Fitness questions and answers for December 5, 2005

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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.

Suggested training supplements
Anaemia by numbers
Acid base buffer
Weights after injury
One foot pronating

Suggested training supplements

I've seen so many products and programmes for fitness/cycling supplements and training drinks. I've been using Powerbar drinks but am curious about any other recommended products or services in the way of amino acids, o2, energy, etc. I have a friend who is pushing the Advocare products but looks like "snake oil" to me.

Any suggested web sites or info would be appreciated.

Jeff Mason

Pam Hinton replies

Jeff,

It's only human nature to seek an advantage over your competitors and to take the path of least resistance in doing so. Hence, the $19.4 billion per year supplement industry.

Most of us would perform better by improving our diets, training to correct our weaknesses, and getting adequate rest. Many athletes, however, have tried supplements and will continue to experiment with each new product that hits the market. The labels claim enhanced athletic performance and accelerated recovery. And who wouldn't want to "tap into the source of stamina"? or have "increased energy and endurance, enhanced recovery, faster race times, and improved overall health"? Athletes are competitive individuals and don't want to concede an advantage to their competitors. So they may take a particular supplement just because that's what everyone else in the peloton is doing. Supplements also offer a kind of insurance against the ups and downs of racing, including illness and injury. There's even a supplement out there called, "Premium Insurance Caps" which is described as, "the premium 'insurance policy' for your health and athletic performance".

The fact that most labels make grandiose claims, promising results that are too good to be true, should be a red flag. If something gives you pause to wonder if it's snake oil, your scepticism is probably well founded. Because of the way dietary supplements are regulated, at least in the United States, manufacturers may put essentially any performance-related claim on the label, even if it is unsubstantiated.

Unlike food and drugs, the Food and Drug Administration does not monitor supplements for ingredient content or purity. In other words, the ingredients on the label may or may not be present and additional compounds not listed on the label may be included. For example, small amounts of anabolic steroids have been found in supplements that claim to increase muscle mass. Many supplements that are evaluated by consumer protection groups are found to contain much less of the active ingredient than what is listed on the label. Both of these practices are illegal, but without quality control of the supplement industry, they nonetheless do take place. So safety of dietary supplements is a concern. Between 1995 and 1999, there were 2,500 adverse events reported to the U.S. FDA by consumers, healthcare professionals, and poison control centres. It is estimated that this represents only one percent of the actual adverse events. A good place to get reliable information on dietary supplements is from the National Centre for Complementary and Alternative Medicine of the National Institutes of Health (www.nccam.nih.gov/health). Information on whether a supplement contains what is on the ingredient list can be found at www.ConsumerLabs.com.

Supplements have value when they are taken to correct a nutrient deficiency. For example, an individual with iron-deficiency anaemia will obviously benefit from an iron supplement. Someone who is lactose-intolerant and does not consume dairy products may need to take a calcium supplement. Long-time vegans should take supplemental vitamin B12. Other sports supplements, sports replacement drinks, energy bars, and gels have value because of their convenience.

Most of us could finish further up in the pack if we trained more often or at a higher intensity, lost a few extra pounds of body fat, ate better, or got more sleep. If you feel you need to spend some money, a set of racing wheels or lighter frame would be a better investment. At least you'd have something to show for your money other than supplement-enriched urine.

Ric Stern replies

Jeff,

Great question. There's many products/supplements that are available, which purportedly help increase athletic performance (be it cycling or something else). It can be extremely difficult to evaluate ergogenic aids, as many web sites - where information can be located - aren't particularly accurate and aren't always reviewed. My suggestion is to read the primary source of information -- that is scientific journals, which can be located via Pub-Med (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd). From searches at Pub-Med, abstracts and full papers can be found and then read. Of course, not everyone wants to do such a search or doesn't have the time to do such a search, etc.

There is a good review paper/position statement published by the very respected journal, Medicince and Science in Sport and Exercise, which can be viewed here http://www.ms-se.com/pt/pt-core/template-journal/msse/media/1200.pdf

It is unlikely that amino acids, protein drinks, and many other supplements are indeed ergogenic. Much of the data available shows highly equivocal results. However, what we do know are that there are some supplements that do work (and are legal), these would include (but not be limited to):

1) Carbohydrate or carbohydrate-electrolyte supplements (e.g., sports drinks, sports bars, sports gels). Choose a sports that is 4 - 8% carbohydrate solution, with sodium and other electrolytes. Choose a drink that is palatable to *you* under hard training conditions
2) sodium bicarbonate (sometimes called soda loading or bicarb loading). High doses are required (0.3 g per kg body mass - e.g., 21 g for a 70 kg person), and this may help short distance maximal efforts (e.g., those up to 10-mins in duration). Be warned that 50% of people who try this, suffer severe gastrointestinal distress. Stay close to a toilet the first time you try it... Bicarb should be taken 1 -hr prior to event and with 1 to 2 litres of fluid
3) Caffeine. There is some evidence that caffeine loading helps with endurance performance, as well as short high intensity work. Loading required is around 1 - 3 mg per kg body mass. However, the effects are not positive for all people
4) Sodium phosphate. There is some (equivocal) evidence that certain types of sodium phosphate maybe ergogenic. In our work (see http://cyclecoach.com/pageID-articles-Phosphates.htm) we found an 8% increase in power output in a laboratory 10-mile TT while using tribasic dodecahydrate sodium phosphate 1g, four times a day for 6 days.

However, the main issue is to make sure that 1) you have a sound diet that supplies a good mixture of the main macronutrients, and includes plenty of fresh fruit and vegetables, and 2) your training is optimal. If these two issues are not good, then the supplements may be a waste of time.

In terms of purchasing sports drinks, bars and gels (which, in my opinion, are the most important supplements) you're best to choose one that is pleasant to drink/eat and that can be consumed during racing etc. You should always try these supplements out well in advance of your main event(s), as some may not 'agree' with you, and you don't want to end up ruining a goal event.

Anaemia by numbers

For the past three years my hematocrit at the start of the season is about 42. By the end of the season it falls into the 36-37 range. All other variables remain nearly the same, including TIBC, Ferritin, MCV, MCH and my weight, but with an obvious corresponding drop in Hgb. I take a multivitamin a day with iron, even had a colonoscopy (screening), the results of which were normal. I assume this is a normal response to training, because by March my hematocrit will increase again. Also are there any training-induced reasons for an increase in BUN with normal Cr (20 to 1) besides being hypovolemic? I've thought about chewing up RBCs for increased BUN with a decrease in hematocrit, but my retic count remains stable. Thanks.

Mike V

Pam Hinton replies

Mike,

It is tempting to assume that a decrease in hematocrit (and hemoglobin) means a reduced oxygen carrying capacity of the blood. However, this may be the wrong conclusion to draw, causing you needless anxiety. Hematocrit (Hct) simply tells you what percentage of your blood volume is red blood cells. It does not tell you the absolute number of red blood cells that you have in circulation. Likewise, a hemoglobin (Hb) lab test gives you the amount of Hb per volume of blood, but not the total amount of Hb. What determines your oxygen carrying capacity is the absolute amount of Hb in your blood. It is possible to have a decrease in Hct, but an increase in the absolute number of red blood cells. In fact, this phenomenon is common in endurance athletes and has been termed, "sports anaemia." In response to regular aerobic exercise, total blood volume increases. If plasma volume increases more than the red blood cells, as often happens during the first couple of weeks of training, you end up with a lower hematocrit, but an increase in red blood cell number.

Another possible explanation for the decline in Hct and Hb, without any other signs of iron deficiency, is seasonal variation. During the summer, assuming you live where it gets hot for several months, the body adapts to the heat by expanding the plasma volume. This hemodilution decreases Hct. Normally Hct will be 3-7% lower in the summer than in the winter. Furthermore, the average biological variation within an individual is about 3%. If you also factor in the measurement error, it would not be unexpected to observe a change of approximately 12% in Hct from one time to the next.

Because your MCV (mean corpuscular volume, red blood cell size), MCH (mean corpuscular haemoglobin, Hb per RBD), and reticulocyte (immature red blood cells) count are normal, there is no evidence of nutritional anaemia. In addition, your normal ferritin level indicates that you have adequate iron stores. It is unlikely that your elevated blood urea nitrogen (BUN) is related to the decrease in Hct. It is possible that your BUN increases slightly during the racing season, depending on your training load. If you do a lot of hard training and racing, breakdown of skeletal muscle could increase urea production and its concentration in the blood.

Unless you are experiencing other physical symptoms, I wouldn't worry about the numbers.

Acid base buffer

I enjoy reading your articles in response to fellow riders and their problems. It seems I'm not the only one with niggly problems. I'm 48 years old, have been riding endurance rides (100 - 500 km rides) for many years and am currently training my butt off for an endurance ride that takes place in the Victorian Alps annually every Australia Day weekend - the Audax Alpine Classic.

It involves a 200 kilometre ride with 3600 vertical metres over four climbs. There are two long climbs at 29 kilometres each and 2 shorter climbs over a pass. Going out it is a 12 kilometre climb, but coming back it is an 8 kilometre climb, getting fairly steep in places. I've done it a few times before and have only completed it once in 12 hours - it's a long day.

I've sorted out my main problems over the years i.e. hydration, electrolytes, magnesium supplements, food, riding to a plan, but I still have an ongoing problem. I read an earlier e-mail from a fellow cyclist about how his sweat smelled of ammonia when putting in a big effort. I also have this problem but have dealt with it somewhat by taking a sports drink with magnesium (500 mg per bidon) and while also feeling the benefits of magnesium in endurance and recovery, my sweat smells less of ammonia. The ammonia is only present after prolonged extreme effort i.e. climbing hills. As the ammonia smell is the metabolic by-product of muscle exertion is there another supplement I could take to lower my acid base.

Obviously my lungs and kidneys are doing their utmost to keep me alkalined, but can I do more to assist my buffer system. I know that in the racing industry they use Sodium Bicarb as a performance enhancer, and in the medical world they infuse sodi-bic when points become acidotic. Magnesium is also used to help reduce lactate levels after certain types of surgery. Is there any formula / rule I can implement to help my performance by reducing my acid levels while riding up hills and maintaining my intensity. I've thought about taking sodi-bic tablets during the ride but are unsure of doses, and don't want to become too alkalined.

Obviously a ride like this is subject to many variances; last year it got to over 37C (100F) while climbing up Mt Buffalo, so it is a huge strain on the body's reserves and any little edge would be most appreciated. Thanks for your help.

Graham Johnston

Macleod, Australia

Pam Hinton replies

Graham,

It seems to me that you are asking two questions. First, how can you further reduce ammonia production? And, second, will you derive any benefits from supplementing with alkalizing agents like sodium bicarbonate? As you note, ammonia is a by-product of muscle metabolism. During high intensity exercise, ammonia is made from adenosine monophosphate (AMP), which accumulates in the cell because of rapid breakdown of ATP into AMP.

During prolonged exercise at moderate intensity, the ammonia comes from using branch chain amino acids (BCAAs) for energy. Ammonia produced in the muscle ends up in the blood and can accumulate in the brain. Ammonia build-up within the skeletal muscle causes local neuromuscular fatigue. In the central nervous system, ammonia alters neurotransmitter function; it depletes the excitatory neurotransmitters, glutamate and its precursor, gamma-amino butyrate, leading to central fatigue. In ultra-endurance cycling events, like the Audax Alpine Classic, the way to reduce ammonia production is to avoid using BCAAs for energy. Because muscles start to rely on BCAAs when glucose is no longer available, maximizing pre-event glycogen stores and consuming adequate carbohydrate during the race are the most effective strategies to reduce ammonia production.

It is true that ammonia production plays a role in acid-base balance. But, rather than increasing the acidity of the blood, ammonia actually helps to remove hydrogen ions from the body. In the kidneys, ammonia (NH3) combines hydrogen ions (H+) to form ammonium, which is excreted in the urine. So, the negative effects of ammonia are not because of an increase in acidity.

An increase in the acidity of the blood and muscle negatively affects muscle contraction and energy production. An increase in the H+ ion concentration (i.e., increased acidity, decreased pH) decreases muscle force generation by interfering with calcium release from the sarcoplasmic reticulum and interfering with interaction between the contractile proteins, actin and myosin. Glycolysis is slowed by a decrease in pH, as is the rate of ATP synthesis. The rationale behind the use of alkalizing agents like sodium bicarbonate is that by preventing the accumulation of H+, the onset of fatigue will be delayed. Sodium bicarbonate (NaHCO3) is alkalizing, i.e., reduces H+, increases pH, because when it dissolves in water, the bicarbonate ion, HCO3-, reacts with H+ to form H2O and CO2.

Most studies investigating the ergogenic effects of sodium bicarbonate have examined the benefits during short-term maximal exercise or repeated maximal efforts rather than during prolonged exercise. This is because during high-intensity exercise, anaerobic metabolic pathways are used. Glycolysis, the breakdown of glucose into pyruvate and ATP in the absence of oxygen, generates H+ ions. Rapid hydrolysis of ATP, beyond the capacity to regenerate it, also causes a net accumulation of H+ ions.

In contrast, endurance exercise uses aerobic pathways to make ATP from glucose and fatty acids without an accumulation of H+. Although the data are mixed, there is a general consensus that sodium bicarbonate delays the onset of fatigue during high-intensity exercise (80-125% VO2max) that lasts for 1-7 minutes. There is no benefit in single efforts less than 30-40 seconds in length; however, there is an advantage if multiple short, maximal efforts are performed. In ultra-endurance events such as your 12-hour race, amino acids in skeletal muscle will be used to make ATP. When amino acids are broken down for energy, they release H+, decreasing pH of the blood. It is difficult to predict the magnitude of this response because it is dependent of many factors, energy and carbohydrate availability, hydration status, and environmental conditions. So, the potential for you to benefit from sodium bicarbonate is uncertain.

You are wise to consider the potential negative consequences of consuming this salt. Gastrointestinal upset, cramps, and diarrhoea are the most common side effects and are caused by a rapid movement of intestinal contents. Oral consumption of large amounts of any salt has the potential to disrupt fluid balance. A sudden increase in the concentration of the intestinal contents will cause water to be pulled from the blood into the gut to dilute the sodium bicarbonate. Consuming sodium bicarbonate with large amounts of plain water can minimize this effect. A dose of 0.3-0.4 g sodium bicarbonate per kg of body weight elevates blood pH by 0.03-0.06 units with the maximal effect approximately 2 hours after ingestion. As an alternative to taking a single dose of sodium bicarbonate the day of the race, you might consider taking 0.4-0.5 g per kg body weight once daily for six days prior to the event. This dosing protocol was shown to be as effective as a single acute dose in improving performance during maximal exercise. The benefits of the bicarbonate loading persist for 2 days after the last dose.

You seem to have been successful in fine-tuning your training and race day nutrition and hydration. If you choose to try the sodium bicarbonate, I recommend that you experiment with it before race day during some long training rides.

Weights after injury

Hello,

I am writing to inquire about strength exercises to do in the off season. I have been riding on and off for several years but this past summer I started to pick things up quite a bit. I am 30 years old and I averaged around 150 miles per week with very strong and experienced local riders. I suffered a high hamstring pull along the way, did rehab, but it still nags me on and off. Sometimes it rides up on the side of my hip. I am looking to increase my strength in the off season and would like your input on new exercises that I can do to make myself a better rider next year. I am very experienced in the weight room. Thanks you for your help.

Terra Brozowski

Ric Stern replies

Terra,

It is unlikely that in a trained endurance cyclist that weight training will make them better. There is some evidence that in low fitness people (e.g., those below race fit levels) can benefit from weight training, as the stimulus it provides is sufficient. There are more details here http://www.cyclingnews.com/fitness/?id=strengthstern

However, if you have some form of injury etc, then some weight training rehab maybe required to correct that issue, and/or other problems. The exercises that you need to do for your specific injury should really be advised by your physiotherapist who will have your details/injury information to hand.

There may be other reasons to do weights (e.g., body aesthetics, increased strength for certain jobs, etc.) but that would be out of the scope of this query.

One foot pronating

In reference to the November 28 posting, Gerald Reyes wrote:

Dear Steve,

I think you are a brilliant man. I have read every article you have published and want to thank you for taking the time to help me with my problems. There are not many people left in this world that do something for nothing, but there you are. Cycling has been a great release for me and there have been many times that I pondered ditching the bike and going back to the cold water of swimming, something I dreaded. Since jumping on the trainer like you said I realised how twisted my body was and how my hip was trying to compensate for the varus/leg length discrepancy. Every question you asked and answered (Jonathon's answer) described my situation exactly. I began to paint a mental picture of exactly what my body was doing to compensate and therein lies the answer to my woes.

Today I made some adjustments with some Lewedge shims and took my bike for a ride. I felt like a kid with a new toy and rode most of my two hour training session in 'Big Plate', something I was never able to do. My left leg felt strange at first almost as though it wasnt mine. I even felt some initial ITB tightness in the left leg, (think the reduced lateral movement was causing the ITB to work or stretch, something it probably never did.) Overall I felt like I had an almost 50% improvement in my left leg and plan to work towards equalizing my hip and discovering the true cause of my pain. I am also beginning to think that my aching knee was 'paying the price' and not some scar tissue as I previously thought. Truly amazing! As of writing this article I am not in pain and don't need to stretch just to be able to sleep.

Scores of hours spent researching articles, stretches. MRI's and expensive doctors only to discover the reason was not my knee but foot/leg length. I have seen many twisted people riding around and plan to use my new found knowledge to help people. Wish everyone knew about you and stop trying to let their bodies adjust to the bike, it never happens but only gets worse. I will chime in and let you know my progress whether you have the time or not and just wanted to say Thank you again for helping me.

Steve Hogg replies

Gerald,

I will reply through the forum because if this thread gets posted, it may help others. The pattern I described to you which it would seem is accurate in your case is very common.

Experience has taught me that most positioning problems come down to a number of 'themes' and almost everything is a variation on these 'themes'. Not everything but an awful lot. Apart from the side effects of trauma and sometimes surgery, my experience is that it is rare for a cycling knee problem to be anything other than a knee inappropriately loaded because of other factors, rather than a problem intrinsic to the knee.

The other thing is that I doubt your description of me - I'm just observant. The pattern of an uncompensated for varus right fore foot with compensatory mechanisms on the other side leading to problems that I described as the likely occurrence is very common and little appreciated, because the health professionals often called upon for advice or treatment are only seeing the rider, not the rider interacting with their bike.

I applaud your idea of applying your own experience to others but remember that your pattern of interaction with your bike while common, is not the only reason that similar problems can arise. Enjoy your bike and best of luck with future self improvement.

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