Fitness questions and answers for July 15, 2008

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Form & Fitness Q & A

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

Carrie Cheadle, MA (www.carriecheadle.com) is a Sports Psychology consultant who has dedicated her career to helping athletes of all ages and abilities perform to their potential. Carrie specialises in working with cyclists, in disciplines ranging from track racing to mountain biking. She holds a bachelors degree in Psychology from Sonoma State University as well as a masters degree in Sport Psychology from John F. Kennedy University.

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

Dave Palese (www.davepalese.com) is a USA Cycling licensed coach and masters' class road racer with 16 years' race experience. He coaches racers and riders of all abilities from his home in southern Maine, USA, where he lives with his wife Sheryl, daughter Molly, and two cats, Miranda and Mu-Mu.

Kelby Bethards, MD received a Bachelor of Science in Electrical Engineering from Iowa State University (1994) before obtaining an M.D. from the University of Iowa College of Medicine in 2000. Has been a racing cyclist 'on and off' for 20 years, and when time allows, he races Cat 3 and 35+. He is a team physician for two local Ft Collins, CO, teams, and currently works Family Practice in multiple settings: rural, urgent care, inpatient and the like.

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

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

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

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

Since 1986 Steve Hogg (www.cyclefitcentre.com) has owned and operated Pedal Pushers, a cycle shop specialising in rider positioning and custom bicycles. In that time he has positioned riders from all cycling disciplines and of all levels of ability with every concievable cycling problem. Clients range from recreational riders and riders with disabilities to World and National champions.

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

Pamela Hinton has a bachelor's degree in Molecular Biology and a doctoral degree in Nutritional Sciences, both from the University of Wisconsin-Madison. She did postdoctoral training at Cornell University and is now an assistant professor of Nutritional Sciences at the University of Missouri-Columbia where she studies the effects of iron deficiency on adaptations to endurance training and the consequences of exercise-associated changes in menstrual function on bone health.

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

Dario Fredrick (www.wholeathlete.com) is an exercise physiologist and head coach for Whole Athlete™. He is a former category 1 & semi-pro MTB racer. Dario holds a masters degree in exercise science and a bachelors in sport psychology.

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

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

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

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

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

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

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

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

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

Sloping saddle question
Foot / knee issue
Feet hurt
Pain in right hip, lower back, pirformis area

Sloping saddle question

I've noticed through the use of 2 different saddles that they tend to slope sideward toward the drive side with use. The most obvious explanation is some imbalance or posture problem; however I don't have any noticeable/ unexplained pain.

About six months ago I experienced some pain in my left hip and tightness in the left calf, which I wonder in retrospect if it could be because it is on the opposite side of the tilt of the saddle. This pain went away after I had my bike professionally fit, and subsequently altered my position to a more correct posture. Since I have no great pain, I hate to pay a doctor for a potentially negligible diagnosis. Is a hip imbalance a possible diagnosis, and can it be remedied? Prior to the fitting, I was using a Selle Italia Flite Gel Flow, but have recently switched to a Selle Italia Signo Gel Flow, but have noticed the tilting still continues despite the elastomers in the saddle and my new position.

Stephen
Alexandria, VA, USA

Steve Hogg replies:

Your tendency to force the seat down on right hand side indicates you are dropping the right hip. As to reasons, there could be a leg length difference or more likely functional issues with pelvis, hips or lower back. I've even seen upper back asymmetries cause a chain of compensations down the spine that end with what you have noted. In short, there are host of possible reasons for it and yes, a hip imbalance (which in itself can have many potential causes) is one possible cause. The left side issues you had some time ago were more than likely caused by your tendency to drop the right hip.

It sounds like you current asymmetries have been accommodated by the gent who fitted you to your bike which is good, but your assumption that the absence of pain means there is no great problem isn't a sound one.

Pain is one of the later signs that there is a problem, not one of the first. Absence of pain doesn't equal absence of problem. I wouldn't advise you to see a doctor either. Seeing as you are curious about this seat issue, I would advise you to see a competent structural health professional (chiropractor, manipulative physio, osteopath or similar) and find out what the story is. Forewarned is forearmed.

Foot / knee issue

I'll begin noting that in all the various sports that I do, my left side has always had the injury-prone limb, from running, to climbing, to biking, even swimming.

The foot issue: The three degrees of cant comes, I think, from the fact that I have always had pronation problems as a runner (orthotics since 1990). The guy who was helping me with the bike fit at the shop really zeroed in on tracking problems that he saw happening with my left foot.

It was all over the place out of plane of rotation; taking my orthotics out of the system and adding the cant seemed to correct it, and certainly felt better until about 3 weeks ago. I'll also note that, during the bike fit, the pro noted that my left knee moves out of plane at the top of the stroke with a quick outward motion, while it tends towards the inside of plane at the bottom stroke. I'm also doing strengthening exercises for my arches.

The hip issue: during PT over the winter, it was noted that my left leg appears shorter than the right, but the bones seem of about parallel length. The PT guys spent a bunch of time measuring and concluded that my left leg inserts into the hip differently from the way my right leg does (in such a way that when I'm bent at the hip, the length discrepancy seems to go away).

I'm pretty sure the bike fit guy watched my hips as part of the bike fit, but didn't remark on them as much as on the foot. I did have my wife this morning watch my butt and hips while I was on the rollers, and she said that it looked like my entire left side was dropping, hips and back included, more than the right side.

Sam

Steve Hogg replies:

Where to start?

Firstly, the 100% solution to your problem lies off the bike, not on the bike. If you keep knocking on doors, sooner or later you will find the health professional(s) with the necessary expertise and insight to point you in the right direction. So don't give up. Given your history with ITB problems, maybe it is time to get serious about sorting out your posture and the way that you function. I can't stress enough that we all butt up against the limits our structures impose on us if we ride hard enough or long enough. You are running into limits at a level of training that isn't unreasonable. After that crash in '06, did you see chiropractor, manipulative physio or osteopath?

If not, it is my standard recommendation based on my and clients experiences that we all should do this. Too often, we feel recovered but experience problems down the track that are the result of a decent hit shoving us out of alignment. So we compensate but for every compensation we pay a price large or small. If the severity of your problems increased post crash, something is awry.

Re the left leg; several things stand out.

1. I'm not surprised that removing your orthotics from your cycling shoes helped. Approximately 50% of riders who have orthotics that resolve walking / running issues and use them in cycling shoes will experience problems with them. The short explanation is that if you sit on a bike in much the same way as you stand, in terms of pelvic obliquities and rotation, then running / walking running orthotics work a treat. If you don't, and 50% or thereabouts don't, then they are part of the problem or another variable added to the picture for no benefit.

2. Leg length - you need to know what the situation is. Organise a standing long leg x ray and find out whether there is a measurable bone length difference. Better to deal with facts than guess-timations.

3. Assuming a reasonable position, knee tracking problems on a bike occur because of foot / ankle issues, hip / lower back / pelvic issues or a combination of those things. The 3 degrees of cant sounds like it has helped but the "entire left side was dropping, hips and back included, more than the right side" that your wife noted won't be solved by canting the foot. If you have a leg length discrepancy, a shim under the left cleat will probably help. If you try a shim and it has no effect on your tendency to drop the hip and left side, then the problem is definitely a hip and / or lower back problem. On the balance of probabilities, have someone knowledgeable check out whether your sacrum or lumbar vertebra are rotated or both.

4. American Classic make a seat post called the J Post that can be used to 'force' you to lessen that left side drop. I think in your case that it is a band aid only. Get the x ray, see a structural health professional and let me know what they find.

5. Once you get some good information and are on the road to resolving this problem, make some sort of structural maintenance like yoga or Pilates part of your training.

Feet hurt

I am a 52-year-old male who rides between 6000 to 7000 miles per year, races road events in the master's category and a sport class mountain bike racer. I have been doing this for the past 16 years. I weigh 168 lbs (broke a couple of ribs on the mountain bike and gained 10lbs) and 5'8" tall. The reason I am getting in touch with you is because I am having BIG problems with my feet.

Usually I'm a spinner (95-105 cadence) but whenever I do something using a big gear and lots of pressure on the pedals, such as a sprint workout, big gear low cadence workout, climbing in big gear seated, the next day my left foot is sore around the ball of my foot and the big toe joint. I'm pretty sure I have the pedal set under the ball of my foot and I also use carbon soles shoes.

I use speed play pedals (have for years) on my road bike. I am beginning to believe that maybe the speed plays don't offer enough support, over a wide enough area of my foot, but I am not sure about that as I see that there are plenty of pro tour riders using speed play and they ride way more and put a lot more pressure on there pedals than I do, In your opinion are they any other pedal systems that offer more support, or is there another problem? Any thoughts or ideas would be appreciated before I start swapping out pedals.

Jeff Dorminey

Steve Hogg replies:

Why the left foot and not the right foot?

That is the question that you ultimately need to answer. Speedplays offer quite a stable platform unless there is play between the bearings and axle, so it is unlikely that the pedals are the root cause. The obvious possibilities are a difference in foot morphology between left and right. This in turn may be caused by:

1. A leg length difference OR
2. A pelvic asymmetry OR
3. An asymmetrical way of sitting on the seat.

Do you have the perception that either leg is stronger or more fluent than the other?

Set yourself up on an indoor trainer and while pedaling in a reasonably hard gear, have an observer stand above and behind you on a chair. Do you drop or rotate forward one hip more than the other?

Strip to your underpants, stand in front of a mirror and run your thumbs down on either side from the height of the lowest rib until they contact the to of the pelvis. Does one side of your pelvis sit higher than the other?

Let me know the answers to those questions and I will attempt to advise further.

Jeff replies:

Thanks for the quick response. To answer you questions, due to a broken hip when I was a child, my right leg is 1cm shorter than the left, also my right foot angles out to the right due to the broken hip(that's one reason I use speed plays due to all the float). Also, I had a podiatrist tell me once that I had a condition in the left foot called long toe syndrome, where the bones in your feet are to long, and anytime you put it in undue stress it inflames the joint and also has arthritis in the joint.

Sounds like I'm a walking wreck don't it? I guess since I broke my hip when I was so young I have learned to adjust to it (or did not realise I had the problems until someone pointed them out) I grew up racing motocross, a runner, and water skied after the broke hip, although the older I get the more nagging stuff happens. I know I need to make some position changes, but am not real sure what to do and don't want to make things worst, the local podiatrist around here only know about running, Its just that the foot problem is getting worst and last year I missed a cyclo cross race because of it, and its seems to be happing more and more so I need to solve the problem.

Steve Hogg replies:

What you say sheds a bit of light on things. I would guess that the long toes on the left foot are not the entire problem with the pain you suffer. You don't mention any type of compensation for that 10mm shorter right leg on the bike. You are very likely to be dropping one hip, but it could be either one depending on your pattern of compensation.

For some people, a life time of exerting more torque at the hip with the longer leg while they walk causes the left it Ilium to tip forward at the top, pivoting on the sacro iliac joint (SIJ). When this happens, the SIJ range of movement is restricted and there is a largely predictable pattern of muscular tightness associated with that. This results in a situation where the hip, lower back and pelvis of the long legged side work as a unit rather than independently and manifests on the bike as a pronounced drop and rotation of the hip on the pedal downstroke. It may be this movement that is loading the left 1st MTP joint more than it likes.

If this is happening, then the shorter right leg would be overextending and I would expect that to be obvious to you in the sense of the right leg feeling less powerful or less fluent. As you haven't mentioned that I suspect that the other general pattern of compensation is what is occurring.

And that is that you are dropping the hip of the shorter right leg to allow it to reach the bottom of the pedal stroke. If this happens, then that dropping and probable rotation forward of the right hip will cause the left leg to be dragged towards the centre line and probably leave you with an internally rotated left hip on the bike because your pelvis isn't square to the direction of travel. It that's happening and it is probable, then you will load the 1st MTP joint of your left foot, which in your case is already sensitive because of the arthritic condition.

You need to establish what his happening, so get on that trainer with your observer standing by as mentioned earlier and let me know.

The other factor that adds to the problem is your cleat position. Get hold of Speedplay part no. 13330 and position your cleats as suggested in these posts:
1. Cleat position and
2. Ball of the foot

That will mean a rearward movement of the cleats which will likely mean greater extension of the legs. So you may need to drop your seat a touch after moving the cleats.

Jeff replies:

Ok, my wife watched me from behind and above, and she said that it looked like I was dropping and rotating my right hip. Also I have always felt like I was limping when I pedal. When I set my seat height, I use the old heel barely touch the pedal using the shorter leg. After I talked with you the about the speedplay pedals, the owner of the local bike shop let me borrow a set of the new style Shimano pedals, saying they had a larger foot bed, but I am worried that the lack of float with my angled out right foot might be a problem. I did install the cleats 9mm behind the ball of my foot (size 43 shoes) and I will try them out this afternoon.

Steve Hogg replies:

Okay, the second scenario I mentioned yesterday is likely to be what is happening. You almost certainly need to shim up the right cleat. You will need to experiment with how much but I would suggest 5mm as a starting point, though don't be surprised if you need more. For every 5mm or so of shim stack, move your cleat one mm further back relative to foot in shoe to preserve a solid feel on the pedals. And yes, with the Shimano's, it is likely that there will not be enough rotational movement to cater for your externally rotated right hip.

Once you have a shim stack in place, ask your wife to have another look. If you are dropping the right hip less or not at all, good. If the shim stack makes no significant difference, then almost certainly, you are much tighter on the right side and that is causing the hip drop. If that is the case, you will need to work to resolve that issue off the bike but will probably still need a shim stack of whatever size to accommodate the 10mm leg length difference.

Ultimately, what you are trying to do is solve the discomfort issue of the left foot. Let me know how you get on.

Pain in right hip, lower back, pirformis area

I am a woman cyclist, 39 years old. I have been riding for fitness for the past 20 years on both road and mountain bikes. I just purchased a new woman's Felt FW25 (Not sure if this is the model name or not).

The main reason for purchasing a new bike is that for the past 4 years I have been having problems with chronic tightness in my lower, right paraspinal area as well as the attachment area and my right hip/pirformis muscle. I was fitted for the new bike which was very different from the old.

I was feeling great for a while and my back/paraspinal/pirformis was not bothering me when I rode at all, but then, my knees started hurting. I went back to the bike shop and the owner moved my seat back a little and up a little and then moved my cleats. Well, now my knees are okay, but my other problem areas have come back and after about 2 hours of riding I am in too much pain and have no power whatsoever in my right leg and I am in spasm.

I am currently seeing a PT for this problem, but I feel that my position on the bike is really a factor. How do I go about resolving this issue?

I don't even know where to start. Do you know anyone in the Chicago-land area who is very knowledgeable in this area that could help me? I live in West Chicago, IL, which is close to Glen Ellyn, Naperville, Wheaton etc.

I really am so frustrated especially since I was feeling so much better riding and then after this last adjustment I feel awful again. I find myself not wanting to even ride anymore.

Gina
West Chicago, IL, USA

David Fleckenstein replies:

What you are describing makes me curious that you actually have excessive joint laxity in your lumbar spine rather than the "tightness" that you describe.

I frequently have patients who come to the clinic with complaints of tightness and stiffness in their low back, but when I test the joint mobility and soft tissue mobility in an unstressed position, they exhibit joint hyper-mobility and more than normal flexibility in their low back musculature.

We know that when the spine is flexed excessively (either with slumped sitting or prolonged forward flexion), the disc and posterior ligaments exhibit creep, which is time dependent lengthening of those tissues.

This is not a good thing as this is one of the major contributing factors to disc and ligamentous injuries of the lumbar spine. In my opinion, the tightness that you perceive is actually excessive activity of their primary and secondary stabilizers trying to guard the spine from being flexed forward any more. These muscles are overworking to protect your lumbar spine and the pain that you perceive is a combination of disc/ligament strain and muscular fatigue. This is further substantiated by your observation that when your position was changed (which by moving your saddle up and back increased your lumbar flexion) your pain increased.

So the question becomes, how do you prevent your knee pain without increasing you back pain? Obviously increasing your leg length helped decrease your knee pain. I would then check to see if you can either, bring your seat forward and up and/or bring your bars up and back which will decrease your lumbar flexion but maintain a longer leg.

I would also recommend work to improve your stabilization which your therapist should be more specifically addressing.

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