Fitness questions and answers for June 5, 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.

Unless your concave chest is extreme, it is probably not the source of your difficulties on the bike. There are two breathing tests in which you might be interested. One measures the speed with which you can exhale. Reduced flow on this test indicates obstructed airways (usually asthma). If you had asthma you'd notice it most likely as a feeling of not being able to get enough air even though you breath hard. The other lung function test of interest would be vital capacity, how much total volume can you move from the deepest inhale to the deepest exhale.

I have an issue that I was wondering if you might be able to resolve--I have been cycling regularly (100-140 miles per week throughout most of the year) for the past three years and have been doing a handful of Cat-5 races every year as well. My problem is this--it seems that toward the end of the every season I have encountered light pain in the front of the left knee, as well as the occasional cramping in the left calf during hard group rides and races. My problems were always with the left leg, the right felt perfect. It seemed like under moderate load the pain was the worst in the knee, under heavy loads things felt actually felt better.

After installing the LeWedges under my both shoes' cleats (I used two wedges stacked on top of each other with the thick part on the inside of the shoe to get the proper cant) I thought that I felt better power transfer immediately as well as a decrease in the lateral knee movement. I felt great at first after using them, but now that the miles have started to pile up for the year I am now having trouble with my right knee while the pain in my left knee has vanished.

To give you a little more info, I also switched recently from Specialized Comp Road Shoes to Diadora Ergo Plus shoes, but I don't think this has contributed to the problem. I also angled my cleats recently so that my foot was a little straighter when connected to the pedal instead of angling out at the front (I usually set up my cleats this way because I tend to walk duck-footed, but I noticed my foot wanting to straighten out when under load on the bike).

Thanks for the feedback and positive thoughts. How did you get your cleats back 25mm with the Speedplay adaptors? Did you modify your shoes at all and/or change to Speedplays from another pedal system? The reason that I ask is that the Speedplay 13330's allow 13-14 mm more rearward travel than the standard Speedplay 3 hole adaptor plate which in turn has approximately 5mm less rearward adjustment than many other pedals (Keo, SPD-SL etc). All of which means that the net gain over other systems is about 10mm unless the other adaptors were all the way forward and more. The other thing is that unless you have tiny feet, a 25 mm rearward adjustment of the cleats wouldn't leave you with the cleat under the arch if your previous cleat position was forefoot. I'm not being critical here, but I am curious!

Is there any benefit in using Asymmetrical Q-factor set-up, where a cleat of one shoe is placed in its narrowest Q-Factor position (closest to cranks) and the cleat of the other shoe is placed on the outermost position (furthest away from cranks)? Would it help any riders, such as those who tend to hang off one side more than other (candidates for the off-centre seat-post or those with small leg lengthy discrepancy) etc.

I ask because I just tried (after having read Steve's reply) using the widest Q-Factor on my SPD-SL pedals and I found that my left foot did not like it (left foot wanted to twist to toe-in heel-out position under high load and also stressed the vastus medialis obliquis) but my right foot did not seem to mind either narrow or wide Q-Factor. So I was thinking perhaps there may be a benefit from Asymmetrical Q-Factor set up.

The short answer is that there can be an advantage in having one pedal or one foot further from the centre line of the bike than the other but it comes down to individual cases. I have had a client for several years who was a pro mtb'er but whose career was cut short by back pain and left knee issues. He is a bit of a mess with a twisted sacrum and fused sacro iliac joint on the right side, though the left side sacro iliac joint moves freely. This means that he drops and rotates forward his right hip markedly on each right side pedal stroke and has a pronounced internal rotation of the right hip and external rotation of the left hip.

I've followed your fitting suggestions for about a year, and every change has brought relief from my rather radical starting position--too high saddle, too far forward cleats, too much stretch on the upper body. I've now got my cleats (Look on size 49 Sidi Genius 4, with the older changeable cleat adapter plate) back as far as they go with appropriate reductions in saddle height and better setback and bar position, and this move has improved a lingering twinge on the inside of my left knee, but not quite eliminated it. I have much better all around comfort for longer distances.

I get the knee pain right away if I pedal with my foot straight, so the float seems to be right. I have the float set for the maximum 9 degrees and the cleats are angled so there's excess available each way. The right foot pretty much tracks straight when floating and there's no pain in any joint in the chain on that side. I'm 60, 6'5" (was 6'6" in my youth, before joint settlement), 210 lbs. and I know that I have flat arches and pronate fairly significantly, according to a podiatrist years ago when I attempted to be a runner. I use and like 180 cranks, as I have a long inseam. Specialized body geometry insoles eliminated some foot pain I was having with the stock Sidi insoles.

I'm a 51 year-old male club rider getting back into riding seriously again after a lay-off caused initially by a crash in 2003. I'm currently building up my mileage and pace for the British Cycling Tour de France sportive on July 1 but have developed a knee problem and am unsure of the best strategy given that I need to build up stamina to handle a 195km approx ride and pick up my current average speed (solo) from 20.9kph to a 24kph or so at least. The question is whether to continue some training (if so what type and intensity) or rest the knee completely and when to expect to be able to resume training in earnest to avoid a nightmare in the sportive!

I had completed rides of 110km the previous two weeks without problem, but the week before last I developed a twinge behind the kneecap at around 80km of a 135km ride that became more painful as I rode home. It still hurt on stairs, albeit reduced, on the Monday so I rested it last week apart from a turbo session on Thursday that amounted to 35 minutes in zone 2 around 80-95RPM and 10 at zone 3/4 border and 70-75RPM mainly. The knee felt a little "odd" but no twinges or pain at all. Last weekend I had to abort my ride because the knee started to hurt at around 20km and was very sensitive to road-shocks when under load.

No changes in position - cleats, shoes, bike - since the previous ride. The only differences I can think of are that, conscious of my weakness on steeper climbs, I rode up an early, short, steepish, climb at around 65rpm staying mainly in the saddle, rode at a higher pace than previously (24-30kph) and pushed bigger gears than before on some flat/slight incline sections and into a headwind. I also tried "pedalling circles" at times up a couple of climbs (I also include this in turbo sessions without problems though) until hints of some cramping showed up. Apart from some aggressive clipping out of the pedal in traffic I can't think of any other possible contributors to the problem. Obviously the distance wasn't the factor as the problem kicked in 30km before the duration of the previous week's ride.

Without knowing a lot more it is hard to pinpoint exactly what the problem is but I can give you general advice based on the most likely reason (but not the only one). This sounds intensity related. Take a rider with no issues (that are apparent to the rider) and increase volume or intensity and it is commonplace for problems to arise. The basic reason is that we run up against the limitations of our structure, symmetry , technique and degree of function. You don't mention which knee but there is an 85% chance that it is your left knee.

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