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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

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.

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.

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?