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Cyclingnews Fitness Q&A - June 24, 2010

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Fabian Cancellara (Team Saxo Bank) fixes his shoes while waiting with other riders in the start gate.

Fabian Cancellara (Team Saxo Bank) fixes his shoes while waiting with other riders in the start gate. (Image credit: Jonathan Devich/
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Ahem: Greipel clears his throat on stage three

Ahem: Greipel clears his throat on stage three (Image credit: Santos Tour Down Under/Russell Mountford)
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The include KéO Grip cleats provide 4.5 degrees of rotational float but careful about walking in these too much - the soft rubber pads wear quickly.

The include KéO Grip cleats provide 4.5 degrees of rotational float but careful about walking in these too much - the soft rubber pads wear quickly. (Image credit: Emily Wren/

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.

Strep throat

I am a cat 2 male, train about 20+ hours, 5'8", 142 lbs. About two weeks ago I felt the beginnings of what felt like a sore throat, which usually meant that I was going to get sick (cold/maybe fever).

However, it never came, but the sore throat lingered, albeit very mild. I've been feeling really tired as of late but thought it was because I was building up to my last hard week before my rest week.

I decided to see a doctor to figure out what was wrong and was diagnosed with strep throat. She gave me a prescription for some antibiotics (amoxicillin) that should be taken twice a day for ten days.

What I am curious about is if antibiotics affects performance. I have always heard from other athletes that taking antibiotics zaps your energy, but I'm wondering if this is true. Additionally, would it be unwise to consider racing this weekend considering my condition? Thanks in advance!


Kelby Bethards says:


That is a very common question. Do antibiotics make you tired? No, probably not. If you think about this logically, the antibiotic is trying to fix a problem (an infection).

The infection will make you tired and run down and so on. So, what I think happens is that people get confused. They get sick with bronchitis or strep or sinusitis or... some sort of infection. Thus, they begin on an antibiotic and think it is making them tired but somehow forget the reason they are on something is that they are sick.

Sickness makes people tired. Even strep throat. So, do antibiotics effect your performance? Possibly. But not as much as an untreated infection will.

Do antibiotics have side effects? Of course they can... we warn patients about them all the time but hopefully the doctor is doing a risk - benefit approach to medications. What is the risk of a medication? What is the risk of an untreated infection? Weigh those and decide if the risk is worth the benefit.

Giancarlo then responded:

Thank you for taking time out to answer me. Seeing as how I've had this sore throat feeling for about two weeks, I did not want to delay and started taking the antibiotics. Would it be unwise for me to race this weekend?

Kelby Bethards says:


That is a good point to address. Your immune system is working a overtime to fight this also. I generally tell people that if they feel awful or tired or just worn, don't race.

Use how you feel as a guide. If you have been on the antibiotics for a few days and feel good, do what you think is OK. That being said, always finish the course of antibiotics given to you. Do not stop once you feel better.

I know this is vague but people should be in tune with how they feel... use that as your guide.

Foot position

I am 33 years old, 1.88m tall and weigh 78kg. I race XC mountain biking and endurance in the masters category and train about ten hours a week. The problem I have is with my position. My leg length is 92cm crotch to floor in bare feet, my saddle height is 88cm but I have a leg length discrepancy of 3mm in my right leg.

But the reason I'm writing is to ask about varus tilt. I have seen a chiropodist who has measured my tilt at 12 degrees right foot and 16 degrees left leg; he suggested I start with 5 degrees of shimming and go up from there. Would that seem appropriate?

It seems a lot and would be hard to achieve on my shoes, which are Mavic Furys. Also, would you say I should shim for the leg length difference?

Many thanks for any info,
Daniel Goode

Steve Hogg says:


Regarding your questions:

The chiropodist's findings - you don't say what the chiropodist was measuring; that is rear foot varus or forefoot varus. If they were using an FFMD (Fore Foot Measuring Device), then there is no clear relationship between FFMD readings and the amount of correction required to achieve clear proprioceptive feedback from the feet.

The FFMD used with care is accurate but its readings relate to a static foot without any load applied. When load is applied when pedaling, then the entire functional picture of what is happening with foot and ankle can change; often dramatically.

The other thing to mention is that when using cleat wedges or in-shoe wedges, what is being corrected 99+ percent of the time indirectly, is the rear foot, not the forefoot and the ideal number of degrees of correction is almost always a lesser number than the FFMD reading if the FFMD reading is high (over 8 or 10 degrees) and often a higher number of degrees of wedging is required for a low FFMD reading (less than 3 degrees).

This difference is more pronounced for left foot readings than right foot readings by some margin in the great majority of cases. If your chiropodist was not using an FFMD, then I need you to find out what they were using and what they were measuring and your description doesn't provide enough information for certainty. If they weren't using an FFMD, then I assume they were measuring rear foot varus. Let me know and we'll start again.

You say the chiropodist mentioned 5 degrees of "shimming". Are you sure that you don't mean 5 degrees of wedging ?

As to your 3mm of leg length difference. How was that measured? By x ray or scan? If so, from what point to what point were the measurements taken?

If that was measured with a tape, then forget it as the margin for error using a tape measure is greater than what you have been told is the discrepancy.

Assuming for the sake of argument that you do indeed have a 3mm bone length difference then that is only part of the picture in a functional sense. You are likely to have one foot that is longer or of different proportions to the other as well as one foot with lower arch than the other.

Additionally, your pattern of flexibility and pelvic function may differ between right and left sides in the hips, lower back, hamstrings and so on. Each of these things can add or subtract a functional component from any measurable bone length difference.

To give you an example that came my way yesterday: a pro cyclist with a known short left leg but who is more flexible on the left side of his body and has a left foot 1.5 Euro cycling shoe sizes longer than the right foot with all of that difference in length being in the foot rearward of the toes.

This meant that pedaling under load on a bike, with cleats adjusted to be in the same relative relationship to foot in shoe (but in different places on the sole of each shoe), the measurably shorter leg was functionally longer.

Sitting squarely on the seat, he needed a 3mm shim under the right shoe, if the longer leg to reach through the bottom of the pedal stroke with equal facility on both sides and without problems at the top of the stroke.

The basic message I'm giving you is that a bone length difference, if verified, is only one part of the functional picture.

Knee brushing top tube

I am again writing for further advice.

Soon after your last response, (December 2009), I discovered that my Keywin pedals were causing my problems. (My originals were damaged in an accident, and a friend gave me a pair which I didn't realise were fixed).

My left foot is now able to externally rotate to a more comfortable position,

* My pelvis is now aligned
* I can now ride with good endurance and intensity without pain in an upright riding position

However, I have noticed that when I ride at intensity in an aero position, (requiring greater amount of hip flexion), I can reproduce my original symptoms of rectus femoris and glute medius pain on the left side (posterior hip muscles do not seem too bad).

Is there a simple bio-mechanical answer to explain this? Does this indicate a weakness in a muscle group that is utilised more in a hip flexed position?

Many thanks,
Rob G

Steve Hogg says:


A lower torso position will always put more stress on pelvic function because hamstrings have to work harder and hip flexors are more cramped. This shouldn't be a problem if you don't have tight hip flexors or hamstrings but I don't know whether you do or not.

The glute med pain suggests you may not stable on the seat and the rectus femoris pain suggests that it is probably being cramped too much; ie too much hip flexion.

The simple solution, at least in the short term is to raise your bars and then reassess. What may play a part but it will seem counter intuitive, is that seat height may be too high. Again, lower a few mm and reassess.

Time trial training

I completed my first 40km time trial last weekend. It was a relatively flat course with one small climb. My time was a disappointing 1:03:27. I am wondering if you have any specific workout I can do in order to increase my power out / improve my time.

I am currently doing sets of 30min tempo. I think I am going hard, or at least it feels like I am going hard when I do my workouts. Any suggestions would be greatly appreciated. I would like to be the one doing the passing instead of the other way around.


Scott Saifer says:


The single most important thing you have to master to get a good time in a long TT is pacing. A good pace in a 40K TT will have close to steady power and gradually increasing heart rate. Good pacing can lead to shaving at least three minutes off your time compared to the usual strategy of starting hard and seeing how long you can hold it.

Time trial pacing has to be refined over many trials. As a first round test, many people do well by riding 20 minutes roughly three beats below their measured LT, 20 minutes at it, and the rest of the race just plain hard.

By the end of the race you should need to remind yourself again and again to keep the effort up. If your heart rate is ever dropping during the race, other than in corners or the turnaround, you went too hard earlier.

What you should do in training to improve your TT racing really depends on what training you've already done. First you'd want a big base of easy paced riding. Then you'd do some sub-LT tempo work and finally race paced stuff.

Each type of training will give some progress whether or not you've done the earlier stuff, but only doing all three in the correct order gets you to your potential. Since you've already started racing, I'll assume you did a good base and some tempo as preparation.

If that is the case, I'd suggest that you practice specifically for TTs by warming up generously and then doing four 15-minute intervals, at the paces suggested above, i.e. do one a bit below LT, one at LT, one a bit above and then the last one all out. Rest five minutes between efforts. And roll around a bit to cool off.

Rod then responded:


This is great stuff. Thank you so much for your advice. At your suggestion I have stopped going to one of my group rides and have lower my intensity for the rest of the days (to use as recovery) I just can't give up both of my group rides. How often would you recommend I do this workout, keeping in mind I do one hard group ride per week? Thanks again.

Scott Saifer says:


You only want to do higher intensity training when your body is really ready for it. Very few people can handle more than two hard days per week, week after week without getting overreached or overtrained, so if you are doing group rides, you'll do at most one extended session of hard intervals per week.

How do you know if a given day is good for a longer or harder ride or better for recovery? Simple: Do a generous warm up and check out how your legs feel, and how easily your heart rate rises (and your power compared to effort if you have a power meter).

If the legs feel great, and the heart rate is responsive (and your power is good), it's a training day, which could be used for intervals, a very long endurance ride, or a group ride or race. If not, it's a recovery day, which can still be long, but the intensity should be very low.

Chicken pox


I am an amateur road racer from Italy. I have been racing in Italy all late winter and all spring with good results, then I took a break (two easy weeks) and I was just about to resume more intense training to prepare for some races that I wanted to do in the US starting July 1st, but I have come down with the chicken pox.

I have just recovered after seven days off the bike (six in bed) and I have no fever as of today (June 10th) even if I am still covered with the dots and I have three more days of antibiotics. I would still like to do the US races, but I don't think it's adviseable that I start riding for another 3 days, then I will only have two weeks for training. I could potentially ride almost every day afterwards.

I was thinking of starting with some base riding for the first 3-4 days to see how I am doing (note I have almost 9000km from the beginning of the year, so I should not have lost much in that area), then eventually try some 'quality' (sprints, intervals, LT workouts etc etc) if my body responds well.

I am a small guy and I typically respond well to training, I don't need months to get to my good level, but I don't recover very well, so I have to be careful not to overdo it. Before the disease I was pretty much at 'that last step' before peak form. Only positive thing: I have lost 2kg, so, ironically, my weight is now perfect.

Any suggestion is very welcome, thank you.
Luca Magnoni

Scott Saifer says:


I'll let the medical experts weigh in on when it's safe to start training again after chicken pox and after antibiotics. Two weeks is a short time to get back up to speed after a week or ten days off, but not totally ridiculous.

Your plan to start with base riding is smart, and don't go to hard or be fooled by feeling good into thinking you are ready for extensive training. Keep the first five days shorter than your usual long rides, (maybe 1/4, 1/4, 1/2, 1/2, 3/4) before jumping back to full distance or harder stuff. Then you are right to think of the hard stuff as testing rather than training.

You don't want to do exhaustive interval sets or sprint sessions just a few days before an important race. Good luck.

Kelby Bethards says:


It's difficult to advise without you sitting right in front of me, so I'd advise you to speak with your doctor. That being said, if you start slow and pay very close attention to your energy levels, you should be fine to resume training.

More than likely you are taking an anti-viral medication, which shouldn't have much effect on your resumption of training.

Increase or decrease training?

I'm a UK 3rd cat road racer, who is in his second year back from 10 years away.

I train 8-10 hours a week. The staples are an intense chaingang, and a hill rep or interval session and a race. I also will have 1.5-hour easy rides or two-hour moderate rides as well.

Recently its been easy to get my heart rate up to high levels but this doesn't seem to have translated to performance. In the last race I did which was hilly I was climbing badly. I wasn't breathing hard at all but the legs just very sore.

I started racing in March and results were good on the rolling courses and reasonably frequent racing. I have recently had a lull in races due to calendar gaps. So I'm trying to decide if my lower relative performance is down to:

a) Everyone else catching up as I was going OK early in the season
b) Not enough recent racing to keep the fitness levels up
c) Needing a rest
d) Needing to do more.

Any thoughts?

Thanks, Ben

Scott Saifer says:


Any time someone says they do okay on rolling courses but the hillier races are not so goo, I have to ask your height and weight? If you are more than bit over weight for your height, even if it is 100 percent muscle, you can't climb no matter how well you dial in your training.

In your case, the problem is not just overweight, since you had sore legs without heavy breathing. If your explanation of your training means you do all those things every week (chaingang, hill intervals, moderate ride, race), your problem is most likely overreaching.

Anyone who does four intense sessions per week is going to get stronger for a few weeks, and then gradually weaker, not stronger as they never have time to fully recover. One hard sessions after another gradually wears them down. This doesn't mean that elite riders can't race four or more days per week, if they are strong enough to get to the ends of races with "mere mortals" without having to dig deep.

Try leaving out all the hard stuff for two weeks, doing 8-10 hours of easy rides and nothing else. Then add back in one day per week of hard stuff. That means if you are racing, that's the hard workout for the week. In a week with no race, take your choice of hard hill intervals, chaingang or a long ride above base pace but below LT. Your pep will be back in a few weeks.

Knee pain

Im a 38-year-old male, cycling and racing since the age of 10. I was diagnosed with left leg shorter than the right by 5mm last year. This was diagnosed after restarting training after a long lay off.

I was getting stabbing pains in my left iliac crest while riding. After placing a 5mm shim in my normal shoes and under my left pedal this pain stopped and I no longer have any pain in the left hip.

My problem now is that after increasing all but gradually my training distances I am now getting terrible right knee pains. The pain is located under and to the medial side of the right knee cap about the location of the Medial Condyle and actually feels more between femur and tibia.

On full extension of the leg its painful, sitting for extended period and standing brings on the pain. Getting out of bed in the morning and standing causes pain. I have bunions on both feet, and a history of flatfeet.

Thanks in advance for any help or advice!

Steve Hogg says:


Most knee pain on a bike is caused by either problems with the foot or ankle at one end of the kinetic chain or problems with the function of the hip or lower back at the other with the knee trapped between.

Leaving aside the issue of being told that you have a shorter left leg, the bunions and flat feet suggest that it is likely that you are in need of some sort of correction of the cant of the foot on the pedal.

1. Do you use cleat wedges, in shoe wedges or cycling orthoses?

2. Do both knees sit at a similar distance from the top tube.

3. Do one or both knees move outward on the pedal up stroke and inward on the pedal down stroke?

4. Mount your bike on an indoor trainer. Warm up thoroughly with your jersey off until you are pedaling under reasonable load which is a gear that is big enough to give you a workout but not so big that it compromises your pedaling technique. Have an observer stand above and behind you on a stool or chair.

I need to know:

a. Do you drop one hip? If so, which one?
b. Do you sit with one hip forward of the other? If so, which side?

Let me know the answers to all of those questions and I'll attempt to advise further.

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.

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.

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.