Effects of Saddle Position on Cycling: An Umbrella Review

Abstract

Objective: This study aimed to perform an umbrella review of existing systematic reviews on the effects of saddle position on cycling. Material and methods: We conducted a systematic search across the electronic databases EBSCO, PubMed, Scopus, Web of Science, and B-On for systematic reviews investigating the effects of saddle position on cycling, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. To prevent the risk of bias, two researchers independently performed the search. To evaluate the methodological quality of the included reviews, the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) checklist was used. Results: A total of seven systematic reviews that met the eligible criteria were included. The systematic reviews showed high heterogeneity among themselves (e.g., type of included studies, participants’ characteristics, or evaluated outcomes) and low to critically low methodological quality. Relationships have been found between the rider’s saddle position and health issues (such as low back pain (four studies), knee injury or pain (three studies), lumbar kyphosis (one study), and impact on perineum (two studies)), and on performance alterations (such as, muscle activation, oxygen uptake, load and intensity, efficiency (one study), and comfort (one study)). The results showed that some research provided conflicting evidence in regard to the studied relations (e.g., knee injury or pain, impact on perineum, and efficiency). Conclusions: Cyclists’ saddle position impacts various issues related to health and performance. More research is needed, and future studies should focus on the clarification of the conflicting evidence observed in this review.

1. Introduction

Cycling is widely recognized as one of the most popular global sports [1] and a major professional business activity, with World Tour Pro teams having annual budgets upward of hundreds of millions of euros [2]. Therefore, as an important social and economic activity, it is natural that some research focuses on factors that may affect performance in cycling. Several factors may influence cycling performance and efficiency, including physiological, training, and biomechanical factors [3,4]. Additional elements, such as nutrition [5], psychology [6], aerodynamics [7], bicycle setup [8], comfort [9], and materials (e.g., oval chainrings) [10], also contribute to cycling. The biomechanical and physiological factors are related to bicycle configuration and setup. Therefore, in addition to selecting the appropriate bicycle frame, the settings for the three points of contact between the cyclist and the bike—handlebars, saddle, and pedals—are crucial [11]. How these points are manipulated changes bicycle configuration and, thus, can change a cyclist’s riding position [12]. For many years, cyclists and coaches have been searching for the optimal position by adjusting the bicycle to the cyclists’ body dimensions, aiming to increase performance while reducing the risk of injury [13].

The process of adjusting the bicycle to the rider is called bike fit. Correct bike fitting is essential for cyclists to prevent injuries and enhance cycling performance [14]. The saddle position is a key component of bike fitting and bicycle setup, and it can vary significantly between different cyclists and cycling disciplines [15]. For many years, bicycle setup was performed based on traditional methods. Recently, advances in technology have introduced new methods of evaluation and new approaches for optimizing bicycle setup (e.g., 2D and 3D systems) [13]. The adjustment of the saddle position can be carried out using dynamic methods (where the cyclist is pedaling) or static methods (where the cyclist is at rest) [16]. Dynamic methods are kinematic-based and the most recommended. The static methods are the most traditional, low-cost, and easy to apply, and they are based on the anthropometry and goniometry of the cyclist. The saddle position can typically be adjusted vertically (height) and horizontally (forward/backward) [12]. Saddle-height selection seems to be the main adjustment variable for most researchers [14,17], with authors suggesting that the optimal height of the saddle is the most important adjustment for power production and, consequently, for the cyclist’s performance [17]. A correct saddle height is fundamental, as it contributes to the production of mechanical work of the lower limbs’ joints, impacting on pedaling efficiency [16]. Although the focus has been on determining the best method for establishing saddle height, previous studies have reported greater comfort when cyclists pedal at their preferred saddle height compared to higher or lower settings [18].

When setting up the saddle, the horizontal position (sometimes referred to as saddle angle) is the configuration that varies the most across different cycling disciplines. For example, authors state that triathletes often prefer a more vertical saddle angle (e.g., the saddle is positioned further forward, relative to the crank center), while road cyclists typically prefer a saddle angle that positions the saddle farther back relative to the crank center [19]. Thus, cyclists seem to modify their positioning in the saddle depending on the race profile [20]. The same authors report that some road cyclists tend to sit farther back in the saddle on climbs, opting for more advanced positions in the saddle in sprints and time trials. On the other hand, during climbs, mountain bikers must make postural adjustments to avoid lifting the front wheel, stabilize their position on the bike, and maintain traction with the ground. This involves adopting a more forward position, along with elbow flexion, so that the cyclist’s weight is transferred to both the front wheel and the ground surface [21].

Positioning the saddle further forward or backward alters the spatial positioning of the joints and angles, influencing the production of forces on the pedals and, consequently, impacting muscle recruitment patterns in the lower limbs [22]. According to the same authors, moving the saddle horizontally backward may recruit a greater muscle involvement and promote increased power output. Although largely studied, it seems that there is still no consensus over this matter, since authors concluded that riding at the forward and backward saddle positions did not significantly affect patellofemoral compressive and tibiofemoral compressive forces [23]. However, no results were presented regarding the association between performance and changes in saddle position, such as mechanical power, oxygen uptake, and speed. The characteristics of mountain biking races require cyclists to continuously adjust their body position on the bike. Cyclists pedal while sitting on the saddle, standing on the bike, adopting more advanced positions, bent over the handlebars to prevent the front wheel from lifting on steep climbs, or shifting their body backward, moving their buttocks behind the saddle on downhill sections. Thus, the saddle position is a crucial element in the bike’s adjustment, influencing the rider’s entire position on the bicycle.

Cycling is generally considered a low-impact sport [24]. In cycling, it is possible to differentiate injuries according to their mode of onset: sudden onset non-contact injury, impact/traumatic injury, gradual onset injury, insidious onset injury, chronic injury, and medical illness [25]. The main injuries appear to be trauma from crashes and extended postural adjustments combined with repetitive limb movements, leading to overuse injuries that primarily affect the lower limbs. In a study on road cycling, it was found that the predominant injuries reported were abrasions, lacerations, and hematomas (40 to 60%) [26]. The most common nontraumatic injuries reported were related to the knee, with patellofemoral syndrome being the leading overuse diagnosis. However, it has been noted that the precise adjustment of the saddle to the athlete’s specifications significantly affects the onset of knee and lower back pain in mountain bikers, either during or immediately after the race [27]. Furthermore, many cyclists’ overuse injuries are alleviated with simple bicycle adjustments, highlighting the importance of a correct bike setup [28].

Cycling is a highly professionalized sporting activity. For this reason, the factors that affect cycling performance are of fundamental importance and have been extensively studied [3,4]. Research suggests that modifications in seat configuration (e.g., height and angle) affect the cyclist’s performance, as they influence lower-extremity muscle kinematics, with implications for the muscle force produced and power output during cycling [15]. Thus, finding the optimal position on the bicycle is crucial not only for performance but also for comfort and injury prevention [8,17,28,29]. On the other hand, the studies currently available are conflicting and insufficient to make well-informed decisions about the effects of saddle position on cycling performance.

The aim of this review is to (1) systematically review the available evidence on the effects of saddle position on cycling; (2) assess the quality, strengths, and limitations of the current evidence; and (3) identify gaps in the literature and propose directions for future research.

2. Results

2.1. Included Systematic Reviews

The literature search on the electronic database identified 27 studies, and 19 were removed as duplicates using the EndNote tools. Two records were removed during the title/abstract screening. With the addition of one study from a personal database, a total of seven studies that met the eligibility criteria were selected for full-text screening [18,30,31,32,33,34,35] (Figure 1). The authors excluded two articles since they were not systematic reviews [36,37]. From the personal database, one study was retrieved, but it was excluded because it used mixed methods [38].

The number of studies included in each review varied between 8 and 41, with an average of 20.6 studies per review. The participants’ cycling experience ranged from recreational to professional cyclists [18,31,34] and from recreational to competitive cyclists [30,35]. Non-cyclists’ participants were included in five reviews [18,30,31,32,34]. No information regarding cycling experience could be retrieved from one study [35]. The number of participants per review ranged from 1 to 142. Five studies included participants from both genders [18,30,31,32,35]. Two studies included only male participants [34,35].

The selected reviews included cross-sectional study designs [18,30,31,32,34,35]; case studies [18,32,35]; randomized controlled trials [18,31,33]. Two reviews included before and after interventions [33,35]. The included systematic reviews presented different outcomes. All the included studies analyzed various injury risks associated with cycling. Low back pain was examined by four studies [30,31,34,35]. Knee-related injury or pain was analyzed by three studies [18,31,32]. Only one study examined lumbar kyphosis [30]. Two studies investigated the impact of cycling on perineum health [33,35]. Only one study examined the effects of saddle height on performance and comfort [18]. Two studies related bike fit and injury risk [31,33].

The authors from four studies declare to have no funding supporting their research [18,30,33,35]. That information was not available in the remaining studies [31,32,34]. Table 2 provides more detailed information on the characteristics of the studies.

2.2. Methodological Quality Assessment

The average score on the AMSTAR 2 checklist was 48%, varying from 38 to 69%. Five reviews were classified as having moderate methodological quality [18,30,31,33,35]. Two reviews were classified as having low methodological quality [32,34]. When using the Amstar 2 assessment quality online tool from the website, five reviews were categorized as being of critically low quality [30,31,32,33,34], and two reviews were categorized as being of low quality [18,35]. The quality assessment of the individual studies is presented in Table 1.

3. Methods

3.1. Search Strategy

The literature search was performed through the electronic databases Ebsco, PubMed, Web of Science, Scopus and B-On, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [39]. The search was conducted on September 2023, combining keywords with Boolean operators (AND/OR), using the following search syntax: (cycling OR bicycling OR bike) AND “saddle position” AND “systematic review”. The database search strategy was guided using the Participants, Issue, and Outcomes (P.I.O.):

Participants: healthy individuals, not limited to sex or age.

Issue: saddle position.

Outcome measures: cycling performance, physiological/biomechanical factors, and risk of injury-related issues.

The search was limited to papers published from 2003 up to the search date and to publications in the English language. To prevent bias, the search was performed blinded by two authors (P.C.V. and R.M.F.). The authors independently reviewed the titles, abstracts, and full texts of the identified studies. Upon completion, they compared their lists of included and excluded reviews. In case of disagreement, a third author (A.R.S.) mediated the process. The final list of studies for reviewing was found with 100% agreement between the authors. The two authors performed the final analysis and extraction of data and results.

3.2. Study Selection and Eligibility Criteria

The screening of the studies found in the search in the electronic databases was performed independently by two authors (P.C.V. and R.M.F.). The records identified in the literature search were imported to EndNote 20′s software (Thomson Reuters, New York, NJ, USA). EndNote 20 was used to remove the duplicates found by using the automated tool “find duplicates”. After the duplicate removal, the studies were manually screened to confirm the full versions and if the inclusion and exclusion criteria were truly met. Reviews that were not specific to the chosen topics but were part of the information gathered were in the umbrella review scope were also considered suitable to be included, and the information was collected independently. The authors examined the studies’ titles and abstracts to identify those suitable for full-text review. After full-text review and the addition of studies from a personal database, the final group of studies was selected for this review, including only those that fully met the following eligibility criteria:

(a)

Examined the effects of saddle position on cycling,

(b)

Analyzed the data using systematic reviews,

(c)

Were published in English,

(d)

Full texts available.

We excluded the following studies:

(a)

Non-systematic reviews, including books, randomized controlled trials, case reports, expert opinions, mixed-methods, conference papers, academic thesis, literature reviews, or narrative reviews;

(b)

Those that assessed traumatic (acute) injuries in cycling;

(c)

Those composed by experimental or control groups that included animals, cadaveric, in vitro, or in silico samples.

3.3. Data Collection Process

Data extraction was performed following the recommendations for umbrella reviews [40]. Data extraction was performed by two authors (P.C.V. and R.M.F.), who collected and recorded the data for analysis. All collected data were recorded in an Excel spreadsheet and cross-checked by the authors to ensure accuracy. The data collected were reviewed by another author (A.R.S.) and included the following:

(1)

List of authors and year of publication,

(2)

Objectives of the studies,

(3)

Number and type of studies included in the review,

(4)

Number and characteristics of participants,

(5)

Outcomes,

(6)

Main findings and conclusions of the studies.

3.4. Outcomes

Given the primary objectives of this study, the outcomes of the analyzed studies were categorized under two umbrella terms: performance and health. For each category, the following outcome subgroups were examined:

Health:

• Low back pain,
• Knee injury/pain,
• Lumbar kyphosis,
• Impact on perineum.

Performance:

• Muscle activation,
• Oxygen uptake,
• Load and intensity,
• Efficiency,
• Comfort.

3.5. Methodological Quality Evaluation

The methodological quality of the included reviews was evaluated by two authors (P.C.V. and R.M.F.) and arbitrarily by a third author (P.N.M.) when discrepancies were found. For the quality assessment, the validated Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) checklist was used [41]. The checklist has a total of 16 items, and the results are presented in

Table 1. Results of the quality assessment using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) checklist.

	Amstar Items
Author(s)	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	Score	Assessment Quality
Antequera-Vique et al. [30]	Yes	Yes *	No	Yes *	Yes	No	No	Yes	No	No	Not applicable	Not applicable	No	Yes	Not applicable	Yes	44% (Moderate)	Critically Low
Bini and Bini. [31]	Yes	Yes *	Yes	Yes *	No	No	No	Yes *	Yes	No	Not applicable	Not applicable	No	Yes	Not applicable	No	44% (Moderate)	Critically Low
Bini and Priego-Quesada [18]	Yes	Yes *	No	Yes *	Yes	No	No	Yes	Yes	No	Not applicable	Not applicable	Yes	Yes	Not applicable	Yes	56% (Moderate)	Low quality
Johnston et al. [32]	Yes	Yes *	No	Yes *	No	Yes	No	Yes *	Yes	No	Not applicable	Not applicable	No	No	Not applicable	No	38% (Low)	Critically Low
Litwinowicz et al. [33]	Yes	Yes *	No	Yes *	No	Yes	No	Yes*	Yes	No	Yes	No	No	No	No	Yes	50% (Moderate)	Critically Low
Streisfeld et al. [34]	Yes	Yes *	No	Yes *	No	Yes	No	Yes *	Yes	No	Not applicable	Not applicable	No	No	Not applicable	No	38% (Low)	Critically Low
Visentini et al. [35]	Yes	Yes *	Yes	Yes	Yes	Yes	No	Yes *	Yes	No	Not applicable	Not applicable	Yes	Yes	Not applicable	Yes	69% (Moderate)	Low quality

Legend: * = partial yes.

Each item on the AMSTAR 2 assessment checklist was rated as “yes”, “no”, or “not applicable”. A score was calculated based on the responses, with only the “yes” answers contributing one point to the total score for the evaluated review. AMSTAR 2 is a comprehensive 16-item tool that rates the overall confidence of the results of the review. The quality of the systematic reviews was considered according to the AMSTAR 2 guidelines: high (zero or one non-critical weakness); moderate (more than one non-critical weakness); low (one critical flaw with or without non-critical weaknesses); and critically low (more than one critical flaw with or without non-critical weaknesses). The AMSTAR 2 quality assessment for each review was conducted using the AMSTAR 2 online tool (https://amstar.ca/Amstar_Checklist.php (accessed on 28 September 2023)).

3.6. Prisma Statement

The literature search was performed through the electronic databases, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [39]. Checklists for systematic reviews and abstracts were used, and a flowchart was constructed (Figure 1). The PRISMA 2020 statement comprises a 27-item checklist addressing the introduction, methods, results, and discussion sections of a systematic review report and can be found in Table S1. Additionally, the Prisma checklist for Abstracts, consisting of 12 items, can be found in Table S2 The collected data was compiled in an Excel spreadsheet and the main results of each included study can be found in

Table 2. Characteristics of each included study.

Author(s)	Objectives	Type of Studies	No. of Studies	Participants Total/Range	Participants Characteristics	Evaluated Outcomes	Main Results and Conclusions
Antequera-Vique et al. [30]	To assess whether cycling affects spinal morphology in postures of the bicycle, such as adapting the spinal curvatures on the bicycle depending on the handlebar type and position on the handlebars.	Cross-sectional or longitudinal (experimental or cohorts)	31	1518/3 to 128	Competitive, recreational, master, and elite cyclists; Both genders; Road, mountain bike and triathlon; Non-cyclists and sedentary; Age 18–57 years.	• Pelvic tilt: ✓ Digital motion video analysis; infrared cameras; goniometer; digital scanning of the body; inclinometer; electromagnetic tracking system. • Lumbar morphology: ✓ Infrared cameras; electromagnetic tracking system; digital motion video analysis; digital scanning of the body; inclinometer; remote posture monitoring system. • Thoracic morphology: ✓ Electromagnetic tracking system; optoelectronic device; digital motion video analysis; digital scanning of the body; infrared motion analysis system. • Hip flexion: ✓ Inclinometer; digital motion analysis system.	Cycling posture influences spinal morphology and biomechanics: Pelvic tilt: Lower handlebar positions increase pelvic tilt. Lumbar kyphosis: Greater lumbar kyphosis is linked to handlebars positioned lower and farther from the saddle. Thoracic adaptations: Prolonged cycling promotes thoracic flexion, with increased kyphosis seen in standing posture. Spinal changes: Cycling fosters spinal adaptations due to prolonged flexion, potentially leading to low back pain. Hamstrings: Hamstring flexibility does not significantly affect spinal posture during cycling. Recommendation: Cyclists should customize bicycle setups to match individual characteristics for optimal performance and spinal health.
Bini & Bini [31]	To assess the main factors related to overuse knee-related pain and/or injuries in cyclists.	Cross-sectional; case studies; randomized controlled trials	10	271/1 to 104	Professional, competitive and recreational cyclists; Non-cyclists.	• Kinematics: ✓ Joints and segments angles and range of motion. • Perceived comfort and fatigue: ✓ Stationary cycling trials and isokinetic dynamometry. • Peak torque, moments and forces: ✓ Isokinetic dynamometry. • Muscular activity: ✓ Surface electromyography.	Cyclists with knee pain display distinct biomechanical and muscular activation patterns. Key observations include the following: Biomechanical changes: Greater knee adduction, increased ankle dorsiflexion, and medial knee projection. Muscle activation: Altered activation of the Vastus Medialis and Vastus Lateralis muscles is noted in cyclists with overuse-related injuries. Knowledge gaps: There is limited evidence on the mechanisms behind overuse-related knee pain and injuries.
Bini & Priego Quesada [18]	To assess the methods to determine bicycle saddle height and the effects of saddle height on cycling performance and injury risk outcomes.	Cross-sectional observational designs; cross-sectional randomized controlled trials; case study	41	n.a./1 to 142	Both genders; Professional, competitive, recreational cyclists; Triathletes and non-cyclists.	• Methods to determine saddle height: ✓ Lower-limb joint angular-based methods; static and dynamics; 2D video motion analysis; anthropometrical. • Influence from changes in saddle height; • Kinematics; • Comfort/pain; • Kinetics; • Muscle activation; • Oxygen uptake, efficiency; • Perceived exertion and performance.	The influence of saddle height on cycling performance and biomechanics is not yet fully understood. Key points include the following: Lower-limb kinematics: Saddle height significantly affects lower-limb kinematics and cyclist comfort. Configuration: Dynamic knee angle measurements are recommended for optimal saddle height configuration. Evidence gaps: Limited evidence supports the use of recommended angles, predictive equations, or the relationship between saddle height changes and supramaximal performance or injury risk.
Johnston et al. [32]	To determine the association between biomechanical factors and knee injury risk in cyclists.	Cross-sectional or longitudinal (experimental or cohorts)	14	239/9 to 24	Both genders; Age 19 to 50 years; Trained, competitive, amateur, experienced and recreational cyclists; Triathlon and non-cyclists; With or without knee pain or injury;	• Knee kinematics: ✓ 2D or 3D video motion analysis systems in the sagittal or coronal plane. • Knee kinetics: ✓ Joint power, muscle/joint moments; patellofemoral compressive forces; tibiofemoral compressive and shear forces. • Pedal forces/pedal force effectiveness, and crank torque: ✓ 2D or 3D video motion analysis systems; isokinetic ergometer. • Muscle activity: ✓ Surface electromyography.	Several biomechanical factors influence knee pain and biomechanics in cyclists. Key findings include the following: Key factors: Cadence, power output, crank length, saddle position, saddle height, and foot position can affect knee pain. Saddle height: Higher saddle heights are associated with increased tibiofemoral peak anterior shear forces. Knee mechanics: Cycling parameters and positioning affect knee movement, forces, and muscle activity. Evidence gaps: No clear link has been established between cycling parameters or positioning and the risk of knee injuries.
Litwinowicz et al. [33]	To assess the effectiveness of strategies for reducing the impact of cycling on the perineum in healthy males.	Randomized controlled trials; crossover; before and after.	22	601/9 to 100	Only healthy males;	• Penile oxygen and blood pressure: ✓ Standing versus sitting; different saddle designs; different positions; ultrasound Doppler instrument; Index of Erectile Function Questionnaire. • Seat pressure: ✓ Standing versus sitting; different saddle designs; different positions. • Bicycle fit, muscle activity, and low back pain; • Bicycle fit and spinal kinematics; • Spinal kinematics, motor control, and low back pain.	Different saddle designs and positions impact the cyclist’s perineum. Key findings include: Anatomy and numbness: Anatomical variations may influence perineal numbness. Sexual dysfunction and Sulcus Depth: A deeper sulcus protects against cycling-related sexual dysfunction. Equipment and ergonomics: Recumbent bikes reduce penile oxygen pressure loss. No-nose saddles, periodic standing, and recumbent bikes safeguard the perineum
Streisfeld et al. [34]	To determine whether relationships exist between body positioning, spinal kinematics, and muscle activity in active cyclists with nontraumatic low back pain.	Comparison studies; cross-sectional studies; case-based studies	8	255/1 to 120	Only men, aged 18 to 57 years; Weight: 54.43 to 72.57 kg; Height: 1.6 to 1.85 m; Elite, masters, professional competitive and unspecified cyclists. Professional off-road cyclists. With or without cycling experience. With or without low back pain.	• Bicycle fit, muscle activity, and low back pain: ✓ Surface electromyography; ultrasound. • Bicycle fit and spinal kinematics: ✓ Various handlebar heights on pelvic and spinal position. • Spinal kinematics, motor control, and low back pain: ✓ On-road cycling tasks; video motion capture; Rehabilitation Bioengineering Group pain scale; Numeric Pain Rating Scale.	Low back pain in cyclists is influenced by prolonged postures, muscle imbalances, and spinal mechanics. Key points include: Muscle activation imbalances: Core and spinal muscle imbalances are significant risk factors for overuse-related lower back pain. Prolonged flexed posture: Spending extended periods in a flexed-spine position during cycling contributes to maladaptive spinal kinematics and increased stress, potentially leading to pain. Lumbar stability: Reduced lumbar stability is correlated with nontraumatic low back pain. Key contributors: Overuse pain may result from the interaction between posture duration, muscle endurance deficits, and imbalances rather than body positioning alone.
Visentini et al. [35]	To identify risk factors associated with overuse injuries in cyclists.	Prospective cohort pretest–posttest design; epidemiological cohort studies; cross-sectional cohort study	18	3881/n.a.	Recreational or elite cyclists on road, track, mountain, city/commuter, and time-trial bikes; Above 12 years old; With overuse pain and injury.	• Symptoms analyzed: ✓ Numbness in the hands, feet, or saddle region; tingling; urogenital or perineal pain; lower back pain; and foot pain. • Body parameters: ✓ Multiple measurements of body function or posture, including knee angle, hip angle, tests for lower-limb kinetic chain capacity, and core muscle performance. • Load parameters: ✓ Training volume, rest intervals, years of cycling experience, and average speeds. • Bike measurements: ✓ Saddle setup (height, width, cut-out, tilt, padding), foot/pedal interface, handlebar height, padded cycling shorts, bike type, and adjustments.	The relationship between cycling parameters and overuse injuries is not fully understood. Key findings include: Load and symptoms: Moderate evidence indicates a relationship between load and symptoms. Bike fitting: Traditional bike fitting measures show no consistent link to overuse injuries or pain. Seat height: Evidence is conflicting regarding the role of seat height in symptom development. Evidence gaps: No strong evidence connects specific bike, body, or load measures to overuse pain or injury.

Abbreviations: n.a. = not available.

.

4. Discussion

This review aims to explore the relationship between the rider’s saddle position and both performance and health. It was confirmed that the bicycle saddle position affects both performance and comfort, as well as the risk of injury. The health-related outcomes identified included low back pain, knee injuries, lumbar kyphosis, perineal impact, and comfort. Regarding performance, outcomes such as muscle activation, oxygen uptake, load, intensity, and efficiency were observed. The following discussion is organized according to these subgroups.

4.1. Health

In recent years, research has focused on injury risk in cycling [1,24,26,27,42,43]. Studies have examined body dimensions, joint angles, muscle activation, and force production to optimize the cyclist’s body–bicycle fit and reduce injury risk. Unlike acute injuries, which are typically associated with accidents, overuse injuries are multifactorial [44], and research has identified associations between overuse injuries and incorrect bicycle setup [1,24,45]. The occurrence of these injuries cannot be overlooked, as studies report that approximately 41% of cyclists with back pain require medical attention, and 22% lose training and/or competition time [1,46].

4.1.1. Low Back Pain

The lower back (11.5%), knee (26.3%), and shoulders (13%) are the anatomical regions most frequently affected by overuse injuries in cycling [47]. This means that one of the most frequent overuse injuries in cyclists is low back pain, and it can be associated with incorrect saddle settings, particularly saddle tilt [46,48,49]. Previous research indicated that approximately 23% of these lower back injuries occurred in mountain bikers [50] and up to 45% in road cyclists [1,46]. The cyclist adopts various positions on the bicycle to improve aerodynamics and increase speed and efficiency. Typically, this involves flexing the lumbar spine [51,52]. Thus, the prolonged and sustained flexed posture of the cyclist may lead to an increase in mechanical strain of the lumbar region, promoting low back pain [53]. The demands of maintaining a prolonged flexed position in cycling are associated with the cyclist’s core stability. The aerodynamic flexed posture of the cyclist results in increased muscle recruitment and fatigue [54]. Core fatigue can lead to altered cycling mechanics, playing a crucial role in maintaining proper biomechanics during cycling, potentially increasing the risk of injury due to greater stress on the knee joint [55]. Enhancing core strength may improve torso stability on the saddle, helping to maintain proper alignment of the lower extremities and facilitating more efficient force transmission to the pedals. In addition, constant isometric contractions of the core muscles have been linked to the potential development of low back pain in cyclists [52]. Cyclists with low back pain and reduced hamstring extensibility were found to have a lower pelvic tilt [56,57]. Thus, the primary risk factor associated with low back pain is the cyclist’s pelvic tilt [53], which is related to both the hip flexion angle [22] and saddle design [58]. Additionally, authors have suggested that adjustments in saddle inclination (also referred to as saddle tilt) could be an effective strategy for reducing low back pain [31].

4.1.2. Knee Injury or Pain

The knee is identified in the literature as the most frequently affected joint by overuse injuries in cycling, impacting both recreational and professional cyclists [28,59]. Knee pain affects between 40% and 60% of recreational cyclists and between 36% and 62% of professional cyclists [46,48,59]. Anterior knee pain is the most common knee injury, likely attributable to patellofemoral pain syndrome, patellar tendinopathy, or quadriceps tendinopathy [48,59,60]. It has been reported that lower saddle heights increase muscular forces, affecting the pressure between the patella and femur [61]. The same authors note that this pressure is also influenced by the contact area between the cartilages, as it expands with greater knee flexion, a common effect of lower saddle heights. Cyclists experiencing overuse-related knee pain or injuries often exhibit an increased medial displacement of the knee [62], as well as altered activation patterns in the vastus medialis and vastus lateralis muscles [63,64]. However, evidence regarding the potential mechanisms underlying overuse-related pain or injury remains limited [31]. Studies suggest that there are no significative differences in patellofemoral compressive forces associated with saddle position [23,64], and no differences in knee load have been observed between cyclists with or without pain [31]. Nevertheless, the published literature identified various factors that may cause anterior knee pain, including increased pressure due to hill climbing, heavy workloads, increased training, altered patellar tracking, or a combination of factors [46,48,59]. Several risk factors may contribute to this issue, including altered patellar positioning, reduced flexibility, an increased quadriceps angle (Q-angle), muscular imbalances, and various torsional deformities of the limbs, as well as foot abnormalities [59]. The Q-angle, which is defined as the angle formed between the tibia and femur in the frontal plane, is one of the most commonly used measures of knee movement in the frontal plane [65]. Previous studies have demonstrated that the risk of knee injuries, such as anterior knee pain or patellar tendinitis, increases when the lower leg is in an abducted position during the generation of a knee extensor moment [62]. The same authors showed that symptomatic cyclists exhibit more medial knee movement compared to non-symptomatic cyclists, and this may lead to an increased medial–lateral force. Medial–lateral force, in turn, has been shown to correlate with Q-angle [65]. Thus, minimizing the change in Q-angle is expected to reduce the risk of knee injury by decreasing medial–lateral force and reducing the abduction of the lower leg. Iliotibial band syndrome (ITB) is a common injury among cyclists, particularly those who engage in long rides or high-intensity training. ITB occurs when the iliotibial band—a thick band of tissue running along the outside of the thigh, from the hip to the shin—becomes tight or inflamed due to overuse, repetitive motion, or improper bike fit [66,67,68]. Cyclists typically experience pain on the outer side of the knee (lateral) which worsens during cycling, and although they spend less time in the impingement zone at lower forces, the primary contributor to the development of iliotibial band syndrome (ITB) seems to be the number of repetitions [66]. The pain may also be felt during running, especially on inclines, or after prolonged periods of activity. ITB is often triggered by a rapid increase in training intensity and volume, whether due to the race profile, conditions, or positional factors. These include inward toe positioning, excessive pedal float, and worn cleats, all of which are linked to repetitive knee flexion–extension movements [28]. Another cause for ITB syndrome has been proposed, suggesting that proximal neuromuscular factors may lead to dynamic valgus collapse, increasing femoral adduction and internal rotation, impinging the iliotibial band against tissue during repetitive flexion and extension activities [69]. ITB syndrome is related, among other factors, to a saddle position that is too high or too far back, anatomical differences, and training errors during cycling [70,71,72]. However, authors noted that saddle setback and, more importantly, individual pedaling technique appear to play a critical role [68]. The main cause for these injuries is incorrect saddle heights, either too high or too low [24]. For example, it has been noted that changes in saddle height affect knee flexion angle, potentially leading to overuse injuries [43]. Thus, it is suggested that for cyclists at risk for ITB pain, a lower seat height may be beneficial, as it can reduce compensatory lateral pelvic motion, which in turn decreases stress on the ITB [66]. Biceps femoris tendinopathy is a condition that involves the degeneration or inflammation of the tendon of the biceps femoris muscle, which is part of the hamstring muscle group. An excessively high saddle, combined with chronic overload of the hamstring muscles and tendons, appears to be the primary cause of biceps femoris tendinopathy, a posterior knee injury that is less common among cyclists [73], although it accounts for 5.8% of knee-overuse injuries in professional cyclists [74]. However, it is still generally associated with repetitive or excessive strain, particularly in activities such as running, cycling, weightlifting, or sudden changes in direction. The biceps femoris is located at the back of the thigh and has two heads: a long one and a short one. This muscle plays a crucial role in knee flexion and hip extension, as well as assisting in external rotation of the knee. Repeated overload can cause microtears in the tendons, leading to pain and inflammation. Increased tibiofemoral peak anterior shear forces have been observed at higher saddle heights [42]. Therefore, tibiofemoral anterior shear forces may be reduced with a more forward or lower saddle position, thereby decreasing potential strain on the anterior cruciate ligament (ACL) [23]. However, studies have reported low in vivo ACL strain and reduced anterior tibiofemoral shear force during cycling [32]. The literature suggests that cyclists with an ACL injury or those who have undergone reconstruction may benefit from a lower saddle height or more forward saddle position [23,42].

4.1.3. Lumbar Kyphosis

Various cycling postures, such as those adopted during road racing, may lead to significant changes in spinal alignment [52]. Specifically, it was noted that the lumbar spine, typically exhibiting lordosis in an upright position, shifted toward a more kyphotic (curved) posture when cycling, particularly in more aggressive, aerodynamic riding positions [30]. This adaptation is thought to help improve aerodynamics, but it may also impact spinal health over time. Therefore, the position on the bicycle is associated with lumbar kyphosis [75,76,77]. This inversion position depends on the type of grip on the handlebar [57]. On the bicycle, the lumbar spine flexes to allow the hands to rest on the handlebars, which are typically positioned lower than the saddle height, aiming to reduce the cyclist’s frontal surface area for improved aerodynamics [78]. The same authors observed an increase in torque power when changing the handgrip position from the tops to the drops. As a result, prolonged lumbar spine flexion can lead to viscoelastic deformation of the ligaments in the posterior arch of the vertebrae, resulting in increased spinal flexion [79,80]. Lumbar kyphosis was more pronounced when the handlebar grip was positioned lower and further from the saddle, highlighting the importance of correct saddle height [81]. However, the saddle tilt position has been shown to have no significant influence [75].

4.1.4. Impact on Perineum

The impact of constant pressure exerted by the saddle can lead to various issues, ranging from saddle sores to urogenital complaints. The main complications identified in the literature include perineal numbness, urethral stricture, and erectile dysfunction [36,43,82,83]. Genital numbness is typically attributed to Alcock’s syndrome, a rare peripheral neuropathy characterized by chronic neuropathic pain affecting the sensory territory of the pudendal nerve, which can be aggravated by prolonged sitting. In cycling, it may result from increased perineal pressure due to sitting on the bicycle saddle, leading to vascular occlusion and subsequent hypoxia of the pudendal nerve [37]. In a study examining the association between erectile dysfunction and bicycle characteristics, the authors reported little association with saddle width, saddle padding, or saddle tilt [43]. However, this finding conflicts with the findings of studies that suggest changes in saddle designs to reduce perineal numbness [31] or that observed that the use of a no-nose saddle reduces internal perineal compression by up to 71%, thereby reducing discomfort and numbness in the perineal area [33]. However, despite the observed advantages, the same authors state that this type of seat was associated with increased posterior seat pressure and discomfort in the ischial tuberosities. Cyclists who used a saddle cutout experienced an increased risk of erectile dysfunction compared to those who used no cutout saddles [43]. Interestingly, the same authors reported that riding a mountain bike was associated with an increased risk of erectile dysfunction compared to riding a road bicycle. The authors suggest that using a higher saddle position relative to the handlebar helps to reduce perineal numbness during cycling. These conflicting findings reported in the scientific literature suggest that the individual anatomy of the cyclist may play a role and should be considered. This aligns with findings in the published literature which suggest that a deeper sulcus nervi dorsalis penis may contribute to more effective protection against cycling-induced sexual dysfunction [84,85]. In the reviewed literature, no data were found linking saddle spatial modifications to perineal health. Nevertheless, authors concluded that using a no-nose saddle, alternating standing on the pedals with sitting every few minutes, and using a recumbent bike are effective in protecting perineal health during cycling [33].

4.2. Performance

In the process of determining the cyclist’s ideal position on the bike, several geometric variables come into play, including the saddle position, handlebar position, crank length, and foot position on the pedal. Changing the position of the saddle modifies the mechanical work of the joints of the lower limbs [86]. These changes can affect muscle dynamics and joint angles, potentially influencing pedaling efficiency and effectiveness, energy expenditure, and, consequently, performance in competition.

4.2.1. Muscular Activation

At higher saddle heights, there was increased activation of the biceps femoris, rectus femoris, and gastrocnemius muscles, whereas activation of the vastus lateralis was reduced at the cyclists’ preferred saddle height [87,88,89]. These findings indicate that bi-articular muscles spanning the lower-limb joints may be more heavily engaged when cycling at a higher saddle height. However, based on the findings from this review, it is not possible to determine an optimal saddle height based solely on muscle activation data. Nevertheless, there is strong evidence that muscle activity is influenced by changes in saddle height [18]. Although the authors concluded that modifications in the participants’ saddle setup affected muscle activation patterns [90], the effects on muscle activation varied between participants, suggesting an individualized response. This outcome is associated with changes in the participants’ pedaling technique.

4.2.2. Oxygen Uptake

Maximum oxygen uptake (VO₂max), defined as the highest rate at which oxygen can be absorbed and utilized by the body during intense exercise, is one of the key variables in exercise physiology and the best indicator of aerobic capacity [91,92,93,94]. Physiological variables such as VO₂max are highly correlated with endurance exercise performance and are considered the golden standard for assessing cardiorespiratory fitness [3,95,96]. Oxygen consumption is a measure that can be used to determine the energy cost of an activity; identify the type of energy substrates utilized, particularly lipids and carbohydrates, through the calculation of the respiratory quotient (the ratio of carbon dioxide production to oxygen consumption, and VCO₂/VO₂); and assess maximum oxygen consumption (VO₂max) [94]. VO₂max is also used as a reference value or benchmark for the specific performance demands of various cycling disciplines [3,92,97]. When fine-tuning seat height, cyclists self-select a position based on sensory and mechanical feedback of the lower limbs, rather than on oxygen cost [98]. There is moderate evidence suggesting that oxygen uptake is not affected by changes in saddle height of less than 4% of leg length [18,98]. However, some authors reported that oxygen consumption was significantly higher when the saddle was raised [99]. This conflicting evidence highlights the need for further studies on this topic.

4.2.3. Load and Intensity

There is moderate evidence suggesting that changes in saddle height less than 4% of the leg length will result in trivial-to-small changes in lower-limb loads. One study reported improved performance at both higher and lower saddle heights, compared to cyclists’ preferred height during 30 s Wingate tests [88]. A study involving 5 s maximum sprints observed reduced performance when saddle height was lowered by 2 cm [100]. The authors concluded that lower saddle positions can alter lower-limb kinematics, decreasing the mechanical performance of the major groups acting on the knee, thereby reducing maximal power output. These findings indicate that further research is required to investigate a variety of supra-maximal intensities in order to assess the impact of saddle height on cycling performance. Regarding saddle adjustments, both a greater saddle setback and a lower handlebar height may increase the peak power output produced by the cyclist [22]. Additionally, as mentioned in Section 4.1.1., the stability and strengthening of the cyclist’s core are also related to their ability to exert force more efficiently. Studies emphasized the importance of core stability in maintaining an efficient cycling posture and optimizing the transmission of force to the pedals, suggesting that a stable core helps with better posture during prolonged cycling efforts [62]. However, they also pointed out that the improvements in power output related to core strength and stability were minimal compared to other factors, like pedaling technique, overall muscle coordination and activation, and aerobic capacity. Nevertheless, significant correlations were found only between thoracic anterior tilt and critical power produced by the cyclists [101]. The authors mention differences in the results obtained between road cyclists and mountain bikers, emphasizing the need for further studies on the topic, with a focus on each cycling discipline individually.

4.2.4. Efficiency

It appears that when a range of saddle heights near the cyclist’s self-selected height are used, no changes are anticipated regarding efficiency and energy expenditure [18]. Moderate evidence suggests that oxygen uptake and efficiency are not influenced by changes in saddle height of less than 4% of leg length [18,98]. This suggests that with changes in seat height of up to 4% of leg length, the nervous system processes adaptive changes in the timing of both gastrocnemius and biceps femoris eccentric contractions based on proprioceptive feedback. This enables the maintenance of cycling efficiency and consistent pedaling trajectories during both the propulsion and transition phases of the pedaling cycle. However, it has been reported that gross efficiency was significantly lower and oxygen consumption significantly higher when the saddle was raised, confirming that there is still a lack of consensus within the scientific community on this matter [99]. In conclusion, no changes in efficiency or energy expenditure are anticipated when using a range of saddle heights close to the cyclist’s self-selected height [18].

4.2.5. Comfort

Although there is limited published literature linking saddle position and cyclist comfort, some authors have suggested that cyclists’ self-selected saddle height is the most comfortable, with lower saddle heights typically associated with reduced comfort [102,103]. Comfort on a bicycle is strongly subjective, as it is highly related to personal preferences [104]. In a study with recreational cyclists, authors noted that they were sensitive to modifications in saddle height, as they reported different levels of comfort between their preferred saddle height and a lower saddle height [105]. However, they were unable to distinguish between comfort and discomfort when comparing high and low saddle heights. It is important to consider cyclists’ perceptions of comfort when selecting saddle position due to its role in injury prevention and cycling performance [103]. The same authors conclude that cyclists found the most comfortable position to be when the saddle height was within the recommended knee angle (30°, calculated from the offset position, or 40 ± 4.0° as an absolute value).

5. Study Limitations

Only seven studies that fully met the eligibility criteria were included in this review. Consequently, the lack of research—and therefore the limited evidence relevant to the study’s aim—restricted the conclusions of this review. Due to the scarcity of published literature on the topic, a substantial number of studies dated back more than five years. Furthermore, the heterogeneity of the included studies (e.g., types of studies, participant characteristics, and evaluated outcomes) contributed to the limitations of this review, preventing the performance of a meta-analysis. Additionally, a majority of the included studies (five out of seven) were of moderate methodological quality according to the AMSTAR 2 assessment, with two studies assessed as low quality. This limited methodological quality constrains the strength of the findings in this review, highlighting the need for future high-quality research. The majority of the primary studies included in our umbrella review focus on road cycling and mountain biking. Due to limitations in the available literature, it was not feasible within our study to separate the results by cycling sub-discipline. This is a limitation that should be taken into account in future studies.

6. Conclusions

The current literature provides evidence that, in cycling, the position of the rider’s saddle affects both performance and health. Saddle position is associated with lower back pain, lumbar kyphosis, knee injury, perineal health and sexual dysfunction, comfort, muscle activation, oxygen consumption, load, intensity, and cycling efficiency. However, there is limited and conflicting evidence regarding the mechanisms of overuse injuries, the use of joint angles to determine the ideal position, and the effects of saddle position on variables such as oxygen uptake, load, pain, and overuse injuries. The evidence also suggests that the individual characteristics of each rider should be considered to ensure proper saddle positioning from both health and performance perspectives. The strength of these findings is limited by the low quality of the reviews included, as assessed by AMSTAR2.

7. Implications of the Results for Practice, Policy, and Future Research

This review indicates that there is still conflicting evidence in the current published scientific literature regarding both health-related issues and performance. Nevertheless, the findings of this review should be considered by coaches and sports scientists in their practice. Future research should focus on how saddle modifications affect cycling performance across various physiological factors, such as oxygen uptake, torque, and power output, as well as cycling efficiency and health outcomes, across different cycling disciplines.