Fitness questions and answers for August 14

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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.

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.They include World and National champions at one end of the performance spectrum to amputees and people with disabilities at the other end.

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.

Brett Aitken (www.cycle2max.com) is a Sydney Olympic gold medalist. Born in Adelaide, Australia in 1971, Brett got into cycling through the cult sport of cycle speedway before crossing over into road and track racing. Since winning Olympic gold in the Madison with Scott McGrory, Brett has been working on his coaching business and his www.cycle2max.com website.

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.cyclecoach.com) is an Associate Coach with Richard Stern Training. He holds a Masters degree in exercise physiology and is USA Cycling Expert Coach. Michael has been a competitive cyclist for over 10 years and has experience coaching road and off-road cyclists, triathletes and Paralympians.

Kim Morrow (www.elitefitcoach.com) has competed as a Professional Cyclist and Triathlete, is a certified USA Cycling Elite Coach, a 4-time U.S. Masters National Road Race Champion, and a Fitness Professional.

Her coaching group, eliteFITcoach, is based out of the Southeastern United States, although they coach athletes across North America. Kim also owns MyEnduranceCoach.com, a resource for cyclists, multisport athletes & endurance coaches around the globe, specializing in helping cycling and multisport athletes find a coach.

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.

Why testosterone?
Cramp
Favoring the right side
Knee pain
Hot Spots and Wedges
Pelvic asymmetry
More on bars

Why testosterone?

All the testosterone doping dialogue seems to revolve around ratios, test methods, etc. There is a noticeable silence in these public forums re: a candid explanation about why an elite cyclist might use synthetic testosterone--meanwhile Landis repeatedly points out the futility of intermittent or event-specific dosing. I have heard from competitive cyclists that it is commonplace to use testosterone patches the night after racing to accelerate muscle recovery. Could this be a simpler and more obvious explanation for the presence of exogenous testosterone in the A and B samples after stage 17? Is this practise and application commonplace? Does it work?

Philip Sheridan

Kelby Bethards replies:

I am writing this without much knowledge of how to use the drugs for doping or research into such things. Call that unfortunate, or fortunate, depending on the circumstance. I probably will get a bunch of email toward my incompetence, but I'll give it a whirl. They just don't teach us the usage of drugs for illegal sports reasons in med school or residency.

If you think about what the ideal doping drug would be……a drug that makes all the pain disappear, makes a rider faster, stronger, etc and recover instantaneously: and is not detectable. And doesn’t have any long term ill effects. In the real world there isn't just one wonder drug for all this. There are drugs to help accomplish various aspects mentioned.

In the past/and currently, riders would try to stay on the envelope of testing technology and stay ahead of the abilities of the labs. With EPO for example, it was so much like our body’s own EPO that it make testing for synthetic EPO very difficult. Thus the indirect way of testing…..haematocrit. If a riders haematocrit was too high, it was suspect for EPO use.

To your question about testosterone: Testosterone should help riders be able to recover quicker, feel less pain and in some circumstances become more aggressive. It does work, but it is also detectable. SO, yes, you are correct, this is the “reason” Floyd is in trouble. The testing found exogenous (aka synthetic) testosterone in his samples. Floyd is maintaining that he doesn’t know how it got there.

That being said, I have not heard much in the media about the following...

Tests can be wrong. Almost all tests have a potential for a false positive or false negative. For example, over 300 tests were performed on the Tour riders this year. Only Floyd’s sample was positive. I am oversimplifying this, but what if a test has a 98% accuracy rate (not the actual term the medicine community uses but that’s ok)? That means there could have been 6 false positive test during that time.

I am not saying this is the case, just something to think about. I think they need to do completely different test method to confirm the results. Which they may have done, its just difficult to ferret out facts on this case.

Cramp

I wonder if you can help. I find that I am susceptible to cramp in my legs on longer or harder rides. Some sources say that a shortage of salt and electrolytes can lead to cramp (others say it has no effect) so I have upped my intake. This does not seem to have made a difference. What else can I do to reduce the risk of cramp?

Neil Crofts

Scott Saifer replies:

Here's the text of a handout from Wenzel Coaching on some causes and cures of cramping in cyclists. I hope one or more of the ideas in it is helpful.

What is a cramp?

Cramps are strong involuntary muscle contractions. They can occur at any time though they are most common during or shortly after hard exercise. They can occur in any muscle, though in cyclists they are most common in the quads, hamstrings and calves. They can be so strong that they cause you to launch out of a chair or actually pull a muscle.

There are many causes of cramps, though on a fundamental level they are all the same. When you move, your brain sends signals to your muscles requesting a contraction. The central nervous system receives feedback on the strength of the contraction that has occurred, from which it can make fine adjustments so that you can make a controlled movement. If the feedback says that the contraction is harder than expected, the brain can send instructions to contract less. If the feedback says the contraction is weak, the brain can send a signal to contract more. As a muscle fatigues, the brain sends more signals to tell the muscle to contract to get the same strength of contraction. When the muscle becomes too fatigued to do what is asked of it, the brain sends a continuous contraction signal, which initiates a cramp.

Causes of cramps and how to correct them

Anything that fatigues a muscle can bring on a cramp, and anything that keeps a muscle fresh helps prevent cramps. Talk to your coach about which of these might be your particular problem.

Inadequate training: You may cramp towards the end of a long or hard ride simply because you have not trained adequately for the distance or the intensity of your ride. Make gradual increases to volume and intensity. Pushing a big gear: One clue that you may be doing this is if you find yourself standing each time you need to accelerate. Another clue is measuring your cadence below 85 rpm for much of a hard ride. The cure? Switch to a lower gear. Spin to save your legs. Get a larger rear cog or a triple crankset if necessary.

Dehydration: Muscles don't contract well if they don't contain their normal amount of water. Stay hydrated.

Fuel: Muscles can't contract if they don't have a good supply of glucose. Keep eating carbohydrate rich foods on longer rides. Eat something at the start of the ride, after about 30-40 minutes and every 15-20 minutes thereafter. Aim for about 300 calories per hour if you are under 150 pounds and 350 if you are over 150 pounds. Electrolyte balance: Muscles will cramp if they don't contain their normal amounts of sodium, potassium, calcium and magnesium, and those amounts change during exercise. Salt your food and eat plenty of bananas.

If you don't eat a lot of dairy, take a calcium supplement. Calcium based antacids such as Tums have cured many cases of cramps. Take one before every ride and one each hour of the ride if you have been having cramps. don't wait for the cramp to take the calcium. Some green vegetables eaten raw, particularly spinach, will leach calcium from your system and make it hard for you to maintain a good calcium level. Avoid excessive amounts of raw spinach.

Creatine Monohydrate supplementation: Much anecdotal and some laboratory evidence point to creatine supplementation (especially loading) as a cause of cramps, especially if the athlete is at all dehydrated. If in doubt, avoid this supplement.

Tight muscles: Regular stretching of muscles that tend to cramp can reduce the cramping.

Impaired circulation: Muscles that are not receiving a good blood supply are deprived of oxygen and fuel. They will not recover from one contraction to the next and so will fatigue quickly. Do what you can to correct pressure points on the saddle, in your shoes, in your shorts and anywhere else they might interfere with circulation.

Heat or cold: On hot or cold days some people will cramp even if they do everything else right. On hot days, do what you can to keep cool. As well as staying hydrated, dribble water on your jersey and shorts and through your helmet every once in a while. Chose shadier and flatter routes on hot days, unless you are racing and don't have a choice. On cold days, dress warmly.

Favoring the right side

Being an asymmetrical rider myself and favouring my right side, I always find Steve's bike fit questions concerning asymmetry fairly interesting. In a link to an article on his website, he states that 95% of riders favour their right side, independent upon whether they typically favour their left or right hand in other matters. He hypothesizes that society favours left brain thinking and since the left brain controls the right side and that riding a bike is a left brain activity, that will cause the favouring of the right side.

Now I am an electrical engineer, not a medical professional, but I gave this some thought after pushing hard through an interval last night. My hands were not symmetrical on the handlebars. My left hand was half on the hood, half on the tape behind the hood but my right hand was ready to shift the rear derailleur (Campy Record 10-speed). As cyclists, we don't shift chainrings that often but shift our rear derailleur quite frequently. Even when not shifting, our hand is ready to shift causing an asymmetric position on the handlebars that I believe translates to dipping the right hip and pointing the right foot outwards more than the left foot.

What do you think? I am now going to concentrate on keeping my hands in the same position and see if that makes a difference.

Dan Steinbach

Steve Hogg replies:

I'm not an a health professional either so don't worry about it. I can't guarantee the correctness of my hypothesis but can guarantee that the right side bias is out there amongst cyclists

What do I think about your idea?

In your specific case who knows, but across the board I can't agree. Track riders and single speed mtb'ers exhibit that right side bias to the same relative degree as riders of geared bikes. No gear levers on their bikes.

The majority of adults who start riding after 30 years off the bike exhibit the same right side bias when they reenter the sport.

The majority of new riders who haven't ridden since infancy do so as well. Etc, etc.

Knee pain

A personal limiting factor for me for many years has been my knees. I'm 56 and ride a road bike mainly to stay fit. When I am physically tasked riding up hills it feels like the muscles around both knees are burning just like your thigh muscles might feel when they burn. As soon as I transition to a lesser slope or a flat where I can "rest" the burning disappears. The pain isn't disabling but primarily uncomfortable. I have no other knee problems and no pain that persists when I am off the bike. If you have an explanation and a training regimen that would help mitigate this condition, I would appreciate your response.

Steve Murphy

Steve Hogg replies:

Are you sure that your seat isn't too low?

As a test, find a hill and ride up it in a hard gear at around 80 -85 rpm. Take an Allen key with you and keep raising your seat in 5mm increments until you know you are too high. You do not want your hips rocking or any sensation of not being fluent at the bottom of the pedal stroke. Once you have established the maximum height where you meet those requirements, drop the seat a further 2- 3mm and that should be about right.

After you have done this, I would be interested to hear the results.

Steve Murphy responded:

I re-measured my seat height and it was right on .883 x inseam. I raised 5mm and I will get back to you with my experimentation results.

Steve Hogg replies:

The 0.883 has never had any credibility and so is a largely irrelevant relationship. There are too many other variables to consider.

1. It takes no account of crank length

2. It doesn't consider overall height of shoe soles, pedal platforms, and cleats.

3. It doesn't consider cleat position. Cleat further forward means ability to reach further. Cleat further back means greater leg extension for the same measurable seat height.

4. It doesn't consider individual differences in pedaling technique under load. For some it is too high. For others too low.

5. No consideration of differences in flexibility. Tighter hamstrings means lower effective seat height etc, etc.

6. Etc, etc, I could go on for some time. It is one of those ideas that has achieved currency because of repetition. It must have worked for someone somewhere at some time. But it is not something that I would care to apply widely.

That said, it is unlikely that you have your seat ridiculously low which was my initial reaction. I seem to have had a run of people through my business lately with chronic knee problems. Most of these were largely sorted out by raising their seats 30 - 50 mm! There were other factors of course but I thought that maybe you were a continuation of this run.

The other things that could be part of the problem are cleat position and seat position fore and aft. Here are a few previous replies that may help on balance, cleats and foot position.

Pelvic asymmetry #1

I've enjoyed reading your articles on the website as well as the letters and articles on cyclingnews.com. I am a USA Cycling Level II coach. One of my athletes is a young talented guy riding in Denmark for the summer. He turned me on to your articles, especially the one on pelvic asymmetry. He suffers from a left hip rolled down and pelvis twisted left (i.e. right hip closer to the handlebars) configuration. The idea of using the K-force seatpost sounds great! What was particularly exciting is that I too suffer from a left hip down problem. My difference is that my pelvis is twisted rightward (i.e. left hip is closer to the handlebars; left knee closer to the top tube than the right). In both of our cases, we tend to worsen this as the miles accumulate during the race season.

I have thought about the appropriate direction to shift the saddle on the K-force post. The trouble is I've thought about it way too much and have thoroughly confused myself. My question is this: In both of our cases, is the goal to shift the seat leftward thus bringing the left ischium back on top of the saddle or is it to shift the seat rightward extending the reach of the relatively under-extended left leg (but leaving the left ischium rolled off the side still perhaps)? Also what about the twisted pelvis? Is there any role in rotating the seatpost? Again, if you do rotate the seatpost are you trying to twist the pelvis back in line or are you trying to accommodate the twist of the pelvis?

For both of us, the article describes what may be Shangri-la in terms of bike fit. The whole issue makes me, at least, feel very odd on the bike. Trouble is, I am feeling the oddest when I am my fittest. Undoubtedly, more diligent stretching would help.

Thanks for any help you can give me.

Joshua G. Barton, MD

Steve Hogg replies:

Your last and second last lines are telling. If you tend to noticeable asymmetries of function and "I am feeling the oddest when I am my fittest. Undoubtedly more diligent stretching would help." You feel odd at the point of max fitness because you are considering fitness as cardiovascular efficiency and muscular strength. That is a poor and incomplete definition of fitness. You and your athletes problems don't stem from having well developed lungs and legs. They stem from poor structural fitness which means in turn that neurological fitness is probably compromised as well.

More diligent stretching would certainly help. You both have the engines but haven't given the chassis you house them in the same consideration and priority as you have given engine development. So I would suggest both of you having a global, shirts off, structural assessment from someone who knows what they are doing and work to minimise the effects of whatever is identified and remedy the situation over time.

Now to the offset seat post. From your description, you both would need to offset the post to the right. That assumes that there is measurable limb length difference. For instance, sometimes a hip drop /rotation is caused by overly protecting a short leg. That is not that common but worth considering. If that is the case, then the seat would have to move to the left, but from what you have said about underextension of the left leg, this is possible, but not that likely. The goal is always to make the athlete on bike as functionally symmetrical as possible even if the bike ends up not being symmetrical. It would help greatly though, if you could find out the underlying reason(s) that cause you to both drop and rotate your left hips forward. It could be a varus forefoot uncompensated for, it could be a left side pattern of tightness, it could be neurological thing etc etc. You may find that you have to have the seat pointing back towards the centre line of the bike as well. Experiment and see what feels best.

Look upon the laterally offset seatpost as a way to minimise functional asymmetries on a bike and by all means do it, but realise too that it would be better to tackle the root cause reasons for those asymmetries, what ever they may be.

Pelvic asymmetry #2

I'm a keen A/B grade road rider from Perth. My problem relates to Steve's pelvic symmetry article. I have only been riding for 2 and a half years and have experienced is this time due to my obsession with the sport a number of cycling related injuries which have been addressed through proper positioning and physio. My problem is I can't even with all the strengthening exercises in the world stop rotating my right hip forward under severe load.

With continuous hard training this has led to excessive internal rotation of my left leg which has caused my piraformis to be continually in spasm bursitis at the tendon and sciatica at my left hamstring. I have just had 5 weeks off and intend to begin training now that all the pain has settled down and would like to test your theory on lateral seat positioning. My question is which side off centre do i begin to position the saddle while sitting on the bike?

Steve Hogg replies:

The simple answer is 'to the left' but I had better explain a few things. You have problems that are causing you grief and you are looking for a magic bullet. A magic bullet is a single measure that makes problems go away. There are no magic bullets. There are ways to work around most problems but there are limits. A laterally offset seat post may help but probably not on its own, given the constancy of the problems you relate. It will almost certainly help as part of a package of other measures. It is not as simple as move your seat to one side and hey presto, all your problems go away.

For instance:

1. Have you had your forefoot varus checked?

If not, do so as it is likely that you have a pronounced right forefoot varus. This can cause internal hip relation under load if left uncompensated for.

2. Do you drink a lot of milk or eat a lot of hard cheese. If so, stop for a few months. Don't ask me the mechanism because I don't know and don't want to even speculate, but I have noticed over a long period that a percentage of people with similar right side problems to yours have them die down or even disappear when they give up dairy foods. This doesn't happen for the majority of people with your kind of problems but seems to have a positive effect for enough to make it worthy of mention.

3. What do you call proper positioning?

4. Do you stretch a lot?

5.What have you been told about your problems?

By that I mean:

a. Is one leg measurably longer than the other? he only definitive way to tell that is by a standing waist down x ray or a CT scan. Anything else is a guess, good or bad.
b. Do you have restricted SIJ motion on one side?
c. Do you have an innominate rotation on one side?
d. Is the right iliac crest tipped forward?
e. Is one iliac crest higher than the other?
f. Are you right or left footed and which foot is longer and by how much?

Ask your physio the answer to those problems and get back to me if you wish.

Hot Spots and Wedges

I have been getting terrible hot spots on my left foot while cycling. I tried many of the earlier suggestions such as "Move the cleat back so the ball of your foot is more forward of the spindle" and I now have custom fit foot beds (The vacuum made kind).

Well according the fine "Andy Pruitt's Medical Guide for Cyclists" he recommends using LeMond Wedges to help alleviate hot spots on your feet. How does that work as I though the wedges were aimed more towards hip and knee problems.

My guess is that the hot spot might be a symptom of a knee misalignment, or foot varus , and by correcting this with the wedge, it will relieve the hotspot caused by the body trying to compensate for the forefoot varus.

I have noticed too, that I get a hot spot in the same location if I am on my feet a lot. My doctor did x-rays and found no indications of problems. What am I missing here?

Rich Ehrlich

Steve Hogg replies:

I'll preface this and say I am not a health professional but here is what I would do in your situation. If you are getting hot spots both on and off the bike on the left foot only, then there is either an issue with foot morphology or you are more heavily loading that foot in both standing/walking and cycling.

You don't say what part of the foot is affected and so I can only offer general advice.

Go and see a physio and have him to a shirt off, stripped to your underpants global assessment of you structurally. If you have a short leg or pelvic alignment problems, they could conceivably cause your pain. Have the physio explain in terms that you understand just what your issues are and if they have any implications for your feet.

Once you are armed with that info, go and see a sports podiatrist and see whether the way your left foot is put together is the reason or part of the reason for the problem.

More on bars

I recently read Steve's reply to the question about Pro Bars and Stems on the Cycling News Fitness Q & A Forum and found it very helpful. I was hoping however, that you could provide me with just a little more direction.

I current ride on Easton EC90 anatomic bars and have yet to find a comfortable and safe hand position in the drops. I am an average sized person 5'10" but have very small hands. I have found that when I find a comfortable position on the drops I can barley reach the STI Levers, (i.e. I can just get the tip of my middle finger around the break lever). When I set up a position that allows me to reasonable reach the STI Lever the wrist angle is far to great and my hands start to tingle and the reach to the hoods becomes less comfortable.

I was thinking of switching to a non-anatomic bar with a short drop. Could you provide me with some good recommendations?

Thanks for the help.

By the way, your direction on cleat placement has made a huge difference in my comfort and climbing ability on the bike. Thank you!

Jason Walz

Steve Hogg replies:

A Modolo Venus would be a good starting point for a bar to suit, but to my knowledge they are only available in 26.0 clamp diameter. The bar you have isn't bad. Here is the least expensive way to tackle it. Position the rearmost lower section of the bars so that it is anything from level to running up towards the front by no more than 5 degrees. Choose the angle that feels best ignoring the needs of brake hood placement for the moment. Now position the brake hoods at a height that is comfortable and minimises the angle of the wrists when holding the brake hoods. From what you have said, you will now have the levers in a position that is hard to reach from the drops. T. Go to a rubber store and buy a small amount of 4 - 5 mm thick rubber. This is to make a shim. Open your brake quick release lever and cut out a shape in the rubber that you can glue to the underside of the brake hood body where the top of the gear barrel would normally contact it. This will prevent the lever from fully closing and bring it closer to your fingers. Your brake calipers will need to be readjusted once this is done.

Shimano do make a short reach STI lever. It will work with all their current 10 speed stuff and costs a touch more than a pair of Ultegra STI's.

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