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Form & Fitness Q & A
Got a question about fitness, training, recovery from injury or a related subject?
Drop us a line at firstname.lastname@example.org.
Please include as much information about yourself as possible, including your
age, sex, and type of racing or riding.
Fitness questions and answers for November 1, 2004
The Cyclingnews form & fitness panel
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.
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
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
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
a resource for cyclists, multisport athletes & endurance coaches around
the globe, specializing in helping cycling and multisport athletes find
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.
Winter track training
Choosing a coach
Alcohol and fitness
More bike fit
Phosphoric acid and nutrient removal
Flat feet redux
Knee problem redux
I'm a 29 year old Cat 3 cyclist who has been road racing for about 3 years.
Although I have seen tremendous improvement in these 3 years in general fitness,
I still have a lot to accomplish on the racing circuit. This year, I participated
in about 25 races, both crits and road races in that featured rolling terrain
and moderate to steep climbs. I finished all races entered in the top 20 with
the exception of 2 that I crashed in and 2 where I just missed the top 20. I
had quite a few 10th-15th places and a few top 10s but nothing ever better than
a 5th. This showed growth from 2003 where I DNF'd quite a bit.
In the beginning of the season I felt that my lack of results was due to a
lack of experience and positioning because I felt that I held better fitness
than the rest of the field. However, as the season progressed, the racing seemed
to get much tougher and I was having some difficulty getting at the front in
If you were an announcer in a booth and were to sum up my racing for 2004 it
would be "A strong all arounder who looks comfortable the entire race, riding
where he feels comfortable, getting into non-winning breaks, but not able to
seal the deal at the last kilo."
After looking back on my races, I feel that I should focus on two things.
1. Be able to key in on winning breakaway moves and be able to stick with them.
Focus on training muscular endurance and TT power.
2. Focus on the closing 2 to 5 minute power that is needed at the end of the
race. (I've got a pretty decent sprint when I'm rested, but after racing for
an hour or longer, I've burned some of those matches.)
What, specifically should I be doing when I start building up these systems
in my build phase of my training regimen in order to increase my chances of
doing better in 2005? I have plenty of time, a power meter, and a passion to
Ric Stern replies:
Firstly congratulations on the huge improvements you've made from being a
DNF to a contender. That's no small feat within one season, and you should
feel happy that you've done well, so far.
The first question that needs to be asked is: why aren't you getting into
the race-winning break? If you tend to race in one particular locale all season,
it may frequently be the same faces who are always in the winning break. Take
note of them, and when the race comes to crunch time make sure you're either
on their wheel or nearby so that you can go with any race winning potential
move. Of course, you also need to keep an eye out for other likely candidates
who you don't know and who may make what appears to be a race winning move.
As you've not been racing that long, if you're in a team ask around to see
who the usual winners are so that you can mark them. Also, if you're in a
team make sure you all work together for a team victory, rather than chasing
team mates down.
As regards the training aspect, to excel you need a high lactate threshold,
a high MAP, good anaerobic work capacity, and possibly good peak (sprint)
To increase your LT and TT power (which are different, but highly correlated)
you need to train at intensities which stimulate these metrics, this would
include, quality endurance training at zones 2 and 3, and TT type intervals
at zone 4. The frequency and volume of these sessions and intervals will depend
on many factors, including your fitness, goals, time of year, time available,
etc. However, the zone 4 intervals should be of 15 to 30-mins duration, with
one to four intervals, repeated once or twice a week. The core of your training
should be zone 2 and 3.
Intervals at zone 5 and 6 will help increase your MAP (which is also correlated
with your LT and TTpower) and VO2max. These maybe done a little less frequently
in the off-season, but you should generally do some (during this period) to
prevent a significant decline in fitness. This type of training can be seen
and would also include doing some efforts uphill as well (over climbs of say
2 to 8 minutes).
Even less frequently in the off-season you may also do some tough zone 7
intervals of ~ 30-secs duration. In general i would probably just do an odd
one or two at this time of year.
All of these workloads will help with the various aspects of where you can
The prescribed zones can be seen here: www.cyclingnews.com/fitness/?id=powerstern.
I'd also suggest that a coach such as ourselves at RST (www.cyclecoach.com)
or one of the others at www.cyclingnews.com will be able to help you and really
get the best out of yourself. Having an objective 3rd party can help see the
big picture and make sure you don't end up doing the wrong training.
Winter track training
I've got access to a Tuesday night training session on an indoor velodrome
this winter and wouldn't mind incorporating this into my winter program with
turbo, weights etc. Not having done this type of work out before I'm not sure
how to fit this into my regime. Should I leave it till after base/weights or
crack on now and use it all winter?
Ric Stern replies:
In part this may depend on many factors such as your current fitness level,
how intense the sessions are going to be (are they likely to turn into races?),
your goals for next season, and may also depend on your track craft (e.g.,
you maybe able to ride a wheel very well, and thus you may be taking it quite
For example, if your current fitness level is somewhat below the other riders
at the track, and the sessions are going to be intense, then this may
be too much for you. On the other hand, if you're quite time limited with
training or want to maintain your fitness over the winter -- so that you don't
find yourself at the beginning of next season desperately trying to regain
some race fitness then this may be just the ticket for you (and others).
If you've had a hard racing season, you may however, want to ease down and
take things a little easier for a period of time, and thus the track may not
be a great idea right now.
Additionally, assuming that you race in endurance events (i.e., races > about
90-secs) there's no evidence that weight training will help you. However,
if you did decide to do weights which maybe primarily for other reasons (e.g.,
to increase strength to help with other activities) then having lots of moderately
or high intense work maybe too much for the winter season and could possibly
leave you overly fatigued for the summer race season.
In summary, for many people I see no reason why you shouldn't do some moderate
or high intensity work regularly over the winter months. Many riders do this
with no adverse effects, for example, many roadies compete at track or cyclocross
over the winter and road in the summer. It certainly maybe more interesting
than thrashing yourself on the turbo trainer on mid-week days after work (etc).
Be aware however, that you may need to schedule in some adequate recovery
periods between the different race seasons, which maybe one to several weeks
duration where the riding is fairly easy.
Choosing a coach
I'm a 47 year old female cat.3 road racer. I do well on climbs and can hold
my own in sprints.
In 2002 I used a coach that had a large variety of training regimens. I had
a very good season under her and secured many top three results and better!
In 2003 I used a different coach since the first coach I used left coaching.
I found the work-outs to be good but not much variety and kind of dull. I still
had a very good season but felt something was lacking in my training. My question
is, how do you interview a coach? How do you know what type of work-outs they
will give you? Can you tell them what you want or are they there to tell you
what you want!
Also, can I just use the print-outs from my previous coaching and not get a
coach at all? My goals really are about the same, to race, do well and have
Scott Saifer replies:
If all you are getting from your coach is the training plan, you can just
reuse the old training plan, but I would suggest getting a different coach.
A good coach does much more than provide training plans. He or she should
be talking with you regularly to help you understand when deviating from the
plan will be more valuable than following it, helping you to decide when to
take time off for illness and when to return to training, helping you see
a larger picture so that working together you can identify weaknesses that
you would not otherwise have noticed or identified correctly, talking to you
about equipment choices, tactics and the dozens (hundreds?) of other things
that can make the difference between a bad race and a good one, or a good
one and a great one and reviewing your training and racing with you so that
you can tweak your program to make the best use of your time.
Since you had a good season, you'd probably have a similarly good season
if you repeated the old plan, but you might have a stellar season if you worked
with someone who could help you improve on the old program from which you
may already have gotten the majority of the benefit.
If there are particular exercises you want to see in a program, you can certainly
ask a potential coach if he or she would include them. The coach should either
include them or tell you why they are not suitable for you. For my own part,
I believe that if athletes are going to succeed as bike racers, they have
to love riding the bike enough for its own sake not to need huge amounts of
variety. I have a library of several hundred exercises that I occasionally
assign, but most of my clients will only see a dozen or so as the rest simply
will not be useful or beneficial for each of them.
I'm an avid cyclist, 41, in good shape, eat a healthy, well balanced diet and
train regularly. I participate in a few local races every season but I always
finish in the middle of the pack. I'd simply like to know if there is any truth
to the performance enhancements that certain "legal" natural supplements claim
to give, like creatine, spirulina, co-enzyme Q10.... Do they really work or
am I simply throwing away my money?
Pam Hinton replies:
It's only human nature to seek an advantage over your competitors and to
take the path of least resistance in doing so. Hence, the $19.4 billion per
year supplement industry.
Because of the way dietary supplements are regulated, at least in the United
States, manufacturers may put essentially any performance-related claim on
the label, even if it is unsubstantiated. The fact that most labels make grandiose
claims, promising results that are too good to be true, should be a red flag
that someone is trying to sell you snake oil. Unlike food and drugs, the Food
and Drug Administration does not monitor supplements for ingredient content
or purity. In other words, the ingredients on the label may or may not be
present and additional compounds not listed on the label may be included.
For example, small amounts of anabolic steroids have been found in supplements
that claim to increase muscle mass. Many supplements that are evaluated by
consumer protection groups are found to contain much less of the active ingredient
than what is listed on the label. Both of these practices are illegal, but
without quality control of the supplement industry, they nonetheless do take
place. So safety of dietary supplements is a concern. Between 1995 and 1999,
there were 2,500 adverse events reported to the U.S. FDA by consumers, healthcare
professionals, and poison control centers. It is estimated that this represents
only one percent of the actual adverse events.
Most of us could finish further up in the pack if we trained more often or
at a higher intensity, lost a few extra pounds of body fat, ate better, or
got more sleep. You say that you participate in "a few local races every season".
Don't let your middle-of-the-pack finishes discourage you from pinning on
a race number and lining up. There is no substitute for experience to work
on positioning in the pack, cornering, getting the right break, timing your
sprint, etc. These are all skills that can be learned and will improve your
placing. If you feel you need to spend some money, a set of racing wheels
or lighter frame would be a better investment. At least you'd have something
to show for your money other than supplement-enriched urine.
Supplements have value when they are taken to correct a nutrient deficiency.
For example, an individual with iron-deficiency anemia will obviously benefit
from an iron supplement. The rest of the time, you are just throwing your
Could you recommend a good book on core strengthening techniques. Also do you
think this is a good addition to cycling training. Is pilates the same thing?
It seems like a good alternative to the weight room, what do you think?
Steve Hogg replies:
No doubt there are other good books out there about this subject, but one
that I recommend is ' Pilates For Dummies' by Ellie Herman. It is available
in most larger bookshops and is well laid out. Everything is explained in
a simple and methodical way.
Pilates or any other core strengthening method is a worthwhile addition to
your training regimen. The better you function off the bike, the better you
will function on the bike. While I am no enemy of weights, most people are
better served by getting their bodies to function well mechanically by core
strengthening before they set about increasing their strength in an external
Alcohol and fitness
What effect does alcohol have on a cyclist's fitness? You always hear that
a glass of wine at the dinner table is good for the heart, but will a few drinks
occasionally harm you fitness? What about getting home and having a beer at
Pam Hinton replies:
The effect of alcohol on a cyclist's fitness is pretty much the same as how
a Highway Patrol trooper looks at it in conjunction with operating a motor
vehicle-it depends on how much alcohol is consumed and when. Having a beer
when you get home is not going to adversely affect your fitness. That's the
short answer to your question. Now just like that trooper I mentioned, we'll
go over just the facts.
When ethanol is metabolized in the liver, it forms acetate and acetaldehyde.
ATP can be made from acetate using the metabolic pathway by which ATP is made
from fat. Acetate (like fat) cannot be used to make glucose, so it cannot
be used to replenish glycogen stores. So, as long as you consume adequate
carbohydrate with your beer, you are still going to replenish your muscle
glycogen. This was shown in a study of well-trained cyclists who exercised
for 2 hours to deplete their glycogen stores and then consumed one of three
test meals to look at the effects of alcohol ingestion on glycogen synthesis
in muscle. The three test meals were: carbohydrate (CHO), providing 7 g CHO
and 24 kcal per kg body weight; alcohol (A), providing 1 g CHO, 1.5 g alcohol
and 24 kcal per kg BW; and carbohydrate + alcohol (CHO+A), providing 7 g CHO,
1.5 g alcohol, and 34 kcal per kg BW). The alcohol, equivalent to ~10 drinks,
was consumed in the first 3 hours after exercise. Muscle biopsies of the quad
were taken 8 and 24 hours after the subjects finished exercising. Although
both groups that consumed alcohol had lower blood glucose levels-at 8 and
24 hours-than the CHO group, muscle glycogen was lower only in the A group.
So moderate amounts of alcohol that are metabolized before you go out for
a training ride or race, are not going to hurt your fitness.
Trying to train with alcohol on board is another matter. The acute effects
of alcohol ingestion on performance tend to be negative and are dose-dependent.
Psychomotor function is impaired and small to moderate doses of alcohol (2-4
ounces of alcohol): slow reaction time; interfere with eye-hand coordination,
accuracy and balance; and make performing gross motor skills more difficult.
Alcohol causes vasodilation of blood vessels and loss of body heat, increasing
the risk of hypothermia when exercising in the cold. Another reason not to
drink and ride is that alcohol lowers blood glucose and decreases glucose
uptake by skeletal muscle, which means you're more likely to bonk.
When, however, you see one of those guys in street clothes riding a bike
with the downturn bars turned straight up and smoking a cigarette, if he is
weaving, he may be bonking, but it probably ain't from too many miles.
More bike fit
I've read with great interest Steve Hogg's ideas on dynamic fitting of bike
to rider, including cleat position, seat fore-aft and seat height adjustments.
I've been fiddling with these three following Steve's rule-of-thumbs and think
I am getting close to an optimal position. However, I am still getting neck
pain on longer rides and during and after long descents (when I've got hands
in the drops), so was wondering if there are any rules-of-thumb for setting
handle bar height and stem length. I already have the bars as heigh as I can
get them, but obviously you can't adjust stem length without buying a new stem.
To avoid having a box full of progressively shorter stems to try out are there
any suggestions for estimating what might be an optimal stem length (or saddle
to handle bar distance).
Melbourne, VIC, Australia
Steve Hogg replies:
Can you beg or borrow a Look Ergostem? They are an adjustable stem with articulating
joints that has massive adjustment potential. With one of those, the bar height
and length can be played with until you feel you have reached an ideal position.
There are no measurement-based methods for resolving your problem that have
any validity as a rider in a dynamic sense, is much more than the sum of their
If you have a good relationship with a local shop, see if you can spend time
on an indoor trainer there while 'test riding' a few stems. Most shops with
any idea of customer service should not have a problem with that.
If that is not the case, you could do a lot worse than ring John Kennedy
for advice on 03 9589 3399. He would have no problem with that at all.
Phosphoric acid and nutrient removal
I am a 46 year old cyclist, riding to keep fit and the occasional audax. I
read in a magazine (which I have now lost) that the phosphoric acid found in
carbonated drinks like Pepsi, Coke etc can remove nutrients from the body. The
article didn't go into a any detail and I wondered whether this was true. Do
you know what nutrients are lost, and how much phosphoric acid does it take.
How much damage would an ordinary can of one of these drinks do ? I am trying
to give up these drinks so any info would be helpful.
Pam Hinton replies:
The main source of phosphoric acid in our diets is soda. Because of the association
between soda consumption and increased risk of bone fractures, the constituents
of soda (caffeine, phosphoric acid, citric acid and fructose) have been scrutinized
for their potential to cause calcium loss from bone. Anyone who has ever soaked
a bone in vinegar would agree that phosphoric acid probably causes a loss
of calcium and a weakening of the bones. However, what we observe in the test
tube is not always what happens in the body, which has the ability to maintain
constant internal conditions, including acidity of the blood. A recent study
compared the effects of caffeine, phosphoric acid, and citric acid (consumed
in soda) on calcium excretion in the urine. Subjects consumed 20 ounces of
either: caffeinated cola (Coke, containing caffeine and phosphoric acid);
non-caffeinated cola (Coke-Free, phosphoric acid only); caffeinated non-cola
(Mt. Dew, caffeine and citric acid); or non-caffeinated, non-cola (Sprite,
citric acid only). Neither phosphoric acid nor citric acid increased calcium
loss. Consumption of the caffeinated sodas caused an increase in calcium excretion,
but the effect was small (6-14mg) compared to the recommended daily calcium
intake (1000 mg).
When the kidney's ability to excrete acid is compromised, as in chronic renal
failure, and the body is exposed to very high acid loads, then appreciable
amounts of calcium may be lost from bone. However, in a healthy individual,
the acid load that results from the phosphoric acid in 20 ounces of soda is
very small (4.5-5.0mEq), which is much less than the acid load produced during
normal metabolism of food (50-100mEq). Consuming seven 12-ounce colas per
day would only produce an acid load of ~20mEq, which is well within the excretory
capacity of the kidney.
So, if colas don't increase calcium loss from bone, how do we explain the
apparent dose-response between soda consumption and fracture risk? The answer,
most likely, is not what's in the soda, but what's missing. Give up these
drinks, replace them with milk, and you'll get the calcium, phosphorous, vitamins
D, A, and K that you need to keep your bones strong.
I am a 37 year old recreational rider. I have been riding for four years. Early
this year I stepped up my training to prepare for and complete the Markleville
Death Ride 130 miles, 16,000 feet of climbing. About a month before the ride
I had a physical and urinalysis done for a life insurance application. I was
denied insurance because I had too much protein in my urine. I went to several
doctors to determine what was going on and had several more UA's done. In September
a nephrologist diagnosed me with "a textbook case of acute tubular necrosis"
(ATN). He says that my kidneys were damaged but will (most likely) recover over
time. In October the amount of protein in my urine has not decreased and the
doc says that is OK since it is not increasing. He has told me to continue my
life/ riding as though nothing is wrong and we will monitor my progress over
the next few months.
My question is two-fold: The doctor told me that the ATN was most likely caused
by a severe dehydration event(s). I have been involved in outdoor sports for
my entire life and know how to stay hydrated and don't think that I was dehydrated
at any point this year. Other than basics of drinking plenty of water and the
occasional sports drink and eating food before, after and while riding to stay
hydrated, is there anything I can or should be doing? For example would any
of the many sports recovery / electrolyte drinks on the market help me to stay
better hydrated than just diligent water consumption? And secondly, is this
diagnosis common among cyclists and if so how long have other riders taken to
get there urine back in to normal ranges.
Coloma, CA USA
Pam Hinton replies:
Acute tubular necrosis (ATN), translated, means "sudden death of kidney cells."
ATN is characterized by a sudden decline in kidney function, which can progress
to kidney failure and death. Specifically, the kidney loses its ability to
excrete waste products, so urea and ammonia accumulate in the blood. The ability
to regulate electrolytes, sodium, acid and water is also severely compromised.
ATN is common among hospitalized patients and patients in intensive care units,
resulting from an infectious, toxic, or ischemic injury to the kidney. In
endurance athletes, ATN most likely results from a pathological condition,
exertional rhabdomyolysis. Rhabdomyolysis is characterized by severe muscle
damage, followed by release of the contents of the muscle cells into the blood
stream. Myoglobin, the oxygen-binding protein in muscle, is one of the cellular
degradation products released into the blood. When myoglobin reaches the kidneys
it contributes to the onset of ATN: it obstructs blood flow in the kidney;
it is metabolized into compounds that are toxic to the kidney; and it contributes
to formation of precipitates in the kidney which block blood flow. Dehydration
also contributes to the development of rhabdomyolysis. Loss of body water
results in decreased blood volume and decreased organ blood flow, which deprives
the kidney of nutrients and oxygen.
Because you may have some residual damage, you are at greater risk for developing
ATN again. Your best bet to prevent another occurrence is to avoid dehydration.
For this reason, you may want to avoid participating in events where the potential
for dehydration is high - extreme heat, dry climates, unsupported events,
etc. But as you physician has advised, you must live your life and do the
things you love to do as far as that is reasonable to do. As you note, staying
adequately hydrated is key. I have a friend who sets his wristwatch alarm
to remind him to drink at regular intervals. You'll need to develop some habits
like that. In general, commercial sports beverages that contain sodium are
superior to plain water because they speed fluid absorption and increase voluntary
The prevalence of ATN in cyclists is unknown, but is relatively rare. In
the United States there are 26,000 cases of rhambdomyolysis reported per year
and only a fraction of these will develop ATN.
Flat feet redux
Thanks for the great advice,
I've been looking at my position in regards to your suggestions and am going
to move my cleats back and see how that works. My leg length discrepancy is
measurable. I was x-rayed and measured by a physical therapist, I don't remember
the exact measurement but my right femur is shorter than my left on. Not a whole
lot, but measurable. Do you have any recommendations on compensating for this
in positioning? I've been looking into the LeWedge system, which claims to be
able to help with this type of issue. Thanks again for your help.
Steve Hogg replies:
There are rules of thumb for accommodating femur length discrepancies with
a packer under the cleat. Like all rules of thumb, they often have limited
relevance in any particular case. Equally, leg length discrepancies can often
cause other changes in a functional sense that mean any packer used may need
to be more, or often significantly less, than the measurable discrepancy.
The question I would ask is do both legs feel much the same in their pedaling
If one feels more fluid than the other, is it the short leg or the long leg?
Let me know about that and I will attempt to advise further. Re the LeMond
Wedges. They work well but can be clumsy if a significant number have to be
used. Often it is a good idea once you have arrived at what you believe to
be the right number to use, whether counterstacked to gain height or used
as wedges, to glue them together.
Knee problem redux
Further to my email from 6th
October, I have seen my physio & a local osteopath, who have both tracked
the problem back to the femoral nerve. It seems the pain is coming from the
L1, L2 & L3 region of my lumbar region which is referring the pain through to
My physio did some work on my back which helped a little, but I had a huge
improvement from my first visit to the osteopath, things have improved on the
bike, but I feel there is still a lot of work to do before I'll feel 100% fit
again. My osteopath said my L1, L2 & L3 vertebrae were very stiff (along with
my left SI joint) he is also doing soft tissue work on both my back and quad
of the affected leg (left) to help. The question still beckons though... what
is the cause? Is it just my physiology, or to do with bike set up? The problem
(this season) first struck on a 4-hour road ride, so it was the duration that
set it off (approx 10 weeks ago) and it has not fully settled down.
The other thing that niggles at my mind is the pain that I get in my left knee,
it is on the inside, right on the side/top edge & when it is sore, to touch
it is very tender. The osteopath reckons that it fits for a nerve referral pain?
The treatment he is doing suggests that it is, but I can't help but wonder if
it is merely relieving the symptom, and that the cause is something different.
I'm not sure, it's a really difficult one to track. I feel sure that my alignment
is good & that I don't appear to have any external rotation during the pedal
stoke. I am getting checked out again by my podiatrist next week for this just
to be sure. I agree that the pain is not coming from the knee itself though.
I will let you know how I get on, in the meantime Steve, I would welcome any
other suggestions you may have? (I have not yet checked for hip drop as you
suggested, thought it best to get this checked out with my podiatrist?)
Alexandra, New Zealand
Steve Hogg replies:
It is hard to answer with any certainty about whether your problem is caused
by the bike or was pre-existing and was exacerbated by the bike. The greater
likelihood is that you already had the problem but it had not bitten you yet.
When we have a functional problem our bodies will accommodate the problem
by functioning in a different and less efficient way. Sooner or later we have
to pay a price for that. In your case for instance; if your left sacro - iliac
joint is restricted as you say, then the ilium and hip on that side will tend
to function as a unit instead on independently.
What usually happens is that there will be a noticeable hip drop on the affected
side on the pedal downstroke. From behind this gives the appearance of a short
leg but often is not in a measurable sense. Packing up the cleat does no good
in most cases because the problem starts higher up the chain and the hip will
drop with or without a packer.
Usually, the seat needs to built up on the affected side to minimise how
far the hip drops; and while this will work to a greater or lesser degree,
it is a band aid and not nearly as good as solving the root cause problem.
An in shoe orthotic can help but at best it only takes the edge off the problem
as the root cause is further up the pedaling chain. When as you do, there
are significant issues with pelvic or lower back function, the effects of
this cannot help but flow outwards to the periphery on a bike. If there is
a lesson to be learnt here, it is that structural fitness needs to assume
a higher priority in your training program. When anyone has a chronic issue
it is never because their lungs are too big or their muscles too strong, but
rather because their body as a structure cannot cope with the stresses their
' engine' allows them to place on it.
Given what you have found about your lower back function, I am not surprised
that your knee hurts. There are the reasons you have been given by the health
professionals to which I would add the likelihood that you are rolling your
left knee inwards on the downstroke. This is very common with a restricted
Go back to your osteopath as you got good results there, but wrap your head
around the idea that maintaining your structure needs to be more important
than maintaining your engine. As a rule of thumb; whatever time you allot
for training in any given week, in your situation 25 - 30% needs to be set
aside to improve the way you function and come back from the situation you
find yourself in, possible more.
A couple of good self education books so you can learn more about how to
help resolve the problems are; "Overcome Neck and Back Pain" and "Stretching
and Flexibility" both by Kit Laughlin, and "Anatomy Of The Moving Body" by
Theodore Dimon. All of these are easy to read and a lot can be learnt in a
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