Fitness questions and answers for July 24

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.

Unless you have an unusually large heart, a low ejection fraction will mean a low stroke volume and so a low cardiac output. Compared to another rider with normal ejection fraction, similar heart size and similar maximum heart rate your VO2-max will be lower. Compared to all other riders, your performance may or may not be worse, depending on how low your ejection fraction is, and how well endowed you are in other ways that support cycling performance.

I know it may be hard to believe, but it is very difficult to detect banned substances in athletes. In fact, it is challenging to measure hormones like erythropoietin (EPO) and growth hormone (GH) in people who are using them therapeutically. Explaining the challenges of detecting these compounds in blood or urine, requires a brief discussion of endocrinology. Hormones are chemicals that are made in one organ, are released into the blood, and then bind receptors in other organs where they exert their effects. For example, GH is made in the pituitary gland.

Six weeks ago an SUV driver neglected to look in my direction pulling out from a stop hitting me square on my right side while I was commuting home by bicycle. The shoulder dislocation went back in nicely as they were preparing to work on it in the emergency room. Surgery later that evening inserted a full length nail into my broken femur. The surgery took an extra 3 hours due to complications, alignment and muscle between the broken femur ends.

At my 6 week check the surgeon indicated that the femur was angled at 7 degrees. There was no change in the angulation between the 3 week and 6 week checks. He indicated that this would have no impact to walking, running, bicycling, skiing, etc. It seems like we're often concerned with much less variation in body structure when it comes to bicycle fitting. Is this angulation something to be concerned about? Is it worth a second opinion from an orthopedic specialist? Could I expect bike fit issues with this angulation such as knee or hib problems (none of which have been experienced in the past)?

A second concern - once my knee flexes enough to get my right leg around a turn of the cranks what should be the path to rebuilding fitness and strength on the bike? I have rollers, but can borrow a trainer. Rollers might need some more leg speed and strength than I'll have at first. Strength, leg speed and leg smoothness is the goal, but with a rollers I'm concerned about the initial ability to pedal a sufficient cadence to balance and achieve an effective workout.

A cautious answer to your query as to whether you will experience issues with the altered femur angle when riding your bike is maybe. I am sometimes surprised by what clients can cope with without problems and sometimes dismayed by how little they can cope with without problems. I would be finding the best person available to check out your position with regard to seat position, cleat position and angle and footplant on pedal before you do too much cycling at any intensity. Ideally it should be someone with experience in remedial stuff and who takes a structural approach to bike positioning.

I am a Cat 2 racer, 5'4" weighing in at 125. I took a year off the bike to find out that I hate running and now that I am back on the bike, 4 months now, and training hard for the late season races and to get a base for next year, I am having major saddle and feet issues. I am on my third saddle because I developed saddle sores on both sides of my butt bones or seat bones (it is actually just below my bones) and I have numbness in my left foot at the ball of the foot extending into my toes. I do have a neuroma in my left foot just below my fourth toe that probably causes me more pain. My shoes are Specialized and I do have an orthotic with a metatarsal pad to help separate my bones. Not helping much for some reason. I am in so much pain with my butt until it goes numb and then my left foot starts to hurt because I have been on the bike for more than two hours. I am riding in so much pain that it isn't much fun. Can you help?

Here is a non medical answer to your query. I have had post knee replacement riders as clients and they were able to get back into racing though not necessarily at the level they participated before the op. I don't know if this is the case will all people post knee replacement but don't give up just yet. I suspect that Dave and Kelby can give you a more considered opinion as I am sure that there are plenty of variables.

A year ago I moved to Denmark and after a few months off for winter started training on the mountain bike and road bike. By early spring last year (may) I was improving a lot and pushed myself with a 40 mile ride. The next weekend I had an intensive mountain bike ride (15km) and later that day my first knee injury symptoms showed and I had to limp a bit as there was pain below my left knee cap. I took a few days off and then tried the method of pushing through the pain and ended up with intense pain across the front of my left knee cap. I took a week off then did a low intesisity spinning road ride and the next day I had similarly bad pain in my right knee. I then took 4 days off and did some easy mountain biking which felt great. The next day I went again and the following day both knees were very sore. I then spent some time adjusting my cleats and seat height to recommended levels and b mid June I was taking short extremely easy road rides and still was getting sore the next day; a dull ache most intense on bony area below knee but extend around the outside of knee area to the top of the kneecap.

It's a year later now and my knees still feel as weak and damaged as before and I am very saddened by missing the summer riding season and the prospect of not riding intensely again. I have removed my clipless pedals for simple platform petals on my road bike but my knees still get injured with a ride. I am supposed to see the orthopedic surgeon next month but don't have much faith. I take glucosamine/chondroitin as well as fish oil before and after I do any riding. Are my knees just broken before the age of 30?

I ride MTB enduro and do a bit of road riding as well. I have been having pain on the side of my right knee (occasionally left too) just below the boney protrusion on the outside of the knee where the tendon meets that. Not the tendons/ligaments on the outside but the one just in from that. I went to a PT person who said it was an ankle stability, which I worked on all winter. After the last 12 hour race, the pain came back. Can it be tracked back to poor bike set up or poor mechanics? I am a 38yo male, small and light. I don't race often, but I put in about 15+ hours a week.

You haven't given me a lot to go on. Assuming your physio was correct, you can strengthen your ankle all you like, but under real load (read racing or training hard) most issues, unless totally put to bed by the strengthening you have done, will reassert themselves. Visit the physio again and ask whether it it a good idea to effect some sort of mechanical solution to your problem, like an orthotic device in your cycling shoe to take the pressure off your knees.

Last week, in a stage course he experienced the same thing in a bunch sprint twice(last occasion the sprinting speed was above 61 km/hr). Both times in a winning position and both times ending up beside the platform. Of course very frustrating. Both times he pulled his right foot out of his pedal in full sprint. After the first time we tightened the pedals up to almost maximum tension. He rides with Look CX7 and Shimano SH R-151 shoes. His cleats were renewed only a week ago. His leg position is rather or very "X-shaped".

The winner of these races is an awesome cyclist, and the only triathlete I know who wins the race on the bike. Cycling is also my strength but not as much as him, I've recently been researching pedal crank length and I want to buy a larger crank. A have rather long legs for my age in comparison to my torso (I'm 1.76m around 5'9 and my inseam is 86-86.5cm (i'm still growing) and my lower legs are long in proportion to my upper legs). My bike comes with the standard 170mm crank, my inseam suggests around a 175-177.5mm crank, but this increase seems so subtle, I was thinking more a 180mm, what are your thoughts on this? The majority of my races are non-drafting, but i do compete in the odd draft legal races.

I am a 21 year old male who is considering a returning to cycling after having surgery to repair a urethral stricture. It has been 18 months since my surgery. Prior to this problem, I participated in endurance mountain bike events and rode around 15-20 hours per week, consisting mostly of road riding. According to my urologist, the stricture was the result of repeated micro-trauma from cycling. After exploring the issue, I have found it difficult to find information concerning strictures and cycling. Have you heard of this problem occurring among cyclists? As I consider a return to cycling more frequently, are there any suggestions concerning fit, or equipment that would help to eliminate a recurrence? Any insight into this issue is greatly appreciated.

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