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Cycling with Bell's Palsy
Cyclingnews Fitness Folks,
What effects do restrictions on nasal airways have on effort? I have developed Bell's Palsy, a paralysis on one side of my face. An MRI that was used to rule out tumours confirmed my sensation of having virtually no opening in nasal passages on the right side.
I cannot open my mouth as wide, either. Combined, they seem to make me feel more winded when working out. But this might all be mental.
I recall from VO2 Max tests that my nose was pinched shut and my mouth was limited by a respiration tube. So perhaps a closed nose and narrow mouth opening have no effect. Do folks who have larger nasal airways and the ability to open their mouth wider have an advantage in oxygen intake and blood oxygen levels during hard efforts?
Biggest issue with Bell's Palsy is the inability to blink one eye, which creates some safety issues while riding, so this is mostly an academic question.
Thanks for your time.
Scott Saifer says:
I've had a few clients experience Bell's palsy. It's no fun for a cyclist.
For readers that are not familiar with this condition, Bell's Palsy is not at all common, but when it occurs, it usually follows a viral infection. There is damage to the nerves that controls the muscles of the face, interfering with things like blinking, swallowing, talking and facial expressions.
Blinking is especially a problem for cyclists because if you can't blink while wind is blowing on your eye, the front surface of the eye dries out, causing all sorts of other problems. Bell's palsy usually clears up on it's own in a few weeks to a few months, though it can drag on a lot longer in some cases.
You are right in thinking that generally one doesn't need to be able to breath through the nose or open the mouth very wide to get plenty of air. People who don't have Bell's Palsy can confirm this as follows: if you breathe in and out hard through an almost closed mouth, you can feel the lips blocking the movement of air, but as you separate the lips, by more than a cm or so, all interference is eliminated as the cross section of the mouth soon exceeds that of the wind pipe.
There is an extra challenge when you have Bell's Palsy though, which is that your lips and tongue may be floppy and get in the way. So, your sense that your breathing is not as free as you'd like it to be may well be right.
You may need to deliberately open your mouth a bit wider than usual when breathing hard in order that the good side can make up for partial blockage on the bad side.
We have a guy in my district who races mountain bikes who only has one eye as the result of an accident, so it is possible though challenging to ride with only one eye available. Good luck. I hope you recover quickly.
Training suggestions post-stent placement
While training for the Assault on Mt. Mitchell Century ride this year (I was hoping to do it in six hours) for most of the Spring, I noticed that I was really not ever getting better. I just did not feel 'on my usual game.'
I am 55 years old and train 150 to 200 miles per week. I weigh 158lbs and am 5'10.5" tall. My max heart rate is about 185bpm, and my resting HR is around 45. I have raced on the road in the past, but it has been two years since my last race.
After a fairly rigorous group ride on May 1, 2010, I made a visit to the ER with dizziness, low blood pressure, irregular heart rate, and tightness across my chest. The ER doctor said I was OK, most likely dehydrated from a very strenuous 60-mile bike ride. But, just to make sure I was sent off with a 24-hour heart monitor.
The next day I took the monitor back and asked the hospital to send the results to a local cardiologist that a nurse friend of mine recommended.
Anyway, he asked to see me and requested a nuclear stress test, which I had done May 19th. After that test I was told by the cardiologist that he "saw" things during the test that were "not normal" and suggested that I undergo a cardiac catheterisation (and of course he told me not ride Mt. Mitchell), I had the catheterisation done on May 25th.
Well, they found a 70 percent blockage in my left obtuse marginal and a few other "bumpy spots" in two other arteries. They did an angioplasty and installed a 2.5mm x 23mm drug coated stent.
I'm already feeling better and have just started back riding my bike. It has been 3.5 weeks since my last 'real' bike ride. I now am taking four medications, (I had been taken Benicar for about a year):
1) 325mg coated aspirin
2) 75mg Plavix
3) 20mg Simvastatin
4) 20mg Benicar
I was told by my cardiologist to start out riding slow, and then ramp it up slowly, and make sure I hydrate! He specifically stressed extra hydration as he did not want my blood to thicken up which could cause issues with the stent. Other than that, he gave me no other training instructions. He said that he did not have much experience with cases like mine (most of his patients are overweight and elderly).
Question: So, with the above information, what are your suggestions for my training for this year? Can I go 'full out' in the future? Are there issues w/ the above medicines and strenuous exercise? Can I race this year in the Fall or Spring of 2011?
Thanks for taking the time to reply. I really appreciate it. In the mean time, I will be taking it fairly easy, doing L3, and light L4's, with a L5 here and there!
Paul A. Christian,
St. Simons Island, GA
Kelby Bethards says:
Glad you are back at it. You made some very interesting points. One is that your own cardiologist doesn't know how to treat you. It is a sad state of affairs in this country that our doctors don't know how to take care of healthy people, because there are so few we get to see.
Of the medicines, the one that stands out the most to me as causing a "problem" is the statin (simvastatin). It can cause myalgias (muscle pains) in people and probably more so in those that exercise. BUT, do not let me bias you. It is an important medicine, and if you don't have the symptoms then don't worry about it.
As far as training and how hard and so on this year... did your doctor say if you would be on Plavix for six weeks or indefinitely? Does your cardiologist know any other cardiologists that could help you out? I have a gentleman on my team that is racing and has a stent. He doesn't seem to hold back. His was placed a little under two years ago.
High maximum heart rate
Hoping you can point me in the right direction here. I am a 38-year-old male and have returned to cycling (for about the fifth time) with a view to losing weight, gaining fitness, and because it's just enjoyable.
I currently weigh in at about 93kg and am 5'8" tall. A relatively muscular build, but with the dreaded middle age spread!
I competed at a high level when younger, and know how to hurt myself, but when really pushing it with a sprint to the top of a hill for example, my heart rate is pinging at 210bpm.
A weekly club run will be 50-60 miles at an average speed of 16mph and an average heart rate for the ride of around 135bpm, with training rides a couple of times a week averaging around 18-19mph and pulse at 150bpm.
I don't want to get too hung up on what the heart rate is doing, but have recorded a resting heart rate of 46bpm and always recover well enough to go out and ride well the next day after a hard training ride.
Am I in danger of 'popping a valve', or is a max pulse this high something that is quite common amoung athletes?
Scott Saifer says:
I've seen plenty of riders with maximum heart rates over 200. That in itself is not cause for concern. If you've been off the bike for a while though, and you are overweight or have other risk factors for cardio-vascular disease, the standard recommendation is that you should talk to your doctor before starting up an exercise program.
If you've been back on for a few months, you're probably safe. If you just started in the last few weeks, it'd still be worth scheduling that visit. The doc should give you a stress test and look for any irregularities in the electrical activity of your heart.
Ideal cleat position
This February I built up a new bike, and naturally purchased new pedals as well (Look Keo classic).
Since then I have had tinkering nonstop to try and find the ideal cleat position, and this is where I run into a problem. On my right leg, I have the cleat pushed pretty far forward, and it feels comfortable right under the ball of my foot. However on my left leg, the cleat is pushed as far back as possible, and it still feels like I am pushing with my toes to some degree.
No pain results from this, I just feel my efficiency falters slightly. I am not sure what to attribute such a large discrepancy (difference in foot length or leg length?). I am open to all suggestions, and am eager to get this figured out.
Steve Hogg says:
Let's start at the start. Stand in bare feet with heels firmly against a wall. Look down at your feet. Which foot is longer and by how much?
Next, determine whether the bulge of the base knuckle (first MTP joint) of the big toe of each foot are level with each other. Also compare where the bulge of the base knuckle of the small toe (fifth MTP joint) is in relation to the same place on each foot. Are both pairs of knuckles in the same place as measured from the wall give or take a couple of millimetres?
Is there any real difference in where these knuckles are located as measured from the wall? If so, on which foot are those two knuckles further forward from the wall you are standing against?
What you are trying to ascertain is whether there is any major difference in foot proportions. If there is, then a different cleat position on the sole of each shoe may be required to have the same cleat position relative to foot in each shoe.
This isn't rare but any major degree of difference isn't that common. And by major I'm talking more than about 3mm of difference in where the MTP joints are located as measured from the heel, or in your case, the wall. Same thing. You may find that you have a substantial difference in foot proportions which will partially explain the problem you are having.
The most likely result of this exercise is that you will have found no major difference, and that leaves the question of why the right foot with cleat all the way forward feels solid on the pedal but the left.
The likely reason is that you are pushing with your toes on the left because the left leg is having to reach further to the pedals than the right leg. The reason for this may be a leg length difference or it may be a pelvic symmetry issue; that is, that you are not sitting squarely on the seat.
The simplest way to gain more info is to mount your bike on a trainer. Warm up thoroughly and take your jersey off. While pedaling under reasonable load, have an observer standing above and behind you. What they need to answer is -
1. Do you sit with either hip forward or down in relation to the other side? If yes, which one?
2. Do you drop either hip on that sides' pedal down stroke? If yes, which one?
Get back to me with the info I have asked for including foot proportions and I'll attempt to advise further.
Different training session types
My question concerns relative training value of two types of sessions.
1. There is a weekly evening urban group ride of about 27 miles, with the group appropriately observant of stop lights, and with a few designated sprint sections. Longest sustained sections without stops might be two miles.
I can get intense heart rates, 100 percent of lactate threshold on the sprints. Last time I did this ride it took two hours to complete due to frequency of stoplights, with an average heart rate of 149, which is tempo level for me (about 90 percent of lactate threshold).
2. I can do a one hour trainer session with a similar average heart rate including intervals up to lactate threshold equalling about 15 minutes of total time. Trainer session is 40 minutes on Monark ergometer and 20 minutes on elliptical.
Are these two workouts equivalent? Is there any marginal benefit for the club ride, other than being with a good group?
I'm 63 years old, riding for 40 years, primarily for fitness and enjoyment, not racing. Main goals are to stay up with the younger riders and continue to do some endurance rides (completed Triple Bypass in Colorado two years ago; rode to 14,000ft elevation in Colorado last summer). Lactate threshold tested at 164bpm on a power tap critical power test earlier this year (20 minute average watts at 215).
Scott Saifer says:
Both of those workouts are potentially very good parts of your training plan. Since your goal is to keep up with younger riders, you'll need both fitness and refined group riding skills. That argues for the group ride, as does the fact that the group ride is twice as long as the proposed trainer session, since more time on the bike is better so long as you are riding well for most of that time. (More time is not better if you are riding exhausted for much of the time).
A two hour trainer session would have more impact on aerobic fitness than the two-hour ride because the trainer session would be more continuous.
Core strength imbalance
I am a 36-year-old B grade vets rider from Australia and have been racing road and mountain bikes for about eight years.
I recently decided to do some core strength work with an exercise ball (I know, shame on me for leaving it for so long) and discovered that my right side is significantly stronger/more stable than my left when doing these exercises. I found this a little odd as I am left handed/footed.
I have been aware of my right leg being stronger during one legged reps on the indoor trainer but was surprised at the overall difference throughout my torso. I have been professionally fitted on my bike and have ridden with many experienced cyclists and nobody has ever commented on me looking imbalanced in the saddle and I am constantly trying to keep my pedalling action as similar as possible in both legs.
My main concern is how should I go about correcting this imbalance? Is it as simple as doing a few extra sets on my right side or is there something else you might suggest?
Adelaide, South Australia
Steve Hogg says:
Dave Fleckenstein is probably best equipped to answer your query but here's my two bob's worth anyway. Handedness/footedness is not an indication of which side will be stronger or more stable. From what I see daily, many more people develop right side biased patterns of stability than do develop a left side bias.
The ratio I see is probably right side 90-95 percent and left side 5-10 percent. There are good reasons for this and while I don't claim specific expertise in this, a combination of many things including hemispheric motor control dominance and diaphragmatic attachment differences between left and right sides would be my pick as the two most likely.
I have found zero correlation with handedness/footedness which is a spectrum anyway, not an absolute. Most right handers have stronger stability patterns on their right sides. Equally, most left handers have stronger stability patterns on their right sides too, so you are not unusual.
How can you become more functionally symmetrical?
Geting hold of a book called "Sport, Stabilty and Performance Movement" by Joanne Elphinston would be a good start. Also, I would advise ditching the one legged drills and if you must do them, practice them with your right hand off the bars so that you have to develop a greater tendency to stabilise with the left side of your torso.
If you do stop the one-legged drills, try riding on flat to undulating terrain (using both legs) but with your right hand off the bars for reasonably lengthy periods.
Reaching threshold heart rate
Dear friends at Cyclingnews,
I'm a 39-year-old (40 in October) rider from Brazil. I've been riding and racing both on and off road for the past 23 years, more competitively for the last five or six on the road. I've lost fat, gained muscle and achieved good fitness after developing a broad base and then adding intensity and structured work in the past three or four years. Intervals, power metering, race scheduling, the works.
This has led me to the podium at some races in my age group, but most of all I've been able to consistently place top 10-20 overall in races even when all categories (except Elite) race together which I consider above my expectations (I'm 6.03ft/163lb. by the way).
This year I decided to 'just ride' so I've been training and racing without any structure or specific targets, as a way to 'rest' my mind and body without much commitment to results or rankings. I'm taking part in races and rides based solely on the 'Fun Factor' and nothing else.
I took off the power meter from my bike, I've still been riding regularly with elite and some really strong guys. Those are usually long, fast group rides which brought me an even higher level of fitness in a very relaxed way.
I've got some knowledge on nutrition and physiology and also my own body so I can balance training/rest for longer periods without much problem. With that I've been placing even better, despite racing more. In short, this has been my best year result-wise and I'm now on the sweeter side of pain-infliction at the local scene.
I'm telling this to ask about something that's been bugging me and perhaps you can help or know something about: for the past few months I'm having a hard time reaching my lactate threshold HR (about 169bpm) or above in training and racing. I've been riding harder, longer and faster than ever, my power/speed has increased (almost six percent gain in FTP in eight months without structured training) but I feel pretty hard to reach higher HRs, above 90 or 100 percent.
My resting HR has lowered too, and even when climbing fast or racing hard and long races I can barely make 20 minutes above LTHR. My PE and power show I've gained fitness, I'm doing 150km/4,500ft elevation rides and races and finishing strong and fresh, but I've become worried I might be suffering a heart condition of any kind. Or is it just a pleateau?
I take no medications or suplements, have no other medical problems in any form, I eat balanced and lead a quite relaxed life.
In short, I feel no discomfort (other that what should be normal for this level of exertion of course) when riding hard, but I need to go REEEALLY hard to reach redline! So I'd like to know if it is possible to have something underlying even with this level of fitness and feeling as good as I have. I'm scheduling a visit to the doctor to have an EKG, blood test and other exams but I'd still appreciate your opinion on this.
Thanks a lot and keep up the excellent work!
Scott Saifer says:
It's never an error to check with doctor when you think you might have a health problem, so keep that appointment, but it looks like you are responding normally to training. The stronger you get, the harder it is to hit those near maximal heart rates. You have to push harder on the pedals and make more power to get the same heart rate so it feels harder.
So long as your power at any given heart rate is the same or higher than before and your peak power is not declining, you are probably fine. It's normal to lose 6-10 beats off maximum heart rate as you go from recreationally fit to really well trained. Some people lose a few more. A maximum heart rate that continues to drop by more than about 15 beats in a few months, or that continues to drop to a level more than 15 beats below the peak of a few years earlier may be a sign of heart disease.
Not being able to stay above LT by more than a few beats for more than 20 minutes is not a problem. It's also normal for people who are well trained. Riders who chronically overreach can often stay well above LT for much longer times, but that is bad, not good.
Improving climbing performance
I’m a 16 years old guy and I’ve been training cycling for almost 2 years. I am not a good climber and I really want to improve myself. I hav? read that when climbing it’s the aerobic base that matters plus the cadence at which it was developed. So my question is how can I learn to climb without breathing heavily. The problem is that I live in a flat area with only few hills. (there are only 1-2 steeper hills about 1km long). I am training 12 hours per week.
Scott Saifer says:
The short answer to your specific question, "how can I learn to climb hills without breathing heavily" is simple: Go slower. If you go slow enough, your breathing will remain calm. Then you'll probably want to climb faster.
There are several things to think about when you want to climb faster. Among them, how long are the climbs you want to be better on? Climbs longer than a few minutes require aerobic power, while your 1km local hills can be climber aerobically but will most likely be ridden anaerobically, meaning even good racers will breath hard when climbing them.
Whether doing longer or shorter climbs, speed depends on power to weight ratio, where the power of interest is the power you can sustain for the length of the hill, if the finish line is at the top of the hill, or lower if you need to keep going. Power to weight ratio of course depends on power and weight. Whether you are heavy or light, aerobic training will make you a better climber, but training will only make you a competitive climber if you are also light. If you'll tell me your height and weight, I can tell you if training alone is going to do it.
Assuming you are light enough that aerobic power is the limiter and that the hills you want to excel on are more than a few minutes long, you build aerobic power by doing a generous amount of aerobic base riding (as many hours as you have time for at 70-80 percent of maximum heart rate or below), mixing in some low cadence work, and then including efforts up to lactate threshold of about the length of your climb.
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 (www.cyclefitcentre.com) 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 (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.
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