Fitness questions and answers for July 24

Form & Fitness Q & A

Got a question about fitness, training, recovery from injury or a related subject? Drop us a line at Please include as much information about yourself as possible, including your age, sex, and type of racing or riding. Due to the volume of questions we receive, we regret that we are unable to answer them all.

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.

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 ( 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.

Eddie Monnier ( is a USA Cycling certified Elite Coach and a Category II racer. He holds undergraduate degrees in anthropology (with departmental honors) and philosophy from Emory University and an MBA from The Wharton School of Business.

Eddie is a proponent of training with power. He coaches cyclists (track, road and mountain bike) of all abilities and with wide ranging goals (with and without power meters). He uses internet tools to coach riders from any geography.

David Fleckenstein, MPT ( 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 ( 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.

Current riders that Steve has positioned include Davitamon-Lotto's Nick Gates, Discovery's Hayden Roulston, National Road Series champion, Jessica Ridder and National and State Time Trial champion, Peter Milostic.

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.

Pam was an All-American in track while at the UW. She started cycling competitively in 2003 and is the defending Missouri State Road Champion. Pam writes a nutrition column for Giana Roberge's Team Speed Queen Newsletter.

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.

Scott Saifer ( has a Masters Degree in exercise physiology and sports psychology and has personally coached over 300 athletes of all levels in his 10 years of coaching with Wenzel Coaching.

Kendra Wenzel ( is a head coach with Wenzel Coaching with 17 years of racing and coaching experience and is coauthor of the book Bike Racing 101.

Steve Owens ( 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.

Through his highly customized online training format, Steve and his handpicked team of coaches at Colorado Premier Training work with cyclists and multisport athletes around the world.

Brett Aitken ( is a Sydney Olympic gold medalist. Born in Adelaide, Australia in 1971, Brett got into cycling through the cult sport of cycle speedway before crossing over into road and track racing. Since winning Olympic gold in the Madison with Scott McGrory, Brett has been working on his coaching business and his website.

Richard Stern ( 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 ( 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 ( is an Associate Coach with Richard Stern Training. He holds a Masters degree in exercise physiology and is USA Cycling Expert Coach. Michael has been a competitive cyclist for over 10 years and has experience coaching road and off-road cyclists, triathletes and Paralympians.

Kim Morrow ( has competed as a Professional Cyclist and Triathlete, is a certified USA Cycling Elite Coach, a 4-time U.S. Masters National Road Race Champion, and a Fitness Professional.

Her coaching group, eliteFITcoach, is based out of the Southeastern United States, although they coach athletes across North America. Kim also owns, a resource for cyclists, multisport athletes & endurance coaches around the globe, specializing in helping cycling and multisport athletes find a coach.

Advice presented in Cyclingnews' fitness pages is provided for educational purposes only and is not intended to be specific advice for individual athletes. If you follow the educational information found on Cyclingnews, you do so at your own risk. You should consult with your physician before beginning any exercise program.

Heart rate
Detecting doping
Femur fracture
Saddle/Cleat issue?
Knee replacement
Knee injury seems permanent
Knee pain
Pedals and more
Sore knees and crank length
Strictures and cycling

Heart rate

Is there a relationship between a low 'Ejection Fraction' (i.e., measure of cardiac output) and maximum heart rate and cycling performance?

James Thacker

Kelby Bethards replies:

As you've alluded to the Cardiac Output, from the "formula" for cardiac output...

Scott Saifer adds:

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.

Detecting doping

[John asked this question last week too - this week we have an insight into the detection problem from Pam Hinton.]

I have a question I'm sure you get a lot, but I never see the answer.

How do you dope on the professional level of cycling and not get caught? Are they taking levels of growth hormones, EPO, testerone and reintroducing their own blood at lower does than the tests can detect? How do they do it? Somebody must know how because it is happening. Example: Ulrich is alleged to have doped in the Giro this year, but he won a stage and the tests showed no signs of doping?

John M. Spidaliere

Pam Hinton replies:

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.

Femur fracture

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.

I am a 47 year old, 6'2", 159 lb male who gets in 3,000 miles bicycling and an equal amount of time cross country skiing and roller skiing, with infrequent runs. I do an occasional TT, but mostly use my bike time for training for the cross country ski season. Riding consists of commuting to work training sessions, group rides and an annual century and recovery rides with the kids.

Michael Sweet

Steve Hogg replies:

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.

Saddle/Cleat issue?

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?

Sherri Bajer
Phx, AZ

Steve Hogg replies:

There could be several reasons for the discomfort caused by your seat. First the positives; the pain is on or near the sit bones which is good, as it means that you are not chaffing more sensitive areas. What is bad is that you are finding this weight bearing uncomfortable.

Knee replacement

Recently Floyd Landis revealed to the world the need to have a hip replacement at the conclusion of this year's Tour De France. Alan Lim, PhD, who is part of his coaching staffing overseeing power outputs and other aspects of Floyd's training and racing said that after the hip replacement Floyd will be even stronger on the bike. I, along with many of his fans certainly hope that is the case.

The question I have relates to knee replacements. I am 56 years old, and after many years of basketball and several knee operations to remove all of the meniscus in the right knee, my doctor has recommended a total knee replacement because arthritis has set in.

Bicycling has been wonderful in controlling the pain but pragmatically I realize at some point I'm going to have to have it done. If I do have the knee replacement, would this put an end to intensive training and competing in local races?

Darryl Perry

Steve Hogg replies:

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.

Knee injury seems permanent

I am a 29 yr old male that enjoyed mostly recreational mountain biking for the two years I lived in CA. I took it seriously and strived to improve. I rode at 15 - 30 miles a week on single track and fire road trails with good elevation changes. At the end of my 2 years I started road ridding and would occasionally put in 30-40 miles on the weekend.

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.

I saw a local Danish doctor and he said it was nothing too serious and that I should try exercising my hamstrings and quads and also use a trainer for light cycling workouts. I tried the exercises for a few months but was constantly in the cycle of feeling pain in my knees and the resting for a week and trying again.

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?

Tim Gagnon

Steve Hogg replies:

Are your knees broken before age 30?

Knee pain

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.

John Gershenson

Steve Hogg replies:

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.

Pedals and more

This is a question about some recent problems my son experienced in racing. I'd like to hear your opinion. He is a 15 year old 2nd year Novice, racing both road and track. Height 182 cm, weighs 63 kg. Last January on the national track championship, in the second lap of the 500 m, he pulled his right foot out of his pedal and after setting the 2nd split time, made the last time.

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".

Is this a biomechanical problem or a purely technical problem? Would another type of pedal (f.i. Speedplay or Time) be better suited for him?

We appreciate your advice,

Hans Eijssens

Steve Hogg replies:

When you describe your sons leg position as X shaped, I assume that you mean that he is knock kneed and / or that he pedals with his knees in towards the top tube. This is a biomechanical thing and people who function like this can get untidy in terms of the plane of movement of their legs when sprinting off the seat. The likely reasons that he is pulling his foot in the sprint are:

Sore knees and crank length

My name's Alexi and I'm a 15 year old male, I race in triathlons and am currently ranked 5th in the New Zealand Secondary School system.

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.

One other thing, just recently I've been experiencing bad knee pains in my left kneecap. It occurs around the 3 o'clock position of the down stroke and is a burning sense beneath the upper kneecap, when this occurs I am usually affected for a few hours after the ride. I don't know what it is. My bike is a Specialised Tarmac, size 52 frame, I use Look 267 pedals.

Another problem (so many) is a nagging lower back pain on my left side. It usually occurs after 12 solid k's on the bike during a race, when I'm on the aerobars (Oval Concepts), but it also occurs after about an hour-an hour 1/2 of riding on the hoods. I've experimented with a high seat, low seat, saddles forward and rearwards, nothing seems to work. Do you have a solution??

Alexi Petrie
Auckland, NZ

Steve Hogg replies:

Firstly, don't even consider longer cranks until you have sorted out the left knee problem. Longer cranks are of no benefit unless the extra range the hip and knee have to work through can be very well controlled. Left knee and back pain suggests that you do not have good control of 170's let alone 180's.

Strictures and cycling

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.

Nick Pedatella

Kelby Bethards replies:

You have a interesting condition. It makes sense that a stricture could form from the microtrauma and inflammation from this. But the stricture would need to be quite a ways into the urethra to be from cycling.

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