Fitness questions and answers for July 12, 2004

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.

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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.

Since 1986 Steve Hogg (www.cyclefitcentre.com) has owned and operated Pedal Pushers, 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.They include World and National champions at one end of the performance spectrum to amputees and people with disabilities at the other end.

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.

I'm a 29 year old male recreational road rider. I used to do 200 to 250km per week, but in early April of this year I was hit by a car and suffered bad facial lacerations, concussion and a broken clavicle. Everything's healing nicely apart from the collarbone. I haven't ridden since the accident and have lost a lot of fitness. I bought a trainer, but can't motivate myself to use it. Getting back on the bike will be a big step, and I wondered if you could tell me if it will do anymore damage to my slow healing bone. The last x-ray showed no sign of healing and a bone graft is a possibility. If no damage is likely, I'd like to get over the mental hurdle. Any tips?

Clavicle fractures are undoubtedly one of the most common cycling injuries and, until fairly recently, were generally left to mend on their own. This resulted in 4-6 weeks of significantly altered training, loss of fitness, etc. However, more and more frequently I am seeing surgical correction (via screws) with excellent results. I have had 4 clients this year have surgery on their clavicle fractures and they have all been back on their bike within 3 days and were racing within about 3 weeks. Two of these clients had waited 6 weeks and had encountered a scenario similar to yours. The other two had surgery within three days of their accident. All are doing very well and having minimal problems. They all reported general local irritation from the screw - we're a skinny bunch without much muscle covering that area - and two have already had the screw removed. The risks of the surgery include the standard infection concerns (as with any surgery) and the concern of a crash damaging the area before adequate bone callous formation has occurred. I would note that, 6 weeks after one of my clients had their surgery, they crashed quite spectacularly and impacted that area with no effects whatsoever. I would also point that different surgeons will have different opinions on this injury, but in general, for a population that quickly needs to return to activity, this is an excellent option.

Why and how do clavicles (collarbones) break in falls, and what could be done to minimize the risk? I suspect that at least two factors are involved: first, at advanced and elite levels cyclists have minimized the "unnecessary" musculature, including pectorals, trapezius, and deltoids, that ordinarily support the clavicles; and second, collarbones break in certain types of falls and not others. As for the first item, would there be a benefit to targeted strength training, and if so, what would the program look like? As for the second, is there a better -- or at least, less bad -- way to fall in a forward crash?

I don't know that your question has been researched in detail, so I'll just be sharing humble opinion here. I've queried about a dozen clients and friends about how they broke collar-bones as well as reading the opinions of other coaches. There seem to be at least two common modes of collar-bone breakage. The one you hear about all the time is landing to the side on a straight, outstretched arm. The second, which is the one that got most of my interviewees is actually landing with a "whump" sideways on the shoulder itself.

I've been riding recreationally since I was a kid, on a range of mountain and road bikes. Until my mid 20s I could ride on anything, with no discomfort, but over the last 4 - 5 years or so I've found riding increasingly uncomfortable. Last winter I bought a fab Bianchi road bike, which felt fine during test rides before I bought it, but now I have it home, it's excruciating - I can't manage longer than an hour on it. The pain is more undercarriage than glutes. So far, I have tried - changing the saddle, to a Terry-style variety with a cutout section; changing the saddle height, angle and distance from the bars; changing the handlebar height; and wearing heavier-padded shorts. All have made slight improvements, but I'm light years away from the degree of comfort I used to have.

Firstly the bad news. This is an all too common experience for small women. Given your size, I will just about guarantee that the seat tube angle on your bike is too steep for you. This is because manufacturers make a lot of compromises in small frames so that they can fit 700c wheels in. In short if you look at your catalogue on the frame geometry page you will almost certainly find that the fork offset in your small frame is the same as that used in larger frames. This allows manufacturers to save a few bucks. It means, though, that the frame has to be designed around that fixed fork offset and still allow reasonable foot/front wheel clearance. With a 700c wheel and the reduced top tube length of a small frame, the easiest way to fit it all in is to steepen the seat tube angle. This allows greater foot/front wheel clearance for a given top tube length, but the corollary of this all to common approach is that small people on small frames are forced to sit proportionally further forward than larger people on larger frames. This in turn means that afflicted people are forced to sit on their perineum and genitals. The weight transfer forward of this approach often also means sore hands and stiff neck and shoulders. There is no justification for this other than reducing production costs and all major manufacturers do it.

I am 35, weigh 220 pounds at 5'10". I raced as a junior pretty aggressively and was always in the top 3 locally and placed competitively in larger events like Superweek. It's been a very long time since riding and I want to get back to it. I used to a good climber at 150 lbs but now I've obviously got a weight barrier and want to know some general guidelines regarding revamping my diet and how to train myself back into riding shape as well as lose the weight in a sensible manner. My goal is to be riding at 175-180 lbs, I am much more powerful now and wonder if the old climbing abilities are now lost and replaced by being a better sprinter/power rider.

Another goal is to be back to racing in 2005 so I've got the summer and early season next year to get ready to race. How should I train myself for the remainder of the year and into next so I've got a solid base and am back to modest racing form? I have 8-12 hours available to train per week in the Boston area. Good variety of hills and flats. I have no baseline HR or past training info to work from and I want to make the most of my training time since I'm fairly limited on time. Any advice and guidelines would be really helpful.

If you go by Nike's motto then all it takes is 3 words - 'Just Do It'. I can relate to the feeling of putting on a bit of weight when you stop riding. Having been off for close to 4 months it packs on pretty quick. The easiest way to change this though is to simply start riding. Since you've packed on close to 70 lbs since your racing days it's not going to take much movement for you to tip the calorie scales back in the favor of losing weight.

I'm a 32 year old male who races Category 4. I raced half a season last year on virtually no base due to recovering from ITBS in my left knee from the previous year. I started my base training this year in early January and with the exception of tendonitis in my right knee for a few weeks in Feb/March, I've been training and racing throughout the season. I average 130-200 miles a week (with the occasional 250 mile week) including one race a week (Crit or RR). In addition to the specific knee injuries (ITBS and tendonitis), I experience periodic aches and pains in my knees but none persist for long with the exception of one.

I find that just about anytime I ride a long (60+ miles) and/or hilly race (or equivalent training ride) both of my knees experience sharp pain by the end of the ride. An illustration of when my knees become painful occurred two weeks ago during a stage race. The first and fourth stages had several long (2-8 mile) climbs and finished with long climbs of 5 & 8 miles after 70 and 90 miles of racing, respectively. My knees were very painful on the last climb of each stage. I would describe the pain as sharp. The pain comes from numerous places around the knee but primarily across the top (inside and outside) and below the knee cap. I have experienced this pain for several years under similar conditions. The pain seems to be alleviated by decreasing the pedal force, i.e., spinning or riding on flat terrain. The pain seems to be starting later in a ride as my condition and strength have improved. I can ride 30-40 miles with no problem regardless of the intensity of the ride. I have been professionally fitted to my bike and my cleats. I have orthotics in my Sidi G4 shoes. I recently switched to Speedplay Zero pedals from Look PP396 pedals, with no apparent improvement. I run a standard 12-25 cassette and 39X53 crank. I ice my knees after these events and try to stretch regularly (but often fail), particularly before long rides. I do not consider myself a gear masher. One of my few cycling strengths is climbing and I would like to improve my climbing, overall endurance and power but fear that my knees are not up to the task. I would appreciate any feedback on this nefarious pain and suggestions to alleviate it.

The area you refer to is the vastus medialis obliquis or VMO. In all the other quads, the muscle fibres run longitudinally. With the VMO the muscle fibres of the head of the muscle run laterally and as well as being an extensor of the knee like the other quads, it can act as a lateral stabiliser of the knee. The question is why is it hurting under load? The likely reason is that you are rolling the knee inwards on the downstroke under load. This can be for a number of reasons.

I used to be a Cat I cyclist in the US and never had any problems. I took a few years off the bike and am just starting to get back into cycling shape. I have gradually built back up to being able to put in four or more hours on the bike but I have two issues that have suddenly become prominent each time I ride. My left arm is more than one inch shorter than my right arm due to a substantial fall that shattered the upper humerus as well as my shoulder. During my racing times it never bothered me very much at all. Suddenly it has become very painful after about two hours of training. Perhaps related to this, my lower back on the right side only also hurts after two or more hours of riding as well. I never feel "right" on the bike. Is the length of my arms affecting my lower back or are these possibly unrelated? I would also like to know what might be suggested to help offset the arm length issue.

An inch difference in arm length could certainly cause you to sit twisted on the bike and lead to lower back pain. My first thought would be to twist the stem on the steerer to bring the left bar closer to your shoulder. Your bike will look odd, but it may be much more comfortable. You may need to change stem length, add padding under the bar tape or move the left brake lever up on the bars to complete the fit.

I have seen a number of people over the years with similar problems as that which you have described and back pain was always part of the scenario due to overreaching on the affected side. This can often cause an affected rider to twist in the lower torso so that sometimes the other side of the back is more troublesome. There are a million and one other reasons that cause you back pain so see the best person you can find to position you. The mechanical solution to your over reaching is as follows. Find an electrical shop and buy some electrical conduit, which is the white hard plastic tubing that electrical wiring runs through. About 40mm diameter should do the trick in your case. Standing a length on end, cut it with a hacksaw vertically so that you are reducing its width by 1/3. Undo your bartape on the left side and using a hair dryer or heat gun fit the conduit to the handlebar with the open side [ cut side] against the bar. The heat gun will soften the conduit so it can follow the curves of your bar. You will need one piece for the drop and another for the top of the bar. You will need to build up or lift the brake lever on the left as well.

I recommend simply making your shorter arm longer. You can use a thicker glove on your left hand (perhaps a thick padded gel glove) or even sew foam padding into a glove. It is certainly possible, and assuming all other areas of your position are balanced, quite likely that your arm length discrepancy is a direct culprit of your lower back pain. I suggest practicing a specific yoga pose off the bike to help realign your spine and reduce the muscular tension in the low back that may be compensating for your arm imbalance on the bike.

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