Form & Fitness Q & A

Got a question about fitness, training, recovery from injury or a related subject? Drop us a line at fitness@cyclingnews.com. 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 (www.carriecheadle.com) is a Sports Psychology consultant who has dedicated her career to helping athletes of all ages and abilities perform to their potential. Carrie specialises in working with cyclists, in disciplines ranging from track racing to mountain biking. She holds a bachelors degree in Psychology from Sonoma State University as well as a masters degree in Sport Psychology from John F. Kennedy University. Dave Palese (www.davepalese.com) is a USA Cycling licensed coach and masters' class road racer with 16 years' race experience. He coaches racers and riders of all abilities from his home in southern Maine, USA, where he lives with his wife Sheryl, daughter Molly, and two cats, Miranda and Mu-Mu. Kelby Bethards, MD received a Bachelor of Science in Electrical Engineering from Iowa State University (1994) before obtaining an M.D. from the University of Iowa College of Medicine in 2000. Has been a racing cyclist 'on and off' for 20 years, and when time allows, he races Cat 3 and 35+. He is a team physician for two local Ft Collins, CO, teams, and currently works Family Practice in multiple settings: rural, urgent care, inpatient and the like. Fiona Lockhart (www.trainright.com) is a USA Cycling Expert Coach, and holds certifications from USA Weightlifting (Sports Performance Coach), the National Strength and Conditioning Association (Certified Strength and Conditioning Coach), and the National Academy for Sports Nutrition (Primary Sports Nutritionist). She is the Sports Science Editor for Carmichael Training Systems, and has been working in the strength and conditioning and endurance sports fields for over 10 years; she's also a competitive mountain biker. Eddie Monnier (www.velo-fit.com) is a USA Cycling certified Elite Coach and a Category II racer. He holds undergraduate degrees in anthropology (with departmental honors) and philosophy from Emory University and an MBA from The Wharton School of Business. Eddie is a proponent of training with power. He coaches cyclists (track, road and mountain bike) of all abilities and with wide ranging goals (with and without power meters). He uses internet tools to coach riders from any geography. David Fleckenstein, MPT (www.physiopt.com) is a physical therapist practicing in Boise, ID. His clients have included World and U.S. champions, Olympic athletes and numerous professional athletes. He received his B.S. in Biology/Genetics from Penn State and his Master's degree in Physical Therapy from Emory University. He specializes in manual medicine treatment and specific retraining of spine and joint stabilization musculature. He is a former Cat I road racer and Expert mountain biker. Since 1986 Steve Hogg (www.cyclefitcentre.com) has owned and operated Pedal Pushers, a cycle shop specialising in rider positioning and custom bicycles. In that time he has positioned riders from all cycling disciplines and of all levels of ability with every concievable cycling problem.They include World and National champions at one end of the performance spectrum to amputees and people with disabilities at the 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 (www.wholeathlete.com) is an exercise physiologist and head coach for Whole Athlete™. He is a former category 1 & semi-pro MTB racer. Dario holds a masters degree in exercise science and a bachelors in sport psychology. Scott Saifer (www.wenzelcoaching.com) has a Masters Degree in exercise physiology and sports psychology and has personally coached over 300 athletes of all levels in his 10 years of coaching with Wenzel Coaching. Kendra Wenzel (www.wenzelcoaching.com) is a head coach with Wenzel Coaching with 17 years of racing and coaching experience and is coauthor of the book Bike Racing 101. Richard Stern (www.cyclecoach.com) is Head Coach of Richard Stern Training, a Level 3 Coach with the Association of British Cycling Coaches, a Sports Scientist, and a writer. He has been professionally coaching cyclists and triathletes since 1998 at all levels from professional to recreational. He is a leading expert in coaching with power output and all power meters. Richard has been a competitive cyclist for 20 years Andy Bloomer (www.cyclecoach.com) is an Associate Coach and sport scientist with Richard Stern Training. He is a member of the Association of British Cycling Coaches (ABCC) and a member of the British Association of Sport and Exercise Sciences (BASES). In his role as Exercise Physiologist at Staffordshire University Sports Performance Centre, he has conducted physiological testing and offered training and coaching advice to athletes from all sports for the past 4 years. Andy has been a competitive cyclist for many years. Kim Morrow (www.elitefitcoach.com) has competed as a Professional Cyclist and Triathlete, is a certified USA Cycling Elite Coach, a 4-time U.S. Masters National Road Race Champion, and a Fitness Professional. Her coaching group, eliteFITcoach, is based out of the Southeastern United States, although they coach athletes across North America. Kim also owns MyEnduranceCoach.com, a resource for cyclists, multisport athletes & endurance coaches around the globe, specializing in helping cycling and multisport athletes find a coach. Advice presented in Cyclingnews' fitness pages is provided for educational purposes only and is not intended to be specific advice for individual athletes. If you follow the educational information found on Cyclingnews, you do so at your own risk. You should consult with your physician before beginning any exercise program.

Fitness questions and answers for May 1, 2007

Arch cleats
Foot drop
Hip impingement
Iron deficiency
Is my bike growing?
Off season rowing training
Piriformis muscle
Fused vertebrae
Who should I see?
Getting back on the bike

Arch cleats

There has been a lot of discussion recently about the benefit of placing the cleat under the arch of the foot. I have a few questions regarding this.

If I remember correctly you mentioned that when placing the cleat midsole there is no need for wedges to shim a forefoot varus/valgus, can you elaborate on this?

Also how would a LLD be affected by this? Would there be a need to change the height of the shim? What about saddle height? How much should I lower it compared to a MT position of the cleat?

Have you ever tried using two cleats under each shoe? A midfoot placement for climbing and a MT position for sprinting/high cadence?

Jens Westergren
Sweden

Steve Hogg replies:

I have to say at the outset that I am fairly new to midfoot cleat position having only been introduced to it a short time ago. I will answer your questions as best as my experience to date allows.

Re shims and wedges: I can't say NO need. Too early for me to say that. I can certainly say LESS need.

For wedging, when the forefoot is not involved, there is no need for forefoot correction providing the heel can sit in the shoe at an angle that accommodates the needs of knee further up the pedaling chain. For some people with calcaneal issues and shoes with an internal shape that force the heel into a certain relationship with the shoe, wedging may be necessary. For most it would be true to say no wedging is necessary. In my own case after eliminating wedging that I had used successfully (in the sense of some reasonably severe injuries from years ago not causing any pain or niggles) I found that I still need a small post under the first MTP. This is the cost of a fairly damaged knee not causing me grief. It is less compensation by far, than I have been able to use successfully in the past.

For shims, again I don't know definitively yet. I have a client with a measurable difference in leg length of 18mm. With his current cleat position and a 16mm shim, his torque curve is quite even and very similar on each leg. He has ordered some Biomac shoes that are designed for midfoot cleat position and I will experiment with differential cleat position which is something that I haven't been crazy about in the past, except when necessary to minimise rocking torque when using a shim. With midfoot cleat position, the tarsometatarsal joint is such a stable area of the foot, that it should be possible to have a measure of difference in cleat position without the negatives that can otherwise occur.

A couple of years ago I had a client visit from the Netherlands whose major issues were back pain. He has a measurable leg length discrepancy and one of the measures that I instituted with him was to place a shim underneath the cleat of the shorter leg. Mission accomplished in the sense of the back pain disappeared and he told me later that his average power had increased. I am still in contact with him and he has been experimenting with differential midfoot cleat position recently. He tells me that he has been able to dispense with the shims that I used and that he still has no back pain and that his average wattage has risen again. This is a sample of one only, but it is a positive sign and I hope to have a more informed opinion as time goes by. There has been interest in midfoot cleat position amongst a number of my customers, so I have a few people who are happy to be subjects for experiment.

If the LLD is all or mainly in the femur, theoretically, a shim should not be necessary with midfoot cleat position unless the femur length difference was so large that differential cleat position would not be enough to compensate without unacceptable trade offs. When any difference in leg length is in the lower limb, the picture is likely to be more complex and there has to be practical limits beyond which shimming is necessary.

I apologise if I'm not giving cut and dried answers but I as I say, early days for me with regard to midfoot cleat position.

Regarding seat height changes, there is no fixed amount that the seat needs to drop. In my limited experience to date it has varied from 27mm (the amount I needed to drop my own seat) to one case I know of where a 50mm drop was necessary. The average seems to be 30-35 mm but a lot of this depends on where the foot was over the pedal prior to changing to midfoot cleat position. I had the centre of my first MTP 20mm in front of the pedal axle centre as measured with the cleat horizontal (Speedplay) or 15 mm in front as measured with the foot level (i.e, that is with shoe leveled where the sole joins the upper at mid heel and where the sole joins the upper at mid forefoot).

In my case, changing to midfoot cleat position meant the cleat had to move back an extra 43 mm for a size 44 shoe. For riders with first MTP over pedal axle, the amount that the cleat needs to be moved back would be greater than that for a similar sized foot.

The biggest problem with midfoot cleat position is actually achieving it. A lot of shoes would need substantial modification and even then, it may not be possible. Swiss made Biomac shoes are made to accommodate midfoot cleat position but only with a two bolt cleat because like many shoes, the shape of the sole in the midfoot is concave.. I got myself a pair of Biomacs and am using long superseded Dura Ace SPD pedals. With the Biomac shoes, the sole is probably 5mm less thick than other shoes and that has an impact on the distance the seat needs to be dropped too.

Have I tried two cleats on the shoe, one under the TMT (midfoot) and one under forefoot?

Yes, but I only bothered persevering for a couple of rides. Firstly it is cumbersome to be trying to exit each pedal and re-enter in a second position in the last kms of a race when a few things can be happening. Secondly, initial jump in the sprint aside, I have found that my ability to rev out a gear on or off the seat has improved, my ability to hold a big gear when off the seat has improved a lot and when on the seat slightly. That is just in the sprint. I am climbing local hills faster than I normally do as well. Basically, as far as I'm concerned it is all positive.

There are definitely efficiency gains. Through the generosity of a few friends I have been able to cobble together torque analysis software and hardware. That shows that the midfoot cleat position makes a substantial difference to the torque curves of any rider that I have tested to date. Simply, at a given wattage, speed and cadence; the midfoot position produces a torque curve with a lower torque peak and higher torque trough than forefoot cleat position. What this means is that the rider isn't pushing harder, but rather has less pressure on the pedals but for more degrees of crank arc. Basically, the rider is able to push for longer in each crank rotation. What the flattened curve also means is that peak muscular contraction must be less for a given wattage. That means that a given effort can be sustained for longer.

I have used the same indoor trainer for years and it measures power output. I know historically, what the relationship between my heart rate and wattage is while performing efforts on this trainer. What I am finding with the change in cleat position is that in the longer efforts at a given wattage, my heart rate is the same as I am used to seeing, but takes longer to rise. That would seem to confirm what the torque analysis shows. In ramps tests, I still crack at the same wattage as usual but can maintain that output for longer.

In conclusion, if you are interested in midfoot cleat position, try it. From my experience to date, the negatives are a lessened ability to jump hard in a sprint but that seems to be largely overcome by increased ability to maintain a high speed in a sprint. The other potential problem is that on a conventional frame, there is substantial toe overlap. This is only an issue at slow speeds - walking pace, but has made me change a few low speed riding habits.

For me, those negatives are a cheap price to pay for the advantages which are substantial.

Foot drop

Here's an interesting one for you. I'm a 42 year Cat 1 from Texas who had a L4L5 right-sided lumbar laminectomy in December 1993. In 2000, I had a L5S1 left-sided microdiscectomy. Due to complications from my first surgery I have foot drop on my right side and my tibialis anterior has completely atrophied and is basically nonexistent.

Obviously, this has resulted in a very inefficient pedal stroke as every time I pull up on my right pedal, get out of the saddle to sprint, climb, etc, my right foot drops resulting in an inefficient pedal stroke. As you might have guessed, with foot drop on the right I have all kinds of muscular imbalances from 12 years of cycling. But, surprisingly, with two back surgeries and a ton of scar tissue to deal with, I have zero back pain and typically ride 250-400 miles per week.

With 12 years of dealing with back pain and a degree as a physical therapist, you kind of become an expert at treating anyone's back pain as a result of your experience with two back surgeries. The four things that I must do every day to ride pain free on a consistent basis are stretch my hamstrings, hip flexors, piriformis and hang from an inversion table for 10-15 minutes.

I have been a physical therapist since 1994 and this is how I have treated my own deficits thus far. I have moved my pedal cleat back on my shoe as far as it would go to decrease the fulcrum distance between the pedal spindle and my ankle joint. This helped to decrease the foot drop during the upward pedal stroke somewhat.

The thing that has helped the most by far is purchasing a set of Rotor Cranks. With the crank arms being offset and the right one coming through quicker to help eliminate the dead spot, these things have almost made my pedal stroke as if I did not have foot drop at all. I am just curious though from your expertise, between moving my cleats all the way forward and the addition of the rotor cranks, is there anything else I should be doing to make my pedal stroke more efficient?

Steve Hogg replies:

Your approach sounds sensible and you have done all the right things. Here are a couple of things that you may want to try.

Modify your existing shoes if possible (if not get hold of a set of Biomac shoes) and move your cleats to a position underneath the tarsometatarsal joint. That will flatten your torque curve, shorten your foot as a lever (and minimise the foot drop on the up stroke), minimise stress on the tibialis anterior as well as most likely allowing you to perform better too.

If you do this, then you may want to experiment with conventional cranks fitted with Rotor Q rings. Depending on the orientation of the Q rings, you should be able to mimic the effect of the Rotor cranks without the extra weight and less than ideal chain line that can accompany their use.

Hip impingement

I am a male 40 year-old veterans/masters cyclist who competes in road races and criteriums. My training loads are about 300km per week. I have an arthritic left hip that has significant ROM limitations in flexion and internal rotation/adduction. My bike set up is tailored to a best fit with my orthopaedic limitations.

Recently I have been suffering from the feeling that my anterior hip impinges on the top stroke and have been experiencing sharp pains with stronger efforts during attacks or pulling turns up hills particularly. I like to ride a lower cadence usually. I have had to quit several races recently due to worsening pain. I plan to consult an orthopaedic surgeon soon.

My questions are:

Are there any set up options that would be of benefit to minimise impingement?
Have you heard of similar cyclists with this problem and have they had symptom resolution with arthroscopic surgery?
Are there off bike training exercises that would be of benefit and maintain race fitness?
If hip replacement surgery is offered would racing be possible still. I assume a total hip replacement will be an option and not a Birmingham resurfacing type replacement?

Theo

Dave Fleckenstein replies:

Femoroacetabular impingement occurs when bony growth of the acetabulum blocks the femoral neck from moving through a normal range of motion and can result in the pattern of restriction identical to what you describe. Arthroscopic and open surgical techniques are used to remove this block and I have had some clients respond extremely well to this surgery.

I would recommend that you choose your orthopedic specialist carefully; often the clients who are candidates for this surgery have seen a number of specialists previously without resolution. I would also want to rule out labral pathology of the hip and referred sacroiliac joint pain as other sources of dysfunction.

From a conservative standpoint, we have had success with a program of gentle, progressive capsular and hip musculature stretching, hip abductor (particularly gluteus medius) strengthening, and alteration of your bike position. On the bike, I try to open the hip joint as much as possible with these clients and typically bring their saddle forward and up to decrease the overall angle of hip flexion.

Again, I must caution you to do your research and choose your specialist carefully! Getting the correct diagnosis is essential with this often confusing injury.

Iron deficiency

I am a 45 year-old male cyclist weighing approx 150 pounds living in Melbourne, Australia. I do not race, but train 8 to 10 hours per week (250-300 kms) so I can ride socially with friends of mine who do race.

I am finding I can go hard (average 34 -38 km/h) for around 40 kms, but hit the wall then. My family has modified its eating habits in the last six months, and I eat very little red meat now, but plenty of fish.

Could my power problem be due to a lack of iron in my diet?

Mark Richards

Scott Saifer replies:

Unless you have been bleeding and your iron status was borderline low before the diet shift, six months is not long enough for you to go from iron-normal to iron deficient, especially if you are eating a decent amount of green, leafy vegetables. Several famous world-beating racers have been vegetarians. Still, if you are really concerned, get your doctor to send you for a blood iron test.

More likely hitting the wall at a bit over an hour of hard riding is related to lack of carbohydrates either in the daily diet or consumed on the bike, hydration issues, or simply riding above the level for which you are trained.

Pam Hinton adds:

To add to Scott's reply, you want to have both your hemoglobin and ferritin tested. If your hemoglobin in low (<13.5 g/dL for males) than your fatigue can be attributed to anemia. Serum ferritin is used as an indicator of iron stores. Following a vegetarian diet, even one that includes lots of plant sources of iron, can result in iron-depletion. Your ferritin level will tell you if your stores are adequate (normal range: 20-300 ng/mL).

Is my bike growing?

Although I've found many of the "fit" articles on CN very informative-there is one topic I don't believe has been addressed: The effect of aging on bike fit! Since I've purchased my bike (fitted!) four or five years ago-I could swear the reach to my hoods has increased!

Since I'm quite certain my titanium frame isn't expanding-is it normal for the body to change enough (a few more kilos, a bit less flexibility) to warrant a bike size change? I've already shortened my stem to a 9cm...I don't want to go smaller and effect handling-and I don't want to move my "sweet spot" seat position up any further. FYI...40 is coming up this summer!

Michael Whalen

Scott Saifer replies:

Aging does not affect bike fit, but riding and not doing body maintenance does. Unless you are actually getting shorter yourself, it sound like you are mostly suffering from gained weight and decreased flexibility or maybe core strength. If you work a bit and fix these issues, your bike will fit the same as it did when you were "young".

Off season rowing training

In the April 17 edition, Dave Palese replied to a reader regarding the use of a Concept 2 rowing ergometer as off-season training for cycling. As a former collegiate rower, and still-occasional user of the rowing erg (it can be oh-so-painful!), I am curious if Dave et al were considering the true benefits of the rowing motion.

Dave noted that rowing "will not improve your cycling". I would challenge this. The rowing motion, when done properly, is 80% reliant on leg strength. I know that many people incorporate weights into an off-season regimen, including leg presses. The majority of the force created in the rowing stroke is from exactly this motion. This of course assumes that one uses correct technique, which many people do not.

I have used the erg in past years during the off season, and noticed an impact on leg strength and good maintenance of CV fitness. Used correctly, the erg's power measurements can be leveraged to design specific workouts focusing on AT, base fitness, etc.

Additionally, it has been estimated that one rowing stroke is approximately equal to 1/4-1/3 of a sit-up, so core conditioning is an added bonus. Considering a 20 minute set done at 20 strokes/minute, this is 400 strokes, or 100-120 sit-up equivalents! As for upper body strength, the use of the arms and lats is at the end of the stroke and is secondary.

I personally am an erg advocate, as you can see!

Thanks,
JS
Southern California

Dave Palese replies:

Thanks for your response.

My reply to Ken's question in no way knocked the rowing machine or its motion/technique as a way to build or maintain general or even rowing specific fitness. I made no statement that eluded to rowing not being a good exercise for developing leg strength and cardio fitness. On the contrary that is what I said:

"But, as I am sure you would agree as a former competitive rower, had you exclusively cycled during the rowing off-season, and then jumped into competition with little or no time on the water or on the rowing ergometer, you performance would surely be less than optimal."

What I said to Ken was that it is fine to supplement his off-season training using the Concept 2, but should not do so to the exclusion of the bike. Cycling has a specific component, as does rowing, that needs to be maintained year round if one wants to be continually improve.

Thanks again for your note.

Piriformis muscle

What is the function of the piriformis muscle during the pedal stroke? I know that the muscle is an external rotator of the hip, but I would have thought that pedaling involved straight flexion and extension of the hips only.

My reason for asking is that since taking up recreational road cycling as a 38 year-old two years ago, I have been battling with a seemingly intractable ache/numbness/pain in my left leg, which after much trial and error I have realized is sciatica due to a tight left piriformis.

I won't bore you with any further details, other than to say that I have read your article on pelvic asymmetry, and can confidently say that I have had every one of the symptoms you describe, and then some.

I've had orthotics, LeWedges, leg length discrepancy assessment, and the whole lot. After six months patient stretching (once I hit on the right diagnosis and found a stretching exercise that worked), there is a huge improvement, and there are times now when the bike actually feels like a bike and not a torture rack. So I am confident that I am going in the right direction.

As the muscle comes back to life (after a probable 20 years of injury and inactivity), I can feel an ache or dragging sensation in the muscle during pedaling. I have not felt this before, and it is clearly the sensation one gets when an injured/recovering muscle is being exercised. It is getting less all the time as function improves. So I am therefore using the piriformis muscles continually when pedaling, and I am wondering as to what their role is.

As I said, the stroke feels like straight flexion and extension only, without external rotation. Have they some function in stabilizing the hip?

Martin Feeley
Ireland

Scott Saifer replies:

I'm not the expert here, so maybe one of the other panelists will jump in, but you are right that the main muscle groups active in pushing the pedals are the flexors and extensors or the knee, hip and ankle, all working in the plane of movement.

Hip rotators are not going to provide power, but they do keep the movements of the leg controlled and coordinated. If not for the adductors, abductors and rotators, how would you keep the knees from floating out to the side or rubbing the top tube, or keep the feet from spinning off the pedals?

Steve Hogg adds:

The piriformis has its origin at the front of the sacrum and inserts into the greater trochanter. It is an external rotator of the hip but even when not switched on must move as the hip moves with the pedaling action.

What I assume you are feeling is a piriformis that is not yet stretched to its ideal length and still maintains some unnecessary tension. This is even more likely if, as you imply, you don't sit reasonably squarely on the seat.

Fused vertebrae

I have somewhat of an unusual problem. I had spinal surgery when I was a child and two of my lower vertebra were fused together. I think it was L3 and L4 or L2 and L3. I was told I would never be able to do a lot of things including having kids etc. and I went ahead and did it anyway!

Now I am 40 and have always had a passion for cycling but until recently had no opportunity because of time, money and commitments to get into it. Now I have a mountain bike and ride a few times a week and go with a group on the weekend to the forest... great fun and minimal pain because I am out of the seat a lot of the time.

I recently decided to get a road bike. Something I have always wanted but I find sitting in the seat is very uncomfortable. As I lean forward for the bars, I am not able to put weight on the sit bones as I guess most people would because my spine doesn't move the same way, so I find myself bearing down on well.... less comfortable bits!

I know there are female seats out there and I was wondering if you could guide me in the right direction as to what to get.

I also realize I could just change the handlebars to flat ones but I would rather not unless there is no other way. It's difficult to explain but because I have a disability (and I realise mine is so slight in comparison to others), it makes me want to be able to match the 'normal' riders all the more.

So, I thought you may have some ideas as to which would be more suitable for someone who has fused spinal vertebrae and whose pelvis tends to tilt back a little further than most.

With much thanks for you time

Sue

Scott Saifer replies:

Your lumbar fusions may or may not be the source of your troubles. I point this out because a large number of the normal riders you aspire to be like have the same problem. In the case of the riders without lumbar fusion, the problem is usually soluble, and I'll bet yours is as well.

The most important dimension of a saddle is the width of the flat part at the back. Not the overall width, but the width of the flat part. It needs to be wide enough that your sit-bones rest on top of that flat part and not on the down-angled part. If the saddle fits into the soft space at your rear, you will descend until you are putting weight on the front no matter how other parts are adjusted. If you are sitting on top that problem is eliminated.

The next saddle question is the amount of padding. If the sit-bone zone is so soft that you settle in until you get pressure on the nose of the saddle as well, you will again have pressure on the nose of the saddle no matter how well other things are adjusted. A rock-hard saddle is not the answer, but one into which you can sink just a little bit.

Most riders, male and female, can be perfectly happy and comfortable on saddles that do not have cutouts. A few riders really do need cutouts, but for them some of the cut-out saddle shapes make things worse and others better, so you may need to experiment a bit.

Now, assuming your saddle is suitable for your anatomy, getting the pressure off the nose requires getting the seat far enough back and properly tilted, and getting the bars high enough. The attached article includes instructions for those adjustments.

Who should I see?

I'm a 25 year old road racer (US Cat 3), who made big gains in a year or two of racing during college five years ago. Since then I have basically floundered every year, training some and then getting hit by some type of use injury, from strained achilles tendon, knee problems resembling chondromalacia, to occasionally tweaking my lower back.

I'm very convinced I have some leg inequality issues, though I haven't done all the tests to determine if they stem from hip alignment, leg length discrepancy, foot orientation, etc. Rather than give a whole bunch of details and look for a diagnosis now, I am just seeking recommendations about the sort of specialist I would best off going to see for a first round at getting these issues resolved.

I assume a proper bike fit is at some point a necessity, but if there are physiological issues I can correct through physical therapy, chiropracty, podiatry, it seems that I should try to solve them first, rather than just accommodate them. Is this thinking correct? If so, who would have the best chance of identifying my issues and helping me correct them?

To complicate the matter, I'll just mention that I have a very limited budget, so shopping around is difficult, and my insurance-provided pediatrician was less than helpful. Lastly, if it useful, I ride old Look pedals, and am kind of big: 6 foot 2 inches, 180 lbs when I'm very in shape, 195 when I'm not.

Also, while I used to jump into training, the last several years I have been very careful about slowly building up miles and intensity, so I'm pretty sure that is not the entire problem.

Much appreciated,

Ben Bryant
Los Angeles, CA

Steve Hogg replies:

I will let Kelby and Dave advise you on the specifics of who you should see but I want to relate something. I see a lot of people with various asymmetries and accidents of birth and development. They fall into two categories - the larger group for whom their structural shortcomings limit their ability on the bike and the smaller group who have the same issues on the surface, but it doesn't limit their performance on a bike.

The second group are the ones who work on their posture, flexibility and core strength. Find a yoga, Pilates, functional exercise or similar class as a starting point and make it a priority in your life.

Getting back on the bike

I want to get back to riding my bike, I haven't really been on my bike for over two years, I feel that I need to get fit enough to ride again,

I used to love going to the Lake District, but I don't think I would make even an easy ride. I need to rebuild myself, and eat better, can you suggest anything or a training program for me.

I am going to enroll at the gym tomorrow to use the exercise bike and walking machine. Is this the right way to go? I feel unfit for the first time in my life.

I'm 6 foot tall and weigh about 12-13 stone, I do walk a little, and I take a vitamin tablet each day. I suffer with ankylosing spondylitis and have done now for over ten years. And I have a wrist injury but I do have 60% use of my wrist.

I do hope you can help me, and I thank you for your time and efforts.

Ken Furber

Scott Saifer replies:

You would do well to get connected with a coach local to you where you are. Meanwhile, the key to getting fit is having a plan you can stick to. That generally means one that starts out very easy and builds up very gradually. Since you are currently pretty inactive, any activity you take up will be an improvement and bring improved fitness, so feel free to mix several aerobic activities as you get started even though the main goal is cycling.

Any of the aerobic machines in the gym, bikes, swimming, walking, hiking can all be good for you. I don't know exactly where you are starting, so join this routine at the appropriate spot:

Start with 15 minutes of some sort of activity that raises your heart rate but not your breathing every other day. When you've managed that for two weeks, start adding five minutes per session to all the sessions for a week at a time (so 15 minutes every day, then 20, then 25...) until you hit 30 minutes per session. Then add one session per week until you reach six per week or don't have time.

Then it is time for reassessment. 30 minutes six days per week will never make you a racer, but it will bring substantial improvements in health and fitness. How much more time do you have to invest regularly? Keep working up by adding roughly 30 minutes per week to your activity time until you are using all the time you want to invest.

Keep the intensity low until you are at peak volume, or until you are doing eight hours or more per week regularly. Then consider going harder, again preferably with a coach's guidance.

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