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I have been having stabbing pains on the insides of my knees. The pain originated about a year ago and at first I dismissed it for bad form, or simply a bad fit.
Now the pain is worse and is occasionally stabbing on the inside of my left knee.
On the right leg, my knee goes very far to the inside and I think it is extremely varus. I have tried to use the Specialized spacers for varus feet but they require so many that it seems to put unnecessary pressure on my ankle. When I ride without the spacers, my knee makes popping sounds and there is not sharp pain, but a general discomfort and it feels like it is 'falling apart'.
I read Andy Pruitt's book on bike fitting and I feel like I could have chondromalacia. Every time I move my knee past a certain point unsupported, just extending into the air, I hear a clicking noise, which I thought could be possible roughness on the underside of the patella.
Of course, I have no medical experience whatsoever so I'm probably wrong. Some help/diagnosis, or instructions to give you better clues would help a lot.
Steve Hogg says
The first thing you should be doing is consulting someone to make sure that there is no intrinsic problem with the knee. The chances are not high but it is possible. The next thing to understand that when walking or riding, rarely is knee pain a sign that there is a problem with the knee. It is almost always a sign that the knee is being loaded in ways that it doesn't like.
Problems arise because the knee, which is more or less a single plane, hinge like joint, is situated between two multi plane joints, the hip and the ankle.
If there are problems with the foot/ankle, then they can be easily corrected by walking/running orthoses or by appropriate wedges when cycling. If the problem is with the hips or lower back, then those issues have to be resolved to get a 100 percent solution.
My first piece of advice is to remove the wedges you are using and read this link http://bikefitpro.blogspot.com/
I can't say more for legal reasons but you can work it out. Scroll down to ITS Wedge Story
It is very likely that you need to use wedges, but I would suggest BikeFit Systems cleat wedges as your first choice. Almost always for pain like yours, the wedges should be positioned so that the thick side is to the inside of the foot.
With this issue, you need to be very careful with all aspects of your position. Any challenge to your position will increase any existing tendency to asymmetry. Have you had Scott look at your position?
Trying to lose weight
Hello, I recently got into the whole scene of cycling about two years ago. I recently bought a new 2010 Specialized Allez. I love it with a passion. The problem is I tend to go up and down with my weight due to bad drinking and eating habits. I tend to quit for a few months then soon enough, fall back into those bad habits.
I decided to quit alcohol cold turkey once again and maybe this time will accomplish my goal on losing a tremendous amount of weight. I turned 24 just last week and I weight approx. 210 lbs. I'm 5'11. That's not healthy at all, I know. My goal is to weigh aprrox 175 or so. It pains me to see my other friends very trim and fit.
What are some ways to better myself and become an avid traithlete mentally and physically? Thank you so much.
Scott Saifer says
Congratulations on your decision to become a healthier person. At 24, you have a lot of years left to live and you'll be happier for most of them if you don't trash your body.
There are a lot of things you can do to improve your chances of sticking with your new plan. The most important is to recognise that the more you do the "right" stuff and the less you do the "wrong" stuff, the more ingrained the habits you want to have will become. So, if you slip, which you probably will at some point, don't beat yourself up, but do get back on track as soon as possible.
If there are situations that you associate with excessive drinking, avoid them. If you tend to drink alone, have someone you can call when the urge hits. If you tend to drink with certain people, hang out with your triathlon friends and avoid the friends that support your drinking.
If you really knew what you needed to do to be healthy, you probably wouldn't be in your current situation, so involve some experts. Let a nutritionist guide your eating for a while. Make sure it's a nutritionist who has worked with endurance athletes since many weight-loss specialists haven't a clue about the needs of a person who does larger volumes of exercise.
Let a coach with experience with triathletes and with heavy and formerly heavy people guide your exercise. The cool thing about working with an expert is that you will know with confidence that the plan will work. You can get most of the same information from books or magazines or websites, but you also get contradictory information from the same sources, making it hard to know what will be the best plan. A good coach or nutritionist will give you solid, confidence-inspiring guidance.
If your alcohol consumption is really the larger part of your problem, get involved with a 12-step program or consult a specialist in addictions.
Good luck! Write back from time to time to tell us about your progress.
Carrie Cheadle says
When it comes to health and fitness goals, a lot of us end up swinging on a pendulum. You haven't worked out in a while, you've been eating poorly so you get motivated to make some changes. You go at it full force and a few months later; you're back to your old habits again.
A body at rest tends to stay at rest and a body in motion tends to stay in motion. It's similar to what Scott said - the more 'right' stuff you do, the more momentum you'll gain doing the right stuff. The more 'wrong' stuff you do, the more momentum you'll gain doing the wrong stuff.
If you are swinging on a pendulum, each time you start up again you have to overcome inertia which takes a lot of effort. The key here is to not beat yourself up after one slip. Beating yourself up will very quickly send you swinging on the pendulum. If you have a day where you eat like crap, tell yourself that you are only one meal away from eating a healthy meal.
If you end up having a lot on your plate and miss workout, let it go and tell yourself that you are only one day from another great workout.
It's also important to hold onto the vision of your goal - what you really want for yourself and what you really value as you are making that immediate decision to grab a 5th slice of pizza or your second or third beer. If you base that immediate decision from the place of what you truly want and value, you'll be able to recognise that the decision to eat another slice isn't in line with what you really want.
Your brain tricks you into wanting the immediate reward, but the true reward lies in taking control of your choices and living the life that you want. It also important not to compare yourself to your friends, but to compare yourself to you - are you making progress toward your goals and the life that you want? I also agree with Scott, it's important to evaluate what role alcohol is playing in your life and get support with it if needed.
Good luck on your journey!
Difficulty raising heart rate
I am a cat 2 road racer, aged 42; I have been riding many years but only recently with a PowerTap. I have noticed over the last few weeks whenever I try to do a hard interval (1.5min climbs at 1.10 gradient ) or similar my heart rate doesn't rise as I would expect and my power is down (perhaps 10 percent).
I've got Polar files going back two years and they show the kind of heart rate response I would expect when doing the same intervals on the same hill (i.e climbing to well above LT HR by mid interval).
My measured LT heart rate is 176bpm, currently when doing the above intervals or slightly longer five-minute steep climb repeats I am struggling to reach 170bpm and I generally feel like I have a lack of power. I wonder whether this could be caused by a virus which isn't really affecting me in day to day life or during steady aerobic riding? Any help advice would be greatly appreciated.
Scott Saifer says
You may be sick or underfed, but what you are describing sounds like classic overtraining or heart disease. Pray for overtraining. A maximum heart rate that continues to fall more than a dozen beats or so is cause to visit your doctor.
If you'll tell me how and when your LT was measured at 176 bpm, a bit more about your regular training schedule and if you were sick in the past few months, I'll try to offer more guidance.
Dave Palese says
The symptoms you are relaying are pretty typical of "overreaching". Not quite overtraining, but the early signs of such a state.
Two great things:
First, the remedy is pretty easy. Usually 4-5 days of easy riding (reduced volume and intensity) will do the trick or at least start you down the right track.
Second, your new training tool, the PowerTap and software like WKO+ from TrainingPeaks can help you identify your "breaking point" (how much stress you can apply and accumulate over a period of time before performance drops off), and then track that stress so that you can apply training stress in the proper doses as not to over do it in the future.
The measurement of that stress is TSS (Training Stress Score). A full discussion of TSS and how to use it are beyond the scope of this response, but there is plenty out there to read and educate you. Just know that this info is know right at your fingertips!
John then responded:
Thanks for the reply.
A bit more background. I unfortunately can only do about 9 or 10 hours a week total training. My LT was measured during a laboratory VO2 max test about nine months ago.
My preparation for my road season which starts in three weeks' time has been as follows with a view to being in top form during April:
September: 25hr at max HR of 150
October: 40hr with max HR of 150
November: 40hr with 2 x 2hr/week at HR of 155
December: 35hr with 2 sessions per week doing long climbs (4 x 15mins) at HR of 160 to 170
Since mid January I am doing 10hr/week
1 x 2hr with 3 x 20 min at LT Power range
1 x 2hr with 6 x 5 min steepish climb repeat (VO2 max range) or 6 x 5min flat VO2 max intervals
1 x 1.5hr with 6 x 1.5 min steep climb repeat (Maximum effort)
1 x 3.5hr steady
1 x 1hr easy if I have the extra time (rare)
Most rides are every other day, I cannot do consecutive days training these days. I also employ a three weeks hard/one week easy routine.
In late January I had a few easy days due to a nasty sore throat and swollen glands which cleared after about four days.
Your opinion would be very welcome.
Scott Saifer says
Thanks for the details. Now I can give an informed answer. Assuming that you were not sick, didn't have huge stress in your life and were able to recover well between rides, your September-December plans look good. You should have had a good base at the beginning of January and been ready for some harder riding.
The work you've described doing since mid-January though is simply too much of that too hard riding. When someone does that much hard stuff, I expect them to feel good and go faster probably for 3-4 weeks, and by five or six weeks, they'd be losing enthusiasm, having trouble with raising their heart rate and maybe starting get sick.
Three hard days per week with workouts at and above LT long enough to get tired is enough to cause overreaching within a month or so in almost all riders, even pros. If you try to keep pushing after the overreaching kicks in, as evidenced by the loss of ability to get up to what used to be your LT heart rate, you move into overtraining. Since it sounds like you contacted us as soon as you noticed the effects of overreaching, you have probably acted in time to save your season.
I'd suggest about two weeks of base riding only, and at an intensity that feels easy. Fill your available time, but don't ride hard. The recovery period continues until you heart rate rises easily again. Don't test that every day since that would be training hard again. Rather, test it at the end of the first week and then every 3-4 days after that.
Once your heart rate response is REALLY normal (don't rush this), reintroduce one or two but not three days per week with work near or above LT. If you have to be on best form from the beginning of April, include some maximal efforts. If you can afford to race into peak shape a bit, don't go higher than LT plus a few beats when you return to harder training, and save the maximal efforts for the races.
When you do your hard days, quit when your form starts to fade or your power drops or you feel less energetic than you did earlier. Don't push to exhaustion or to complete a set number of intervals.
Good luck. Let us know how the recovery goes.
John then responded:
Is it really the case the body can only cope with two hard traing sessions per week? If that is the case almost every rider I know trains too hard most of the time or maybe they train mediocre most of the time because they do too much...
When I am not doing either of my two hard session what should I be doing at this time of year? One long steady ride at endurance pace and one shorter ride at tempo?
What power/hr do you have in mind for the non-hard days based on the fact I am doing 295w average in a 20minute test, ave HR 174bpm?
Scott Saifer says
Most bodies can cope with one or two days of hard training per week, long term. Most can also get a big burst of improved fitness from doing 3-4 days per week for 2-3 weeks. That's the trap: people train hard for a few weeks, feel much stronger as a result and think they should keep going. Then they start to get tired and plateau.
Training should always make one faster until one reaches one's potential, so if your buddies are "training" but they aren't riding quite well and aren't faster than a few months ago, there's something wrong with their training.
The non-hard days should be aerobic base rides if you feel great, or recovery if you don't. For aerobic base and recovery rides, riding by heart rate is probably better than power. There are a variety of factors that will affect the power you make at a particular heart rate, but the heart rate for a particular physiological effect changes a lot less. You can safely do aerobic base below 75% of maximum heart rate (below 80% when you are not in the least overreached) and recovery below 70% of maximum heart rate.
You'll know it's working if your average power for your endurance rides starts to rise.
The Cyclingnews Form & Fitness panel
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.
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.
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.
Pamela Hinton has a bachelor's degree in Molecular Biology and a doctoral degree in Nutritional Sciences, both from the University of Wisconsin-Madison. She did postdoctoral training at Cornell University and is now an 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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