Fitness questions and answers for August 13, 2008

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Form & Fitness Q & A

Got a question about fitness, training, recovery from injury or a related subject? Drop us a line at fitness@cyclingnews.com. Please include as much information about yourself as possible, including your age, sex, and type of racing or riding. Due to the volume of questions we receive, we regret that we are unable to answer them all.

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.

Jon Heidemann (www.peaktopeaktraining.com) is a USAC Elite Certified cycling coach with a BA in Health Sciences from the University of Wyoming. The 2001 Masters National Road Champion has competed at the Elite level nationally and internationally for over 14 years. As co-owner of Peak to Peak Training Systems, Jon has helped athletes of all ages earn over 84 podium medals at National & World Championship events during the past 8 years.

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.

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.

Fiona Lockhart (www.trainright.com) is a USA Cycling Expert Coach, and holds certifications from USA Weightlifting (Sports Performance Coach), the National Strength and Conditioning Association (Certified Strength and Conditioning Coach), and the National Academy for Sports Nutrition (Primary Sports Nutritionist). She is the Sports Science Editor for Carmichael Training Systems, and has been working in the strength and conditioning and endurance sports fields for over 10 years; she's also a competitive mountain biker.

Eddie Monnier (www.velo-fit.com) is a USA Cycling certified Elite Coach and a Category II racer. He holds undergraduate degrees in anthropology (with departmental honors) and philosophy from Emory University and an MBA from The Wharton School of Business.

Eddie is a proponent of training with power. He coaches cyclists (track, road and mountain bike) of all abilities and with wide ranging goals (with and without power meters). He uses internet tools to coach riders from any geography.

David Fleckenstein, MPT (www.physiopt.com) is a physical therapist practicing in Boise, ID. His clients have included World and U.S. champions, Olympic athletes and numerous professional athletes. He received his B.S. in Biology/Genetics from Penn State and his Master's degree in Physical Therapy from Emory University. He specializes in manual medicine treatment and specific retraining of spine and joint stabilization musculature. He is a former Cat I road racer and Expert mountain biker.

Since 1986 Steve Hogg (www.cyclefitcentre.com) has owned and operated Pedal Pushers, 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.

Current riders that Steve has positioned include Davitamon-Lotto's Nick Gates, Discovery's Hayden Roulston, National Road Series champion, Jessica Ridder and National and State Time Trial champion, Peter Milostic.

Pamela 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 assistant professor of Nutritional Sciences at the University of Missouri-Columbia where she studies the effects of iron deficiency on adaptations to endurance training and the consequences of exercise-associated changes in menstrual function on bone health.

Pam was an All-American in track while at the UW. She started cycling competitively in 2003 and is the defending Missouri State Road Champion. Pam writes a nutrition column for Giana Roberge's Team Speed Queen Newsletter.

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.

Scott Saifer (www.wenzelcoaching.com) has a Masters Degree in exercise physiology and sports psychology and has personally coached over 300 athletes of all levels in his 10 years of coaching with Wenzel Coaching.

Kendra Wenzel (www.wenzelcoaching.com) is a head coach with Wenzel Coaching with 17 years of racing and coaching experience and is coauthor of the book Bike Racing 101.

Steve Owens (www.coloradopremiertraining.com) is a USA Cycling certified coach, exercise physiologist and owner of Colorado Premier Training. Steve has worked with both the United States Olympic Committee and Guatemalan Olympic Committee as an Exercise Physiologist. He holds a B.S. in Exercise & Sports Science and currently works with multiple national champions, professionals and World Cup level cyclists.

Through his highly customized online training format, Steve and his handpicked team of coaches at Colorado Premier Training work with cyclists and multisport athletes around the world.

Richard Stern (www.cyclecoach.com) is Head Coach of Richard Stern Training, a Level 3 Coach with the Association of British Cycling Coaches, a Sports Scientist, and a writer. He has been professionally coaching cyclists and triathletes since 1998 at all levels from professional to recreational. He is a leading expert in coaching with power output and all power meters. Richard has been a competitive cyclist for 20 years

Andy Bloomer (www.cyclecoach.com) is an Associate Coach and sport scientist with Richard Stern Training. He is a member of the Association of British Cycling Coaches (ABCC) and a member of the British Association of Sport and Exercise Sciences (BASES). In his role as Exercise Physiologist at Staffordshire University Sports Performance Centre, he has conducted physiological testing and offered training and coaching advice to athletes from all sports for the past 4 years. Andy has been a competitive cyclist for many years.

Michael Smartt (www.wholeathlete.com) is an Associate Coach with Whole Athlete™. He holds a Masters degree in exercise physiology, is a USA Cycling Level I (Elite) Coach and is certified by the NSCA (Certified Strength and Conditioning Specialist). Michael has more than 10 years competitive experience, primarily on the road, but also in cross and mountain biking. He is currently focused on coaching road cyclists from Jr. to elite levels, but also advises triathletes and Paralympians. Michael is a strong advocate of training with power and has over 5 years experience with the use and analysis of power meters. Michael also spent the 2007 season as the Team Coach for the Value Act Capital Women's Cycling Team.

Earl Zimmermann (www.wenzelcoaching.com) has over 12 years of racing experience and is a USA Cycling Level II Coach. He brings a wealth of personal competitive experience to his clients. He coaches athletes from beginner to elite in various disciplines including road and track cycling, running and triathlon.

Advice presented in Cyclingnews' fitness pages is provided for educational purposes only and is not intended to be specific advice for individual athletes. If you follow the educational information found on Cyclingnews, you do so at your own risk. You should consult with your physician before beginning any exercise program.

Hip damage and leg length
Unresolvable knee pain
Climbing and power to weight ratio

Hip damage and leg length

I'm 68 years old, and cycle for pleasure and fitness. I'm 6 feet tall and weigh around 70 kilos.

Unfortunately, just before Christmas I came down on black ice and suffered a double fracture of the pelvis plus a fracture of the right hip socket, caused when the head of the femur rammed into it.

I was in traction for two months and rehab for four.

The surgeon who initially put me into traction said that I would never ride again and that I would need a hip replacement in three to four months.

Happily, I made an exceptionally good recovery, and am now walking normally, albeit with a slight limp. A different surgeon, to whom I went for a second opinion, has said that I will not need a hip replacement for two - five years, and that it's a good thing for me to go cycling again.

I've been riding a trainer bike for a month, and the effect on my right leg, which was badly wasted, has been enormously beneficial. As far as I can tell, my training sessions do not cause the kind of pain which would suggest that I am causing further damage to the recently healed hip. My resting heart rate is back to normal at around 48.

However, it's clear to me that the right leg is now around 10mm shorter than the left, and that the hip has lost some rotation.

What should I do to deal with this when I eventually get back on my road bike?

Tony Drapkin

Steve Hogg replies:

Sorry to hear that you hit so hard but happy to hear that you are exceeding expectation while recovering. A shim under the cleat of the shorter leg would be the best solution. There is no magic formula as to how many mm to use. As your problem stems from the hip / femur which doesn't point directly down when seated, you shouldn't have to completely compensate for the entire 10mm that you think you are lacking.

What you want is a shim stack that will allow you to reach fluently through the bottom of the pedal stroke while not causing you problems over the top of the pedal stroke. Assuming you are reasonably functional in the hips and lower back, a shim should work well but you will need to experiment a bit to find what best suits you, particularly under load.

If you are handy, you can make one. If not, contact Bicycle Fitting Systems www.bikefit.com as they have purpose made shims.

One thing to remember is that as you shim up the cleat, you are increasing the work that your leg will have to do to stablise foot on pedal with the increased stack height of shim plus cleat. To negate or largely negate any problems with that, I suggest that you move the cleat a couple of mm further back on the shoe than your current position once you fit the shim. I would be interested to hear how you get on.

Unresolvable knee pain

I have two issues (possibly unrelated) I need some advice about:

1. I've noticed over the course of this season (my third riding / racing on the road) that when I lie flat on my back, as to go to sleep, my very lower back is uncomfortable, and it seems that my spine is quite curved, as if my hips were rotated forward. I theorize that tightness across the front of my hips (I'm unfamiliar with the muscle(s?) scientific name(s), but the one(s) that would allow you to lift your leg forward) is rotating my hips forward, putting strain on my spine. If, lying on my back, I lift my knees so my feet are flat on the floor, the back discomfort disappears. Also, I have no back pain on the bike, despite a fairly aggressive position.

Does this seem like a correct analysis? If so, are there any effective stretches for this area that you could recommend?

2. Weird, unresolved knee pain:

Preface: I've read through the vast majority of your articles on fit, and have actually been fit by no less than two members of this panel, with no luck resolving this issue.

The pain that's come and gone for over two years now is on the upper-outside of my left knee. IT Band related stuff. I've seen a PT and worked on my flexibility (as related to all the stuff attached to the IT Band) quite a bit, and I'm convinced my flexibility is much better, if perhaps not perfectly ideal. Still, the pain has come back. Rather than dwell on every detail of my fit, I'm going to go to the one weird bit that I think might just be the cause of it all:

As measured, my left foot is 6 degrees varus. The forefoot tilts down to the outside visibly. My right foot is neutral. Experiments with my foot wedged to accommodate this, however, show that under load my foot rotates back towards a neutral position--i.e. I can't apply power with my foot in the position it sits naturally.

The position that has worked the best has been to have both feet wedged the opposite way, vargus, but I don't see how this could be correct.

Finally, back in middle school I has a spiral fracture to my left Tibia skiing. No one has seen a noticeable leg length discrepancy, but I can't help but wonder if some resulting misalignment is causing my problem.

Any thoughts would be greatly appreciated.

Nick M.
Santa Barbara, CA, USA

David Fleckenstein replies:

The first issue that you describe is hip flexor tightness. Our hip flexors (psoas, illiacus, and rectus femoris) run from the front of the vertebrae and pelvis to the femur (or tibia in the unusual case of the rectus). If those muscles are restricted, they pull the spine forward into an increased lordosis. When you are lying down and you bend your knees, your spine flattens because the hip flexors are now on slack.

Restriction in these muscles is a common source of pain and pathology for cyclists. In previous posts, I have given instruction for how to stretch them. Regarding your second issue, I am concerned that if you have marked hip flexor tightness, you probably do not have adequate ITB length or pelvic stability and I would further examine this with your therapist.

Steve Hogg replies:

The muscles you are talking about are your psoas. If they are overly tight, what you describe can result. Why they don't hurt on the bike and when you pull your knees up in bed is that they aren't being stretched. Why they hurt when you lie on your back in your bed with your legs extended is that you are stretching them more than their current flexibility will allow comfortably. I've got to say that if your psoas are so tight that laying in bed is a problem, you've got some work to do. That's fairly dysfunctional. Do something about them or seek advice on how to do something about them.

Re: "weird unresolvable knee pain." You may well be right about some after effect of your skiing accident. The hypertonicity of the psoas may also play a part because the psoas plays a part in the internal rotation of the hip. The difference in foot plant that you have between left and right usually goes hand in hand with pelvic asymmetries so it is worth checking that out. The way that the left foot comes back to what you describe as 'neutral' under load suggests that your apparent 'valgus' reading is more the result of a long time pelvic obliquity with or without a leg length difference. The left foot feeling better with a valgus wedge may because:

That is what you need

Or

You are sitting with right hip down on the bike causing the left leg to reach further and to have its plane of movement challenged .Sometimes a valgus wedge tidies up that up even though it wouldn't be ideal with a square pelvis.

Lastly, theory and practice about appropriate foot canting with cleat wedges is at odds. It isn't as simple as X degrees of varus or valgus = a certain number of wedges or particular direction of canting. What I'm saying is that your experience with wedges isn't rare. While there is a method that is definitive, it doesn't lend itself to explanation in a Q & A forum like this. If the wedging you used felt more stable under foot, use it that way. As you improve your incidence of back pain, don't be surprised if you need to revisit the wedging.

Climbing and power to weight ratio

The Garmin Chipotle official website lists Christian Vande Velde's weight as being 69 kg's and David Millar's as being 77 kg's, an increase of approx 11.5%. For David to climb as well as Christian would he therefore have to put out at least 11.5% more power than Christian at lactate threshold in order to keep in the lead group or are there other factors that also come into play?

Andrew Greenhalgh
United Arab Emirates

Scott Saifer replies:

So long as we are talking about a long climb and the riders with the highest power-to-weight ratio are pushing the pace, yes, the heavier rider has to produce proportionally more power at threshold to maintain speed.

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