Fitness questions and answers for July 12, 2004

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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.

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.

Collarbone
Drinking during 30-60 minute hard efforts
Female bike posture
Getting back into the game
Knee pain at the end of long, hilly races
Neck pain
Overuse of medial quadriceps
Saddle position
Shorter arm

Collarbone #1

I'm a 29 year old male recreational road rider. I used to do 200 to 250km per week, but in early April of this year I was hit by a car and suffered bad facial lacerations, concussion and a broken clavicle. Everything's healing nicely apart from the collarbone. I haven't ridden since the accident and have lost a lot of fitness. I bought a trainer, but can't motivate myself to use it. Getting back on the bike will be a big step, and I wondered if you could tell me if it will do anymore damage to my slow healing bone. The last x-ray showed no sign of healing and a bone graft is a possibility. If no damage is likely, I'd like to get over the mental hurdle. Any tips?

Ray Bergin
Western Australia

Dave Fleckenstein replies:

Clavicle fractures are undoubtedly one of the most common cycling injuries and, until fairly recently, were generally left to mend on their own. This resulted in 4-6 weeks of significantly altered training, loss of fitness, etc. However, more and more frequently I am seeing surgical correction (via screws) with excellent results. I have had 4 clients this year have surgery on their clavicle fractures and they have all been back on their bike within 3 days and were racing within about 3 weeks. Two of these clients had waited 6 weeks and had encountered a scenario similar to yours. The other two had surgery within three days of their accident. All are doing very well and having minimal problems. They all reported general local irritation from the screw - we're a skinny bunch without much muscle covering that area - and two have already had the screw removed. The risks of the surgery include the standard infection concerns (as with any surgery) and the concern of a crash damaging the area before adequate bone callous formation has occurred. I would note that, 6 weeks after one of my clients had their surgery, they crashed quite spectacularly and impacted that area with no effects whatsoever. I would also point that different surgeons will have different opinions on this injury, but in general, for a population that quickly needs to return to activity, this is an excellent option.

Collarbone #2

Why and how do clavicles (collarbones) break in falls, and what could be done to minimize the risk? I suspect that at least two factors are involved: first, at advanced and elite levels cyclists have minimized the "unnecessary" musculature, including pectorals, trapezius, and deltoids, that ordinarily support the clavicles; and second, collarbones break in certain types of falls and not others. As for the first item, would there be a benefit to targeted strength training, and if so, what would the program look like? As for the second, is there a better -- or at least, less bad -- way to fall in a forward crash?

Andrew Reyniak

Scott Saifer replies:

I don't know that your question has been researched in detail, so I'll just be sharing humble opinion here. I've queried about a dozen clients and friends about how they broke collar-bones as well as reading the opinions of other coaches. There seem to be at least two common modes of collar-bone breakage. The one you hear about all the time is landing to the side on a straight, outstretched arm. The second, which is the one that got most of my interviewees is actually landing with a "whump" sideways on the shoulder itself.

It seems that any impact that asks the distance from the shoulder to the mid-line to suddenly decrease can break a collarbone.

The classic recommendation for avoiding a break is to convert every crash into a shoulder-roll. I've crashed enough without breaking a collar bone to be pretty sure that one other method works as well. My own solution was always to do what my gymnastics teacher called a "Swedish Fall", that is to land on bent arms as if coming down from a push-up. On pavement this usually results in road rash on the forearms near the inside of the elbows. I suppose rolling would be better, but I never figured out how to get from sliding-out to rolling.

Two of my riding buddies are a martial arts instructor and a judo-champion. I've seen one and heard of the other crashing over the bars by straddling the handle-bars on the way off the bike and landing running. This is by far the best solution I've seen or heard of, but might take some years of study to develop the necessary reactions.

I don't have a good answer to the question of whether muscle development would help, but strongly suspect that how you land will turn out to be much more important than what muscle you are carrying. After all, don't built-up, muscular track sprinters break collar bones too?

Drinking during 30-60 minute hard efforts

How important is it to drink water or a sports drink during intense 30-60 minute efforts. During long hard climbs and 40k time trials I usually don't drink. Can I get dehydrated enough for my performance to suffer during that time period? What about the effect of not consuming calories?

Matt Morenzon

Scott Saifer replies:

The short answer is yes, you can dehydrate enough in a one hour time trial to lose significant amounts of time. The one study I was able to find on this question simulated a time-trial for one hour on rollers, and found that riders went the equivalent of two minutes faster if they drank one pint (500 ml) of water than if they went without. The conditions of the test were not extremely warm.

If you have readily digestible, high-carbohydrate food in your gut at the start of a one hour event, you'll probably still be absorbing it at the end of the hour, so eating during the hour is less important. Depending on what you've eaten, a dose of some high glycemic index food during the exercise may help to maintain blood sugar. In longer events, eating definitely becomes important.

Dario Fredrick replies:

It is more important during a 60 min effort than a 30 min effort. Research suggests that carbohydrate and electrolyte feeding improves 40 km but not 20 km time trial (TT) performance. This is one reason why exercise scientists have begun to replace the 40 km TT with a 20km as a standard for validating performance tests.

As far as dehydration risk goes, it depends on your hydration level going into the event, ambient temperature, and how well your equipment allows the cooling effects of air passage over your body (e.g. some aero helmets are poorly ventilated). In short, if it's hot, drink. Even if dehydration were not a concern, your performance in a TT of more than 30 min can be improved by drinking a light carbohydrate and electrolyte solution (for dilution recommendations see Dr. Hinton's recent response to hydration/sodium question).

Female bike posture

I've been riding recreationally since I was a kid, on a range of mountain and road bikes. Until my mid 20s I could ride on anything, with no discomfort, but over the last 4 - 5 years or so I've found riding increasingly uncomfortable. Last winter I bought a fab Bianchi road bike, which felt fine during test rides before I bought it, but now I have it home, it's excruciating - I can't manage longer than an hour on it. The pain is more undercarriage than glutes. So far, I have tried - changing the saddle, to a Terry-style variety with a cutout section; changing the saddle height, angle and distance from the bars; changing the handlebar height; and wearing heavier-padded shorts. All have made slight improvements, but I'm light years away from the degree of comfort I used to have.

Some vital statistics, if they are relevant - I'm 29, about 5'2", 55 kg, never had a child, no injuries.

I'd be really grateful if you can suggest anything else!

Louise
UK

Scott Saifer replies:

There are many, many factors that all have to be just right to avoid the pain you are experiencing. Here's a short list:

Padded shorts with no seam or wrinkle in the sensitive area

No underwear with bike shorts

Chamois lubricant (they come in creamy and sticky varieties, try both)

Saddle shape as it affects contact pressure: Your weight should be supported by your ischial tuberosities (The "sit bones"), and not on your pubic bone. One of the key dimensions of a saddle is the width of the flat part in back. If it's too narrow, it goes up between the sit bones until you get pressure on the pubic bone, which sounds like what you might be experiencing. A narrow saddle can also push outwards on the sit bones, causing soreness there as well.

Saddle tilt as it affects contact pressure: Don't be afraid to tilt the nose of the saddle dramatically downward. If it starts to throw you forward onto the bars, you've gone too far. If you can't get the pressure off the front of the saddle in this way, you do need a different saddle.

Saddle height: Adjusted by an expert so that you can pedal smoothly and not grind away at your "undercarriage".

Some women report that they can't have a comfortable bike ride for several hours after sex.

I hope one or more of these helps. Also, a question to help with the detective work. Can you still remain comfortable on the old bikes on which you used to enjoy riding more? Has anything else changed in the last few years?

Steve Hogg replies:

Firstly the bad news. This is an all too common experience for small women. Given your size, I will just about guarantee that the seat tube angle on your bike is too steep for you. This is because manufacturers make a lot of compromises in small frames so that they can fit 700c wheels in. In short if you look at your catalogue on the frame geometry page you will almost certainly find that the fork offset in your small frame is the same as that used in larger frames. This allows manufacturers to save a few bucks. It means, though, that the frame has to be designed around that fixed fork offset and still allow reasonable foot/front wheel clearance. With a 700c wheel and the reduced top tube length of a small frame, the easiest way to fit it all in is to steepen the seat tube angle. This allows greater foot/front wheel clearance for a given top tube length, but the corollary of this all to common approach is that small people on small frames are forced to sit proportionally further forward than larger people on larger frames. This in turn means that afflicted people are forced to sit on their perineum and genitals. The weight transfer forward of this approach often also means sore hands and stiff neck and shoulders. There is no justification for this other than reducing production costs and all major manufacturers do it.

What can you do about it?

Purchase an FSA SL 220 seatpost. They have 22mm more rearward offset of the seat clamp than a standard seat post such as a Shimano or Campag. This will allow you to get your weight back a lot further, hopefully far enough. While everyone is different when it comes to saddles, I've found the seat that's most of my female customers like best is the Selle Italia Ladies Trans Am. It is a moderately wide seat. In all but a few cases, small women have sit bone separation greater than that of men because this part of the pelvis forms part of the birth canal. If you are one of the minority that finds this seat too wide i.e. the back of the thigh hitting the wide part of the rear of the seat, then the Selle San Marco Arami Gelaround is a similar but narrower seat.

Once you have the post and the seat, get on an indoor trainer with the bike level and set the seat up in such a way so that you can feel that the great majority of your weight is borne on your sit bones. You will almost certainly have to adjust stem length and height as well. Forget the plumb bob dropping from the knee approach and sit far enough back so that you can take your hands off the drops while still pedalling without dropping uncontrollably forward over the bars. You should teeter on the point of balance. If not you are too far back.

Don't be tempted to tilt the seat down at the nose. If anything it will probably need to be up a degree or so at the nose.

Above all, if you can, find someone competent to position you. You don't want anyone who takes a measurement based approach but rather someone who takes a capability based approach.

Getting back into the game

I am 35, weigh 220 pounds at 5'10". I raced as a junior pretty aggressively and was always in the top 3 locally and placed competitively in larger events like Superweek. It's been a very long time since riding and I want to get back to it. I used to a good climber at 150 lbs but now I've obviously got a weight barrier and want to know some general guidelines regarding revamping my diet and how to train myself back into riding shape as well as lose the weight in a sensible manner. My goal is to be riding at 175-180 lbs, I am much more powerful now and wonder if the old climbing abilities are now lost and replaced by being a better sprinter/power rider.

Another goal is to be back to racing in 2005 so I've got the summer and early season next year to get ready to race. How should I train myself for the remainder of the year and into next so I've got a solid base and am back to modest racing form? I have 8-12 hours available to train per week in the Boston area. Good variety of hills and flats. I have no baseline HR or past training info to work from and I want to make the most of my training time since I'm fairly limited on time. Any advice and guidelines would be really helpful.

Ehren Roder

Brett Aitken replies:

If you go by Nike's motto then all it takes is 3 words - 'Just Do It'. I can relate to the feeling of putting on a bit of weight when you stop riding. Having been off for close to 4 months it packs on pretty quick. The easiest way to change this though is to simply start riding. Since you've packed on close to 70 lbs since your racing days it's not going to take much movement for you to tip the calorie scales back in the favor of losing weight.

I wouldn't be so concerned about nutrition at this stage. Take it one step at a time and you'll be surprised what happens once you start exercising again. If you've got 8 to 12 hours to train then simply start by riding this all in a low to moderate heartrate zone (65% max hr). This will help your body coach itself back into optimizing fat burning stores. It also helps you prevent doing anything you're not ready for yet also and subsequently resulting in injury or illness.

Begin by building this base, monitoring your weight loss as the main priority and develop a nutrition plan only after you've settled back into a regular training routine (maybe one month down the track). After about 8 to 12 weeks you could then begin to concentrate more on building specific training in (namely intervals) which in turn will help you raise your metabolic rate as well as your fitness and stop any plateauing of your weight loss. When you reach this stage you need to start rigorously monitoring and measuring your progress and redirect your focus/goals towards competing at a certain level.

As far as being a better sprinter this is highly unlikely although power may have improved. What's happened is that the extra weight/fat gain has most likely resulted in extra muscle mass to support this extra load. While this maybe good when you are already rolling or going down hills you have to keep in mind that cycling 99% of the time is all about power to weight ratio, not necessarily power!

Good luck, maybe we can share some weight loss meal plans!

Knee pain at the end of long, hilly races

I'm a 32 year old male who races Category 4. I raced half a season last year on virtually no base due to recovering from ITBS in my left knee from the previous year. I started my base training this year in early January and with the exception of tendonitis in my right knee for a few weeks in Feb/March, I've been training and racing throughout the season. I average 130-200 miles a week (with the occasional 250 mile week) including one race a week (Crit or RR). In addition to the specific knee injuries (ITBS and tendonitis), I experience periodic aches and pains in my knees but none persist for long with the exception of one.

I find that just about anytime I ride a long (60+ miles) and/or hilly race (or equivalent training ride) both of my knees experience sharp pain by the end of the ride. An illustration of when my knees become painful occurred two weeks ago during a stage race. The first and fourth stages had several long (2-8 mile) climbs and finished with long climbs of 5 & 8 miles after 70 and 90 miles of racing, respectively. My knees were very painful on the last climb of each stage. I would describe the pain as sharp. The pain comes from numerous places around the knee but primarily across the top (inside and outside) and below the knee cap. I have experienced this pain for several years under similar conditions. The pain seems to be alleviated by decreasing the pedal force, i.e., spinning or riding on flat terrain. The pain seems to be starting later in a ride as my condition and strength have improved. I can ride 30-40 miles with no problem regardless of the intensity of the ride. I have been professionally fitted to my bike and my cleats. I have orthotics in my Sidi G4 shoes. I recently switched to Speedplay Zero pedals from Look PP396 pedals, with no apparent improvement. I run a standard 12-25 cassette and 39X53 crank. I ice my knees after these events and try to stretch regularly (but often fail), particularly before long rides. I do not consider myself a gear masher. One of my few cycling strengths is climbing and I would like to improve my climbing, overall endurance and power but fear that my knees are not up to the task. I would appreciate any feedback on this nefarious pain and suggestions to alleviate it.

Philip Bentley
Portland, Oregon

Steve Hogg replies:

Firstly you need to make sure that there is no intrinsic problem with your knees. A visit to a good sports doc or physio should sort out whether that is the case. If there is no pre existing problem you need to understand that knees only like to work in a single plane. They don't tolerate lateral or rotational loads well at all.

Knee pain on a bike, assuming that you are well positioned, has only 2 basic causes. The first is problems with the foot/ankle complex and the other is problems with hip and or lower back function. In many cases knee pain can be caused by a combination of both of these. If your foot/ankle is the problem, then sorting it out is easy. If the hip/lower back is the problem or a major part of the problem, then the only 100% solution is to resolve the hip/lower back problem.

Now let's assume for the sake of argument that none of the above applies and that you are not well positioned even though you have been professionally set up. I cast no aspersions here, I am only trying to tick all the boxes in an effort to help. If this is the case, the factors that could lead to the type of problem that you experience are:

1. Seat too low
2. Seat too far forward
3. Cleats too far forward on the shoe
4. Any combination of the above

Don't assume because you may have been set up to some set of norms that this is necessarily correct. Get a second opinion from some one with a track record of solving your kind of problem.

Neck pain

For the last six months I have been troubled with neck pain when I ride. I am a recreational rider to work and back as well as on weekends. Initially I had neck pain off the bike that was worsened by riding. After seeing a physio and chiropractor, the neck pain is no longer present at rest.

I am still experiencing lower cervical neck/upper thoracic pain on the left hand side as soon as I start to ride.

I have recently purchased a new bike - Specialized sequoia, to see if that would help, but I still experience neck pain on riding (after being fitted out on the bike after purchasing).

Could you give me suggestions about common causes of neck pain in cyclists and possible solutions to my problems?

Phillip Good

Steve Hogg replies:

What happened 6 months ago that started this pain? Were you riding prior to that? Did you have a fall or some other problem that could account for this?

Neck pain has a number of causes on a bike. If the bars are too low and/or too far away, the extension of the neck and/or the upper thoracic spine required to reach the bars and/or brake hoods will cause neck pain. If the seat is too far forward, the body's weight transfers forward with it and this weight has to be borne by the shoulder complex and surrounding areas. Can you ride on the drops and then take the hands away without collapsing forward onto the bars?

If not, then you may have your seat too far forward.

You say you only get pain at the moment on the left side. I would just about bet that you have a functional asymmetry any where from the hips upwards that is the cause here. Your best bet is to get the best person that you can find to position you on your bike. From your email it seems that it is now only the bike that is the problem. It follows that you are not set up correctly with regard to your condition. Find someone with experience in these matters and see them, even if you have to travel.

In the mean time if you want to take a self help approach, get your bars up higher, raise the left brake lever higher than the right and pad up the left handlebar substantially more than the right. That should make a noticeable difference in comfort till you can achieve a proper resolution.

Overuse of medial quadriceps

When cycling, my medial quadriceps appear to be doing the bulk of the work, and become tired more quickly and indeed lactate more quickly than the other muscles in the leg. I feel that this is detrimental to my overall cycling performance. What would be the most likely cause?

I'm 22, have been cycling for 4 years, and consider that my cycling muscles are fairly well developed. I'm not trying to win the tour, but would like to maximise performance.

The discomfort I'm feeling is immediately above, and on the inside of the knee.

Brendan Harris
Australia

Steve Hogg replies:

The area you refer to is the vastus medialis obliquis or VMO. In all the other quads, the muscle fibres run longitudinally. With the VMO the muscle fibres of the head of the muscle run laterally and as well as being an extensor of the knee like the other quads, it can act as a lateral stabiliser of the knee. The question is why is it hurting under load? The likely reason is that you are rolling the knee inwards on the downstroke under load. This can be for a number of reasons.

1. Poor cleat position: check that you have a range of lateral motion either side of where your foot naturally wants to sit under a reasonable pedalling load.

2. Varus forefeet: 90% of the population fit into this category to a greater of lesser degree. This means that the forefoot rolls in towards the first metatarsal joint [ ball of the foot] relative to the heel. The solution here is to evert [ lift the arch side] the appropriate amount.

3. Cleat to far forward on shoe: If this is the case, the weakest link in the chain, which in your case may be your knee, will load up.

4. Hip imbalance: this is a common one. If you sit on the bike with one hip forward of the other, what can happen is that the anterior [forward] hip rolls in and down on the downstroke and the other leg has to move laterally to accommodate this movement. Does one leg feel that it has more power than the other?

5. Seat too high: if the seat is a little too high, you will do whatever you have to do to reach the bottom of the stroke with power. Often this means a loss of good control, which can mean lateral movement at the knee.

You mention that you have been cycling for 4 years. Has this pain been with you the entire time or has it come on recently? If it is recent, what changed at that time? Was there a change in training intensity or a change in equipment?

One thing I would also suggest is find the best person you can to position you on your bike. Ideally someone with plenty of experience with knee issues. Once you have found a solution, I would be interested to hear what the problem was.

Saddle position

I'm 33 years old and have been riding for 5 years now. My problem is that whenever I ride long distances, 100 km, there is pain in the inner side of my left sitbones going straight along my inner thigh (feels like a groin pull) up to the lower inner side of my left knee. When I feel my left and right sitbones it feels like my right sitbones are a little thicker than my left

Also, how do you align the cleats on Shimano SPD-SL pedals as I have them newly installed and they don't quite feel the same. I can't quite install them in a way that satisfies my knees. Should my toes be pointing in or out, how about the thighs should they be pointing out or straight or what?

John Poon

Steve Hogg replies:

It sounds to me that you are not sitting square on the seat. Whether because of measurable or functional asymmetries or a combination of both you would have to establish. I would arrange to have my position looked at by someone who knows what they are about and has extensive experience in dealing with issues such as yours.

Re the SPD-SL cleats; firstly the fore and aft position should be adjusted. With your cycling shoe on, mark the centre of the first metatarsal joint [ centre of the ball of the foot ] on the shoe with a marker pen or similar. Bear in mind that this may vary from one foot to the other because on differences in foot size and proportion. This mark on the shoe should be slightly in front of the pedal axle as viewed from above with crankarm forward and horizontal and shoe horizontal.

Once this is done the angular adjustment needs to be addressed. Ride along and then stop pedalling and coast with the right foot forward. Turn the heel outward. Is there available movement? If not, stop and adjust the angle of the cleat so as to allow the heel to sit further out from the crank. Repeat this till there is some freeplay outboard of where your foot naturally wants to sit.

If you find however that there is freeplay as you twist the heel outwards while coasting, then repeat the pedal and coast procedure but twist your heel inwards. Again, is there play? If yes then you are fine, if not, stop and adjust the angle till there is. Essentially, where your foot naturally wants to sit should be in the middle of the available range of movement.

Repeat all of the above on the left shoe. It is now a good idea to recheck the fore and aft adjustment. SPD-SL's don't have a lot of freeplay so it may take a few attempts to get it right. Once this has been done then the issue of inverting or everting the foot on pedal arises. At this stage I would not worry unless you find that once the cleats are correctly adjusted that you have problems with knee pain or localised foot numbness.

Shorter arm

I used to be a Cat I cyclist in the US and never had any problems. I took a few years off the bike and am just starting to get back into cycling shape. I have gradually built back up to being able to put in four or more hours on the bike but I have two issues that have suddenly become prominent each time I ride. My left arm is more than one inch shorter than my right arm due to a substantial fall that shattered the upper humerus as well as my shoulder. During my racing times it never bothered me very much at all. Suddenly it has become very painful after about two hours of training. Perhaps related to this, my lower back on the right side only also hurts after two or more hours of riding as well. I never feel "right" on the bike. Is the length of my arms affecting my lower back or are these possibly unrelated? I would also like to know what might be suggested to help offset the arm length issue.

Donald Miller
Washington DC

Scott Saifer replies:

An inch difference in arm length could certainly cause you to sit twisted on the bike and lead to lower back pain. My first thought would be to twist the stem on the steerer to bring the left bar closer to your shoulder. Your bike will look odd, but it may be much more comfortable. You may need to change stem length, add padding under the bar tape or move the left brake lever up on the bars to complete the fit.

You didn't say what part of your arm ends up hurting or whether you have regained full mobility at the elbow and shoulder. That information would help if you needed a second thought to follow up on the first.

Steve Hogg replies:

I have seen a number of people over the years with similar problems as that which you have described and back pain was always part of the scenario due to overreaching on the affected side. This can often cause an affected rider to twist in the lower torso so that sometimes the other side of the back is more troublesome. There are a million and one other reasons that cause you back pain so see the best person you can find to position you. The mechanical solution to your over reaching is as follows. Find an electrical shop and buy some electrical conduit, which is the white hard plastic tubing that electrical wiring runs through. About 40mm diameter should do the trick in your case. Standing a length on end, cut it with a hacksaw vertically so that you are reducing its width by 1/3. Undo your bartape on the left side and using a hair dryer or heat gun fit the conduit to the handlebar with the open side [ cut side] against the bar. The heat gun will soften the conduit so it can follow the curves of your bar. You will need one piece for the drop and another for the top of the bar. You will need to build up or lift the brake lever on the left as well.

Use electrical tape to secure the conduit to the bar and then buy some heat shrink plastic from a hardware store and further secure the conduit with this. Using the heat gun again, shrink the plastic wrap over the conduit and handlebar. Once done, retape the bar and you are in business.

Above all, don't worry about the appearance of the bike, only how you perform on it.

Dario Fredrick replies:

I recommend simply making your shorter arm longer. You can use a thicker glove on your left hand (perhaps a thick padded gel glove) or even sew foam padding into a glove. It is certainly possible, and assuming all other areas of your position are balanced, quite likely that your arm length discrepancy is a direct culprit of your lower back pain. I suggest practicing a specific yoga pose off the bike to help realign your spine and reduce the muscular tension in the low back that may be compensating for your arm imbalance on the bike.

The pose, called "revolved reclining big toe pose," is a simple lying down twist that requires a soft belt or a similar prop (an old necktie also works well). To practice the pose, lie on your back and keeping your left leg extended straight on the floor, place the belt around your right foot and holding the belt with your right hand, extend the right leg up as high as possible without bending your knee. Avoid straining the back of the leg, only bringing the leg as high as you can hold it without struggling.

Holding the belt then with the opposite (left) hand, exhale bringing the right leg across your body to the left and down to the floor. If necessary, you can release the belt a bit if you find it difficult to bring the right foot down to the floor.

Hold the belt with your left hand as close to the right foot as possible with the left arm extended. Extend through the heels of both feet keeping the legs straight. Without lifting the right foot, extend the right arm out from the right shoulder, releasing the right shoulder and arm to (or toward) the floor.

Extend through both arms and both legs. Keep your head in a neutral position (facing up) and breathe, holding the pose between 30 sec and 2 min (longer as you gain experience practicing the pose). Inhale as you take the leg back up then repeat with the left leg. Attached is an image of the pose. Feel free to contact me if you have questions.

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