Fitness questions and answers for October 1, 2008

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.

Jon Heidemann (www.peaktopeaktraining.com) is a USAC Elite Certified cycling coach with a BA in Health Sciences from the University of Wyoming. The 2001 Masters National Road Champion has competed at the Elite level nationally and internationally for over 14 years. As co-owner of Peak to Peak Training Systems, Jon has helped athletes of all ages earn over 84 podium medals at National & World Championship events during the past 8 years.

Dave Palese (www.davepalese.com) is a USA Cycling licensed coach and masters' class road racer with 16 years' race experience. He coaches racers and riders of all abilities from his home in southern Maine, USA, where he lives with his wife Sheryl, daughter Molly, and two cats, Miranda and Mu-Mu.

Kelby Bethards, MD received a Bachelor of Science in Electrical Engineering from Iowa State University (1994) before obtaining an M.D. from the University of Iowa College of Medicine in 2000. Has been a racing cyclist 'on and off' for 20 years, and when time allows, he races Cat 3 and 35+. He is a team physician for two local Ft Collins, CO, teams, and currently works Family Practice in multiple settings: rural, urgent care, inpatient and the like.

Fiona Lockhart (www.trainright.com) is a USA Cycling Expert Coach, and holds certifications from USA Weightlifting (Sports Performance Coach), the National Strength and Conditioning Association (Certified Strength and Conditioning Coach), and the National Academy for Sports Nutrition (Primary Sports Nutritionist). She is the Sports Science Editor for Carmichael Training Systems, and has been working in the strength and conditioning and endurance sports fields for over 10 years; she's also a competitive mountain biker.

Eddie Monnier (www.velo-fit.com) is a USA Cycling certified Elite Coach and a Category II racer. He holds undergraduate degrees in anthropology (with departmental honors) and philosophy from Emory University and an MBA from The Wharton School of Business.

Eddie is a proponent of training with power. He coaches cyclists (track, road and mountain bike) of all abilities and with wide ranging goals (with and without power meters). He uses internet tools to coach riders from any geography.

David Fleckenstein, MPT (www.physiopt.com) is a physical therapist practicing in Boise, ID. His clients have included World and U.S. champions, Olympic athletes and numerous professional athletes. He received his B.S. in Biology/Genetics from Penn State and his Master's degree in Physical Therapy from Emory University. He specializes in manual medicine treatment and specific retraining of spine and joint stabilization musculature. He is a former Cat I road racer and Expert mountain biker.

Since 1986 Steve Hogg (www.cyclefitcentre.com) has owned and operated Pedal Pushers, a cycle shop specialising in rider positioning and custom bicycles. In that time he has positioned riders from all cycling disciplines and of all levels of ability with every concievable cycling problem. Clients range from recreational riders and riders with disabilities to World and National champions.

Current riders that Steve has positioned include Davitamon-Lotto's Nick Gates, Discovery's Hayden Roulston, National Road Series champion, Jessica Ridder and National and State Time Trial champion, Peter Milostic.

Pamela Hinton has a bachelor's degree in Molecular Biology and a doctoral degree in Nutritional Sciences, both from the University of Wisconsin-Madison. She did postdoctoral training at Cornell University and is now an assistant professor of Nutritional Sciences at the University of Missouri-Columbia where she studies the effects of iron deficiency on adaptations to endurance training and the consequences of exercise-associated changes in menstrual function on bone health.

Pam was an All-American in track while at the UW. She started cycling competitively in 2003 and is the defending Missouri State Road Champion. Pam writes a nutrition column for Giana Roberge's Team Speed Queen Newsletter.

Dario Fredrick (www.wholeathlete.com) is an exercise physiologist and head coach for Whole Athlete™. He is a former category 1 & semi-pro MTB racer. Dario holds a masters degree in exercise science and a bachelors in sport psychology.

Scott Saifer (www.wenzelcoaching.com) has a Masters Degree in exercise physiology and sports psychology and has personally coached over 300 athletes of all levels in his 10 years of coaching with Wenzel Coaching.

Kendra Wenzel (www.wenzelcoaching.com) is a head coach with Wenzel Coaching with 17 years of racing and coaching experience and is coauthor of the book Bike Racing 101.

Steve Owens (www.coloradopremiertraining.com) is a USA Cycling certified coach, exercise physiologist and owner of Colorado Premier Training. Steve has worked with both the United States Olympic Committee and Guatemalan Olympic Committee as an Exercise Physiologist. He holds a B.S. in Exercise & Sports Science and currently works with multiple national champions, professionals and World Cup level cyclists.

Through his highly customized online training format, Steve and his handpicked team of coaches at Colorado Premier Training work with cyclists and multisport athletes around the world.

Richard Stern (www.cyclecoach.com) is Head Coach of Richard Stern Training, a Level 3 Coach with the Association of British Cycling Coaches, a Sports Scientist, and a writer. He has been professionally coaching cyclists and triathletes since 1998 at all levels from professional to recreational. He is a leading expert in coaching with power output and all power meters. Richard has been a competitive cyclist for 20 years

Andy Bloomer (www.cyclecoach.com) is an Associate Coach and sport scientist with Richard Stern Training. He is a member of the Association of British Cycling Coaches (ABCC) and a member of the British Association of Sport and Exercise Sciences (BASES). In his role as Exercise Physiologist at Staffordshire University Sports Performance Centre, he has conducted physiological testing and offered training and coaching advice to athletes from all sports for the past 4 years. Andy has been a competitive cyclist for many years.

Michael Smartt (www.wholeathlete.com) is an Associate Coach with Whole Athlete™. He holds a Masters degree in exercise physiology, is a USA Cycling Level I (Elite) Coach and is certified by the NSCA (Certified Strength and Conditioning Specialist). Michael has more than 10 years competitive experience, primarily on the road, but also in cross and mountain biking. He is currently focused on coaching road cyclists from Jr. to elite levels, but also advises triathletes and Paralympians. Michael is a strong advocate of training with power and has over 5 years experience with the use and analysis of power meters. Michael also spent the 2007 season as the Team Coach for the Value Act Capital Women's Cycling Team.

Earl Zimmermann (www.wenzelcoaching.com) has over 12 years of racing experience and is a USA Cycling Level II Coach. He brings a wealth of personal competitive experience to his clients. He coaches athletes from beginner to elite in various disciplines including road and track cycling, running and triathlon.

Advice presented in Cyclingnews' fitness pages is provided for educational purposes only and is not intended to be specific advice for individual athletes. If you follow the educational information found on Cyclingnews, you do so at your own risk. You should consult with your physician before beginning any exercise program.

MCL tear and cycling level
Heels hit the crank
Crank arm length
Knee pain and Synvisc treatment
Knee pain

MCL tear and cycling level

My right knee suffered a MCL tear level 2, about 4 weeks ago, inside of knee, the Orthopaedic surgeon did x-rays and decided, based on the fact that it wobbled like limp noodles, it was level 2 but no surgery.

I have a lateral stability brace w full range of motion. I started physio therapy with ultrasound, electric stimulation, ice and heat alternating.

Also I was allowed to ride the indoor trainer easy with no cleats so I wouldn't twist it getting in or out of pedals. Now I'm allowed to ride outside, with cleats, but only on the flats.

Neither physiotherapy nor the surgeon could tell me exactly what level I could train at.

I'm a cat 2 racer of 25+ years of racing. Normally I spin at 90-100 rpm on the flats but for some reason it feels more stable to ride at low rpm with this injury. I'm doing some walking, cycling and the PT exercises with leg straight, calf raises and leg curls as well as upper body weights.

So, my questions are:

1 How hard can I go in a seated position while allowing maximum healing? Length of ride?
2 if lateral motion is controlled by the brace, what can be damaged by cycling at high intensity? Why can't I ride uphill if I'm not even anaerobic?
3 Is it better to stay at low rpm or spin?
4 Is there any way that cycling can damage or slow the healing?

Ann

David Fleckenstein replies:

This question falls into the "ask 5 providers and get 10 answers" category, because treatment with MCL's can differ significantly. The good news is that, since the MCL is extra-capsular (as compared to your ACL and PCL), it has a good blood supply and generally heals without surgery.

Personally, I use the bike to maintain aerobic fitness for all of my clients who have MCL tears and I encourage them to ride as aggressively as they wish, provided they have a fairly neutral pedal stroke. If you were my client I would allow you to ride to your tolerance, including hills, maintaining a seated position. I would ask you to be respectful of the injury and, if there is swelling or pain with increased intensity, you should moderate so that every ride is a "successful" ride. At 6 weeks I would allow you into clipless pedals with the retention set to low resistance. This is also an injury that I think Speedplay pedals is good for - it allows relatively frictionless rotation and fairly easy entry/exit.

Heels hit the crank

My husband's feet point out. One foot in particular points out at such an angle that his heel hits the crank arm with each revolution. If we try to straighten his feet so he doesn't hit the crank arm, then his inner knee suffers quite a bit of pain to the point where he has almost given up cycling all together. Are there any spacers or something mechanical that can be added between the pedals and the crank so he feet can rest more naturally on the pedal without hitting the cranks?

Marsha Kirschbaum

Scott Saifer replies:

I think you want a "Knee Saver". Check this link: http://www.kneesaver.net/

Crank arm length

I have been noticing lately that, after hard rides with intervals, my calves are tighter than if I were just pedaling normally on a recovery or aerobic ride. I am 6'3" and run 175mm cranks. I was wondering if that length is too short, thus forcing me to "toe pedal" more frequently, as my limbs are looking for that extra 5 mm on their own, due to the size. I have been toying with getting 180mm cranks, but have heard answers on both ends of the spectrum. Any advice you can give me would be amazing!

Dan Gaz

Scott Saifer replies:

Too-short cranks can indeed cause some excess tension as you force your toes to follow the too-small circle, but that effect is very subtle if the crank length is only off by 5 mm. Have you already set your cleats such that the pedal axle is behind your 1st metatarsal head (the bony bump on the medial side of your foot at the base of the big toe). The distance behind should be in the vicinity of 10 mm for a size 45 or 46 shoe, and 1 extra or less mm for each two additional or less shoe sizes. If the cleats are already set properly and you still feel that excess tension in the calves, it would be worth experimenting with crank length.

Daniel replies:

I assume they have been set up properly, as they were fitted by my LBS twice, when my bike was adjusted. I will check and see, but if that has already been done, would it be time to play with new crank arm lengths? Thanks for your response!

Scott Saifer replies:

Many local bike shops use a sloppier "put the pedal spindle under the ball of the foot" approach which often puts the cleats farther forward than my recommendation. Having the cleats farther forward increases the lever arm from ankle to pedal-contact, increasing calf tension during pedaling above what it would be with a shorter arm. It's like standing on your toes. My suspicion is that the excess tension in your case is small enough that you don't feel it during lower-intensity riding, but it becomes noticeable when you go harder. If your cleats are indeed set per the recommendation, it would be time to play with new crank arms. If there's any way you can borrow some rather than plunking down cash though, I'd suggest you do that since the longer cranks may or may not fix your problem, and they may induce new problems as well.

Knee pain and Synvisc treatment

I'm a 49 year-old male Cat. 5 racer and avid all around cycling enthusiast and have recently experienced a great deal of discomfort on the inside of my right knee, which has curtailed any biking activity for the past several weeks. I've tried rest, light strengthening and anti inflammatory medications and I just can't seem to escape the pain.

As background, I've had a tear of the meniscus in both of my knees a few years ago, which may have been brought on by running. As a result, I had arthroscopic surgery on my left knee three years ago and a year later tore a meniscus in my right knee and had the same subsequent surgery. At the time of my second surgery, I was diagnosed with cartilage deterioration in my right knee. Since that time, I've rebuilt my strength and conditioning and have turned to biking as my sport of choice. Until recently, I have been pain free, healthy and fit so this has been a real depressing setback for me.

After looking at an x ray, my doctor (the same one who performed the operations previously) suggested the recent pain and discomfort in my knee is a result of this cartilage deterioration and he suggested I try a course of Synvisc. I've heard of the treatment and was wondering if you had any pro or con feelings regarding this course of treatment or perhaps had other alternative suggestions to share.

John

Kelby Bethards replies:

In short it sounds as though you are progressing though the stages of some arthritis. In general there are a few things that I can mention about this. First off, get yourself to a good bike fitter and mention where your pain is and see if a change could be made to your position. Of course, only so much can be done with fit of the bike if one has pre existing arthritis.

In terms of Synvisc injections; I do quite a few of these. Interestingly, I haven't done them much on athletes. They do work well, and I tend to see people get anywhere from 6 months to a year of relief from them. They are not, however, a cure all. They help, but for how long is a bit of a guessing game. You, being fit in general, may get a longer period of relief.

John replies:

Thank you so much for the thoughtful reply. I really appreciate it. I had an x-ray and it does appear that the cartilage has gone missing, which I guess is a cause or a symptom related to arthritis. I am scheduled tomorrow for the first of three Synvisc injections. Your response was encouraging in that regard. I gather there are diminishing returns after time to repeating the process?

I live and work in New York if you have suggestions for a fitter up to this task. I have been fitted by Performance Labs in the past and work with them for a coaching program, but I haven't approached them concerning this condition and a possible suggestion for a different fit. I've also heard positive things about Signature Cycles.

Kelby Bethards replies:

You are correct. There would be diminishing returns to the process. However, it'd be interesting to see how much time you get from the Synvisc injections.

Keep in mind, the injection doesn't work quickly AND I have had a few patients that have a little worse pain during the series, but then it "gets rolling" and feels better.

I'm sorry, I do not know of any fitters that way. In general, they may be able to shim your cleats or footbeds in essence to "unload" that knee area. However, you do not want to make a change that would wear on another area and cause injury that way. Ask around. Hopefully somebody will know of a place to go.

Knee pain

I have just started to experience knee pain for the first time. Just below the knee cap. After using campag pro-fit pedals on DMT Ultimax shoes for years (on both my bikes, plus a weekly ergo session), I upgraded to Keo pedals (4.5 degree float cleats on the same shoes on my road bike).

This is when the problems began.

To complicate matters, I still have campag pro-fit pedals on my fixie, with the cleats mounted to an old pair of Shimano shoes. I also use these Shimano shoes once a week at an ergo session. I have not adjusted the seat position but suspect I may need to

To resolve my knee problems, should I:

- Stick to one pair of shoes/pedal system & if so how do I reconcile the different stack height/float differences?
- Another solution perhaps involving seat adjustments etc.?

Philip
Melbourne, Australia

Steve Hogg replies:

I'm making the assumption that there is no underlying problem because you don't mention any previous knee pain. When changing from Campag Pro Fits to Look Keo pedals and assuming that you are using the same shoes, you will need to drop your seat approximately 8mm.

As you are still riding your fixie with older shoes and Campag pedals, leave that alone. With the Keo equipped bike(s), drop the seat and drop the bars by the same amount.

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