Cyclingnews Fitness Q&A - June 29, 2011

The more aggressive position, the more strain you put on your body. (Image credit: Tour of Japan)

Topics: Plica Syndrome, Technical aspects of criteriums, RE: Foot discomfort, Hamstring Soreness, How much to spend on Bike fit, Returning from respiratory infections

I am an avid cyclist living in Malaysia. In November 2009 I developed a small pain in my left knee. The pain started (or at least this is when I began noticing it) during a fairly long ride of 160km. The pain was isolated to about a "dime size" point on the medial side - basically right where the quad connects with the knee. The pain was more debilitating than anything. When I would stand the leg felt powerless and like it would almost give out. I rested for a few weeks and tried the bike again. However I had no luck, after about 10 km I had the small pain and the leg felt weak.

Now the discomfort/unusual feeling is back and has been progressing. I do not have the pain yet, but I can feel there is something not quite right. When I get off the bike and bend the knee joint I can feel a "snapping" sensation of a tendon - not painful, but unusual. You can also visibly see (when I squat a little) my left knee cap is rotated towards the outside as compared to the right knee cap. The longest ride has only been 70km and I am afraid to push it any further.

Here's what may be part of the picture. The plica can vary in it's location and there is individual variance so this may be an accident of birth in your case. However, that the left knee only is affected and that only cycling irritates this may mean (I say cautiously) that is is related to your bike fit. My experience is that left knee problems are far more common on a bike than right knee problems. The reason for this is that when a riders position is subject to any challenge they will not compensate symmetrically. What I call a challenge is any factor that reduces the riders stability or symmetry on a bike.

To take the simple example of a seat height set too high. It is a rare rider who will sit symmetrically on the seat and equally overextend both legs. What happens in the vast majority of cases is that without conscious thought, the rider will automatically drop one hip and reduced the leg extension of the 'favoured' leg. Of course, doing so further extends the already overextended leg on the other side and often challenges the plane of movement of the knee on the other side. What makes this interesting to me, is that probably 90% or a touch more, when presented with a simple challenge like this, will drop the right hip, reducing leg extension on that side while further increasing the extension of the already overextended left leg. This happen whether the rider is right side dominant or left side dominant, meaning that at some level most riders have a Right Side Bias. Have a look at that link, particularly the video clips.

When I mention seat height, that is only one potential challenge. There are many others and usually with overlapping consequences. For example, have a look at two things when you get a chance. Firstly, strip the waist in front of a mirror and and run your thumbs down from your ribcage until they contact the top of your pelvis on each side. Is there a noticeable difference in height between each side of the pelvis. If my fit clients over the last umpteen years are anything to go by, there is a 95% chance that the answer is yes. If so, you need to find a physio or similar who can determine whether there is a measurable or functional leg length difference. Your issue on the bike (assuming it is only a bike related issue) could be as simple as one leg being shorter than the other.

If you are good in mountains and time trials then you already have aerobic power. There are two places you might look for improvement. Most likely is bike handing. If you are using your brakes more than once every few laps, not counting courses with hairpin or other tight turns, you need to get past that. That can mean learning to watch holes rather than wheels, learning to open a little gap before turns and then roll into that gap when the rider in front slows or several other things. If there is wind, you need to learn to plan which side of the field to exit the corners on at each corner, and then get there.

2) When you feel crowded, put your elbows out. Each rider has an amount of personal space they need to be comfortable. If the guy next to you is happy with a few inches less than you, he's willing to ride closer to you than you are comfortable riding next to him. You are tempted to make yourself small in order to not be too close to him, but when you pull your elbows in, that gives him permission to come closer. Put your elbows out and you push his comfort zone away from you and claim your space.

As best I could, I made some of the measurements described on your webpages, but the numbers seems to be a bit contradictory. On my right foot I measured the 1st MTP joint at 203 mm from the wall and the 5th MTP joint at 176 mm from the wall. On my left foot I measured the 1st MTP joint at 199 mm from the wall and the 5th MTP joint at 177 mm from the wall. On my right shoe I measured the distance of the pedal axle behind my 1st MTP joint at 8 or 9 mm. On my left shoe I measured the distance of the pedal axle behind my 1st MTP joint at 15 mm. I have my cleats set up so that the left one is about 5 mm farther back on the shoe than is the right cleat. I established these cleat positions largely by feel when riding. I should note that, although the right cleat is farther forward, it feels better positioned---slightly farther back---under my foot, while the left cleat sometimes feels too far forward under my foot. This has proved true for all of the cycling shoes that I have ever used.

Right, my current shoes are not tight in the sense that there is plenty of vertical room in the toe box. I would not say that the shoes are tight laterally, either at the 1st or 5th MTP joints, but there is certainly no wiggle room in the lateral direction there. My previous shoes were definitely tight at the 5th MTP joint and perhaps somewhat tight at the 1st MPT joint, so I specifically sought out shoes wide enough to accommodate my wide forefoot.

1. Your seat is too high. Probably quite a bit too high. When this happens, almost no one will sit reasonably squarely and equally or near equally overextend both legs. They will asymmetrically attempt to compensate by hanging one way or twisting forward on one side. For 90 something percent, it is the right side that the rider will hang towards or twist towards and the left leg will be forced into overextension. If your left foot ever feels like it wanders around on the pedal a bit, whereas the right feels planted more solidly on the pedal, then the possibility of what I am saying being correct is high. If this strikes chord with you in any way, drop your seat 10mm and reassess. If better but not better enough, drop some more. I have found people with the same self description as your quote above can need a seat height drop of 12 - 35mm before they can reach the pedals fluently on both side and sit squarely or more squarely on the seat. Assuming of course that that is the reason or a large part of the reason for the problem.

2. That you are not necessarily sitting too high but that you twist your pelvis forward on the right side markedly or drop it markedly, either of which causes the left leg to overextend. That doesn't explain the incidence of pain on both sides though or why the pain occurs only in hot weather. The only way you will verify whether this possibility is the case is to mount your bike on a trainer, strip to the waist and have an observer stand above or behind you while you pedal under load. See this link for video clips showing cues that your observer should be looking for.

3. That either 1. or 2. are happening, with the additional impact of less than ideal arch support of cant of the foot on both sides. I don't know how high your arches are but would suggest that you try a pair of eSoles Supportive insoles. They have modular arch support in 4 different heights (with a 5th highest option available separately) as well as 2 different heights of metatarsal lifts in each kit. See this link here for instructions on how best to use them. The combination of arch support and and metatarsal lifts will likely improve or resolve your situation. If it improves but doesn't totally fix, then almost certainly the cant of your foot on the pedals needs to change. See this link for info on that.

I'm 30 years old and I've been riding for several years. This is my first year racing. I typically ride 3 strong group rides per week (30-40miles, average speeds in the mid 20s, maxing out in mid 30s). This year I have progressively been adjusting my bike fit to get into a more aggressive riding position for racing. I feel very comfortable while riding and have only one pain that may be related to my fit. I get some pain in my right hamstring.

Since I live in Florida I don't spend much time out of the saddle, typically I'm down in the drops and a pushing large gears for a good portion of each ride. My seat is low enough that my legs do not fully extend so I don't think I'm overextending. In recent weeks I have made intentional effort to ride at a higher cadence and it seems to help some but I still get that slight pain randomly throughout the ride. The pain doesn't lead to cramping and I don't ever get the pain in my left hamstring. Do you have any idea what may be causing this or suggestions on how to prevent it? Would stretching more throughout the week help?

By a more "aggressive position" I assume you mean you have lifted your seat, dropped your bars or some combination of both. The increased forward lean of your torso that caused by the changes to your position is causing more stress on your right hamstring as the hamstrings are being stretched out more to help allow the lower torso position which is what I assume you mean by "more aggressive riding position" (though I'm not sure what aggression has to do with it). Why the right hamstring and not the left?

Any number of reasons is the answer. It could be a functionally (tighter hip / lower back) or measurably shorter right leg; it could be that a compensatory mechanism you are using for the challenge to your position caused by the lower torso is causing you to load the right side more than the left and so on. You may have already had a difference in range of movement of the hips on left and right sides and the lower torso position is enough to highlight that difference.

The solution to your problem is to think about what you have changed, whether it be seat height, bar height or other parameters in combination. Back the changes off incrementally until your right hamstring niggle disappears. Then you will have the most "aggressive" position (sorry, I don't like the term because it doesn't describe what it means) you can ride with your current state of structural fitness and knowledge of how you function. If you improve either of those underlined phrases, it is likely that over time, you can reach the position you desire without problems.

I do often experience tightness in my lower right back and realize now that it could be connected to the pain in my hamstring. One thing I will try (which i have been told can help with back alignment and back pain) is removing my wallet from my right rear pocket. Its usually pretty thick, unfortunately not because there is money in it though. Also, I'll try to refine my bike fit a bit more. Thanks again.

If yes, you will already know if you have any real differences in range of motion between left and right sides. If not, it's a good habit to get into for pre hab (which is better than rehab) and the benefits of knowing several times a week where you are tight and where you are not. A good and inexpensive self help book is "Flexibility for Cyclists" available from here. It is worth getting the stretching strap as well unless you have one or something similar already.

I have always cycled recreationally and commuted etc but I am now trying to get a bit more serious about my cycling with the intention of doing some sportives or similar. I have never had a bike fitting but have played about with various positions myself, but haven't every found anything that works for me, which is causing a problem now I am trying to cycle for longer periods of time (more than an hour and a half). I know that I have a significant (3cm) leg length discrepancy which I have tried to correct, but it's crude at best. I am about to move to Australia.

As the bikes I do have will take 3 months to get there and I haven't really got a proper road bike I will be buying a new bike when I get over there. I intend on spending about AU$1200-1500 on the bike, which I appreciate isn't a lot compared to most others. I also want to get fitted to check I am buying a frame that suites me and is setup so I can enjoy it properly. While I could spend $680 getting a first class fit is this really justifiable i.e. 50% of the cost of the bike. If I were to spend that much I would need to be on the lower end of my range or even below. Others offer fits for free when you buy a bike, but I fully expect them to be a lot less thorough and probably insufficient to consider cleat positioning etc, which I think will be important with my leg length discrepancy. Is there a maximum percentage of a bike spend that you think it is worth spending on a bike fit or should I go for the lower spec bike with a top notch fit?

The goal of a bike fitting is of course to get you to a comfortable, powerful position in which you can ride injury free for many years. There's no reason that has to cost a lot, but it probably will. I'd suggest you start with the free fit that comes with your bike. If you feel great, keep that position. If not, see a mid-priced fitter. If that works, and there's a good chance it will, keep that position. If that doesn't do it, go for the high-zuit fit from someone who really knows what they're doing and has experience with special cases, not just your average, symmetrical riders. Given your large leg length discrepancy, you're probably going to need someone with a lot more experience than the bike-shop guy, though not necessarily the top-level, $680 fit.

I agree that it can seem crazy to pay half as much for the bike fit as for the bike, but I've had lots of people come in with $4000+ bikes that they really didn't like or enjoy riding due to various pains and handling issues, and with a few tweaks, they leave with a bike they love. A cheaper bike that really fits well is a lot more fun to ride than a great bike that doesn't fit, so I think you'd be on the right track if you set aside at least a few hundred for the fit.

The obvious answer, which I dont like considering it's June and I had really hoped to be racing today and not riding an hour in my little ring, is to ride really easy until everything is completely clear. I understand that infections like this have the potential to cause some serious long term damage to the lungs. I guess my question then is, am I wrong to be so concerned? Am I freaking out about this for nothing and should I just go out, race, and deal with it?

Scott Saifer (www.wenzelcoaching.com) is head coach, CEO of Wenzel Coaching.com and has been coaching cyclists professionally for 18 years. He combines a master's degree in Exercise Physiology with experience in 20 years of touring and racing and over 300 road, track and MTB races to deliver training plans and advice that are both rigorously scientific and compatible with the real world of bike racing.

Steve Hogg has owned and operated Pedal Pushers since 1986, 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. Clients range from recreational riders and riders with disabilities to World and National champions. He can be reached at: www.stevehoggbikefitting.com

James Hibbard progressed from the junior to the professional ranks as a rider and has over 15 years of competitive cycling experience. He is a former Collegiate All-American track cyclist, trained as a resident athlete at the United States Olympic Training Center, earned international medals as part of the U.S. National Team, and was a member of the powerhouse Shaklee and HealthNet Professional road cycling teams.

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.