Fitness questions and answers for March 25, 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.

This manifests itself in knee pain of the medial aspect of the epicondyle of the left femur. I have regular massage to relieve the muscular tension (which seems to be more on the right) - but this was not actually addressing the problem of asymmetry. Added to this I have constant back pain in the L5-S1 area, particularly on the RHS (same chiropractor diagnosed it as a cat 3 injury). Subsequently I have been doing clinical Pilates with a left bias focus for some time now, which has seen my left glute and vastus muscles 'catch up' with the right side. The exercises I have been doing have been focusing on isolating left glutes, vastus, and to a degree the left hip flexors. I have confirmed no issues with leg length.

I'm a cat four, 45 year old cyclist entering into my 4th year of fairly serious training efforts. Late in last years training I started having discomfort on the bike on the right side ischial tuberosity. At the time it wasn't severe and I rode thru the discomfort but it made rides over two hours pretty difficult. I crossed trained over the winter pretty much forgetting about the issue. Its back now and pretty painful, it's getting difficult to ride 60 minutes on the trainer. I stand and stretch every 10 minutes or so and that gives some temporary relief but only temporary. When I investigate the area with my hand I can feel a "knot" about grape size that seems to come and go with the ride. I had not been having any discomfort off the bike but now while it's not painful there is a noticeable "feeling" pretty much constantly but especially while sitting.

I intend to see the doctor about the issue I've done some research and I have seen there are modalities (RICE, cortisone) that can help but before I go through that I was wondering if just a new seat or change in seat position will help. My ride position is similar to what is often discussed here, cleats mostly rearward and seat well back. I do have the nose on my seat probably higher than might be normal. I'm pretty comfortable on the bike and make good power otherwise. Any help is greatly appreciated

I would like to know the best training schedule to prepare me for the ride. I have ridden about 450 miles since Feb 1, 2008. Now that it is about 3 months until the ride, what is the best training for weekday and weekend rides (I want to avoid the trap of overtraining)? Besides local rides in my area, the only organized ride with climbing I will use to prepare is a ride at the end of April that will include 7,000 feet of climbing. Also, do you have any suggestions for altitude training as I live at sea level?

You are really asking for something you'd do better to get from a coach with whom you work personally and individually. There are lots of additional questions a coach should ask before assigning you a training schedule. I can tell you that some researchers have looked at the relationship between training volume and injuries sustained during multi-day tours and found that there is a sharp drop off in injuries among riders who consistently train 100 miles (160 kilometres) or more per week, so at the very least you should aim to build up to that level. Adding one hour per week to total training time is generally considered a safe way to build up without danger of over-training. The vast majority of your training time should be spent at an "all day" pace, the effort you expect to make on the tour. That means you'll be training slower at first than you will eventually go on the tour. If you use a heart rate monitor, keep your heart rate below 80% of your individually measured maximum heart rate most of the time.

As a trauma surgeon and surgical critical care intensivist, care of those with poor physiologic condition is common. Over the last several years we have witnessed the debunking of several medical issues that lead to 'performance enhancement' in those patients whom have been physiologically compromised. First, although transfusion with packed cells may increase cardiac index/output by increasing intravascular volume, we know that the short term (first 24 to 48 hrs) increased oxygen carrying capacity is lost initially due to storage issues and long term lost to extremes of total ability to off-load oxygen to the tissues above a certain hematocrit so, the use is questionable. We also know that erythropoietin offers up no benefit in all but those with end-stage renal failure (NEJM 2006). So, It is with great pleasure that the effects of growth hormone have finally been thrown into the trash bin of junk science, as well (Annals Internal Medicine 2008). I can only hope that the days of performance enhancement from anything other than more/perfected training regimens are over.

Thanks for the link and I share your hope that the doping era can be brought to an end sooner rather than later. I should point out however that I know of at least one instance where a pharmaceutical intervention has a different effect in highly-trained athletes than in healthy "fit" members of the broader community. (Studies of creatine use in fit individuals show no increase in aerobic capacity, plus an increase in weight leading to a net negative effect on running or cycling performance. At least one study of creatine use in highly trained athletes showed an increase in aerobic capacity, apparently because creatine availability in the muscle actually becomes a limiting factor in energy transduction in these individuals). Until the studies you quote are repeated specifically with highly trained athletes, I'm afraid they will be of little value in the discussion of the effectiveness of doping in professional sport, and of course researchers are going to have a hard time finding athletes to go on record using EPO or HGH or blood packing.

I have thought about the issue of midfoot placement since reading your online explanations. It makes good sense when you think about the concept relative to physics. My only concern for this is that I am afraid that the "balance point" of my foot/axle will tend to allow my foot to fall forward - something it does really well - especially when I am standing. It is kind of a "collapse" in a forward motion at my ankle. I don't have much control in that direction - i.e. when I am coming down stairs, I need to be sure my whole foot is on the step and not just the rear portion. I have taken a couple dramatic - and exciting - tumbles as a result of negligence in this regard.

The other issue with my ankle turning out is also a result of the weakening of the muscles in the lower leg and ankle. I have about 15% of varus which has been addressed with shims, but in the exact opposite place than I expected. I thought I would be shimmed on the outside to get my ankle over my foot, but shims have been placed on the inside to take up the "space" that is caused by my foot dropping out. I have a nasty foot pivot to the outside when there is room for the ankle to flex out. Not so hot on the knees.

Re whether the midfoot cleat position would help with the foot drop; the answer is that I don't know but think it is worth a try. I was thinking about this and something else occurred to me. I was visiting a prosthesist a while back and he showed me a device that supported the foot and the lower part of the lower leg and had an "ankle joint" that had a controllable range of movement. It wasn't large or bulky. Basically it was a skeleton that the foot sat in but was cutaway hugely so that only the perimeter of the foot was supported. It had a thin heel cup with an vertical extension of that that ran up the back of the leg and that was secured by a large velcro strap below the calf.

I wanted to let you know that my knee has been improving. I've talked with another physio and he determined that I was obscenely tight in my left hamstring/calf and I've been doing regular stretching exercises as prescribed, and it's helped a great deal. He's also recommended getting a weekly massage, and I'm looking into doing that. If I slack on my stretching, I notice the knee discomfort flares up pretty quickly.

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