Fitness questions and answers for June 17, 2008

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.

Jon Heidemann (www.peaktopeaktraining.com) is a USAC Elite Certified cycling coach with a BA in Health Sciences from the University of Wyoming. The 2001 Masters National Road Champion has competed at the Elite level nationally and internationally for over 14 years. As co-owner of Peak to Peak Training Systems, Jon has helped athletes of all ages earn over 84 podium medals at National & World Championship events during the past 8 years.

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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.

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.

Michael Smartt (www.wholeathlete.com) is an Associate Coach with Whole Athlete™. He holds a Masters degree in exercise physiology, is a USA Cycling Level I (Elite) Coach and is certified by the NSCA (Certified Strength and Conditioning Specialist). Michael has more than 10 years competitive experience, primarily on the road, but also in cross and mountain biking. He is currently focused on coaching road cyclists from Jr. to elite levels, but also advises triathletes and Paralympians. Michael is a strong advocate of training with power and has over 5 years experience with the use and analysis of power meters. Michael also spent the 2007 season as the Team Coach for the Value Act Capital Women's Cycling Team.

CT scan shows both legs equal total leg length.
Weak core. (Working on it)
Physios surprised by weakness of gluts generally (given that I raced bikes).
Weak hamstrings generally (not surprised given that I raced bikes).
ART done to following areas: right hip, both adductors (a lot was needed, more scar tissue on right side), and lower back, glut med and minimus right side were very knotted/adhesions.
After ART the left side adductor and hip flexor is now tighter. MD thinks left side was original problem; right side wore itself out working around the problem.
Weak VMO on left knee
Bigger quads on right side
Quad and hip flexor tightness both sides.
Pelvis rotated forward. (Probable cause said to be tight quads, hip flexors combined with weak hamstrings)
Flat left foot for twenty five years, now corrected with orthotics. Probably the cause of chondromalicia in left knee.
SI joint misalignment.
Some joint capsule tightness where right femur meets hip.

Despite equal leg length, pedal as if right leg is shorter (drop that hip and have more extended ankle on that side at 6 o'clock)
Adductor cramps both sides, much more on the right. When adductors lock up sometimes the right hip flexor cramps/locks up, sometimes right hamstring as well.
Produce more power with left leg, but am right side dominant and much bigger quad on right. Prior to injury the opposite was the case. When out of saddle produce more power with right leg though.
Drop right hip. Seem to rotate right hip towards rear wheel a bit.
Spin-scan shows lack of power produced across the top of pedal stroke of right leg.
Rocking of hips despite conservative seat height.
Retul fit shows the right knee not tracking straight. Under load it seems to come towards top tube and back out again. That is strange since left knee was problem originally, perhaps orthotics correct it and now biomechanical weakness in right hip/adductor area presents itself. Probably right hip problems come from adaptation to flat foot/chondromalacia in left foot and knee respectively.
Left knee quad still weak, but that pedal stroke has better form than other side.
Trouble engaging core and getting gluts to fire, especially on left side.
When I concentrate on engaging core and straightening out hip rotation and drop I can feel gluts work, especially firing of left glut. But I just can't seem to hold the form for long even with a stronger core.

Your athletic life doesn't sound like a lot of fun and thank you for the detailed info. If someone phoned me with a list like that I would be tempted to refuse to offer advice except in person because a lot of trial and error testing is likely to be needed to see how you respond to each change and the cumulative changes in position. When someone has such structural asymmetries, there is no 'road map' as everyone varies in their responses. However I am sensitive to your need to get back on the bike and will try to offer useful advice, here goes:

I wondered if you have had experience and could give advice on this subject. I am a 51 year old road cyclist and have raced in time trials for 34 years. On one occasion last Summer I was riding to the start of an evening event, which included a fast downhill stretch of approximately one and a half miles on a gently curving very exposed dual carriageway road. Halfway down the hill I began to experience a wobble through the front forks, which gradually got worse as I applied the brakes to control it. The 'wobble' eventually became very violent and I ground to a rather inelegant stop on the grass verge.

I had never experienced anything like it before, and the next time I went down the same hill I experienced the wobble again (on a different bike), although I suspect that this was more to do with nerves after my earlier experience. The net result is that I have now developed a fear of fast descents which is seriously affecting my riding, as I go out of my way to avoid them. I have also not raced this year as I am 'holding back' on the downhill stretches.

I have a fairly significant leg length difference of just under 1 inch, all of which is at the hip from Perthes. I've tried shims on my SPD-style mountain bike cleats, but the shims lifted the shoe off the pedal platform so that there was added instability - i.e. the cleat was raised above the level of the shoe tread so that the tread no longer touched the pedal. It wasn't a lot, just a few millimetres, but enough that there was some wobble back & forth.

I'm a competitive CAT3 in my early 30's. I have been racing for 4 seasons and during the regular season I train 14 - 16 hrs a week and race pretty actively. Every 3-4 weeks I schedule a rest week where I ride less than 5 hrs at recovery pace, and include 2-3 days completely off the bike. I find that for several days following a rest week, I feel sluggish and unmotivated and have trouble riding at higher intensities. I'm wondering if this is typical, or am I taking too much time off the bike. After a few days of regular workouts I'm usually back to normal.

After months of frustration, I think I've discovered that the root of my problems comes from an old knee injury. In 2003 I had surgery to repair a torn medial meniscus in my right knee, and during the surgery they noticed that the cartilage below the kneecap was gone, so several holes were "poked" (don't know the medical term) in the kneecap to facilitate scar tissue regrowth. After the surgery I was able to return to racing and felt fairly good, but after two years I began to develop pain in my right hamstring during squash and cycling. I recently began seeing a PT who diagnosed the main problem as an inflammation of the sciatic nerve. After seeing him a few times the injury is getting better and I'm able to ride again mostly pain free, though the stretches he's prescribed to me are painful and sometimes especially after a hard ride there is significant stiffness and soreness in the right leg.

You have answered your own question. That chronically tighter right hamstring post ride suggests that your functionally shorter right leg is overextending. The cramping you have experienced in the right hamstring indicates over enlistment, all most certainly because of over extension in an already tight muscle group. When subject to pain a body will autonomically protect itself. Compensatory measures only shift the load elsewhere; in this case probably the left side; they don't solve the problem.

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