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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 14, 2006

Anti-depressants and weight loss
Riding with a prosthesis
Maximum heart rate increase
Total workload
More saddle pain
Knee stiffness
Outer knee pain
Lemond wedges

Anti-depressants and weight loss

I am taking the anti-depressant Wellbutrin and one of the side effects is weight loss. I ride approximately 5000 miles a year and I am pretty lean already. 6 ft, 167 lbs. I am having to overeat to keep the weight healthy so my questions is what kind of nutrition I need to counter the combined weight loss effects of training and the medicine? The high caloric is making me sluggish and giving me a gut. None of which I enjoy. What are the good calories that can keep it all in check and allow me to keep riding? Thank you.

John H

Pam Hinton replies


I wish that there was a straightforward and simple answer to your question. The best I can offer you is a possible explanation for why it is difficult for you to maintain a healthy body weight without feeling sluggish. Wellbutrin, generically known as bupropion, has been approved by the Food and Drug Administration to treat depression; smoking cessation is another approved use. Bupropion improves mood by altering brain chemistry. It is a weak inhibitor of dopamine and noradrenaline reuptake, meaning it effectively increases the levels of these neurotransmitters in the brain.

Some individuals with mood disorders respond to bupropion, while other people do better on drugs that increase the levels of other neurotransmitters like serotonin. Thus, patients are classified as responders and non-responders. Similarly, only some individuals taking bupropion lose weight. Most people on the drug remain weight stable, but others experience weight gain. Two mechanisms have been proposed for bupropion's weight-lowering effect: reduced food intake and increased metabolic rate. Studies using experimental animals have shown that bupropion acts, not by reducing food intake, but by increasing metabolic rate and therefore, energy expenditure. If the same holds true in humans, than the dietary energy required to maintain your body weight will be increased. Obviously, you have experienced weight loss and you are "overeating" to keep a healthy weight.

So, why are you getting a "gut?" The buproprion may alter other hormones that affect body fat distribution. There is very limited evidence from healthy, non-depressed, male athletes that buproprion increases cortisol levels in the blood at rest and in response to exercise (British Journal of Sports Medicine 38:129-133, 2004). Elevated cortisol secretion is associated with increased fat in the abdominal region. If this explanation is, in fact, what is happening (admittedly, I am speculating) then there's not a lot you can do to prevent the redistribution of body fat. I suggest that you follow a reasonable diet of complex, whole grain carbohydrates (60-65% of energy), fat (20-30% of energy) and protein (10-20% of energy). Eat enough calories to maintain your body weight. Remember that the purpose of the Wellbutrin is to improve your mood. If it is keeping you from enjoying something you like to do, you might consider an alternative antidepressant. Keep in mind that it can take several weeks for your body to adjust to antidepressant drugs. Give the Wellbutrin a fair shot before calling it quits. There is strong evidence that regular exercise improves mood, so stay on the bike. Take care.

Riding with a prosthesis


I am a 49 year old male who started cycling three years ago as a short commute. Last year at the urging of my brother I decided to get more serious about the sport in order to improve overall fitness and, to be honest, impress him with my skills. Here is the thing, I was in a motorcycle accident and became a below the knee amputee on one side when I was 18. When I cycle I use my prosthesis. Currently I am in good health and ride 70 miles per week on average, 50 of that is on weekends where I sustain 80-90% of my estimated max HR. I also spend about two hours a week on a trainer where I sustain 70-85% of max HR. Several months ago I completed a metric century and want to get a 'real' century in this year. Long term I want to be able to keep up with my brother who is quite a strong rider. To that end I am in the process of dropping 15 pounds off my current weight of 170 and want to optimize my training.

I have read some of your responses to others and am heartened by the some of the opinions of the contributors; especially in regards to strength being a less important factor when it comes to endurance riding as I am pretty sure I don't have the ability to generate the raw force with my right leg as with my left leg. What I want to know is what you think my capabilities are as a cyclist given a reasonable training regimen for a working stiff with a family. How big a factor is loss of a foot in terms of endurance? Is it reasonable to expect to be able to drop my brother someday?

Len Esparza

Steve Hogg replies


Some time ago I had a bit to do with double below the knee amputee from New Zealand named Mark Inglis who is well known over there. A lot of Kiwis I have met know of him and many have told me that he is a match for many able bodied cyclists. What I am saying is that I suspect your abilities to to perform your goal are limited more by training time than having lost a foot.
One thing though. Does your prosthesis have something akin to an ankle joint?

If so, I have found that amputees have a lot of trouble controlling the movement of the 'ankle' on a bike. What works really well from a power transmission point of view is if you can lock the 'ankle joint' and come up with a 'foot' that is fairly stiff but has some flexion with load on it. That will help smooth out your pedal stroke at the bottom of the stroke without needing to try and control the movement of the 'ankle joint'. To do this well may mean getting a different prosthesis for cycling with the cleat mounted directly onto the prosthetic foot.

Maximum heart rate increase

Howdy folks!

I am a 39 year old male road cyclist living in Sydney. I weigh 72kg, 177cm tall. I don't race but train like I do! Averaging 1200 to 1400km per month. I have a mild case of Hyperthyroidism. I used to get mild heart palpitations earlier last year but these seem to have disappeared as I've become fitter. My current resting HR is 58bpm.

I have been riding on and off for the last 20 odd years. I don't smoke, drink occasionally and try to eat well. My career can be quite stressful at times and the diet and sleep can suffer. I have been back on the bike since May 2005 after a break of almost three years. The last time I rode seriously was in Wellington NZ. By the time I left NZ my resting HR was 46bpm and my max HR seemed to be around 189bpm.

My training in Sydney peaked towards the Alpine Classic (200km in 41deg heat!) in Victoria end of January this year. Steve Hogg helped with my set up which I'm grateful for and I rode beyond my expectations. I rode Twaonga on the Friday, 10km climb and Mt Hotham on Sat, 30km climb before the Alpine Classic on the Sunday. My total time wasn't fast but my climbing was, (not A grade fast but better than most). Up to and including the Alpine Classic my max HR was 187bpm. Work commitments and the need for a rest (even though I didn't really feel like it) prompted a lay off since the end of January to now, approx 6-7 weeks. In that time I have managed 600km and the odd ride here and there; some hard, some relaxed.

A few weeks into this 'rest period', I started seeing a max HR of 195bpm on my POLAR HR monitor. This was after the unit had been returned from service. These were not spikes caused by interference from train lines but gradual curves up to that figure and back down again. I am able to download the data into my computer and examine the curves so I know its not spiking. This has happened several times and seems repeatable. Whereas once I could maintain 171bpm for quite some time, I can now do the same at 181bpm for the same perceived level of exertion. I think I'm going faster in some areas but I can't tell for certain. My HR seems normal the lower it gets, i.e. cruising, rolling down hills, resting etc. I have yet to cross check the readings with another POLAR unit and eliminate this as the cause. All other HR readings seem consistent with past experience.

My question is this: is it possible for a person's max HR to go up through intense training - did the extended rest period really do me good? Or is this a sign of some other problem?

I am planning on riding L'Etape du Tour this year in France, but if this higher max HR is the symptom of something wrong then I need to consider backing off on riding at that level. I feel fine otherwise when riding apart from what appears to be a higher HR at the top end. The usual aches and pains associated with riding a bicycle up hill and down dale so far have yet to disappear!

Any thoughts or advice on this would be greatly appreciated. To all who contribute answers to this forum, many thanks!

Wayne Haag

Scott Saifer replies


There are a few possible explanations, but the most likely seems to be that you had been keeping yourself somewhat fatigued with all your training and now that you are rested and fully recovered, you are seeing your "true" maximum heart rate again. This conclusion is supported by the fact (if it is a fact) that you are also riding faster than before your break. In fact, you must have been fairly deeply fatigued because, had you been training well, it should take more than a few weeks of training to get you back up to speed after a layoff of more than a month.

Unfortunately, you are right that you have been training like a racer. Many racers do keep themselves fatigued and therefore slower than they could be, just not a lot of the most successful ones. As you go forward, keep track of your pace for a given perceived exertion or heart rate. If it begins to drop again, give yourself a few easy days.

Ric Stern replies


I may be incorrect in the way that I'm reading your question, but it appears that you were doing consistent training, and then for a period of 6 - 7 weeks vastly reduced your training load, and your HRmax and sustainable HR have increased. If I understand that correctly, that's consistent with a decrease in fitness, such that a given workload will result in a higher heart rate when you have lower fitness. The same is true for HRmax - that too *increases* as you lose fitness (often around 5 - 10 b/min). Your HRmax decreases as you gain fitness.

I don't know if there is anything wrong with you, and while the issues you present don't appear to suggest anything wrong, if you're at all concerned with your health you should always seek the opinion of your doctor.

Your normal HR should return as you regain your fitness and your training becomes more consistent again.

Total workload

The more I read and learn about modern training science, the more it seems that many (most) self-coached athletes suffer not only from "the wrong kind of training" but also from "too much training, not enough recovery."

Judging from the number of questions relating to injury and overuse, I suspect you'll agree.

So, to my questions:

1) If I have a long/hard day planned, should I train to complete exhaustion (bonk), or almost to bonking, or leave plenty in the tank for later? What are some ways I can quantify that while still on the bike?

2) I've noticed that a really long hard ride, where I finish with no reserves, can leave me dragging for what seems like a week or more. In this case, should I go to "recovery only" with no hard efforts for a week or more, until back to normal? Or should I work through the fatigue at a reduced effort or volume level? Or continue with training as normal?

3) As a self-coached athlete, what are some ways I can determine that my workout is "not done yet," "just enough" or "over-doing it" while still on the bike?

Thanks for all the great answers!

Scott Braden
Richardson TX USA

Dave Palese replies


You are correct when you say that many cyclists tend to run themselves into the ground and are very often running an over-fatigued state which lowers potential performance.

Getting to your specific questions:

From the description of your training practices, I am wondering what kind of event you are training for? I don't, nor can I think of a situation where I would, prescribe a workout where an athlete rides to total exhaustion, so much so that the athlete can't train effectively for several days. If you intent is to improve endurance, you may want to rethink you approach.

It isn't important to just ride as long as physically can until your body starts to shut down (bonk). Look at your target performances and base your total training time on the length of those events. Whether those events are a local group ride or a race, doesn't matter. For club-level and non elite cyclist (cat 2-5 USCF) there isn't much need to have your longest ride be longer than 5 hours. Unless you are doing the few races on the domestic calendar that are the exception.

This all being said, you needn't look for a way to quantify your long training in the way you mentioned. Decide how long your rides need to be based on your targets, and design those sessions to address the needs of those events.

Adopting the above practice should help answer your second question, and you'll be able to train at a higher quality level more often.

To your third question, as a general rule, when your performance degrades below what it was at the beginning of the workout, it's time to call it a day. We train to go faster, not slower. Example, if you are doing an interval workout. When you can maintain the same speed you did on your first interval, within 1-1.5 mph, call it a day. Spin easy and come out fighting next time. You can apply this same thought process to many types of workouts, not just intervals. Your long days shouldn't be so long or intense that you are unable to maintain the same speeds, or riding quality as you did when you started. If you are barely making it home, try reducing the length or reducing your intensity at the beginning of ride so your average speed is more even through out the ride.

I hope this helps.

Scott Saifer replies


You are correct that many self-coached athletes are either doing too much or riding too hard, those that aren't doing too little. Very few ride too easily.

Bonk is specifically carbohydrate depletion exhaustion. I would never recommend training to a bonk. Rather continue eating and drinking to avoid bonking as much as possible. When you have ridden long or hard enough that your power or form are tailing off, you are done training for the day. Consider the concept that you become expert at what you practice. How good do you want to be at riding slowly while in pain? This relates to the concept of training quality: While you are making good power for the perceived effort (good speed given the conditions) you are doing valuable training.

You are right that it takes a week or more to recover from a really exhausting training bout. Therefore I'd recommend not training to exhaustion if you have a choice, but if you do end up exhausted, you should ride through the tired period, but at very low intensity and with short sessions. A common prescription is one hour rides with heart rate below 70% of at your CP-all day power level. Getting on the bike and turning the legs over speeds recovery so it's best to get back on. On the other hand, you can't do high quality training until you are recovered again so it doesn't make sense to try to really train. Really training while already tired keeps you tired, but does not gain you the fitness or efficiency you are looking for.

More saddle pain

This letter is a continuation of a March 6 posting

I am glad you replied. The sitting problem is painful and annoying, since it hinders me to ride my bike and train.

Because of the sitting problems last week, I skipped one day. Rode a week, and I had always an imbus spanner nearby and made several adjustments. On Saturday I was frightened as I felt there were going to be troubles in the pants again: Sunday there was a swelling again, so no riding. I am medicating it and hope it will be ok soon. Besides that, I would like to prevent the problem in the future by a structural solution.

Your reply made me think, so I will give some more info and history about the saddle - dip, shape and problems.

There are three sorts of sitting problems I encountered. Firstly in the genital area when the pelvis is rotated forward, where there was indeed an influence of dip in the saddle and saddle tilt. If you want the rear levelled it's good, but an upward tilted saddle nose is painful and if you level the seat to the nose, you slide forward, which is also painful. But this is not a problem anymore as I described before.

The other two are the ones that annoy me now: temporary saddle pain (sometimes when riding intense) and swelling or saddle sores.


1. My seat (Flite Ti) and former seats, last summer. I bought the flight seat last summer. It was one of the steps I took to resolve the sitting problems I had back then. The reason I chose the Flite is because someone advised me to buy a good saddle such as the Flite and only wear shorts without seams. And the flight itself does not have seams too. With the new saddle, I also started to use a more forward position and went to sit on the narrower part of the saddle (to prevent shifting)
2. My position. Because my position was not that good, I played with it a few centimetres this winter. But changing a good position in order to resolve all sitting problems does not seem to work. Now I think it can not be a solution to the saddle problems if your position is ok and stable.

I can use this saddle as a reference.

1. Now I try to sit on the sitting bones (for stability and not directing problems to another region).
2. With this saddle, the rear has to be levelled right.
3. But a little later, I still have to search for the right spot. Plus there still is temporary saddle pain at the contact points - hot spots (and saddle sores).
4. The swelling or saddle sores - I think if I am really on the sitting bones, thus on relative rear of the saddle, my legs may need more space, so the saddle shape can be wrong - too wide, the curve too gradual.

Conclusion and your suggestions

1. I do not think the replacement of the saddle will be the solution.
2. I hope the choice of another saddle can resolve it. As you suggest the dip (less dip and/or more forward dip) and shape could do it.
3. I hope you have some comments and concrete suggestions about shape and saddles that may fit well. Anything.


Steve Hogg replies


Thanks for the detailed info as it all helps. A seat that perhaps you should have a look at is the Selle Italia Pro Link Gelflow. They have a good thickness of firm padding, very little dip in the length of the seat, are quite flat across the rear of the seat and have a perineal cutout which may be of some benefit.

There are a number of other factors that may play a part in your issues as well.

1. Seat height: if the seat is even a few mm too high and the bars are low as well, perineal pressure and moving about on the seat can be one kind of fallout. To see whether this is the case, drop your seat 3 - 5mm and see if the difference is positive. If seat height is the reason or one of the reasons, dropping the seat should still allow good power, just more comfort.

2. Seat set back: if the seat is too far forward, then the rider won't be stable under load and will often enlist the shoulder complex to stabilise with. This causes the rider to shorten up their position by moving forward on the seat to maintain good stability.

Equally if the seat is too far back, then the rider is likely to move forward under pressure (that is going hard) to allow good power. Position the seat the minimum distance behind the bottom bracket that allows you to remove your hands from the drops without collapsing forward onto the bars. You should be able to teeter on the point of balance at about 85 - 90 rpm in 53 x 16 on the flat without too much trouble. If you are rock steady you are probably too far back. If you cannot do as described, you are probably too far forward.

3. Bar height: If your bars are too low, then perineal pressure and a tendency to move forward under load can be a symptom, though usually not the only one. Often neck and shoulder tightness is part of this as well. There are some people though who are flexible enough in the shoulders, neck and upper back that they feel no problems there even when the root cause problem is a bar height that is too low.

Once you have tried the new seat, let me know what happens.

Knee stiffness

I am 21 years old and have been cycling for about a year. I competed in triathlons all last season and am going to be racing bicycles in the spring. I have been battling an annoying right knee problem for most of the season. I have seen an orthopedic surgeon and he did not find anything just put me on steroids for a week and told me to take it easy. It helped for a little but it is back again. The problem seems to be mostly aggravated by biking. My knee becomes stiff and a bit achy after biking and I have trouble standing for long periods of time, however, I very rarely have any sort of sharp pain.

I have tried ice and IB profin without much success. I do not have any pain when running distances up to 18 miles but it seems to bother me on the bike which seems a bit odd to me. I occasionally have a stiff lower left part of my back and when I stand in the mirror my right hip is higher then my left. I had a friend also look at me while riding to see if I sit straight on the saddle and he said I did; if anything just slightly to the left. The condition gets worse when I push big gears so I have been trying to keep my cadence at 90+ or so. I would really like to fix this during the off season if it is a bike fit problem. Any suggestions would be appreciated.

I have been playing with my cleat alignment and setup a little bit and have notice that my right foot wants to point outward and my left is foot ahead or a little inward during the pedal stroke. Also, at the bottom of the stroke when going up my right knee rotates inwardly whereas my right knee track straight throughout the pedal stroke. I have a feeling this could be my issue however I am not sure what is causing this imbalance in pedal stroke. Thanks.

Nick Sparler

Steve Hogg replies:

Find a good physio and start working on your structural fitness, which from what you are describing lags a long way behind your 'physical fitness'. From what you have said, there is a discrepancy, measurable or functional, in leg length. You haven't given me enough to attempt to be definitive. See the physio, have yourself structurally assessed in a whole of body sense and get back to me with what you find. We will proceed from there.

Nick Sparler then responded:

I have been working with a chiropractor for a few months now and have seemed to improve upon my structurally fitness/alignment etc, however the above problem is still persisting. I was fit after the previous message and we lowered the seat a significant amount (.5-.75 in). However, this has not helped the problem. I am now also having calf tightness in the same leg right under the knee after an hour or so on the bike. I have tried shifting the cleats backwards to take some of the strain of the calf but that has not seemed to help either.

I have also tried Speedplay pedals with more float in an attempt to help the knee problem and they seemed to for a bit but not anymore. However I believe they may be precipitating the calf tightness as I never had this problem previously (SPD SL pedal and cleats). In addition, just from observation there seems to be slightly more "laxness" in the right knee than the left and a "clicking" on the medial side of the right knee when squatting. I recently got a fixed gear and when applying reverse pressure on the pedals to slow down I can feel a clicking in the medial side of the right knee below the quadriceps and not on the left knee. This problem has not stopped me from training due to pain but it is very annoying to have an aching knee while standing and one that just plain feels "weird" sometimes.


Steve Hogg replies


Has the chiro you have been seeing been able to shed any light on the causes of your knee problem? Has any one checked your feet to see whether or not there is a significant level of varus or valgus in the forefoot? You mentioned in your original email that "my right knee rotates inwardly whereas my right knee track straight throughout the pedal stroke".

Could you clarify that please? From all that you have told me I suspect that no matter what your friend says that you are not sitting squarely on the seat. Can you confirm this? Set your bike up on an indoor trainer. Make sure that the bike is level and have your friend stand on chair above and behind you. I need to know which side if any of the pelvis is forward and which side do you drop if any during the pedal downstroke.

Let me know the answers and I will attempt to advise.

Outer knee pain


I am a 48 year old female who races on the road and track. I am 5'4" and weigh 135 lbs. I have been riding for over 20 years. In the last five years I have been battling a sharp pain on the low outside of my left knee. This has been one of those ongoing issues I have had to deal with at the beginning of the season. It eases off over the year but never really goes away.

I'll include a bit of a medical history. About 15 years ago I fractured my pelvis in three places in a crash. Approximately 10 years ago I had a series of three injections in my back to deal with L4-L5 disc issue and the left side leg weakening sciatica which accompanied it. 3 years ago I had a very serious fall at the track resulting in a free fall landing on my backside. I have had PT and Chiropractic therapy to correct a tilted and rotated pelvis....probably dating back to the fractured pelvis. Yep, I am an old war horse!

This off season I took over two months off the bike. Starting this year the pain is back with a vengeance and feels like someone is stabbing the outside of the knee with an ice pick. The pain can start as early as 15 miles into the ride. I have worked on the premise it is ITB tightness. I trigger point, compress on a closed cell foam roller and stretch the IT and the quads, all of which hurt like hell. I would say I am flexible in my back since I can easily bend in half. My inner thigh muscles are not as flexible but I do yoga/stretching at least 2-3 times a week. My quads also seem flexible since my heel can touch my butt when stretched.

I did get a new bike and the brains trust looked into changing the position a bit. I am now 1cm higher and a bit more forward of my old position. I read with interest your comments, on your website, about foot positioning for women being 5-10 mm farther forward. I wonder how much lower the saddle would need to go to facilitate this? I suppose you would encourage I do the "hands off" test, yes?

Any thoughts or comments would be appreciated. Thanks.

Ann Marie

Steve Hogg replies

Ann Marie,

If you are going to move your cleats back, there may be implications for seat height but rarely are they more than a few mm. Occasionally more. Sometimes a change of cleat positioning will dramatically alter a riders pedalling technique and as a consequence the seat height change, either up or down may be larger than a few mm.
Re the pain, something is not working symmetrically and you have had enough injuries for me not to want to waste time speculating about the endless possibilities. Let me ask you a few questions:

1. Does the left knee waver at the top of the pedal stroke?

2. With the changes in seat height and setback, is the severity of the pain better, worse or no different?

3. What changes over a season for the severity of the pain to diminish as you describe?

4. Go for a ride until the pain starts to come on. Once you feel the onset, count 50 pedal strokes with your left leg descending. Does this make the pain better, worse or no different?

I still have to move the cleats back the 5-10mm but I will wait to hear back from you before making any other changes. I really want to hammer this problem out and believe one step at a time will give the info necessary to troubleshoot the problem. Get back to me with those answers and we'll proceed from there.

Ann Marie then responded:

Howdy Steve, here are my answers

1. No. I marked an X on my knee and observed the action myself then had someone stand in front of me while on the trainer to confirm the knee is not wavering.

2. I have only dropped the seat height by 3mm. I want to take it one step at a time. I did a 40 mile ride and the knee felt good. I wasn't riding hard by any means but the 2.5 hours went by smoothly.

3. I am not certain but can only assume I work it enough for the ITB to loosen enough for the range of motion to be accomodated. Perhaps my body simply settles into the machine more so or I compensate without knowing it.

4. I thought this was weird but hey what the heck, you are the expert so I gave it a go. Weirder still the knee felt better as I concentrated on the downstroke. Placebo effect? After thinking about it I realised by concentrating on the stroke I was performing a better "up and over" action.

Steve Hogg replies

Ann Marie,

There a couple of things that come out of your answers. Firstly, dropping the seat seems to have been positive at least for the time being as does counting pedal strokes with the left leg. It is likely that the way you sit or pedal or both is not quite symmetrical. This is common and I would say that 95% of riders favour their right sides at some level from subtle to obvious. Did you have these problems before the 'brains trust' raised the seat?

If the seat is even slightly too high for many people, it will cause them to obviously favour the side that they have a bias towards anyway. In your case it would seem to be the right side as counting left pedal strokes seems to help. What I mean by favouring the right side is that at a level below conscious thought, even when we are not consciously doing it, almost all riders have a bias towards one side which is usually ( there are exceptions) the right side. If your seat is a little too high and this causes you to favour the right side, you may be slightly over reaching with the left leg and even though your left knee tracks straight, this loads the area where the pain occurs.

Try dropping your seat another couple of mm and move the cleats back to where they should be. That may necessitate a further seat drop if the movement of the cleats is large. And yes, I would suggest you try the 'hands off ' test as well. It is a bit of blunt instrument approach but will work for most people to a reasonable degree.

Lemond wedges

Hi Steve,

I am writing in regards to the letter on the last issue of Q&A in Cyclingnews. The one titled "Q Factor on SPD-SL pedals". The writer says that his right leg tends to naturally move a few mm to the outside of the pedal. You told him to try Lemond Wedges to see if he could correct it. My question is this: in this case, are you asking for the wedges to be mounted with a cant or just flat to simply shim what could be a shorter leg?

The reason I ask is because I have the same problem. My right foot seems to always move to the outside of the pedal. Not only that but I have problems with pain on the outside of my right knee and on the front of the left knee. I have gone to physiotherapists and they all say that I do not have a leg length discrepancy but because I have scoliosis, my right hip is higher than the left. When standing in front of a mirror with just riding shorts, it is very obvious.

I figured it would be worth a shot to try your recommendation on the shims but I was just confused as to using them for canting the foot or to stack them so that they are flat. Thanks for your help.

Steve Hogg replies


Sorry for the confusion. It was my intention that he uses them as cants. This is not a guaranteed solution but well worth trying as I find an extraordinary number of people who have a noticeable right forefoot varus not present to the same degree on the left foot. This can be the driver or at least part of the problem for many on bike problems.

As to the leg length thing, trust nothing but a scan or similar. Again I have seen far too many people who found the results of a scan (which is pretty hard to argue with) quite at odds with opinions they had been given regarding leg length. Get hold of 'Overcome Neck and Back Pain' by Kit Laughlin as a self help manual for dealing with asymmetries. It is not as good as a switched on health professional but you can take it home with you.

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