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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 July 3

Training for young cyclists
Climbing speed
Making training harder
Pedal position vs. spin rate
ACL Tear
Best women's saddles
Different leg sizes
Elbow pain
"Crunching" knees
Top end speed
Inside leg/ knee pain
Quad cramps
Bike fit isssues

Training for young cyclists

Hi, I am a 15 year old cyclist and I am trying to find out how hard I should train at my level. I live in Southeastern North Carolina and where there are no hills or mountains to train on and few events to enter into.What would you recommend?

Troy Allen, North Carolina

Scott Saifer replies:

How much and how hard you, or any other cyclist older or younger, should train depends on at least:

1) Your goals
2) Your experience
3) Any health issues
4) How much time you have to train
5) What else you have going on in your life.

My personal goal for 15 year old cyclists is to provide them with guidance that will allow them to develop their cycling ability slowly but continuously for several years, so that they will ride long enough to find out what they really like to do on a bike and what they are good at.

If your goal is to develop into a bike racer or long distance rider, you should train hard enough every day to get just a little tired, but so that you feel well recovered and ready to go again the next day. Once every three weeks or so, allow yourself a longer, harder ride that leaves you tired for several days. For a 15 year old the emphasis should be on fun and on surmounting challenges rather than on competition, unless you are beating up on the elite categories already. By challenges I mean new distance records, tours, getting to the top of far side of something, going by bike to visit someone who lives far enough away that most people would drive...

Climbing speed

I'm a 22 Male Cat 4 racer 5'9 160lb. I just picked up racing this year and I'm now upgrading to Cat 4. I want to pick up my climbing speed by about 1-2mph on a 3.5mile 8% climb. I'm currently climbing this hill in 20 minutes at TT threshold (Heartrate) I'd like to climb it in about 18 but I can't seem to get any faster on it. What would be the best route to achieving this goal, so that I can maintain the pace with racing?

Grady Reel

Scott Saifer replies:

Interestingly, you are 10% heavier than the average successful professional rider your height and you are asking for a 10% increase in speed, so the obvious answer to your question is that you need to lose about 15 pounds to transform your body into a bike-racer body. The weight range for successful pro at 5'9" is roughly 135-155 pounds, with the climbers at the low and and the TT/sprint guys at the higher end. Note that there is a low end of the range as well as a high end. If you get too light, you lose power and climbing suffers. If you are too heavy, you may have power but your power-to-weight ratio is not compatible with fast climbing.

You haven't told us anything about your training, so some adjustment there might serve you well as well. Prescribing a training plan is beyond the scope of the forum, but at the least, you should be going above LT for long enough to get tired NO MORE THAN two days per week, and you should be riding comfortably below LT the rest of the time. If you are going hard on most of your rides, then simply backing off to keep your heart rate below 80% of max all but two days per week will make you much stronger in about 3-4 weeks.

Making training harder

I am recreational cyclist who goes on tours with a mountain bike. I normally train by commuting to school (around 10km each way) and other places (up to 30km) during weekdays. During weekends, I go for long rides of around 80 to 150km.

For my weekday commutes and weekend rides, Is it true that it's better if I train using knobby tires and go on the actual tour with slick tires, since I get a harder workout on each ride? As for my weekend long rides, assuming effort spent is about the same, is there any significant difference between a shorter ride (say 90km) on knobby tires and a longer ride (say 100km) on slick tires?

Your advice is much appreciated.

Leung Weiwen

Scott Saifer replies:

No, it is not better to train on knobbies. If you want a "harder workout", just go faster on the slicks. The only time I recommend deliberately increasing the rolling resistance of a bike is if you are training outdoors on very cold days. In that case working harder while going slower can be advantageous. The optimal intensity for your training is a whole other question.

Pedal position vs. spin rate

I recently tried changing my pedal position from the traditional 'ball of the foot right above the axel of the pedal' to maybe 7 or 8 mm in front of the axel. I noticed less muscular stress when climbing seated (was able to sustain high outputs without feeling tired muscles as much). However, it has severely capped my pedalling speed. During high output, I am accustomed to pedal rates around 105 rpm (sometimes above 110). Now, it feels very awkward when I get over 95 rpm. I'd like to get my high pedal rate back. Should I just spend some time re-training my spin? Or is it something about my pedal position? It's worth noting that my pedals do feel a bit too far forward, and my heels have a tendancy to rise (which they didn't before I moved my cleats). I also moved my seat forward to prevent me from overextending my legs due to the new pedal position.

Noah Bronstein

Steve Hogg replies:

Move your seat back to whatever setback it was before and drop your seat 3mm from your previous height. This should be enough to accommodate the 7 - 8mm that you have moved the cleats back. Then go for a hill ride as see if you have power and fluency through the bottom of the pedal stroke. By that I mean that you should not feel any sense of over reaching. If you do, drop the seat another couple of mm. Try this for a couple of weeks, say 3 - 4 rides a week.

If you then find yourself at a point where you are fluent and strong through the bottom of the stroke but still can't spin as smoothly as you would like, then it is likely that you have the cleats too far back.

If too far back, ankle movement is limited and there is not enough 'flow' at the bottom of the stroke. If you get to this stage, try 2mm further forward at a time until you find a point where you still have that solid balanced feel underfoot that you have now but can pedal at reasonably high rpm without trouble.

I have had a number of clients in the last 18 months who have followed my cleat positioning recommendations on CN and who I have subsequently postioned in person. In some cases, they had more foot over the pedal than they intended or thought that they had; i.e. cleats too far back. It is a tricky thing to measure without a helper who has had experience in this.

As I said, you will find a point where you are strong with the pedalling load widely spread but still able to spin freely. That point is your correct cleat position.

ACL Tear

Not really a question here, just a note.

On December 27th of this past winter, I tore my ACL (100%) in a soccer game. There was minor cartiledge damage and a minor sprain to my MCL. I got on the indoor trainer 3 days later to test it out. Needless to say, there was limited range of motion, but I could pedal at about 20 rpms and a 49 watt normalized power for 20 minutes. I gradually built up from that, even after the MRI and follow-up suggested surgery. At the second opinion I got a month after the injury (from a trusted ortho), I was told that it would not be a problem to wait until after the cycling season for surgery. This was partly because the MCL and cartiledge had healed and my knee was doing extremely well. I was back on the bike and up to my full training, sans full-on sprinting. Now, I have gone back and seen the ortho, and he is absolutely amazed. My legs strength, from years of soccer and cycling, is compensating for the lack of an ACL to the point that he can tell no discernable difference between my two knees. This is to the point that he says I don't need surgery, period. I have no problems or pain other than occasional stiffness and no swelling after workouts. I have also, so far, had a successful season with several top-10 finishes and have just won my state's elite criterium championship.

Basically, what I'm saying here, is that a knee injury is not going to throw off season plans. Cycling is about the best thing a person can do for their knees, and is generally the first step to recovery anyway. Just something to reference when you give advice on injuries.

Ben Faulk

Kelby Bethards replies:

You are correct about the bike being great for the knee. You are also very fortunate that your joint structure and musculature allows you to rehab and function well without an ACL.

I have torn mine and likewise road a lot. As a matter of fact my knee was just feeling wrong for a long time and finally I was diagnosed with the ACL tear (8 months after my injury - yeah, I waited a while). The bike felt great, but for most, any sport that requires lateral movement (soccer, tennis, ultimate Frisbee, etc.) requires an ACL. There are the few (there are few American style football players out there playing without an ACL) who can get by without ACLs, which is great, but for most, they need repaired.

So, your advice is warranted. Cycling does not utilize the ACL and you can ride with or without one and have a good season. However, you are actually in a small percentage of people that get away with tearing an ACL.

Watch your knee over the years to come also, and make sure you do not get too much increased joint laxity. That extra laxity can lead to arthritis and an increased valgus deformation over time (sort of knock kneed angulation).

Dave Fleckenstein replies:

I like the approach that your second surgeon is taking. In the short run it is not essential for the ACL to be repaired, particularly when performing a non-impact sport such as cycling. In the long run, however, my opinion is that having it repaired is the right thing. Now, before our readers bombard us with letters saying how they have done well without their ACLs, I would say that certainly some function well if they are ACL deficient, particularly if they do not participate in any high impact or lateral activities. But, in the long run, once the ACL is gone one of the primary restraints to anterior shear of the tibia is lost. This excessive motion is absorbed over time by the meniscus, which is not ideal and can lead to accelerated degenerative changes at the knee.

Please look at this prior posting.

Best women's saddles

I have read the articles related to women's specific bike fit by Steve Hogg on the web site and any emails related to fit on the cyclingnews fitness Q&A section. Steve has a list of recommended women's saddles in his "More Sensitive Issues" article dated 2000. I would love to see an updated list of saddles that he recommends for women and am sure there are many other women who would benefit from this advice. I desperately need a new saddle, but getting one that is comfortable is such an ordeal.

Thanks for any help that you can provide.

Robin Crumpton

Steve Hogg replies:

Here is your list but I will qualify it by saying that a lot of 'seat' problems are not caused by the seat but by it's fore and aft position on the bike and how that forces a womens weight to be supported. Additionally, there is no one seat that suits everyone and even with a good position, some experimentation with seat types is sometimes necessary.

Other factors can play a part in 'seat' problems too. If bars are too low or too far away, this is often seen as a 'seat choice' problem because of pressure on soft tissue when it isn't necessarily. Rather it can often be how other parameters of our position force us to bear our weight on our seats. For many women, 'too low or too far away' can be as little as 3 - 5mm and have negative effect on genital comfort.

If the seat is too far forward, this too can mean weight being borne on tender areas unnecessarily no matter how 'good' the choice of seat is.

Another thing worth mentioning is that anything from nose up a couple of degrees to nose down a couple of degrees can have a large impact on comfort. By a couple of degrees I literally mean 2 degrees. This can be established fairly easily with a dial protractor providing of course the bike is dead level. If in doubt, place a steel 300mm straight edge along the length of the seat and place dial protractor on top of that. Read what it says and then turn the bike 180 degrees and take another reading. If the floor isn't level, you will get two different numbers. The true number is halfway between the two you have read off the protractor.

There are a significant number of women who are flexible in the low back but have poor core strength. The nett effect of this is that when they are stretched out with hands on drop bars or sometimes brake hoods, their lower torso profile as viewed from the side tends towards concave. Their degree of low back flexibility means that they feel no back pain but to achieve that concave extension of the lower back ( often but not always accompanied by tension in the shoulders because they are using the shoulder complex in an attempt to stabilise themselves) they have to rotate their pelvis forward excessively which means jamming genitalia into the seat. Contact with the seat is fine. A lot of pressure isn't.

The lower back should tend slightly or more towards convex, not concave.

Here is your list along with a few comments:

Selle Italia Ladies Gelflow ( the OEM versioncan also be called a Ladies Trans Am). Probably the safest choice out there as in my experience more than 90% of women have no problem with this seat providing it is reasonably well positioned.

Terry Butterfly seems to be a clone of the Gelflow / Trans Am.

Selle San Marco Atola and Arami these are the same seat but one has a longer nose than the other. They have two elevated gel filled raised sections at the rear that the sit bones are supposed to be supported by. These seats often have to be raised a bit more than average at the front for best comfort.

Selle San Marco Aero isn't specifically a womens seat but I have come across a number of women who won't ride anything else.

There are also a million iterations of big, fat, overly padded seats. Too many of these are so wide and have such short effective seat rail length that they force the rider to sit further forward than they should but are so soft that any negatives are related to performance rather than comfort.

These are seats that I have extensive experience with. I have come across customers with various models of Koobi seats that the felt were very comfortable but they are little known as a brand in Australia where I am. The Selle SMP seats look interesting but importation of them has only just started here and I have ordered some, both men and womens versions to trial with 'difficult' customers.

I sometimes find women for whom the seats listed above are too wide in the sense that they contact the rear of the thigh with the wide part of the seat during pedalling. Some of them are quite comfortable on what are usually termed men's seats but I have found no hard and fast rule as to anything that I can recommend. Another thing that I see a lot of is women who are not aware of any seat related problems but don't sit on the seat as it's designer's intended. Instead they sit almost on the rearward edge of the seat and pay a performance price in the sense of reduced on seat stability.

Lastly, if a women rider has tried a lot of seats and can't get comfortable, then often it isn't the seat specifically that is the issue, but rather the position she has on her bike that is at fault.

Different leg sizes

I am a 21 year old male and I am currently into bike racing as well as triathlons. I think that I have seen this question asked before on your website but I can't seem to find it when I search. My right side of my body is the more dominant side and I have read that usually your non-dominant side will be a little bigger due to it not being as well trained so therefore it has to work harder. But in my case, the size difference in my right leg is about 1 inch to 1 ½ inches smaller than my left. Is this size difference normal or am I doing something incorrectly on the bike or in my workouts? Any suggestions or feedback would be helpful. Thanks.

Joshua McKean

Steve Hogg replies:

Am I safe to assume that when you say ":my right leg is about 1 inch to 1 ½ inches smaller than my left." that you are talking upper or lower leg circumference and not leg length?

If you have a difference of 1 - 1.5" in circumference, then you have a problem. It may be functional, it may be neurological or a combination of both. I would suggest that you see a good physio and find out why you are like this.

If one leg is that much bigger, then it is doing more work, that simple, and by the size difference, a lot more work. The tough question to answer without seeing you is why it is doing more work.

If your right leg is shorter, and I'm reasonably sure that isn't what you mean, then get back to me and I will advise.

Joshua replied:

Sorry for not specifying on whether it was leg length or circumference but yes, it is circumference. When I do sprints on my bike, am running on a track for interval work, or ride down a ramp on a time trial, I always start with my left leg because I can get more power for my first stroke or first step. Even when I play basketball I always jump off of my left leg when getting a rebound or trying to do a lay-up. Do you think that over the years of doing this on the same leg over and over could cause such a dramatic size difference between the two legs?

Also, when I was younger I had a bike accident and landed on my right knee so ever since 6th grade, my right knee has been noticeably weaker than the left. Do think that because of this, my body and brain have just become used to the fact that its weaker so therefore my left one ever since that incident has been working harder?

Do think I would specifically need to see a physio or would an orthopedic doctor with a specialty in sports medicine do the trick? Thanks for your response and suggestions. I really do appreciate it.

Steve Hogg replies:

I may be wrong in this. We can self protect an injury to the point where we evolve patterns of motion that don't load that area or injury. These patterns of motion can often outlast the injury and be semi permanent and hard to break out of. I would be seeing some sort of health professional with a good grounding in neuroanatomy and an understanding of how these things happen and how they are broken down and replaced with more symmetrical use patterns.

Go and see you physio as the first point of contact and ask him or her who they feel they should refer you to.

Let me know what happens with this as I find this sort of stuff interesting.

Elbow pain

I am a 50 year old, female who just purchased a Terry Madeline road bike. I'm in the test driving period and have made several trips to the bike shop for adjustments. One of the first adjustments made was to slide the seat forward a bit so that I didn't feel like I was hyper extended with no bend in my arms. This helped me relax my shoulder and took the kink out of my back but as soon as I did that my elbows began to ache. Another adjustment we made was to add one more spacer to the handbars, thinking that perhaps that would make take some of the pressure off my arms and reduce the pain. I like riding in a more upright position.

I've tried to get out on the bike a much as possible since I only have a two week window to test drive it before sending it back if I choose not to keep it. Today, I did a 10 - 15 mile ride and even with cycling gloves (which on shorter rides seems to help with the pain) my elbow ached during and long after the ride.

Do you have any suggestions? Aside from the aching elbows it's a great to be out on the bicycle again and nothing else seems to be a problem. It rides like a dream but the elbow pain is a nightmare.

Nancy Alemany
Texas, USA

Steve Hogg replies:

When the seat was moved forward, the weight of your upper body moved with it. That weight has to be supported somehow and it is the job of the arms to do that. It is the bearing of two much weight on your arms that is the likely culprit. The other possible but less likely happening is that the reach to the bars is no too short as well as the seat being too far forward and your arms are working hard to keep you upper body supported and stable.

A better solution would have been to leave the seat back where it was and shorten the handlebar stem. In your previous seat position you say that there was no elbow pain but a 'kink' in your back and shoulders that weren't relaxed.

Pay another visit to the shop and ask them to move the seat back where it originally was and to shorten the stem by the same amount as they have to move the seat back.

That should at least resolve your problem. Once that is done and if you have any other queries, let me know.

"Crunching" knees

I have been a runner for about 7 years. I used to run marathons and run 10-15 at least five days a week. For the past 5-6 months, whenever I bend down or do squats, I can hear this "crunching" noise in my knees which is accompanied by pain. I have stopped running and do yoga and work out at the gym. Do I need to worry about this "crunching" noise in my knees and if so, is there anything I can do to eliminate and/or stop this from getting worse. I am concerned about it and it does cause me pain, especially when I first get out of bed in the morning. I have always been very physically active. Any suggestions would be very helpful. Thank you.

Susan Kelley

Scott Saifer replies:

You don't need to worry about the crunching noise necessarily, but you should worry about the pain. Both have many possible causes, some of which are benign and will go away with a little rest, and others which could get gradually or rapidly worse without some real medical attention. After 5-6 months of noise and pain, you can conclude that the problem is not going to go away by itself so it's time to see the doctor (sorry).

Top end speed

I'm a mid 40s masters racer in the Pacific Northwest. At 5'7" and 135 lbs, I hold my own in road races with longer climbs but what I really lack is a decent top end. Once the spring road race season is over in early June I'm suffering in the crits. I stay with the pack usually without too much trouble, but when it's time to come around or make a break forget it. Because of my general endurance I can post some decent times in longer TTs but fare much worse on a windy or short TT course. I'm looking for suggestions on developing more power (and hopefully something that will work for a guy busy chasing three kids under the age of 6). Thx.

Brad Laesch
Seattle, WA USA

Ric Stern replies:

It sounds most likely that you need to increase your sustainable power output. Currently, it sounds like your absolute power isn't that high but that your power to mass ratio is good. This would allow you to climb well, but could potentially see you disadvantaged when mass is of less importance (although mass is of importance) such as in a short time trial or a criterium.

Potentially, there's two areas that you need to work on:

1) increasing your MAP (maximal aerobic power)/VO2max

2) increasing your lactate threshold/TTpower

These can be increased with short intervals of ~4-mins at above TTeffort and longer intervals at around TTeffort. It's impossible to make specific recommendations - you need coaching for that (which we or the others at cyclingnews can help you with). These intervals could be performed a couple times per week, and as they're short (up to 1hr or so in total) can hopefully work for you and your kids.

Watch out for some general advice on these aspects on my daily Tour de France reports and


I am a 47 year old athlete who recently underwent a stress-test (Bruce protocol). My physician wanted a baseline stress-test due to my age and a complaint of sharp chest pain during some climbing. My beginning heart rate was 48 bpm and my blood pressure was 135/85 at the start of the test. The stress test was normal except for an increase in blood pressure that went as high as 250/122 when I reached my predicted heart rate of 147 bpm. My heart rate went down to the mid forties within two minutes of the conclusion of the test but my blood pressure remained elevated for sometime. I do have a history of mild hypertension (usually 130/78-80mmHg). Now that I have a graphic illustration of what happens when I work out I am willing to go on anti-hypertensive to help lower my blood pressure to the recommended 120/70. My concerns are as follows: Can the medications effect my performance by limiting my heart rate? Will the medications effect my electrolyte balance since I train in the desert? Do athletes have a tendency towards a higher blood pressure due to their bradycardia? Finally, what medications do you recommend in athletes, ace inhibitors, beta blockers or diuretics?

Kurt Luedtke
Tucson, Arizona

Kelby Bethards replies:

You have a few good questions. Here are the answers. Yes, possibly, no, diuretics or ACE.

Okay, for real:

Yes: medications can limit your max heart rate, but not all of them. Beta blockers do as can calcium channel blockers.

Possibly: Diuretics come in a few varieties, all of which change the resorption or excretion of electrolytes to lower your total body water volume. This of course may be bad for someone in the desert. ACE inhibitors can also, but in my opinion, less so. I would lead towards an ACE in your case.

No: Athletes actually tend towards lower blood pressure from their conditioning. They have bradycardia because the pump (heart) has a larger stroke volume and is more efficient. You case is probably from good ol' genetics without actually hearing more about you.

I would talk to your doc about these exact concerns. Tell him/her you need to not have your heart rate limited and don't want to run "dry". I'd bet an ACE or maybe even another class of med will be prescribed.

You have a case of an exaggerated blood pressure response. Usually the systolic goes up, but tops out, depending on the person in the 160 ish range and the diastolic goes up the drops a bit. You may want to consider further testing on your heart, that is more reliable than the stress treadmill.

Inside leg/ knee pain

I am a 48 yr old male, recreational cyclist, riding about 100 or so miles a week. Recently purchased a new bike, shoes and pedals. On a recent ride a friend noticed my right leg, rather than tracking up and down, was essentially "wobbling", with the right knee moving in and out towards the center of the bike as the foot travels down.

I have been experiencing pain and cramping on the inside of my quads, ( I think in the adductors and Gracilis, maybe sartorius??), and I had cramps there even before the new bike, seems as if I use the inside much more than any other part of my leg for some reason. I also have pain in the inside right beside the knee, nothing locking up, but sharp pain there.

Seat height appears about right I don't seem to be rocking at the hips.

Any idea what might be causing this?

Sid Kitchings

Steve Hogg replies:

When you say "I have been experiencing pain and cramping on the inside of my quads"; is this like the other stuff you mention, only apparent on the right side or are both sides affected?

Sid responded:

Cramping on both sides, more tightness and pain on the right though some on left, just seem strange that those muscles are bothering me vs. quad or hamstrings?

Steve Hogg replies:

How far from the top tube are your knees at the top and bottom of the pedal stroke?

Have you checked the rotational angle of your cleats?

If not, you need to make sure that whatever pedal system that you use has the cleats angled so that where your foot naturally wants to sit under reasonable load, that you have a more or less equal range of free movement either side of that. Is that the case?

If not, it may be the reason or part of the reason for your problems. What pedal system do you use?

Next, if it is your adductors being strained, I can't believe you are stable on the seat. Typically, the adductors only protest on a bike if the rider is moving laterally on the seat as they are a pelvic stabiliser amongst other things. If you are not stable on the seat, under any sort of pressure, you will enlist whatever you have to try and regain stability and it is this type of scenario that can cause the adductors to fire up.

How flexible in the lower back, glutes and hips are you?

The right knee wavering could be for a number of reasons. The most likely are that you have uncorrected foot issues on that side or that you are favouring the left side in the sense of twisting forward on that side and / or dropping it on each pedal stroke and dragging the right side around as a consequence.

Possible too, is that you are inflexible but have your seat too low which allows you not to move around on the seat but as a consequence, your knees rise higher at the top of the pedal stroke than you can easily accommodate.

Have someone eyeball you on a trainer and give me as much info as you can.

Quad cramps

Like most who refer to your site, thanks for all the good advice and your patience in trying to solve problems. I am a 49yo male cyclist, 6', 182#. I have been riding off and on since about 1980. I ride with a local club in Honolulu and average 100-125 miles per week of club rides.

Pertinent Facts: I ride a 58cm bike, with a 57cm top tube. I wear Sidi Genius 4 shoes with the red cleats (size 45.5) and use Look CX6 pedals selected to 9 degrees of float. Seated on a table with my legs hanging down my left foot is pretty straight but my right foot angles out (toes out). My cleats are set up as you have described on the site.

Issue: On rides longer than 30 miles, my right quadricep cramps, preventing me from continuing until I take a break and stretch. Even then, at a much reduced level of effort. The cramping extends from the upper inside of my right thigh, past the quad to the knee. It seems that my right leg works much harder than my left. As you might expect, it is exacerbated by big ring riding and climbing. I can't really define when I first noticed the problem. Some other facts. When pedaling, my right quad is closer to the top tube than my left. Attempts at adjusting the right pedal Q factor out (away from the bike) have not corrected the issue. The sensation I have is that I am not able to sit square on the saddle and that my left foot is lower than my right. In addition, my sense is that the right leg is always under a load, and never feels relaxed like the left.

In reading your columns, you have suggested to others that the issue might be a leg length discrepancy. I have never had this problem. I am, however, considering purchasing some Lemond Lewedges and placing one under my left cleat. Do you think this a wise action?

Lee Hankins
Honolulu, HI

Steve Hogg replies:

Get the Lemond wedges but hold fire for the moment. As a diagnostic method, drop your seat 10mm and tell me what happens. Does this make the right side problems better or worse?

What is the effect of the seat drop on the left side?

As viewed from above and behind, and you will need an observer to have a look at you while you are stripped to the waist on an indoor trainer to establish this, which hip do you drop and / or rotate forward?

If you can get back to me with those answers, I will attempt to advise.

Bike fit isssues

I am 28 years old and am a typical season bike rider and do most of my biking during the wormer months. I cycle about 3 times a week but would like to do more. In the winter I mostly cross country ski. I haven't been cycling that long. About four years ago I started competing in some sprint distance triathlons at a beginner's level. I hade been cycling a little mountain bike the year before that but mostly as rehabilitation because I was diagnosed with patella tendonitis the year before that (about 6 years ago now, before this I never biked).

Last year I did not do that much cycling because I was traveling a lot but started up again this year.

Symptoms I have had for the past few years.

Pain around the Patella in my right knee during and after longer (1:30-2:00 hours and more) bike rides. I get this more or less every time I go over 2:00 hours, it helps a little bit if I stretch a lot before the bike ride and do a good worm up.

Pain on the outside of my right knee. Use to get this a lot more before but not so much anymore. I will still get it if I don't do a lot stretching of the IT band right before a bike ride, or if I have not done any stretching for a few days.

New Symptoms for this year:

Irritating feeling in my left knee, feels like the patella isn't tracking correctly. It is not as bad if I do a lot of aggressive quad stretching right before the bike ride. It is also not as bad with, but still not great, with the new LOOK pedals that I recently put on my road bike where my feet are more angled out on the pedals.

I can get bad hip pain, mostly in right hip, after some of my longer bike rides but never during the ride itself. If I get hip pain it usually comes a little wile after I have finished riding and lasts anywhere from a few hours to a few days. I don't always get this, maybe every second or third week depending on how much riding I have done. I have also noticed that if I go to a chiropractor my hip is better for a week or so.

Lower back pain during, but mostly after, longer bike rides.

Also pretty often both my knees feel a bit sore and get a bit worm in the evenings after a bike ride that I have had previously that day.

Eddie Hult, USA

Steve Hogg replies:

It sounds like you are not sitting squarely on the seat. Can you verify this?

I need you to mount your bike on a trainer and pedal under load with your shirt off. You will need an observer to stand on a chair behind you and look down at your low back and pelvis. Which side twists forward if any?

On which side do you drop your hip if any?

What brand, model and size of shoe do you use?

What type of pedal are you using?

What seat do you use?

How flexible are you?

Have you noticed any differences in flexibility between left and right sides?

Do any differences in left / right flexibility become more pronounced in your cycling season as distinct from your skiing season?

Eddie responded:

I jumped on the trainer with my road bike and had my girlfriend observe me for a wile.

She looked at me for a few minutes and said that if anything is going on my right hip is dropping. She said if it is dropping it is very little, so little that she is not sure it is actually dropping.

She is quite sure however that no side is twisting forward.

(I did the same with my MTB and she saw no difference)

I have the Specialized S-Works Road shoe size 46 EU, 13 USA. These are my new shoes (about 3-4 weeks old, before I used my MTB shoes which are Specialized mountain bike shoe (don't know what they are called) size 46 and 12 USA (for some reason the USA size differ between the two??))

I am now using Look Keo Carbon pedals (use to have the same as on my MTB before I got new shoes, Shimano SPD)

My seat is a SelleRoyal Wing (came with the bike, looks like a regular road bike seat).

I am pretty flexible, I do a lot of stretching, I can touch my hands on the floor with my legs strait without bigger problems. However my thighs are very heavy to stretch, that is, I have to use a lot of strength to stretch them, it takes a lot of energy. The only thing that may not be as flexible as it should be is my ankles and calf muscles, they are a bit tight.

No bigger difference between left and right flexibility, if any my left thigh is bit tighter and perhaps my left glut, but not much if any.

I notice no difference at all in my flexibility between my cycling and skiing season or left vs right.

Steve Hogg replies:

Given everything you have told me, that you are flexible and reasonably square on the bike, there are a number of things that come too mind:

1. Have a look at these posts and position your cleats accordingly: and

2. Are your cleats at an angle that allows free movement either side of where your foot naturally wants to sit on the pedal?

If you have the grey Keo cleats, replace them with the red Keo cleats. The grey ones have very little rotational movement and it can be a chore to get them just right. The red cleats have more than twice as much rotational movement and are cheap insurance. If you are not using the freeplay, it isn't there. If you are using it, then you need it.

Once you have done this, go for a ride and put real pressure on the pedals for 10 - 15 strokes on each side. Now coast with right foot forward and attempt to move your heel inwards.

Is there available movement?

If no, adjust the angle of the cleat by twisting the nose of the cleat outwards and retest.

If yes, repeat the process of push hard for 10 - 15 strokes on each side but this time attempt to move your heel outwards when you coast. Is there available movement?

If yes and the amount is similar to the amount you have in terms of heel inwards, mission accomplished and repeat the process on the other side.

Once you have done both feet, it often pays to recheck the first one.

I think this is worth doing, but given that you have problems of two different bikes with differing pedal systems and shoes, this probably isn't your problem.

3. The knee is a single plane hinge joint. The plane of movement it is forced to work through can often be dictated by the function of the hips, and lower back at one end of the chain and the function of the foot and ankle at the other end end of the leg.

Get hold of some Lemond Wedges and fit 2 for starters to the right shoe and 1 to the left shoe with the thick side of the wedge to the inside of the shoe on both sides. Often this will mean that you have to change the angle of your cleats on the sole of your shoes by following the process outlined in Step 2. You should be able to determine fairly quickly whether the wedges are an improvement or not. If your feet feel more stable on the pedals it is a good sign. If this is what occurs, there should be a positive improvement in the knee wavering. Experiment with the number of wedges until you arrive at the number that feels appropriate.

4. Now for the big one; the back pain. At six foot 5, it is possible but not probable that you are riding bikes that fit you. You may have your seat too far forward and possibly too low. This will cause you to load your quads, work your hip flexors hard with back pain the result. If the bars are too low, this will just add to this effect. Alternately, you may have your seat too far back causing you to flex the lower back too much to reach forward to the bars.

Raise your seat to the maximum height where you can ride up steep hill at 75 -80 rpm pushing hard at a high heart rate and still feel like you are smooth through the bottom of the pedal stroke. Once you have done this, drop the seat 3mm from whatever height you are at.

Once the seat height is set, you want your seat at the minimum distance behind the bottom bracket that allows you support your upper body weight while maintaining a relaxed upper body. Test for this by riding at speed in a big gear at 85 - 95 rpm on the flat. You should be able to remove your hands from the drop bars without uncontrollably collapsing forward. You should be able to teeter for a period without arching your back or swinging your arms back towards the seat to assist you. If you pass this test easily, then move the seat forward until it becomes hard to pass and then move it backwards, say 10mm.

If you can't pass this test easily, move your seat back until you can. If this means a change in seat post, let me know and I will advise you what to buy.

At higher rpm than stipulated, it will be harder but not impossible to pass this test for most. At lower rpms it will be easier, so try and stick to that. If you have good core strength, you will do it easily. If you have poor core strength, pick the position where you are challenged but not massively. If your self description of flexibiltiy and your girl friends observations of your on bike symmetry are accurate, then you shouldn't have a problem

Once you have done all of this; if the seat needed to move back substantially, drop it 1mm for every 3mm that it moved back. If it moved forward substantially, raise it 1mm for every 3mm it moved forward. Then retest both cleat angle as described in Step 2 and seat height as described in Step 4.

5. Now you have to position your bars well. The correct position is where you can exercise all your hand placement options; i.e. brake hoods, bar tops, and drops with ease and comfort. It helps if you have an understanding bike shop that will let you trial different stem lengths and angles on a trainer until you are reasonably sure that you have the correct one. Once you think this is the case; confirm or otherwise on some longer, reasonably challenging rides.

When you are fairly sure that you have the right stem length and angle, re try the balance test and modify seat position as necessary. This may entail another stem length or angle change.

Once you have worked your way through this, let me know what happens. I apologise for the length of reply but you don't seem to have any standout obvious problems in the sense of the information that you have given me.

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