Form & Fitness Q & A

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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 January 9, 2007

Chronic knee pain
Muscle fatigue
Sit bones and scar tissue
Pelvic asymmetry and the bottom bracket
Left foot pedal positioning
Shorter crank for leg length discrepancy?
Testicular pain

Chronic knee pain

Steve, I have read with interest your take on optimal positioning, particularly as it relates to pelvic asymmetry. I'm a practicing podiatrist and avid cyclist with pain in the right knee of 21 months duration. At this point there may be something intrinsically wrong with the knee although it was scoped in November 2005 with no evidence of arthritis. My pain is patellofemoral in nature and localized to the inferolateral aspect of the patella.

Here are findings pertinent to pelvic asymmetry:

1. Right side pelvic and hip drop with resultant valgus knee position on the downstroke (thigh and knee angle in toward top tube) severe enough to wear away the right side of the nose of the saddle

2. Chiropractic evaluation confirmed right side pelvic drop with anterior tilt. Leg length discrepancy as a result of pelvic drop is functional with right leg functioning longer although this is minimal (1/4 inch)

3. Forefoot varus bilateral and equal

I have made the following changes in setup:

1. Moved cleats back as far as they will go (speedplay zero)

2. Moved seat back about 1cm (I can pass balance test easily)

3. Tilted nose of saddle to the right about 5mm

4. Placed 2mm varus wedges between cleat and shoe (I already have cycling specific orthotics with 4 degree varus posts)

Any other suggestions at this point? I've been in this new setup for one week with nothing miraculous in terms of knee pain.

Scott

Steve Hogg replies:

A few things occur to me.

1. Cleat position. You imply you have read the cleat positioning posts. How far away from those recommendations are you?

2. If you can, get hold of an SMP seat. I have been playing with these a bit lately and for the user it is obviously apparent at any time if they are not sitting squarely. Much more so than with other seats. For some, this constant tell-tale leads to self correction on the bike, enough to solve problems similar to yours. For others not, but it is worth a try.

3. From what you have said, the great likelihood is that the asymmetric seating and pedaling technique is the source of your knee problem. I assume you are tackling the causes of these issues off the bike?

4. Your left side will be dragged towards the centre line by the right side hip drop and rotation. That will probably mean that you need to reduce the varus compensation in/under the left shoe temporarily and reassess as you square up on the seat.

5. Consider laterally offsetting the seat to the left. You will almost certainly still need to point the seat nose off centre to the right. For more info, have a look at this article.

The FSA Data Head mentioned in the article will also fit Thomson posts perfectly if you can get the Data Head separately. If you own a Thomson post or an earlier two bolt FSA post and can't source Data Head as a separate item, contact me privately.

By offsetting the seat to the left, you will minimise your ability to drop and rotate the right hip. You will still do it but be less able to, probably a lot less. The seat can be moved up to 12mm off the centre line in an attempt to get the pelvis over or more nearly over the centre line of the bike.

Not everyone needs the full 12mm and I don't think you should look at this a permanent solution unless you have some sort of congenital or injury-caused permanent issue. What offsetting the seat is likely to do is relieve your knee of pressure while you work on off bike solutions to achieving greater functional symmetry.

6. I'm concerned about you being able to pass the balance test easily though, functioning as asymmetrically as you do. Unless you have superior dynamic core strength (many can demonstrate static core strength but have it all disappear when they get on a bike), you may be too far back.

From your self description my experience is that it is very unlikely that you should be able to "pass the balance test easily" unless your seat is too far back or noticeably too low.

Muscle fatigue

It’s cold and dark where I live right now so I’m doing interval training on my indoor trainer. While doing fairly intense one minute intervals, I find that after about 45 seconds of pedaling, my shin muscles begin to fatigue and pretty much give up. No problems with any other muscle groups at all. Any thoughts on the cause?

Chris Hines

Scott Saifer replies:

Most likely you are pulling up with your ankles dorsiflexed (trying to keep your ankles closer to 90 degrees). The shin muscle or tibialis anterior is a tiny muscle with virtually zero-ability to deliver power. It is good for getting your foot in position for the downstroke, but not if you ask it to work under load. If you ask it to flex the ankle under load, it quickly gets tired and then sore. Try relaxing your ankle during the early part of the up-stroke, allowing the ankle to stay extended until the upper dead spot and then dorsiflexing with no resistance.

Sit bones and scar tissue

I am a 34 year old male. I am six feet even and weigh 160. I have been riding almost 10 years.

The last few years the focus of my training has been the annual Lotoja Classic. A 204 mile one day race through the mountains of Utah to Jackson Hole, WY.

This past year I switch my saddle to a SLR a few months before the race. I felt great the entire race. The next day I noticed that I was bruised on both sides right on my sit bones (ischial tuberosities). There was no sign of exposed sores, just bruising.

I took time off the bike and when I started riding again I noticed some pain right where my sit bones make contact with the saddle. I replaced the SLR with the SLR XP and the pain has continued. It feels like there is a small marble right on the end of my sit bones. When I feel it, there is something hard that moves right up against the bone. I have been told that it might be scar tissue from the 10 hour bruising that happened in the race.

Have you every heard of something like his before? If so what is the best course of action?

Carl Richards
Las Vegas, NV, USA

Steve Hogg replies:

Basically, your sit bone problem stems from supporting a boney area on a hard surface. More padding will diffuse the load over a wider area.

I use an SLR on my race bike too as the shape suits me. I am a similar height and weight to you and lean as I suspect you are. The SLR shape is very comfortable for me for up to 3 hours then my sit bones 'light up'. I rarely ride that bike for that long so no problem there.

People are different and I know SLR riders who have ridden long 230km + hilly races on them comfortably. As you know they have no real padding, more or less a milimetre or so over a hard shell and I'm sure that you have realised that is your problem. The SLR XP you changed to has only marginally more padding than the SLR, so no surprise that it didn't fix the problem either. I wouldn't consider either as first choice for the type of racing you are doing.

If you want to stick with the SLR family, try an SLR Gelflow. They have the same shell shape but more padding. I use one on my training bike and have never ridden far enough (up to 7 hour rides) for it to be uncomfortable in anything like the sense that you are finding with the less padded versions.

If you try a Gelflow, they are firmish at first but soon soften up. Once they do, you will need to raise the seat 3mm or so higher than your SLR because you will sink into the padding to a degree. If that advice doesn't work, then time to consider a change in seat shape.

Pelvic asymmetry and the bottom bracket

I have a pelvic asymmetry, just like a previously submitted question appearing on November 22, 2006.

From Steve Hogg's response: "The second way to tackle the problem won't change you but is likely to relieve current stressors to some degree and allow you to function more symmetrically on a bike while you work on your body's lack of symmetry." Then there's a link to an article about a FSA K-force seatpost.

Is there a bottom bracket currently available that separates a cyclist's left leg effort from the right leg effort? Has any manufacturer ever tried? Is anybody going to try?

About myself: I've been riding seriously for 9 years now, starting at age 21. I've never raced and I don't want to. What I have accomplished is that I've ridden my bike to work more often than I've driven. For five years I carried my lunch and clothes to work with a messenger bag, thus destroying any pelvic symmetry I had. I need it back. Yoga and chiropractic treatments are helping somewhat but I want a bottom bracket that isolates my left leg effort from the right.

Andrew Smith
San Francisco, CA, USA

Scott Saifer replies:

There is a device which separates the right and left leg effort, but I don't think it's really what you want. Actually, it's a bottom-bracket and cranks set called "Power Cranks".

The problem or advantage of them, depending on how you look at it, is that when you separate the two legs' efforts, you can't rely on the front leg to lift the back leg and you actually have to lift the back foot up to the top of the stroke.

Left foot pedal positioning

Steve, I read your articles on cycling news very often and truly enjoy your frank commentary back to the folks you are trying to help. I was looking to see if you could recommend someone in my area with your level of expertise on biomechanical positioning.

Let me give you a little background on my problem: Two years ago I had a back injury to my L3, L4 that affected my siatic nerve - effectively reducing the power in my left leg by about 50%; today I am at about 85-90% power on the leg.

The problem that I have is as follows: I can never get my left foot to feel comfortable on the pedal. I have tried moving the pedal forward, back, side to side but it always feels as if I have my left foot not forward enough (axle closer to my toes) than my right foot. I have also tried seat positioning but that has not helped either.

Two things I have noticed that may or may not matter: Left leg swing; when riding I look down at my leg and notice that my knee swings out and in with every turn. My right knee tracks pretty true.

Shims on cleats; I have installed shims on my cleats ever since I moved from old SPD to look Keo red cleats and pedals. If I don't have two or three shims installed on each cleat I tend to get pretty serious pain in my inner knee on both legs. I installed the shims so that they raise the ball of my foot.

Juan Victoria
Miami, Florida, USA

Steve Hogg replies:

Do you sit squarely on the seat? The way to find out is to set your bike up on an indoor trainer and pedal under load with your shirt off. Have an observer stand above and behind you on a stool or seat. What I want to know is do you drop or rotate your right hip forward and down on each right side pedal stroke?

If as I suspect, you drop and rotate the right hip forward, that is the likely underlying reason for all of the other stuff. If you hang to the right, the plane of movement of the left leg is constantly challenged and it has to reach further to the pedal. The left knee swings out at the top of the stroke because that is when the right hip drop is greatest. It swings in on the downstroke because that is when right hip drop is least as it is the top of the right pedal stroke.

Whatever is the root cause of this suspected right side tightness/tendency to drop the hip etc, may also be the underlying cause of your left side sciatica as well.

Do you stretch regularly? If not, get on a first name basis with your local yoga or Pilates teacher. A good self help manual is "Overcome Neck and Back Pain" by Kit Laughlin.

Shorter crank for leg length discrepancy?

I am a 29 year old male racing cyclist, 5'10" and 155 pounds. I suffered Perthes disease from 10-15 years of age and as a result, my right leg is 8mm shorter than my left leg. The entire discrepancy is in the femur and this has been established from x-ray images. In addition the hip joint and supporting ligaments and muscles are often very tight which creates a further apparent leg length discrepancy, but this element is variable depending on the condition of the joint - if it becomes inflamed as it regularly does, the apparent leg length discrepancy will worsen for a time, sometimes for days or weeks.

Like many others I feel rather locked in an ongoing fight to achieve the best pedaling action I can and to compensate appropriately for my leg length discrepancy and related pelvis, knee and foot alignment problems. However my motivation to try and keep developing as a rider is very high.

I have been using cleat stacking to aid more balanced pedaling throughout my cycling career. I also have my seat nose rotated to the left side slightly (the nose is 8mm approx from dead centre), as my left hip is forward through my pedal stroke in comparison with the right hip. I also tend to drop my right hip. Both of these symptoms have been confirmed by an observer while I pedaled on a turbo trainer.

I also use Lewedges to level the apparent pedaling surface - three on the right shoe and one on the left, both with the taller side of the wedge on the crank side. This is in addition to having two wedges stacked thin to thin on the right (shorter) side, giving about 2mm of vertical stack height.

I am working with a sports clinic to try and achieve a better aligned lower spine and pelvis as well as greater flexibility and strength through the core.

I have read with interest many of the replies to previous questions regarding leg length discrepancies. One thing I have taken from the responses is it often seems a good principal to compensate for the discrepancy with a range of small adjustment methods rather than to simply stack the cleat on the shorter side, or to simply twist the seat nose toward the shorter side.

This has got me thinking that perhaps I should consider using a shorter crank on the shorter side. I use 172.5mm cranks currently.

My thinking is that while cleat stacking is effective when the crank is at the bottom of the pedal stroke (and the leg is fully extended), it doesn't seem to do anything to help when the crank is at its foremost position within the pedal stroke (with the knee at its highest position). This is because the cleat stacking is in the vertical plane only, assuming the shoe remains more or less parallel to the ground throughout the pedal stroke. Indeed the rocking torque effect seems to simply introduce new problems. I think this is exacerbated by the cleat stacking as there seems to be an exaggerated feeling of 'not pedaling in circles' and a difficulty in achieving a strong driving power at the very top of the pedal stroke. The effect seems to be a specific weakness in parts of the pedal stroke where a pushing forward (from the top of the pedal stroke) or pulling backward (from the bottom of the pedal stroke) force is involved.

If I used a 170mm crank on the shorter side, rather than simply stacking the cleat, I think this would help ameliorate not just impact of the leg length discrepancy in the vertical plane, but in the horizontal plane also, and without creating the same rocking torque problems that the cleat stacking has introduced. Lastly the hip joint tightness I experience might also be relieved somewhat as the impact of this is felt most at the top of the pedal stroke.

Am I right in thinking this? Would using a shorter crank potentially introduce other problems? Would 'out of the saddle' efforts be impacted negatively?

Simon Fraser
Boulder, Colorado, USA

Steve Hogg replies:

Thanks for a fairly complete description of your issues. With Perthes disease and inflammation of the joint capsule, the key to minimising the impact of this is to gain best possible control of the pedaling movement. As you suggest, the key to this is how far the leg has to extend but also and more importantly, how far the knee rises at the top of the stroke. By all means try the shorter crank as I have seen many instances of this working fine in similar situations.

There are a few people with theoretical reservations in doing this but my view is that when there is a congenital of developmental issue, often the only workable solution is the 'least worst choice'. You are unlikely to have problems when standing on the pedals. Ultimately the only thing to do is try.

You have tried stacking the cleat and are not totally happy with the results so try another way. Without seeing you I can't be definitive, but from what you have said I think that there is a good chance of it working okay. RH cranks are expensive as they can't generally be purchased alone but only as part of a pair, so it is worth trying to borrow a RH crank of the same type that you use prior to buying any.

One small thing I want to correct though is when you say "to simply twist the seat nose toward the shorter side". When you twist the seat nose towards the shorter side, you move the rear of the seat and hence the hip of the shorter leg rearwards; i.e. further from the pedals. This is only of value if the rider sits with pelvis twisted towards the side of the shorter leg as it will help square them up on the seat and a means will then need to be found for them to reach the now increased distance to the pedal.

More commonly, people with a measurably shorter leg tend to sit with the pelvis twisted forward on the long legged side though this isn't universal. If they do, then what you suggest is going to increase the problem in many cases by reducing the distance that the long leg reaches and increasing the distance that the short leg reaches.

Testicular pain

I am a male cyclist, late 30's and have developed the following problem. When I first get onto the bike I get a sharp needle like stabbing in my left testicle. It takes a few minutes for the sharp pain to subside, then it becomes a dull ache.

It first arose 3 years ago and I spent over 4 months off of the bike, with no improvement. I had testicular scans, x-rays, etc. and nothing came up. Rest did nothing. I even visited a physiotherapist who did testicular massage, but without any results. Finally I saw my osteopath who diagnosed a misaligned pelvis, a regular ongoing problem of mine. After re-alignment the problem subsided for a few months and I raced a full season on the road. However it is now back again.

I have visited my osteopath on a few occasions but my pelvic alignment is good. I have taken time off, but no improvement. The problem mainly surfaces on the bike, but something hits me when I bend over or when weight training.

I haven't raced much since the problem re-appeared. I train four to five times per week, although the sessions are now less than 90 minutes in general. I should point out that the problem doesn't typically get any worse if I spend 2 to 3 hours on the bike.

Steve Hogg replies:

There is no shame in having sore testicles. We all hurt somewhere sooner or later. It is interesting that a pelvic realignment seemed to solve the problem which makes it possible that the cause is the same again. It is worth checking that out.

I have seen instances of this in the past and finding a solution was always frustrating and eventually solved by cutting away any part of the seat that contacted the testes. In your shoes I would try an SMP seat. Have a look at www.sellesmp.com. My limited experience is that they work for more problems than yours.

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