Fitness questions and answers for March 25, 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.

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.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.

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.

Lower back and symmetry issues
Ischial tuberosity pain
Training for the bike tour of Colorado
Growth hormone
CMT, Foot Drop and Supination
Follow up on previous advice

Lower back and symmetry issues

First of all a great forum and I love reading your insights in how to be more efficient on the bike.

I am a 34 year old MTB and road racer, usually competing in solo enduro mtb events with the use of road cycling as a form of training for these races.

It has been identified by a fellow training partner (who is a chiropractor) that I am quite stable on the bike while pedaling under easy load, but once I push hard gears I tend to drop my right side down and forward.

It has also been identified that I really drop my heels on the end of the down stroke which may be contributing to lack of pelvic symmetry when sitting on the bike.

As a result a I have the sensation of the left leg overextending and to try and stabilize this while pedaling, my adductors get overloaded and get to a point of too much discomfort to ride.

This manifests itself in knee pain of the medial aspect of the epicondyle of the left femur. I have regular massage to relieve the muscular tension (which seems to be more on the right) - but this was not actually addressing the problem of asymmetry. Added to this I have constant back pain in the L5-S1 area, particularly on the RHS (same chiropractor diagnosed it as a cat 3 injury). Subsequently I have been doing clinical Pilates with a left bias focus for some time now, which has seen my left glute and vastus muscles 'catch up' with the right side. The exercises I have been doing have been focusing on isolating left glutes, vastus, and to a degree the left hip flexors. I have confirmed no issues with leg length.

You have mentioned in previous posts that this right hip drop is a common trait in 95% of cyclists, but my question is this:

Have you any suggestion as to how I can be specific as to 'switching on' my left side with particular reference to Pilates and my left illiopsoas?

How do I translate this onto the bike to stop the hip drop?

I have made great progress in the Pilates studio, but once out riding (particularly as I get tired) I revert back to my old ways. I was thinking that given the platform on the bike is a seat; there may be differences in what can be done as most exercises rely on standing not sitting?

Can shortening a stem help reduce the hip drop by reducing the need to reach forward to hold onto the hoods?

I am getting very frustrated as the above is affecting my ability to train without discomfort, so any suggestions or experiences would be greatly appreciated.

Chris

Steve Hogg replies:

The big heel drop at the bottom may just be your natural technique, but more commonly it is because of cleats that are too far forward so tick that box first.

Next, why do you drop your right hip?

I can't tell you without seeing you, but I can give you a check list to work through.

1. Check leg length. I know you have said that there is no confirmed leg length difference but unless this has been assessed with a scan or X-ray, then it is a guess and that's all, no matter who tells you otherwise. Have a scan or X-ray and put a number on it. In many cases like yours, the right leg is short and the brain protects by dropping the hip. In many others, the left leg is short and the brains' response is to use the right leg hard because the left leg can't contribute through the same number of degrees of crank arc. This sort of stuff is really obvious if you have access to torque analysis.

2. Feet; check whether there are any issues,(varus / valgus) that you may be autonomically protecting on the right side that may cause the hip drop.

3. Have someone knowledgeable with trigger points check you out thoroughly. Particularly in the psoas.

4. Find out whether either sacro iliac joint is restricted in any way.

5. Find out whether you have a dominant left cerebellum. If that is the case, Feldenkrais stuff can be very effective in remedying that. A good (plenty aren't) neurological chiropractor can make a big difference.

6. Don't forget the simple things, like seat height and set back and the reach down and out to the bars. You should be using the minimum effort to maintain your position on the bike. Your description of pelvic symmetry at low intensity and the lack of it at high intensity suggest to me that at least part of your issue is the position you hold on the bike.

7. I accept that the Pilates you have been doing has improved the function of the left side muscles but the left side isn't your problem. It is protesting because you drop your right hip under load. This challenges the plane of movement of the left knee. From what you have said, you have a right side problem with pain caused by the left side fallout. All the strengthening of the left side won't help at all unless the right side issue (whatever it is) is diagnosed and addressed. Have someone REALLY knowledgeable, preferably someone who is also a cyclist, or has a lot of experience with cyclists, give you a stripped to underwear global structural assessment. Too often issues like yours are tackled piecemeal rather than in an all of body sense.

Any health professional advising you should give you that global assessment as first order of business.

8. Above all, don't give up. The major issue we all face with a seemingly intractable problem is getting the right advice. It is harder to find someone with insight into your particular problem than it is to work towards resolving it once you know what you have to do.

Ischial tuberosity pain

I'm a cat four, 45 year old cyclist entering into my 4th year of fairly serious training efforts. Late in last years training I started having discomfort on the bike on the right side ischial tuberosity. At the time it wasn't severe and I rode thru the discomfort but it made rides over two hours pretty difficult. I crossed trained over the winter pretty much forgetting about the issue. Its back now and pretty painful, it's getting difficult to ride 60 minutes on the trainer. I stand and stretch every 10 minutes or so and that gives some temporary relief but only temporary. When I investigate the area with my hand I can feel a "knot" about grape size that seems to come and go with the ride. I had not been having any discomfort off the bike but now while it's not painful there is a noticeable "feeling" pretty much constantly but especially while sitting.

I intend to see the doctor about the issue I've done some research and I have seen there are modalities (RICE, cortisone) that can help but before I go through that I was wondering if just a new seat or change in seat position will help. My ride position is similar to what is often discussed here, cleats mostly rearward and seat well back. I do have the nose on my seat probably higher than might be normal. I'm pretty comfortable on the bike and make good power otherwise. Any help is greatly appreciated

Mike
Philly, PA

Steve Hogg replies:

It is very likely that you are either dropping the right hip OR overextending on the left leg. Either can make you load up one side of the seat. Can you confirm that either of these things is happening?

Sometimes the problem can be as simple as a seat a touch too high which in turn can make the rider 'prefer' one side over the other.

Why do you feel the seat nose needs to be tipped up more than 'normal'?

It is conceivable that the seat tilt is a contributory factor.

Training for the bike tour of Colorado

I am participating in the Bike Tour of Colorado this June and wanted your opinion on the best training method. The ride is a 400 mile loop in the San Juan mountain range which starts and ends in Durango, averaging about 65 miles per day. I am 31 year old female, 5 feet tall and 108 lbs. I have been road riding for 5 years as a recreational rider. I did my first century 2 years ago.

I would like to know the best training schedule to prepare me for the ride. I have ridden about 450 miles since Feb 1, 2008. Now that it is about 3 months until the ride, what is the best training for weekday and weekend rides (I want to avoid the trap of overtraining)? Besides local rides in my area, the only organized ride with climbing I will use to prepare is a ride at the end of April that will include 7,000 feet of climbing. Also, do you have any suggestions for altitude training as I live at sea level?

Secondly, I would like to know your opinion regarding eating habits I should implement before, during and after rides. I would like to weight 100 lbs in Colorado, so what is the best way to loose 8 lbs while training to maintain optimum efficiency?

San Diego cyclist

Scott Saifer replies:

You are really asking for something you'd do better to get from a coach with whom you work personally and individually. There are lots of additional questions a coach should ask before assigning you a training schedule. I can tell you that some researchers have looked at the relationship between training volume and injuries sustained during multi-day tours and found that there is a sharp drop off in injuries among riders who consistently train 100 miles (160 kilometres) or more per week, so at the very least you should aim to build up to that level. Adding one hour per week to total training time is generally considered a safe way to build up without danger of over-training. The vast majority of your training time should be spent at an "all day" pace, the effort you expect to make on the tour. That means you'll be training slower at first than you will eventually go on the tour. If you use a heart rate monitor, keep your heart rate below 80% of your individually measured maximum heart rate most of the time.

Growth hormone

As a trauma surgeon and surgical critical care intensivist, care of those with poor physiologic condition is common. Over the last several years we have witnessed the debunking of several medical issues that lead to 'performance enhancement' in those patients whom have been physiologically compromised. First, although transfusion with packed cells may increase cardiac index/output by increasing intravascular volume, we know that the short term (first 24 to 48 hrs) increased oxygen carrying capacity is lost initially due to storage issues and long term lost to extremes of total ability to off-load oxygen to the tissues above a certain hematocrit so, the use is questionable. We also know that erythropoietin offers up no benefit in all but those with end-stage renal failure (NEJM 2006). So, It is with great pleasure that the effects of growth hormone have finally been thrown into the trash bin of junk science, as well (Annals Internal Medicine 2008). I can only hope that the days of performance enhancement from anything other than more/perfected training regimens are over.

Scott Saifer replies:

Thanks for the link and I share your hope that the doping era can be brought to an end sooner rather than later. I should point out however that I know of at least one instance where a pharmaceutical intervention has a different effect in highly-trained athletes than in healthy "fit" members of the broader community. (Studies of creatine use in fit individuals show no increase in aerobic capacity, plus an increase in weight leading to a net negative effect on running or cycling performance. At least one study of creatine use in highly trained athletes showed an increase in aerobic capacity, apparently because creatine availability in the muscle actually becomes a limiting factor in energy transduction in these individuals). Until the studies you quote are repeated specifically with highly trained athletes, I'm afraid they will be of little value in the discussion of the effectiveness of doping in professional sport, and of course researchers are going to have a hard time finding athletes to go on record using EPO or HGH or blood packing.

CMT, Foot Drop and Supination

I have thought about the issue of midfoot placement since reading your online explanations. It makes good sense when you think about the concept relative to physics. My only concern for this is that I am afraid that the "balance point" of my foot/axle will tend to allow my foot to fall forward - something it does really well - especially when I am standing. It is kind of a "collapse" in a forward motion at my ankle. I don't have much control in that direction - i.e. when I am coming down stairs, I need to be sure my whole foot is on the step and not just the rear portion. I have taken a couple dramatic - and exciting - tumbles as a result of negligence in this regard.

I am keen on giving this a try - maybe on a trainer first :-) - and having an old pair of shoes drilled to see if I can tolerate the cleat being back that far. I also remember in your column when you said that any amount of rear placement would be better than none, so maybe I can find a spot where the forward motion of my foot is not of concern. Never know until you try.

The other issue with my ankle turning out is also a result of the weakening of the muscles in the lower leg and ankle. I have about 15% of varus which has been addressed with shims, but in the exact opposite place than I expected. I thought I would be shimmed on the outside to get my ankle over my foot, but shims have been placed on the inside to take up the "space" that is caused by my foot dropping out. I have a nasty foot pivot to the outside when there is room for the ankle to flex out. Not so hot on the knees.

Thanks again for your advice. To be honest, I am grateful that I even have an opportunity to ride considering the state of others with this syndrome. Never give in.

Michael Nash

Steve Hogg replies:

Re whether the midfoot cleat position would help with the foot drop; the answer is that I don't know but think it is worth a try. I was thinking about this and something else occurred to me. I was visiting a prosthesist a while back and he showed me a device that supported the foot and the lower part of the lower leg and had an "ankle joint" that had a controllable range of movement. It wasn't large or bulky. Basically it was a skeleton that the foot sat in but was cutaway hugely so that only the perimeter of the foot was supported. It had a thin heel cup with an vertical extension of that that ran up the back of the leg and that was secured by a large velcro strap below the calf.

I had a look at this briefly but as that wasn't the purpose of my visit, I didn't spend a lot of time with it. It looked to me like it was designed to fit inside a shoe. What I am getting at is if something suitable can be found on the shelf or perhaps be custom made with the prosthetic "ankle joint" range of movement limited to what you need to walk and ride, then it might just help solve your problem.

Follow up on previous advice

I'm emailing to follow up on some advice you gave me in November. Your advice was published in the Nov. 21 Fitness Q&A.

Sorry for not emailing you directly, but the computer I was using then was stolen, so I've lost all of my email and contacts etc.

I wanted to let you know that my knee has been improving. I've talked with another physio and he determined that I was obscenely tight in my left hamstring/calf and I've been doing regular stretching exercises as prescribed, and it's helped a great deal. He's also recommended getting a weekly massage, and I'm looking into doing that. If I slack on my stretching, I notice the knee discomfort flares up pretty quickly.

I've done some extensive reading and tinkered with my bike/cleat position. My cleats were set up with a really wide stance on the pedals, so I've narrowed that. I've also corrected the angle of the left foot, as it was a little toe-in-heel-out compared to the right foot. I've slid my saddle back on the rails, and it feels so much more comfortable now.

So... After getting myself feeling like I'm improving my knee and feeling good on the bike, I notice now that my left leg is weaker than my right, especially during one leg drills. Any suggestions on equalizing/correcting this?

Kevin

Steve Hogg replies:

I'm glad to hear that you are feeling much better, at least off the bike. As to your query about what you can do to make the left leg as capable as the right leg on the bike I would ask why was the left leg tighter in the first place.

I don't know the answer to that but likely causes are:

1. Measurably shorter right leg

2. Unresolved issues on right side causing you to autonomically protect and favour that side at the expense of the left leg. The simplest way to determine whether that is the case is to mount your bike on an indoor trainer and warm up into a big gear under reasonable load. Work your self hard with shirt off, but not so hard that you sacrifice technique. Have an observer standing on a chair above and behind you. What he needs to tell you is whether you drop and / or rotate either hip forward or down or both with each pedal stroke on that side.

If he is unsure, use a gear that you have to 'force' a bit.

Get back to me with that info and I will attempt to advise from there.

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