Fitness questions and answers for August 15, 2007

Form & Fitness Q & A

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.

Jon Heidemann (www.peaktopeaktraining.com) is a USAC Elite Certified cycling coach with a BA in Health Sciences from the University of Wyoming. The 2001 Masters National Road Champion has competed at the Elite level nationally and internationally for over 14 years. As co-owner of Peak to Peak Training Systems, Jon has helped athletes of all ages earn over 84 podium medals at National & World Championship events during the past 8 years.

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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.

Fiona Lockhart (www.trainright.com) is a USA Cycling Expert Coach, and holds certifications from USA Weightlifting (Sports Performance Coach), the National Strength and Conditioning Association (Certified Strength and Conditioning Coach), and the National Academy for Sports Nutrition (Primary Sports Nutritionist). She is the Sports Science Editor for Carmichael Training Systems, and has been working in the strength and conditioning and endurance sports fields for over 10 years; she's also a competitive mountain biker.

David Fleckenstein, MPT (www.physiopt.com) is a physical therapist practicing in Boise, ID. His clients have included World and U.S. champions, Olympic athletes and numerous professional athletes. He received his B.S. in Biology/Genetics from Penn State and his Master's degree in Physical Therapy from Emory University. He specializes in manual medicine treatment and specific retraining of spine and joint stabilization musculature. He is a former Cat I road racer and Expert mountain biker.

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 assistant professor of Nutritional Sciences at the University of Missouri-Columbia where she studies the effects of iron deficiency on adaptations to endurance training and the consequences of exercise-associated changes in menstrual function on bone health.

Steve Owens (www.coloradopremiertraining.com) is a USA Cycling certified coach, exercise physiologist and owner of Colorado Premier Training. Steve has worked with both the United States Olympic Committee and Guatemalan Olympic Committee as an Exercise Physiologist. He holds a B.S. in Exercise & Sports Science and currently works with multiple national champions, professionals and World Cup level cyclists.

Richard Stern (www.cyclecoach.com) is Head Coach of Richard Stern Training, a Level 3 Coach with the Association of British Cycling Coaches, a Sports Scientist, and a writer. He has been professionally coaching cyclists and triathletes since 1998 at all levels from professional to recreational. He is a leading expert in coaching with power output and all power meters. Richard has been a competitive cyclist for 20 years

Andy Bloomer (www.cyclecoach.com) is an Associate Coach and sport scientist with Richard Stern Training. He is a member of the Association of British Cycling Coaches (ABCC) and a member of the British Association of Sport and Exercise Sciences (BASES). In his role as Exercise Physiologist at Staffordshire University Sports Performance Centre, he has conducted physiological testing and offered training and coaching advice to athletes from all sports for the past 4 years. Andy has been a competitive cyclist for many years.

Michael Smartt (www.wholeathlete.com) is an Associate Coach with Whole Athlete™. He holds a Masters degree in exercise physiology, is a USA Cycling Level I (Elite) Coach and is certified by the NSCA (Certified Strength and Conditioning Specialist). Michael has more than 10 years competitive experience, primarily on the road, but also in cross and mountain biking. He is currently focused on coaching road cyclists from Jr. to elite levels, but also advises triathletes and Paralympians. Michael is a strong advocate of training with power and has over 5 years experience with the use and analysis of power meters. Michael also spent the 2007 season as the Team Coach for the Value Act Capital Women's Cycling Team.

I live in East London. Is it possible to send you the appropriate measurements for you to assess what size bike I require? Recently I bought a Cannondale Synapse, frame size 47 compact and it is too small for me. I just cannot get comfortable on it. I have consulted several people who are respected in the cycling fraternity who have confirmed the wrong size, but would like your opinion as well before embarking on buying another frame. Which measurements would you require?

The short answer is "no", it is not possible to prescribe a frame size strictly based on any body measurements with total confidence that the result will be a bike that is comfortable to ride. I could give you a bunch of questions to answer that might get you close, but I have another suggestion that is almost guaranteed to get you the right size bike. Go to a shop and try bikes. Have the shop employee adjust the bike for you and really test it by riding hard, taking some corners, riding it up a hill and down. Keep trying different bikes until you find one you love. This method guarantees you'll end up with a bike you love.

I am a 60-year-old cyclist, having been so for 46 years. I raced up to the age of 40, with a little success – a handful of wins and completion of an 8-day stage race as the highlights. At 40 I was diagnosed with type 1 diabetes, and by 50 was suffering from atrial fibrillation, a form of arrhythmia. This curtailed my cycling to 20-mile rides, generally about 90 minutes exercise. In 2002 I started to use an insulin pump to improve my blood sugar control, and removed the pump whilst cycling. In 2006, I had an ablation procedure which cured my fibrillation, and since then with the absence of beta blockers and warfarin, I have improved my ability on the bike, moving up to 3-hour + rides – approx 50 miles.

The downside of my increased endurance is that I finish these rides with high blood sugars, in excess of 15mml/l. I am currently combating this by keeping the pump running on a reduced basal dose (50% of normal, though I can adjust it to any fraction of the standard dose) and stopping every 30 minutes to take a sugar-level reading. I react to each reading by applying more insulin, more carbohydrate, or nothing, as the case may be. Although each stop is brief, I don’t really like stopping at all, and would like some advice from people who have already solved this problem, either for themselves or for others, to help me establish the most effective pump regime for my longer rides.

Before recommending any shim changes, I have two issues of concern. I would very seriously question the ability of anyone to consistently measure a 3 mm difference in leg length - research shows us that these measurements have poor validity and the only true way to measure leg length is with long leg x-rays. Secondly, I would question whether you have a true leg length difference or a functional difference due to pelvic rotation/shear and would recommend having this evaluated by a PT or chiro. The concern with shimming to make up the functional difference is that rather than addressing the root cause, you are potentially making the original problem worse. I have found frequently that by normalizing length of the hamstrings, hip flexors and hip external rotation musculature rather pronounced leg length differences suddenly are minimal or eliminated.

Secondly, in years past when I used to run (before an ACL tear and reconstruction ended that—on my good side by the way) I noticed that on my left foot, the one in question, I was an inside “heel striker,” whereas on my right foot I was a more typical outside heel striker. Is this an indication of valgus angulation on the left and varus on the right—or is the running motion unrelated to cycling?

I can give you a general picture but I can't diagnose what I can't see. I can make educated guesses as I do all the time but that isn't the same thing.Regarding whether you need further varus compensation - I don't know. Perhaps, perhaps not. That's why I suggested you visit a podiatrist or someone knowledgeable regarding feet and gait and find out what the situation is with regard to forefoot varus or valgus. Once you have done that you will have information, fact rather than guess work, that will allow me to advise you further based on hard information.

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