours in the saddle, or, miles ridden, and perineal problems?
  • how long does it take to recover?
These are important questions and it would seem that a book on the medical complications of cycling would address them.

Part III has some good information -- such as the chapters on biomechanics, stretching, and the final chapter which addresses unanswered questions -- but chapters 14, 15, and 16 should be eliminated.  Since this is a book about medical issues, discussing training regimens (chapter 14) seems out of place.  Chapter 15 encourages women to take calcium supplements and warns that "nearly all OTC cold remedies contain pseudoephedrine".  Both of these statements are too dogmatic.

There are other examples where the authors make inappropriate statements on pharmacologic therapies.  For example, on p. 90, to prevent chafing, they recommend "petroleum based products that contain antibiotics."  The use of topical antibiotics like this cannot be endorsed, and may be harmful.

Chapter 16 reviews several dietary supplements that cyclists should take.  It's unfortunate that the authors elected to include this chapter, as it seriously undermines what is otherwise an excellent book.  It represents an example of the blind leading the blind.

• What I Liked About This Book: the information and guidelines on bike-fitting are excellent.  The text is easy to read.  The photos are helpful.

• What Could Be Better:  eliminate the discussion of supplements and training regimens as these topics are inconsistent with the title of the book; avoid making pharmacologic recommendations that cannot be supported with evidence; include a discussion of the risk of osteoporosis in distance cyclists who do not weight-train.


In general, I like this book. As the authors point out, make the bike fit the athlete, not the other way around. If you are a serious cyclist, and are having pains from your rides, then this book is for you. However, the discussions of supplements, training regimens, and the use of medications should be eliminated.


"Zinn & The Art of Triathlon Bikes" by Lennard Zinn (2007)

Reviewed by: Stan Reents, PharmD 4/13/2019 6:31:05 AM

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