Fitness questions and answers for May 9, 2005

Got a question about fitness, training, recovery from injury or a related subject? Drop us a line at...

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.

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.

Arm length discrepancy
Fitting a new bike
Back-calculating power
Borderline cholesterol
Sodium phosphate
Saddle discomfort through structural imbalance
Achieving a high heart rate
Loose knee
Post-Tib pain and bike fit
Shoes and stress fractures
AHR
Cycling for fitness and pleasure
Hammertoe and cycling
Cycling with a fever
High heart rate

Arm length discrepancy

Hello, I'm a male cyclist of 46 years old with an arm length discrepancy. I ride mostly for pleasure with some cyclosports. The difference in length is approximately seven inches (the left is shorter); if I pull on my left arm I can reduce the length difference to about four inches. I would like any ideas on how to minimise the discomfort I have during a long ride.

I thought that one solution would be special handlebars, where the left side is modified in the appropriate way: the left side of the bar could drop almost immediately after a space for the brake lever so it should be easier to be resting on the brake hood. The drop should be longer on the left so I'm able to be in the drops easier. What do you think of this and do you know people or company that can make customised handlebars.

Michel Jalette

Montreal, Canada

Steve Hogg Replies

I have in the past encountered people with similar issues though not as marked a difference as yours. I have investigated having custom handlebars made in the past for this purpose but there is not enough demand and I didn't have any luck with finding anyone who could make asymmetric bars at a reasonable price. Don't worry though as there is a solution.

Before going into that though, DON'T stretch the left side further to minimise the difference which would still be substantial anyway. Overreaching on the left side will over time cause painful problems to your back, shoulder and neck. I have seen several instances of this and would not recommend it.

To solve your problem you will need a pair of Cinelli Spinaci bars which are a small pair of aero bars without cups or pads, and the services of a good machinist or toolmaker. That is someone with access to lathes and milling machines and the skills to use them.

Fit one Spinaci bar horizontally behind the top of the left side of the top of your road bar. The bracket allows it to be adjusted in/out and up/down. With some experimentation you will be able to have a comfortable position to grip with hand on the shorter arm side when riding upright on the top of the bar with the Spinaci.

For using the drops and brake levers hand positions things get a bit more interesting. Given amount of your discrepancy you will be able to mount the other Spinaci vertically behind and probably above the drop of your bar on the left side. The Spinaci shape when turned vertically is similar to that of a drop handlebar. If you can get an appropriate bracket fabricated to allow this, you will be able to have a drop position using the second Spinaci with enough room in front of it to mount a STI or Ergolever without fouling your road bar. I hope this helps. If you need further clarification, please let me know.

Fitting a new bike

Hi all.

Here's my situation - I have the potential to get a Lemond at a very good price; the problem is that I can't sample one. So I have to base it on some information I currently understand. My previous bike was a Giant TCR1 (2003) size medium. The overall fit was barely small. It had a giant 110mm stem. I had it set to a positive rise and the distance from seat to bar was signifigant at 3.5"

I've demoed a Trek Madone 5.2, and in the 58cm size it felt amazing. Couldn't find any problems with fit, and the bike was set up pretty much neutral (seat fore/aft etc). My measurements are: 177.5cm tall, 146.5 to sternum, 85cm inseam, 44cm shoulders, 74cm arm reach, (give or take a bit, it's awkward to figure out). I'm 38 and a masters age racer at a weight of 165lbs. I'm looking for a 'do-it-all' bike. I race road/crit (as well at mtb/cross/track). My choice is between a 55 or 57cm Lemond Victorie 2005 bike. I guess I'd rather be a bit on the smaller size if I have to choose. I sat on a 53cm belonging to another racer this weekend, and it was simply too small. Any very quick input would be greatly appreciated!

Don Ricker

Steve Hogg Replies

You have left out a lot of pertinent info, but given me something to go on. Given that you state the 58cm Trek Madone felt the best and reiterated that fact in your attachment, I will assume based on what you have told me that that is the ideal bike and position, or close to to it. The implications for the two Lemonds are as follows: Firstly, I would go back to the shop and measure the head tube length of the Trek Madone 58 cm frame. All of these frames will have similar bottom bracket drops and by buying the Lemond with the closest head tube length to the Trek you are getting a similar height frame in terms of front end height. If it is the 55 cm Lemond, the seat tube angle is the same and the top tube is 7mm shorter. This means that if you had the seat centred in the seat rail clamp of the seat post, you would need a stem 7mm longer set at the same relative height to have the bars in the same position relative to seat.

No one makes stems with 7 mm differences between sizes. Some brands are longer than their stated nominal length by 3-4 mm, so if you played around and measured a few, you would end up with a stem of 5-10 mm greater nominal length for the same reach and drop from seat to bar. For the 57 cm Lemond, the seat tube angle is 0.5 degree more relaxed and the top tube is 3mm longer than the Trek. Making an assumption regarding your likely seat height, you would have to move your seat 6mm further forward in the seat rail clamp of the seat post to maintain the same seat setback as the Trek. This 6mm factored down to the top tube would approximate 5mm.

In effect, you are reducing the effective top tube length by 5mm moving the seat 6mm forward. Given that the Lemond has a 3mm longer top tube, the distance from seat to bar is now 2mm shorter on the 57cm Lemond than on the 58cm Trek. This is hardly worth worrying about and you could use the same stem length as on the Trek. All of the above assumes that you are comparing like with like. That is same seat and handlebar type and shape. If this is the case, what I have said is accurate. If not, then the picture becomes somewhat murkier. In summary, the Trek position could be duplicated easily on either Lemond. I would buy the one with the head tube length closest to the Trek.

Back-calculating power

Is there a way to reverse calculate a racer's wattage average wattage distance, course profile, an individual's average speed, and pace, time? You could also make assumptions of their weight and efficiencies. The end game is I would like to find out the wattage of the winner, and then potentially train to that output for that amount of time. Thanks for your help,

Kenny Deemer

Lakewood, Colorado

Eddie Monnier Replies

Kenny,

You can go to www.analyticcycling.com and click on Power & Speed, then choose "Power, Given Speed." You won't need to know anything about anyone's efficiency, but you will have to make assumptions about effective frontal area. But solving for their power doesn't help you much. What you really want to do is figure out what wattage you would require to better their average speed, right? Whatever your intent, you should find the models there relatively helpful.

And don't forget, for a time-trial, you want to optimize watts/aerodynamic drag which means you can either improve your power output and/or reduce your drag.

Just a quick comment that if the difference between your current power output and what you determine to be your goal power output is 10% or more, it probably won't make sense to just start doing intervals at the goal level because you'll accumulate very little training time before becoming utterly spent. Search our archives for "time-trials", "functional threshold power" and "lactate threshold power" and you'll find discussions about training for time-trials. You might also see "Go Hard, Go Easy, Go Hard: The How and Why of Interval Training" which is available in the library on my website (www.velo-fit.com).

Borderline cholesterol

I enjoy reading the fitness section for the insight into all things cycling. Your panel is very well rounded and their service much appreciated. Just received my CHO results form the Doc and it's a tad high. LDL is 146. HDL is good at 60. He's prescribed 500mg daily of niacin. I know the better type is Inositol Hexaniacinate. So I'll try that one. Will this affect my cycling in any way? Thanks for the forum.

Jon H

Arizona

Kelby Bethards Replies

Jon,

Perhaps one of the dietary oriented panelists has a better answer to your question, but I do not think it should have an impact on your riding. You may have a very common side effect; hot flushing soon after taking the medicine, but this can be alleviated somewhat by taking a baby aspirin 1/2 hour prior to your niacin dose.

The sustained release Niacin formulations tend to do this less so than the others. As your doctor may have pointed out, we are getting much more aggressive in treating Hyperlipidemia (high cholesterol). You have a very good HDL, for a male, likely from your cycling. The LDL is too high, and in the long run, its better to get it controlled now.

So, I don't think you should notice the Niacin (also called Vitamin B3) with regards to cycling. But, if you do, talk to your Doc about it...we have plenty of other things to try. It does have a rare side effect of rhabdomyolysis (muscle breakdown at rest...but you would know if this was happening; you would hurt).

Sodium phosphate

Hey,

Any thoughts about sodium phosphate loading prior to a few races per season? Joe Friel has a bit on it in the Cyclist's Training Bible and it's sold as 'Race Day Boost' by e-caps.com. I recently tried it, but it's hard to know if it really made any difference. I've read some of the research and it seems pretty equivocal, but I wondered if you had any thoughts.

Steve Smith

Ric Stern Replies

Steve,

I have no idea where JF's loading regimen originates from as there is no research to substantiate his loading protocol (which, if I recall correctly, uses a very low dose every day). Although at first it appears that phosphate loading is equivocal, it appears that many or all of the studies that used tribasic sodium phosphate showed a significant ergogenic effect. Currently, we are unable to explain why it is only this phosphate that appears to work. In our study (Folland, Stern & Brickley, 2001, A, CJAP) (see http://cyclecoach.com/articles?article=Phosphates&ext=.htm) we found an 8% increase in power output compared to a control and placebo trial.

We used 4 x 1g/day for six days. This led to a reduction in time during a 10-mile TT of 40-secs. Currently, no one has determined the exact mechanism which improves performance via phosphate loading (although there are a couple of hypothesis) and it hasn't definitely been determined that it always works.

It's important to note that phosphate loading isn't for everyone, and in some people it can cause instantaneous vomiting or diarrhoea. With this in mind, and with all new supplements and sports drinks etc you should always try these out in training first and not directly prior to, or during a race. It is strictly recommended that phosphate is not taken on a regular basis. Some research suggests that it may cause calcium to be leached from the bones if consumed regularly. Current advice is to not take it more than four times per year.

Saddle discomfort through structural imbalance

I am a 34 year old male who has been riding competitively for 15 years. I have trained in the gym for six years. The last couple of years I have been suffering from saddle discomfort and a really stiff neck. I have tried almost every saddle on the market to get comfortable and nothing has worked, even though the saddle has always been set up with correct fore/aft adjustment. The saddle height, bar and stem adjustments were also in the correct range.

The discomfort from the saddle always comes from the middle right hand side of the saddle edge. The right hand side of the saddle digs into my groin as opposed to the left side which does not. Its been observed that when I ride I don't sit in the middle of the saddle but more pushed out to the left hand side .The left hand side of my shoulder also looks like it's pushed up more, relative to my head. There is obviously some fundamental muscular imbalance going on. What action can I take?

Oliver Romov

Steve Hogg Replies

I would gently take issue with your contention that you have been correctly set up. If you had been, you would not have the comfort issues that you speak of and/or would have been referred on to whatever type of health professional was deemed appropriate.

First things first, however. Your problems sound acute, and so you need to know the structural state of play of your own body. Do four things. First, buy a book called " Overcome Neck and Back Pain" by Kit Laughlin. It has a very good chapter on self assessment which is ideal in the sense of self education. If you choose to follow the recommendations in that book, it is hard to injure yourself providing the instructions and cautions are rigorously observed.
Secondly, enlist the help of a GOOD structural health professional to assess you and plan a way to address the problems that give rise to your on-bike asymmetries.

Thirdly, find someone to position you who takes a structural approach to positioning, not a measurement or predictive tables based system as I suspect you have been using. Though I am happy to be corrected on that.

Lastly, as with any acute problem, take responsibility for it yourself. Enlist the help of whatever professionals you deem fit, but make sure that you always know what is going on and that this is explained to you in terms that you understand so that you know what your options are.

Achieving a high heart rate

I have been cycling for two years, mostly to train for Half Ironman triathlon distances. For the first time I have been incorporating interval sessions in my cycling program.

Last year I averaged 22 mph for the 56 mile bike leg of the 2 Half Ironman races I did on rolling courses. I would like to improve my speed on the bike and this is why I'm doing intervals. During running intervals of 1/2 mile to 1 mile in length my heart rate gets up to 180-185 bpm. Using the same HR monitor for my cycling intervals, my heart rate won't get any higher than 165 bpm - regardless of interval length - at my maximum perceived effort. I have been doing intervals of 2 minutes, 10 minutes and 20 minutes. During the cycling intervals I have tried using big gears and lower rpms and smaller gears and higher rpms but the resulting HR is about the same.

My heart rate is also much lower during longer rides (145 bpm for 3.5 hours) than it is during longer runs (170 bpm for two hours) of equal perceived effort. The only time my heart rate while cycling has risen close to my heart rate while running was when I recently rode to the top of Brasstown Bald while in Georgia for the TdG. I live in Chicago, so I am challenged any time the road tips up. Should I try to achieve the same HR during cycling intervals as I can during running intervals? If so, how should I try and do it?

Dan Litwora

Andy Bloomer Replies

Hi Dan

Nothing to worry about on this one; it's quite common for multi-sport individuals to report the same problem and it is down to the amount of muscle mass used for each sport. During running you use a lot more muscle mass than cycling and the heart rate responds accordingly with a slightly higher heart rate. I wonder - do you use your heart rate monitor for the swim training? You would possibly notice a lower heart rate in the pool/ocean than in cycling as you use a slightly smaller muscle mass again.

If you were to visit your local university or sports performance laboratory for tests you would also see the same phenomenon for oxygen uptake with lower values on the bike than on the treadmill, again due to the lower muscle mass in activation. Cross country skiers are reported to have the highest oxygen consumption of all athletes and at a guess I'd say it's because that unlike for running, where you use the arms more for stability, in cross country skiing they actually use them for propulsion as well.

In your case you shouldn't try to achieve the same heart rates for cycling as you do for running. My advice would be to complete two maximal heart rate tests for the different sports and use heart rate training zones for each sport separately. Hope this helps.

Loose knee

Hi,

I am a 40 year male Cat 3 who has been riding competitively for the last 10 years. I am 5'10' and 168lbs with a stocky build. I ride 10 to 15 hours a week depending on the season; commuting to work, doing team rides and racing. For our team, I have been the one to set up for the final sprint and have been working to develop my time trialing. In 1985 I had surgery on my right knee to reconstruct both the inside collateral and the anterior cruciate ligaments. The surgery was a result of a motorcycle accident and included repairing the bottom of my left tibia (two screws to re-attach). Ever since the surgery there has been "play" in my knee, allowing it to move forward and back about an inch when it is relaxed.

I have seen two doctors recently because I have developed what they call a 'baker's cyst' behind my knee which is about the size of a large marble and to assess the overall health of my knee. An MRI was done to identify that it was non-cancerous. Surprisingly, there is no damage at all to any of the cartilage as confirmed by x-ray. One said that all I have to do is to keep my quads strong and I shouldn't have any problems, and didn't advise anything for the cyst. The other suggested more reconstructive surgery.

Considering that these two opinions are at the opposite sides of the spectrum, I would like any opinion or information that any of you could give me. At this point, my inclination is to have the cyst removed, but that's all. Thank you very much.

Patrick Edenfield

Pacific Northwest, USA.

Dave Fleckenstein Replies

Patrick,

A Baker's cyst results from fluid in the knee pushing out the posterior joint capsule. Since the cyst is simply the result of inflammation, accurate resolution of the cyst requires us to determine the source of inflammation. Typical sources of inflammation that result in a Baker's cyst are meniscal tears and arthritic processes. I want to stress that treating the cyst rarely results in resolution - the real problem generating the inflammation must be resolved for the cyst to resolve.

Given your history of having an ACL injury with significant laxity still present, I would imagine that you have translation at your knee (that a normal ACL would prevent) with even minor activities like walking, and this can cause irritation of the meniscus, cartilage, and joint surface. Both physicians are trying to resolve the translation at your knee, albeit through very different methods. While one is trying to improve stability indirectly through strengthening, the second is doing it directly through repair. My advice (through my non-surgical lenses) would be to perform aggressive, appropriate strengthening first, and if problems appear unresolved, have the joint imaged (x-ray, MRI) to see if there is a meniscal tear or arthritic change. Given the number of asymptomatic ACL-deficient patients and the fact that your ACL is somewhat intact, I would proceed cautiously with a reconstruction. While I have discussed ACL repair vs. deficiency in the past in this post. I would look at the non-cycling activities that you perform (ie; are you a skier or runner), the general condition of the knee, and multiple opinions to develop an intelligent decision.

While I am sure that your surgeons have examined this, I feel obliged to mention one additional concern for our readers. In your case, with the amount of laxity you describe and injury mechanism, I would also be very curious as to the integrity of your PCL. While not as frequently injured, I would definitely make sure that it has normal function.

Finally, you mentioned that your pro-strengthening physician stated that quad strength was a primary focus for you. While this is true, it is the hamstrings that most closely associate biomechanically with the ACL and I would definitely incorporate that into your strength program. Best of luck!

Post-Tib pain and bike fit

My story is very similar to the story told by Shane Anderson in the March 7 edition of the Cyclingnews Fitness column.

I am a 39-year old Cat IV road and mountain bike racer. I ride a custom steel frame, use Sidi Genius 4 shoes (size 48), and Speedplay pedals. I'm 6'3" and weigh 185 lbs. (84 kg). In March, I started experiencing nagging pain in the area of my left achilles. It wasn't severe, so I kept riding. In mid-March I attended a team training camp and did two back-to-back days of long climbs in cold weather. The climbs were between 20 and 45 minutes in length, and I was definitely overgeared for both, resulting in cadences as low as 40 rpm on some steep pitches. I had to cut the following week's training short due to severe pain in the left achilles area. I saw an orthopaedic doctor in the next week and took a MRI. The diagnosis was achilles tendonitis, and the prescribed treatment was complete immobilisation for 1.5 weeks, physical therapy and anti-inflammatories, and to stay off the bike.

While I was off the bike, I had a professional bike fit using the Wobblenaught method. The changes to my existing setup were minimal - saddle moved back almost one inch and down about 2 mm, cleats moved back to farthest possible point on Sidis (using Speedplay adapter on 3-hole drilling of Sidi sole), and everything else stayed the same. The fit results suggested that my cleats should be even farther back (194mm from back of heel), but the shoe would not allow the Speedplay cleat to move back that far. During the Wobblenaught fit, we measured the distance from my heel to the sesamoid bone to be 195mm on the left and 198 on the right. Fast forward to four weeks later…the pain in the achilles has disappeared completely, and I have had nearly two weeks of pain-free walking, stair climbing, and some limited running.

Given that success, I thought I would try riding again. Unfortunately, after two short rides with NO hard efforts (kept wattage below 150 watts), the pain in my left ankle returned. It was bad enough that I had to unclip the leg and pedal home on the other leg. Now, however, the pain is localised to a small area on the inside of the ankle - my physical therapist believes it is on the posterior tibialis tendon, not the achilles. There is noticeable bogginess in the area of the post-tib, and there is NO pain in the achilles area. Walking continues to be pain free. My physical therapist has found obvious flat-footedness on the left leg, and has recommended orthotics. She believes the problem is related to excessive pronation. I am continuing with physical therapy, including eccentric calf exercises and stretching. I also have scheduled another appointment with the orthopeadic doctor to examine the post-tib issue.

Now, at last, I come to my questions! Because the pain seems to be clearly related to cycling, and specifically to the interaction of the foot and the pedal, I am wondering what can be done to prevent the problem from reoccurring.

1. Do I need a medical grade bike fit? Where can I go to get a medical grade bike fit in the United States?
2. Would orthotics help? Are there differences in cycling and running orthotics? Are there specialists in making cycling-specific orthotics? 3. Would cleat shims help? Should I attempt them on my own, or are there fit specialists who have experience in dealing with post-tib issues? Any advice you could provide would be greatly appreciated!

Ken Woodrow

Steve Hogg Replies

Re question 1. I assume by a medical grade bike fit, you mean having your structural and or functional shortcomings addressed. If that is the case, the answer is an absolute 'yes'. I thought that was what bike fitting was about anyway. As to where in the States you would go, as an Australian who has never been to the States, I cannot help with a personal recommendation. I hope some of the U.S based panellists can.

Re question 2. Orthotics?. Depending on what the basic stressor is, 'possibly'. If I can give you my two bob's worth about the use of these in cycling shoes. The prescription of an orthotic is predicated around a predictable heel strike such as when walking. The contact area on a cycling shoe is the forefoot, not the rear foot. Additionally, part of the prescription of an orthotic may be based around asymmetries further up the body, like pelvic obliquities causing a functionally long and short leg etc, etc. which alters footplant. When we walk or run, we support ourselves on our legs and exert force with them too. When we cycle we support our weight on the base of the pelvis [ideally] and exert force with our legs. Any asymmetries of function that a given person displays off a bike may be noticeably lessened or increased when they get on a bike. This means that the prescription for a cycling orthotic often needs to be different than what a given person would need for running/walking.

As rough figure, I have found that of the people that I see that use one pair of orthoses for both cycling and walking/running, approximately 50% have no problems and the orthoses are beneficial in their cycling shoes. Of the other 50%, either a portion or a major part of whatever problem brought them to me is their orthoses, even though the same ones have been beneficial off the bike. Yesterday I had a gent with an on-bike knee issue who uses his orthoses in his cycling shoes. I was able to solve the problem but part of the solution was to remove the right one and leave the left one in place. This is not particularly uncommon though it doesn't happen every week. If you plan to go down that route, the best advice that I can give you is to find a podiatrist who is a competitive cyclist and who has applied him or herself to the task of thinking about the requirements of cycling as opposed to walking/running.

Re question 3. Cleat shims. Do you mean shims in the sense that the cleat is packed up in the vertical plane or wedges meaning that the shoe is canted? You mention a flat left foot and imply, but don't say, that the other is not. Proceeding on that assumption, have yourself structurally assessed by a good structural health professional with a cycling background or experience. You need to know what measurable or functional asymmetries led to your feet developing differently. Once you have that info, potential options for solution paths become obvious. Assuming that you sit reasonably square on your bike, get some Lemond wedges and have a play.

Approach the task with some care and thought, not bull-at-a-gate style, and you may well come up with a positive result. There is not a lot to lose if you are sensible. Additionally, once you have been assessed by someone, get back to me with the results and I will try and advise further. One last word: your less than ideal cleat position may be a contributing factor. Cleat position is a big deal to my mind. The people who made a positive difference with your positioning session should have been harder on you. If I can't get a clients cleats where I want them because of the shoe/pedal combination they have, I ask them to spend money to acquire a pedal/shoe combination that will allow good cleat position. If the client won't do that for whatever reason, it all stops there. There is no charge but I will not proceed further.

Anyone in the positioning business is going to be judged by the client on the results they achieve. I want the best chance of that being the case. To that end, where is the centre of the ball of the foot in relation to each pedal axle centre? If you need to move your cleats further rearward there is a solution available. If you have a good relationship with your bike shop or another that stocks DMT shoes, that brand has the most rearward cleat mounting holes that I am aware of. You would need to fit your cleats and measure where your foot is in relation to the pedal axle before buying. If that is not possible and at the risk of being seen to tout for business, have a look at http://www.cyclefitcentre.com/cyclefit%20services.htm and scroll down to Specialist Fittings and look at Speedplay Rearsets. Lack of rearward adjustment is common with Speedplays which otherwise are a very good system. I hope this gives you something to go on.

Shoes and stress fractures

Ivan at Spin City gym suggested I contact you for any possible solutions to my problem. I had a stress fracture on the navicular bone in the right foot - diagnosed and treated August 2004. At the time my two forms of exercise were walking and spinning. I had orthotics in my shoes but had removed them for about three months before the break - but not in my spin shoes.

A sports doctor thought it was the walking and a specialist thought it could be the spinning and the radiologist that checked my bone scan thought it could have been stressing the foot when I took the orthotics out. The orthotics were originally prescribed as I had shin splints but as I don't really run now I have removed them from all my shoes to try and pinpoint what is bugging my feet.

I was straight back on bike when the plaster came off but foot was still too swollen to wear my Carnac bike shoes, so just used my runners. Foot settled down but then as soon as I started to wear my Carnacs again both feet stressed across the top of the foot. When that happened Ivan made me take a month off the bike - that was what made me realise that it was the bike shoes stressing my feet. I am back in runners and my feet almost completely settled now. My problem is - is there a reason that after four years my Carnacs would stress my feet? I realise a stress fracture for whatever reason is caused over time, etc - not easy when no-one is really sure of why it happened. Any info or suggestions would be greatly appreciated.

Cheers,

Anne Hood

Steve Hogg Replies

Interesting story. I am not familiar in any depth with the latest Carnac shoe models, but from what you have said yours are 4+ years old. I am quite familiar with their shoes from that period and before. Carnac cycling shoes for many years stood alone in design terms in a negative sense, in that they did not [and possible still don't, I am not sure of the current stuff because I don't see much] have the same proportional placement of the cleat mounting holes in every size. Essentially the smaller the shoe, the further forward in a proportional sense the cleats had to be because of where the holes were placed. At the time Carnac used an insert system in the sole so that their shoes could be configured for any pedal system by changing the sole insert to the appropriate one for a given pedal type. A great idea in practice but when combined with the Carnac style high arch, heel lift last shape, it was a problem.

The inserts from memory were 90mm or thereabouts long. That meant that the shoe needed 90 plus mm of more or less flat or slightly curved space forward of the high arch and kicked up heel. To get that 90mm the only solution was to move the insert further forward as the shoe size decreased. In practice my experience is that with a size 42 or below it is nigh on impossible to position a 3 or 4 bolt pattern cleat where I would put it unless the subject had freakishly proportioned feet. Sizes 43,44 and 45 shoes had a rough proportion of achieving successful cleat position of probably 50%, and with size 46 or above there was rarely a problem because the shoe was big enough to position the cleat mounting holes in pretty much the same place as the better shoe manufacturers do on their products.

As a woman it is likely that you have small feet and a contributing factor to your problem has been less than ideal cleat placement - the smaller the shoe size, the greater the potential for and severity of any problems. Why your navicular bone and why four years? The simple answer is that I don't know; but if I saw you in your shoes on your spinning bike I could probably make a good guess. I strongly advise you to change your shoes to one of the following brands: Nike, DMT, Sidi, Specialized, Shimano, Gaerne or Diadora. Once you have done that have a look at this cleat positioning post, and this posting and position your cleats as per that. Once that has been done and if there are any ongoing issues, look me up. If you know Ivan then we are in the same part of town. Say g'day for me to him when next you see him.

AHR

I am a 48 year old woman of Mexican Basque descent who is 5'3" and weighs 115 lbs. My resting heart rate is in the low to mid 40s. Since childhood I have enjoyed running, swimming, and biking.

I ride five to seven days per week in the hills of San Francisco and like to keep my average heart rate for the 50 to 60 minute ride between 160 and 165. Is this a problem?

A friend thought my heart rate was too high and suggested I see a cardiologist to avoid having an "enlarged" heart. I enjoy my workouts and thought my heart rate was fine. Thank you for your prompt consideration.

Eli Aramburo

San Francisco, California

Scott Saifer Replies

Hi Eli,

There is nothing wrong with maintaining a heart rate of 160-165 for an hour. Being able to do so certainly does not suggest that you have any heart problem. If you have any other symptoms of heart disease you should see a doctor of course, but not simply because you can ride at 160-165. Many of my clients can do that.

Kelby Bethards Replies

Eli,

Without knowing too much more about you, I do not think you need to worry about an enlarged heart. Using the simple formula of having a maximum HR of 220 - AGE, that would give you a maximum of around 172. So, you are exercising at a fairly high percentage of your "maximum heart rate". HOWEVER, this is a highly individualised parameter and you may have a max HR that is higher than what the formula states.

I feel as long as you are tolerating the exercise without difficulty and aren't "passing out" or having an extremely hard time with recovery and not having chest pains, then you are probably fine. The hills of the San Fran area are challenging and you will have quite a few ups and downs of your heart rate, which correspond to the terrain.

Enlarged hearts happen for a multitude of reasons, but I would suspect that most of the pathologic reasons for heart enlargement (bad reasons) would cause you to have a decreased exercise tolerance and you would fatigue too easily and not recover well amongst other symptoms. Exercise tends to thicken the heart wall muscle, but not to a point of inefficiency.

Of course if you feel better seeing a cardiologist for the piece of mind, please do so and see what he/she thinks.

Cycling for fitness and pleasure

I am a 61-year-old female, quite fit, and until very recently a regular gym user. I used weight machines and aerobic machines. I am coming to resent the boredom and lack of return from going to the gym - I just don't feel the gain is equal to the effort. I used to love cycling when I was young and have decided to start again.

My only health problem has been wear and tear in my knees - which started early in life; when I was about 35 years old, and has now become chronic. I control the pain with codeine when necessary as I can't tolerate any form of aspirin. I find that when I have been exercising the pain lessens for the most part, except for the odd time when it flares up. Am I right in thinking that cycling will replace the aerobic activity and also build up the muscle in my legs? I am thinking of a mountain bike.

Jackie Ryan

Kim Morrow Replies

Hi Jackie,

The cardiorespiratory benefits from cycling will be very similar to other aerobic activity that you may have done in the gym. I'd suggest checking with your physician regarding your knee problems and to answer all questions you may have regarding beginning a cycling program. Also, you would want to make sure that you have a proper bike fit for your new bike, so that your knee problems are not aggravated. You may also consider taking a few bike skills sessions if you have been off the bike for a while. This will help you feel more comfortable with riding in traffic, in groups, etc. In general, cycling is a great activity and certainly beats the boredom of working out solely in the gym!

Hammertoe and cycling

Hello,

I was recently diagnosed with a minor case of Hammertoe on my pinky toe. I inquired what possible treatment there might be for a competitive cyclist and the doctor could only tell me "padding". Surgery is an option but since it is such a small case it would probably cause more long-term harm than short-term relief.

Are there any other remedies that I could try to help relieve my foot pain? I'm already using orthodics and I'd prefer not to buy new shoes since the price point is so high. How have others handled this?

Nathan

Steve Hogg Replies

For similarly afflicted riders use I corn pads. These are like a padded sleeve that fits over the toe and have found them to be quite effective in many cases. How effective comes down to two things; the basic suitability in a fit sense of the shoe they were using, and how severe the problem was to start with. Another handy trick is to take the insole out of the shoe, place your foot on it and using a pen, mark around the toe from webbing on the inside to just before the metatarsal joint on the outside. Once this is done, cutaway the insole in that area, using you pen line as a guide. If that and or corn pads doesn't work the bottom line is that if you are in enough pain, the price of new shoes becomes secondary. If you have to look at new shoes, look for ones with a wide toe box. DMT and Shimano stand out in road shoes but they are not alone, so try a few others as well. If you get to that point and can't find anything you are happy with, consider custom made shoes. On the better ones, a cast is taken of your foot, a foot mould is made from that and then a shoe is made around the cast.

Cycling with a fever

Reading a number of articles about the pro riders it seems that they still race even when they have a fever. I would have thought that this was quite a dangerous thing to do as I know of one person locally who died while running and I personally know someone who was taken to hospital with a heart rate of 300; it was fibrillating at the time, doing an orienteering event. Both people thought that they had a flu-type disease but tried to run through this.

Is this just a bad idea or is there something about cycling that is safer than running?

Cheers

Brett Rallings

Scott Saifer Replies

Hi Brett,

No, cycling is not safer than running on this measure. How many runners have run with fevers and not died though? Probably quite a few.

High heart rate

I'm a 20 year old male and I've been riding for a couple of years. But my main focus has been running for about five years now. I'm thinking of changing that and getting into cycling for my college team.

I'm 5'10 and I weigh 150lbs. I recently bought an HRM and have been wearing it for the past three weeks. My question relates to my heart rate. My resting heart rate averages out to about 85 and the max I've been able to hit is 197 (only a couple of times).
I was expecting my resting heart rate to be much lower. Is this range normal or could there be some underlying problem, if these values are unusual? Your help would be very much appreciated.

Vikram Singh

Scott Saifer Replies

Hi Vikram,

A resting heart rate of 85 is very unusual for a trained athlete, even an overtrained one. When you say resting, do you mean lying on your back, relaxed resting or sitting on your bike between hard efforts resting? If you are seeing a resting heart rate of 85 while lying down for 20 minutes or more and not thinking about anything exciting, make an appointment to see you physician. There are several possible explanations that are not horrible but should definitely be attended to.

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