Fitness questions and answers for July 31, 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.

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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.

Last week you responded to a letter from a reader about feeling exhausted. Does this mean that you can go anaerobic at a low HR? One example would be where as you warm up, your HR stays low, but you push hard on a steep climb - you are placing energy demands on your muscles that they can't meet through aerobic metabolism but you are way below your anaerobic threshold in terms of HR. What is the effect of this in terms of depletion of muscle glycogen, production lactate and bicarbonate buffering? Are you burning through more of your "matches" than if you go anaerobic after reaching the top end of energy production when you are at the max of aerobic capacity?

A bit of history - my first road bike for racing was a Bontrager Road Lite that was roughly a 55 cm top and seat tube (effective, since it had a sloping top tube). This was back in 1998. That bike was the last time I felt "perfect", but it got wrecked in a conflict with an SUV that decided to hit me. All I know about my fit back then was that my tibial tuberosity was roughly 1.5 cm behind the pedal axle of my Shimano SPD pedals.

So, the driver of the SUV cut me a check and I got a Bianchi EV2, 57 cm, Look 247's with the red cleat, Sidi Genius 4's. I was re-fitted by the bike shop, who recalled that I liked to be a bit behind the axle, and we used the fit kit cleat adjustment tool that has two sticks out the side. I raced, was upgraded twice, and did quite well, but my right knee never felt quite right. I always had a twinge on the medial side, above the knee, that I could sometime poke and make it go away for a few pedal strokes.

I gave up racing for a couple of years after a move, and then started again, with the same bike and equipment. I started out easy enough, then perhaps jumped into it a bit too hard and had some knee pain, rested, switched to Speedplay zeros. This all felt pretty decent, but the right knee was still "funny". When I got tired of feeling like I was pedalling on the outside of my feet, I got orthotists which addressed some forefoot varus on both sides, a bit more on the right.

Now I have a new bike (Felt F45, used, 54 cm, with a steeper seat tube). Same Sidi shoes with the orthotics, the cleats in the same position and Look 247's again. I got fitted by the local bike shop since I knew I needed to change some parts. I got a seat post with a bit of setback (Specialized carbon - 25 mm setback) to help make up for the shorter top tube on the 54 cm frame, and a 70 mm stem with rise to make up for the short headtube on the Felt frames. The shop guy watched me pedal and suggested an additional varus shim in my right shoe since my knee wasn't tracking up and down but migrating. He put me essentially in KOPS and my saddle was raised a ton - up to 30.25" from the centre of the bottom bracket, versus my old 29.5". I rode like this for two days and knew it wasn't right. My calves and shins hated it, and my rectus femori on both legs (but mostly the right) were in pain.

I ditched the varus shim and lowered the saddle back to 29.5" and moved it back, almost as far as I could go. It feels better, but the right knee still complains, usually with pain on the medial side - like it hurts between where the tibia and the femur meet as well as behind the knee on the medial side and the upper calf (medial side). My cleats match Steve Hogg's suggestion for being about 9 mm behind the axles, and I can float to either side. But, I get the sense that my right leg wants to go away from the bike more and the toes out more on the right. I can't, since the cleat is all the way to the inside of the shoe, and I would hit the cranks and chainstay if my toes were out more.

Lastly, it feels like my right hip is forward and my left hip is dropping. If I sit on a table top with my knees and lower legs hanging off, my right foot appears to hang lower. I have asked a number of health professionals over the years, and they all swear my legs are about the same length (statically). Chiropractors have never said my hips seem twisted. But my right leg seems less locked when standing and my muscles of my left quad seem much more developed. If I move my left cleat backward in an attempt to square up my hips, things improve, but my left foot then really feels like it is "reaching" and I get pain under the ball of the left foot (under the base of the second toe). I have new Speedplay Zeros at home, but I am waiting for the base extenders (backordered) before I switch pedals.

1. Most times I walked in a straight line for at least 10 meters. I repeated the test, and on two occasions out of eight, I started slowly turning to the right after about 5 meters. The turn was very slight, since I performed the test in a one meter wide corridor. I never hit the walls and made it across the room. If backed up and allowed to proceed eventually there was some right turn. Does this suggest a shorter right leg? Maybe that is jumping to conclusions...

2. Before I answer this one I wanted to add that I made one modification. I removed one of the two varus shims I had in the right shoe (Specialized grey shims that add 1.5 degrees). This means I have an orthotic that corrects for some varus, plus another 1.5 degree varus shim in each shoe. I would estimate the ortho+shim = 5 degrees on the right and 3 degrees on the left - both varus. As before, my right cleat is all the way inboard, so foot is furthest from BB as possible on the Speedplay Zero (stainless, so longest axle). Why did I do this? I was on a ride and the medial side of my right knee started really acting up - it felt like my MCL was going to give! After I took out the shim the relief was remarkable. I slid my seat back a bit (3 mm) and still have that "feeling" on the medial side, next to the kneecap, but it isn't severe pain. Next day I was not sore at all. This even though the (short) ride was a medium-hard 60 km and included a 4 km hill that averages close to 8% with switchback sections of 20%.

A week later though when I rode again following the vacation I had the knee pain again followed by major stiffness and difficulty bending the knee (ice and Advil cured this after a couple of hours though after the ride). A week of rest again and two fairly flat rides this weekend and the knees are better. Still trying to figure it out but I am wondering if I should get the right knee looked at since it seems like a wear and tear thing.

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