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Fitness questions and answers for November 28, 2005

Form & Fitness Q & A

Got a question about fitness, training, recovery from injury or a related subject? Drop us a line at fitness@cyclingnews.com. Please include as much information about yourself as possible, including your age, sex, and type of racing or riding. Due to the volume of questions we receive, we regret that we are unable to answer them all.

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.

Dave Palese (www.davepalese.com) is a USA Cycling licensed coach and masters' class road racer with 16 years' race experience. He coaches racers and riders of all abilities from his home in southern Maine, USA, where he lives with his wife Sheryl, daughter Molly, and two cats, Miranda and Mu-Mu.

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.

Eddie Monnier (www.velo-fit.com) is a USA Cycling certified Elite Coach and a Category II racer. He holds undergraduate degrees in anthropology (with departmental honors) and philosophy from Emory University and an MBA from The Wharton School of Business.

Eddie is a proponent of training with power. He coaches cyclists (track, road and mountain bike) of all abilities and with wide ranging goals (with and without power meters). He uses internet tools to coach riders from any geography.

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.

Current riders that Steve has positioned include Davitamon-Lotto's Nick Gates, Discovery's Hayden Roulston, National Road Series champion, Jessica Ridder and National and State Time Trial champion, Peter Milostic.

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.

Pam was an All-American in track while at the UW. She started cycling competitively in 2003 and is the defending Missouri State Road Champion. Pam writes a nutrition column for Giana Roberge's Team Speed Queen Newsletter.

Dario Fredrick (www.wholeathlete.com) is an exercise physiologist and head coach for Whole Athlete™. He is a former category 1 & semi-pro MTB racer. Dario holds a masters degree in exercise science and a bachelors in sport psychology.

Scott Saifer (www.wenzelcoaching.com) has a Masters Degree in exercise physiology and sports psychology and has personally coached over 300 athletes of all levels in his 10 years of coaching with Wenzel Coaching.

Kendra Wenzel (www.wenzelcoaching.com) is a head coach with Wenzel Coaching with 17 years of racing and coaching experience and is coauthor of the book Bike Racing 101.

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.

Through his highly customized online training format, Steve and his handpicked team of coaches at Colorado Premier Training work with cyclists and multisport athletes around the world.

Brett Aitken (www.cycle2max.com) is a Sydney Olympic gold medalist. Born in Adelaide, Australia in 1971, Brett got into cycling through the cult sport of cycle speedway before crossing over into road and track racing. Since winning Olympic gold in the Madison with Scott McGrory, Brett has been working on his coaching business and his www.cycle2max.com website.

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.cyclecoach.com) is an Associate Coach with Richard Stern Training. He holds a Masters degree in exercise physiology and is USA Cycling Expert Coach. Michael has been a competitive cyclist for over 10 years and has experience coaching road and off-road cyclists, triathletes and Paralympians.

Kim Morrow (www.elitefitcoach.com) has competed as a Professional Cyclist and Triathlete, is a certified USA Cycling Elite Coach, a 4-time U.S. Masters National Road Race Champion, and a Fitness Professional.

Her coaching group, eliteFITcoach, is based out of the Southeastern United States, although they coach athletes across North America. Kim also owns MyEnduranceCoach.com, a resource for cyclists, multisport athletes & endurance coaches around the globe, specializing in helping cycling and multisport athletes find a coach.

Advice presented in Cyclingnews' fitness pages is provided for educational purposes only and is not intended to be specific advice for individual athletes. If you follow the educational information found on Cyclingnews, you do so at your own risk. You should consult with your physician before beginning any exercise program.

One foot pronating continued Left foot issues Knee pain Wrist pain Pain behind the knee Cycling after injury Neck discomfort Different crank lengths Leg and arm numbness Anatomical leg length difference

One foot pronating continued

Hey Steve, sorry for the delay.

Unfortunately with my busy schedule I have not been able to find the time to get on the trainer with someone but I will still try. Since writing my last letter too you I noticed that I have been getting a lot of pain in the lower left side of my lower back and even switched back to the Time pedals. I also noticed that that same left leg hamstring is always very tight and do I mean tight! Hamstring stretches give immediate relief to the point where it feels like morphine or some great pain killer. I can also definitely say my right leg is my favoured leg and is much more developed than my left, especially the quadriceps. The distance between the top tube is less on the right side. Sorry to have to guess about the hip rotation but I did have tendonitis on the right side of the soft tissue area where you sit on the saddle last season, so maybe the right side is 'grinding on the saddle' so to speak. The left elbow seems slightly more bent than the right but there is a chance that the shifter isn't perfectly aligned. The left knee has quite a bit of lateral movement especially while pushing a hard gear, the right knee seems perfect.

I am using specialized pro carbon shoes with cleat fully forward on the left foot and centred, and right foot cleat fully forward and pointed all the way right 'heel in'. I even tried moving the cleats back like you recommended in one of your earlier articles but I got terrible pain in the ITB, especially the right.

Right leg pedal stroke seem smooth but left seems almost square at times and weak. Sometimes I get the feeling like I am reaching with the left leg as though I can't get on top of the pedal and even bouncing at times. Riding buddies have not told me that I am too low on the saddle but I know that the problem stems much deeper. I do not rock on the saddle.

Might I also add that I get a lot of pain in left knee in which I have done two MRIs and seen a knee specialist in which I am presently awaiting a second evaluation, this happens on and off the bike like climbing steps for example and even while swimming. The first MRI found a ganglion cyst which the doctor said could be nothing. A year later the cyst was gone but doctor saw no abnormalities in the MRI but bit of synovial fluid in the knee. The doctor did offer arthroscopy as an option to find out more.

It's obvious that the left knee and especially the left tight hamstring is causing some problems but wondering what I could do with the cleat or seat or what ever since I have tried almost everything. Seeing a back doctor or a physio are also my other options.

Gerald Reyes

Steve Hogg replies

Gerald,

Left foot issues

I was interested to see if there was any follow-up or advice that was given to this question and response so far? I have almost the same exact issues as Gerald Reyes with my left foot. I do use Speedplay pedals as well. I can answer the questions posed below if it helps. I have gone to many different bike fitters and they do not seem to be able to comfortably solve the problem. If they do, I end up lacking much power in my strokes on both legs. I would hate to change up much to my right leg since it seems "ideal" to me when I ride.

Here are my own responses:

1. Which hip you drop and/ or rotate forward on the pedal downstroke?

My left hip, but it may be because my left foot speedplay cleat is shifted back significantly in respect to the right foot cleat with two Lemond wedges underneath them to account for vargus and also the difference in effective leg length that would result from the posterior placement of my clean.

2. Which knee if any, is closer to the top tube?

Left knee is closer to top tube and seems to get closer at cetain points of the pedal stroke (specifically the downstroke).

3. As viewed from behind, on what side is the gap between inner thigh and seat post greater?

Left side is greater

4. Viewed from above and behind which shoulder if any, is thrust further forward?

Left side is slightly shifted forward.

5. As viewed from either side, which elbow if any is more locked than the other?

Left seems a little more locked but perhaps no significant differences can be felt.

6. Which knee if any, moves laterally at the top of the stroke?

Left knee moves laterally on up stroke and medially on the down stroke.

7. Lastly, do you have any feeling of one leg being your preferred or stronger leg?

The right leg is by far the stronger, smoother and faster leg for any cadence or speed. This includes climbing out of the saddle.

Thank you so much, and I look forward to hearing from you soon.

Jonathan Tan

Steve Hogg replies

Jon,

Knee pain

Hi,

I have been cycling now for ten years, both mountain biking and road biking. I cycle about 50-70 miles at weekends, and also commute daily [10 miles per day for my commute]. I also do circuit training twice a week. I'm 35 years old.

In the last two years I have had experienced a painful knee after prolonged cycling (more than 50 miles). The pain comes on quickly at the 40 mile point. At first I feel a slight pain or tightness at the back of my knee, which then seems to focus just underneath the kneecap. I am forced to stop my bike ride because of the pain. For a few hours afterwards I find lowering my body weight, and descending stairs, on that knee to be extremely painful. After 24 hours rest and ice the knee feels better enough for moderate cycling. The problem has been with me now for two years.

Some things I have tried:

An MR Scan was clear, so I tried resting and then slowly increasing mileage, plus taking strong anti-inflammatories as routine. I also stretched and strengthened my quads, hamstrings and calves. I also tried strengthening the vastus medialis, plus knee bends to strengthen the patellear tendon. I changed the seat height and changed my SPD shoes for both mountain and road bikes. I also wrapped up in cold weather etc, etc.

I have a tight piriformis on the same side as my right knee. Could this be related?

Paul Davies

Steve Hogg replies

Paul,

Wrist pain

A couple of months ago I was out training on a fixed wheel bike. Now I don't ride fixed wheel too often and so I have a habit of forgetting I'm doing so! In consequence, when I tried to bunny hop a hole in the road, I stopped pedalling. On a fixed, this really isn't a good idea.

Consequentially, the bike tried to throw me over the bars. Luckily it didn't but what it did do was snap my left wrist hard against my Polar HRM. I now find it impossible to put any weight on the wrist when my hand is bent and it causes a lot pf pain when doing push-ups or even pushing open a door for example. At all other times, it causes no discomfort at all. The pain is located in the centre-top of my wrist - looking at the top of my hand it's exactly in the centre of the point my wrist starts to widen into my hand.

On the bike, riding on the hoods or drops is fine but using the tops with a bend wrist is really uncomfortable. Any ideas on what the problem could be?

David Laing

Scott Saifer replies

David,

Pain behind the knee

Hi,

I recently lost my cycling shoes and upgraded to a new pair of carbon soled shoes but a different brand. I previously used Carnac, but the new shoes are DMT. I found that on long climbs of 5km I developed ache behind my left knee. I bought another pair of shoes of the old brand Carnac and found that the three holes for the cleats are 0.5cm forward in the DMT shoes compared to the Carnac, thus effectively lengthening leg length by 0.5cm with the DMT shoes. I have gone back to the Carnac shoes, dropped the seat tube by 0.5cm, and put the seat forward by 0.5cm, but I still start to ache behind the left knee when climbing seated and riding in the drops. Standing climbing is ok. There has been a slight improvement. After a ride if I keep my knee straight it's ok, but if I bend my knee, I develop ache beginning at 30 degrees of bend to 90 degrees of bend. Lowering my knee the ache continues until 30 degrees of bend, and then it disappears. I would be most grateful if you could indicate what this might be. I am a 56-year-old male road cyclist who rides 200 to 250km a week, races twice a year, likes long climbs and descents. My height is 185cm and I weigh 65kg. Look forward to hearing from you.

Rob Sloane

Steve Hogg replies

Rob,

Cycling after injury

I had an accident 2 months ago when I was hit by a car doing approx 80kph while out training. I broke my ankle, fibula and wrist all on the left side. I love road racing and averaged 400km per week. My question is when and how do you know when to begin training again on an indoor trainer. Is it a case of when I feel comfortable on the trainer or after a particular length of time? I had two screws inserted into my ankle. It feels pretty strong but I don't want to aggravate it by training too early.

Ian Adams

Scott Saifer replies

Ian,

Neck discomfort

Hi,

I was wondering if you can give me any advice. I have a road bike and when doing longer kilometres I get pain in my neck shoulders - any advice would be appreciated.

Dwayne Barry

Steve Hogg replies

Dwayne,

Different crank lengths

Sir Steve

My left femur is 2cm shorter than the right but my tibia on the left leg is also 1cm longer than the right. Essentially I have a 1cm leg length difference (LLD) when standing. I've been riding around tilted to the left (b/c of the 1cm total LLD) and with my pelvis twisted forward on the left (because of the femur length difference (FLD). The LLD was easily corrected with shims but the shim doesn't really seem to address the FLD and its resulting twisted pelvis.

My question is...would it be better to use a shorter crank on the left? I theorize if I used a crank that was 1cm shorter I would correct the total LLD and 1/2 the FLD, which would address the twisted pelvis too. Or worded another way...wouldn't it be better to address differences in femur length at the crank?

Dr Kemp

Steve Hogg replies

Matthew,

Leg and arm numbness

Hi

Thanks for running such a great website. I'd be very grateful for any advice you can offer.

I'm a 35 year-old recreational cyclist, 5' 11", 147 lbs. I've been cycling to work (round trip 15 miles) for 15 years on a hybrid bike (not clipless pedals), with no problems. About two years ago I became interested in road cycling as a hobby, and purchased a racing bike, with Look clipless pedals. I find that after riding for an hour or so, I get numbness in my left leg, starting at the foot and working up, and also numbness in my left arm & hand. If I keep riding the numbness gets so bad that, for example, I can't move my left hand and fingers enough to work the brake or change gears. The numbness subsides on resting for a minute or so, but returns on restarting. Essentially, the problem is there from the moment I start cycling, but takes time (about an hour) to really become noticeable, and eventually becomes impossibly uncomfortable.

I have a 2cm anatomical leg length discrepancy, the left being the longer. (I don't know why: I've never had major trauma to either leg.) This has been confirmed by a physiotherapist who has some experience of dealing with cyclists, and whom I trust. I did quiz her as to whether it was truly anatomical as opposed to functional, but she seems pretty sure its anatomical. I got custom orthotics from her, with a heel lift on the right, and find them very comfortable for walking.

The orthotics do not solve the cycling problem, however (unsurprisingly), and the physiotherapist hasn't really had much more advice to offer. (She feels I need to see a cycle fitting expert, which is fair enough, but this will involve the hassle of going overseas with the bike: I accept that I may end up doing this.) I have tried shimming the right shoe, everything from 2mm to 12mm. I find that a shim of about 10mm makes me feel more balanced on the bike, and the numbness is perhaps less, but still present.

I don't think it's a forefoot varus problem, as I don't get knee pain, and my knees don't track laterally during the pedal stroke. (I did try LeWedges just in case it might be a varus problem, but the problem persisted).

When I pedal on a stationary trainer, I notice that my right iliac crest is in front of my left (ie my pelvis is tilted). I also notice that if I take my right hand off the handlebars when pedalling, my balance is not really affected, but that if I take my left hand off, I feel very imbalanced, like as if I'm falling left). This suggests that my torso is leaning left, which explains the left arm & hand numbness (the arm is bearing too much weight).

Turning the saddle nose to the right (as far as will allow me to pedal) straightens my pelvis a bit (and makes my left arm feel better, and (I think) makes my left leg feel more natural), but my balance is still not quite right.

It may be that I have a muscular pelvic asymmetry which has evolved over my whole life in response to the LLD. I've only had the orthotics for 8 months, and have been trying shimming of the right pedal for 6 months, so adjustments may still be occurring with my core musculature. I don't actually know if the pelvic tilt has become less since I started using a shim, as it is only in the last few months that I have realised that the pelvic tilt is probably the central problem (although I realise that the LLD is probably the cause of the pelvic tilt). I've been stretching and doing Pilates-type exercises since I realised this.

Have you any advice? Is there anything quick and simple I can do, or is it a matter of persisting with the orthotics, shimming, and stretching until the musculature comes back into symmetry (rather a long term solution, this!).

Sorry for such a long email, but I have found it to be a complicated and somewhat frustrating problem.

Martin Feeley

Co Kildare, Ireland

Steve Hogg replies

Martin,

Anatomical leg length difference

I read your response to many e-mails regarding anatomical leg length discrepancies - very interesting and informative. Here are my questions: I am a male, 33 years old, 1.92m in height and of slender build, broad shoulders, straight legs, arm length difference of approx 1cm with right longer than left, although I haven't been x-rayed and measured for this yet. I know because of my own comparison. I pronate moderately in both feet, with the right more than the left. I have Louis Garneau Tri-Air (Eur 46) shoes.

I have completed my first sprint distance triathlon, without having done any cycling prior on a borrowed bike. I have been dreaming about being a pro on the Xterra series. I bought a mountain bike three months ago (haven't ridden it yet) and recently a road bike. I'm going to start with road triathlon first (easier)...but I have an anatomical leg length difference, I have had x-rays of my legs and been measured by two radiologists who got the same measurements from the same x-rays.

The right femur measures 55.3cm. The right tibia measures 44.4cm and the left femur measures 54.8cm. The left tibia measures 44cm. There is thus a 0.9cm limb length discrepancy with the right leg being the longer.

My new road bike was set up according to www.online.bikefitting.com. The normal measurements were taken without consideration of my leg length difference. I had pain in my longer leg (right), hip area and knee after completing my first triathlon and after two sessions of 20km on my bike on the king cycle at gym. This is the same pain that I used to get while cycling three years ago on the gym bikes. I stopped cycling when the pain became to severe. That's when I consulted a sports physician and the leg length difference was made apparent to me. I know the resurfacing of the same pain is a result of my leg length difference on the bike which has not been addressed yet.

I have full length orthotics in my running shoes with anti-pronation build up and a gradual raise in my left heel, maxing at 9mm. All my previous aches, pains and resulting injuries have gone away.

Please can you give me advice on how to build up shorter side leg, cleat adjustment, etc? What does shim, packer, spacer mean? I was thinking of getting an engineered aluminium spacer of 9mm (other advice suggests raising only the difference in tibias 4mm for me) between my cleat and my left cycling shoe with longer screws to hold it in, but after reading your advice I'm not sure. Using your method, how should I set up the cleats? What happens when you cycle standing up i.e. hill climbs, don't I need rather a 9mm spacer? Isn't equal leg length what I want? Using a 9mm spacer how does that affect me when in the saddle? When riding out of the saddle how does a smaller 4mm spacer affect me (what bodyfix.net suggested)? What is the best way of remedying my problem?

Pieter Visser

Cape Town, South Africa

Steve Hogg replies

Pieter,

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