Fitness questions and answers for November 14, 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.

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 have just stumbled across your website and have been reading some of the questions from people and the advice you have gave them and I thought I would ask you a question. I am a group fitness instructor and I teach an RPM (stationary cycle class). About a day or two after I teach or participate in a class I find that the top of my left hip gets extremely sore and it stays sore for a week or more and because I do classes each week I constantly have this sore hip. It doesn’t ache it is just sore. Recently I’ve also noticed that my left knee is also sore. I know that you probably give most of your advice to road cyclists but I would appreciate any feed back you can give me on this as I have asked a number of fitness professionals and they can’t seem to help me. It is very frustrating because I can’t work out if it is my pedal stroke or my bike setup or something else. I am a 33 years old woman and 157cm tall.

I have a couple of questions regarding cleat position, first of all, can you please send me the links to the relevant discussions that have already been posted? thanks, ok, so my first question would be how much of a leg length discrepancy do you need to have before you start using shims? I don't remember how much the doctor told me it was when he measured it but I remember it being a really small number. Also, I've been using shims for a long time and recently got a mountain bike, whose shoes I never placed shims on, despite this when I ride my mountain bike I find it to feel rather normal. So I decided that I would take out my shims from my road shoes. I did this and hopped on the bike for a bit and felt that maybe the cleat (ex-shim shoe) felt a little to far forward, so I moved them back some. The next day I did the Sunday group ride, the ride went really well, no knee problems whatsoever, and my ability to ride hard/fast was not hindered either. But when I look at my legs, my left leg is obviously bigger than that of my left (left quad diameter, 2 cm bigger, left calf, 1 cm bigger). Was it because I was using shims on my right when it wasn't needed? Or is this a pedaling problem? I'm currently in the gym trying to work out the right more than the left in hopes that I could balance things out, but we will see. I know that this email is really disorganized in regards to the questions being asked, but I hope to hear from you soon so thanks in advance.

Of the three symmetry checks, only the first revealed a perceivable difference. Against the wall, heels on the baseboard, and feet aligned to the ruler per instructions, the right kneecap (heel out leg) points essentially straight ahead and the left knee moderately more out (outboard or left). Other than while pedaling, I've never noticed anything asymmetric about the orientation of my feet when walking, running, or standing but just getting into position around the ruler with my feet close together and parallel felt unnatural.

I cut piece of the cardboard off the cleat package and placed it under the inboard part of the right cleat with the cleat place as far back as allowed by the shoe/cleat and mounting angle. I placed the left cleat slightly forward of the aft limit as I have done in the past. The shoes were Shimano carbon fiber soled from the SPDR time frame (2000?). The shoes are efficient but really painful (felt ok in the store in 01') because of either poor fit and/or overly stiff sole and/or poor insole. I sucked it up an road for 10 miles to see what would happen. I didn't note any further aggravation of the ankle but I quickly remembered why I haven't favored Look pedals in the past years. They work fine seated, the work fine standing, but the transition between standing a seated is annoying for the right foot because of the friction float and the hunt for the sweet spot that occurs every time I sit. I didn't really notice the presence of the minor right cleat cant (right heel still was out more than left) and power transfer felt as good or better than anything I can remember.

2. Old (1998?) Specialized Mtn Shoes with Shimano 747 mtn SPD and SH51 cleat (floating single release) with plastic toilet shim under the inboard side of the right cleat (minus the shim, this is the setup that caused the recent ankle trouble). My right heel seemed to be less rotationally active (could be shoe lug pedal interference/friction from canted cleat) and a little closer to the frame but still out more than the left. The ride was short, less than 10 miles, and there was no noticeable ankle irritation and the cant from the shim was initially noticeable but did not feel odd or unnatural. I had the sensation of a small bump being in the right shoe under the inside part of my forefoot (the ball). I pulled the insole out and there are some irregularities in the forefoot area of the shoe where the cleat nutplate access flap is located. These irregularities aren't related to the shim and have been present for a long time and caused no problems on the mountain bike. My theory is that the bump became noticeable/annoying because more of the force was being carried by the inside of my forefoot due to the presence of the shim. I replaced the insoles with those from the shoes above but the bump feeling was still there. Nonetheless, power/effort felt reasonably balanced between both legs. Note that these shoes and pedals (no shims) work fine on the mountain bike. On the mountain bike, the right heel is still out more but the increased pedal spacing width is probably beneficial in that respect.

3. Same Specialized mtn shoes with 1st generation Dura Ace SPD and brand knew DA floating cleats - no shims. The ride was 15 miles and I tried two fore - aft cleat positions for the right foot to try to get a feeling of balance power. It took a pronounced difference between right and left cleat fore-aft position to get a reasonable sense of balanced effort. With the right heel was well outboard, I guess the ball of the foot is effectively moved aft relative to the center of the pedal. The ankle was ok which makes me wonder about cleat wear. While it has little to do with comfort, something about this combination was producing noticeable slop in the shoe/cleat to pedal interface within the float range on both sides.

I plan to try on some Specialized carbon soled road shoes (3 hole look only) at the local bike shop this afternoon but even if they feel good (these are the built-in varus wedge types), I'm not yet sure what I would do for pedals (they are not SPD compatible) so I'm not buying anything just yet. Alternative shoes that aren't locally available would be SIDI (carbon sole - good for my feet and worth the money?) or Shimano R215 or the cheaper 151 carbons. Pedals I haven't ruled out include Zeros, SPD SL, Look Keo, and SPD (M540 mountain with new mountain shoes). If any combination stands out as lower risk for my situation please let me know. If it turns out that cleat canting is an improvement (irrespective of internal hip rotation), I'm sure some shoes/pedals work better than others.

On the balance of what you have said, it certainly seems like you need a varus wedge under the right cleat or alternately, a build up along the medial side of the right shoe insole. The Specialized shoes you mention do have a little varus compensation but so do many other shoes who don't ' market' that as a feature. The amount of compensation is unlikely to be enough to solve your problem without extra help.

I have three different pains in my knees depending on how hard I ride. First is a general uncomfortable feeling below and behind my kneecap which has gotten better with ice, ibuprofen, and physical therapy. Second, while I am riding at a "moderate" pace, somewhat difficult, I get a pain running along the back of my knee along the top of my calf muscle. When I ride intensely I get a bad pain on the inside of my right knee where the femur meets my lower leg bones.

It is impossible to answer your question as you have posed it without writing a book about the many possibilities. For the moment, let's keep this simple. You have been sitting too far forward and are in the process of remedying that. Once you have your seat post, go through the archives and read anything to do with the 'balance test' and cleat position. Once you have instituted changes to your position based on what you read in the archives, get back to me with how you get on and whether your knees improve.

I see that you guys get a ton of questions on Achilles injury's but I feel that mine is somewhat unique. I started getting some Achilles pain in late February 2005 while training and "rode through" the pain without making any adjustments until the end of April. I took two weeks off completely followed by a 5 hour easy week and followed your instructions for moving my cleat(Speedplay X/2 pedal, Specialized Pro Carbon Road Shoe) back and compensating by lowering my seatpost and moving my seat forward. I even received some physical therapy, ultrasounds, and electrotherapy from an athletic trainer. From this point, the grinding sound and tenderness to the touch of the achilles region went away, and the pain nearly disappeared. I went from barely being able to walk, to only feeling the discomfort on the bike. I was able to train and race through the slight discomfort the rest of the year, but it never totally disappeared.

I don't want to over-simplify your injury, but have you tried any anti-inflammatories? Ibuprofen or Naproxen. I would try rest and ibuprofen for a week to 10 days. Maybe it'll need 2 weeks. The key with the anti-inflammatories is to take them scheduled, not just when it hurts. For example, I would suggest you take Ibuprofen 600 mg (3 of the 200mg over the counter pills), three times a day for 10 days straight, pain or no pain. The anti-inflammatory properties don't work until about 2 days into the course and are most effective once the drug reaches a "therapeutic window" and stays there. That requires consistent dosing.

I am a 36 yr old Cat 4, Cross B, MTB Expert racer and train regularly. I am a cancer survivor, having taken massive doses of chemotherapy 12 yrs ago, which may not matter for the question at hand. I have been noticing during races that I seen to breathe slower than most of the other racers. Some are panting like dogs and I have a very steady even breath. I was doing LT intervals last night and counted roughly 40 inhalations per minute. Does any of this even matter? I am competitive in my class and am having good results, so I don't think anything is necessarily wrong. Just curious.

The calf and soleus muscle of inner right leg are not well developed at all. The lower leg is so weak that I have trouble lifting myself up onto my toes. Currently, if I do try to lift myself up onto my toes the shin splints symptoms come right back which hampers any strengthening I try to do. I should also mention that my right foot pronates rather badly and I have gotten a custom orthotic to try and counter the problem and have noticed some improvement in muscle tone on the inside of the lower leg. I have also had other trouble with the right lower leg, including Achilles tendonitis, and peroneal problems but they were solved by orthotics and replaced by the shin splint symptoms after I started riding with the orthotic. I'm not sure, but I think that when pedaling I push down with the outside of my foot instead of applying even pressure with the ball of the foot which may have caused asymmetric development.

In the interest of being thorough I should mention that I have had a leg X-ray done recently and no problems were found with the muscles and ligaments of the lower leg and ankle. I also tried Steve Hogg's cleat positioning tips but didn't notice a change at all. The problem also doesn't seem to be affected by bike positioning. Any help or suggestions as to what I can do to rehabilitate the right lower leg would be greatly appreciated.

It sounds likely to me that the orthotic that has solved a lot of your problems walking is possibly overprescribed for cycling; i.e. too much lifting of the inside edge of the foot. A simple way to see if that is the case is to get a piece of A4 paper, fold it in half across the short axis and keep folding a total of 4 times. This will leave you with a 210mm x 20mm x 2.5mm piece or thereabouts. Using packing tape, stick this along the outside edge of the underside of your right orthotic, starting at the heel. Unless you have extraordinarily long feet, this paper should extend to the 5th metatarsal joint or beyond.

I am a 46 male 5'10"- 210 pds( I know too much weight but I am working on it) who rides the road. I have been riding for 14 yrs ,centuries and club rides. These rides are done as strong as possible. I used to have pain all around my knees but after reading this column and following Steve Hogg's advice I have solved these problems. I would consider myself a spinning type of rider no real big gears but I have started to do more short rides with slightly bigger gears . My problem is that 2 days after a strong ride with my son ( you got to watch these young kids) the side of my knees are sore. If you were looking at your knee cap from above it would be the right side near the top of the triangle on the right knee and just the opposite on the left. I have movement with my feet when they are at the bottom of the pedal stoke ( heels move equal distance from side to side) and my knees do not splay out to the side . Is this just my body getting used to the bigger gears or do I have a set up problem?

I am 21 years old and have been cycling for about a year. I competed in triathlons all last season and am going to be racing bicycles in the spring. I have been battling an annoying right knee problem for most of the season. I have seen an orthopedic surgeon and he did not find anything just put me on steroids for a week and told me to take it easy. It helped for a little but it is back again. The problem seems to be mostly aggravated by biking. My knee becomes stiff and a bit achy after biking and I have trouble standing for long periods of time, however, I very rarely have any sort of sharp pain. I have tried ice and IB profin without much success. I do not have any pain when running distances up to 18 miles but it seems to bother me on the bike which seems a bit odd to me. I occasionally have a stiff lower left part of my back and when I stand in the mirror my right hip is higher then my left. I had a friend also look at me while riding to see if I sit straight on the saddle and he said I did; if anything just slightly to the left. The condition gets worse when I push big gears so I have been trying to keep my cadence at 90+ or so. I would really like to fix this during the off season if it is a bike fit problem. Any suggestions would be appreciated.

I have been playing with my cleat alignment and setup a little bit and have notice that my right foot wants to point outward and my left is foot ahead or a little inward during the pedal stroke. Also, at the bottom of the stroke when going up my right knee rotates inwardly whereas my right knee track straight throughout the pedal stroke. I have a feeling this could be my issue however I am not sure what is causing this imbalance in pedal stroke. Thanks.

Find a good physio and start working on your structural fitness, which from what you are describing lags a long way behind your 'physical fitness'. From what you have said, there is a discrepancy, measurable or functional, in leg length. You haven't given me enough to attempt to be definitive. See the physio, have yourself structurally assessed in a whole of body sense and get back to me with what you find.