Fitness questions and answers for July 26, 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 am a 28 year old A grade racer (height: 176cm, weight: 71kg) that suffers from cramps during long intense road races. I have read a lot of information about the subject and have been trying a variety of different approaches to avoiding cramps. I eat a variety of foods that includes fruit and vegetables, carbos and protein but also supplement this with multi vitamins 2-3 times a week and take magnesium and potassium tablets for several days before a big race. During the race I try to eat at least every 30min (gels and bananas) and am always drinking both water and sports drinks such as Endura throughout the race. After my last race, where I cramped earlier than usual I spoke to some of the stronger more experienced riders and they said that they took salt tablets before a race (plain sodium chloride). After all that I have done, I am now considering this option too. Please advise if this is worth trying and if so should I stop with the magnesium and potassium as it seems that this approach is not the solution?

I consume a large water bottle of Cytomax per hour when riding and usually do fine when the weather stays below 80 degrees. However, when the weather gets warm I start to really combust after about an hour and a half. I am a very "salty" sweater and if I stick to just water it gets much worse. I have tried supplementing with gels and Powerbars after 45 minutes. On one occasion I finished riding and suffered nausea and severe fatigue. Oddly I was craving salt so I put some table salt in water and drank it and felt tremendously better in about 10 minutes.

With all this pain and suffering being the zeitgeist of successful bike racing, some things may just seem too easy - and cheap - to be believed. Your honor, I give you exhibit A: a man forms a new Salt Lake while exercising, feels like crap afterward and, surprise of surprises, craves salt. So he ingests salt and within moments feels better. A true entrepreneur here would waste no time getting on cable to hawk the miracle Egyptian muscle cramp "vaccine" for the low, low one-time-only price of $49.99, including a glass trophy case for displaying all the hardware you can now expect to be dragging home.

A bit of background--I am 2m tall, weigh about 91kg. My bikes are custom made (race bike is 62x62), and my 'race bike' has 177.5mm cranks while the commuter/crap weather bike has 175mm cranks. I use full float pedals, and wear cycling orthotics. My bike fit is a combination of my experience with pain over the last few years, physios/video analysis, and 'ball of foot over pedal axles, knees 1cm behind the bottom bracket' approach. My cadence is typically 90-110 when riding flats, and drops to 65-90 when climbing, depending on how tired I am.

The problem with my right knee is that, say, once a month, I start to get discomfort around the right VMO and to the inner side of the knee. Not painful, just discomfort. When I end up pushing it a bit, like I did in a stage race this week-end (with about 1000m of vertical in the first stage in 72km). I end up getting a sharp 'swelling' pain underneath the kneecap, which feels like a vertical strip of pain right in the middle of the knee cap. After some initial rest (say, sleeping), it is stiff and painful. It resolves within two days usually.

I am a 37 year old Cat 2 male, been racing for about 7 years. The last few years I have been experiencing pain in my left leg. It started bothering me occasionally, then became more frequent and now it bothers all the time. I feel it mostly in the upper part of my hamstring, but also get numbness and discomfort in my left foot, aches in my shin, and around the knee. It does not bother me too much riding relatively easy, but I am aware of it and have a hard time getting comfortable. As I go harder though, usually a few minutes say into a TT effort, my hamstring becomes extremely painful and I have to back off.

I do have a leg length discrepancy (my left femur is about 2 cm shorter) that I addressed last fall with shims of various thicknesses under my cleats with no luck. I've tried orthodics as well with no success. I have tried various shoes, seat height and fore aft changes, none of which have helped. I had an angiogram done to check for blood flow problems which came back negative. I had x-rays and an MRI as well that did show a slight degeneration of a disc (L4) and a twisting of my lower spine (my left hip is more forward than the right). I was going to Physical Therapy for a couple of months where they performed some muscle energy techniques and prescribed stretching, but no answers. Currently I am trying a 170 crank on the left and my usual 175 on the right which has not made a difference either. I feel like I sit crooked on the bike and my left leg tends to point out. My left foot kind of curls or skwenches a bit too.

The doctor wants to try a cortisone injection, but to me it feels muscular/skeletal and not nerve related and that isn't something I really want to do if I can avoid it. I am still winning races and feel if I could fix this problem I would be stronger than ever. Are these problems due to riding with a leg length discrepancy for several years without addressing it and perhaps poor pedaling habits or could it be nerve damage or something else? Any suggestions? I'm just a little frustrated that I can't figure out what the problem is.

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?

While cyclists are known more for (ahem) what is below the waist, having a lean upper body plays a minimal part in why we break clavicles so frequently. In fact, I some of the more serious fractures I have seen were on very muscular riders. These fractures occur more as a result of the mechanics of falling from the bicycle. While there is no "standard" way to crash, we tend to be levered over the bicycle so that we are approaching the ground "head first." While our helmets hopefully bear the brunt of our head's impact, the shoulder is left relatively unprotected. The other frequent crash injury is a torn or sprained acromioclavicular ligament). Unfortunately, there is not a great deal that can be done to protect this area from a training standpoint!

I tend to experience foot pain/numbness and hotspot at the balls of my feet when I ride. The numbness starts at my toes and works its way back to about mid-foot, past the ball. Two years ago I used Nike shoes which did not give me numbness but took a little while for my feet to get used to (pain walking out of the shoes after rides went away after a short time). Then last year I switched to Diadora Veloce and had little problem other than fit. I fixed the fit (little bit large around the foot) by transferring the Nike insoles to the Diadora (not in place of the insoles, but added to). They worked pretty well. This year I got a new pair of Diadora Veloce and the numbness began. I still use the Nike insoles as they help the fit. I think that the problem stems from toes hitting the end of the shoes. I have always worn shoes that fit my foot exactly length-wise for various reasons, mainly they fit best this way and I don't like much, if any, movement of my foot in the shoe. I am unable to cinch the any shoes super tight as it causes a lot of pain around my mid-foot, especially at the outsides. My college soccer trainer had to take extra care when taping my ankles for this reason.

Am I looking at shoe fit all wrong? I would go back to the Nikes but the straps are failing and I've not gotten around to getting them fixed (plus team sponsor is Diadora). Shoe size is currently 41.5 and 42 never felt right (at least in the Nike). One more note: yesterday on a ride, I was getting some serious numbness/heat after about 1.5 hours and unclipped for a bit letting my feet dangle. Discomfort went away quickly and feeling came back. That lasted for most of the rest of the ride (only about 40 minutes).

5. Make sure that the ball of your foot [centre of the first metatarsal joint] is in front of the pedal axle with the crank arm forward and horizontal. For a rough guide for shoe size metric 36 - 38, 7mm in front; 39 - 41, 8mm in front; 42 - 43, 9mm in front; 44 -45, 10mm in front. It is unlikely that your feet are bigger than that. Don't forget to move the right cleat further back again as outlined in point 3. I know that this is at variance with the commonly given advice but you will find as you try it that it works.

The cleat position I recommended for her was not specific to her but rather a general recommendation. It is a normal recommendation for me but somewhat at odds with a lot of what I would describe as ' recieved wisdom' advice re fore and aft cleat position. If I saw that lady in person I may have changed my recommendation a mm or so either way depending on her particular pedalling technique, amount of heel lift in the shoe last she has, her particular foot morphology etc.

Here is the sizing info you requested for cleat positioning. Shoe size 36 - 38: centre of ball of foot 7mm in front of pedal axle; 39 - 41: 8mm; 42 - 43: 9mm; 44 - 45: 10mm; 46 - 47: 11mm 48 - 50: 12mm. There are a number of qualifiers that I will attach to those recommendations. 1. This info is for road and mtb riders. For general track riding, I would reduce the amount of foot over the pedal by a mm or 2 depending on shoe size and event. For sprinters and kilo riders, I would halve the recommended amount of foot over the pedal. 2. If positioning someone in person, I might vary the above a mm or so either way depending on other factors. 3. For riders with an exceptional heel dropping pedalling style, I would increase the amount of foot over the pedal slightly. The converse is true for the exceptional toe down style pedallers. For both groups I'm talking about technique under moderately severe load, not cruising in a small gear pedalling fast. 4. For riders with a lot of heel lift in their shoe last, I would increase the amount of foot over the pedal slightly. 5. For riders with flexible soled shoe, I would increase the recommendation slightly as with this type of shoe the heel deflects downwards more under load.

I want to thank you for your recent reply to my question regarding knee pain. I must confess however that I'm not sure precisely who to see regarding assessing whether there is an intrinsic problem with my knees. My experience with orthopedic surgeons for example is that unless I go in with a particular, well-defined injury they are not inclined to investigate possible root causes of my knee pain. I have seen a physio for my prior knee injuries and consider him to be excellent (an Aussie no less). He commented once that my knees feel "loose." I presume this means the knee joint moves more than a typical knee and could be the source of my knee pain late in races. However, he did not suggest a particular course of treatment. Is there anything that you would suggest if this were indeed the problem? Exercises, etc? In addition, I had an x-ray of my pelvis about a year or so ago, and the chiropractor indicated that my pelvis was rotated. I did not follow a course of treatment with him as I was not overly concerned by the diagnosis at the time. I was looking for something more serious in my back after car accident, which was ruled out. Could a rotated pelvis also be a culprit or would it be more likely a limitation in my range of motion.

You mention that the chiropractor told you that your pelvis was twisted. What follows is a scenario that I see on a daily basis. It may be you, it may be not. When a pelvis appears to be twisted, what is often occurring is that the iliac crest on one side sits further forward than the other side. The corollary of this is that the sit bone on the side of the anterior iliac crest is posterior. This in turn means that when you feel like you are sitting squarely on the seat it is likely that you are twisted towards the side of the anterior iliac crest. To verify whether this is the case, set your bike up level on a trainer and have a helper stand behind and above of you whilst pedaling with your shirt off.

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