From liver transplant to comfort and performance on the bike: an in-depth look at bike fitting after PSC (liver disease)

In our bikefitting practice, we sometimes see patients with complex medical histories that require a unique approach. One example of this is Erik Van Rompaye, who in 2021 underwent a liver transplant as a result of primary sclerosing cholangitis (PSC), a long-term and progressive liver disease that leads to scarring and narrowing of the bile ducts. This condition can lead to chronic liver inflammation, gallstones, and eventually liver failure. After a decade of struggle, a transplant became inevitable. Thanks in part to Transplantoux, an association that motivates transplant recipients to live healthily, to move and to play sports after a transplant, Erik fought back, and his goal is to complete a full triathlon again on 15/08. First, in July, he will still take part in the European Transplant Games in Lisbon. In April last year, he became triathlon world champion at the World Transplant Games in Australia. After his transplant, Erik rejoined Atriac, the triathlon club of which he had been a member for many years, until the liver disease made triathlon all but impossible. We take a deeper look at his bikefit. A tour de force of bodily balance.

Physical compensations resulting from the liver transplant

Post-transplant, Erik experienced various physical complaints that affected his daily life and his cycling performance. Specific complaints such as pain in the knees and lower back, especially on the left side, were aggravated by physical activity such as cycling and running. The dissection of the abdominal muscles during the transplant procedure may have contributed to an altered body posture, such as an increased lordosis (hollow back), which in turn affects the tension and length of the muscles around the hip and lower back.

The increased lordosis placed the hamstrings under constant tension, which led to shortening and an increased risk of injury. Moreover, the change in posture, such as a forward head posture, can put extra pressure on the neck muscles, which in turn can lead to neck pain and headaches. An implication that we saw recurring during the bikefit. The asymmetry in his body – the structurally longer left femur and the reduced internal rotation of the hip – can further contribute to imbalance during cycling. Everything was mapped out to let Erik move as comfortably as possible and to prepare him for new goals.

Moreover, the dissection of the abdominal muscles possibly led to a weakened iliopsoas (a hip flexor you use when pulling on the pedals) and gluteal muscles (the buttock muscles, which are used when pushing on the pedals) on the right side, which reinforces the need for an asymmetrical approach in training and bikefitting. To compensate for the hyperlordosis and to support the back, it is crucial to adequately stretch and strengthen the hamstrings and the back muscles. With Erik, we saw that he slid to the right of the saddle, so we had a slight suspicion that this came from a strength difference in the gluteal muscles, and that indeed turned out to be the case. After a number of osteopathic tests, we were able to trace Erik’s asymmetry and guide him towards a more comfortable posture.

From a kinesiological perspective, if we look at the location of K27 (below the collarbone, at the first rib), manipulations at this point can influence the ribcage and breathing patterns. Improved breathing dynamics can increase the venous and lymphatic return from the liver, which helps with the detoxification process and supports overall liver health.

Although these connections are mainly conceptual within TCM and there is limited direct scientific evidence for these specific interactions, the approach offers a holistic view of the body from which some people may benefit. In practice, stimulating K27 could therefore have an indirect effect on the liver through the general improvement of body functions and energy levels, but we did not apply this with Erik within the bikefit domain. Kevin Van Staeyen - Bikefit Consultant

Although these connections are mainly conceptual within TCM and there is limited direct scientific evidence for these specific interactions, the approach offers a holistic view of the body from which some people may benefit. In practice, stimulating K27 could therefore have an indirect effect on the liver through the general improvement of body functions and energy levels, but we did not apply this with Erik within the bikefit domain.

Kevin Van Staeyen - Bikefit Consultant

Adjustments to saddle, handlebars and cleats

These biomechanical deviations required specific adjustments in his bikefitting to optimise comfort and efficiency. The adjustments included lowering the saddle by 8mm and adjusting the tilt, shortening the stem (1cm shorter at -6 degrees instead of -10 degrees), and repositioning the cleats to ensure better support and power transfer.

The cleats were placed further back and the saddle lowered because of some biomechanical limitations that we saw recurring in our measuring instruments. To take the pressure off his neck, we decided to adjust the stem so that Erik could reach the handlebars a little more comfortably.

At Bikefit Van Staeyen, we strive to offer every cyclist, from recreational riders to professional racers, an optimised and personal experience. Our in-depth knowledge of both the biomechanics and the medical aspects of bikefitting enables us to offer tailor-made solutions that not only improve performance but also contribute to long-lasting cycling enjoyment and health. This is the core of our mission: a seamless integration of science and passion for cycling, allowing you to enjoy every ride.

Do you have medical questions about your cycling position yourself? Or do you have complaints that you cannot get rid of? Then send us an e-mail using the button below and we will help you as soon as possible.

Jarno Widar wins Giro d’Italia Next Gen: a biomechanical success story

From talent to triumph: Maxim Van Gils and the rising stars of Lotto Dstny and Team Flanders Baloise