Fitness questions and answers for July 26, 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.

Cramps & Hyponatremia
Knee Pain in good knee!
Pain in left leg
Hot Feet
Collarbones
Foot numbness
Cleat position
Knee pain redux

Cramps

I am a 28 year old A grade racer (height: 176cm, weight: 71kg) that suffers from cramps during long intense road races. I have read a lot of information about the subject and have been trying a variety of different approaches to avoiding cramps. I eat a variety of foods that includes fruit and vegetables, carbos and protein but also supplement this with multi vitamins 2-3 times a week and take magnesium and potassium tablets for several days before a big race. During the race I try to eat at least every 30min (gels and bananas) and am always drinking both water and sports drinks such as Endura throughout the race. After my last race, where I cramped earlier than usual I spoke to some of the stronger more experienced riders and they said that they took salt tablets before a race (plain sodium chloride). After all that I have done, I am now considering this option too. Please advise if this is worth trying and if so should I stop with the magnesium and potassium as it seems that this approach is not the solution?

Matt Murray
Brisbane, Australia

Hyponatremia

I am a 38 year old male, 6'1", and 210 lbs., who started riding for fitness this season. I am pursuing the goal of a very tough century in September over 6 mountain peaks. When younger I was a competitive endurance runner and was fairly resistant to problems from dehydration, etc... When the consequences of age setting in I am experiencing some problems, particularly when riding in hot weather.

I consume a large water bottle of Cytomax per hour when riding and usually do fine when the weather stays below 80 degrees. However, when the weather gets warm I start to really combust after about an hour and a half. I am a very "salty" sweater and if I stick to just water it gets much worse. I have tried supplementing with gels and Powerbars after 45 minutes. On one occasion I finished riding and suffered nausea and severe fatigue. Oddly I was craving salt so I put some table salt in water and drank it and felt tremendously better in about 10 minutes.

I am considering supplementing with salt tablets but I feel like I could mess this up rather easily. Should I be considering a different hydration strategy or product? Should I eat something specific to help reduce the problem?

I rode 51 miles in 90 degree weather yesterday and was literally unable to drive home from severe exhaustion and dizziness but would like to keep training despite the warm weather.

Randy Walton

Pam Hinton replies:

With all this pain and suffering being the zeitgeist of successful bike racing, some things may just seem too easy - and cheap - to be believed. Your honor, I give you exhibit A: a man forms a new Salt Lake while exercising, feels like crap afterward and, surprise of surprises, craves salt. So he ingests salt and within moments feels better. A true entrepreneur here would waste no time getting on cable to hawk the miracle Egyptian muscle cramp "vaccine" for the low, low one-time-only price of $49.99, including a glass trophy case for displaying all the hardware you can now expect to be dragging home.

Truth is, dehydration and excessive sodium loss are the most common causes of muscle cramps in athletes. Water lost via sweat comes from all fluid compartments of the body, including the blood. If fluid losses are not matched by consumption during exercise, the body becomes dehydrated and blood volume decreases. The decrease in blood volume means that the heart has to work harder to pump blood to the body and blood flow to the muscles is reduced. This is bad news for the muscles because less blood coming in means less oxygen and glucose to fuel muscle contraction and less blood leaving the muscle causes lactic acid to accumulate more readily.

The reason your dog loves to lick your leg after a workout is because the fluid lost in sweat is not plain water; it contains minerals as well. These minerals are called electrolytes because they dissolve in water to form molecules that carry an electrical charge. And just as with a battery, normal transmission of nerve impulses and muscle contraction depend on the correct charge differential across the cell membranes of the neurons and muscle fibers. If there is an electrolyte imbalance, the power shuts off. With batteries, your toys stop working. With muscles, your legs get stuck in contraction mode and can't relax-a cramp.

The electrolytes in the body are located in one of two fluid compartments. The fluid inside the cells is called "intracellular fluid" or ICF and the primary electrolytes in the ICF are potassium and phosphate. The fluid outside of the cells, which includes the blood plasma, is called the "extracellular fluid" or ECF. The major electrolytes in the ECF are sodium and chloride-yes, good old-fashioned table salt. When we sweat, most of the fluid lost is ECF. This explains why sweat is salty and why excessive sweating over a prolonged period of time can result in a sodium deficit, i.e., an electrolyte imbalance, and cramping. (We also lose chloride in sweat, but it is the loss of sodium that causes our nerves and muscles to short-circuit.) The average concentration of sodium in sweat is 1150 mg per liter, but can vary greatly (450 mg to 2300 mg per liter). Assuming a sweat rate of 1.5 liters per hour, an athlete with sweat of average saltiness would lose about 1700 mg of sodium per hour. In events lasting over an hour, replacing some of the sodium lost in sweat may reduce cramping. The recommended concentration of sodium in a fluid replacement beverage is 500-700 mg per liter. Most sports drinks contain sodium, although the amount varies from 300 to 650 mg per liter. So read the "Nutrition Facts" label. You can always make your own electrolyte replacement drink by adding a quarter to a half teaspoon of salt to one liter (32 ounces) of water, which is equivalent to about 600 and 1200 mg of sodium per liter. Salt (sodium chloride) tablets are available, but you need to consume 8 ounces of fluid (250 mL) for every 200 mg of sodium you take in tablet form so that the concentration of sodium in your blood doesn't rise too rapidly. Salt tablets are more effective and better tolerated (they may cause gastrointestinal problems in some people) if they are crushed and mixed with water. Because it is difficult to replace all of the sodium lost in sweat while you are exercising, be sure to include sodium in your diet. This is especially important during rehydration after exercise because sodium helps increase blood volume to normal levels.

Because potassium is located in the ICF, much smaller amounts are lost in sweat compared with sodium. The average potassium concentration in sweat is about 350 mg per liter, so the amount lost in sweat is negligible compared to the total amount of potassium in the body (180,000 mg for a typical adult male). As long as you get enough potassium in your diet, there is no reason for you to take potassium supplements. The Institute of Medicine recommends a daily potassium intake of 4700 mg per day. Fresh fruits and vegetables are the best food sources of potassium. Like potassium, the amount of magnesium lost in sweat is very small. This is because most of the magnesium in the body is part of the bone mineral matrix or in the ICF of muscle cells. It is not necessary to consume a sports drink that contains magnesium while exercising, but it is important to consume adequate amounts of magnesium in the diet. The recommended intake is about 300 mg daily for adult females and about 400 mg daily for adult males. Nuts, legumes, whole grains, green leafy vegetables, and chocolate are good food sources of magnesium. While it may be tempting to take magnesium as a dietary supplement, do so with caution. Because magnesium and calcium are chemically similar, magnesium can interfere with intestinal absorption of calcium and with calcium's function in the body. For example, magnesium can block calcium binding to muscle cells and inhibit normal muscle contraction.

To prevent muscle cramps you need to minimize dehydration and sodium losses. The first step is being adequately hydrated before your event. Drink 16 ounces of fluid two hours prior to your race. Sodium pills offer no real advantage over sports drinks. You must drink water with sodium pills, so why not just drink something that already has sodium in it? Check the labels on various sports drinks and find a "special sauce" that has a minimum of 500 mg of sodium per 32 ounces and drink at least that amount every hour. That seems like a lot to swallow, especially when you may prefer to drink something other than your special sauce. But tough days, when the salt is really flowing, will require tough measures. You gotta just do it.

Knee Pain in my good knee!

I'll spare the details of my left leg issues (ITB syndrome which I am able to 'treat through stretching etc.' + prolapsed disc L4-L5 which caused problems until I had a microlamenectomy) because my biggest issue in getting into better form has been a recurrent problem with the right knee.

A bit of background--I am 2m tall, weigh about 91kg. My bikes are custom made (race bike is 62x62), and my 'race bike' has 177.5mm cranks while the commuter/crap weather bike has 175mm cranks. I use full float pedals, and wear cycling orthotics. My bike fit is a combination of my experience with pain over the last few years, physios/video analysis, and 'ball of foot over pedal axles, knees 1cm behind the bottom bracket' approach. My cadence is typically 90-110 when riding flats, and drops to 65-90 when climbing, depending on how tired I am.

The problem with my right knee is that, say, once a month, I start to get discomfort around the right VMO and to the inner side of the knee. Not painful, just discomfort. When I end up pushing it a bit, like I did in a stage race this week-end (with about 1000m of vertical in the first stage in 72km). I end up getting a sharp 'swelling' pain underneath the kneecap, which feels like a vertical strip of pain right in the middle of the knee cap. After some initial rest (say, sleeping), it is stiff and painful. It resolves within two days usually.

Often the pain is associated with long slogs into the wind combined with climbs.

It began when I started upping my distances for the Alpine Classic in January. I have seen two physios who say ITB, but I am suspicious about this diagnosis.

My guesses:

- chondromalacia (which I had as a junior cyclist and resolved with specific quad exercises)
- VMO is weak and kneecap tracking is off/hamstrings very tight
- need new orthotics
- fore-aft cleat position may need changing.

I stretch a lot, and am in that camp of flexible folk who find it often difficult to get a really good stretch.

I have read many of Steve Hogg's articles, and also have read the counter-arguments.

Heck, I just want to be able to ride and race and enjoy myself. I'll try anything (and I am patient), but I am at a bit of a loss where to start (more physios? specific exercises? Cyclefit?).

Peter Benda
Melbourne, Australia

Dave Fleckenstein replies:

I'd like to give a little different perspective than Steve or your physios had, and may even unify a little of what they're saying.

I would like to introduce the notion of "culprit and victim." This idea deals with the fact that where you are having pain may simply be the point in the chain where force is finally dispersed (the victim), and the true driving pathology may lie above or below (the culprit). This very frequently happens with the knee, and we very frequently (and successfully) treat cyclists with knee pain by treating adjacent joints.

The knee is made to function primarily as a hinge joint, with the patella gliding along a bony trough in the femur. There are a number of factors responsible for how the patella moves properly (or improperly) through the groove. If the muscle in the hip such as the gluteus medius and the hip external rotators are weak, the femur tends to move through a "knock knee" position when riding. This can be very slight, but can create great problems when magnified over thousands of pedal strokes. This will often present as ITB soreness, plica irritation, meniscal irritation, patellar pain or (more likely) a combination. The point is, if the musculature is no longer controlling the knee rotation, the force will be dispersed through something else. Your previous back issues make me wonder whether some of these deeper stabilization muscles have become weakened (glute medius for example, receives its innervation from the L5 nerve root).

Interestingly, for those cyclists with hip pathology issues, orthotics can sometimes actually make the problem WORSE. The reason is that if the hip is rotating in, the foot is one place where the force can be successfully dispersed through pronation. By blocking the pronation mechanism, the only place where the torsion is dispersed is at your knee, the one joint in the leg that really isn't made to rotate much! While this occurs only in the minority of riders, I make this comment because I see far too often cyclists slapped into a pair of orthotics at the first sign of knee pain, and this is not always the answer.

So, in our last example, the hip was the victim and the knee was the culprit. Well, it can also occur that the foot is the culprit, with unchecked pronation causing internal rotation of the knee, again resulting in the same irritated structures (patellafemoral joint, plica irritation, etc) that we saw with the hip weakness. The important thing here is to have the entire chain (back, hip, knee, foot) evaluated - all must be working correctly.

Regarding your pain at the VMO, I would seriously doubt that it is due to VMO weakness - it is extremely rare in cyclists who are training with any significance. I have seen cyclists with patellofemoral pain told that they needed stronger VMOs when these muscles were actually 3 times the normal size!! More likely the pain is from the plica, a strip of connective tissue that runs along both medial and lateral borders of the patella and feels like a very dense strip along the knee. You could also have some spasm and reactivity of the VMO, as is it may be overstressed.

The last possibility is that the culprit and victim are one and the same. In some of the population, the patella and femur don't match up well - the patella simply doesn't match the groove. When we place it under higher stress, the dysfunction is magnified and breakdown results.

Your treatment:

1. Look at your cleat alignment per Steve - the axis of your leg must line up with the axis of your pedal. This should hopefully allow you to get back in the short term.

2. Have your hip abduction, hip rotational strength, lumbar stability, and foot mechanics evaluated. Any therapist earning their keep should be evaluating all of these components with a complex history such as yours.

3. Take an anti-inflammatory if you can tolerate them from a digestion standpoint. Decrease the progression and cycle of inflammation. Your physician should be helpful here.

4. Ice massage the sore structures in your knee after every workout.

Pain in my left leg

I am a 37 year old Cat 2 male, been racing for about 7 years. The last few years I have been experiencing pain in my left leg. It started bothering me occasionally, then became more frequent and now it bothers all the time. I feel it mostly in the upper part of my hamstring, but also get numbness and discomfort in my left foot, aches in my shin, and around the knee. It does not bother me too much riding relatively easy, but I am aware of it and have a hard time getting comfortable. As I go harder though, usually a few minutes say into a TT effort, my hamstring becomes extremely painful and I have to back off.

I do have a leg length discrepancy (my left femur is about 2 cm shorter) that I addressed last fall with shims of various thicknesses under my cleats with no luck. I've tried orthodics as well with no success. I have tried various shoes, seat height and fore aft changes, none of which have helped. I had an angiogram done to check for blood flow problems which came back negative. I had x-rays and an MRI as well that did show a slight degeneration of a disc (L4) and a twisting of my lower spine (my left hip is more forward than the right). I was going to Physical Therapy for a couple of months where they performed some muscle energy techniques and prescribed stretching, but no answers. Currently I am trying a 170 crank on the left and my usual 175 on the right which has not made a difference either. I feel like I sit crooked on the bike and my left leg tends to point out. My left foot kind of curls or skwenches a bit too.

The doctor wants to try a cortisone injection, but to me it feels muscular/skeletal and not nerve related and that isn't something I really want to do if I can avoid it. I am still winning races and feel if I could fix this problem I would be stronger than ever. Are these problems due to riding with a leg length discrepancy for several years without addressing it and perhaps poor pedaling habits or could it be nerve damage or something else? Any suggestions? I'm just a little frustrated that I can't figure out what the problem is.

Matthew T. Forbes

Steve Hogg replies:

Experience suggests that the limb length discrepancy and the compensatory mechanisms that you have developed to cope are the cause of your problems.

First things first. You mention that you don't sit square on the seat. Have someone observe you from behind whilst on a trainer and see which hip is forward. From what you have said, this is likely to be the left side which is atypical. More commonly, a longer leg will exert more torque at the hip, and over a life time of walking the iliac crest on the longer legged side will move forward relative to the other side because of this. Which ever hip sits forward, twist the nose of the seat in that direction till you feel straighter on the seat. If the seat feels obviously twisted, you are likely to have gone to far. If the nose of the seat rubs more than lightly against the inside of your thigh, you have gone to far.

Adjust your cleat position so that once you have marked the centre of the ball of your foot on your shoe with a marker pen or similar, that the mark is slightly in front of the pedal axle when your shoe and crankarm are forward and horizontal. It is likely that you will have to move the cleats rearwards to achieve this.

Now that is done, move the seat back far enough so that you can almost support your self, after taking your hands off the bar while pedalling with hands in the drops. You should be teetering a bit on the point of balance, but no worse than that.What you are trying to achieve is a stable pelvis with minimum enlistment of extraneous musculature to achieve this. You are likely to find that you need to tilt the saddle nose 1 - 2 degrees above horizontal.

Now you are ready to pack up the cleat on the left side. Your using a 5mm shorter crank is a good idea and so stick with that. But the tightness you mention at the top of the hamstring is almost always caused by overextension. The other pains you mention could also be caused by overextension [ and about 50 other things, but let's play the odds].

Using your observer again, pedal in a moderately hard gear that works you, but that you don't have to sacrifice pedaling smoothness for, and have your helper eyeball you from either side and compare the degree of extension of each leg and whether there is any jerkiness towards the bottom of the stroke in the short leg that is not present in the longer leg. If so, pack up the shorter leg till they look and feel the same. For every 5mm of packing you use, push the cleat 1mm further back on the shoe so as to negate the rocking torque effect.

Once you have done all of this, you are likely to have to adjust your bar position. You need to be able to reach the tops, brake hoods and drops with ease while under reasonably severe load.

If all this seems too hard, find someone who knows what they are doing to position you. Ideally it should be someone used to coping with cases such as yours and who takes a capability based, rather than measurement based approach.

Hot Feet

I'm 50 years old, 5'8" 175lbs. I ride mostly on the road. I've been getting hot feet after about 20 miles into my training rides. The hotness is mainly on the balls of my feet. Any help on this matter will be greatly appreciated.

Tom Locke
Ligonier, IN

Steve Hogg replies:

Is this a recent problem or one of some standing? If it is recent, what has changed at that time? Have you changed shoes, cleats or pedal systems in the recent past?

For instance, I am aware of people who have purchased snugly fitting shoes in winter, only to have them be too tight in summer with the onset of warmer weather and consequent slight swelling of the feet that can accompany higher temperatures for some people.

Assuming none of the above is applicable, the other causes of your problems can be:

1. Shoe too tight across the forefoot or too short in length causing compression of the metatarsal joints and pressure on the nerve junctions in that area.

2. Cleat position too far forward. Make sure that if you mark the centre of the ball of the foot on your shoe, that the mark is slightly in front of the pedal axle with foot forward and crankarm horizontal.

3. Shoe sole that is too stiff or paradoxically, far too flexible. Stiffer is generally better for cycling shoe soles, but there is such a thing as too stiff a sole for some people.

4. Foot misalignment. This is common but usually only affects people in the way you describe, in my experience, if the cleat position in also less than optimal.

I suggest that you work through the above points 1 - 4 if you have had the shoes and pedal system unchanged for some time. If not and something has changed at a roughly similar time to the onset of your problem, get back to me and let me know what changed and so on and I should be able to refine the advice given.

Collarbones

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

Dave Fleckenstein replies:

While cyclists are known more for (ahem) what is below the waist, having a lean upper body plays a minimal part in why we break clavicles so frequently. In fact, I some of the more serious fractures I have seen were on very muscular riders. These fractures occur more as a result of the mechanics of falling from the bicycle. While there is no "standard" way to crash, we tend to be levered over the bicycle so that we are approaching the ground "head first." While our helmets hopefully bear the brunt of our head's impact, the shoulder is left relatively unprotected. The other frequent crash injury is a torn or sprained acromioclavicular ligament). Unfortunately, there is not a great deal that can be done to protect this area from a training standpoint!

Foot numbness

I tend to experience foot pain/numbness and hotspot at the balls of my feet when I ride. The numbness starts at my toes and works its way back to about mid-foot, past the ball. Two years ago I used Nike shoes which did not give me numbness but took a little while for my feet to get used to (pain walking out of the shoes after rides went away after a short time). Then last year I switched to Diadora Veloce and had little problem other than fit. I fixed the fit (little bit large around the foot) by transferring the Nike insoles to the Diadora (not in place of the insoles, but added to). They worked pretty well. This year I got a new pair of Diadora Veloce and the numbness began. I still use the Nike insoles as they help the fit. I think that the problem stems from toes hitting the end of the shoes. I have always worn shoes that fit my foot exactly length-wise for various reasons, mainly they fit best this way and I don't like much, if any, movement of my foot in the shoe. I am unable to cinch the any shoes super tight as it causes a lot of pain around my mid-foot, especially at the outsides. My college soccer trainer had to take extra care when taping my ankles for this reason.

I hope that the problem is from cleat placement too far forward and once I get some new screws (stripped) I can try and slide the cleat further back on the foot. Maybe another type of insert would work, but I am afraid that softer insoles would negate the stiffness of the carbon soles and cost me power and efficiency (serious racer).

Am I looking at shoe fit all wrong? I would go back to the Nikes but the straps are failing and I've not gotten around to getting them fixed (plus team sponsor is Diadora). Shoe size is currently 41.5 and 42 never felt right (at least in the Nike). One more note: yesterday on a ride, I was getting some serious numbness/heat after about 1.5 hours and unclipped for a bit letting my feet dangle. Discomfort went away quickly and feeling came back. That lasted for most of the rest of the ride (only about 40 minutes).

Ben Faulk

Steve Hogg replies:

Numbness of the feet can be caused by a plethora of reasons. Here are some of the common ones.

1. Shoe too flexible causing the rider to fight like mad for stability in the shoe.

2. Shoe too stiff. For some people there is such a thing as a sole that is too stiff. If this is you a slightly more flexible soled shoe would help. Given that you are using a thicker than standard insole, this is unlikely, unless the insole has little give.

3. Shoe too short. Your assumption is that this is likely and you may well be right. Take your shoes to a boot maker, have him cut the toe box open where your toes hit and sew in some more material to increase the length. The fact that taking your feet out of the pedals rapidly improved things make this even more likely. If when riding reasonably hard, the toes are being constricted, this can compress the metatarsal joints. There are nerve plexus' in this area and compression of this area is a likely cause.

4. Cleat too far forward. As a guide, for your shoe size, I would position the cleat so that the centre of the ball of the foot is 9mm in front of the centre of the pedal axle. If the position of the cleat is the problem, this is likely to solve the problem.

5. Shoe too tight across the fore foot. From what you have written, this is unlikely.

Get back to me when you have worked through the above. If none of that advice helps, we'll get into the less common problems.

Cleat position #1

A question for Steve Hogg. When commenting on the lady with the short femur you mentioned the following re cleat position:

5. Make sure that the ball of your foot [centre of the first metatarsal joint] is in front of the pedal axle with the crank arm forward and horizontal. For a rough guide for shoe size metric 36 - 38, 7mm in front; 39 - 41, 8mm in front; 42 - 43, 9mm in front; 44 -45, 10mm in front. It is unlikely that your feet are bigger than that. Don't forget to move the right cleat further back again as outlined in point 3. I know that this is at variance with the commonly given advice but you will find as you try it that it works.

Are you just commenting on her specific case or is this the normal
recommendation for cleat position?

Mike Sinclair

Steve Hogg replies:

The cleat position I recommended for her was not specific to her but rather a general recommendation. It is a normal recommendation for me but somewhat at odds with a lot of what I would describe as ' recieved wisdom' advice re fore and aft cleat position. If I saw that lady in person I may have changed my recommendation a mm or so either way depending on her particular pedalling technique, amount of heel lift in the shoe last she has, her particular foot morphology etc.

In most publications the advice given is to position the cleat fore and aft so that the centre of the first metatarsal joint [ ball of the foot] is over the pedal axle centre with crankarm and shoe forward and horizontal.

The idea, apparently, is to

1. Maximise the lever length of the foot as measured from metatarsal head to centre of ankle; and

2.To engage the 'windlass mechanism', the term used to describe plantarflexion of the ankle [ point foot down] accompanied by dorsiflexion of the toes [flex toes upwards] causing the tightening of the plantar fascia which turns the foot into more or less a rigid beam.

That reasoning makes sense in any quick reading but my experience is that it is way off the mark. Point 1 maximises the effective lever length of the foot but neglects the issue of control. If leverage is everything, then you and I should be able to hit a ball out of the ground with tip of the bat, because that point of contact maximises the lever length of the bat. If you have ever tried it you will know that it is not possible. All that happens is that you jar your wrists and elbows because we cannot fully control the movement. The greatest effective lever length of the bat is approximately 100mm up from the tip, the aptly named 'sweet spot'. And so it is with a foot on a pedal. By reducing lever length slightly we massively increase our ability to control the movement of it. Another factor in my view of this, is that many people are concerned about the amount of leverage they have on the crankarm and rightly so. But to many are hung up with quantifying this at the 3 o'clock position because this is the point of greatest leverage and hence torque development. No matter what parameters of seat and cleat position we set our self on a UCI legal bike this [give or take a fraction] will be where we exert greatest torque. So the question then becomes where can a rider make gains elsewhere in the pedal stroke. The major area in my view, where improvements can be made, is how soon after top dead centre can we get behind and over the pedal axle to propel it forward and down.

At that point, we all relative to individual technique, drop the heel more than elsewhere in the stroke under any reasonable load. If the ball of the foot is over the pedal axle as measured by the usual method, then at that point, the ball of the foot is BEHIND the pedal axle. If the ball of the foot is positioned the way I would do it, then at the same point in the pedal stroke, coming off top dead centre, then the ball of the foot would be OVER the pedal axle. This makes a big difference.

Point 2 is in my view, the misapplication of running / walking foot mechanics to cycling. I am convinced that the windlass mechanism is at work when we are riding OFF the saddle. I am equally convinced that the windlass mechanism is either not engaged or barely engaged when riding ON the seat, which is what we do the great majority of time spent on a bike. The question I would pose, is that if the windlass mechanism is strongly engaged when pedaling on the seat, then why does a rigid soled cycling shoe feel so much better than a more flexible soled cycling shoe. The answer that I would give is that the rigid sole is performing a function that the foot cannot.

I could go into more detail about the way most manufacturers have reduced the amount of heel lift in their shoes over the last 10 years [ this reduces the possibility of windlass mechanism engagement] but this should suffice.

My apologies for the length of this reply, but yours was one of many inquiries that I have received about just this point and I am hoping that this reply will satisfy those others too.

Cleat position #2

[Editor's note: Kim Lopez asked Steve about his reasoning on cleat position and received a reply substantially the same as the one above, then asked the question below.]

I was trying to look for your reply to a similar question (where you listed shoe sizes with appropriate cleat set-back) but I couldn't find it. I hope you don't mind sending it to me (or tell me where I can find it on my own).

Kim Lopez
Phillipines

Steve Hogg replies:

Here is the sizing info you requested for cleat positioning. Shoe size 36 - 38: centre of ball of foot 7mm in front of pedal axle; 39 - 41: 8mm; 42 - 43: 9mm; 44 - 45: 10mm; 46 - 47: 11mm 48 - 50: 12mm. There are a number of qualifiers that I will attach to those recommendations. 1. This info is for road and mtb riders. For general track riding, I would reduce the amount of foot over the pedal by a mm or 2 depending on shoe size and event. For sprinters and kilo riders, I would halve the recommended amount of foot over the pedal. 2. If positioning someone in person, I might vary the above a mm or so either way depending on other factors. 3. For riders with an exceptional heel dropping pedalling style, I would increase the amount of foot over the pedal slightly. The converse is true for the exceptional toe down style pedallers. For both groups I'm talking about technique under moderately severe load, not cruising in a small gear pedalling fast. 4. For riders with a lot of heel lift in their shoe last, I would increase the amount of foot over the pedal slightly. 5. For riders with flexible soled shoe, I would increase the recommendation slightly as with this type of shoe the heel deflects downwards more under load.

Knee pain redux

I want to thank you for your recent reply to my question regarding knee pain. I must confess however that I'm not sure precisely who to see regarding assessing whether there is an intrinsic problem with my knees. My experience with orthopedic surgeons for example is that unless I go in with a particular, well-defined injury they are not inclined to investigate possible root causes of my knee pain. I have seen a physio for my prior knee injuries and consider him to be excellent (an Aussie no less). He commented once that my knees feel "loose." I presume this means the knee joint moves more than a typical knee and could be the source of my knee pain late in races. However, he did not suggest a particular course of treatment. Is there anything that you would suggest if this were indeed the problem? Exercises, etc? In addition, I had an x-ray of my pelvis about a year or so ago, and the chiropractor indicated that my pelvis was rotated. I did not follow a course of treatment with him as I was not overly concerned by the diagnosis at the time. I was looking for something more serious in my back after car accident, which was ruled out. Could a rotated pelvis also be a culprit or would it be more likely a limitation in my range of motion.

I will also investigate your other suggestions regarding position.

Phil Bentley

Steve Hogg replies:

You mention that the chiropractor told you that your pelvis was twisted. What follows is a scenario that I see on a daily basis. It may be you, it may be not. When a pelvis appears to be twisted, what is often occurring is that the iliac crest on one side sits further forward than the other side. The corollary of this is that the sit bone on the side of the anterior iliac crest is posterior. This in turn means that when you feel like you are sitting squarely on the seat it is likely that you are twisted towards the side of the anterior iliac crest. To verify whether this is the case, set your bike up level on a trainer and have a helper stand behind and above of you whilst pedaling with your shirt off.

If once this had been done, that does not describe you, disregard the rest of this email. If it does describe you, read on.

The side that is forward on the seat will have a knee that typically rolls in because the restricted sacro - iliac joint on the anterior side means the hip and pelvis move to some degree as a unit, rather than independently. This means that the anterior hip will drop and roll forward with every pedal stroke and the knee will have to follow. This may or may not be made worse by the way your foot functions. This could explain the knee pain on the anterior side.

Knee pain on the other side is usually because of a combination of that leg over reaching and moving laterally to accommodate the hip drop on the other side.

If this seems to be you so far, a band aid that can be applied is to twist the seat nose towards the anterior hip. This will square up the hips to a greater or lesser degree. If you do this you may have to tilt the seat nose up a degree or so as well.

By far the best solution would be to get advice from an appropriate health professional to straighten yourself up. On a bike you support the majority of your weight on the base of your pelvis, the legs hang down from it and the upper body cantilevers out from it . It's placement and function are fundamental to our success or otherwise on a bike. Problems with pelvic function and alignment can cascade through the rest of our body when cycling. If the centre doesn't function properly, it is hard to expect any body part towards the periphery to function optimally. Knees are susceptible simply because they like to function in a single plane.

Given that your problem sounds chronic, it might pay to reassess your fitness priorities. By this I mean to spend more of your available time on getting your structure to work properly and a bit less on developing your cardiovascular system. The pursuit of cardiovascular fitness stresses our bodies as a structure but not many people put requisite effort into maintaining their structure.

I would also advise that seek out someone who knows what they are doing with regard to bike positioning and have wide experience with problems such as yours.

If what I've written sounds like you, great. If not, there are a host of other reasons that could cause your problem. I would be interested to hear how you get on.

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