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Form & Fitness Q & A
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Fitness questions and answers for May 23, 2005
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.
Injured but feeling great - why?
Knee pain post-crash
New to cycling
Bike fit and cleat adjustment
Fit with Power Cranks
Sensitive rear-end problem
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.
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
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?
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
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.
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.
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
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.
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
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
Scott Saifer Replies
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
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
one...ie; 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?
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
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,
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
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.
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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