In this video I discuss with Lucas Owen how physiotherapy can help cyclists with their performance.

Video Transcript

David Heatley: Welcome to Cycling-Inform cycling tips. My name is David Heatley and today I’m interviewing Lucas Owen. Now Lucas, I met Lucas, where did we meet? Where was the first time that we met?

Lucas Owen: It was a corporate breakfast related to the Tour De France about 5 years ago?

David Heatley:  With…

David Heatley: Bicycle Network was running that?

Lucas Owen: That’s right.

David Heatley: That’s right, yes. Now I remember you coming up to me, and look, I get approached by physiotherapists all the time, and you said, “Look, I’m doing some stuff with cycling and I’m really good with hip flexors,” and that was really where we started, wasn’t it?

Lucas Owen: It was, yeah.

David Heatley: And like I said, I get approached by people all the time going “yeah, okay well look, you know, we’ll do a session and see what happens” so I mean I was certainly open to it, and then amazing things happened! (laughs) And this is the really interesting thing – before I came to see you, one of my legs was longer than the other one, right? So I had… and I thought that that was more of a “one of my legs is longer than the other one …”

Lucas Owen: Yep.

David Heatley: Problem.

Lucas Owen: Structural rather than muscular difference.

David Heatley: That’s right. And I used to have a shim, like a packer, underneath my pedal, for a very long period of time. In fact Steve Hogg set me up with one of those when I first started being fit by him, he put this… it would’ve been a 6mm packer underneath.

Lucas Owen: Yep.

David Heatley: And then, I did a little bit of work with you, and the next time I went up to see Steve, he had to remove the packer, because my legs were even again.

Lucas Owen: Yep.

David Heatley: So, interesting isn’t it?

Lucas Owen: Indeed!

David Heatley: How you can do that… now that’s, now we talked about releasing the hip flexor didn’t I? So run us through what was happening there. How did I go from one leg shorter than the other, to both legs being pretty similar?

Lucas Owen: Sure. So hip flexors are one of the muscles that can affect the relationship between the spine and the pelvis.

David Heatley: Yeah.

Lucas Owen: And if there is an imbalance in the tightness on one side to the other, it can either raise or slightly twist the pelvis.

David Heatley: Yeah.

Lucas Owen: And end up in what we call a functional leg length difference. So the comparison to that which is much less common, is – there is a small percentage of the population who have a genuine leg length difference, so that would be a skeletal difference.

David Heatley: Yeah.

Lucas Owen: And that’s obviously something that you have to adjust for mechanically on a bike setup such as a shim or a difference in insole.

David Heatley: Yeah.

Lucas Owen: Whereas a functional muscular difference, if the correct treatment techniques and then exercise rehab is provided, people can over time change that and adapt to a genuine symmetry.

David Heatley: Now I was amazed at how quickly it happened.

Lucas Owen: In your case it did adapt very quickly, so often, the better the physical condition of the patient, the more used the body is to actually having different load applied and actually doing body maintenance.

David Heatley: Yeah.

Lucas Owen: The more readily they tend to adapt. So even within that first session I recall seeing a marked change within the session.

David Heatley: Yeah.

Lucas Owen: It did then drop back out functionally to a degree and it took a couple of sessions to really…

David Heatley: Yeah.

Lucas Owen: … finalize that. But for a lot of people, again, treatment of the right region combined with then, diligence with what they need to do in their own time, which you were good with…

David Heatley: Yeah. (laughs)

Lucas Owen: … allows those changes to be maintained.

David Heatley: Yeah. Now the story behind that, around the hip flex and stuff, just to recap on that, I liken the hip flexor group to be the Achilles’ heel of cyclists. We’re in a position of not really stretching out the hip flexor group.

Lucas Owen: Yep.

David Heatley: We spend a lot of our time sitting down at an office desk…

Lucas Owen: Yep.

David Heatley: … all day, we’re driving to work, or we’re riding to work, we then come home, we’re spending a lot of time sitting in front of a TV or a computer or whatever, so we really don’t get to stretch it out very well, and it creates quite a lot of dysfunction especially for cyclists because they’re developing power through a very small range of movement, compared to other sports like for example running or swimming, where the flexion is, correct me if I’m wrong, the flexion’s a lot greater, isn’t it?

Lucas Owen: It’s… certainly the range is greater, so… and it’s also at a different point in the range, so cycling, we’re normally seeing the hip range change anywhere between 40 to 45 degrees from the top of the stroke to the bottom of the stroke…

David Heatley: Yeah.

Lucas Owen: … and as you said, it’s in a very sustained, deep flexion. So we’re normally going from around 75 to 80 degrees of hip flexion as a minimum…

David Heatley: Yeah.

Lucas Owen: … and then up from there. And like you say, there are a number of lifestyle factors involved so any muscle and tissue in the body adapts to the position it spends its majority of its time in, and for the hip flexors, like you say, we’ve got generally sleeping in a position where our hips are flexed…

David Heatley: Yeah.

Lucas Owen: … for most of us. We’ve then got leisure and work activities and transport requiring us to be flexed.

David Heatley: Sure.

Lucas Owen: And then as a cycling population we go out into an even more extreme flexion of the hip.

David Heatley: Yup.

Lucas Owen: And call on that muscle to work as a stabilizer and as a power generator and the overall influence and effect is that that muscle ends up very short. And generally, clinically, the flow and effect that that has, yes it can certainly, if there’s an imbalance in the tightness, you can have a leg length difference, but also very commonly just a generalized and even tightness will tend to weaken or inhibit the hip extensors, particularly glute max. And then often say that leads to over-recruitment of hamstrings, which then get tight, and the sort of common sequence that cyclists say, “Yep, can’t really stretch my hamstrings, I get sore on sustained climbs, I feel very stiff when I get up out of a chair,” all of these, as you say. An Achilles’ heel for cyclists is quite an apt description, because it seems to be the foundation of a lot of further functional problems.

David Heatley: Yeah, dysfunction really.

Lucas Owen: That’s right.

David Heatley: Yeah, it’s interesting, because I mean I came in like… I’ve historically had a lot of issues with my knees, and that’s really contributed, and that’s the reason why I’ve sought out people like Steve Hogg, and Matt Brindle and yourself, to be able to help me maintain good function so that I can ride the bike. And for me, I mean I’ve gone through the phases where my knees have been that bad that I’ve made the decision to hang up my bike.

Lucas Owen: Yep.

David Heatley: And because I love cycling so much, I’ve persevered and found masters. Now, you’re one of the very few people in Australia that I know of, and I would think that there’s probably more out there. But you’re one of… I know of 2 people in Adelaide, I know of 2 people in Melbourne that can do the sort of work that I’m expecting with the hip flexors, and you’re one of those 2 people in Melbourne. Out of all the people that I know in Australia that are able to release hip flexors, you’re certainly by far the best person at doing it. So that’s really important. So we’ve obviously talked about the hip flexor being the Achilles’ heel of cycling…

Lucas Owen: Yep.

David Heatley: We’ve talked a little bit about the story associated with how we found out. So let’s talk about some of the stuff you do here, because you’re a fully qualified physiotherapist that specializes in looking after cyclists, don’t you?

Lucas Owen: That’s right. Yep, so my clinic in Bulleen in Melbourne is set up with a specific room which is the room we’re in currently, which is completely set aside for managing cyclists. So general treatment is still a major part of what I do for cyclists, so often like yourself, it’s muscle release, it’s joint mobility…

David Heatley: Yeah.

Lucas Owen: … it’s exercise rehab, but also for a certain cycling population I’m also offer bike fitting services, so again, coming from that clinical background, a major point within the bike fit session is always a full assessment off the bike…

David Heatley: Yeah.

Lucas Owen: …. then considering what people are actually doing on the bike, so looking at their technique, looking at their power analysis, so we’re able to look at left-right power balance using CompuTrainer

David Heatley: Yeah.

Lucas Owen: Also as part of data-gathering, I use Retul for motion analysis so we’re able to look at joint angles and the comparison between sides.

David Heatley: Yeah.

Lucas Owen: But certainly my focus is always on trying to blend together the findings from all of those different avenues…

David Heatley: Yes.

Lucas Owen: … to arrive at a functional benefit for the patient, and certainly because… probably the majority of cyclists coming to me for that sort of bike fitting service have an underlying issue or pain or pathology, so it’s quite different to a lot of people going to get fit elsewhere. Generally the population I’m seeing, we may not even be able to get a clear resolution about everything being beautifully symmetrical and what I look for more, is again, functional balance, and sometimes that’s changes to the bike position, but equally often it’s that combination and again requires the patient input to then do the work off the bike and between sessions to really maintain and improve function and to then see that carry through into their technique on the bikes.

David Heatley: Yeah, yeah. And it’s interesting, because I’ve just come back from Sydney and I’ve had a video interview with Steve Hogg and he talks about the Retul system being a good tool, but that’s really as far as it is, you know? It’s not a one-step solution to solving bike positioning. You know? And it’s like any tool used by a master, you can get fantastic results, but used by a monkey, don’t get very good results. That’s great that you’re using that type of tool and interpreting the data, and it’s very similar to what I do with power analysis as well.

It’s like there’s some fantastic tools around there and some methodologies around how to use power, but it’s actually in the interpretation of that data that really where the secret… where you get the rubber on the ground, so to speak. It’s where you can start using that information to the greater benefit, and just relying on the pure numbers is not good enough.

Lucas Owen: No, and again it’s marrying together the findings from different aspects. So if I’ve got someone from the initial assessment who measures up with a leg length difference then I’m assessing whether that’s more likely to be structural or functional because the management for that on the bike will differ. If it’s a structural leg length difference, then you have to look at whether you need insoles or shims or…

David Heatley: Yeah, crank length.

Lucas Owen: …crank length, depending on whether it’s a difference in the femur length or the tibia length, so there are many factors. Equally, if it’s a functional leg length difference, then quite often within that session, before we start changing things on the bike, I’ll get that patient off, actually provide a treatment for the hip flexors and other muscles that are relevant…

David Heatley: Yeah.

Lucas Owen: …try as best and as quickly as we can to balance them so that the time we spend on the bike is trying to correct that position for what hopefully becomes their sustained functional position rather than setting them up when they’re already imbalanced.

So, as you say, it’s very much being able to analyze the data, choose your priorities… there are certainly some people who come in and they… physical assessment’s great. They’ve got great range of motion, good stability, everything symmetrical, and that’s in some ways, a bike fitter’s easiest client, because then you can then really drill down. But for, again, a lot of people coming to me, they’ve had fantastic input from bike retailers who offer bike fitting, they’ve had input from coaches and experienced friends in the cycling game, and if they haven’t been able to resolve the issue, often that’s where people are then coming to me, and again it’s being able to look a little bit deeper from a clinical perspective, so…

David Heatley: Yeah, fantastic. So just for… just coming back to the hip flexor, for… in layman’s terms, what is the hip flexor group, when we talk about that muscle group, what are we talking about? And what sort of function… two questions, what is it? And what sort of function or role does it play within cycling?

Lucas Owen: Sure. So, when people generally talk about the hip flexors, they tend to lump together 2 muscles in particular, and there are actually 3 muscles that can flex the hip. The one that most people, well… I’ll start again. The 2 muscles that get grouped together are because they have a common insertion into the thigh.

So on the inner upper thigh around here, and those 2 muscles are illiacus which comes from the inner portion of your pelvis, that’s what I generally refer to as your short hip flexor, and then there’s a muscle called psoas, which is spelled p-s-o-a-s, and that one is what I call the long hip flexor, it attaches into that upper femur but it comes from the lumbar spine.

So it attaches from L1, 2, 3, 4 and 5 and so it’s actually attaching almost up under the ribcage and because of its greater length and leverage, that’s the one that tends to have a greater influence on postural position. It’s also the only hip flexor that has the lever arm and the attachments to be able to influence pelvic alignment.

So the short hip flexor doesn’t really have that role because it’s not attaching with the same sort of leverage, whereas psoas is quite different. The third hip flexor is the superficial portion of your quadraceps, called Rectus femoris, but that generally is much more of an influence as far as knee posture and position rather than the effect on the spine and the pelvic posture.

David Heatley: Yeah. So Illiac – so I’ve always thought illiac psolas was… one…

Lucas Owen: So and again..

David Heatley: Yeah, and that’s what it’s referred to as illius… illiac psoas and you’re talking about two muscle groups…

Lucas Owen: That’s right.

David Heatley: The psoas being the larger one and the illiac being the shorter one…

Lucas Owen: The shorter, yeah.

David Heatley: Right.

Lucas Owen: So generally, again, as you say, mostly it’s referred to in anatomy books as illio-psoas. It’s just a hyphen between the two but the name actually refers to the 2 muscles which form together, rather attach together into the thigh, but very different attachments and very different functional contributions to how we move.

David Heatley: Ah.

Lucas Owen: Certainly, as you say then, how does it influence us on the bike?

David Heatley: Yeah.

Lucas Owen: Certainly hip flexors have a role in power production during the pulling through the bottom of the stroke and particularly the initiation of the upstroke. There’s not a great capacity for it to produce power there unless we’re either climbing out of the saddle or pedaling at lower cadence. So quite often mountain bikers who are on really steep terrain will actually activate psoas very strongly as a power producer.

For a road rider, it’s actually often much more its role is as a stabilizer, so it’s controlling that relationship between the spine and the pelvis, and certainly as the load increases with a hill climbing effort or a time trial effort or trying to make a break in a race, we certainly are engaging all of those stabilizer muscles as well as using everything we can to try and produce power. So again, if there’s an imbalance there or if there’s an influence of that muscle on changing our pelvic position or our spinal position on the bike, it can certainly be less than optimal for the effect on not only performance but also comfort which is obviously essential to maintaining your riding style.

David Heatley: Yeah. The really interesting thing that I found, that once we got the hip flexor released,  meant that I felt like I was pedaling the bike better…

Lucas Owen: Yes.

David Heatley: Instead of stomping away at the pedals, I was actually being able to get more of a stroke, and that’s very important, especially when you’re loading up the bike like for example hill climbing. I know Steve alluded to that last week in the interview I had with him. As soon as you start loading it up with… when you’re having to produce a lot of power, that’s when the stabilization has to really kick in.

Lucas Owen: Absolutely.

David Heatley: So I know, as soon as I had my hip flexor sorted out, suddenly I’ve got all this free available power. Now I’ve also heard there’s a relationship between the amount of production you can get out of a glute power-wise and the strength of your hip flexor, so what sort of relationship… is that a true thing? Is the relationship between the glute and the hip flexor, the illio-psoas, is that correct?

Lucas Owen: Absolutely. So one of the basic functions and contributions of muscle is that they influence each other. So generally the muscle that’s working is called an agonist and the muscle that would create the opposite movement is called its antagonist. And a basic structure again with muscle is that when a muscle is working, it weakens or inhibits its antagonist. So if we’re bending our elbow our bicep is creating the movement. Via a spinal cord reflex we get inhibition of the tricep so that we’re not fighting against our own muscular system.

In the case of hip flexing… hip flexors and hip extensors, absolutely there’s a relationship. So as we were touching on before, if you’ve got tightness in your hip flexors or if the hip flexor is being activated and contracted during a particular activity such as cycling, it will have an inhibitory influence on the hip extensors, and particularly gluteous maximus which is obviously an essential power producer.

David Heatley: Yeah, for cyclists.

Lucas Owen: Absolutely. And again, it’s a very common pattern that I see in this physio assessment that I run through for cyclists and before a bike fit, is that quite often there’ll be a match between tight hip flexors and then trying an isolated hip extension movement often gluteals are either not firing properly or they’re delayed in their activation pattern compared to other muscle groups, and that will then flow through onto the bike. So very much you have to, in that case, release the hip flexors before you can achieve effective strengthening of the gluteal muscles because otherwise you’re fighting that reflex neural activity that’s trying to switch it all off.

So really important one, and very commonly, again, it can be an imbalance, so we might have one glute firing well and the other glute that’s not, and then that can lead to those dysfunctions when you’re getting fatigued on the bike or doing sustained effort, where people start to get needles on one side and then ache in the lower back on one side and those factors, it’s often as the load and the fatigue increases, the dysfunction increases also.

David Heatley: Yeah, and then it becomes quite a spiral

Lucas Owen: Absolutely.

David Heatley: Down into total dysfunctional, or failure.

Lucas Owen: Yeah, and potentially over-recruitment of other muscles. So again, if one and the primary muscle that should be working is restricted, the body of course is going to try and recruit whatever else it can find, and I know that Steve Hogg talks about that with breathing function. So there are a lot of muscles that can be involved in breathing, and to assist and improve that, but if they’re being called upon to provide a stabilizing role or as force producers, it’s very difficult for a muscle to do 2 things at once. So that’s again, that’s the same throughout the body.

Cleat position affects that as far as how you’re activating the control between your calf and your foot stabilizing muscles, and everything is affected in exactly the same way. We need a balance in the system and we need the right muscle groups to be providing the right stability.

David Heatley: Yeah.

Lucas Owen: And function, rather than just starting that vicious cycle of one thing compensating for another. And yeah, that’s… it’s again, fortunately the same system can be used very effectively in the rehab. So again, something where, and you may recall, when we released the hip flexors, we then work on strengthening the hip extensors, the gluteals, so that the influence of maintaining good function of those muscles will at least slow down or restrict the tightening effect on your hip flexors. So you can use that same principle to your favor, but if you’re not doing much work off the bike, then we just tend to see that gradual increase in dysfunction and tightness.

David Heatley: Yeah, and it’s maintenance for cyclists, for me, it’s just such an important part of it. And I know when I’m dealing… when I’m coaching athletes, the first question I ask them is, “do you have any pre-existing issues?” And they may have lower back issues, they may have tight hamstrings, and if they say any of that, I’ll say, “Right, well you need to get your hip flexors.” If I do just a quick setup on their bike and just check to see where they’re at, and they’ve got a twist in their pelvis, immediately, it’s like, “You need to get your hip flexor released.”

Lucas Owen: Yeah.

David Heatley: So… and the thing is, that as we start ramping up the cycling, if you’ve got a pre-existing issue and we start loading you up, the result is just going to be a spiral down into dysfunction and further injury or that issue to progressively get worse.

Lucas Owen: That’s right.

David Heatley: So I’m really keen, and what I spend a lot of time with my athletes when I’m working with them is, to initially up front, is to work through those body maintenance issues and make sure that we’ve got them sorted out first before we start loading up the athlete. And I know, working with Jess Douglas, with her 24-hour world mountain bike campaign, she was having a few tightness issues and a few imbalances, I won’t go into it, but we certainly worked on addressing that, and we put together an action plan to manage those issues. And the result was that when we got straight into the training, she didn’t have those issues that she had to address at the same time, and it frees you up, because there’s nothing worse than being at training and having some small problems that you’ve got to manage all the time.

Lucas Owen: Yeah.

David Heatley: And it reduces your ability to be able to perform, your ability to be able to train and those sorts of things. So, just on that, I mean, you’ve had a lot of success stories, I mean I’m certainly one of them. What are some of the other, and you don’t have to mention names or anything, but what are some of the sort of a classic case study of somebody that’s come into your physiotherapy clinic here in Bulleen, and gotten a result, a really good result. So…

Lucas Owen: Yeah, so, as I was mentioning before, a lot of the time cyclists coming to me have had input elsewhere, haven’t been able to manage or solve the problem, and come in. So probably the most common recurring patient, so to speak, is often 30 to 40 year old male, they’ve maybe taken some time out of sport and activity because they’ve started a family and establishing their career, they’ve tried to get back into some activity and often have found that running-based sports are no longer feasible for them because they’ve got either past injuries or they’ve found that their knees can’t cope, so a lot of them, our peers who’ve taken up cycling, they’ve found a new passion.

And generally, coming in, there is again a common pattern, so they’re generally de-conditioned, there may be postural adaptations that have happened over a number of years from sitting in office chairs, driving long distances for work, again, just general lack of conditioning from not having regular sporting activity.

And so the common pattern I see with those people is that often, first of all from a bike fit perspective, we’re often somewhat conservative with positions such as seat height and reach and drop to the bars, because from a physical condition aspect, they’re not going to cope with something that’s as aggressive as what a racing cyclist or an experienced cyclist can cope with. So that’s first of all one aspect, and certainly I can get, and I have often frequent questions about, “Oh, so is that you know, like… these are the measurements for life? With bike fit?” And the answer in short is no.

So, bike fit is an evolving position for every cyclist, even between your on-season and off-season, you’re going to have different body condition, different flexibility, different stability, and so you do sometimes need to adapt to that – not a lot. So that’s one aspect and then again from those same people it’s often a pattern of general lack of core stability because they haven’t been particularly active, so we’re looking at basic stabilizing exercises. There’s plenty you can do at home, even like… you’ve obviously got Matt Brindle’s style of activity…

David Heatley: Definitely.

Lucas Owen: … and there are lots of great resources like that that people can access, so building that condition off the bike and then certainly again treatment for underlying factors. So it’s often that they have tightness in the hamstrings, they’ve got weakness through the hip flexors and the hip extensors because they’ve just become functionally tight in that whole region.

Often as well it’s upper back and shoulders are quite rounded and stiff from sitting in front of computers and poor posture on the bike even if they’ve begun. So it’s that whole series of conditions and issues which need management off the bike and as you say, getting that foundation is absolutely key to then being able to improve.

So as one specific example, a gentleman who was in about 6 months ago, and he hadn’t ridden a bike for probably a decade, and knew that he had a pre-existing knee issue. He had a friend who invited him to join about 3 months later into a charity ride, and he was a bit overwhelmed by the concept, but he borrowed a bike, started riding, was having a few issues, came to see me before buying a new bike, we were able to select the position and therefore guide his choice of frame size and components so that the bike was going to work for him.

And by the time he had that new bike and that was set up correctly, he’d done the work and the background off the bike as far as strength and flexibility work, and he was then able to improve very, very rapidly with his performance. He wasn’t having to take time out through an injury that had him off the bike for a week or he wasn’t finding it difficult to recover and do day- to-day back up rides.

So that is probably the most common sort of scenario with the patients that come through, and being able to really get that foundation of function so that then as you start to increase your load and your volume on the bike, you’re able to sustain that effort and maintain your base.

David Heatley: Yeah, fantastic. And it’s great to see your progression. This is the first time I’ve come to your new clinic and I know you’ve been talking about it for a while, and you’ve… it’s taken you a long time to get it set up, but when I first met you, you were running out of somebody else’s clinic, weren’t you?

Lucas Owen: That’s right.

David Heatley: Yeah.

Lucas Owen: So I used to work employed at a clinic in Eltham and I was able to work outside my normal work hours to see cycling patients for the bike fitting and treatment. And yeah, the long term plan which has now been 18 months that we’ve been in the clinic here came to fruition to again have a dedicated space for the bike fitting and somewhere that people can really come for a specialized service for the cycling population. And it’s, yeah, certainly, still an evolving process. There’s always plenty more to add into the system, there’s always fresh understandings coming from research.

Even in the time that I’ve been interested in the bike fitting over the last 10 years clinically, there’s huge changes in general and average position that people are being set up. If you look at the pros over the last 10 years there’s been a definite evolution and I’m sure it will continue with bike fitting, with the understanding of sport science. So it’s an always changing field, and again, in some ways, that can make it more challenging for people who are not really focused on that – it’s easy to fall behind.

So it’s something that certainly is my passion, and I love having the opportunity to really work with cyclists to keep enjoying what they do and like you say, you’ve been at points where you’re ready to hang the bike up because of physical discomfort and pain and most of us have had that point at some stage, but it’s the love of the sport that keeps bringing us back. And that’s what I really… that’s what gets me out of bed every morning is knowing how to help other cyclists keep going with what makes them passionate and really bring something positive to their lives.

David Heatley: Fantastic, Lucas. So where do people find you? What’s the best way to get in contact you… where are you based?

Lucas Owen: Yep, so there’s multiple ways to get in touch. We’ve got an e-mail which is [email protected] so a bit of a mouthful. You can easily also find a link to send an email through the website which is cyclingphysiotherapycentre.com.au and I’m based in Bulleen in Melbourne, so we’re about 10 kilometers northeast of the C.B.D. and as far as contact details again, you can either e-mail or find the phone number through the website.

David Heatley: Fantastic and if you were to do a Google search on Lucas Owen physiotherapy?

Lucas Owen: Certainly if you just did “cycling physio” then you’d find that it’d come up very rapidly on Google search with certainly a map to get you to the clinic as well.

David Heatley: Fantastic, excellent Lucas. Well look, I really appreciate Lucas taking the time out of his busy schedule to have a chat to me about all this physiotherapy stuff and also to cover in depth… obviously I learned something today around hip flexors, so thank you very much Lucas.

Lucas Owen: It’s a pleasure! Thanks David.

David Heatley: You’re welcome.

Lucas Owen is a physiotherapist that specialises in treating cyclists and is based in Melbourne. For more information please contact him using the following information:

www.cyclingphysiotherapycentre.com.au
Cycling Physiotherapy Centre
52 Templestowe Road
Bulleen, VIC, 3105
(03) 9852 1618