Cyclingnews Fitness Q&A - May 25, 2011

Your fitness questions answered

Got a question for the fitness panel? Send it to fitness@cyclingnews.com. Emails may be edited for length or clarity, but we try to publish both questions and answers in their entirety.

To find advice that relates to you more easily:

A reader's advice on last week's question on cold feet

Neck Pain issue

A question about cycling as you age

Depression and riding performance

Severe Knee Pain

ITB Friction Syndrome

A reader's advice to last week’s question on cold feet

Panel,

I was reading the Fitness Q&A last week, and when I read the toe post [Circulation affected by socks], I had several thoughts.

I live in Minnesota, and I have been riding bikes year round in this state for about a decade.

To keep toes warm here are a number of tried and true tips.

1) Your cold weather shoes should be one size larger than your warm weather shoes (in particular, toe box must be roomy). If you like wooly socks, then perhaps consider going one and one half sizes larger. Consider getting a pair of winter cycling shoes. Summer shoes are designed to allow for air circulation, and winter shoes are not. I ride the Lake winter boots when it is about 0 deg C - down to around minus 10 deg C or so (add booties for colder). My Lakes are about one size bigger than my summer shoes, and I usually wear thin-ish wool socks with them. I have loads of toe-wiggle-room, and my feet stay quite warm.

2) You must get off and walk BEFORE you lose circulation. The goal is to keep circulation going - not attempt to regain circulation. Regaining circulation takes about ten times the effort of maintaining circulation (at least it feels that way). Get off at all red stop lights and many stop signs and walk around 20 steps... If you do this BEFORE your toes go numb, you will greatly extend happy toe time. If you are into cyclocross, this is a great way to keep your dismount/remount sharp.

3) Booties plus winter boots plus toe warmers are essential for particularly cold weather (your definition of particularly cold may differ from mine).

4) Cold calves lead to cold toes. Full length socks under your tights are a surprising boost to toe warmth.... This lesson I just recently learned, and my toes were extra happy this winter.

Best wishes and happy cold weather riding!

Lee

Neck Pain Issue

Panel,

I've been an avid road cyclist for around five years now. I usually ride 6-7 days a week, with mileage in the 150-250 range. I also ride 12 months a year. Overall I feel great on the bike, but the one issue I have not been able to cure is neck pain. After about an hour in the saddle my neck starts to get sore at the base, where my neck meets my upper back. Putting my chin to my neck alleviates it a bit, but when I first do this the pain in the base of my neck is pretty bad, I'd say a 5/10. I try to roll my neck, swing my arm, roll my shoulders, but the pain never goes away completely.

I did see a chiropractor for six visits this fall and he noted my neck was out of alignment, a bit cocked to one side with the muscles tighter on that side. He helped out and I felt improvement immediately, but I also don't want to spend the rest of my life going to a chiropractor. I'm 31 years old, 5'8", and 145 pounds. I should also mention that I played sports in college and injured my neck pretty badly, chipping the C-5 vertebrae when my head was snapped back abruptly and forcefully.

I try to stretch my neck throughout the day when I'm off the bike. I also try to use my own hands as resistance and strengthen it. I've even been doing neck "bridges," like a wrestler might. I'm not religious about any of these though.

I've never been fitted by a professional on a bike, but my reach of 67 cm on a 53 cm top tube bike falls in the range suggested by many fit calculators. I have a 63 cm arm reach.

I was hoping the neck pain would go away as my body got used to a road bike position, but it hasn't. I don't run a ton of saddle-bar drop, just around 6-8 cm or so. (I have three road bikes I rotate through).

I wonder what to do next. Stretching? Strengthening? Chiropractor? I could flip my stem, but I do a lot of fast group rides/races and do prefer the slightly aggressive position on the bike. The pain isn't horrible, but it is bad enough that I'd like to solve it. Some days I do have neck pain off the bike. I should also mention that I do a lot of reading, with the book on a table, so my neck is straight down in that position or back, when on the bike, for most of the day.

My neck has felt better since I went to the chiropractor. I was also traveling for eight weeks this February and March so completely off the bike and my neck felt wonderful. But, six weeks back on the bike and my neck is sore again.

Any advice is appreciated!

Thank you!

Ron

Scott Saifer says:

Hi Ron,

Stretching and strengthening your neck are great ideas, but do take a look at bike fit and make adjustments in the meantime, so you can ride pain-free until you gain flexibility and strength. The majority of base-of-neck pain situations are caused by having the bars low enough that you have to strongly contract the muscles in that area to keep your head high enough to see down the road. Here's a test to see if that's your particular problem:

1) Put your bike on the trainer and set it up pretty close to level (you can do the test on the road, but it works better on a trainer)

2) Get on the bike and pedal for while to get a bit warmed up and settled into your normal riding position

3) Put your hands on the drops in a comfortable position for your hands and arms (if there is no such position, you need to tilt the bars.)

4) Close your eyes and drop your head.

5) Very slowly raise your head until you feel the first hint of tension in the back of your neck

6) Lower your head until the tension turns off again

7) Raise and lower a few more times to find the highest no-tension position for your head

8) Without moving your head, open your eyes and roll them up until you feel a hint of tension around your eyes

9) Lower your eyes until the eye tension turns off again.

10) Roll your eyes up and down a few more times to find the highest you can look with no eye tension.

11) You are now looking as far down the road as you'll be able to look for more than a few minutes without getting a sore neck. If you are looking comfortably to the horizon or close to it, bar height is not the source of your neck problem. If you are looking at the ground a few bike lengths out or any nearer in that you'd like to be able to see when you are riding routinely, your neck is getting sore because your bars are too low and you should raise them.

After you've done the test, please share the result with us. If the bars are not too low, get back to us for more advice.

A question about cycling as you age

Panel,

I’m a 56 year old male. I am in training and want to soon start road racing with my local Vets cycling club. While there is a wealth of information out there about training for road racing there is very little information that mentions or is specific for older cyclists.

Is training for the older cyclist any different?

NB: I am not a complete beginner to exercise as I have been a recreational runner for the last 20 or so years and over that time I have competed in marathons, half marathons, cross country and mountain running. Back in the mid 90’s I competed in a few Triathlons and a few TT’s. My knees are starting to suffer from the running and I have some neck and back problems, I now just do a few mountain-running events which I really enjoy.

Tony

Scott Saifer says:

Hi Tony,

You can see training for older cyclists as being very different or completely the same depending on your perspective. It is often said, sometimes correctly, that older riders need more recovery time and need to include strength training to maintain muscle mass.

If your idea of a training plan is just writing out the times and intensities you plan to ride each day, then programming for older riders is quite different since you have to allow for that extra recovery time. If, as I advocate for riders of all ages, your plan includes alternatives to be executed depending on your current state of energy or fatigue each day, then a plan for a 20-something will work great for a 50-something as well.

Similarly, since I advocate strength training for most riders and that the strength training be adjusted to the current abilities of the rider, the plans for older and younger riders could be exactly the same, even if the amount they end up lifting turns out to be quite different.

Depression and riding performance

Dear Cyclingnews Fitness Panel,

I have been on various anti-depressants for many years. My doctor has recently put me on Wellbutrin XL (300 mg) and I’ve noticed a significant decrease in my riding – most notably my ability to generate short bursts of power seems to have evaporated. Though, my general endurance hasn’t suffered as much. The doctor indicated that the medicine should not impact athletic performance, but the correlation between my poor riding and the new medicine is striking.

Have you see similar cases where anti-depressants negatively impact riding? If so, are you aware of any medicines that may be less likely to cause problems? I would appreciate any thoughts on how to fight depression without sacrificing athletic performance.

Thank you,

Anonymous

Carrie Cheadle says:

There are very few studies that have looked at the impact of antidepressants on athletic performance, but the studies that have been done were mostly with cyclists.

The studies specific to Bupropion (Wellbutrin) showed a positive effect on time trial performance in the heat, but no effect in temperate conditions. Another study in 2009 to determine the effects other SSRI's had on the level of fatigue in time trial performance, but did not find a significant effect. An additional study of SSRI's showed exercise time was less, but no impact to cardiac response. Overall, they don't seem to significantly impact performance, but much of the research has been done on very small groups of athletes and often with doses less than a therapeutic dose.

Tricyclic Antidepressants can reduce cardiac capacity and increase the risk of arrhythmias, but has not been researched with athletes.

You may try and figure out if there would be any other reason for you to be experiencing a decrease in power. Other panelists may be able to chime in on other factors that could impact this. Since the new medication is the biggest change, it's easy to define it as the culprit, but don't let it mask something else that may be to blame. If you have ruled everything else out, then you can start looking at Plan B. The side-effects one person encounters with medication may be different than what someone else experiences. If you continue to have issues with your performance, you could work with your doctor to try a different anti-depressant or a different dosage until you figure out what works for you.

Scott Saifer says:

Carrie's right. We get questions regularly from people whose power has gone missing who aren't even on any medication, so your loss of burst power may well have nothing to do with the medicine. The only way I can see to determine for sure would be to have your doctor help you cycle on and off your Wellbutrin (using something else to keep your mood stable at the same time) and see what happens to your power.

Just to get you thinking, some other things that can cause a sudden loss of high-end power: chronic under sleeping, seat post sinking into frame, overtraining, recent head-cold or other illness, under-eating carbohydrate, increased ride volume, increased stress at home or work, reduced motivation et cetera. If any of these could be the problem, fix them. If not - check with the doc about trying different meds.

Severe Knee Pain

Panel,

Yesterday I started experiencing a sharp pain in my right knee cap as I cycle almost independent of the speed I rode. It becomes more intense if I exert more pressure, especially when I try to ride uphill. Walking today has not caused any pain.

Previously, I had sometimes experienced a dull ache in the right knee cap, followed by a stiffness in the right thigh. This dull ache began after 40 km, but did not worsen, even if I rode another 50km or 100km on that day. I was riding at a moderate speed and cadence for me. In fact after riding and massaging both my leg and lower back the ache stopped almost immediately.

Can you suggest any remedies? Obviously, I wish to continue cycling as much as possible. I am not worried about training for racing, but would like to continue riding Audax and day rides of at least 100km.

Thanks in anticipation,

Marcus

Steve Hogg says:

G'day Marcus,

You don't give much info other than your right patella hurts! If walking is fine but riding is not, then something about the way you relate to the bike is the problem. Let's start with the simple things first. When riding down the road, stop pedaling and coast with right foot forward. Try to move the right heel inwards. Is there available movement?

If no, stop and adjust your cleat so that the front of the cleat is pointing further towards the inside edge of the shoe and retest until you have some available free movement.

If yes, repeat the stop pedaling and coast procedure but this time try to move the heel outwards. Is there available movement?

If no, stop and adjust your cleat so that the front of the cleat is pointing further towards the outside of your shoe and retest until you have movement.

Overall, what you are trying to achieve is to have your foot sitting where it naturally wants to sit with a reasonably even amount of play either side of that point. Once you go through this exercise, repeat on the other side. Sometimes an issue on one side is caused by the compensations we evolve to work around an issue on the other side.

Next, have a look at this link about seat height. Too high a seat is at least part of the problem with many clients I see.

Once you've been through the suggestions above, and if you haven't got a positive result, then I need answers to the questions below.

1. What brand, model and size of shoes do you use?

2. What pedals do you use?

3. What is your cleat position on each side relative to foot in shoe?

4. Do your knees track vertically, or does one or both sit noticeably inboard or outboard of the feet while you pedal?

5. Do you have the sensation that one leg is stronger or more fluent than the other? Which one?

That should be enough to get started with.

Marcus replies:

Hi Steve

Thanks for the prompt reply advice and information. As you write it is likely to be "something about the way(I) relate to the bike (that) is the problem". Here are my answers to your questions

1. Either Shimano or Specialised entry level SPD MTB/ Touring/ General purpose shoes without the cleat removed. They are very comfortable for walking, which is necessary since I am a cycle tourist. The view from the saddle is wonderful and sometimes to be explored on foot.

2. I am old fashioned and use large toe clips with touring pedals, either MKS Sylvan or unbranded one supplied with a Dawes Super Galaxy touring bike. I usually have them fairly loose to allow for "float"/ movement of my foot as I pedal, ie so that, in your words, I have some "available movement". In addition, if I have the straps very tight I get pins and needles, so I avoid very tight straps.

3. N/A

4. There is noticeable lateral movement of my right knee as I ride. My right foot also moves laterally as I pedal. This is probably because I have a slight neurological condition that means my right leg is shorter than my left. The difference is less than 1". I had corrective surgery when I was six years old. As an adult, an orthopedic surgeon advised that any further surgery would have little positive corrective effect. Built up shoes were not recommended, but I use arch supports in my shoes when I walk, although not when I cycle.

The resting position of right foot means that my right toes point outwards further to the right. I am definitely not pigeon toed. I do knock the outer chain wheel crank with my ankle bone at times. I believe it is possible to buy pedal extensions which might prevent such knocking. As I understand them, they will mean that the pedal is further from the crank. Therefore my foot would also further away and less likely to hit the crank. I may experiment with such extensions, but I am concerned that it might increase the lateral movement of foot and knee and lateral alignment of my right leg. What is your opinion? The shorter leg means my lower back and pelvis is slightly twisted. As a consequence I have suffered from episodes of bad lower back pain. Appropriate regular stretching has lessened the frequency of such episodes.

5. My left leg is noticeably stronger and more fluent than the right. It does not move laterally when I cycle. My left knee tracks vertically.

NB: I stopped riding for 3 days when I experienced pain,walked instead and was careful to do stretching exercises. There was no pain, although some slight and some very infrequent twinges. Yesterday I rode 16km steadily on a turbo trainer. My average cadence was 71, as opposed to my normal 80. I rode a lower gear and kept my HR BPM between 65-70%. I did not feel any discomfort. Last Monday when I rode, the pain was immediate, but I did not notice my ankle bone hitting the crank.

Steve Hogg says:

A 1 inch shorter right leg explains a lot!!!. I wish you had said that at the outset. I can't see you and don't want to second guess the advice you've had in the past from people who have seen you in the flesh, but 1 inch / 25mm is a significant difference to NOT compensate for.

Even assuming this is / was good advice; that advice was given for walking which is an activity we have evolved to perform. We have not evolved to cycle and on a bike are in a more or less fixed position in that we have to relate to 5 contact points; bars, seat and pedals. When walking our only contact is with the feet on ground and our pelvis and arms are not fixed in space. The upshot of what I am saying is that there is a greater need for functional symmetry on a bike than there is when walking because are trying to interact well with a positionally symmetrical apparatus in the bike while not compensating for a substantial leg length difference. You are on a hiding to nothing.

One example. I have a customer who is a Navy Clearance Diver. This gent has done all the special forces training, jumped out of plains, walked long distances with heavy packs, done all the other death defying stuff, all with a one inch leg length difference like yours. His LLD is the result of a severely broken leg at a very young age. He has never had a moments problem or any pain performing any of the heavy physical activity he has subjected himself to until he took up cycling. He came to see me complaining of chronic low back and knee pain on the shorter legged side. I was very surprised at how functional he was off the bike but he needed an 18mm shim under the foot of the shorter leg to resolve his issues.

One example doesn't make an argument. I've seen other examples of similar uncompensated for large leg length differences who were in chronic pain during ALL activities, so you are lucky. But you are asking one leg to reach 25mm further to the pedals than the other. There is a price to be paid for that and you are paying it. You need to compensate for the difference at least partially. Doing so with clip and strap pedals is nigh on impossible. What is possible is for you to change to MTB style clipless pedals, buy a set of high quality MTB shoes with a discrete sole (not a moulded around the upper type sole as many less expensive MTB shoes have) - your current shoes might be of this type already, and have a boot maker remove the sole and insert a full length dense EVA foam build up of the appropriate height and re-glue the whole thing back together. Competently done, it looks like the shoe left the factory like that.

The cleat on the built up shoe will need to be further back than on the other side to minimise rocking torque. Moving the cleat further back extends the already shorter leg but there is a decent compromise to be had in there somewhere.

As to how to work out what size build up you need, you are probably going to need some professional help. Where are you located?

ITB Friction Syndrome

Panel,

I am a 31 yr old road cyclist. I have been told by 2 physiotherapists that I have developed ITB Friction Syndrome in my right leg. The physio clinic is heavily associated with a large number of elite AFL players amongst other athletes and private patients. I am currently working in a remote area of Western Australia and only get to ride on my breaks from work back in Melbourne (where I live), thus I can't get out on the road as often as I like.

My right knee started playing up during a very slow flat 40km (approx 15km/h) charity ride with my girlfriend in February this year (I was frequently turning around to my right to check and see where my girlfriend was and if she was ok during the ride and the pain started towards the end of the ride) and has been unshakeable since then. Prior to this problem surfacing, I'd be able to get out for a few 40-80km (gradually building over the week or two of my break) rides without any problems during my time off. Have been following the prescribed stretches and exercises (including Glute stretches, ITB stretches, Single leg squats, lower back exercises (laying on back with knees bent and then lifting lower back up to form a straight line from knees to chest) and single leg step ups) whilst away at work with a few sporadic gym sessions on the cross trainer for roughly 30 minutes (so as to not overdo it).

I have found that the pain comes back roughly around 30 minutes after commencing exercise on the cross trainer and bike. Jogging doesn't stir it up, but have had some problems with shin splints and near compartment syndrome in the past, so only try and jog on grassed surfaces. On my last trip at home I went to 3 rides, first one was 40mins in duration, and then the second was 30mins in duration with a rest day in between, then was unable to get out until a week after the second ride and only got about 15mins in before the pain started to reappear on the outside of the right leg approximately 5cms below the knee in the area where the calf muscle meets the bone (this has been a constant area of pain throughout this problem). The initial pain was located in this area along with directly under the patella, with some small discomfort transferring to the inside of the right knee.

I have been toying with the idea of paying for a BGFit, but am thinking that it might not be a good time to do it with my knee playing up. I have not had any prior knee trouble in the past whilst riding my bike.

Do you have any advice on how to put an end to this very annoying problem as I'm trying to train up to eventually join a club and start racing later this year when I finally return to working and living in Melbourne full time.

Steve Hogg says:

If you have done all the exercises prescribed and are fine performing other activities but still have problems when riding then something is not right about the way that you relate to the bike. There are so many potential causes of ITB pain on a bike that I can only speculate. One common aspect is that almost always, the rider is not sitting squarely on the seat. That is they are dropping one hip or sit with one hip forward. Usually the dropping or more forward hip is on the opposite side to side experiencing pain. A good bike fitter should be able resolve or moderate the ITB issue on a bike. That said, there aren't many good bike fitters. If you can find someone well credentialed in Melbourne, by all means give them a try. If that doesn't help, get back to me and I'll try and help further.
 

Full Specifications

The Cyclingnews Form & Fitness panel

Scott Saifer (www.wenzelcoaching.com) is head coach, CEO of Wenzel Coaching.com and has been coaching cyclists professionally for 18 years. He combines a master's degree in Exercise Physiology with experience in 20 years of touring and racing and over 300 road, track and MTB races to deliver training plans and advice that are both rigorously scientific and compatible with the real world of bike racing.

Scott has helped clients to turn pro as well as to win medals at US Masters National and World Championship events. He has worked with hundreds of beginning riders and racers and particularly enjoys working with the special or challenging rider. Scott is co-author of Bike Racing 101 with Kendra Wenzel and his monthly column appears in ROAD Magazine.

Steve Hogg has owned and operated Pedal Pushers since 1986, a cycle shop specialising in rider positioning and custom bicycles. In that time he has positioned riders from all cycling disciplines and of all levels of ability with every concievable cycling problem. Clients range from recreational riders and riders with disabilities to World and National champions. He can be reached at: stevehoggbikefitting.blogspot.com/

Kelby Bethards, MD received a Bachelor of Science in Electrical Engineering from Iowa State University (1994) before obtaining an M.D. from the University of Iowa College of Medicine in 2000. Has been a racing cyclist 'on and off' for 20 years, and when time allows, he races Cat 3 and 35+.

He is a team physician for two local Ft Collins, CO, teams, and currently works Family Practice in multiple settings: rural, urgent care, inpatient and the like.

Pam Hinton has a bachelor's degree in Molecular Biology and a doctoral degree in Nutritional Sciences, both from the University of Wisconsin-Madison.

She did postdoctoral training at Cornell University and is now an associate professor of Nutrition and Exercise Physiology at the University of Missouri-Columbia where she studies the effects of energy balance on bone health. She has published on the effects of cycling and multi-day stage racing on bone density and turnover.

Pam was an All-American in track while at the UW. She started cycling competitively in 2003 and is a three-time Missouri State Road Champion.

James Hibbard progressed from the junior to the professional ranks as a rider and has over 15 years of competitive cycling experience. He is a former Collegiate All-American track cyclist, trained as a resident athlete at the United States Olympic Training Center, earned international medals as part of the U.S. National Team, and was a member of the powerhouse Shaklee and HealthNet Professional road cycling teams.

He has earned 13 National Track Championship medals, as well as numerous junior, U-23 and elite California State championships on both the road and track. Since retiring from full-time racing in 2005, James has focused on his development as a coach.

David Fleckenstein, MPT, OCS (www.physiopt.com) is a physical therapist practicing in Eagle, ID and the president of Physiotherapy, PA, an outpatient orthopedic clinic focusing in orthopedics, spine, and sportsmedicine care.

His clients have included World and US champions, Olympic athletes and numerous professional athletes. He received his Masters degree in Physical Therapy from Emory University and is currently completing his doctorate at Regis University.

He is a board certified orthopedic specialist focusing in manual medicine and specific retraining of spine and joint stabilisation musculature. He is a former Cat I road racer and Expert mountain biker.

Carrie Cheadle, MA (www.carriecheadle.com) is a Sports Psychology consultant who has dedicated her career to helping athletes of all ages and abilities perform to their potential. Carrie specialises in working with cyclists, in disciplines ranging from track racing to mountain biking. She holds a bachelors degree in Psychology from Sonoma State University as well as a masters degree in Sport Psychology from John F. Kennedy University.

Dave Palese (www.davepalese.com) is a USA Cycling licensed coach and masters' class road racer with 16 years' race experience. He coaches racers and riders of all abilities from his home in southern Maine, USA, where he lives with his wife Sheryl, daughter Molly, and two cats, Miranda and Mu-Mu.

Dario Fredrick (www.wholeathlete.com) is an exercise physiologist and head coach for Whole Athlete™. He is a former category 1 & semi-pro MTB racer. Dario holds a masters degree in exercise science and a bachelors in sport psychology.

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