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Cyclingnews Fitness Q&A - November 27, 2009

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.

Ruptured Patella Tendon

I am a rider/racer on the road and mountain bike. I have been training for fitness for the past 10 years and compete in about 10 races per year as a Cat 3 racer. I recently ruptured my left patella tendon on my left leg playing basketball. I am a male and will be 34 in January. I had surgery to repair it two weeks ago and am in a brace and on crutches for seven weeks without physical therapy to allow the tendon to heal.

I am looking for alternative fitness advice and thoughts on when and how much cycling I can do as my knee starts to heal. I don't believe seven weeks using a knee brace and crutches is the correct prescription for everyone.

Thanks for any advice,
Jeromy Vigil

Kelby Bethards says


Left patellar tendon rupture? OUCH! I would most certainly talk this over with your orthopedic surgeon. I know it seems like a long time to be immobile. BUT, that is the same with downhill ski racers and so on. The key here is to let the patellar tendon heal completely prior to stress. That tendon takes a large burden of stress and tension and at this point, a re-injury would be a even larger set back.

It's hard to wait, but the surgery is only a portion of the process. The rehab and physical therapy is horribly important.

So, as you are correct, not all heal at the same rate, nor are all injuries the same, I would certainly talk to your orthopod about the time frame. I actually think seven weeks for that injury sounds pretty good.

Excess Post-exercise Oxygen Consumption

Hello and thanks for taking the time to read this; could I please get your opinions regarding the use of EPOC to:

1) Determine the session intensity and desired effect and
2) Determine when it is the appropriate time to conduct the next "hard" session.

As these seem like the most important indicators in our fitness, I haven't seen much press about EPOC until now. Any thoughts on their accuracy and usefulness would be appreciated.


Pam Hinton says


Let me start by providing a brief explanation of Excess Post-exercise Oxygen Consumption (EPOC). During exercise, oxygen use (i.e., volume of oxygen consumed, VO2) is increased above resting values due to the increased rate of ATP production to meet energy demands. After exercise, however, VO2remains elevated above the resting rate for several hours, and this post-exercise increase in VO2 has been termed 'EPOC.'

EPOC shows a curvilinear relationship with exercise intensity. That is, at intensities less than 50% of VO2max, EPOC is negligible. However, at intensities greater than about 50-60 percent of VO2max, EPOC increases exponentially with exercise intensity. Exercise duration also increases EPOC, if the exercise intensity is sufficient - about 70 percent of VO2max. Because the magnitude of EPOC depends on both the intensity and duration of the exercise session, EPOC might, as you suggest, be used to quantify the stress or training load of a given workout.

This is all well and good until you realise that *direct* measurement of EPOC requires the ability to measure oxygen consumption. This can only be accomplished in a laboratory using an expensive piece of equipment that measures respired gases - a metabolic cart. Furthermore, to determine the increase in oxygen use above resting rates, i.e., EPOC, you must first determine resting VO2.

Accurate measurement of resting VO2 is actually much more involved than it sounds. Variables such as feeding, activity, and menstrual status - even whether the subject is seated or laying down-must be carefully controlled, as they all affect resting metabolic rate and, therefore, resting VO2. Needless to say, direct measurement of EPOC for the evaluation of training session intensity is not feasible.

A mathematical model that estimates EPOC from heart rate has been developed based on previously published studies that measured both heart rate and EPOC in response to exercise of varying intensity and duration. This model has only been validated in one study that included 32 adults, only 8 of whom were relatively fit, and that used short-duration exercise (10 min at 40 percent of VO2max, 10 min at 70 percent of VO2max, and an incremental max test). Moreover, use of heart rate to estimate EPOC requires a specific heart rate monitor and the corresponding software.

Thus, at present, I am not confident that indirect estimation of EPOC based on heart rate offers a better way of quantifying training intensity than other better-known methods.

Serious saddle sores

Fitness team,

I'm a keen male racing cyclist riding at elite level on the road here in the UK, aged 32. Over the last few weeks I've developed a cyclist nodule/perineal nodule/biker's nodule. It is basically a 1/2" by 1/4" lump of fibrous tissue positioned at the bottom of my perianal which becomes irritated as I ride. This is now impacting my riding as I can't manage longer training rides and have to have days off between rides.

Can you give me any advice on how to handle the condition? I've done some research of my own and the options appear to be complete rest for a period of months, surgery to remove the nodule or possibly steroid injections. Neither option is really appealing!

Do any of you have any further advice or know of anyone who has had this condition and managed to contain it and recover without the need to go under surgery?

Duncan Putman

Kelby Bethards says


Well, there are a few options, but none of which I can promise will work without actually knowing exactly what it is. There are, in some health stores, salves called "drawing salves". The intent is to help draw out the material in the area in the situation of a cyst or minor abscess. HOWEVER, if it is a bit of scar tissue the only options in my estimation are steroid injections or removal.

Now, I know the idea of being "operated" on in that region is not appealing. I'm pretty sure nobody wants to be cut near their nether regions, but you DO NOT want an abscess in the region. So, with that being said (written I should say), go to your physician. If it is an abscess or cyst, it can be drained relatively easily before it gets out of control. If it is scar tissue or a nodule, that will need removal.

I realise no many want procedures... however, sometimes a little bit of discomfort initially prevents larger and much worse and limiting problem, with sometimes permanent implications.

Tasting blood after workout

I was working out pretty hard yesterday, harder than I usually do and when I stopped I felt this taste of blood on my throat and mouth so I stopped working out but the taste would not go away eventually I felt like throwing up and had the feeling I was going to faint. I could understand why I wanted to faint and throw up but I can't understand why I felt the blood taste in my throat and mouth.

Can you guys explain this to me I will really appreciate any information that you can give me. I am 27 years of age, male and do some sort of exercises daily.

Thank you,

Kelby Bethards says


Let me start by saying, go see your physician or practitioner. This could be something completely benign but I would want to talk to your doctor about that.

Reasons for a blood taste, can be a few reasons. IF you have sinus problems they can bleed a little and you will get the taste in the posterior area of your tongue on those taste buds. Also, gastroesophageal reflux can give a bad or sour taste, but it doesn't usually have the iron/metal taste of blood. Did you spit up any blood or cough up and blood?

Anyway, I think it's worth a visit to your practitioner.

The Cyclingnews Form & Fitness panel

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.

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.

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.

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