Form & Fitness Q & A
Got a question about fitness, training, recovery from injury or a related subject? Drop us a line at firstname.lastname@example.org. 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.
Great Q&A! I am a 32 year old male and have been road riding (non-competitive) for about 2-3 years. With potential thoughts of entering a few races this summer, I'm trying to stick with a "block" training plan as outlined by Carmichael. My question relates to balancing winter cycling workouts with other aerobic activities.
The trainer is tedious at best and it is very hard to ride for much beyond an hour or so. When the weather is nice, I can get in 1-1.5 hours outdoors during lunch. Combined with a couple of trainer rides I might get 3 to 4 hours on the bike each week. Each ride includes Carmichael Stomps and Powerstarts (i.e. strength/power) according to the foundation block prescription.
When weekends come I head for the mountains. I generally ski tour (backcountry ski) 2 days per week. A typical ski tour ranges from 3-7 hours of aerobic activity and might involve 3000 to 7000 ft of climbing per day. Due to the wide variety of terrain travelled through my heart rate can range from aerobic level to something near my cycling LT.
Ski touring is not cycling specific but how does this activity fit into a foundation block that requires 9 to 10 hours of cycling per week? How will this affect my foundation block training and cycling specific aerobic gains? Thanks for you insight.
Salt Lake City, Utah
Cross-country skiing and cycling are highly compatible sports as they work the major muscle groups in a similar way more so than, for example, running and cycling. When I say compatible, what I mean is that to train for a sport effectively, the training has to be specific so that it works the muscle groups at the same joint angles, velocities and movement patterns as they would in competition. So, if you look at how the legs move during running they're not working in the same way as cycling, where as the movements for cross-country skiing and possibly speed skating are very similar and so would have some cross over benefit for cyclists.
The rest of your training has to be effective and help achieve the goals you have set for your racing. Carmichaels Stomp and Powerstart workouts might be beneficial if you would like to become a successful sprinter as they work predominantly short term anaerobic power delivery systems used for sprinting. In addition, the plan tells you to 'do this workout for 3 weeks and then stop for two months to allow the body to adapt to the stress' (The Lance Armstrong performance programme, 2003). Most sports scientists would agree that stopping a workout for two months would lead to almost total de-training of the system that was stressed in the first place.
Training for the sprint is all well and good but you have to get to the finish line if you want to be able to use that sprint and at this time of the year you would be better off getting your long term aerobic energy systems working as efficiently as possible with training rides that give you the best bang for your buck per unit of time. Yes, the trainer is dull but it needn't be if you spice up the session with some variety and it needn't last more than an hour to get a great training effect. If you use it when the weather is bad you can simply shorten the duration of the session in favour of little more intensity and save the longer training rides when the weather picks up. Thirty well-constructed minutes on a trainer will not only maintain fitness but can move it on.
I intend to participate in a 40k ITT and want to place better, if not win it. What training would you recommend to achieve this goal? I am an intermediate rider. Thanks for your help!
You've taken what is really a very complicated question and stated it as if it were simple, so I'll do the same with an answer.
To prepare to do well in a 40K TT, do lots of base mileage at a pace you can sustain for several hours on your bike set up as you will use it for the TT for many months, and then in the final six weeks before the event start to incorporate gradually longer intervals done at race pace. If you really want to do well in time trials, the most important element by far is developing your sense of pace so that you can use up all your effort during the TT, but not overdo it and slow down near the end. The only way to really do this is by riding a lot of time trials and paying attention to your effort and what happens as a result.
I am entertaining the idea of purchasing a tri-specific bike this season. A local bike shop was very keen on selling me a bike with 650 wheels. They maintained that this was the only way to go; however, I don't see many of these machines at local races.
I'm not a physics/engineering type, but wouldn't a bike with 650 wheels require a higher cadence to move the same distance in the same amount of time as one with 700 wheels given the same gear ratios? I also have noticed, via the internet, that some bikes with 650 wheels come with bigger chain rings. Is this to make up for the smaller wheels?
It seems that using 650s would require more effort at a higher pace to keep up with those rolling on 700s.
What's the deal with these wheels? Is there less rolling resistance?
It sounds like your local bike shop is either a "believer" or has some stock to move. In a nutshell, a 650c wheel has greater rolling resistance because of their reduced size and less aerodynamic penetration than a 700c wheel of the same spec. By spec, I mean the same, rim, tyre, number and type of spokes as a 700c wheel but downsized to 650c. A 650c wheel has to rotate more often to travel the same distance than a 700c wheel and the spokes generate greater turbulence for a given distance travelled because of that.
The advantages of a 650c wheel are that they are stronger than a 700c wheel of the same spec and accelerate more quickly due to their lesser mass. Neither of these benefits would give a triathlete an advantage because the nature of the sport is steady paced cycling other than the dictates of terrain. Equally, the extra strength is unlikely to be necessary because triathlon doesn't impose the loads on a wheel that criterium or road racing can for instance, and 700c wheels seem quite adequate there.
The larger chainrings that often come with 650c wheels are to give equivalent gearing in the sense of distance travelled per pedal stroke. 650c wheels have their place, but in my view it is usually only when the size of a frame for a particular rider precludes the use of 700c wheels without unreasonable compromise in the design of the frame.
A couple of my guy friends are cyclists, and they do quite a bit of long distance and two spinning classes during the week. They are in their 40's and are complaining come race day that they are fine to keep up with the groups on the flats and downhills but are battling to stay with them on the long hills. What would you recommend to help them get up those monster hills?
If your friends are keeping up on the flats by doing work equal to the other riders but not keeping up on the hills, they need to lose weight. If they are keeping up on the flats by sitting in 100% and never pulling, but they can't keep up if they do trade pulls they need to increase aerobic power, and maybe lose weight. Increasing aerobic power may be as simple as skipping hard spin classes during the week so they'll be recovered on weekends, or they may need to actually improve their training overall.
This letter is a continuation from last week's Form & Fitness
Before I start I would like to thank you for your response. I cannot express in words the gratitude I feel. Thank you. Here are the answers to the questions you requested:
1. It is just general lower back pain, but I feel as though whatever causes the pain also causes strain to other parts. I sometimes get pain in my traps and neck.
2. For a long time I thought of the pain as just general low back pain, but after really concentrating on the location of the pain, I would say I am 80% sure it (pain) starts on the right side of my lower back. I feel as though this is fooling me to think there is pain on both sides. So yes, I would say it does start on the right side and the pain is more severe on the right side also.
3. My observer saw that my right side does drop down more. He felt as though I was hanging to the right.
3a. They looked pretty much equal to my observer. Personally I feel as though my right side rotates foreword in the down stroke.
4. My back does look like a single curve.
5. My left elbow locks more than my right. This was very noticeable to my observer. On a side note, this has been something I have noticed in the past. I have noticed it when on the hoods. My left hand tends to rest on the hood, while my right is not quite on the hood, as though my right arm were shorter and my left longer.
6. My upper back does seem to run down and forward to my neck.
7. My right knee has always been very sloppy. A bike fitter once asked me 2 years ago if I ever had any injuries to that leg (Which I have not). My right knee tends to want to move outwards. This is most noticeable when my right leg is at the top of the stroke. When I lean down lower than my normal position on the hoods, my right knee seems to want to move outwards more, and at the same time my hip flexor will feel tight and restricted. Again, this is when I am in the upstroke. On the down stroke on the other had, my heal on my right foot will move inwards towards the bike, and my toes pointing away from the bike. With every pedal system I have owned, I have had problems with this. I feel the need to want to move my right cleat so that there is enough outward play so that I do not feel constricted while pedaling. Meanwhile, my left foot is perfect and not nearly as finicky.
8. I own a Trek 5500 carbon in a 56cm, which I have had for 2 years. I have been hoping to get a LeMond Zurich Steel/Carbon frame for this year, just to have something with different geometry. My saddle for a while was a Selle Italia Flite but I have recently (within the past three weeks) changed to a Fizik Arione but have not noticed any changes/improvements in any of my issues. My current shoes are Northwaves and I believe they are size 43 or 44 (sorry, the size is worn off and I can't remember), in the past I used Answer and Diadora, they were both either size 43 or 44 as well. My current pedals are Ultegra PD-6610 (6 degrees float). I have just gotten these pedals a few days ago. Up in till then, I used LOOK Keo carbons (9 degree of float). Before that I used campy Daytona pedals.
Also, I would like to mention something I noticed recently. When I walk my right leg seems to be turned outwards more than the left. If I were to walk, then stop and look at the position of my feet, my right foot is pointing outwards, just the same as when I am on the bike as I mentioned in question 7 when I am in the down stroke. Also around this time last year I had tendonitis in my right knee, I believe that this happened because of my imbalances in my right side. Another note, before I started cycling (about 4 or 5 years ago) I did weight lifting at my house for about 1 year. I was lifting very regularly, usually 3 days per week. I was unsupervised. Maybe this has some to do with my imbalances. My workouts included upper and lower body stuff. Thank you very much!
1. Firstly, raise you bars and check that your seat height is conservative. By conservative I mean that you should feel like you are reaching the bottom of the pedal stroke with ease and with something to spare. The increased bar height and maybe slightly lower seat height should diminish the back pain to some degree.
2. Check that your shoes will allow you to gain the cleat position explained in this post and this post. If you can do as suggested, you will find that you are more stable on the pedal and this should have a positive effect on your comfort on the bike. Northwave shoes are a brand that has the cleat positioning hardware further forward on the sole than most brands and you may find that you have difficulty achieving the cleat position suggested. If this is the case, and it is likely, the brands of shoes to look at are Sidi, Shimano, Nike, DMT, the current Times (re-badged DMT shoes), Specialized, Gaerne, and Diadora. Buy whatever fits best from what is available to you. Of these Nike and DMT have the most rearward cleat mounting holes in their carbon soled shoes.
3. You need to establish why you are hanging to the right. Do you have a measurably longer or shorter right leg?
Are your hip flexors noticeably tighter on the right side?
Is your RH sacro iliac joint restricted in any way?
A good structural health professional (physio, chiro, osteopath or similar) should be able to tell you this. With the leg length, a CT scan or similar is definitive, everything else has a margin of error large or small.
4. My feeling is that something is not right with the function of your right hip, right foot or both. Any would explain why the right knee wanders around but again, (3) should supply at least partial answers to that.
5. Your left elbow locks because it has to reach further because of the twist to the pelvis on the seat. The right arm reach is short because (a) you need tension there to help stabilise your asymmetric way of pedalling and ( b) it is a fair bet that your entire right side is tighter than the left side from hips upward.
Re your (7), all of this is likely the effect of tightness in the right side hip and lower back possibly complicated by common malformations of the foot. Firstly to keep you on the bike in the short term with enhanced comfort, do as suggested in 1 and 2 above. Next, get some answers about the stuff in 3 above and get back to me with that.
Lastly, a good investment would be "Overcome Neck and Back Pain" by Kit Laughlin as it is as good a self help manual as I have seen and has some good stuff on asymmetries and how to solve or work around them. If you do this, don't just look at the illustrations. Read everything and let me know how you get on.
I am a 34-year-old category 2 road racer with a history of knee problems. To give you some background, I have scoliosis and my right leg is 1.1 cm shorter than my left (confirmed by CT scan). I started racing approximately 12 years ago, when I made the switch from avid mountain biker to roadie. I never had knee pain prior to making the switch to clipless pedals, but the very first ride I went on with clipless pedals caused really severe knee pain. I recovered from that pain, and then had someone look at my fit, but I was not able to resolve the issue. I was just about to give up road biking and go back to toe straps, when I got a really excellent fit. This took care of some, but not all, of my knee pain, which was essentially limited to my left knee.
The knee pain is hard to describe, but it feels as though my knee is "crunchy," and when I get done with a hard ride it feels as though my knee needs to pop back into place (like the patella is too far to the outside of my knee and needs to slide back to the middle). Once my knee pops, the tension in my knee is relieved. I just joined a new team, which is sponsored in large part by a well known sports medicine center in Pittsburgh (UPMC sports medicine). They offered to look at the problem. They said that my left knee is making a huge loop at the top of the stroke, to the outside and then to the inside. It stays to the inside through the stroke.
Surprisingly, they also said that my seat was approximately 3.5 cm too far back using the KOPS method (they measured from the bony protrusion below my patella). This was surprising because I am 6'1" with an inseam of approximately 33 inches and my seat tube angle is 73.5. My seat isn't pushed that far back, and my femur is long in comparison to my lower leg. I remembered that during the fit that set my old position, the guy doing the fit slid my seat forward but didn't want to go any further, even though he though he could/should have, because he didn't want to alter my position so drastically.
Anyway, what I'm now trying is about .5cm of spacers under my cleat for my right (short) leg, and with my left leg I placed 4 LeMond wedges to tilt my foot to the outside (with the thick part of the wedge toward the frame). This seems to cause my left leg to track...if not straight then a little straighter. But the wedges on my left at least partially offset those on the right. According to this new position I would need a frame with 75 degree seat tube angle to get in the appropriate KOPS position, and a long top tube since I have a long torso. Also, there still seems to be tension in my left knee, but there is definitely less. My knee has been "popping" more easily now, however, which leads me to believe either that a) the position is closer to what it should be, and therefore there is less tension and so it pops back into place more easily, or b) my knee is getting worse, as evidenced by the popping. Any advice you might have, on the physical condition, the KOPS position, etc., would be really, really appreciated.
I can't be certain of this but my feeling is that your left knee problems stem from having to accommodate whatever is happening on the right side which is the side that most people favour and protect under pressure on a bike.
If you have not packed up the right cleat or are not using a shorter right side crank, then at least part of the issue is likely to be the increased load on the left knee because your seat height is set to suit the right leg.
Additionally, the loop you describe the left knee making is a consequence of you leaning to the right or dropping the right hip on each pedal downstroke on that side. The left knee has to move laterally for that to happen.
I need more info:
1. Have you packed up your right cleat and if so, how much?
2. Mount your bike on a trainer and enlist an observer. The observer needs to stand above and behind you. With you under reasonable load on the trainer, do you drop or rotate the right hip down and forward?
Lastly, in relation to KOPs, I don't believe it had any basis in fact when the idea was formulated and nothing has changed since. In my experience most riders need to sit further back than this and the occasional rider further forward. It is an arbitrary static measurement that has little relevance to a dynamic effort.
There is a lot of stuff in the archives about this and position generally and it is probably a good idea to have a look there for some background that may be of help.
I'm a 49 year old male, ex-semi-competitive cyclist. I really haven't been able to ride much in the last two years due to a pain that develops in my right lower leg in the peroneal nerve after I've been cycling. The cause of this pain is believed to originate in my lower back. They have found that I have a small hemipelvis on the left side that causes a 6mm tilt to the left. I use a hip pad of 6-7mm on the left side now, when I'm sitting for any period of time.
My question is what is the correct way to level my hips for cycling? Is the correction made by shimming under the cleat on the left shoe or should the left side of my seat saddle be built up? I would love to be able to cycle again pain free and would really appreciate any advice on this subject.
Ideally you need to pack up the seat to the point where you are more or less square on the seat. Neoprene like the type that is used in wetsuits is good. Try and get the densest neoprene that you can in the greatest thickness you can find. 5mm is easy to get but thicker is available if you contact wetsuit manufacturers. You will need to experiment with the amount and allow for the compression of the neoprene with your weight on it.
Don't glue it immediately. Use electrical tape at first to fix it to the rear of your seat. You will have to taper the edges of the neoprene pad for comfort. Once you have achieved the best compromise that you can, get some appropriate adhesive and glue it to your seat.
You may well find that a compromise is necessary and that the best solution is a seat pad as described plus a packer under the cleat, but assuming that your legs are the same length, go as far down the seat build up route as you can because that will minimise asymmetries of lower back function and keep your spine as straight as is achievable.
I am a 45 year old male rider who has recently taken up track cycling. I normally ride a mountain bike to and from work each day, and would ride average around 200km a week.
Over the last few months I am finding that I experience a lot of tightness in my hamstrings when I have been track cycling, particularly if the races (in C grade anyway!) are of a longer distance i.e. over 15 laps. The tightness, in the inside hamstring on both legs, gets to the point where it limits my ability to maintain power to the pedals. I have sought advice on bike set up from a number of people at the club I ride with (and have also had physio and have been stretching daily) but the problem is not going away. I don't have any problems on the mountain bike. Are you able to provide me with any possible solutions?
Drop your seat 5mm. This should make a noticeable difference either better or worse. Either way you will have something to go on. Let me know what happens.
I enjoyed reading your fit article regarding knee pain and leg length difference. I don't know if I have a difference but your questions did interest me.
I have ongoing crotch discomfort on long rides after trying many solutions. Here are some things I have noticed:
-My right knee buckles inward and comes much closer to the top tube than the left. Under heavy load it may brush the top tube.
-The left knee wavers in and out a little.
-I sometimes get pain in the medial arch and side of my right foot just in front of the ankle.
-My hips are tight - my right is worse.
-I am noticeably tighter in my left lower back.
-I have tight hip flexors and I have difficulty with good back extension. I recently began to see a structural specialist and started a stretching program.
-My left hamstring is tighter than the right and my structural specialist said that I stand with slight hyperextension at my right knee.
-My right leg/foot is a little externally rotated.
-I suspect that my left leg carries more of the pedaling load.
I was hoping you might be able to make sense of some of this as well as recommend a fit specialist in the USA. I am a triathlete who struggled to a 14:56 finish at IMAZ and I hope to ride stronger at Ironman Wisconsin in September.
Baton Rouge, LA
I am happy to try and help but one thing needs to be said. Ironman training and racing probably places more stress on your body as a structure than any other non contact sport out there. That in turn means that structural fitness (posture, flexibility and core strength) needs to be a priority. Your training priorities should be:
2. Structural maintenance and improvement (stretching and similar) and 3. Running, riding and swimming - in any order you like.
I stress this because I have seen thousands of triathletes (bike riders are not immune either) with problems and have never yet seen one whose problems stemmed from having muscles that were too strong or lungs that were too big. You sound like you have realised this with your starting of a stretching program but I feel the need to reinforce this.
The smartest tri guy that I have met (Euro long course champ, Olympic medallist, national champ) had the view that if because of time pressures he had the choice between a stretch session on one hand or a run, ride or swim on the other; then the stretching won out every time.
From what you have said you are aware of your short comings. I assume that you are doing 12 - 15 training sessions a week. Still do them but make sure that 1/4 - 1/3 of them are structural stuff.
Now that I have said that, let's get down to your problems. I can't personally recommend anyone in the States as I have no first hand knowledge of the positioning scene over there but will be looking at remedying that in the forseeable future. But that doesn't help you for now.
Everything that you say suggests that you are probably favouring the right side. If you are tighter in the right side hip flexors than the left, along with what you have told me about the left side hammie and lower back tightness, tighter right side hip flexors would be enough to all but confirm that. A common theme among many riders is a right side hip drop or pelvic twist, often concurrent with a varus right forefoot to a degree not present on the left side. Much of the time, this is associated with tighter right side hip flexors with the left side lower back and hamstring tightness caused by overextending on that side because of the right side twist/drop.
Assuming you use a 3 bolt cleat or Speedplays, get hold of some Lemond wedges and have a play starting with the right shoe only at this stage. It is likely that the left knee waver is a consequence of the right side hip drop or twist (providing of course that that is what is occurring which you can confirm with an observer).
Additionally, have a look at this post and this post and research the archives for anything that you can find about seat, bar and aero bar position. Basically, your seat needs to be the minimum distance behind the bottom bracket where you can largely support your torso weight under load without heavy enlistment of upper body musculature. You don't say what type of bike you have but if it is a 'tri' specific bike, this may not be
Act on these suggestions which should make a positive difference and get back to me with what happens subsequently.