Fitness questions and answers for November 1, 2004

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.

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.

Improving weaknesses
Winter track training
Choosing a coach
Supplements
Core strength
Alcohol and fitness
More bike fit
Phosphoric acid and nutrient removal
Kidney issues
Flat feet redux
Knee problem redux

Improving weaknesses

I'm a 29 year old Cat 3 cyclist who has been road racing for about 3 years. Although I have seen tremendous improvement in these 3 years in general fitness, I still have a lot to accomplish on the racing circuit. This year, I participated in about 25 races, both crits and road races in that featured rolling terrain and moderate to steep climbs. I finished all races entered in the top 20 with the exception of 2 that I crashed in and 2 where I just missed the top 20. I had quite a few 10th-15th places and a few top 10s but nothing ever better than a 5th. This showed growth from 2003 where I DNF'd quite a bit.

In the beginning of the season I felt that my lack of results was due to a lack of experience and positioning because I felt that I held better fitness than the rest of the field. However, as the season progressed, the racing seemed to get much tougher and I was having some difficulty getting at the front in certain races.

If you were an announcer in a booth and were to sum up my racing for 2004 it would be "A strong all arounder who looks comfortable the entire race, riding where he feels comfortable, getting into non-winning breaks, but not able to seal the deal at the last kilo."

After looking back on my races, I feel that I should focus on two things.

1. Be able to key in on winning breakaway moves and be able to stick with them. Focus on training muscular endurance and TT power.

2. Focus on the closing 2 to 5 minute power that is needed at the end of the race. (I've got a pretty decent sprint when I'm rested, but after racing for an hour or longer, I've burned some of those matches.)

What, specifically should I be doing when I start building up these systems in my build phase of my training regimen in order to increase my chances of doing better in 2005? I have plenty of time, a power meter, and a passion to get better.

Calvin Washington

Ric Stern replies:

Firstly congratulations on the huge improvements you've made from being a DNF to a contender. That's no small feat within one season, and you should feel happy that you've done well, so far.

The first question that needs to be asked is: why aren't you getting into the race-winning break? If you tend to race in one particular locale all season, it may frequently be the same faces who are always in the winning break. Take note of them, and when the race comes to crunch time make sure you're either on their wheel or nearby so that you can go with any race winning potential move. Of course, you also need to keep an eye out for other likely candidates who you don't know and who may make what appears to be a race winning move.

As you've not been racing that long, if you're in a team ask around to see who the usual winners are so that you can mark them. Also, if you're in a team make sure you all work together for a team victory, rather than chasing team mates down.

As regards the training aspect, to excel you need a high lactate threshold, a high MAP, good anaerobic work capacity, and possibly good peak (sprint) power.

To increase your LT and TT power (which are different, but highly correlated) you need to train at intensities which stimulate these metrics, this would include, quality endurance training at zones 2 and 3, and TT type intervals at zone 4. The frequency and volume of these sessions and intervals will depend on many factors, including your fitness, goals, time of year, time available, etc. However, the zone 4 intervals should be of 15 to 30-mins duration, with one to four intervals, repeated once or twice a week. The core of your training should be zone 2 and 3.

Intervals at zone 5 and 6 will help increase your MAP (which is also correlated with your LT and TTpower) and VO2max. These maybe done a little less frequently in the off-season, but you should generally do some (during this period) to prevent a significant decline in fitness. This type of training can be seen here: www.cyclingnews.com/fitness/trainingstern.shtml and would also include doing some efforts uphill as well (over climbs of say 2 to 8 minutes).

Even less frequently in the off-season you may also do some tough zone 7 intervals of 30-secs duration. In general i would probably just do an odd one or two at this time of year.

All of these workloads will help with the various aspects of where you can improve.

The prescribed zones can be seen here: www.cyclingnews.com/fitness/?id=powerstern.

I'd also suggest that a coach such as ourselves at RST (www.cyclecoach.com) or one of the others at www.cyclingnews.com will be able to help you and really get the best out of yourself. Having an objective 3rd party can help see the big picture and make sure you don't end up doing the wrong training.

Winter track training

I've got access to a Tuesday night training session on an indoor velodrome this winter and wouldn't mind incorporating this into my winter program with turbo, weights etc. Not having done this type of work out before I'm not sure how to fit this into my regime. Should I leave it till after base/weights or crack on now and use it all winter?

Andy Walne
UK

Ric Stern replies:

In part this may depend on many factors such as your current fitness level, how intense the sessions are going to be (are they likely to turn into races?), your goals for next season, and may also depend on your track craft (e.g., you maybe able to ride a wheel very well, and thus you may be taking it quite easy).

For example, if your current fitness level is somewhat below the other riders at the track, and the sessions are going to be intense, then this may be too much for you. On the other hand, if you're quite time limited with training or want to maintain your fitness over the winter -- so that you don't find yourself at the beginning of next season desperately trying to regain some race fitness then this may be just the ticket for you (and others).

If you've had a hard racing season, you may however, want to ease down and take things a little easier for a period of time, and thus the track may not be a great idea right now.

Additionally, assuming that you race in endurance events (i.e., races > about 90-secs) there's no evidence that weight training will help you. However, if you did decide to do weights which maybe primarily for other reasons (e.g., to increase strength to help with other activities) then having lots of moderately or high intense work maybe too much for the winter season and could possibly leave you overly fatigued for the summer race season.

In summary, for many people I see no reason why you shouldn't do some moderate or high intensity work regularly over the winter months. Many riders do this with no adverse effects, for example, many roadies compete at track or cyclocross over the winter and road in the summer. It certainly maybe more interesting than thrashing yourself on the turbo trainer on mid-week days after work (etc). Be aware however, that you may need to schedule in some adequate recovery periods between the different race seasons, which maybe one to several weeks duration where the riding is fairly easy.

Choosing a coach

I'm a 47 year old female cat.3 road racer. I do well on climbs and can hold my own in sprints.

In 2002 I used a coach that had a large variety of training regimens. I had a very good season under her and secured many top three results and better! In 2003 I used a different coach since the first coach I used left coaching. I found the work-outs to be good but not much variety and kind of dull. I still had a very good season but felt something was lacking in my training. My question is, how do you interview a coach? How do you know what type of work-outs they will give you? Can you tell them what you want or are they there to tell you what you want!

Also, can I just use the print-outs from my previous coaching and not get a coach at all? My goals really are about the same, to race, do well and have fun.

Liz

Scott Saifer replies:

If all you are getting from your coach is the training plan, you can just reuse the old training plan, but I would suggest getting a different coach. A good coach does much more than provide training plans. He or she should be talking with you regularly to help you understand when deviating from the plan will be more valuable than following it, helping you to decide when to take time off for illness and when to return to training, helping you see a larger picture so that working together you can identify weaknesses that you would not otherwise have noticed or identified correctly, talking to you about equipment choices, tactics and the dozens (hundreds?) of other things that can make the difference between a bad race and a good one, or a good one and a great one and reviewing your training and racing with you so that you can tweak your program to make the best use of your time.

Since you had a good season, you'd probably have a similarly good season if you repeated the old plan, but you might have a stellar season if you worked with someone who could help you improve on the old program from which you may already have gotten the majority of the benefit.

If there are particular exercises you want to see in a program, you can certainly ask a potential coach if he or she would include them. The coach should either include them or tell you why they are not suitable for you. For my own part, I believe that if athletes are going to succeed as bike racers, they have to love riding the bike enough for its own sake not to need huge amounts of variety. I have a library of several hundred exercises that I occasionally assign, but most of my clients will only see a dozen or so as the rest simply will not be useful or beneficial for each of them.

Supplements

I'm an avid cyclist, 41, in good shape, eat a healthy, well balanced diet and train regularly. I participate in a few local races every season but I always finish in the middle of the pack. I'd simply like to know if there is any truth to the performance enhancements that certain "legal" natural supplements claim to give, like creatine, spirulina, co-enzyme Q10.... Do they really work or am I simply throwing away my money?

Vincent Desmarais

Pam Hinton replies:

It's only human nature to seek an advantage over your competitors and to take the path of least resistance in doing so. Hence, the $19.4 billion per year supplement industry.

Because of the way dietary supplements are regulated, at least in the United States, manufacturers may put essentially any performance-related claim on the label, even if it is unsubstantiated. The fact that most labels make grandiose claims, promising results that are too good to be true, should be a red flag that someone is trying to sell you snake oil. Unlike food and drugs, the Food and Drug Administration does not monitor supplements for ingredient content or purity. In other words, the ingredients on the label may or may not be present and additional compounds not listed on the label may be included. For example, small amounts of anabolic steroids have been found in supplements that claim to increase muscle mass. Many supplements that are evaluated by consumer protection groups are found to contain much less of the active ingredient than what is listed on the label. Both of these practices are illegal, but without quality control of the supplement industry, they nonetheless do take place. So safety of dietary supplements is a concern. Between 1995 and 1999, there were 2,500 adverse events reported to the U.S. FDA by consumers, healthcare professionals, and poison control centers. It is estimated that this represents only one percent of the actual adverse events.

Most of us could finish further up in the pack if we trained more often or at a higher intensity, lost a few extra pounds of body fat, ate better, or got more sleep. You say that you participate in "a few local races every season". Don't let your middle-of-the-pack finishes discourage you from pinning on a race number and lining up. There is no substitute for experience to work on positioning in the pack, cornering, getting the right break, timing your sprint, etc. These are all skills that can be learned and will improve your placing. If you feel you need to spend some money, a set of racing wheels or lighter frame would be a better investment. At least you'd have something to show for your money other than supplement-enriched urine.

Supplements have value when they are taken to correct a nutrient deficiency. For example, an individual with iron-deficiency anemia will obviously benefit from an iron supplement. The rest of the time, you are just throwing your money away.

Core strength

Could you recommend a good book on core strengthening techniques. Also do you think this is a good addition to cycling training. Is pilates the same thing? It seems like a good alternative to the weight room, what do you think?

Andrew Australia

Steve Hogg replies:

No doubt there are other good books out there about this subject, but one that I recommend is ' Pilates For Dummies' by Ellie Herman. It is available in most larger bookshops and is well laid out. Everything is explained in a simple and methodical way.

Pilates or any other core strengthening method is a worthwhile addition to your training regimen. The better you function off the bike, the better you will function on the bike. While I am no enemy of weights, most people are better served by getting their bodies to function well mechanically by core strengthening before they set about increasing their strength in an external sense.

Alcohol and fitness

What effect does alcohol have on a cyclist's fitness? You always hear that a glass of wine at the dinner table is good for the heart, but will a few drinks occasionally harm you fitness? What about getting home and having a beer at dinner?

Raff

Pam Hinton replies:

The effect of alcohol on a cyclist's fitness is pretty much the same as how a Highway Patrol trooper looks at it in conjunction with operating a motor vehicle-it depends on how much alcohol is consumed and when. Having a beer when you get home is not going to adversely affect your fitness. That's the short answer to your question. Now just like that trooper I mentioned, we'll go over just the facts.

When ethanol is metabolized in the liver, it forms acetate and acetaldehyde. ATP can be made from acetate using the metabolic pathway by which ATP is made from fat. Acetate (like fat) cannot be used to make glucose, so it cannot be used to replenish glycogen stores. So, as long as you consume adequate carbohydrate with your beer, you are still going to replenish your muscle glycogen. This was shown in a study of well-trained cyclists who exercised for 2 hours to deplete their glycogen stores and then consumed one of three test meals to look at the effects of alcohol ingestion on glycogen synthesis in muscle. The three test meals were: carbohydrate (CHO), providing 7 g CHO and 24 kcal per kg body weight; alcohol (A), providing 1 g CHO, 1.5 g alcohol and 24 kcal per kg BW; and carbohydrate + alcohol (CHO+A), providing 7 g CHO, 1.5 g alcohol, and 34 kcal per kg BW). The alcohol, equivalent to 10 drinks, was consumed in the first 3 hours after exercise. Muscle biopsies of the quad were taken 8 and 24 hours after the subjects finished exercising. Although both groups that consumed alcohol had lower blood glucose levels-at 8 and 24 hours-than the CHO group, muscle glycogen was lower only in the A group. So moderate amounts of alcohol that are metabolized before you go out for a training ride or race, are not going to hurt your fitness.

Trying to train with alcohol on board is another matter. The acute effects of alcohol ingestion on performance tend to be negative and are dose-dependent. Psychomotor function is impaired and small to moderate doses of alcohol (2-4 ounces of alcohol): slow reaction time; interfere with eye-hand coordination, accuracy and balance; and make performing gross motor skills more difficult. Alcohol causes vasodilation of blood vessels and loss of body heat, increasing the risk of hypothermia when exercising in the cold. Another reason not to drink and ride is that alcohol lowers blood glucose and decreases glucose uptake by skeletal muscle, which means you're more likely to bonk.

When, however, you see one of those guys in street clothes riding a bike with the downturn bars turned straight up and smoking a cigarette, if he is weaving, he may be bonking, but it probably ain't from too many miles.

More bike fit

I've read with great interest Steve Hogg's ideas on dynamic fitting of bike to rider, including cleat position, seat fore-aft and seat height adjustments. I've been fiddling with these three following Steve's rule-of-thumbs and think I am getting close to an optimal position. However, I am still getting neck pain on longer rides and during and after long descents (when I've got hands in the drops), so was wondering if there are any rules-of-thumb for setting handle bar height and stem length. I already have the bars as heigh as I can get them, but obviously you can't adjust stem length without buying a new stem. To avoid having a box full of progressively shorter stems to try out are there any suggestions for estimating what might be an optimal stem length (or saddle to handle bar distance).

Jeremy Austin
Melbourne, VIC, Australia

Steve Hogg replies:

Can you beg or borrow a Look Ergostem? They are an adjustable stem with articulating joints that has massive adjustment potential. With one of those, the bar height and length can be played with until you feel you have reached an ideal position.

There are no measurement-based methods for resolving your problem that have any validity as a rider in a dynamic sense, is much more than the sum of their measurements.

If you have a good relationship with a local shop, see if you can spend time on an indoor trainer there while 'test riding' a few stems. Most shops with any idea of customer service should not have a problem with that.

If that is not the case, you could do a lot worse than ring John Kennedy for advice on 03 9589 3399. He would have no problem with that at all.

Phosphoric acid and nutrient removal

I am a 46 year old cyclist, riding to keep fit and the occasional audax. I read in a magazine (which I have now lost) that the phosphoric acid found in carbonated drinks like Pepsi, Coke etc can remove nutrients from the body. The article didn't go into a any detail and I wondered whether this was true. Do you know what nutrients are lost, and how much phosphoric acid does it take. How much damage would an ordinary can of one of these drinks do ? I am trying to give up these drinks so any info would be helpful.

Euan Bull

Pam Hinton replies:

The main source of phosphoric acid in our diets is soda. Because of the association between soda consumption and increased risk of bone fractures, the constituents of soda (caffeine, phosphoric acid, citric acid and fructose) have been scrutinized for their potential to cause calcium loss from bone. Anyone who has ever soaked a bone in vinegar would agree that phosphoric acid probably causes a loss of calcium and a weakening of the bones. However, what we observe in the test tube is not always what happens in the body, which has the ability to maintain constant internal conditions, including acidity of the blood. A recent study compared the effects of caffeine, phosphoric acid, and citric acid (consumed in soda) on calcium excretion in the urine. Subjects consumed 20 ounces of either: caffeinated cola (Coke, containing caffeine and phosphoric acid); non-caffeinated cola (Coke-Free, phosphoric acid only); caffeinated non-cola (Mt. Dew, caffeine and citric acid); or non-caffeinated, non-cola (Sprite, citric acid only). Neither phosphoric acid nor citric acid increased calcium loss. Consumption of the caffeinated sodas caused an increase in calcium excretion, but the effect was small (6-14mg) compared to the recommended daily calcium intake (1000 mg).

When the kidney's ability to excrete acid is compromised, as in chronic renal failure, and the body is exposed to very high acid loads, then appreciable amounts of calcium may be lost from bone. However, in a healthy individual, the acid load that results from the phosphoric acid in 20 ounces of soda is very small (4.5-5.0mEq), which is much less than the acid load produced during normal metabolism of food (50-100mEq). Consuming seven 12-ounce colas per day would only produce an acid load of 20mEq, which is well within the excretory capacity of the kidney.

So, if colas don't increase calcium loss from bone, how do we explain the apparent dose-response between soda consumption and fracture risk? The answer, most likely, is not what's in the soda, but what's missing. Give up these drinks, replace them with milk, and you'll get the calcium, phosphorous, vitamins D, A, and K that you need to keep your bones strong.

Kidney issues

I am a 37 year old recreational rider. I have been riding for four years. Early this year I stepped up my training to prepare for and complete the Markleville Death Ride 130 miles, 16,000 feet of climbing. About a month before the ride I had a physical and urinalysis done for a life insurance application. I was denied insurance because I had too much protein in my urine. I went to several doctors to determine what was going on and had several more UA's done. In September a nephrologist diagnosed me with "a textbook case of acute tubular necrosis" (ATN). He says that my kidneys were damaged but will (most likely) recover over time. In October the amount of protein in my urine has not decreased and the doc says that is OK since it is not increasing. He has told me to continue my life/ riding as though nothing is wrong and we will monitor my progress over the next few months.

My question is two-fold: The doctor told me that the ATN was most likely caused by a severe dehydration event(s). I have been involved in outdoor sports for my entire life and know how to stay hydrated and don't think that I was dehydrated at any point this year. Other than basics of drinking plenty of water and the occasional sports drink and eating food before, after and while riding to stay hydrated, is there anything I can or should be doing? For example would any of the many sports recovery / electrolyte drinks on the market help me to stay better hydrated than just diligent water consumption? And secondly, is this diagnosis common among cyclists and if so how long have other riders taken to get there urine back in to normal ranges.

Spencer Rubin
Coloma, CA USA

Pam Hinton replies:

Acute tubular necrosis (ATN), translated, means "sudden death of kidney cells." ATN is characterized by a sudden decline in kidney function, which can progress to kidney failure and death. Specifically, the kidney loses its ability to excrete waste products, so urea and ammonia accumulate in the blood. The ability to regulate electrolytes, sodium, acid and water is also severely compromised. ATN is common among hospitalized patients and patients in intensive care units, resulting from an infectious, toxic, or ischemic injury to the kidney. In endurance athletes, ATN most likely results from a pathological condition, exertional rhabdomyolysis. Rhabdomyolysis is characterized by severe muscle damage, followed by release of the contents of the muscle cells into the blood stream. Myoglobin, the oxygen-binding protein in muscle, is one of the cellular degradation products released into the blood. When myoglobin reaches the kidneys it contributes to the onset of ATN: it obstructs blood flow in the kidney; it is metabolized into compounds that are toxic to the kidney; and it contributes to formation of precipitates in the kidney which block blood flow. Dehydration also contributes to the development of rhabdomyolysis. Loss of body water results in decreased blood volume and decreased organ blood flow, which deprives the kidney of nutrients and oxygen.

Because you may have some residual damage, you are at greater risk for developing ATN again. Your best bet to prevent another occurrence is to avoid dehydration. For this reason, you may want to avoid participating in events where the potential for dehydration is high - extreme heat, dry climates, unsupported events, etc. But as you physician has advised, you must live your life and do the things you love to do as far as that is reasonable to do. As you note, staying adequately hydrated is key. I have a friend who sets his wristwatch alarm to remind him to drink at regular intervals. You'll need to develop some habits like that. In general, commercial sports beverages that contain sodium are superior to plain water because they speed fluid absorption and increase voluntary fluid intake.

The prevalence of ATN in cyclists is unknown, but is relatively rare. In the United States there are 26,000 cases of rhambdomyolysis reported per year and only a fraction of these will develop ATN.

Flat feet redux

Thanks for the great advice, I've been looking at my position in regards to your suggestions and am going to move my cleats back and see how that works. My leg length discrepancy is measurable. I was x-rayed and measured by a physical therapist, I don't remember the exact measurement but my right femur is shorter than my left on. Not a whole lot, but measurable. Do you have any recommendations on compensating for this in positioning? I've been looking into the LeWedge system, which claims to be able to help with this type of issue. Thanks again for your help.

Andy Weir

Steve Hogg replies:

There are rules of thumb for accommodating femur length discrepancies with a packer under the cleat. Like all rules of thumb, they often have limited relevance in any particular case. Equally, leg length discrepancies can often cause other changes in a functional sense that mean any packer used may need to be more, or often significantly less, than the measurable discrepancy.

The question I would ask is do both legs feel much the same in their pedaling action?

If one feels more fluid than the other, is it the short leg or the long leg? Let me know about that and I will attempt to advise further. Re the LeMond Wedges. They work well but can be clumsy if a significant number have to be used. Often it is a good idea once you have arrived at what you believe to be the right number to use, whether counterstacked to gain height or used as wedges, to glue them together.

Knee problem redux

Further to my email from 6th October, I have seen my physio & a local osteopath, who have both tracked the problem back to the femoral nerve. It seems the pain is coming from the L1, L2 & L3 region of my lumbar region which is referring the pain through to my knee.

My physio did some work on my back which helped a little, but I had a huge improvement from my first visit to the osteopath, things have improved on the bike, but I feel there is still a lot of work to do before I'll feel 100% fit again. My osteopath said my L1, L2 & L3 vertebrae were very stiff (along with my left SI joint) he is also doing soft tissue work on both my back and quad of the affected leg (left) to help. The question still beckons though... what is the cause? Is it just my physiology, or to do with bike set up? The problem (this season) first struck on a 4-hour road ride, so it was the duration that set it off (approx 10 weeks ago) and it has not fully settled down.

The other thing that niggles at my mind is the pain that I get in my left knee, it is on the inside, right on the side/top edge & when it is sore, to touch it is very tender. The osteopath reckons that it fits for a nerve referral pain? The treatment he is doing suggests that it is, but I can't help but wonder if it is merely relieving the symptom, and that the cause is something different. I'm not sure, it's a really difficult one to track. I feel sure that my alignment is good & that I don't appear to have any external rotation during the pedal stoke. I am getting checked out again by my podiatrist next week for this just to be sure. I agree that the pain is not coming from the knee itself though.

I will let you know how I get on, in the meantime Steve, I would welcome any other suggestions you may have? (I have not yet checked for hip drop as you suggested, thought it best to get this checked out with my podiatrist?)

Grant Anderson
Alexandra, New Zealand

Steve Hogg replies:

It is hard to answer with any certainty about whether your problem is caused by the bike or was pre-existing and was exacerbated by the bike. The greater likelihood is that you already had the problem but it had not bitten you yet. When we have a functional problem our bodies will accommodate the problem by functioning in a different and less efficient way. Sooner or later we have to pay a price for that. In your case for instance; if your left sacro - iliac joint is restricted as you say, then the ilium and hip on that side will tend to function as a unit instead on independently.

What usually happens is that there will be a noticeable hip drop on the affected side on the pedal downstroke. From behind this gives the appearance of a short leg but often is not in a measurable sense. Packing up the cleat does no good in most cases because the problem starts higher up the chain and the hip will drop with or without a packer.

Usually, the seat needs to built up on the affected side to minimise how far the hip drops; and while this will work to a greater or lesser degree, it is a band aid and not nearly as good as solving the root cause problem. An in shoe orthotic can help but at best it only takes the edge off the problem as the root cause is further up the pedaling chain. When as you do, there are significant issues with pelvic or lower back function, the effects of this cannot help but flow outwards to the periphery on a bike. If there is a lesson to be learnt here, it is that structural fitness needs to assume a higher priority in your training program. When anyone has a chronic issue it is never because their lungs are too big or their muscles too strong, but rather because their body as a structure cannot cope with the stresses their ' engine' allows them to place on it.

Given what you have found about your lower back function, I am not surprised that your knee hurts. There are the reasons you have been given by the health professionals to which I would add the likelihood that you are rolling your left knee inwards on the downstroke. This is very common with a restricted SIJ.

Go back to your osteopath as you got good results there, but wrap your head around the idea that maintaining your structure needs to be more important than maintaining your engine. As a rule of thumb; whatever time you allot for training in any given week, in your situation 25 - 30% needs to be set aside to improve the way you function and come back from the situation you find yourself in, possible more.

A couple of good self education books so you can learn more about how to help resolve the problems are; "Overcome Neck and Back Pain" and "Stretching and Flexibility" both by Kit Laughlin, and "Anatomy Of The Moving Body" by Theodore Dimon. All of these are easy to read and a lot can be learnt in a practical sense.

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