Topics: Piriformis pain, Forward positioning, Cramps guide, Peaking, Adjusting to bike-fits, Improving your sprint
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I am currently training for the 2011 Etape in July and doing about 100 - 125 miles per week and I'm now suffering from pretty bad piriformis pain which has crept up over the last 2 months. Just to give you a bit of background. I slipped a couple of discs back in 2003 in L4/L5 and L5/S1 but it happened on the right hand side. I have been on/off with the bike ever since, but I decided to push on through with the pain since I signed up. When my spine is out of alignment, I go and see and Osteopath and he puts me right. What I have found since training from about August last year is that I have the pain mostly in my lower back in the left hand side which used to cause pinching of my hamstring especially going uphill. This has mostly gone to be replaced by this Piriformis syndrome in the last 2 months.
Symptoms are the usual; real tenderness in my left buttock which runs down my leg and numbing, nagging nerve pain that runs down my leg through to my calves and then a tingling in my feet. I'm fine when I'm on the bike, but when I stop to sit at my desk it can be extremely uncomfortable. I've had acupuncture, sports massage, I do the stretches etc, but when it gets bad, the only real relief is taking an anti-inflammatory pill.
I'm trying to tackle it from a different angle and see if the bike set up is causing the pain. I went for an all singing an dancing gait analysis, power analysis, expensive set up back in January 2010. The magic numbers were
Tip of Seat to Bottom Bracket: 6.5cm
Seat to stem height: 5.5cm
Tip of seat to centre of Handlebar/to edge of hoods: 58/71.5cm
Crank length: 172.5mm
They also did my cleat alignment. I pronate so they put in a couple of shims under each cleat, aligned the cleats correctly and put in some Sidas footbeds to compensate for the pronation. I'm convinced that this is the adjustment I need to be making. I currently use Look Keo pedals with Red (9 degree float).
After a few outings on my bike, I made some adjustments to the distance between the seat to the stem by shortening the stem and changing the handle bars so now it's 55/68 which is much more comfortable for long distances. I may not get the power that I had as the ideal set up but I can go long distances. All the other measurements are the same except that I have raised the saddle by 0.5cm in the last 2 weeks as I felt it made it easier on my knees/got less lactic burn going up steep hills, but that will obviously have no effect on the problem I've been experiencing over the last 2 months.
Is there anything I can do to improve this before July?
Dave Fleckenstein says:
The symptoms that you describe are much more consistent with disc and nerve root irritation than with Piriformis syndrome. When you state that 'your spine is out of alignment' I would surmise that this is most likely a compensatory shift, done reflexively by the body to decrease stress on the injured tissue.
The interesting symptom that you note is that it feels worse with prolonged static sitting then when riding, and I have seen this with a number of patients with disc injuries. There have been studies performed looking at stresses on the disc and prolonged sitting is far and away the worst thing that we do our back.
The posterior ligaments and annular fibres of the disc are placed on stretch, the deep stabilizing musculature is inhibited, and the circulatory flow through the region is minimal. Thus, the combination of prolonged sitting and the flexed position of cycling is very problematic for the spine as there is significant accumulation of the negative effects of flexed postures. I highly recommend the book 'Ultimate Back Fitness and Performance' by Stewart McGill - it is an excellent resource on how we develop and prevent lumbar pathology.
My first recommendation is to have a more thorough work-up of your spine. Additionally, my general rule in sitting is to stand 15 seconds every 10 minutes, as this reduces the accumulation of creep (time dependent deformation) on the posterior support structures and improves the local circulation. I'm sure that Steve will be able to add in some additional fit information, but my concern is that your cycling position and issues are just magnifying a deeper underlying problem.
Pro position setup
My question is about an observation I have of pro riders forward position on the bike as they are pedaling in race form.
It seems they are forward in the saddle and they all seem to have long stems (120+) while having seat posts well set-back.
They seem to want to be forward on the bike yet their seats/posts are set back. I am amazed by their fluid pedaling, their saddle heights seem to contribute this (none are overextending), and they seem very comfortable in this position. I myself have been in race situations where I have been forced to get "on the rivet" but only for brief period until everything was under control -but it never looked or felt as pretty! What gives?
My question is - if I try moving seat further up, about 10mm say, will I then would have to increase stem by 10 as well? or do nothing now and give it a try next build season?
Steve Hogg says:
At the risk of upsetting people who view the pro scene what we should all attempt to imitate, I'd tell you that if a rider crawls forward on the seat under high load, there is something wrong with their position, or the way that they function, or both. The term "on the rivet" comes from a time when leather seats had a rivet at the front and it was common for riders to creep forward on the rivet at full noise efforts. Somehow or other it has become viewed as necessary or normal. It is neither.
It is only necessary if the rider cannot maintain stability on the seat with the position they have and the degree of functionality they have. Any challenge to stability will autonomically cause the rider to attempt to use any stabilisation mechanism they can find. If the position the rider holds doesn't allow them what I call Passive Stability, they will do achieve it with Active Stability which on a bike takes 2 forms. Excessive use of arms, shoulders and upper backs OR shortening effective torso length by arching the back.
Just a few examples:
If the rider's bars are too low, or too far away, they may be more or less stable at lower intensities, but at high intensity they will have to shorten up to maintain stability. The bars aren't going to rise and the stem isn't going to shorten in length, so autonomically, in an effort to stabilise the rider has to move forward to reduce their reach.
If the seat is too high, same story. Moving forward reduces leg extension. You said " I am amazed by their fluid pedaling, their saddle heights seem to contribute this (none are overextending), and they seem very comfortable in this position". Comfort, I can't speak for but you're right about seat height contributing, but possibly not in the way that you meant it.
If the rider has poor functional stability, again, under load when the challenge is greatest, they will do whatever they have to do to stabilise themselves, which invariably means shortening up their position by moving forward.
As to your own position, the thrust of your answer suggests that you are trying to find out how to perform better "on the rivet". Set your balance point as per what you've read and experiment with seat set back within a 5mm range forward and rearward of that. If your cleat and bar position is appropriate, you will be fine.
If you think you've got all that sorted out and still cannot quite get to where you want to be, Pilates or any functional stability training you take on will make a noticeable positive difference.
I have ridden a bike all my life (now 48) and have always suffered from cramp in my legs toward the end of rides and then often also later on (usually during the night). Not every ride by any stretch - usually just the more arduous ones. I find this very frustrating as some of my riding companions don't even seem to know what cramp is! What I would like someone to do is offer some clear explanation of why cramping occurs and a simple list of the things that you need to do to best avoid it. Whenever I read articles they always seem vague and full of caveats about this and that. Drinking and eating plenty seems to have the best effect - but are there good and bad things to eat/drink?
Thanks for your help.
Scott Saifer says:
There are many causes of cramps, each with it's own corresponding cure. Here's a handout I share with my clients when they report cramps. Take a read through and see if any of the causes might apply to you:
What is a cramp?
Cramps are strong, involuntary muscle contractions. They can occur at any time but are most common during or shortly after hard exercise. They can occur in any muscle, though in cyclists they are most common in the quads, hamstrings and calves. They can be so strong that they cause you to launch out of a chair or actually pull a muscle.
Cramps have many causes, though fundamentally they are similar. When you move, your brain sends signals to your muscles requesting a contraction. The brain receives feedback on the strength of the contraction that has occurred, from which it can make adjustments to create a controlled movement. If the feedback says that the contraction is harder than expected, the brain can send instructions to contract less. If the feedback says the contraction is weak, the brain can send a signal to contract more. As a muscle fatigues, the brain sends more signals to tell the muscle to contract to get the same strength of contraction. When the muscle becomes too fatigued to do what is asked of it, the brain sends a continuous contraction signal, initiating a cramp.
Anything that fatigues a muscle can bring on a cramp, and anything that keeps a muscle fresh helps prevents cramps. Talk to your coach about which of these might be your particular problem.
Pushing big gears: One clue that you may be doing this is if you find yourself standing each time you need to accelerate. Another clue is measuring your cadence below 85 rpm for much of a hard ride. The cure? Switch to a lower gear. Spin to save your legs. Get a larger rear cog or a compact or triple crankset if necessary.
Dehydration: Muscles don’t contract well if they don’t contain their normal amount of water. Stay hydrated.
Fuel: Muscles can’t contract if they don't have a good supply of glucose. Keep eating carbohydrate rich foods on longer rides. Eat something at the start of the ride, after about 30-40 minutes and every 15-20 minutes thereafter. Aim for about 250 calories per hour if you are under 150 pounds and 300 if you are over 150 pounds.
Electrolyte balance: Muscles will cramp if they don't contain their normal amounts of sodium, potassium, calcium and magnesium. Those amounts change during exercise. Salt your food and eat plenty of bananas. If you don't eat a lot of dairy, take a calcium supplement or eat plenty of brassica veggies (collards, kale, cabbage, broccoli, Brussels sprouts and cauliflower).
Calcium: Calcium-based antacids such as Tums have cured many cases of cramps. Take one before riding and one each hour of the ride if you've been cramping. Don't wait for the cramp to take the calcium.
Raw Spinach: Some leafy green vegetables eaten raw, particularly spinach, will leach calcium from your system. Avoid large amounts of raw spinach. Cooked is okay.
Creatine Monohydrate supplementation: In some people creatine supplementation (especially loading) may cause cramps, especially if the athlete is dehydrated. If in doubt, avoid this supplement.
Tight muscles: Regular stretching of muscles that tend to cramp sometimes reduces cramping.
Impaired circulation: Muscles that are not receiving adequate blood supply are deprived of oxygen and fuel. They will not recover from one contraction to the next and so will fatigue quickly. Correct pressure points on the saddle, in your shoes, in your shorts and anywhere else they might interfere with circulation.
Heat or cold: On hot or cold days some people will cramp even if they do everything else right. On hot days, do what you can to keep cool. As well as staying hydrated, dribble water on your jersey and shorts and through your helmet every once in a while. Choose shadier and flatter routes on hot days, unless you are racing and don't have a choice. On cold days, dress warmly.
Bike Fit: A poorly fit bike may cause some muscles to work harder than necessary, bringing on a cramp. If in doubt, have your coach check your fit.
Rhabdomyolysis: If cramps are followed by red or brown urine, you are experiencing a breakdown of muscle tissue and release of muscle contents into the blood. This is a medical problem needing immediate professional attention to prevent kidney damage. Treatment for acute rhabdomyolysis is high volume IV rehydration.
Pamela Hinton adds:
Scott has provided you an excellent summary of potential causes of cramps and corresponding treatments. I would like to briefly elaborate on the electrolytes. If your cramps affect more than one muscle group, than electrolyte imbalance or dehydration is likely the cause. It is important to recognize that the primary electrolytes lost in sweat are those that are found in the greatest amounts in extra cellular fluid--sodium and chloride. Unfortunately, people who have high concentrations of sodium in their sweat, i.e., "salty sweaters", and/or who have high sweat volumes, lose sodium at a higher rate than it can be replaced. These individuals may lose up to 1500 mg of sodium per hour, while the recommended rate of consumption is 500-700 mg per litre of water per hour, which is based on the rate at which sodium is absorbed from the gut. Not all sports drinks are equal in how much sodium they provide, so read the label!
Peaking at the right time of the year
I am currently in my final year of high school, so my time on the bike is limited to two or three training sessions per week. My question is, what would be the most effective ways to utilise these sessions, so that I will be most ready for next season? I will be competing in many one day road races around 100-140km long, criteriums as well as a few three day stage races next year. My current program consists of Thursday: 1 hour spinning, Saturday: 2 hour, high intensity group ride, and Sunday: 5 hour endurance ride. I am currently not racing or doing any interval or specific hill training. (Looking to peak in mid-April 2012).
Scott Saifer says:
The dates when you need to be on form are always key in forming a training plan. To be on form in mid-April 2012, you'll want to set yourself up with a formal, periodized training plan from roughly mid-December 2011 or a bit earlier. To start training you need to be rested, so you'd set up a few weeks of rest or recovery oriented exercise before that. Between now and the rest period, you can do whatever you like more or less so long as you ride a lot. Your current routine is fine, though I would suggest one change, that being to get in at least a 40 minute spin on Tuesday so you don't have that gaping three-day hole in your training every week. Riders who ride at least a little, at least every other day make far more fitness progress than those who routinely take long breaks between sessions.
Adjustments to changes in foot/cleat position
I have a question about getting used to foot changes.
I've recently had a bike fit from a reputable company.
The main outcome was some wedging under my cleats and a 3mm stack under my left leg to compensate for a length discrepancy. There were also some minor tweaks to my saddle position.
Due to my own mistake, before the fit I was riding with 1 degree wedges the wrong way round, i.e. the thick end of the wedge was on the side of the shoe furthest from the bike when it should have been on the inside.
I have switched to new shoes (Specialized) with a built in 1.5 degree angle plus 2 degrees on the left and 1 on the right from wedges. So for example on my right foot I have gone from -1 degree to +2.5 degrees. I understand from my fitter that the wedges make my hip/knee/ankle line up straight when I pedal rather than the crooked line I had before, so theoretically it's a big improvement.
I did 2 x 1 hours' steady riding with the new setup before a 25 mile TT 2 days later and then some more hard training (with a decent warm up) 2 days later after that.
The problem is that since the fit I have been troubled by pain in my right knee. It is a dull pain under the knee cap which I can feel within 10-15 minutes of starting even a gentle ride and builds up over days to become quite sore. My left knee is fine by the way.
I have gradually reversed all the changes made in the fit, to no avail. First I reverted the saddle position, then I gradually removed the wedging under the right foot. I think this has improved things a bit although I am conflicted because it is moving away from the theoretical ideal.
I have tried old shoes with the old wrong cleat wedges but that feels odd now and I still got some knee pain. It may well be a reaction of the existing soreness build up though.
So finally to my question: how should I attempt to apply in these changes? Have I made a mistake going to hard, too soon? Should I expect a long running in period during which I have to tolerate knee pain until my body gets used to the new position? Should I have gradually applied the changes towards my final new position rather than making them all at once? Is it possible that the nice straight action is actually not right for me and never will be?
Any suggestions to get out of the hole I am now in?
Steve Hogg says:
Interesting experience. Have you taken up your subsequent problems with the people who fitted you?
If not, you should. You have paid for a fit and have developed problems subsequently. This may well have been because you have ridden too hard too soon post fit as you say. It may have been because of some aspect of the fit. Either way I would be talking to the fitter to see if they can help resolve the issue.
I caution fit clients verbally and give them a written reminder that they are only to ride at low / moderate intensities for 3 weeks post fit. That is good advice and something similar should have been passed on to you at your fit session. Did this happen?
Any repetitive action causes us to develop a muscle firing sequence called a motor pattern. We don't learn new ones overnight. So you are in the situation where you have had a significant change to the cant of your feet on the pedals (but not as much as you think; more about this later) Your pre fit motor pattern was dictated by the position you hold in space relative to gravity and relative to your bike as well as force feedback from the feet. All of these relationships then changed at the fit but your motor pattern won't have changed. That takes time. The best way to learn a new motor pattern is to ride at low / moderate intensities because we adapt best when we are not under pressure. When you are under pressure, as in your TT 2 days later, you will have reverted back to the motor patterns that were embedded from the previous bike position. You would have been out of sync with those because of the altered position and altered cant of the foot. What ever part that played in your subsequent injury, you can blame yourself for and you should have been advised accordingly.
In response to other matters you raise. Specialized claim their shoes have compensation built in. My experience is that it is either not there or is ineffective, which amounts to the same thing. So the change in cant was not as pronounced as you were told it was. Next, the wedges you were fitted with. You don't say what brand or type, though as it was a BG fit, I assume Specialized. If they were Bike Fit cleat wedges, Bike Fit ITS (in shoe) wedges, or Specialized cleat wedges (licensed from Bike Fit) the wedges themselves are not the problem, though the number used might be. If the wedges were Specialized in shoe wedges, I would advise taking them out, because they may be part of the problem. This link will explain more.
If your 3mm shim is a Specialized shim, there is the same material problem as with the in-shoe wedges.
Don't try and ride through knee pain in the hope that somehow you will come good. I think the best solution is to contact the bike fitter, tell them what has happened subsequently and ask for help. If they are unwilling or unable to help, let me know where you live and I'll try to point you in the right direction.
Improving your sprinting
I consistently have the aerobic power and fitness to get to the end of races in the bunch sprint but seem weak in the sprint finish and in strength-training type efforts. My height is 1m66cm and I weigh 51kilos so I am fairly light for a female rider.
Generally, I race once to twice a week from April to July, with big groups of riders generally (up to a hundred riders in a CP).
When I do finish in a bunch sprint scenario it can make me occasionally nervous also in moving up in the last 200 metres (the last minute of a race). Any advice on improving on this?
James Hibbard says:
Congratulations in so often making it to the finish in the lead group! In thinking about sprinting, it works well to think of the tactical demands on one hand and the physiological demands on the other.
From a physiological perspective, good road sprinters are capable of producing a finishing burst of power that usually lasts between nine and fifteen seconds. Among elite female sprinters, 900-1100 watts of peak power at 115-125 R.P.M. are fairly typical.
The question thus becomes: what sort of training should one undertake to increase their peak power. If you are not already, I would recommend doing at least one sprint session weekly during the season. Strike a balance between power development, which can be accomplished through hill sprints, seated sprints and gym work, and top-end speed which is developed through downhill sprints, roller work, lead outs and motor pacing.
I’ll turn now to the tactical component that I mentioned earlier. In terms of developing your confidence, it helps to race a lot (which it sounds as if you are already doing). Another useful approach for developing your confidence is to have a teammate or more experienced rider guide you through the final kilometer or so of a race. Think of this rider as your “pilot fish” who can guide you through the race and show you when and how to best maintain your position, what wheels to follow and where and when to move up. The aim here is not to simply have another rider lead you out but to show you the nuances of moving through the field and positioning yourself.
An experienced sprinter will sense what corner they can move up on, what wheels are safe and fast, and what teams tend to work well for their sprinter, and be able to use all of this information to make decisions that help them to be near the front and fresh with a clear shot to the finish line.
One side note; be prepared to expend some energy to establish and maintain position in the final one or two kilometers. You may feel as if you are expending energy that you would like to save for the sprint, but if you are not positioned well for the sprint you will be starting from a huge deficit that more often than not can not be overcome.
Best of luck!
The Cyclingnews Form & Fitness panel
Scott Saifer (www.wenzelcoaching.com) is head coach, CEO of Wenzel Coaching.com 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: www.stevehoggbikefitting.com
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 (www.physiopt.com) 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 (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.
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.