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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 March 6, 2006

Leg length problems
Knee pain
Patellofemoral maltracking
Saddle pain
Q Factor on SPD-SL pedals
Antibiotics and training
Hips and LLD
Riding for weight loss

Leg length problems


I have had a bio-mechanical problem and would like your opinion if possible. In a nutshell my right leg moves inwards then outwards on the upstroke. I have had both legs measured and have had different results, as it is difficult to pinpoint reference points any part of the pelvis. With my index finger placed on the anterior-superior region of each side of the pelvis the right side seems lower, however when I am lying supine and have a measurement taken, the difference seems negligible? Have built up my right shoe and am using a crank length difference of 2.5mm. What do you think the problem is?


Steve Hogg replies


I assume from what you say that you have a long left leg? The only definitive way to measure leg length is with CT scan or similar. Measuring from bony landmarks is prone to a large error factor.

If this is the case, a common result from a long leg is an anterior iliac crest on the long legged side (left?) as a result of the extra torque developed over a lifetime of activity by a long leg. Often this can be the case without any difference in leg length for a variety of reasons.

If the left iliac crest is forward, then the sacro iliac joint on the left side is restricted to a greater or lesser degree as the left ilium moving forward at the crest is pivoting on the sacro iliac joint. This in turn means that the left hip, left ilium and the lower spine have to move more or less as a unit rather than independently.
Set your bike up on a trainer. Ride with your jersey off and an observer standing behind and above you. On a chair is ideal. If as I suspect, you are dropping the left side on every left pedal downstroke, then that forces the knee movement you describe on the right side upstroke. Let me know what you find.

Knee pain

I have a question about knee pain. The pain started during a century ride in January which I was not properly conditioned for and shouldn't have attempted in the first place. It began as stinging pain on the medial-anterior surface of both patellas. With rest and Anti-inflammatory meds I seemed to recover quickly. I have had no more pain in the right knee but if I ride 20 miles or more the pain returns to the left knee only. What puzzles me is that when I stand up on the pedals the pain immediately goes away. I have checked my bike fit numerous times and I have been careful about cadence and not pushing hard in big gears. Your thoughts and suggestions are very welcome.

Tim Hammond

Steve Hogg replies


Firstly where is the centre of the first MTP joint in relation to the pedal axle centre? I have seen this before almost exactly as you describe and the reason with those (several) people was a combination of:

1. Unaccustomed mileage or load
2. Poor cleat position
3.Less than optimal foot plant on the pedals in the sense of pronation and/or varus forefeet that has not been corrected
4. Often seat slightly low or too far forward
5. The subsequent right knee recovery/ left knee continuation is likely to be because you are protecting the right side ( most people do and there is no correlation with handedness/ footedness) and paying a compensatory price on the left.
6. In a couple of cases, too low a seat height played a part as well.
Why the pain goes away when you get off the seat is that then the the leg extends more and knees typically hurt when either/ or compromised foot/ ankle mechanics at one end and compromised hip / pelvic mechanics at the other end combine to load a single plane joint like the knee in ways it doesn't like. Off the seat your butt isn't trapped in one place and you are free to shift your weight from side to side, autonomically loading the knee in a favourable plane to a degree not present when you are on the seat.

Check out this cleat positioning post and this one and apply them. Also research the archives for setting seat height and seat position fore and aft. Once done, it would be worth investigating whether your foot plant on the pedal is ideal. Let me know how you get on.

Patellofemoral maltracking

Hi there,

I have been a competitive road cyclist and triathlete since my late teens (now 28) and am trying to get back to cycling after almost a two year lay off due to injury. The injury in my right knee occurred during a long hilly ride over a weekend (105 miles on the Friday with no problem), returned same route on the Sunday and developed a soreness in the centre of my right knee under the kneecap around 40-50 miles from home. Unfortunately I had no choice but to continue riding and took several breaks to stretch. The pain was quite discomforting by the end of the ride and hurt whilst going up stairs. After 2 weeks rest the discomfort disappeared. I then took 6 weeks with no cycling/running and returned to the bike to find I developed the same anterior pain under the patellar after approx 20-30 minutes. Before the onset of pain, I found a tightening in the right hamstring and when I stand out of the saddle to stretch I feel a tightness in the back of the knee. As soon as I get off the bike the pain disappears and I can walk/run with no discomfort.

After the first year of repeated attempts at recovery with no success I started physio treatment which I've now had for a year. After the first month of flexibility/manipulation I was able to extend my cycling to 40-50 minutes before knee pain. Since then I started strength work and more recently core strength including regular stretching, however, my ability to cycle without knee pain is back down to 15-20 minutes.

I took my bike and turbo to a sports/orthopaedic physician who concluded that the bike was well set up and the look cleats have good lateral movement. When fatigue begins there is a tendency for the right knee to drift towards the frame. At this point when I sit up and cycle I feel soreness just above the knee cap, like something is hooking the tendon tight on each downward pedal stroke. It was also noticed that the toes on my right foot grip the floor when doing a single leg squat on right leg. The specialist found nothing evident in the modified Thomas and Ober's test to point to tensor fascia lata, itb or rectus femoris but noted that my pain is around the superior medial aspect of the patella. He noticed I have a very slight inward squinting of the right knee and right foot (and slight pronation). In addition to this, a knee ultrasound found everything to be normal apart from a small amount of fluid when knee is flexed suggesting a minor abnormality in patellofemoral area. There is also a slight thickiening of the femoral insertion on the lateral collateral. The good thing is that at least the physios and specialist have the same opinion that my problem is maltracking related.

I have followed the advice to strengthen external hip rotators, VMO and hamstrings and kept the stretching going, especially as both specialist and physio found my right hip to be less flexible and a reduction in balance from the pelvic region. Since then my core strength has improved and my right foot appears normal (like the left) when doing a one legged squat. Other areas of weakness are that my right abductor is tight, left hamstring is slightly tighter due to more focus on right leg stretching, and both glutes are noticeably tight so I need to regularly work on these.

When doing strength work my right hamstring seems considerably weaker, and I have pain in the back of the knee when performing hamstring curls or isolated hamstring bridges with a Swiss ball. This pain tends to last for a day or two afterwards and I find it is hampering my progress although I have used ice and anti-inflammatories. My most recent bike session on the turbo trainer (with 2 LeWedges in my right shoe for the first time) showed the same early symptoms where the discomfort started in the superior medial part of the patella, especially so when I take hands of the bike and pedal sitting upright. I stopped quickly before onset of pain and iced my knee.

A final comment is that over the last couple of weeks I have had a feeling of inflammation or fluid in the same area as above probably due to irritation from exercises. It is more noticeable when sitting at the office desk for long periods with 90 degree knee angle so I feel I need to keep the right leg stretched out. I also find that if I clamp my right foot whilst sitting and try to bring my knee upwards I get a discomfort in the back of my knee where the hamstrings insert. Oddly, I was pain/inflammation free whilst on holiday for 2.5 weeks last month when I did quite lot of walking in the mountains.

Do you have any advice on what might be happening here with the inflammation/irritation and advice on my injury in general? Any opinions are very welcome!

On a final note, well done on a great Q&A section, it provides excellent reading and has proven a good source for ideas to help with my injuries. Keep up the good work!

Rich Hurley

Bristol, England

Steve Hogg replies


I suggest that you set your cleats up as suggested on this post and this post. This may involve seat height change if the amount of adjustment that you require is large. I assume that you will need to move the cleats rearward. If so, let me know how much and I will advise on how much to drop the seat.

Once you have done this and adjusted to the change and if the problem is still present, I would hazard a guess (and it is the most likely reason but at this remove it is a guess) that you could do worse than get hold of a packet of Lemond wedges and experiment. The reason that I say this is that most riders favour their right legs (no matter whether they are right of left handed or footed) and my belief is that there are neurological reasons for this.

If you were tired on the Sunday of the injury and your position and biomechanics were less than optimal (likely?) then the injury in broad terms is a result of this right side favouring when under pressure. I find too that there is a high correlation between the sort of thing I am talking about and a right forefoot varus to a degree not present on the left side. It would be worth showing your physio this and determining the forefoot varus (or valgus) of both feet. I would be interested to hear what you find.

Saddle pain


On Cyclingnews and your own site I have been reading your thoughts about bike positioning - the ways to fit your bike and positioning solutions to many problems. I tried many ways to sit on my bike to improve pedal efficiency, comfort, weight distribution and aerodynamics. Now I have a huge problem: whatever saddle position I use, there is always pain involved at the contact points between me and the saddle.


A higher position (powerful, but…) my pelvis rotates forward which sometimes brings pain when riding at higher intensities on the soft areas and the sit bones. Having the saddle more forward to be on the wider part of the saddle is not a solution as there's still a stab of pain in the genital area sometimes. With a lower position I am really sitting on the saddle experiencing no pain in the genital area anymore and still powerful.


When I remove my hands from the bars, I do not fall forward and can maintain the position (now the bar is a centimetre higher and rotated so the hoods and drops are more easy to reach)

I get pain, and I'm not comfortable when pedalling when my saddle is more backwards, and later, I get swelling at the place where the bone is on the saddle on both sides (not the saddle sore place but a little more forward - I had this during last summer because of the seams in one of my shorts).

I put the saddle a little bit more to the back (so I am more on the smaller part). It seemed to ease the pain. I do not know if that is the solution, but it was already too late. I rode the last part standing. I can't ride until it has healed. Just at the moment my morale was good because I was noticing results of my training.

What is the problem now? Maybe the saddle is too wide or too far forward and the wider part of the saddle is in contact with the femur - hip joint, and I have to sit on the smaller part to prevent that. I have a Flite saddle.

Jan Denayer

Steve Hogg replies


How much use has your seat had? One thing that I have noticed with Flites is that the underlying plastic shell can sag quite quickly and end up with quite a dip in the middle. The problem with this is that the rider either slides into the dip (discomfort) or has to actively present themselves from sliding into the dip (also discomfort). If this is the case, it could be making you slide too far to the rear of the seat and cause the problem you outline.

You may need a new seat or you may need a change of seat shape. It is impossible to be certain from the info that you have given me. The first thing I would suggest is a new seat if your seat is at all worn and has sagged. The other thing is that some seats just do not suit some riders. Have you used other seats in the past that you were happy with?

Q Factor on SPD-SL pedals

Hello Cyclingnews

I am a 46-year-old male fitness-road-rider

I have late model SPD-SL Shimano Ultegra pedals, cleats and Shimano road shoes (R151, black/silver with carbon sole).

I am looking for any rules of thumb/guidance as far as positioning my cleats with regards to Q-size. My pedals allow a few mm (2-3) of sideways movement either way and I am trying to figure out which way to position them. The reason for my question is that I noticed that my left leg naturally wants to "go out wide" a bit more than my right leg (else my left VMO starts to hurt a little bit under load) but the right one seems to be more or less in the centre of the pedal, so I wonder if this situation irregular and my body is telling me something. I am a left hander/footer and a flat-footed, if it makes any difference.

Yuri Budilov

Melbourne, Australia

Steve Hogg replies


From what you are saying, I will just about guarantee that you are hanging to the right to some degree on the seat. As your pelvis tips to the right, the left leg has to move outwards to compensate. Get hold of some Lemond wedges and try 2 as a starting point under the right foot. More than likely, this will help you feel more square on the seat, though to what degree you won't know until you try.

The reason that your left VMO hurts is that the left knee is moving laterally to compensate for the right hip down pedalling technique. From previous queries and if memory serves, you have a leg length discrepancy; which one was the longer?

Antibiotics and training

Hi, I am a 37 year old cyclist.

I train about 15 hours a week, including about 2 hours weight room the rest is on the bike. About 6 months ago I underwent surgery for the second time on my nose in order to get rid of recurring sinus infections. This included several antibiotic cures before and after. Because the sinusitis didn't pass I got new cure today for three months of antibiotics. Are there any guidelines or restrictions on training with antibiotics ?

Dave Duvekot

Kelby Bethards replies


Which antibiotic were you given? Different meds have different properties
and adverse effects.

Most of the time, the antibiotics are not the problem. The problem is the condition for which the antibiotics were prescribed.

Dave Duvekot then responded:

Dr Bethards,

The antibiotics are 10 days Oflodex (ofloxacin 200 mg) twice a day and three months of Resprim forte (800 mg sulphamethoxazole and 160 mg trimethoprim) one tablet a day. This medication is given for recurring sinus infections, after having had surgery twice. The last time six months ago.

Dave Duvekot

Kelby Bethards replies


So the two medicines you are on have different risk profiles. If you want I can send you the drug warnings, which of course is great reading. YEEHOO. With Ofloxicin (a medicine in the class of fluoroquinolones) there have been incidents of tendonitis and tendon rupture. Achilles tendon comes to mind when I think of it. I, personally, have never seen a case of this, nor do I wish to. Pay attention to tendons that seem inflamed though. Don't just "push" through the pain. That may lead to very bad consequences. The medicine has other reported adverse affects, but if I listed everything someone has reported on it, we'd be here a while. So, be careful about your tendons and just pay attention to what you body is telling you for side effects.

The other medication (a sulpha based medicine), the biggest thing that comes to mind is increased sun sensitivity. You'll burn easier. It also has a host of "side effects" but if you don't feel "off" while on it, then you likely aren't experiencing the effects. SO, wear the sun screen on the rides outdoors.

Hips and LLD


I've noticed in many of your helpful answers lately, you've mentioned if distance between the inner thighs at the seat post is different on one side or the other it may cause problems. But, isn't it natural for the gap to be bigger on the right because of the chainrings?

Jason Warner

Belleville, IL, USA

Steve Hogg replies


The short answer is no. All modern road cranks that I am aware of, place the outermost surface of each crank are where the pedal screws in, equidistant from the centre line of the frame, the dimension known as ' Q' factor. There are occasional exceptions but usually the difference is a mm or two. Most Mtb cranks are the same though the distance is greater.

The reason I mentioned inner thigh to seat post distance is that most riders favour one side in the sense of hanging or rotating forward or both to one side, usually the right side but not always. Unless someone has large thighs that brush the seat post, it is easier for people to determine to which side they hang by looking between their legs on a bike at the inner thigh to seat post gap, than it is for them to enlist an observer to watch what happens to them pelvically.

To recap, if the inner thigh to seat post gap is greater on one side, the rider will be hanging to the other side. To give an example; greater gap on left side means that rider is hanging towards the right. There are a host of reasons that this may be so but it is very common though the degree varies enormously.

Jason Warner then responded:


Your advise it wonderful! Thank you again. Your recent advice has focused on rotated hips and LLD, and I seem to have similar issues. But, my problem seems to be different from people you've recently helped. My left hip rotates forward while I'm on the trainer; however, my left leg seems to have the smoother stroke compared to the right while the left knee is closer to the top tube. Here's the difference, when I have my wife compare the length of my legs while sitting or lying down, my right is about three to five millimetres shorter. I may be reading your advice wrong, but it seems my hip rotation would mean my left leg should be shorter, correct? My varus on both feet has been measured, and I'm using shims on both feet to correct it. Any advice you could give would be greatly appreciated!

Jason Warner

Steve Hogg replies


The affected leg may be longer or shorter depending on the compensatory mechanisms that a person evolves. There may be no measurable discrepancy, just functional ones. I have written that a dropping right hip and various patterns of movement and compensation are very common. They are but are not universal and there is plenty of other ways different people function.

I wouldn't take your wifes' measuring of your legs as a reliable guide. If your left leg stroke is smoother, either that leg is longer [ and your wife is right about the length difference] or you are favouring the left in the sense of looking after that side at a subliminal level, while paying whatever price is to be paid on the other side. This is not common but far from rare.

Try twisting your seat nose slightly to the left. This will square up your hips to some degree and cause your left leg to reach further, but shorten the distance that your right leg reaches. Let me know how you get on.

Jason Warner then responded:


I've followed your suggestion and rotated my saddle slightly to the left. I've ridden about 200 miles like this, and it seems to help quite nicely. I do feel my left hip moving forward every now and then, so I have to rotate it on the seat some to get back in place. My right leg pedals a little smoother, but I have slight movement on the top of the stroke. But, overall, much better. Thank you much! Would you now suggest a pack up my right cleat a bit?

Jason Warner

Steve Hogg replies


Don't pack up the right leg unless you feel like you are not reaching the bottom of the stroke with the same power and control as with the left. Ideally you need to establish whether there is a measurable leg length discrepancy first. If your right leg is not reaching the bottom of the pedal stroke with conviction, yes pack it up, but understand that part or the entire problem may be related to the left hip drop making the right leg reach further because of not sitting squarely on the seat.

The movement at the top of the stroke you mention (and I assume that you are talking about the right leg) is a consequence of the left leg with concurrent left hip drop reaching the bottom of the stroke.
One bit of homework that is worth practising is when out riding, count pedal strokes with the right leg. Count 1 - 50 and after a short period do it again. Power and to some extent symmetry will follow awareness.

Riding for weight loss

My partner and I have just purchased a bicycle each to exercise and lose weight. How long each day should you bicycle ride to help you lose weight? 30 mins, etc, and does it have to be very hard riding?

Gail McGaw

Kelby Bethards replies


The general rule for weight loss (and I'm sure you'll get a much more verbose, informative answer from the other on the panel) that I tell my patients is that they need to do 50 minutes of aerobic exercise (and some anaerobic if possible) 5 times a week. The old rule you hear about 30 minutes a day for 3 days a week, that is for general heart health, not weight loss.

NOW, this assumes that you are eating healthy and not enormous portions. So, I tell my patients to eat healthy, do 5, 1 hour work outs at a good heart rate and give yourself a day off or two a week. DO NOT get on the scale daily. Do it weekly, and see how you progress.

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