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Form & Fitness Q & A
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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. |
One foot pronating continued
Left foot issues
Knee pain
Wrist pain
Pain behind the knee
Cycling after injury
Neck discomfort
Different crank lengths
Leg and arm numbness
Anatomical leg length difference
One foot pronating continued
Hey Steve, sorry for the delay.
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.
I am using specialized pro carbon shoes with cleat fully forward on the left foot and centred, and right foot cleat fully forward and pointed all the way right 'heel in'. I even tried moving the cleats back like you recommended in one of your earlier articles but I got terrible pain in the ITB, especially the right.
Right leg pedal stroke seem smooth but left seems almost square at times and weak. Sometimes I get the feeling like I am reaching with the left leg as though I can't get on top of the pedal and even bouncing at times. Riding buddies have not told me that I am too low on the saddle but I know that the problem stems much deeper. I do not rock on the saddle.
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.
It's obvious that the left knee and especially the left tight hamstring is causing some problems but wondering what I could do with the cleat or seat or what ever since I have tried almost everything. Seeing a back doctor or a physio are also my other options.
Gerald Reyes
Gerald,
When trying to offer advice on this forum, I am often ill at ease in the sense that I am advising based only on what someone I can't see has told me. Usually I have to play the odds of likely occurrences and though I get plenty of positive feedback, I am sure that my advice is wrong more often than I would like. That is why I asked you those supplementary questions, to try and nail down some variables. The message is that if you want the best advice I have to give, find the time in your busy schedule to make my life and by extension your life a little easier, by getting on your trainer and answering those questions.
From what you have just told me, it's likely that the following is happening: everyone protects or favours one side over the other, usually the right side is the favoured side. In my experience there is no correlation with handedness which has led me to guess that the underlying reason for this is a brain hemispheric dominance thing. I can't prove this but my reasoning goes like this. The modern world rewards left brain thinking, that is methodical, analytical behaviour. The left brain controls the right side of the body and cycling is a left brain activity. I see a vast preponderance of people who protect their right sides in the sense that even if a right side issue is the problem, most fallout occurs on the left side. This is not universal, just very, very common.
I suspect that you have a right forefoot varus that is much greater than any similar problem on the left side. Why?
Because I see a far greater percentage of people with a pronounced right forefoot varus not present on the left side than the other way around. A pronounced varus of the forefoot will usually load the knee in ways that it is not designed to cope with. In these cases a common right side self protection mechanism is to internally rotate the right hip [which twists the right heel outwards] which keeps the right knee tracking well, but usually causes in the long term a host of potential compensatory measures on the left side which my guess is what you are suffering from; i.e. tight psoas [the left side lower back pain], tight hamstrings and though you haven't mentioned it, I would be that the left side glutes are tighter than the right as well.
It's this favouring of the right side that is causing the unsettled feeling and lateral movement on the left side. How do you establish whether this is indeed the case?
Well, you could start by answering my previous questions. Additionally, get hold of one of those 'foot protractors' that I think Lemond Fitness sell. Sorry, I don't know what else to call them. Read the instructions and have someone, preferably your physio quantify your foot alignment with one of those. Get back to me with what you find.
If I am correct in my assumptions, then your right foot is the underlying driver of your left side issues and that needs to be addressed first. If I am correct, you will still have the left side pattern of tightness because it is now well established, but by treating the cause, you can begin to make headway on the fallout.
Left foot issues
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.
Here are my own responses:
1. Which hip you drop and/ or rotate forward on the pedal downstroke?
My left hip, but it may be because my left foot speedplay cleat is shifted back significantly in respect to the right foot cleat with two Lemond wedges underneath them to account for vargus and also the difference in effective leg length that would result from the posterior placement of my clean.
2. Which knee if any, is closer to the top tube?
Left knee is closer to top tube and seems to get closer at cetain points of the pedal stroke (specifically the downstroke).
3. As viewed from behind, on what side is the gap between inner thigh and seat post greater?
Left side is greater
4. Viewed from above and behind which shoulder if any, is thrust further forward?
Left side is slightly shifted forward.
5. As viewed from either side, which elbow if any is more locked than the other?
Left seems a little more locked but perhaps no significant differences can be felt.
6. Which knee if any, moves laterally at the top of the stroke?
Left knee moves laterally on up stroke and medially on the down stroke.
7. Lastly, do you have any feeling of one leg being your preferred or stronger leg?
The right leg is by far the stronger, smoother and faster leg for any cadence or speed. This includes climbing out of the saddle.
Thank you so much, and I look forward to hearing from you soon.
Jonathan Tan
Jon,
There has been no subsequent advice to Gerald as he has not got back to me. Let's have a go with you. Everything you have said confirms that you are dropping the left hip with the upper body stuff being things you are doing to compensate for that challenge to stability on the seat. The question is why?
There are three common things that drive what you describe on the bike.
1. A noticeably varus left forefoot to a degree not present on the other side that leads to or is associated with an internally rotated left hip.
2. A measurably shorter left leg.
3. Left side hip flexors, glutes, hamstrings and lower back that are tighter on the left side making the leg functionally shorter in use; i.e. lesser range of movement at the hip.
Just to make life interesting, any combination of the above can be happening as well.There are any number of less common causes, even occasionally a measurably longer left leg with hip and lower back musculature that is so jammed up that the leg appears functionally shorter. Long term, find a good hands-on physio and determine your structural state of play and find out what you have to do to become more symmetrical in function. As well as any specific tasks you are given, make friends with your local yoga teacher or someone similar.
In the short term, try this:
1. Have a look at this post and this post and position your cleats as described. This may or may not lead to the cleats being placed differently on each shoe sole. The reason that you feel the need to have the left cleat further back on the shoe is that it makes that side more stable. I am not trying to undermine that, just get to the bottom of why there is this challenge to foot on pedal stability.
2. Increase the number of wedges placed with thick side to crank arm side of shoe. Keep adding one at a time until the left leg feels more stable and has limited lateral movement at the knee. If you get to 5 stop, because it is rare [but not unknown] that anyone needs more than that. Even if it is not enough, five should make a significant difference for the better [assuming that this is the problem or part of the problem] and once you feel you are on top of things, more wedges can be added or removed as necessary.
3. When you are satisfied with the wedging with whatever number feels best, get some spare Speedplay baseplates, punch out the 4 nuts on the underside that the cleats attach too and using extra length screws, mount one additional baseplate at first and then possibly a second with these extra baseplates mounted between the cleat and the original baseplate. Does this stop or diminish your hip drop?
If not, then the problem is related to hip/lower back and needs to be addressed probably with the help of a good physio or similar.
If so, then you have a shorter left leg and the task now is to fine tune just how much to build up under the left cleat. If you find this last suggestion as the way to go, move the cleat 1mm further back on the shoe for every 5mm you add under the left cleat to keep a solid, stable feel under the foot in pedal. Let me know how you get on.
Knee pain
Hi,
I have been cycling now for ten years, both mountain biking and road biking. I cycle about 50-70 miles at weekends, and also commute daily [10 miles per day for my commute]. I also do circuit training twice a week. I'm 35 years old.
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.
Some things I have tried:
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.
I have a tight piriformis on the same side as my right knee. Could this be related?
Paul Davies
Paul,
A few queries:
1. Which knee?
2. Stand in front of a full length mirror stripped to your underwear and bare chested. Which knee do you lock most when standing as you normally would?
3. Do you stand with one foot more heel in than the other?
4. Run your thumbs down the side of your ribcage until you strike the top of your pelvis [iliac crest]. Which side if any is higher?
5. Do you stretch regularly? If so, on which side are your hamstrings tighter?
6. On which side are your hip flexors tighter?
7. On which side are your glutes tighter?
8. You will need an observer for this one. Mount your bike on an indoor trainer and level the bike. With your observer standing above and behind [ on a chair is ideal], and with you pedalling fairly hard, which hip sits forward and do you rotate it forward and down?Let me know those answers and we can proceed from there.
Wrist pain
A couple of months ago I was out training on a fixed wheel bike. Now I don't ride fixed wheel too often and so I have a habit of forgetting I'm doing so! In consequence, when I tried to bunny hop a hole in the road, I stopped pedalling. On a fixed, this really isn't a good idea.
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.
On the bike, riding on the hoods or drops is fine but using the tops with a bend wrist is really uncomfortable. Any ideas on what the problem could be?
David Laing
David,
When you get intense bone pain on loading a bone, there's a decent chance that you've broken it. I'd suggest a visit to the medical professional of your choice for a diagnosis. You may also have a really bad bruise or pulled ligament, but that really should have healed in a couple of months.
Pain behind the knee
Hi,
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.
Rob Sloane
Rob,
The pain behind the knee is typically caused by overextension; that is, reaching to far. The fact that it now occurs when seated climbing [higher torque, lower rpm pedalling than on the flat with consequent greater heel drop and hence extension of the knee] and riding in the drops [prone position will strain the hamstrings more than a more upright position and limit their ability to eccentrically contract when on the left side pedal downstroke] serves to confirm this.
When you say that the cleat holes on the DMTs were further forward than on the Carnacs by 5mm [something that would surprise me greatly if we are talking about the same shoe size], did you measure this in relation to foot in shoe? Or did you measure this in relation to the heel of shoe or by some other external method?
If the latter, it is an unreliable indicator of cleat hole positioning. The only definitive way to measure the difference in cleat mounting hole position between different brands is with foot in shoe and the shoes levelled. Perhaps the new shoes had a thinner sole than the previous ones and you did not lower your seat to account for the difference. Perhaps the cleat position on the new shoes was further forward relative to foot in shoe on the left foot than with the previous shoes. If so, this may have caused a greater heel drop on the left foot causing greater extension of the left knee.
Perhaps the cleat on the new left shoe was further back which would limit ankle movement and cause greater extension of the left knee.
Perhaps a slightly higher effective seat height challenged your stability on the seat slightly causing you to favour the right side in the sense of not sitting square on the seat and causing the left leg to reach further. Most riders favour their right sides to varying degrees. If you are particularly sensitive to this, a rise of 2 - 3mm in effective seat height [if the new shoes did have a thinner sole] can be enough to tip people over the edge.Whatever the cause, the likely solution is to lower your seat a touch. While you are at it, it wouldn't hurt to have a look at this post and this post and possibly repositioning your cleats.
The other thing to consider is that you may have done yourself an injury and that you need to recover from that. Have you sought any advice from a physio or sports doctor? If not, that is probably what you should do next.
Cycling after injury
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.
Ian Adams
Ian,
You can train again when your doctor says it is okay, and in modes that the doctor okays. We coaches cannot tell from your email if your bone is mending. You should certainly be ready for physical therapy long before you are ready for serious bike training. If your doctor has not prescribed that, go back and request it.
Neck discomfort
Hi,
I was wondering if you can give me any advice. I have a road bike and when doing longer kilometres I get pain in my neck shoulders - any advice would be appreciated.
Dwayne Barry
Dwayne,
This is typically brought on in the circumstances that you describe by slight overextension of either the neck or upper back or by weight bearing.
This means either that your seat is too far forward and this causes you to be bearing too much weight on your arms, or that the bars are a bit low, or that the bars are too far from the seat [ stem too long], or that there is any combination of these factors going on.
In the short term, pull your bars up enough to solve the problem. Longer term, research the archives on CN for any advice regarding position and you will probably make a noticeable difference to your comfort and performance. Once you have researched the archive, let me know if you have specific queries.
Different crank lengths
Sir Steve
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.
My question is...would it be better to use a shorter crank on the left? I theorize if I used a crank that was 1cm shorter I would correct the total LLD and 1/2 the FLD, which would address the twisted pelvis too. Or worded another way...wouldn't it be better to address differences in femur length at the crank?
Dr Kemp
Matthew,
I see that you are still alive and well.
Living your life and riding a bike the way that you have prior to compensating for the LLD with shims has caused changes in pelvic function and you will find an asymmetric pattern of tightness in any or all of the muscles that control the hip, lumbar spine and pelvis [ and probably elsewhere as well] You have corrected for the LLD but still drop your hip, because the hip drop no doubt started as a compensatory measure for a measurable asymmetry, but is perpetuated by the left / right patterns of asymmetry that have developed from your asymmetric walking/running/cycling patterns of movement.
While there is something to be said for differential crank lengths, what you need to do is consult a good physio or similar, assess the asymmetries and get a stretching regime under way to set you on the path to minimising or eliminating them. A good yoga class wouldn't go astray either.
Your pelvis is the foundation of your position on a bike. The legs hang down from it and exert force, the upper body cantilevers out from it. This means that if you want to ride symmetrically, it is fundamental that the pelvis function symmetrically or nearly so. Asymmetries of pelvic function on a bike have effects that flow outward and interfere with symmetrical function of both the legs and upper body. This is independent of leg length differences which can be accommodated with various shims or as you suggest by crank length differences.
From previous correspondence I see you as a sensible, thinking kind of bloke. So start at the start and do what it takes and see who you have to see to get the pelvis functioning symmetrically.In the meantime, twist the seat nose of your seat so that the centreline of the seat points to the left hand edge of the bar clamp of the handlebar stem. This will help square your hips up on the bike by bringing the left hip back and pushing the right hip forward but is no substitute for having a straight pelvis. Bear in mind that by doing this, you may have to increase the shim under the right foot.
If you want to play with crank length differences I recently saw a pair of carbon fibre cranks that were adjustable in 1mm increments between 155mm and 185mm. They seemed well made, weren't overly heavy and the adjustment system is simplicity itself. The only negative is that the Q factor was just over 160mm which compares poorly with the 146 - 148mm of a typical dual chainring crank set. I contacted the manufacturer and they do make a 150mm Q version but from memory there is a weight restriction. When I get some spare pennies I am going to get a set of the 150mm version to play with. You can contact the manufacturer at www.murraytourdeforce.co.za. Best of luck and let me know how you get on.
Leg and arm numbness
Hi
Thanks for running such a great website. I'd be very grateful for any advice you can offer.
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.
I don't think it's a forefoot varus problem, as I don't get knee pain, and my knees don't track laterally during the pedal stroke. (I did try LeWedges just in case it might be a varus problem, but the problem persisted).
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).
Turning the saddle nose to the right (as far as will allow me to pedal) straightens my pelvis a bit (and makes my left arm feel better, and (I think) makes my left leg feel more natural), but my balance is still not quite right.
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.
Have you any advice? Is there anything quick and simple I can do, or is it a matter of persisting with the orthotics, shimming, and stretching until the musculature comes back into symmetry (rather a long term solution, this!).
Sorry for such a long email, but I have found it to be a complicated and somewhat frustrating problem.
Martin Feeley
Co Kildare, Ireland
Martin,
It is a bit hard to advise in detail but your approach to date is rational and methodical. I would continue to experiment with the seat nose twisted to the right. Aim the centre of the nose of the seat at the right hand edge of the handlebar stems' bar clamp. That is about as much of a seat twist as most people will cope with. This should help straighten your pelvis to a greater or lesser agree which should take pressure of the left side.
Twisting the seat though, may mean that you have to increase the size of the shim under your right cleat and by squaring up the pelvis to whatever degree will mean that the right leg will have to reach further.
I think with what you have done that you are on the right track in a general sense. Don't neglect structural improvement; i.e. stretching and core strength training. In some ways this is more important than time spent on the bike as it sets the scene so to speak for the bike.
I know that this is a frustrating thing to deal with but it has taken you many years to become the asymmetrically functioning person that you are now and is likely to take a while to remedy these problems.
The other thing that occurs to me is that the numbness in the left foot and leg may be caused by nerve pathways being compressed by over tight musculature on that side. If you are sitting asymmetrically this is quite likely. So find that yoga or Pilates class or similar.
Anatomical leg length difference
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.
The right femur measures 55.3cm. The right tibia measures 44.4cm and the left femur measures 54.8cm. The left tibia measures 44cm. There is thus a 0.9cm limb length discrepancy with the right leg being the longer.
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.
I have full length orthotics in my running shoes with anti-pronation build up and a gradual raise in my left heel, maxing at 9mm. All my previous aches, pains and resulting injuries have gone away.
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?
Pieter Visser
Cape Town, South Africa
Pieter,
I would need to know a lot more about you and see you in person to give the definitive answers that you seek but I will do my best. The first thing that you need to do is relax. Your letter shows signs of you being a 'stress head' type of person. And before you take offence, I am often accused of the same and my accusers are probably right, at least some of the time.
Forget the arm length "difference" as arm lengths are notoriously hard to measure accurately. An X ray or a CT scan are the only things that I will believe unless the difference is pronounced and obvious. What is important is how this effects your upper body position on a bike, which may be anything from not at all to noticeable [www.online.bikefitting.com] I know nothing about. I assume it is a measurement based method of positioning. If so, be a little wary. Body measurements are not unimportant but are not nearly as important as what your capabilities are and what techiques you use to propel a bike. In short I am saying that what is important is what you do and how you do it, not how you measure. The likely reason that you pronate more on the right foot is a lifetime of leaning slightly to the left when you run.
Regarding the guts of your question, here are the considerations.
1. You have a left tibia that is 9mm shorter than on the right. But the tibia never points vertically down when seated on a bike though it does when standing on a bike. When seated the 9mm discrepancy will be less in an effective sense. When standing it will be 9mm but can be accommodated unthinkingly in the same way that you do when running. You might have the same effective leg length with your heel lift on the heel strike of a running stride, but you certainly don't have that on toe off of the running stride because as you say, the heel lift is graduated in length. This means that on toe off you are leaning slightly to the left and as you have said you are injury free running since the heel lift was fitted.
In effect, you are likely to need a shim under your cycling shoe that is less than 9mm but there is no way to be certain without seeing you and how you pedal.2. The other issue is a lifetime of activity with a difference in leg lengths will likely have caused changes in how your pelvis works. It is unlikely that you are symmetrical or near symmetrical in the way that your pelvis functions unless you are one of those uncommon males that are naturally flexible or that you stretch a LOT and frequently. Playing the odds of likely occurrences, you will probably have a varus right forefoot [ meaning that the either the heel rolls outwards relative to the forefoot or more likely , the forefoot rolls inwards relative to the heel] as I see a lot of this in people with long right legs. This will either cause a lateral load on the knee or alternately, no knee pain but an internal rotation of the right hip which may be further exacerbated by other common compensatory mechanisms for a leg length difference. Are you tighter in the right side hip flexors?
Is the right glute tighter than the left?Both of these are often associated with long right legs where there is forward tilt of the ilium [side of the pelvis] associated with that.
If so, then the accommodations that you make for the LLD probably cause you to drop the right hip to some degree and increase the effective distance the left leg needs to reach. If not, then it is possible but less likely that you either sit relatively square on the bike or that you drop the left hip. I have no way of knowing.Set your bike up on an indoor trainer, warm up without your shirt on, put it into a hardish gear and have an observer standing on a chair behind you tell you which hip you drop if any. Get back to me with the answer to that and we will proceed further.
