Fitness questions and answers for May 23, 2005

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 38yo male, 6' 165lbs. I have been racing competitively for several years now. In the past, I have always suffered from chronic knee pain on the outside of my left knee. After switching teams, our main sponsor (who is a local bike manufacturer) gave me a complete dynamic fitting. The results were impressive, but I do still get a little nagging pain in the left knee on occasion. He mentioned that when he measured the knee angles, there was a 1-2 degree difference between the two. He felt that this small difference was not enough to warrant placing shims under the cleat of the left shoe. I definitely feel as though I need to reach a little more with the left leg than I do with the right.

I always look forward to Mr. Hogg's detailed attempts at alleviating other riders' difficulties, so this is mostly directed to him (no offense to the others on the panel). Steve, in your professional opinion, would you prescribe the addition of a shim for a difference as small as 1-2 degrees? I realize that it is nearly impossible to diagnose someone over the internet, but given the results of my fitting, can you use those results to suggest a treatment for my knee pain? Thank you in advance for your reply, and again, I look forward to your responses.

I can't see you and can only speculate about whether your bike position plays a part in this. Given your size and youth, I suspect that any bike you own is probably too small and that is part of the picture too. You could do worse than have a talk to John Kennedy on [Melbourne local no. 9589 3399] about this. In regards to the bad posture and weak back muscles - of course they are part of the problem. Find a good Pilates class or similar and work on that aspect of your fitness. If that isn't possible for one reason or another invest 30 or 40 bucks on "Pilates for Dummies" by Ellie Herman, available in larger bookstores.

I have been riding/racing (on and off) for 5 years now, Cat 4 road (6', 225 lbs), sport MTB and I recently was injured in a race. 5 fractured ribs, collapsed lung, fractured scapular, torn rotator cuff muscles, whiplash, and a deep bruised hip/hip pointer. I am now getting better and took 28 days off the bike completely to allow my body to recover from the injuries. At the time of the accident I had just started my 8 week final phase(s) for my "peak race" of the year, June 5th, basically following Chris Carmichael/Joe Friel training methods.

After reading many comments here and in the literature, I though that when I returned to riding again that I would have (1) Lost endurance, both aerobic and anaerobic and (2) and for a lack of a better term have "dead legs" and feel horrible. Oh, one other thing, in the past few years, I have had my hematocrit tested on several occasions and it hovers between 47-48.5, however after my accident it was measured at 45. All other blood indicators were normal and I was not dehydrated when the blood samples were taken.

Well, my first ride in 28 days was our team training ride (~2:20) and I felt great. My legs felt incredible, my body (excluding my ribs and shoulders) felt like I had not missed a day of training! My HR was slightly elevated compared to similar efforts 28 days prior. My pace was approximately the same as previous rides. I am sure that overall my endurance has decreased compared to 28 days ago, but my question is why did I feel good? I am not complaining but there has to be some physiological reason behind this. I can honestly say that my legs have not felt this good in a long, long time and I have been training on the Carmichael/Friel type stuff for four years.

The problem I'm writing to you about concerns my 15 year old son. He has been competing for two years. He has trained hard and raced well this year with his most important races just around the corner. He has now got a sore gland under his jaw and is tired, so he has stopped training to rest. Is this the sign of an over-stressed immune system or could it be some low grade infection? Is the best advice to stop training altogether and seek medical help? What do you advise.

Sore gland eh? If the sore gland is isolated, it may be infected. Otherwise, the gland is a lymph node, which is usually strung together in a chain of lymph nodes. Inflamed nodes, painful nodes, etc generally are associated with fighting infections (even just low grade viruses, or the less virulent viruses). But, they can also be a sign of overtraining. I would be seen by your regular doc just to look for something, but a lot of times we don't find a specific reason. But, if a specific reason is found (ie: Streptococcal pharyngitis, mononucleosis, lymphadenitis, etc) then it can be treated or at least guidance can be given.

My question is: could this be to do with me subconsciously "protecting" the previously injured right knee, after only a week of training. Two weeks before the crash I changed my shoes and for a day or so my knees were a bit sore, but it passed and I put it down to "wearing in" issues. Could this come on after a single week of training when it didn't seem to affect me before the crash on the other leg? I also suffer from collapsed arches and I wear insoles in my walking shoes, but not when cycling, and my feet naturally seem to pronate.

I've seen a number of physios but am still not sure myself what has brought it on as I was very conscious of not trying to save the left at the expense of the right. I'm doing stretching to make sure my iliotibial band is not pulling my knee cap out of alignment and icing five or six times a day for 15 minutes. Any advice would be most appreciated as I have a contract to ride a big criterium in the US in exactly one month.

I am a 50 year old woman who hadn't ridden a bicycle since childhood until last Dec '04 when I decided to train to do the ALC4 ride from SF to LA in June '05. I was loaned an amazing Serotta to use, and have good bike shorts. I was about two months ahead of the recommended training schedule in terms of distance and difficulty. I did my first Century in Solvang in March with fatigue, but no problems. I did back to back 95's at the end of April and about 60 miles into the second day developed a "Pinching Pain" in the groin area, right in the crease at the top of my thigh where it meets my groin. I used chamois butter at one of the stops, per their recommendation and managed to get home okay, but after resting almost 10 days, I still have a "sore" there. It is very small, about the size of a spider bite, and still extremely tender. I have used antibiotic ointment and it is better, but seems to me it should be gone by now.

I have previously experienced some lower back issues (to the right of the spine), primarily due to tight hamstrings, which compounded into some right knee pain. My doctor/physical therapist has been focusing on strengthening my core and improving flexibility via consistent stretching. My most recent back flare-up occurred earlier this year and has improved to mostly a non-issue in the last few months. In the last few months; the back, knee and hip have all been feeling great. About 6 weeks ago, while cycling, I noticed that (from the top view) my left leg seemed to be aligned (thigh, knee and foot) while pedaling and that my right leg looked as if the knee and thigh were angling inward more giving the perception that the pedal strokes were very broken (as opposed to smooth revolutions). Trying to perform my own troubleshooting, I raised the saddle about 1/4 of an inch and adjusted the right cleat outward on my right shoe. I rode for several weeks without issue and thought everything was fine.

Then a week ago, we did a group ride that involved more climbing (4 miles at avg 8%) than normal and I rode it and felt fine. Two days later my left knee, in the front, directly above the kneecap, was very sore to the touch and would "click" whenever I tried to straighten out my leg. After some web research, I identified the area of pain as the rectus femoris tendon. After 7 days, most of the pain had subsided, but the clicking remained when I turned the pedals from the 3 to the 6 position on the downward stroke. After a few more days the clicking went away entirely and I decided to ride again. I checked my cleat alignment and decided to shift the left cleat forward a 1/8 of an inch because it looked a little farther back than the right cleat. After riding at an easy pace and limited mileage for two days, I noticed some tightness in the quad and tendon area.

My searches to determine the cause have led to a couple of different possibilities: Pushing too big a gear and strained the area - doesn't seem likely because I was using high gears and high cadence. Strained the area by doing too much climbing when I hadn't trained for much climbing - a possibility (but not likely) but I consider myself a 'natural' climber Poor alignment of cleat or fore/aft positioning on the bike - seems like the most likely but not sure where to start since I've never had any issues with my left side. Is this a common problem? Can you point me in the right direction? I was professionally fitted several years ago, which included cleat alignment and bike adjustments. However, I have been on a new bike and shoe for the last year.

I was curious if you had any experience fitting people on bikes who were using Power Cranks? I routinely swap my normal crank in and out with my powercrank. When riding on my normal crank the position that I ride in is a fairly comfortable one...ie; I pedal from my glutes with no prostate pain and I'm on the hoods with a relaxed/no pain upperbody. However, when I ride with the Power Cranks everything changes. I immediately have to assume a postion on the bar tops. I constantly feel like I'm using my arms to push me to a more upright position.

I anticipated this at first as Frank Day (the designer of Power Cranks) said that I would have to assume a more open hip angle at first to aid my hipflexor in lifting the crank over the top end of the stoke. I've since gained enough strength in my hip-flexors to pedal easily with my hands on the hoods or drops...BUT I'm never comfortable. I always feel like I'm sitting on my prostate so I always revert back to the bar top to releave pressure from my 'unit'. I'm considering 2 options to remedy this...

2) I have a fizik Alliante saddle. I feel like the rise in the rear forces my prostate down into the lift in the front. I don't notice this when I'm on my normal cranks but b/c with the powercrank I pull-up over the top and pull-back where I would normally push I just feel squished. Sorta like the sensation of riding on a trainer indoors without wind. Anyway, I've been considering a saddle with the goodies cut out.

Please be forewarned that many doctors are not aware of anusitis. Anal itch or pruritis is itching of the skin on the outside of the anal opening but most people don't realize that the problem arises from up inside the anal canal, due to anusitis. Hence treating with skin creams and suppositories such as Preparation H, which go up into the rectum, give only temporary relief and the problem recurs.

I was diagnosed with this about 2 years ago and have suffered ever since. I have been to 2 specialists, had a colonoscopy, tried diet, naturopath, creams, ointments etc. They all told me it was due to diet and stress, and when I mentioned cycling, they all said that shouldn't be the reason. When nothing helped I was then told that IT IS my cycling that is causing the condition to become chronic; not allowing it to heal completely. Two doctors have said that the combination of sweating and rubbing for extended periods of time on the bike is the cause. I didn't want to accept that conclusion so I ignored it, which I can't anymore.

This winter I stayed off the bike for three months (other than 45 min spin classes 2xwk) and my condition healed itself. Four club rides into this season and it is back with a vengeance. The itching, swollenness, cracking and bleeding have all returned. I have decided to stay off the bike for a month or two and see if my condition gets better. My feeling is that I will need to stay away from the sport for a couple of years and allow the tissue in the area to completely rebuild itself.

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