| 
 Form & Fitness Q & AGot 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. 
  Fitness questions and answers for July 12, 2004 
    | The Cyclingnews form & fitness panelCarrie 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. 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. 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. |  CollarboneDrinking during 30-60 minute hard efforts
 Female bike posture
 Getting back into the game
 Knee pain at the end of long, hilly races
 Neck pain
 Overuse of medial quadriceps
 Saddle position
 Shorter arm
 Collarbone #1I'm a 29 year old male recreational road rider. I used to do 200 to 250km per 
  week, but in early April of this year I was hit by a car and suffered bad facial 
  lacerations, concussion and a broken clavicle. Everything's healing nicely apart 
  from the collarbone. I haven't ridden since the accident and have lost a lot 
  of fitness. I bought a trainer, but can't motivate myself to use it. Getting 
  back on the bike will be a big step, and I wondered if you could tell me if 
  it will do anymore damage to my slow healing bone. The last x-ray showed no 
  sign of healing and a bone graft is a possibility. If no damage is likely, I'd 
  like to get over the mental hurdle. Any tips? Ray Bergin Western Australia
 Dave Fleckenstein replies: 
  Clavicle fractures are undoubtedly one of the most common cycling injuries 
    and, until fairly recently, were generally left to mend on their own. This 
    resulted in 4-6 weeks of significantly altered training, loss of fitness, 
    etc. However, more and more frequently I am seeing surgical correction (via 
    screws) with excellent results. I have had 4 clients this year have surgery 
    on their clavicle fractures and they have all been back on their bike within 
    3 days and were racing within about 3 weeks. Two of these clients had waited 
    6 weeks and had encountered a scenario similar to yours. The other two had 
    surgery within three days of their accident. All are doing very well and having 
    minimal problems. They all reported general local irritation from the screw 
    - we're a skinny bunch without much muscle covering that area - and two have 
    already had the screw removed. The risks of the surgery include the standard 
    infection concerns (as with any surgery) and the concern of a crash damaging 
    the area before adequate bone callous formation has occurred. I would note 
    that, 6 weeks after one of my clients had their surgery, they crashed quite 
    spectacularly and impacted that area with no effects whatsoever. I would also 
    point that different surgeons will have different opinions on this injury, 
    but in general, for a population that quickly needs to return to activity, 
    this is an excellent option. Collarbone #2Why and how do clavicles (collarbones) break in falls, and what could be done 
  to minimize the risk? I suspect that at least two factors are involved: first, 
  at advanced and elite levels cyclists have minimized the "unnecessary" musculature, 
  including pectorals, trapezius, and deltoids, that ordinarily support the clavicles; 
  and second, collarbones break in certain types of falls and not others. As for 
  the first item, would there be a benefit to targeted strength training, and 
  if so, what would the program look like? As for the second, is there a better 
  -- or at least, less bad -- way to fall in a forward crash?  Andrew Reyniak Scott Saifer replies: 
  I don't know that your question has been researched in detail, so I'll just 
    be sharing humble opinion here. I've queried about a dozen clients and friends 
    about how they broke collar-bones as well as reading the opinions of other 
    coaches. There seem to be at least two common modes of collar-bone breakage. 
    The one you hear about all the time is landing to the side on a straight, 
    outstretched arm. The second, which is the one that got most of my interviewees 
    is actually landing with a "whump" sideways on the shoulder itself. It seems that any impact that asks the distance from the shoulder to the 
    mid-line to suddenly decrease can break a collarbone. The classic recommendation for avoiding a break is to convert every crash 
    into a shoulder-roll. I've crashed enough without breaking a collar bone to 
    be pretty sure that one other method works as well. My own solution was always 
    to do what my gymnastics teacher called a "Swedish Fall", that is to land 
    on bent arms as if coming down from a push-up. On pavement this usually results 
    in road rash on the forearms near the inside of the elbows. I suppose rolling 
    would be better, but I never figured out how to get from sliding-out to rolling. Two of my riding buddies are a martial arts instructor and a judo-champion. 
    I've seen one and heard of the other crashing over the bars by straddling 
    the handle-bars on the way off the bike and landing running. This is by far 
    the best solution I've seen or heard of, but might take some years of study 
    to develop the necessary reactions. I don't have a good answer to the question of whether muscle development 
    would help, but strongly suspect that how you land will turn out to be much 
    more important than what muscle you are carrying. After all, don't built-up, 
    muscular track sprinters break collar bones too? Drinking during 30-60 minute hard effortsHow important is it to drink water or a sports drink during intense 30-60 minute 
  efforts. During long hard climbs and 40k time trials I usually don't drink. 
  Can I get dehydrated enough for my performance to suffer during that time period? 
  What about the effect of not consuming calories? Matt Morenzon Scott Saifer replies: 
  The short answer is yes, you can dehydrate enough in a one hour time trial 
    to lose significant amounts of time. The one study I was able to find on this 
    question simulated a time-trial for one hour on rollers, and found that riders 
    went the equivalent of two minutes faster if they drank one pint (500 ml) 
    of water than if they went without. The conditions of the test were not extremely 
    warm. If you have readily digestible, high-carbohydrate food in your gut at the 
    start of a one hour event, you'll probably still be absorbing it at the end 
    of the hour, so eating during the hour is less important. Depending on what 
    you've eaten, a dose of some high glycemic index food during the exercise 
    may help to maintain blood sugar. In longer events, eating definitely becomes 
    important. Dario Fredrick replies: 
  It is more important during a 60 min effort than a 30 min effort. Research 
    suggests that carbohydrate and electrolyte feeding improves 40 km but not 
    20 km time trial (TT) performance. This is one reason why exercise scientists 
    have begun to replace the 40 km TT with a 20km as a standard for validating 
    performance tests.  As far as dehydration risk goes, it depends on your hydration level going 
    into the event, ambient temperature, and how well your equipment allows the 
    cooling effects of air passage over your body (e.g. some aero helmets are 
    poorly ventilated). In short, if it's hot, drink. Even if dehydration were 
    not a concern, your performance in a TT of more than 30 min can be improved 
    by drinking a light carbohydrate and electrolyte solution (for dilution recommendations 
    see Dr. Hinton's recent 
    response to hydration/sodium question). Female bike postureI've been riding recreationally since I was a kid, on a range of mountain and 
  road bikes. Until my mid 20s I could ride on anything, with no discomfort, but 
  over the last 4 - 5 years or so I've found riding increasingly uncomfortable. 
  Last winter I bought a fab Bianchi road bike, which felt fine during test rides 
  before I bought it, but now I have it home, it's excruciating - I can't manage 
  longer than an hour on it. The pain is more undercarriage than glutes. So far, 
  I have tried - changing the saddle, to a Terry-style variety with a cutout section; 
  changing the saddle height, angle and distance from the bars; changing the handlebar 
  height; and wearing heavier-padded shorts. All have made slight improvements, 
  but I'm light years away from the degree of comfort I used to have. Some vital statistics, if they are relevant - I'm 29, about 5'2", 55 kg, never 
  had a child, no injuries. I'd be really grateful if you can suggest anything else! LouiseUK
 Scott Saifer replies: 
  There are many, many factors that all have to be just right to avoid the 
    pain you are experiencing. Here's a short list:  Padded shorts with no seam or wrinkle in the sensitive area No underwear with bike shorts Chamois lubricant (they come in creamy and sticky varieties, try both) Saddle shape as it affects contact pressure: Your weight should be supported 
    by your ischial tuberosities (The "sit bones"), and not on your pubic bone. 
    One of the key dimensions of a saddle is the width of the flat part in back. 
    If it's too narrow, it goes up between the sit bones until you get pressure 
    on the pubic bone, which sounds like what you might be experiencing. A narrow 
    saddle can also push outwards on the sit bones, causing soreness there as 
    well. Saddle tilt as it affects contact pressure: Don't be afraid to tilt the nose 
    of the saddle dramatically downward. If it starts to throw you forward onto 
    the bars, you've gone too far. If you can't get the pressure off the front 
    of the saddle in this way, you do need a different saddle. Saddle height: Adjusted by an expert so that you can pedal smoothly and not 
    grind away at your "undercarriage". Some women report that they can't have a comfortable bike ride for several 
    hours after sex. I hope one or more of these helps. Also, a question to help with the detective 
    work. Can you still remain comfortable on the old bikes on which you used 
    to enjoy riding more? Has anything else changed in the last few years? Steve Hogg replies: 
  Firstly the bad news. This is an all too common experience for small women. 
    Given your size, I will just about guarantee that the seat tube angle on your 
    bike is too steep for you. This is because manufacturers make a lot of compromises 
    in small frames so that they can fit 700c wheels in. In short if you look 
    at your catalogue on the frame geometry page you will almost certainly find 
    that the fork offset in your small frame is the same as that used in larger 
    frames. This allows manufacturers to save a few bucks. It means, though, that 
    the frame has to be designed around that fixed fork offset and still allow 
    reasonable foot/front wheel clearance. With a 700c wheel and the reduced top 
    tube length of a small frame, the easiest way to fit it all in is to steepen 
    the seat tube angle. This allows greater foot/front wheel clearance for a 
    given top tube length, but the corollary of this all to common approach is 
    that small people on small frames are forced to sit proportionally further 
    forward than larger people on larger frames. This in turn means that afflicted 
    people are forced to sit on their perineum and genitals. The weight transfer 
    forward of this approach often also means sore hands and stiff neck and shoulders. 
    There is no justification for this other than reducing production costs and 
    all major manufacturers do it. What can you do about it? Purchase an FSA SL 220 seatpost. They have 22mm more rearward offset of the 
    seat clamp than a standard seat post such as a Shimano or Campag. This will 
    allow you to get your weight back a lot further, hopefully far enough. While 
    everyone is different when it comes to saddles, I've found the seat that's 
    most of my female customers like best is the Selle Italia Ladies Trans Am. 
    It is a moderately wide seat. In all but a few cases, small women have sit 
    bone separation greater than that of men because this part of the pelvis forms 
    part of the birth canal. If you are one of the minority that finds this seat 
    too wide i.e. the back of the thigh hitting the wide part of the rear of the 
    seat, then the Selle San Marco Arami Gelaround is a similar but narrower seat. 
   Once you have the post and the seat, get on an indoor trainer with the bike 
    level and set the seat up in such a way so that you can feel that the great 
    majority of your weight is borne on your sit bones. You will almost certainly 
    have to adjust stem length and height as well. Forget the plumb bob dropping 
    from the knee approach and sit far enough back so that you can take your hands 
    off the drops while still pedalling without dropping uncontrollably forward 
    over the bars. You should teeter on the point of balance. If not you are too 
    far back.  Don't be tempted to tilt the seat down at the nose. If anything it will 
    probably need to be up a degree or so at the nose. Above all, if you can, find someone competent to position you. You don't 
    want anyone who takes a measurement based approach but rather someone who 
    takes a capability based approach. Getting back into the gameI am 35, weigh 220 pounds at 5'10". I raced as a junior pretty aggressively 
  and was always in the top 3 locally and placed competitively in larger events 
  like Superweek. It's been a very long time since riding and I want to get back 
  to it. I used to a good climber at 150 lbs but now I've obviously got a weight 
  barrier and want to know some general guidelines regarding revamping my diet 
  and how to train myself back into riding shape as well as lose the weight in 
  a sensible manner. My goal is to be riding at 175-180 lbs, I am much more powerful 
  now and wonder if the old climbing abilities are now lost and replaced by being 
  a better sprinter/power rider.  Another goal is to be back to racing in 2005 so I've got the summer and early 
  season next year to get ready to race. How should I train myself for the remainder 
  of the year and into next so I've got a solid base and am back to modest racing 
  form? I have 8-12 hours available to train per week in the Boston area. Good 
  variety of hills and flats. I have no baseline HR or past training info to work 
  from and I want to make the most of my training time since I'm fairly limited 
  on time. Any advice and guidelines would be really helpful.  Ehren Roder Brett Aitken replies: 
  If you go by Nike's motto then all it takes is 3 words - 'Just Do It'. I 
    can relate to the feeling of putting on a bit of weight when you stop riding. 
    Having been off for close to 4 months it packs on pretty quick. The easiest 
    way to change this though is to simply start riding. Since you've packed on 
    close to 70 lbs since your racing days it's not going to take much movement 
    for you to tip the calorie scales back in the favor of losing weight.  I wouldn't be so concerned about nutrition at this stage. Take it one step 
    at a time and you'll be surprised what happens once you start exercising again. 
    If you've got 8 to 12 hours to train then simply start by riding this all 
    in a low to moderate heartrate zone (65% max hr). This will help your body 
    coach itself back into optimizing fat burning stores. It also helps you prevent 
    doing anything you're not ready for yet also and subsequently resulting in 
    injury or illness. Begin by building this base, monitoring your weight loss as the main priority 
    and develop a nutrition plan only after you've settled back into a regular 
    training routine (maybe one month down the track). After about 8 to 12 weeks 
    you could then begin to concentrate more on building specific training in 
    (namely intervals) which in turn will help you raise your metabolic rate as 
    well as your fitness and stop any plateauing of your weight loss. When you 
    reach this stage you need to start rigorously monitoring and measuring your 
    progress and redirect your focus/goals towards competing at a certain level. As far as being a better sprinter this is highly unlikely although power 
    may have improved. What's happened is that the extra weight/fat gain has most 
    likely resulted in extra muscle mass to support this extra load. While this 
    maybe good when you are already rolling or going down hills you have to keep 
    in mind that cycling 99% of the time is all about power to weight ratio, not 
    necessarily power! Good luck, maybe we can share some weight loss meal plans! Knee pain at the end of long, hilly racesI'm a 32 year old male who races Category 4. I raced half a season last year 
  on virtually no base due to recovering from ITBS in my left knee from the previous 
  year. I started my base training this year in early January and with the exception 
  of tendonitis in my right knee for a few weeks in Feb/March, I've been training 
  and racing throughout the season. I average 130-200 miles a week (with the occasional 
  250 mile week) including one race a week (Crit or RR). In addition to the specific 
  knee injuries (ITBS and tendonitis), I experience periodic aches and pains in 
  my knees but none persist for long with the exception of one.  I find that just about anytime I ride a long (60+ miles) and/or hilly race 
  (or equivalent training ride) both of my knees experience sharp pain by the 
  end of the ride. An illustration of when my knees become painful occurred two 
  weeks ago during a stage race. The first and fourth stages had several long 
  (2-8 mile) climbs and finished with long climbs of 5 & 8 miles after 70 and 
  90 miles of racing, respectively. My knees were very painful on the last climb 
  of each stage. I would describe the pain as sharp. The pain comes from numerous 
  places around the knee but primarily across the top (inside and outside) and 
  below the knee cap. I have experienced this pain for several years under similar 
  conditions. The pain seems to be alleviated by decreasing the pedal force, i.e., 
  spinning or riding on flat terrain. The pain seems to be starting later in a 
  ride as my condition and strength have improved. I can ride 30-40 miles with 
  no problem regardless of the intensity of the ride. I have been professionally 
  fitted to my bike and my cleats. I have orthotics in my Sidi G4 shoes. I recently 
  switched to Speedplay Zero pedals from Look PP396 pedals, with no apparent improvement. 
  I run a standard 12-25 cassette and 39X53 crank. I ice my knees after these 
  events and try to stretch regularly (but often fail), particularly before long 
  rides. I do not consider myself a gear masher. One of my few cycling strengths 
  is climbing and I would like to improve my climbing, overall endurance and power 
  but fear that my knees are not up to the task. I would appreciate any feedback 
  on this nefarious pain and suggestions to alleviate it.  Philip BentleyPortland, Oregon
 Steve Hogg replies: 
  Firstly you need to make sure that there is no intrinsic problem with your 
    knees. A visit to a good sports doc or physio should sort out whether that 
    is the case. If there is no pre existing problem you need to understand that 
    knees only like to work in a single plane. They don't tolerate lateral or 
    rotational loads well at all.  Knee pain on a bike, assuming that you are well positioned, has only 2 basic 
    causes. The first is problems with the foot/ankle complex and the other is 
    problems with hip and or lower back function. In many cases knee pain can 
    be caused by a combination of both of these. If your foot/ankle is the problem, 
    then sorting it out is easy. If the hip/lower back is the problem or a major 
    part of the problem, then the only 100% solution is to resolve the hip/lower 
    back problem. Now let's assume for the sake of argument that none of the above applies 
    and that you are not well positioned even though you have been professionally 
    set up. I cast no aspersions here, I am only trying to tick all the boxes 
    in an effort to help. If this is the case, the factors that could lead to 
    the type of problem that you experience are:  1. Seat too low2. Seat too far forward
 3. Cleats too far forward on the shoe
 4. Any combination of the above
 Don't assume because you may have been set up to some set of norms that this 
    is necessarily correct. Get a second opinion from some one with a track record 
    of solving your kind of problem. Neck painFor the last six months I have been troubled with neck pain when I ride. I 
  am a recreational rider to work and back as well as on weekends. Initially I 
  had neck pain off the bike that was worsened by riding. After seeing a physio 
  and chiropractor, the neck pain is no longer present at rest. I am still experiencing lower cervical neck/upper thoracic pain on the left 
  hand side as soon as I start to ride. I have recently purchased a new bike - Specialized sequoia, to see if that 
  would help, but I still experience neck pain on riding (after being fitted out 
  on the bike after purchasing). Could you give me suggestions about common causes of neck pain in cyclists 
  and possible solutions to my problems? Phillip Good Steve Hogg replies: 
  What happened 6 months ago that started this pain? Were you riding prior 
    to that? Did you have a fall or some other problem that could account for 
    this? Neck pain has a number of causes on a bike. If the bars are too low and/or 
    too far away, the extension of the neck and/or the upper thoracic spine required 
    to reach the bars and/or brake hoods will cause neck pain. If the seat is 
    too far forward, the body's weight transfers forward with it and this weight 
    has to be borne by the shoulder complex and surrounding areas. Can you ride 
    on the drops and then take the hands away without collapsing forward onto 
    the bars? If not, then you may have your seat too far forward.  You say you only get pain at the moment on the left side. I would just about 
    bet that you have a functional asymmetry any where from the hips upwards that 
    is the cause here. Your best bet is to get the best person that you can find 
    to position you on your bike. From your email it seems that it is now only 
    the bike that is the problem. It follows that you are not set up correctly 
    with regard to your condition. Find someone with experience in these matters 
    and see them, even if you have to travel. In the mean time if you want to take a self help approach, get your bars 
    up higher, raise the left brake lever higher than the right and pad up the 
    left handlebar substantially more than the right. That should make a noticeable 
    difference in comfort till you can achieve a proper resolution. Overuse of medial quadricepsWhen cycling, my medial quadriceps appear to be doing the bulk of the work, 
  and become tired more quickly and indeed lactate more quickly than the other 
  muscles in the leg. I feel that this is detrimental to my overall cycling performance. 
  What would be the most likely cause?  I'm 22, have been cycling for 4 years, and consider that my cycling muscles 
  are fairly well developed. I'm not trying to win the tour, but would like to 
  maximise performance.  The discomfort I'm feeling is immediately above, and on the inside of the knee. Brendan HarrisAustralia
 Steve Hogg replies: 
  The area you refer to is the vastus medialis obliquis or VMO. In all the 
    other quads, the muscle fibres run longitudinally. With the VMO the muscle 
    fibres of the head of the muscle run laterally and as well as being an extensor 
    of the knee like the other quads, it can act as a lateral stabiliser of the 
    knee. The question is why is it hurting under load? The likely reason is that 
    you are rolling the knee inwards on the downstroke under load. This can be 
    for a number of reasons. 1. Poor cleat position: check that you have a range of lateral motion either 
    side of where your foot naturally wants to sit under a reasonable pedalling 
    load. 2. Varus forefeet: 90% of the population fit into this category to a greater 
    of lesser degree. This means that the forefoot rolls in towards the first 
    metatarsal joint [ ball of the foot] relative to the heel. The solution here 
    is to evert [ lift the arch side] the appropriate amount. 3. Cleat to far forward on shoe: If this is the case, the weakest link in 
    the chain, which in your case may be your knee, will load up. 4. Hip imbalance: this is a common one. If you sit on the bike with one hip 
    forward of the other, what can happen is that the anterior [forward] hip rolls 
    in and down on the downstroke and the other leg has to move laterally to accommodate 
    this movement. Does one leg feel that it has more power than the other? 5. Seat too high: if the seat is a little too high, you will do whatever 
    you have to do to reach the bottom of the stroke with power. Often this means 
    a loss of good control, which can mean lateral movement at the knee. You mention that you have been cycling for 4 years. Has this pain been with 
    you the entire time or has it come on recently? If it is recent, what changed 
    at that time? Was there a change in training intensity or a change in equipment? One thing I would also suggest is find the best person you can to position 
    you on your bike. Ideally someone with plenty of experience with knee issues. 
    Once you have found a solution, I would be interested to hear what the problem 
    was.  Saddle positionI'm 33 years old and have been riding for 5 years now. My problem is that whenever 
  I ride long distances, 100 km, there is pain in the inner side of my left sitbones 
  going straight along my inner thigh (feels like a groin pull) up to the lower 
  inner side of my left knee. When I feel my left and right sitbones it feels 
  like my right sitbones are a little thicker than my left Also, how do you align the cleats on Shimano SPD-SL pedals as I have them newly 
  installed and they don't quite feel the same. I can't quite install them in 
  a way that satisfies my knees. Should my toes be pointing in or out, how about 
  the thighs should they be pointing out or straight or what? John Poon Steve Hogg replies: 
  It sounds to me that you are not sitting square on the seat. Whether because 
    of measurable or functional asymmetries or a combination of both you would 
    have to establish. I would arrange to have my position looked at by someone 
    who knows what they are about and has extensive experience in dealing with 
    issues such as yours. Re the SPD-SL cleats; firstly the fore and aft position should be adjusted. 
    With your cycling shoe on, mark the centre of the first metatarsal joint [ 
    centre of the ball of the foot ] on the shoe with a marker pen or similar. 
    Bear in mind that this may vary from one foot to the other because on differences 
    in foot size and proportion. This mark on the shoe should be slightly in front 
    of the pedal axle as viewed from above with crankarm forward and horizontal 
    and shoe horizontal. Once this is done the angular adjustment needs to be addressed. Ride along 
    and then stop pedalling and coast with the right foot forward. Turn the heel 
    outward. Is there available movement? If not, stop and adjust the angle of 
    the cleat so as to allow the heel to sit further out from the crank. Repeat 
    this till there is some freeplay outboard of where your foot naturally wants 
    to sit. If you find however that there is freeplay as you twist the heel outwards 
    while coasting, then repeat the pedal and coast procedure but twist your heel 
    inwards. Again, is there play? If yes then you are fine, if not, stop and 
    adjust the angle till there is. Essentially, where your foot naturally wants 
    to sit should be in the middle of the available range of movement. Repeat all of the above on the left shoe. It is now a good idea to recheck 
    the fore and aft adjustment. SPD-SL's don't have a lot of freeplay so it may 
    take a few attempts to get it right. Once this has been done then the issue 
    of inverting or everting the foot on pedal arises. At this stage I would not 
    worry unless you find that once the cleats are correctly adjusted that you 
    have problems with knee pain or localised foot numbness. Shorter armI used to be a Cat I cyclist in the US and never had any problems. I took a 
  few years off the bike and am just starting to get back into cycling shape. 
  I have gradually built back up to being able to put in four or more hours on 
  the bike but I have two issues that have suddenly become prominent each time 
  I ride. My left arm is more than one inch shorter than my right arm due to a 
  substantial fall that shattered the upper humerus as well as my shoulder. During 
  my racing times it never bothered me very much at all. Suddenly it has become 
  very painful after about two hours of training. Perhaps related to this, my 
  lower back on the right side only also hurts after two or more hours of riding 
  as well. I never feel "right" on the bike. Is the length of my arms affecting 
  my lower back or are these possibly unrelated? I would also like to know what 
  might be suggested to help offset the arm length issue. Donald MillerWashington DC
 Scott Saifer replies: 
  An inch difference in arm length could certainly cause you to sit twisted 
    on the bike and lead to lower back pain. My first thought would be to twist 
    the stem on the steerer to bring the left bar closer to your shoulder. Your 
    bike will look odd, but it may be much more comfortable. You may need to change 
    stem length, add padding under the bar tape or move the left brake lever up 
    on the bars to complete the fit. You didn't say what part of your arm ends up hurting or whether you have 
    regained full mobility at the elbow and shoulder. That information would help 
    if you needed a second thought to follow up on the first. Steve Hogg replies: 
  I have seen a number of people over the years with similar problems as that 
    which you have described and back pain was always part of the scenario due 
    to overreaching on the affected side. This can often cause an affected rider 
    to twist in the lower torso so that sometimes the other side of the back is 
    more troublesome. There are a million and one other reasons that cause you 
    back pain so see the best person you can find to position you. The mechanical 
    solution to your over reaching is as follows. Find an electrical shop and 
    buy some electrical conduit, which is the white hard plastic tubing that electrical 
    wiring runs through. About 40mm diameter should do the trick in your case. 
    Standing a length on end, cut it with a hacksaw vertically so that you are 
    reducing its width by 1/3. Undo your bartape on the left side and using a 
    hair dryer or heat gun fit the conduit to the handlebar with the open side 
    [ cut side] against the bar. The heat gun will soften the conduit so it can 
    follow the curves of your bar. You will need one piece for the drop and another 
    for the top of the bar. You will need to build up or lift the brake lever 
    on the left as well.  Use electrical tape to secure the conduit to the bar and then buy some heat 
    shrink plastic from a hardware store and further secure the conduit with this. 
    Using the heat gun again, shrink the plastic wrap over the conduit and handlebar. 
    Once done, retape the bar and you are in business. Above all, don't worry about the appearance of the bike, only how you perform 
    on it.  Dario Fredrick replies: 
  I recommend simply making your shorter arm longer. You can use a thicker 
    glove on your left hand (perhaps a thick padded gel glove) or even sew foam 
    padding into a glove. It is certainly possible, and assuming all other areas 
    of your position are balanced, quite likely that your arm length discrepancy 
    is a direct culprit of your lower back pain. I suggest practicing a specific 
    yoga pose off the bike to help realign your spine and reduce the muscular 
    tension in the low back that may be compensating for your arm imbalance on 
    the bike.  The pose, called "revolved reclining big toe pose," is a simple lying down 
    twist that requires a soft belt or a similar prop (an old necktie also works 
    well). To practice the pose, lie on your back and keeping your left leg extended 
    straight on the floor, place the belt around your right foot and holding the 
    belt with your right hand, extend the right leg up as high as possible without 
    bending your knee. Avoid straining the back of the leg, only bringing the 
    leg as high as you can hold it without struggling.  Holding the belt then with the opposite (left) hand, exhale bringing the 
    right leg across your body to the left and down to the floor. If necessary, 
    you can release the belt a bit if you find it difficult to bring the right 
    foot down to the floor.  Hold the belt with your left hand as close to the right foot as possible 
    with the left arm extended. Extend through the heels of both feet keeping 
    the legs straight. Without lifting the right foot, extend the right arm out 
    from the right shoulder, releasing the right shoulder and arm to (or toward) 
    the floor.  Extend through both arms and both legs. Keep your head in a neutral position 
    (facing up) and breathe, holding the pose between 30 sec and 2 min (longer 
    as you gain experience practicing the pose). Inhale as you take the leg back 
    up then repeat with the left leg. Attached is an image of the pose. Feel free 
    to contact me if you have questions. Other Cyclingnews Form & Fitness articles |