Fitness questions and answers for November 1, 2004

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'm a 29 year old Cat 3 cyclist who has been road racing for about 3 years. Although I have seen tremendous improvement in these 3 years in general fitness, I still have a lot to accomplish on the racing circuit. This year, I participated in about 25 races, both crits and road races in that featured rolling terrain and moderate to steep climbs. I finished all races entered in the top 20 with the exception of 2 that I crashed in and 2 where I just missed the top 20. I had quite a few 10th-15th places and a few top 10s but nothing ever better than a 5th. This showed growth from 2003 where I DNF'd quite a bit.

In 2002 I used a coach that had a large variety of training regimens. I had a very good season under her and secured many top three results and better! In 2003 I used a different coach since the first coach I used left coaching. I found the work-outs to be good but not much variety and kind of dull. I still had a very good season but felt something was lacking in my training. My question is, how do you interview a coach? How do you know what type of work-outs they will give you? Can you tell them what you want or are they there to tell you what you want!

If all you are getting from your coach is the training plan, you can just reuse the old training plan, but I would suggest getting a different coach. A good coach does much more than provide training plans. He or she should be talking with you regularly to help you understand when deviating from the plan will be more valuable than following it, helping you to decide when to take time off for illness and when to return to training, helping you see a larger picture so that working together you can identify weaknesses that you would not otherwise have noticed or identified correctly, talking to you about equipment choices, tactics and the dozens (hundreds?) of other things that can make the difference between a bad race and a good one, or a good one and a great one and reviewing your training and racing with you so that you can tweak your program to make the best use of your time.

I'm an avid cyclist, 41, in good shape, eat a healthy, well balanced diet and train regularly. I participate in a few local races every season but I always finish in the middle of the pack. I'd simply like to know if there is any truth to the performance enhancements that certain "legal" natural supplements claim to give, like creatine, spirulina, co-enzyme Q10.... Do they really work or am I simply throwing away my money?

The effect of alcohol on a cyclist's fitness is pretty much the same as how a Highway Patrol trooper looks at it in conjunction with operating a motor vehicle-it depends on how much alcohol is consumed and when. Having a beer when you get home is not going to adversely affect your fitness. That's the short answer to your question. Now just like that trooper I mentioned, we'll go over just the facts.

I've read with great interest Steve Hogg's ideas on dynamic fitting of bike to rider, including cleat position, seat fore-aft and seat height adjustments. I've been fiddling with these three following Steve's rule-of-thumbs and think I am getting close to an optimal position. However, I am still getting neck pain on longer rides and during and after long descents (when I've got hands in the drops), so was wondering if there are any rules-of-thumb for setting handle bar height and stem length. I already have the bars as heigh as I can get them, but obviously you can't adjust stem length without buying a new stem. To avoid having a box full of progressively shorter stems to try out are there any suggestions for estimating what might be an optimal stem length (or saddle to handle bar distance).

I am a 46 year old cyclist, riding to keep fit and the occasional audax. I read in a magazine (which I have now lost) that the phosphoric acid found in carbonated drinks like Pepsi, Coke etc can remove nutrients from the body. The article didn't go into a any detail and I wondered whether this was true. Do you know what nutrients are lost, and how much phosphoric acid does it take. How much damage would an ordinary can of one of these drinks do ? I am trying to give up these drinks so any info would be helpful.

The main source of phosphoric acid in our diets is soda. Because of the association between soda consumption and increased risk of bone fractures, the constituents of soda (caffeine, phosphoric acid, citric acid and fructose) have been scrutinized for their potential to cause calcium loss from bone. Anyone who has ever soaked a bone in vinegar would agree that phosphoric acid probably causes a loss of calcium and a weakening of the bones. However, what we observe in the test tube is not always what happens in the body, which has the ability to maintain constant internal conditions, including acidity of the blood. A recent study compared the effects of caffeine, phosphoric acid, and citric acid (consumed in soda) on calcium excretion in the urine. Subjects consumed 20 ounces of either: caffeinated cola (Coke, containing caffeine and phosphoric acid); non-caffeinated cola (Coke-Free, phosphoric acid only); caffeinated non-cola (Mt. Dew, caffeine and citric acid); or non-caffeinated, non-cola (Sprite, citric acid only). Neither phosphoric acid nor citric acid increased calcium loss. Consumption of the caffeinated sodas caused an increase in calcium excretion, but the effect was small (6-14mg) compared to the recommended daily calcium intake (1000 mg).

I am a 37 year old recreational rider. I have been riding for four years. Early this year I stepped up my training to prepare for and complete the Markleville Death Ride 130 miles, 16,000 feet of climbing. About a month before the ride I had a physical and urinalysis done for a life insurance application. I was denied insurance because I had too much protein in my urine. I went to several doctors to determine what was going on and had several more UA's done. In September a nephrologist diagnosed me with "a textbook case of acute tubular necrosis" (ATN). He says that my kidneys were damaged but will (most likely) recover over time. In October the amount of protein in my urine has not decreased and the doc says that is OK since it is not increasing. He has told me to continue my life/ riding as though nothing is wrong and we will monitor my progress over the next few months.

My question is two-fold: The doctor told me that the ATN was most likely caused by a severe dehydration event(s). I have been involved in outdoor sports for my entire life and know how to stay hydrated and don't think that I was dehydrated at any point this year. Other than basics of drinking plenty of water and the occasional sports drink and eating food before, after and while riding to stay hydrated, is there anything I can or should be doing? For example would any of the many sports recovery / electrolyte drinks on the market help me to stay better hydrated than just diligent water consumption? And secondly, is this diagnosis common among cyclists and if so how long have other riders taken to get there urine back in to normal ranges.

Acute tubular necrosis (ATN), translated, means "sudden death of kidney cells." ATN is characterized by a sudden decline in kidney function, which can progress to kidney failure and death. Specifically, the kidney loses its ability to excrete waste products, so urea and ammonia accumulate in the blood. The ability to regulate electrolytes, sodium, acid and water is also severely compromised. ATN is common among hospitalized patients and patients in intensive care units, resulting from an infectious, toxic, or ischemic injury to the kidney. In endurance athletes, ATN most likely results from a pathological condition, exertional rhabdomyolysis. Rhabdomyolysis is characterized by severe muscle damage, followed by release of the contents of the muscle cells into the blood stream. Myoglobin, the oxygen-binding protein in muscle, is one of the cellular degradation products released into the blood. When myoglobin reaches the kidneys it contributes to the onset of ATN: it obstructs blood flow in the kidney; it is metabolized into compounds that are toxic to the kidney; and it contributes to formation of precipitates in the kidney which block blood flow. Dehydration also contributes to the development of rhabdomyolysis. Loss of body water results in decreased blood volume and decreased organ blood flow, which deprives the kidney of nutrients and oxygen.

Thanks for the great advice, I've been looking at my position in regards to your suggestions and am going to move my cleats back and see how that works. My leg length discrepancy is measurable. I was x-rayed and measured by a physical therapist, I don't remember the exact measurement but my right femur is shorter than my left on. Not a whole lot, but measurable. Do you have any recommendations on compensating for this in positioning? I've been looking into the LeWedge system, which claims to be able to help with this type of issue. Thanks again for your help.

My physio did some work on my back which helped a little, but I had a huge improvement from my first visit to the osteopath, things have improved on the bike, but I feel there is still a lot of work to do before I'll feel 100% fit again. My osteopath said my L1, L2 & L3 vertebrae were very stiff (along with my left SI joint) he is also doing soft tissue work on both my back and quad of the affected leg (left) to help. The question still beckons though... what is the cause? Is it just my physiology, or to do with bike set up? The problem (this season) first struck on a 4-hour road ride, so it was the duration that set it off (approx 10 weeks ago) and it has not fully settled down.

The other thing that niggles at my mind is the pain that I get in my left knee, it is on the inside, right on the side/top edge & when it is sore, to touch it is very tender. The osteopath reckons that it fits for a nerve referral pain? The treatment he is doing suggests that it is, but I can't help but wonder if it is merely relieving the symptom, and that the cause is something different. I'm not sure, it's a really difficult one to track. I feel sure that my alignment is good & that I don't appear to have any external rotation during the pedal stoke. I am getting checked out again by my podiatrist next week for this just to be sure. I agree that the pain is not coming from the knee itself though.

It is hard to answer with any certainty about whether your problem is caused by the bike or was pre-existing and was exacerbated by the bike. The greater likelihood is that you already had the problem but it had not bitten you yet. When we have a functional problem our bodies will accommodate the problem by functioning in a different and less efficient way. Sooner or later we have to pay a price for that. In your case for instance; if your left sacro - iliac joint is restricted as you say, then the ilium and hip on that side will tend to function as a unit instead on independently.

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