Cyclingnews Fitness Q&A - July 6, 2011

The breathing exercises are less fun than they look.

The breathing exercises are less fun than they look. (Image credit: Rochelle Gilmore)

Topics: Adjustments to setup after changing to a new bike, Breathing exercises, Pudendal Nerve problems, Ankle pain, Returning from extensive shoulder surgery

Got a question for the fitness panel? Send it to Emails may be edited for length or clarity, but we try to publish both questions and answers in their entirety.

To find advice that relates to you more easily:

Adjustments to setup after changing to a new bike

Breathing exercises

Pudendal Nerve problems

Ankle pain

Returning from extensive shoulder surgery

Pain arising after a change in bikes


I am a triathlete and switched bikes last year from a Specialized Transition frame to a Gray Storm frame.

I have narrow hips, I tend to overpronate and toe-out, and my knees tend to brush the top tube as I ride.

When I switched bikes, I retained the majority of my fit measurements, but began to get pain the outside back of my right knee that arises within 15 minutes of being on the bike. My knee angle did not change, so I know seat height is not an issue. From everything I can tell, the pain is in the biceps femoris attachment.

Here is what *did* change when I switched bikes:

1) I have found that on the new bike setup, I am unable to ride with right toes as externally rotated and right heel in without brushing the crank with my right shoe (I use Look Keo). Therefore, my toes are slightly less externally rotated than what I was accustomed to on the previous bike. When I attempt to remedy this issue by switching to a pedal with a longer axle (Speedplay), or by moving my cleats medially, my Q-angle changes enough to where I begin to get pain on the *inside* of the right knee, feel as if I'm pedalling bowlegged and my hips feel unnaturally oriented.

2) The top tube of the Gray is nearly twice as thick as the top tube of the Specialized, which means my knees, cannot come in as much at the top of the pedal stroke. This knee pain issue is frustrating and has kept me from enjoying my bike rides. My question is two-fold: 1) are there any pedal/spindle/cleat/crank/seat fore-aft changes that could be made to allow my right foot to be more externally rotated? 2) Would the thickness of the top tube be aggravating this issue?



Steve Hogg says:

Interesting story. I think you've answered your own question. If the only things that have changed are the top tube diameter increase, which prevents your knees moving as close to the centre line as previously, and the angle of your cleat is not quite the same as before, either directly, or indirectly, those changes have caused your problem.

Do you have any foot correction?

I ask, because optimising foot plant on the pedal is the likely solution to your problem. I can't guarantee this, but once you sort that matter out, your feet shouldn't need to rotate as far out; i.e., heels in / toes out as they currently do which will allow you to bring your feet closer to the centre line of the bike and also allow you to have your cleats set at an angle so that both feet naturally sit in the middle of the range of rotational movement offered by the cleat.

Re foot correction, start with arch support as this is the most important aspect in my view. This link will explain how to get the ideal result. Once you have got Level 2 arch support inside your shoes, have a look at this info and experiment with wedges. By the time you have finished that process you should be fine.

A couple more things; If as is likely, the result of correcting your feet results in your them pointing closer to straight ahead, you should be able to bring your feet closer to the centre line of the bike and have them more underneath your knees which is good. However Keos have limited ability to laterally adjust the cleats. If you find this isn't enough, switch to Speedplay as they have more. Additionally, Speedplay make a range of axle lengths including one that is 1/8" shorter than standard.

Ben replies:

Thanks Steve.

I have custom cycling orthotics that provide fabulous arch support.

I also have some BFS Cleat Wedges and I believe I will go on a 'wedge ride' and try the heel wedging approach you recommend. My only concern is that once this is done, medial adjustment of either the Look or the Keo’s, my foot would potentially be rubbing the crank even more than it is now. Or would that possibly be alleviated through the wedge placement?



Steve Hogg says:

G'day Ben,

Not necessarily so. You ride heel in / toe out because the combined effects of your hip lower back function and the feet you have necessitate that to keep your knees tracking more or less okay. If you get the wedging right, and gauge it on feel under foot, not visual alignment, there is a substantial chance that you will pedal less heel in / toe out. I can't be certain as a lot depends on how your function.

Once you have settled on the number of cleat wedges that you feel is ideal, go through the process of determining cleat angle as suggested at the end of this post.

Scroll down to the italicised text at the end.

Breathing problems/Spinning on the hills


I and many others appreciate your consistent and detailed log of advice and information. One thing I would like you to touch on is the importance of breathing, particularly during high intensity exercises like racing. I’m not sure if there is much detail on its merits. I've found that I have to consciously will myself to breathe steadily & deep when I'm near the end of a race in order for me to arrive at the finishing sprint as fresh as possible. Primarily my breathing has been subconscious I would only tend to breathe hard when I'm quite tired and starting to get gassed but now I'm starting to actively breathe hard and deep even when I'm not under much pressure. I've only tried it recently and I'm wondering if it’s something that I need to keep in mind every race/high intensity workout.

Most critically though so far this year I've been noticing a trend for most of my road races. I'm decently strong and competitive for most of the race until the last 1-2km and then I get shot out the back in the closing several hundred meters as guys start winding up for the closing (usually uphill) sprint. I'm a small guy (5'4 130lbs) but I tend to struggle on the hills in the closing lap despite being fairly comfortable on the hills for most of the race.

Part of me wonders if it’s an energy thing but I've found that I tend to bloat easily and eating a bit too much before a high intensity workout makes me feel like I can’t breathe efficiently- but then apparently if I don't eat enough then I won’t have the pop to finish off a race strong. Would a dietician provide a worthwhile return on investment? How do I know how much food before and during a race is the ideal amount. Or maybe my issue also has to do with my cadence. I tend to find that I can spin more easily on the flats and downhills but when the road becomes mildly steep I tend to prefer pushing a slower cadence. Would working on keeping my cadence high on uphills help me arrive with more pop for the closing meters of a road race?


Scott Saifer says:

Hi Novo,

You've packed a bunch of questions in here. I'll do my best to answer the ones I can identify.

Breathing, yes, very good, do it. Hah! Some riders do and some don't breathe efficiently without thinking about it. By all means, if you feel that deliberately breathing more deeply helps your performance, do it, and practice it routinely in training so you won't have to think about it so much when you race.

Make a habit of spinning up all the hills in your races and saving the high force pedalling for the end. When you drop your cadence on the hills you are engaging the higher-force, fast-twitch fibres. They are great for bursts of speed, but they recover poorly during a race, so if you use them on the hills before the end, they won't be as powerful when you need them in the finale. So, learn to spin on the hills, and take enough gears that you can do so on whatever hills you'll find in your races.

Someone your size should be consuming about 175 carbohydrate calories per hour of racing, on top of 100-200 calories just before the race. If you are getting less than that, your late race fade may be due to a lack of carbs.

Not warming up right before a criterium race puts you at a huge disadvantage for the reason you suggested and several others. Bottom line though is that you should be warming up at least 45 minutes before a criterium, increasing from a mellow spin in the first 20 minutes or so, up to a few, short efforts that get your breathing increasing just a little in the last few minutes.

Pudendal Nerve Problem


I was a keen road cyclist, who trained about 250 km per week. I was a member of a local club and raced on weekends. For many years I rode injury free and without any nerve irritation. As a result of a radical change to my bike set up recommended by a bike shop (being a major increase in my seat height), I ended up rolling forward on the bike seat to reach the handle bars. This has caused me pudendal nerve irritation and I have been off the bike for 18 months. I have consulted various medical specialists, but none can offer any definite advice on returning to the bike. Can anyone help, as I am really depressed being off the bike.



Steve Hogg says:

G'day Matt,

Sorry to hear of this. I hope you gave the gent who fitted you some feedback. Re: returning to riding; have you considered SMP seats?

There should be zero contact pressure on the pudendal nerve with a Lite 209, Dynamic, Glider or Avant as the SMP's have a larger perineal cut-out as standard than any other brand of seats. Which one you should use would depend on your size and weight. See if you can find a shop that will allow you to trial them on an indoor trainer at their premises. I would be surprised if an SMP is not the solution or a major part of the solution to getting you back on your bike.

Matt replies:

Thanks Steve for the prompt reply. I did move to a SMP seat shortly after the dramatic increase in my seat height as it was too painful riding so far forward on my pelvic area. Rather than reduce my seat height, the bike shop guy recommended that I move to a cut out style seat. I ordered a composite model, which had no padding, as a way of handling the discomfort of riding with the high seat height. Unfortunately, the positioning on the SMP only served to compound the problem as I was still too far forward on my pelvis, which meant the soft tissue was being forced into the cut-out section of the seat and the edges of the cut out felt like it was digging into me.

I ultimately reduced the seat height, but because of the nerve injury, I think I would need a more padded version of the SMP seat.

I am 6ft tall, and am about 78kgs.

Steve Hogg says:

G'day Matthew,

If you were sitting way too high, it wouldn't matter what brand of seat you use. Equally, an SMP Composit would not be my first choice from the SMP range for someone with nerve damage. Assuming average build for your height and weight, I would suggest the SMP Lite 209. Moderate width and well padded. Depending on how flexible you are, they are designed to be ridden with the rise towards the nose 2-5 degrees lower than the high point at the rear. More flexibility equals more nose down / less flexibility equals less nose down.

I hope you have given feedback to the shop involved so they learn from your bad experience.

Ankle Pain


I am 45 years old and have been cycling for only 3 years. I manage about 8 hours per week, including club rides and have even tried some road racing.

Recently I have suffered with ankle pain, initially in my right ankle, now in the left. It takes the form of pain and swelling on the outside of the joint, below and around the ankle bone. It's as if I twisted it.

My feet are considerably different in length and I recently dropped the cleat on the right shoe back, which seemed to alleviate the problem. The right cleat was positioned so my toe pointed out slightly to alleviate a knee problem, but I have changed this to a straighter position. Both these seem to have relieved the right ankle pain, though the cleat is now as far back as it will go. I have never had any problems with my left cleat, or knee or ankle pain, though it seems to have come on this week since I sorted the right one.

The pain comes on when out of the saddle or when I do hard rides. Is this problem likely to be because I am dropping the ankle when tired or under heavy load and is the left ankle problem either in my head (there is no swelling) or compensation for the right foot finally being sorted?



Steve Hogg says:

G'day Owen,

From what you're saying, I suspect that you don't have the right side "sorted". I know the pain on the right side has disappeared but most riders protect their right sides at some cost to their left side. This happens below conscious thought which is why you are not aware of it (assuming what I'm saying is the case). If you are shifting your pelvis on the seat to ensure that the right leg tracks well, then that can be enough to put pressure on the left ankle. Have a look at this link and scroll down to the italicised text at the bottom and follow that method to ensure that the angle of your cleats is okay for both sides.

Next, you mention a "considerable difference in (foot) length". Often that goes hand in hand with a difference in leg length or a long term pelvic tilt from an early age. Have you ever had anyone check your leg length?

If not, now is as good a time as any.

Even if there is no difference in bone length between legs, a substantial difference in foot length functionally shortens the leg with the shorter foot when pedalling. Have you compensated for that functional difference with a shim?

You don't mention which foot is the shorter, but if there is a functional (or measurable?) difference in leg length, you are going to be chasing your tail trying to resolve the problem unless you compensate for it. The best method of compensation is with a shim underneath the shorter foot (leg). This link will explain more in detail.

Get back to me with your answers and I'll try to advise further.

Owen replies:

Thanks for such a prompt reply.

I have read most of the link, but didn't need to read too much as a little light pinged on as I read. I have not had time to read it all and act on it, though it sounds like common sense.

I have just been out for a quick 24 miles, average speed 20mph. Lovely. I had no discomfort in my left ankle, but did have some on the original side, the right. I have noticed on many occasions that I drop my right heel but not left. Tonight, before I read your article, I looked harder.

On the left I am perfectly comfortable and very slightly toe down, on my right, the short foot, I had to concentrate to prevent the heel dropping: when it did I felt some discomfort - not really pain. It feels like my cleat is too far forward, so I intend to drop it back a little more if I can. Could that mean that I then have to lift the saddle? That would probably over extend the left leg? Is that extension of the ankle causing the problem?

I have noticed in the past that my right quad is better defined that the left, though thought that was the result of an old rugby injury to my right ACL (don't ask what the injury was, my doctor was rubbish, it was probably a very slight tear causing instability and pain) and resultant muscle wastage. When I stopped rugby I tried running and suffered from ITB syndrome a bit.

My chiropractor sister-in-law diagnosed one of my legs as functionally shorter that the other some time ago, I cannot remember which one though. She is 9 months pregnant as is not able to help at the moment.

My other question is why now? I presume it is because I am fitter and stronger and able to put more stress through the pedal, thus accentuating the weakness?

Once I've read your article properly and acted on it I'll get back to you, though I can feel an expensive bike fit coming on! (I'm in Cambridge in the UK, if you can recommend anyone.)

Steve Hogg says:

G'day Owen,

Why now?

Because pain isn't the first sign of a problem. It is actually one of the last signs! If there is an incipient problem, then sooner or later an invisible threshold is reached after which the problem intrudes into your consciousness. Once you've read the post fully, get back to me with any questions.



Returning after shoulder surgery


I just had arthroscopic left shoulder surgery, so will be off the bike for a while. Please suggest a regimen or a training DVD for staying in shape and being ready for the road in a couple months. I have a fluid trainer.

Extra information:

Currently I ride about 80-100 miles per week, 50 on Sat, 30-40 on Sunday. I have no specific training per se (that's my problem, probably). I ride a fluid trainer a couple times during the week, sometimes TT and sometimes hills, sometimes short intervals.

I can't expect to come back from shoulder surgery stronger than I left, but would like to have some decent legs and lungs.

I rode a few 200K brevets with my ultra friends last year (averaged about 16mph on them, too), but this year am off some. I would like to get back to that level by next March.

I am retiring in July (just turned 66), and hopefully I’ll then have more time to ride during the week.

Scott Saifer says:

Hi David,

Looking through your notes, I'm calculating that you have been riding about 5-6 hours per week. That's not a crazy amount of time to put in on a trainer, especially for someone who is retired. I'd suggest you aim to keep that up or boost it a bit as follows. Aim for a one hour ride five days per week at first, with the days off separated by at least one work day, increasing the length of one or two of those rides by 30 minutes, or more if you can stand it.

The really important thing is to be on the bike and pedalling. It won't make a big difference if that pedalling is harder or easier so long as you don't go so hard that you use up your energy and motivation so much that you are tempted to skip the next ride. So, the main challenge is to keep the riding entertaining enough that you will keep it up until you are okayed to ride outside again. One easy way to keep the riding entertaining is to set the bike up in front of a TV and watch TV or movies. So long as you keep pedalling at a decent clip, you'll maintain most of your fitness.

If you want to focus more on the riding, here are some exercises to do to keep your attention and make the time pass. For each, start by warming up spinning for 15 minutes or so. Then pick one of these, or mix up several:

Single Leg Pedalling: Pedal with one leg for one minute or as long as you can do so smoothly. Then two legs for one minute, then the other leg for one minute. Repeat until you've used up the time. This will make you a smoother peddler when you get outside again.

Cadence Pyramids: Work up a pyramid of cadence in 1-minute, 5 rpm increments with spinning in between. Thus do one minute chunks of 90, 95, 90, 100, 90 105, 90, 110, 90, 115 and so on until you can't pedal with power any more, and then step back down. This will give you coordination at higher cadences. Coordination underlies power, so this is good preparation for sprinting.

On-Bike Strength: Alternate 2-minute periods of 90 rpm and 60 rpm. This will give you strength that underlies power.

Back workout: Alternate 10 pedal strokes on the drops with 10 pedal strokes on the hoods for as long as you can take it.

Zig-zags: Use a heart rate monitor and make efforts to bring your heart rate up to 80 percent of max as quickly as possible without overshooting, and then down to 70 percent again without going under. Repeat as long as you can stand it.

The Cyclingnews Form & Fitness panel

Scott Saifer ( is head coach, CEO of Wenzel and has been coaching cyclists professionally for 18 years. He combines a master's degree in Exercise Physiology with experience in 20 years of touring and racing and over 300 road, track and MTB races to deliver training plans and advice that are both rigorously scientific and compatible with the real world of bike racing.

Scott has helped clients to turn pro as well as to win medals at US Masters National and World Championship events. He has worked with hundreds of beginning riders and racers and particularly enjoys working with the special or challenging rider. Scott is co-author of Bike Racing 101 with Kendra Wenzel and his monthly column appears in ROAD Magazine.

Steve Hogg has owned and operated Pedal Pushers since 1986, 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. He can be reached at:

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.

Pam 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 associate professor of Nutrition and Exercise Physiology at the University of Missouri-Columbia where she studies the effects of energy balance on bone health. She has published on the effects of cycling and multi-day stage racing on bone density and turnover.

Pam was an All-American in track while at the UW. She started cycling competitively in 2003 and is a three-time Missouri State Road Champion.

James Hibbard progressed from the junior to the professional ranks as a rider and has over 15 years of competitive cycling experience. He is a former Collegiate All-American track cyclist, trained as a resident athlete at the United States Olympic Training Center, earned international medals as part of the U.S. National Team, and was a member of the powerhouse Shaklee and HealthNet Professional road cycling teams.

He has earned 13 National Track Championship medals, as well as numerous junior, U-23 and elite California State championships on both the road and track. Since retiring from full-time racing in 2005, James has focused on his development as a coach.

David Fleckenstein, MPT, OCS ( is a physical therapist practicing in Eagle, ID and the president of Physiotherapy, PA, an outpatient orthopedic clinic focusing in orthopedics, spine, and sportsmedicine care.

His clients have included World and US champions, Olympic athletes and numerous professional athletes. He received his Masters degree in Physical Therapy from Emory University and is currently completing his doctorate at Regis University.

He is a board certified orthopedic specialist focusing in manual medicine and specific retraining of spine and joint stabilisation musculature. He is a former Cat I road racer and Expert mountain biker.

Carrie Cheadle, MA ( 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 ( 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.

Dario Fredrick ( 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.

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