Fitness questions and answers for November 4, 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.

1) When lying flat on a hard floor, with my legs extended and ankles together, I take a deep breath and then completely relax everything from my chest down to my toes. Immediately, it is noticeable that my left foot falls closer to the ground than my right foot, and my left hip the same.
2) When standing in a shower (a hard, flat surface), I always notice my left foot and leg is either behind my right and leg, or in front of it. When I put both feet and legs together, I feel unbalanced. Also, when I look down at my torso and legs, I'd swear my body was twisting towards the left side and about to the same degree as the left foot is pointing out.
3) Both feet measure nearly identical, down to the millimetre, in width and length.
4) A definitive standing x-ray showed that the left femur is 4mm shorter than the right, but all three physio-chiropractor professionals said that shouldn't even be an issue for me because of the core strength and flexibility present.
5) Left cleat has four lemond wedges with the thick side towards the crank/inside. Right cleat has 1 wedge with the thick part pointing towards the inside. I have ridden this way for nearly 11 years, with no previous noticeable problems.
6) Left interior shoe, along with the four wedges under cleat. It has a 2mm-thick full-length insert added to account for the LLD
7) I've never had right or left knee, ankle, hip, back or muscle/tendon problems before (unlike the right iliac area, right psoas, and right adductors-down-into-rectus femoris muscle pain I am now getting). I have practiced fairly intense core strengthening and yoga stretching nearly every day for the past 20 years.
7) I have no other known medical issues, 46 years old, in seemingly very good health.

When the left hip is viewed from the side, my left hip seems to be forward compared to the plane of my body and right hip. My right thigh/leg/knee is closer to the seatpost under load on a trainer, but not by much compared to the left. In fact, both thighs rub the seatpost, but neither knee hits the top tube unless I get get sloppy and careless with my form. My knees, when viewed from the front, are tracking fairly straight up and down, but I must confess again, I do focus intensely on keeping things correct, even during time trails

My heels are straight; neither heel shoots in and/or out on either foot, under any type of load. I am twisting on the bike under load; noticeably pushing or twisting the left side forward. Please note that I am left-handed, left-sided and I jump off my right leg. Strangely, though, despite my always concentrating on the left leg as if it were the problem, the left leg still feels like the smoother and more powerful leg compared to the right.

1) The right iliac and right psoas, and right hip adductor-into-rectus femoris pain is sometimes becoming unbearable, sometimes on the bike, and also very noticeable off the bike after a long ride.. The more I ride, afterwards, off the bike, the more I hurt. This all causes pain to go into the right lower back too. When this all started a few years ago, it used to be that 45 minutes of intense Yoga stretching took this pain all away, but not anymore. The right side iliac, psoas and adductors-to-rectus femoris muscle pain are with me nearly constantly, on and off the bike.
2) Then to make matters more fun, the past four months, the right hamstring is developing pain in the middle of its length (I'm 6'2", 190lbs, 10% body fat). I know you can combat that by either lowering your seat, raising the handlebars, etc., but not much helps here and I have tried combinations of it all. I am thinking the right lower back and hip issues that have recently been added to everything else is a consequence of the right side issues being suffered, thus causing the right hamstring to act up, and the right side of my lower back.

But about seven years ago I was in a stressful work environment, and developed glandular fever. This remained undiagnosed and I subsequently developed a liver problem causing blood LDL to rise from normal range of 20-50 up to around 600 - it remained high for a while but subsequently fell back and has remained normal for five years. I think I eat in a healthy manner and several digestive problems (eg coelic) were investigated and rejected as being problematic. Your comment did however pique my curiosity hence my email.

While I think my current alternating knee pain can be helped by slight downwards seat height adjustment, I am also planning to check out my limb length, as I'm wondering whether the back/hip problems may have a root cause there (I have done a lot of bushwalking in the past). I also want to move my cleat position back (yes, a keen follower of the forum!), as I think will help my general bike geometry given I have very long legs and a relatively shorter torso. I also need to step up the stretching and core strength work. I'll use a local physio specialising in cycling to guide me in this.

You're welcome. About that back of knee pain on alternating sides. Drop your seat. If the seat is a touch too high, behind the knee is one of the places you will feel it particularly if your cleats are too far forward on the shoe as you suggest. What happens is that under severe load (climbing hills or accelerating hard on the flat from moderate rpm in a big gear) the heel is dropped explosively and this is the source of the discomfort. If the cleats are moved rearwards, then ankle movement is moderated and the problem lessened but it can only happen if the seat is too high to start with.

This time I have a question about crank length, partly related to my calf problems. I live in Switzerland, which means a lot of mountains and a lot of climbing on the bike, which is what I like to do. However, with my current set-up, Dura-Ace 53/39 with a cassette of 12-27 and a weight around 95 kilos, I just dont have the power to push a proper cadence on climbs steeper than 8-9%, Im down to a cadence of 55 on 10% climbs.

I have decided to get the new Dura-ace compact crankset 50/34, which should help me to improve the cadence and climbing (preferable in combination with some weight loss). When ordering these, I need to decide on a crank length and this is something I never really thought about before, I just now checked that I currently have 175mm which came originally with my bike. I have a 62 cm frame, shoe size 48, inseam 93 cm and I am 198 cm tall, I would assume that I should have the longest cranks available, 180mm, considering my data? I still have stiff calfs after extensive climbing and I have read that longer cranks should be better for the calves. What is your opinion, should I go for the 180mm or should I stay with my 175mm? Or maybe it doesn't matter.

I have just recently started bike commuting (three miles each way) to work and my left knee has been bothering me. After it started bothering me, I stayed off my bike for two weeks and then went to my bike shop and they helped fit the bike to me more properly (my seat was far too low) and a little too far back. I've started riding again, and while my knee isn't hurting, it doesn't feel right. Now when I squat down, with my hand on the front and a little to the inside of my knee, I can feel a little tendon or muscle pop over the corner of my knee towards the inside. I can feel it doing this each time I push down on the pedal as well.

I know it might be hard to diagnose anything from this brief description, but my main question is whether you would recommend getting clipless pedals and shoes. Right now I am riding with toe cages and regular work-out shoes. I have very high arches and tend to over-pronate and I wonder if this coupled with possibly improper shoes/pedals might be aggravating my knee? I have been hesitant to buy the shoes and pedals because I'm worried I will buy them and find that they don't help my knee issue. If you do recommend purchasing a clipless system, do you have any advice on which kind someone with my particularities should get? Any other insights as to what is happening with my knee are greatly appreciated.

I'm not sure what is causing your knee problem based on the info you have given me, but the first thing I would do is get rid of your toe clips. When combined with gym shoes, it is almost impossible to get enough foot over the pedal. This alone may be the source of your problem, directly or indirectly. When you remove the toe clips, place your foot further forward over the pedal and play arond wiith positioning the foot until they feel solid and comfortable on the pedals. This in turn may mean that the seat may have to come down a bit to allow for the extra leg extension that will occur.

The first thing Beth needs to realise is that this is truly a life-changing experience, and to remember to take the small pleasures in life along the way. Goals change, life changes, and attitudes change during this transformation that she is planning, and it will take determination, it will be frustrating, but it will be worth it, and she will find new faith in herself as she takes on this challenge. She will not know all of the rewards until they happen, and she will not even know what some of those rewards are until they happen. Like her doctor telling her that her cholesterol numbers dropped 45 points in one year.

I started out with a 40" waist, and I am just about ready to go buy a pair with a 34" waist. Every inch was huge victory. It can be very frustrating at times when the weight does not come off. I went through five months this summer where my weight did not move one pound while I was riding 200 miles per week and running 25-30 miles per week. But I can tell you my shirt size dropped from a large to a medium. It was extremely frustrating until I went to buy a few long-sleeve shirts for winter and the long-sleeve medium shirt I tried on in May now fit and I had not lost one pound. My body was dramatically different, and it feels great.

It was important for me to set intermediate goals, not weight goals, but fitness goals. It is important to find a goal and meet it, even if the weight is not coming off like you want it to. Set long-term goals for yourself, I volunteered at a water station for a 20km run last year, and this year I ran it. I added running to my biking workout routine and made it a long-term goal to complete the race. I did a few 5km races along the way, but after finishing the 20km one, I set more goals.

I completed three triathlons over the summer and I just ran a half marathon five months after the 20km run, completing the half marathon five minutes faster than I completed the shorter 20km time by over five minutes, and I am now setting my sights for a full marathon in March. The goals should be something that you question yourself over. I was so scared the night before the 20km I hardly slept, but I lost 18 lbs during my 16-week training programme for the race, and I was so proud of myself for taking on the task, it pushed me to do more, and it helped shed some pounds along the way. I was not specifically training to lose weight, I was accomplishing a different goal, and in the end two great achievements were made.

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