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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 Please include as much information about yourself as possible, including your age, sex, and type of racing or riding. Due to the volume of questions we receive, we regret that we are unable to answer them all.

The Cyclingnews form & fitness panel

Carrie Cheadle, MA ( 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 ( 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 ( 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 ( 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 ( 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 ( 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 ( 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 ( 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 ( 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 ( 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 ( 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 ( 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 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.

Fitness questions and answers for May 23, 2005

Leg Discrepancy
Back Pain
Injured but feeling great - why?
Sore glands
Knee pain post-crash
New to cycling
Bike fit and cleat adjustment
Fit with Power Cranks
Sensitive rear-end problem

Leg Discrepancy


I am a 38yo male, 6' 165lbs. I have been racing competitively for several years now. In the past, I have always suffered from chronic knee pain on the outside of my left knee. After switching teams, our main sponsor (who is a local bike manufacturer) gave me a complete dynamic fitting. The results were impressive, but I do still get a little nagging pain in the left knee on occasion. He mentioned that when he measured the knee angles, there was a 1-2 degree difference between the two. He felt that this small difference was not enough to warrant placing shims under the cleat of the left shoe. I definitely feel as though I need to reach a little more with the left leg than I do with the right.

I always look forward to Mr. Hogg's detailed attempts at alleviating other riders' difficulties, so this is mostly directed to him (no offense to the others on the panel). Steve, in your professional opinion, would you prescribe the addition of a shim for a difference as small as 1-2 degrees? I realize that it is nearly impossible to diagnose someone over the internet, but given the results of my fitting, can you use those results to suggest a treatment for my knee pain? Thank you in advance for your reply, and again, I look forward to your responses.

Robert Moskal

Philadelphia, PA

Steve Hogg Replies

I assume that the 1 or 2 degree difference noted was with the use of a goniometer which is a joint angle measuring tool. While they are fine if a fitter feels the need to use them, there is a margin of error in their usage and it approximates what you have been told is the difference. The bottom line is that you can feel a difference in power, control, or whatever between legs. Act on it.

As a starting point, fit a 3mm spacer under your left shoe and see if there is a positive difference. If so, you have a solution for the time being. It is worth your while finding out why you have this difference in feel. It could be a measurable limb length discrepancy; it could be a tendency to be tighter on one side than the other; it could be that you favour your right side slightly and your left leg pays a price for this. I know I say this a lot but have someone look at you on an indoor trainer while stripped to the waist and pedalling under load. It is very common for people to favour their right side in the sense that they drop their hip anywhere from a little to a lot. If you are doing this at the lower end of the scale, the symptoms you describe are typical.

I have no way of knowing whether this is indeed the case but check it out anyway. If you need any further info once you have tried a packer, let me know.

Back Pain

I'm a 17 year old, 6'4" male who's experiencing lower back pain while riding. I've been riding for around 6-7 months now and haven't had this problem before. It usually occurs after around 40-50 km of riding. I don't have back pain while I'm off the bike. I have been told I have bad posture and weak back muscles; could this be a factor? What can I do to get rid of the pain in my back?

Simon Frost

Melbourne, Australia

Steve Hogg Replies

I can't see you and can only speculate about whether your bike position plays a part in this. Given your size and youth, I suspect that any bike you own is probably too small and that is part of the picture too. You could do worse than have a talk to John Kennedy on [Melbourne local no. 9589 3399] about this. In regards to the bad posture and weak back muscles - of course they are part of the problem. Find a good Pilates class or similar and work on that aspect of your fitness. If that isn't possible for one reason or another invest 30 or 40 bucks on "Pilates for Dummies" by Ellie Herman, available in larger bookstores.

Injured but feeling great - why?

I have a couple of questions.

I have been riding/racing (on and off) for 5 years now, Cat 4 road (6', 225 lbs), sport MTB and I recently was injured in a race. 5 fractured ribs, collapsed lung, fractured scapular, torn rotator cuff muscles, whiplash, and a deep bruised hip/hip pointer. I am now getting better and took 28 days off the bike completely to allow my body to recover from the injuries. At the time of the accident I had just started my 8 week final phase(s) for my "peak race" of the year, June 5th, basically following Chris Carmichael/Joe Friel training methods.

The day of the accident I noticed that I was feeling particularly well.

After reading many comments here and in the literature, I though that when I returned to riding again that I would have (1) Lost endurance, both aerobic and anaerobic and (2) and for a lack of a better term have "dead legs" and feel horrible. Oh, one other thing, in the past few years, I have had my hematocrit tested on several occasions and it hovers between 47-48.5, however after my accident it was measured at 45. All other blood indicators were normal and I was not dehydrated when the blood samples were taken.

Well, my first ride in 28 days was our team training ride (~2:20) and I felt great. My legs felt incredible, my body (excluding my ribs and shoulders) felt like I had not missed a day of training! My HR was slightly elevated compared to similar efforts 28 days prior. My pace was approximately the same as previous rides. I am sure that overall my endurance has decreased compared to 28 days ago, but my question is why did I feel good? I am not complaining but there has to be some physiological reason behind this. I can honestly say that my legs have not felt this good in a long, long time and I have been training on the Carmichael/Friel type stuff for four years.

Just interested in your opinions as to why this is the case, and is there some lesson for me in my future training (i.e. maybe my body responds better to low intensity training or maybe I was overreached/overtrained before the crash?) Thanks in advance.

Scott L. Roberson

Scott Saifer Replies

Hi Scott,

This is an intriguing question, but most likely has a very simple answer: If taking 28 days off makes your legs feel better than they have in years, you've been tired for years. If you are actually as fast over shorter and longer distances and recovering as well now as before you accident, then you were not only tired but overtrained.

It sounds like you need to build some more flexibility into your program. Being willing to take easy days (long, but lower than normal intensity) when your legs are not feeling great will help you get stronger and faster than consistently riding yourself into the ground. While the Carmichael and Friel books are great for setting up training plans, they do have one danger which is that riders tend to get hung up on sticking to the intricate plans they've made, trying to make the numbers, whether or not the plans are realistic. I'm sure if you were working with Chris or Joe themselves, they would help you figure out when more rest would be more beneficial than more hard work.

Sore glands

The problem I'm writing to you about concerns my 15 year old son. He has been competing for two years. He has trained hard and raced well this year with his most important races just around the corner. He has now got a sore gland under his jaw and is tired, so he has stopped training to rest. Is this the sign of an over-stressed immune system or could it be some low grade infection? Is the best advice to stop training altogether and seek medical help? What do you advise.

A Ettles

Kelby Bethards Replies

Sore gland eh? If the sore gland is isolated, it may be infected.
Otherwise, the gland is a lymph node, which is usually strung together in a chain of lymph nodes. Inflamed nodes, painful nodes, etc generally are associated with fighting infections (even just low grade viruses, or the less virulent viruses). But, they can also be a sign of overtraining. I would be seen by your regular doc just to look for something, but a lot of times we don't find a specific reason. But, if a specific reason is found (ie: Streptococcal pharyngitis, mononucleosis, lymphadenitis, etc) then it can be treated or at least guidance can be given.

So, I think your choice was good in resting, but it may be worth your while to see your doctor.

Knee pain post-crash

Hi there,

I'm category 1, 19 year old British rider who recently crashed in a big international race, landing on my right knee. I continued, eventually being forced to abandon. After returning to training two weeks later I now have pain in my left knee after only one week back into training. It's mostly on the inside of the knee around the edge of the knee cap.

My question is: could this be to do with me subconsciously "protecting" the previously injured right knee, after only a week of training. Two weeks before the crash I changed my shoes and for a day or so my knees were a bit sore, but it passed and I put it down to "wearing in" issues. Could this come on after a single week of training when it didn't seem to affect me before the crash on the other leg? I also suffer from collapsed arches and I wear insoles in my walking shoes, but not when cycling, and my feet naturally seem to pronate.

I've seen a number of physios but am still not sure myself what has brought it on as I was very conscious of not trying to save the left at the expense of the right. I'm doing stretching to make sure my iliotibial band is not pulling my knee cap out of alignment and icing five or six times a day for 15 minutes. Any advice would be most appreciated as I have a contract to ride a big criterium in the US in exactly one month.

Stuart McManus

Kelby Bethards Replies


Your problems, as you have mentioned, are complicated by more than one variable changing at one time - shoes and an injury. You most certainly could be protecting your right knee somewhat, thus adding to stressors on the left knee/leg. If you tend to pronate more, and your new shoes do not support the arches as well, that can cause rotation and angulation of the lower extremity that causes more of what we call a valgus stress on the knee (ie; knee "angles" inward, or toward the bike more). This could be part of the problem with the location of your pain.

Does your right knee still hurt? Or is there a reason you think you are protecting it?

We have, as well as outdoor and shoe stores, a multitude of different options for footbeds. I tend to tell people to get some 30-50 dollar footbeds that are thin enough for his/her cycling shoes and will help hold the foot in a more "neutral" position, thus helping prevent the angulation and valgus strains on the knee.


Of course I am completely against drugs in sport and doping of any kind. So how many caffeine tablets should I (an average everything male) take before a one hour criterium and when? Does the amount and timing change for a longer event?


John Perry

Scott Saifer Replies

Hi John,

You didn't say how long you've been racing and how instinctive a tactician you are. It is true that caffeine does a variety of things that can help your physical performance. I've also seen numerous cases where the added excitability that comes with ingesting a stimulant has made clients stupid to the point of riding aggressively beyond their physical ability (usually with a comment like, "Well, I was feeling great so I went for it") and then performing well below their ability.

If you are an experienced rider and a good tactician who does very little work in races but always ends up in the breaks anyway, you might consider one or a few cups of tea or coffee. If you tend to race aggressively and not be ready for the winning breaks because you've already blown your wad, stay away from stimulants.

[According to the Australian Institute of Sport, the caffeine content of coffee and soft drinks - 50-150mg - is enough to provide a performance benefit, and there is no additional benefit beyond that level. Typical caffeine tablets contain 100mg. - Ed]

New to cycling

I am a 50 year old woman who hadn't ridden a bicycle since childhood until last Dec '04 when I decided to train to do the ALC4 ride from SF to LA in June '05. I was loaned an amazing Serotta to use, and have good bike shorts. I was about two months ahead of the recommended training schedule in terms of distance and difficulty. I did my first Century in Solvang in March with fatigue, but no problems. I did back to back 95's at the end of April and about 60 miles into the second day developed a "Pinching Pain" in the groin area, right in the crease at the top of my thigh where it meets my groin. I used chamois butter at one of the stops, per their recommendation and managed to get home okay, but after resting almost 10 days, I still have a "sore" there. It is very small, about the size of a spider bite, and still extremely tender. I have used antibiotic ointment and it is better, but seems to me it should be gone by now.

I don't know if this is something common to biking, in which case you may have the solution, or if I need to go to my doctor. I have 585 miles coming up in two and a half weeks and I am getting concerned that it hasn't disappeared yet - any suggestions?


Scott Saifer Replies

Hi Lorna,

Most likely you have a classic saddle sore, which will most likely respond to treatment with a drawing salve (available at the drug store), but since you are only two weeks away from your big ride, I'd suggest visiting the doctor. While most saddle sores respond to the drawing salve, some need to be lanced. The doctor should be able to tell the difference and get you on the right track to treatment and recovery.

Bike fit and cleat adjustment

I am 37 year old cyclist and have been riding mountain bikes for about 7 years and road bikes about 4, with the majority of time spent on the road bike over the last few years. I am just below 6' and weigh 164 pounds. My pedaling style is typically to ride an easier gear and higher cadence (106) than mash out lower gears at sub 100 cadence, regardless of the terrain.

I have previously experienced some lower back issues (to the right of the spine), primarily due to tight hamstrings, which compounded into some right knee pain. My doctor/physical therapist has been focusing on strengthening my core and improving flexibility via consistent stretching. My most recent back flare-up occurred earlier this year and has improved to mostly a non-issue in the last few months. In the last few months; the back, knee and hip have all been feeling great. About 6 weeks ago, while cycling, I noticed that (from the top view) my left leg seemed to be aligned (thigh, knee and foot) while pedaling and that my right leg looked as if the knee and thigh were angling inward more giving the perception that the pedal strokes were very broken (as opposed to smooth revolutions). Trying to perform my own troubleshooting, I raised the saddle about 1/4 of an inch and adjusted the right cleat outward on my right shoe. I rode for several weeks without issue and thought everything was fine.

Then a week ago, we did a group ride that involved more climbing (4 miles at avg 8%) than normal and I rode it and felt fine. Two days later my left knee, in the front, directly above the kneecap, was very sore to the touch and would "click" whenever I tried to straighten out my leg. After some web research, I identified the area of pain as the rectus femoris tendon. After 7 days, most of the pain had subsided, but the clicking remained when I turned the pedals from the 3 to the 6 position on the downward stroke. After a few more days the clicking went away entirely and I decided to ride again. I checked my cleat alignment and decided to shift the left cleat forward a 1/8 of an inch because it looked a little farther back than the right cleat. After riding at an easy pace and limited mileage for two days, I noticed some tightness in the quad and tendon area.

My searches to determine the cause have led to a couple of different possibilities: Pushing too big a gear and strained the area - doesn't seem likely because I was using high gears and high cadence. Strained the area by doing too much climbing when I hadn't trained for much climbing - a possibility (but not likely) but I consider myself a 'natural' climber Poor alignment of cleat or fore/aft positioning on the bike - seems like the most likely but not sure where to start since I've never had any issues with my left side. Is this a common problem? Can you point me in the right direction? I was professionally fitted several years ago, which included cleat alignment and bike adjustments. However, I have been on a new bike and shoe for the last year.

Also, my riding consistency and mileage have decreased over the last year due to a new baby last summer. Any help or suggestions would be appreciated.

Christopher L. Pritchard

Steve Hogg Replies

The simple answer is to drop your seat the 1/4" that you raised it and move your cleats back to the position that they were in prior to raising the seat. You make no mention of having problems immediately prior to that. You noted your right leg not tracking well and your right foot toeing in on the pedal and say that this prompted the changes. Why?

The history of right side low back pain suggests to me that you don't function symmetrically so why expect symmetry in pedalling action? I absolutely agree that symmetry is a goal to be striven for but be careful with mechanical solutions to structural problems. For instance, one of two scenarios is likely:

1. You have right side issues with the lower back, hip and pelvis and this is the reason that your right leg doesn't track as well when pedalling. This leads to you favouring the left leg which does track well. You then raise your seat and do a solid hill ride that would certainly cause you to drop your heel more than usual because of the high torque required when climbing 8% grades. This greater heel drop combined with the raised seat leads to greater extension of the knee which in turn caused the tendon strain. OR,

2. You have a left side low back/hip/pelvis issue and autonomically protect it at all costs. This causes you to move laterally towards the left and drop the left hip when pedalling. The left leg tracks well but the right leg moves laterally to accommodate the left hip drop which compromises its ability to track well. This left hip drop causes the right spinal erector to fire up as it is also constantly under pressure as a result. You then raise your seat and do your hill ride and the greater extension forced by the higher seat does the rest as mentioned in 1.

Either way, the solution is to go back to the position you had when you were largely pain free.

You mention looking at your cleats, checking the alignment and then moving your left cleat forward another 3mm or 1/8" because it "looked a little farther back than the right cleat". If you want a self-help solution you need to be more methodical in your approach. What you need to do before making a change like that is check where your cleats are RELATIVE TO FOOT IN SHOE. This does not necessarily mean the same place on the sole of the shoe on each side.

The best overarching advice I can give is to keep working on your structural problems as you have indicated that you are; and before you make changes to position in future, ask yourself whether what ever you see in your own pedalling style is actually causing you a problem physically rather than aesthetically. In a sense, if it's not broken don't 'fix' it.

Fit with Power Cranks

I was curious if you had any experience fitting people on bikes who were using Power Cranks? I routinely swap my normal crank in and out with my powercrank. When riding on my normal crank the position that I ride in is a fairly comfortable; I pedal from my glutes with no prostate pain and I'm on the hoods with a relaxed/no pain upperbody. However, when I ride with the Power Cranks everything changes. I immediately have to assume a postion on the bar tops. I constantly feel like I'm using my arms to push me to a more upright position.

I anticipated this at first as Frank Day (the designer of Power Cranks) said that I would have to assume a more open hip angle at first to aid my hipflexor in lifting the crank over the top end of the stoke. I've since gained enough strength in my hip-flexors to pedal easily with my hands on the hoods or drops...BUT I'm never comfortable. I always feel like I'm sitting on my prostate so I always revert back to the bar top to releave pressure from my 'unit'. I'm considering 2 options to remedy this...

1) I have mild tenderness/soreness in my hamstrings after long rides of really hilly rides (normal or Power Cranks). I've been considering that my seat might just be a few millimeters too high or perhaps the saddle it slightly too far back. I figured I'd lower my saddle and not move the saddle back to see if the took the pressure off.

2) I have a fizik Alliante saddle. I feel like the rise in the rear forces my prostate down into the lift in the front. I don't notice this when I'm on my normal cranks but b/c with the powercrank I pull-up over the top and pull-back where I would normally push I just feel squished. Sorta like the sensation of riding on a trainer indoors without wind. Anyway, I've been considering a saddle with the goodies cut out.

Do you think these modifications would help? Any additional suggestions?

Mike Kemp

Steve Hogg Replies

The third option that you haven't considered is to stop using your Power Cranks. I have used them without problems myself as part of a magazine test some years ago but cannot say that I am a fan of them.

Conceptually they are clever with what amounts to a one way clutch and their marketing spiel sounds good too. BUT and it is a big but, Power Cranks force greater enlistment of hip flexors just to turn them, and I am far from convinced that this is of benefit to a majority of riders.

Hip flexors, particularly iliopsoas [iliacus and psoas], are poorly adapted to upright human posture and very susceptible to overload for anyone with a job involving a lot of sitting, or bending forward or repetive activity. In our society this is a majority, probably a large majority of people. Overly tight hip flexors are directly implicated or a pre condition or associated factor for much back pain and many of the structural ills that plague Western society.

Given this is the case, why on earth would anyone use a crank that forces further enlistment of a relatively small postural muscle group that is opposed by gravity during the pedal stroke? They would be better served by achieving a decent individual bike position that relies on the enlistment of larger more appropriate musculature that is assisted by gravity. Rhetorical question I know, but 'marketing' is probably the answer. To be fair to Power Cranks, if someone is a functional, reasonably flexible person, Power Cranks are unlikely to do them any harm unless they over do it a lot. And in my experience some do. The problem is a majority of bike riders [and I am talking the totality here, not just elite riders] fail that "functional, reasonably flexible" test.

Given what you describe about your own issues, what I would suggest is to firstly drop your seat a few mm as it MAY be too high. If this does not improve things or the problem gets worse, it is likely that your Power Cranks are part of the problem. This is because if the Power Cranks have forced you to tighten your hip flexors too much, your glutes will switch off in an autonomic sense and your hamstrings will try and take over some of that load. This may be the problem as I have seen it before in users of Power Cranks. If this is the case with you, it will affect you with and without the Power Cranks on, until you free up the hip flexors particularly iliopsoas. If by following this advice, you end up not using your Power Cranks for a couple of months and you stretch out your hip flexors, I would be interested to know what follows. Basically, what you have said is that sore hammies aside, you are problem-free when not using them. Those sore hamstrings could well be caused by using them.

Sensitive rear-end problem

I have been told to stop cycling because of a diagnosed condition called 'anusitis'(as follows) has become chronic. Anusitis is the most frequent anal problem and is also the most frequently missed anal diagnosis. Anusitis is a term we first coined in our article "Anusitis" in THE CANADIAN FAMILY PHYSICIAN, Vol. 30, March 1992.

Anusitis is an inflammation of the lining of the anal canal which is just over 1 inch long and just up inside the anal opening. The condition is usually caused by diet or stress and is best treated by a cold reusable suppository stick called Anurex, which can be ordered by most major drug stores in Canada.

Please be forewarned that many doctors are not aware of anusitis. Anal itch or pruritis is itching of the skin on the outside of the anal opening but most people don't realize that the problem arises from up inside the anal canal, due to anusitis. Hence treating with skin creams and suppositories such as Preparation H, which go up into the rectum, give only temporary relief and the problem recurs.

When severe enough, anusitis can cause the lining and skin to split, resulting in what we call fissuring, with severe pain and bleeding. Indeed, anusitis causes bleeding more often than hemorrhoids and some patients have been operated on for hemorrhoids when all they had was anusitis. The cause of anusitis is usually diet and sometimes stress.

I was diagnosed with this about 2 years ago and have suffered ever since. I have been to 2 specialists, had a colonoscopy, tried diet, naturopath, creams, ointments etc. They all told me it was due to diet and stress, and when I mentioned cycling, they all said that shouldn't be the reason. When nothing helped I was then told that IT IS my cycling that is causing the condition to become chronic; not allowing it to heal completely. Two doctors have said that the combination of sweating and rubbing for extended periods of time on the bike is the cause. I didn't want to accept that conclusion so I ignored it, which I can't anymore.

This winter I stayed off the bike for three months (other than 45 min spin classes 2xwk) and my condition healed itself. Four club rides into this season and it is back with a vengeance. The itching, swollenness, cracking and bleeding have all returned. I have decided to stay off the bike for a month or two and see if my condition gets better. My feeling is that I will need to stay away from the sport for a couple of years and allow the tissue in the area to completely rebuild itself.

I cycle about 200km per week, including a 100k club ride on Sundays. Cycling is my passion and it breaks my heart that I need to potentially walk away. Any advice or comments would be much appreciated.

John Ferris

Kelby Bethards Replies


I am not averse to learning about new conditions, which anusitis is probably not; just more a matter of nomenclature. Anything on the body can become inflamed (then we just tack on an -itis the word). BUT, it is compelling for what you are experiencing. The thing I find interesting, it that after one ride back the problem recurs. Not what I would expect for a condition as such.

What creams, suppositories, etc have you tried? I know you mentioned trying many, but do you know what they were? You have good shorts? Good saddle? Is your seat height correct?


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