Fitness questions and answers for July 24, 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.

Quadriceps pain
Appetite suppressant
Weight loss
Heel pain

Quadriceps pain

Let's start with the basics. I am a 6'4" 190 lbs 27 year old former swimmer who turned to cycling about a year ago. After eight months of learning - about 100 miles a week - I began to gradually increase my weekly volume. I now try and go between 200-300 miles a week, which includes a long 100-130 mile ride over the weekend. My swimming background has dictated my training, form is necessary to properly execute volume. Thus my reason for writing.

Over the past two to three weeks, I have experienced extreme soreness in my left quadricep, specifically the Vastus Medialis muscle. I initially thought it was just the standard-issue workout soreness or the fact that my right quad is stronger than my left. However, simultaneously my lect Hallucis MTP joint experienced a dull pain (I have not altered my cleat position) so I am wondering if perhaps there is a correlation between the two? I use the KEO Look Classic pedals and have the cleat as far back as they can be set. Also, my right and left cleats are in the exact same position, because standing, both feet are slightly pointed out at the same angle.

I guess my initial speculation would be that as I push my body harder with longer rides, I am losing form and perhaps not dropping my heel enough or dropping it too far. My athletic background contains a mindset that says push through the pain. However, this is the first time I have relied on a machine to be apart of my workout, and being that in cycling, the machine and the athlete work in unison, so I am green behind the ears when dealing with these sorts of things. Do you have any thoughts or suggestions?

Steve Hogg replies:

The location of the pain suggests that the plane of movement of your left knee is being challenged as you tire. The VMO is a muscular lateral stabiliser of the knee. The most likely reason is that as you tire, you exaggerate an already present tendency to favour the right leg. Most riders do favour the right leg and their are various reasons for that. So what to do?

Firstly, check seat height. If your seat is even a few mm too high, then any tendency to asymmetric function will worsen as you tire. Try lowering it by 5 mm and reassessing on the next long ride.

If that doesn't help, get hold of some BFS Cleat wedges and have a play. And don't just try wedging the left shoe. Often issues such as yours are caused by a tendency to autonomically protect a right side which needs compensation.

While you are doing as suggested, give me a bit more info. Does the left knee waver a bit on the up and downstroke?

Or, does the left knee move outward on the upstroke or at the top of the stroke, and inward on the downstroke?

If you look down at the gap between inner thigh and seat post as you tire while pedaling; is there a difference in the gap between each side and if so, on which side is the gap larger?

Troy replies:

I wanted to go on at least two rides - one long and one short - to get a full understanding of my knee movement. Almost unexpectedly, my knee moves outward on the upstroke and inwards on the downstroke when I am relaxing the first 30 miles but seems to correct itself when I tire. It seems as though the more rested I am the more knee movement I noticed. The gap with my thighs are seemingly the same but my left leg wants to push down and in on each downstroke.

Is knee movement common? Is there a way to correct this or is it the natural movement of my leg and I need to modify my setup?

Steve Hogg replies:

The inward outward cycle of movement of the left knee means that it is 99% certain that you are dropping and / or rotating the right hip forward on each right side pedal stroke. It works like this:

1. Right hip goes down (and probably forward too) on each right side pedal downstroke. Concurrently the left knee, which is on its' upstroke has to move out from the centre line to accommodate the pelvic movement involved.
2. As right crank up stroke begins, the pelvis rebounds towards the centre line of the bike resulting in the left knee rolling in on the left side pedal down stroke.

Stand bare legged in front of a mirror and bend your right knee several times, rolling it towards the centre line as you bend it. Once you are doing that, watch what happens to the left knee. It will move outward as the right knee moves inward and return inward from that position as the right knee moves outwards. The foot pain you experience on the left side is caused by the way you are loading your foot and is generally indicative, in the context of the other symptoms you mention, of over extension of the left leg while the plane of movement of the left knee is being challenged. The VMO pain is caused because it is trying to stabilise the knee under load against this inward / outward cycle of movement.

Here is what to do.

Re read my first reply and act on it. If dropping the seat a touch and / or wedging the right foot don't help, then you need to visit a good structural health professional (chiropractor, osteopath, physio, sports doc). A 'good' one is one who cycles regularly and / or treats a cycling clientele and is thorough enough to take a stripped to underwear, all of body approach to sorting you out. People like this aren't as common as they should be, so you may have to look around. I will bet on their being issues with the way your pelvis, lower back or hips work. There may or may not be a leg length difference associated with this.

Bikes are symmetrical in a positional sense. Human beings aren't, but functional symmetry is a goal to be striven for if we want to perform well, injury free on a bike. Once you are reasonably functionally symmetrical, your problems will disappear. If you run into trouble following my suggestions, let me know.

Appetite suppressant

As a rule, I try to avoid taking new-age supplements and pills. That being said, I am very interested in appetite suppressants. I feel like I am doing everything on the bike I can to achieve race weight, but the pounds are still not coming off. I ride hours of tempo at 45-55% MHR. I take a spin in the morning to get my heart rate up before going to work. Sometimes I take a nap in the afternoon to get an extra burst of HGH. I have even started taking green tea supplements, a general vitamin, and omega-3s.

This is all on top of drinking water like it's my full-time job. I think I know my downfall: I love carbohydrates, and lots of them. Would any of the over the counter appetite suppressants be a safe/effective addition to my daily routine?

Peter Simonsen

Eddie Monnier replies:

You don't give any information about your current body composition. Nevertheless, it is not uncommon to see athletes who are trying to lose weight under eat, which actually slows down their body's metabolism. I'm not a registered dietician so I cannot give specific advice, but I have seen people lose weight when they increased their caloric intake and shifted the types of foods they ate.

Additionally, it is a misnomer to think that you need to exercise at a low intensity to "burn fat off".

My recommendation is to seek the help of an RD who is used to working with athletes.

Pamela Hinton replies:

If weight loss is so difficult, perhaps your goal "race weight" is unrealistic. Each of us has a set-point body weight that is "normal" for us, if we try to deviate too far from that weight, the body's defence mechanisms will kick in. Regulation of body temperature is a great analogy. When our temperature is elevated above 98.6, vasodilatation and sweating occur to dissipate the extra heat. If your body temperature drops below 98.6 vasoconstriction and shivering act to raise body temperature. The point is that, if your goal weight is unrealistic, i.e., too far from your set-point weight, it will be very difficult to achieve your goal weight and even more difficult to maintain it.

I would not recommend the use of an over-the-counter appetite suppressant. The most common type of active ingredient in appetite suppressants are herbal-derived stimulants. The most notorious of these compounds is ephedra, which was ultimately banned by the US Food and Drug Administration because of its life-threatening side effects, especially when combined with caffeine.

Bitter orange has replaced ephedra as the "natural" appetite suppressant of choice. However, it contains synephrine, which is chemically very similar to ephedra. Neither the effectiveness or safety of bitter orange have been demonstrated. Which brings up an important point about dietary supplements in general: the regulatory standards for dietary supplements are much lower than those for foods and drugs. See this website sponsored by the National Institutes of Health for more information on regulation of dietary supplements in the United States. There are prescription appetite suppressants available, but their use is restricted to the clinically obese.

If based on your height, weight, and body composition, you determine that your goal weight is realistic; the only way to lose weight is to create an energy deficit. In addition to the strategies you are currently using, you might try adding some high-intensity interval training or resistance training.

Weight loss

I am a 25 year old who is 5ft 6.5, 8 1/2 stone and takes part in regular exercise.

I have been taking ferrous sulphate regularly as I was diagnosed with anaemia a while ago. I was wondering if this medication can cause you to lose weight?

As I seem to be eating the same as I have done for years, yet for some unknown reason have lost at least half a stone.

Any advice given greatly appreciated.

Anon

Scott Saifer replies:

I'm not aware that iron sulphate will directly cause weight loss, but if you were significantly anaemic, improving your blood iron will bring back your energy and zest for life, and being more energetic and zesty uses more calories than sitting more quietly, so you may simply be expending more calories while taking in the same number, resulting in weight loss. It comes as a surprise to many, but simply sifting positions frequently, pacing while talking on the phone, talking with hand movements and similar movements can add up to a hundred or more extra Calories expended each day.

Heel pain

I have recently moved to France from Sydney and boy is it conducive to cycling. I have upped my kilometres to about 500-600 a week from 300 or so and I was feeling fine until recently when my right leg started playing up, specifically my foot and ankle. On a slightly longer ride than usual with a few 10km climbs I noticed my foot starting to go numb or getting pins and needles.

I loosened my shoe off and this did help a bit but after my ride my foot was getting sharp pains and going numb every so often even when sitting. I had a day off and then rode again and it was still not right so I have backed the kilometres right off. I feel like my foot is being used as a lever too much and putting a lot of pressure on my heel and Achilles. I am a big rider (100kg's 194cm) and a grinder (180mm cranks) so I put a fair bit of pressure on to my ankle. I am pretty sure my position is good as Steve Hogg set me up about 3 years ago. I am on a different pair of shoes now, but have had no problem with them for the last year or more.

I am probably 4 bikes down the track as well as I have a habit of snapping frames and cranks due to my size. But the over all set up is still very close to what you prescribed. I am wondering if moving my cleats back a bit will take a bit of pressure off my ankle / heel (which isn't great after a good break in my teenage years) and if I do this should I change anything else?. Any help would be most welcome.

Ian Jennings

Steve Hogg replies:

Long time no hear. I accept what you say that you think the position is still close 4 frames and a new pair of shoes down the track, but there are two variables.

One, none of us is static in the sense that we all change over time. And two, my records say that you were using an SLR XP seat, Time shoes and pedals and a Vinicolo carbon bar when I last saw you in '05. If any of these pieces of equipment have changed, variables are introduced which means it is very hard to duplicate a position when transferring it to another frame by measurement alone. That said if you have been able to ride 300kms weekly for the last year or so in new shoes without problems, the problem isn't acute.

You're absolutely right that cleat position is the likely cause as my records tell me that while you had a slightly lesser range of ankle motion in total, that lack wasn't apparent on the bike. I would suggest moving your cleat (s) to the rear and depending on how much potential you have to do that, perhaps drop the seat slightly. Once you do this, if there is any problem, get back to me for Plan B.

Ian replies:

Thanks for getting back to me so quick. Yes I do have pretty limited movement on that ankle, I think old age is also well and truly creeping into the joint that had a compound fracture when I was 16.I understand what you are saying about not been able to truly replicate position. I now ride on alloy standard bars, Shimano custom fit shoes and a Fi'zi:k Alainte saddle all on a Cannondale System 6.

Will it hurt to move my cleats all the way back? (they are in the middle of the 5 markers on the shoe). I am tempted to move them all the way to take as much strain off the joint as I am having trouble walking this morning with my ankle and heel pain...not totally out of the ordinary with its previous history.

Steve Hogg replies:

So a lot has changed and the ankle has got worse. I agree about moving the cleats all the way back, so do that and drop your seat 3 - 5 mm to accommodate the extra leg extension that is likely to occur afterwards.

Then test out the change for a few longer rides. The discomfort should disappear or be much less. If it doesn't totally disappear, try a 3mm shim under the right cleat and let me know what happens.

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