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. Jon Heidemann (www.peaktopeaktraining.com) is a USAC Elite Certified cycling coach with a BA in Health Sciences from the University of Wyoming. The 2001 Masters National Road Champion has competed at the Elite level nationally and internationally for over 14 years. As co-owner of Peak to Peak Training Systems, Jon has helped athletes of all ages earn over 84 podium medals at National & World Championship events during the past 8 years. 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. Clients range from recreational riders and riders with disabilities to World and National champions. 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. Steve Owens (www.coloradopremiertraining.com) is a USA Cycling certified coach, exercise physiologist and owner of Colorado Premier Training. Steve has worked with both the United States Olympic Committee and Guatemalan Olympic Committee as an Exercise Physiologist. He holds a B.S. in Exercise & Sports Science and currently works with multiple national champions, professionals and World Cup level cyclists. Through his highly customized online training format, Steve and his handpicked team of coaches at Colorado Premier Training work with cyclists and multisport athletes around the world. 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. Michael Smartt (www.wholeathlete.com) is an Associate Coach with Whole Athlete™. He holds a Masters degree in exercise physiology, is a USA Cycling Level I (Elite) Coach and is certified by the NSCA (Certified Strength and Conditioning Specialist). Michael has more than 10 years competitive experience, primarily on the road, but also in cross and mountain biking. He is currently focused on coaching road cyclists from Jr. to elite levels, but also advises triathletes and Paralympians. Michael is a strong advocate of training with power and has over 5 years experience with the use and analysis of power meters. Michael also spent the 2007 season as the Team Coach for the Value Act Capital Women's Cycling Team. Earl Zimmermann (www.wenzelcoaching.com) has over 12 years of racing experience and is a USA Cycling Level II Coach. He brings a wealth of personal competitive experience to his clients. He coaches athletes from beginner to elite in various disciplines including road and track cycling, running and triathlon. 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 June 17, 2008

Advice on position
Speed wobbles
Reduced breathing and heart rate on Aciphex
Simvastatin and energy levels
Cleat shims
Tired after recovery
Side to side knee movement

Advice on position

Thank you for all of your advice over the years. I am coming back from injury and need some positioning advice. I got a full structural assessment from a sports MD and from several manual physios. It is a long history, but here are the details.

Sports MD diagnosed:

• MRI shows minor cartilage damage to left knee
• Ultrasound shows signal noise around right adductor, diagnosis tendinosis, but not tendinitis. My understanding is that this means some damage to tendon, short of tendinitis, possibly an old junior hockey injury.

Structurally the following were diagnosed by physios and MD:

• CT scan shows both legs equal total leg length.
• Weak core. (Working on it)
• Physios surprised by weakness of gluts generally (given that I raced bikes).
• Weak hamstrings generally (not surprised given that I raced bikes).
• ART done to following areas: right hip, both adductors (a lot was needed, more scar tissue on right side), and lower back, glut med and minimus right side were very knotted/adhesions.
• After ART the left side adductor and hip flexor is now tighter. MD thinks left side was original problem; right side wore itself out working around the problem.
• Weak VMO on left knee
• Bigger quads on right side
• Quad and hip flexor tightness both sides.
• Pelvis rotated forward. (Probable cause said to be tight quads, hip flexors combined with weak hamstrings)
• Flat left foot for twenty five years, now corrected with orthotics. Probably the cause of chondromalicia in left knee.
• SI joint misalignment.
• Some joint capsule tightness where right femur meets hip.

On the bike

• Despite equal leg length, pedal as if right leg is shorter (drop that hip and have more extended ankle on that side at 6 o'clock)
• Adductor cramps both sides, much more on the right. When adductors lock up sometimes the right hip flexor cramps/locks up, sometimes right hamstring as well.
• Produce more power with left leg, but am right side dominant and much bigger quad on right. Prior to injury the opposite was the case. When out of saddle produce more power with right leg though.
• Drop right hip. Seem to rotate right hip towards rear wheel a bit.
• Spin-scan shows lack of power produced across the top of pedal stroke of right leg.
• Rocking of hips despite conservative seat height.
• Retul fit shows the right knee not tracking straight. Under load it seems to come towards top tube and back out again. That is strange since left knee was problem originally, perhaps orthotics correct it and now biomechanical weakness in right hip/adductor area presents itself. Probably right hip problems come from adaptation to flat foot/chondromalacia in left foot and knee respectively.
• Left knee quad still weak, but that pedal stroke has better form than other side.
• Trouble engaging core and getting gluts to fire, especially on left side.
• When I concentrate on engaging core and straightening out hip rotation and drop I can feel gluts work, especially firing of left glut. But I just can't seem to hold the form for long even with a stronger core.

Should I shim up right cleat and move cleats back a bit too engage gluts? Anything else?

Just strugglin'

Steve Hogg replies:

Your athletic life doesn't sound like a lot of fun and thank you for the detailed info. If someone phoned me with a list like that I would be tempted to refuse to offer advice except in person because a lot of trial and error testing is likely to be needed to see how you respond to each change and the cumulative changes in position. When someone has such structural asymmetries, there is no 'road map' as everyone varies in their responses. However I am sensitive to your need to get back on the bike and will try to offer useful advice, here goes:

Off the bike

1. The proper solution to your issues lies off the bike, not on the bike. I hope you are getting good advice and treatment. You could do a lot worse than ask Dave Fleckenstein to comment on the structural aspects of your overall problems. Seeing as you have addressed your query to me, I'll do my best.

2. The tight hip flexors you mention and the restricted SIJ(s), and the chain of mechanical and neurological inhibitions that flow predictably from them, make it near impossible to achieve a decent level of core strength in a dynamic sense. That is an issue because a reasonable level of core strength is necessary to sit symmetrically (or nearly so) on a bike. Do whatever you have to do to free them (and other postural musculature up) One often overlooked avenue of treatment is trigger points, particularly psoas trigger points. Ask lots of questions of the health professionals whose services you are using so you can educate yourself to the priorities you need to follow.

3. Find a good Feldenkrais practitioner or get hold of some Feldenkrais reading material as past experience suggests that clients, who are in really bad shape structurally, often improve noticeably using Feldenkrais and similar methods in addition to postural retraining.

4. The flat left foot suggests that you have been functionally asymmetric for a LONG time. Problems that take 20 years to cause don't have 5 minute solutions. The only way is to nibble away at the issues methodically for cumulative gains.

5. Above all, don't give up. Keep knocking on doors until you find someone with the knowledge, experience and insight to help you get a result. Structural improvement needs to be your athletic priority.

On the bike

1. You are very tight in all the wrong places and I would look at cycling as a 'smell the roses' to keep your head in the right place activity for the time being, rather than a method of increasing the strain on your already creaking structure. No PB's, no hard efforts, enjoy the ride. Otherwise you risk perpetuating the asymmetric patterns of motion that you are currently using.

2. You need to stop that right hip from dropping. A shim under the right cleat will work only if the leg overextending because it is functionally shorter; i.e. Tighter in general any where from lower back and right hip downwards. Is it the right SIJ that is restricted?

If you fit a shim and it has little or no effect on the hip drop, then it isn't a functional leg length issue on the right side but a hip / lower back issue. If so, get hold of an American Classic J post. They are available on in 27.2mm diameter. The design of the seat rail clamp means that if you fit a J post to your bike and a seat to the post but don't tighten the fixing bolt that holds the seat in place, one side of the seat can be elevated by 6 - 7 degrees before the seat rail clamp bolt is tightened. That will elevate the right hip. It won't stop you dropping it but will limit how low it can drop and probably improve your on bike dynamic symmetry to some degree. Your spin scan deficit over the top of the stroke on the right side shows that you are under extending on that side and minimising the right side hip drop should improve that. If you fit a J post, you may need to fit a shim under the right cleat to prevent your right leg from overextending.

3. Very interesting that you drop the right hip but sit with the right hip rearward. That makes you a rare bird in my experience. I have just re read this and frankly think I'm kidding myself trying to advise you from this remove. But one more thing while I think of it. You say "When I concentrate on engaging core and straightening out hip rotation and drop I can feel gluts work, especially firing of left glut. But I just can't seem to hold the form for long even with a stronger core" Again, my experience is that it is just not possible to exhibit dynamic core strength on a bike with tight hip flexors. So I repeat, any measure that will help free up your hip flexors or reduce load on them is something to prioritise. Also have a good think about your diet and any unknown food sensitiveness or allergies you may have. If you don't have a healthy bowel, you're not going to make any headway on dynamic (as opposed to static) core strength.

I'm not satisfied with my reply but is the best I can do at this stage. Let me know how you get on and if you think I can help further, I will try.

Speed wobbles

I wondered if you have had experience and could give advice on this subject. I am a 51 year old road cyclist and have raced in time trials for 34 years. On one occasion last Summer I was riding to the start of an evening event, which included a fast downhill stretch of approximately one and a half miles on a gently curving very exposed dual carriageway road. Halfway down the hill I began to experience a wobble through the front forks, which gradually got worse as I applied the brakes to control it. The 'wobble' eventually became very violent and I ground to a rather inelegant stop on the grass verge.

I had never experienced anything like it before, and the next time I went down the same hill I experienced the wobble again (on a different bike), although I suspect that this was more to do with nerves after my earlier experience. The net result is that I have now developed a fear of fast descents which is seriously affecting my riding, as I go out of my way to avoid them. I have also not raced this year as I am 'holding back' on the downhill stretches.

Peter Loader
Kingsteignton, Devon, England

Scott Saifer replies:

The front end of a bike is a sort of pendulum, and like any pendulum if you pump it at the right frequency, it will build up a large oscillation. The harmonic frequency of a bike depends on the geometry and weight distribution and also the speed as the front wheel acting as a gyroscope changes it's resistance to being steered as the speed of the gyroscope changes.

So, you get a speed wobble when you push on the bike just the right way at just the right speed, and you may be able to get rid of it by making a change in any of the variable: loosen or tense your body, move forward or back on the bike, or best, pedal harder to move through the wobble-speed. Take note that even when wobbling, the bike will go straight pretty well, so the wobble doesn't mean you have to crash, unless you are on a tight turn. I'd suggest taking the bike to a wide, straight descent and seeing if you can get it to wobble, then get out of the wobble by the methods suggested.

A bike with different geometry or material will not have the same problem. If you're not getting satisfaction from the stuff suggested above, consider a new bike.

Now, there is another question: You have been racing for 34 years apparently without this problem. What changed? Can you undo the change?

Reduced breathing and heart rate on Aciphex

I am a 45-year-old recreational sport level ride. I have been a long time sufferer of acid reflux and have tried all the proton-pump inhibitors (PPI). Protonix, Prilosec and Prevacid all gave me heart palpitations and on two occasions, sent me into arrhythmias.

Nexium made me feel sick to my stomach. Aciphex was the only one that didn't seem to have side effects. However, after having been on Aciphex for several years, I finally realized that it was probably the Aciphex that has been keeping me from being able to breath and reach my maximum heart rate on even moderately hard rides.

I have finally stopped taking it and am trying to manage my acid reflux and heart burn with diet and behaviour methods. It has been three weeks now since I have stopped and I have been feeling very good on the bike again. My breathing appears "normal" and while I have not been wearing my heart monitor, I seem to have much less difficulty on hills I have been struggling on for a long time.

Do you know of other reports of problems with athletes that are on PPI's? I'm really hoping I can finally stay of all these medications and get my cycling form back.

Vincent J. Amodeo
USA

Kelby Bethards replies:

That is a very interesting observation. I have not had anybody complain about such a problem with a PPI. I just read the very long list of possible, yet very rare, side effects and it mentions the arrhythmias and interestingly asthma as a rare possibility. It does not mention maximum HR reduction, but why would it? They don't test medications for athletic performance impairment.

So, what do I think was happening? I'm not sure I know. It is possible you were getting just a little bit (and at a high performance level, a little bit of any impairment is all that is needed) of asthma or breathing impairment, thus limiting your ability to perform, attain max HR, etc.

I'd be interested to hear back on this if your troubles stay away off the medicine, if indeed you are able to stay off the medicine.

Simvastatin and energy levels

I'm a 72 year old cyclist who has been cycling for 30 years. I've been across country twice recently and I do about 6000 miles per year.

I had two stents installed in my heart last July, and started Altace, Plavix and Simvastatin to prevent further damage to my heart. I felt great as a result of the treatment, and that lasted for the next 6 months, and then my doctor doubled my Simvastatin.

Since that time, my energy level has decreased noticeably, and I'm having trouble keeping up with the riders that I had no trouble with before the increase in Simvastatin.

My question is "Could the doubling of the dose affect my cycling or should I look elsewhere?"

I would ask my Cardiologist that question, but I never get a satisfactory answer from him about the meds I'm taking.

Joe

Kelby Bethards replies:

Let me start by saying, I will always defer to your cardiologist about your health, he/she knows your situation. Now, that being said, I do think it is your statin dose increase giving rise to some of your troubles.

The statin class of medications can cause a condition called rhabdomyolysis and/or myopathies. Rhabdo (that's what we in the business call it, probably because we can't pronounce rhabdomyolyis) is a breakdown of the muscle which can have dangerous consequences which I won't talk about here. Myopathy, simply put, means muscle pathology. That is why your doctor and all the obnoxious television commercials warn you of muscle aches with the medicine. If the muscle aches are severe the medicine is stopped.

So, what may be happening is that you have reached a "threshold" of medication dosage that you are feeling some of the potential side effects. Not enough for you to have muscle aches, but on the continuum of myopathy, you may be getting a little bit of muscle weakness. Not enough to be dangerous for your health. Just enough to slow you down a bit.

Of note: I asked a cardiologist whom I work with about my cholesterol, which is fine since I'm racing my bike. But, I asked what if my cholesterol went up? Would he give me a statin drug? He said no, it would give me muscle aches. But, that is at a racing level of riding, but that information is useful to me for my patients that are avid activity seekers.

ONE CAVEAT: While I believe your medicine could be to blame, I would like to mention that with your history of stents being placed, your heart condition could be part of the cause, but that decision would absolutely up to your cardiologist.

Either way, I think it is worth another talk with your cardiologist about switching to a combo medicine or different cholesterol lowering regimen. One way to tell, with permission from your cardiologist, is to cut your dose in half again for a few weeks and see if the energy level returns.

So, talk to your doctors and see what they say.

Cleat shims

I have a fairly significant leg length difference of just under 1 inch, all of which is at the hip from Perthes. I've tried shims on my SPD-style mountain bike cleats, but the shims lifted the shoe off the pedal platform so that there was added instability - i.e. the cleat was raised above the level of the shoe tread so that the tread no longer touched the pedal. It wasn't a lot, just a few millimetres, but enough that there was some wobble back & forth.

I'd like to try the shims on my road shoes which have Look cleats/pedals. Do you know if I'll experience the same stability problems with the Look platform?

A second part to this question is whether I should even bother... in my road shoes I have one additional insole on my short side which is about 3mm, and my long leg has the cleat a couple of mm further back than my short leg. Otherwise there are no other corrective measures. I'm very comfortable on the bike and I don't have any pain/discomfort.

David Mackay

Scott Saifer replies:

On your MTB shoes you maybe able to improve the stability of the shimmed cleat by adding additional rubber or a second sole in the area of the cleat. You may need a real shoe-maker to help you attach it firmly enough

I don't expect you'll have a similar problem with the Look pedals as the larger cleat provides its own lateral stability.

Tired after recovery

I'm a competitive CAT3 in my early 30's. I have been racing for 4 seasons and during the regular season I train 14 - 16 hrs a week and race pretty actively. Every 3-4 weeks I schedule a rest week where I ride less than 5 hrs at recovery pace, and include 2-3 days completely off the bike. I find that for several days following a rest week, I feel sluggish and unmotivated and have trouble riding at higher intensities. I'm wondering if this is typical, or am I taking too much time off the bike. After a few days of regular workouts I'm usually back to normal.

Ben Harris

Earl Zimmermann replies:

Overall your training levels seem to be in line with your peers and depending on the different types of events you are racing, it might be considered above average.

You physical responses could be considered normal given the training cycle. Based on your in season training levels you are taking too much time off the bike during your rest week.

I would suggest that you ride everyday during your rest week and alternate between recovery and endurance pacing. Use one day during the middle of the week to catch up with life in general, friends and family. This should allow you to return to your higher level of training sooner and not feeling as sluggish.

Sciatic nerve and cycling position

I am a 27 year old cyclist/racer (cat III road expert mtn) with some leg pain and numbness issues.

After months of frustration, I think I've discovered that the root of my problems comes from an old knee injury. In 2003 I had surgery to repair a torn medial meniscus in my right knee, and during the surgery they noticed that the cartilage below the kneecap was gone, so several holes were "poked" (don't know the medical term) in the kneecap to facilitate scar tissue regrowth. After the surgery I was able to return to racing and felt fairly good, but after two years I began to develop pain in my right hamstring during squash and cycling. I recently began seeing a PT who diagnosed the main problem as an inflammation of the sciatic nerve. After seeing him a few times the injury is getting better and I'm able to ride again mostly pain free, though the stretches he's prescribed to me are painful and sometimes especially after a hard ride there is significant stiffness and soreness in the right leg.

Yesterday on a ride I was doing a rather steep and long climb at close to maximum effort, and began to experience numbness in my left leg on the outside of my glut, and also some numbness in my left toes.

I did experience a very similar sensation last year during a 40k TT, also in the left leg, which I attributed to not being accustomed to the TT position during hard effort.

My questions can be boiled down to this: Is there a specific positioning aspect that affects the sciatic nerve? I have never been professionally fitted, nor have I ever felt truly comfortable on the bike, but I don't know if professional fitting is an option for me (don't know of anyone in the area and cost issues).

Some additional information:

On a few occasions during especially hard/hot races/rides I have experienced cramping, and it is almost always in my right hamstring exclusively.

I am a squash pro by trade, and mostly plant on my right foot during games, which leads to some strength imbalances in my legs. (This was also the cause of my original knee injury).

I do a lot of core strengthening and I don't have any lower back pain.

My right leg is effectively shorter than my left according to my PT, which he thinks will correct with further treatment. He also says that my right arch is higher to correct for this, but he has watched my on the bike and says there are no blatant symmetry issues.

Any suggestions you might have would be greatly appreciated, I am a big fan of the Form and fitness column!

Pete Avitable

Steve Hogg replies:

You have answered your own question. That chronically tighter right hamstring post ride suggests that your functionally shorter right leg is overextending. The cramping you have experienced in the right hamstring indicates over enlistment, all most certainly because of over extension in an already tight muscle group. When subject to pain a body will autonomically protect itself. Compensatory measures only shift the load elsewhere; in this case probably the left side; they don't solve the problem.

The recent sciatic pain on the left side may suggest that part of what you are doing to enable the right leg to reach the bottom of the pedal stroke is causing your to bend your lower back to the right. If you are, then sciatic pain on the left is one of the possible / probable consequences.

I accept that there are no "blatant symmetry issue" on the bike but 'blatant' is a qualifier. That probably means that there are symmetry issues but your observer didn't think they were bad. Did he observer make this comment after watching you ride at high load, heart rate and fatiguing?

If not, it would be worth your while asking him to. He may have a different view after that. Fatigue and intensity tend to exacerbate any tendency to asymmetry.

The best advice I can give you is to relieve the load on the right hamstring when riding. Hamstring flexibility is a prime determinant of seat height. The hamstrings contract in part while extending as a whole on the pedal downstroke. You need to reduce the distance the right leg extends by:

a. moving your seat forward somewhat
b. dropping seat height
c. shimming the right foot inside or outside the shoe, or
d. a combination of those measures.

David Fleckenstein replies:

There are a couple of issues that must be addressed/further examined.

1. If you are getting pain now in your other leg, your body is trying to tell that what you are doing is failing, so stop. Figure out the source, fix the cause, adapt your position. The number of cyclists who can train aggressively through nerve or disc irritation are few, and not very bright at that. This leads to #2.
2. What is the source of your sciatic irritation? Sciatic irritation is a symptom, not a cause. The majority of sciatic nerve pain originates in the lumbar spine. Has this been examined in more detail? The sciatic can also be entrapped or irritated as it courses down the leg (as is the case with the most over diagnosed back issue in my opinion, piriformis syndrome). If you have not been evaluated to discover the source of the symptoms, this is the first place to start. Keep in mind that most disc/radicular injuries do not yield central back pain.

3. The more flexed in your lumbar spine that you are in your position, the more stress you are placing on the disc and sciatic. When under heavier stresses, and in particular with climbing, cyclists tend to flex more through the spine and this in turn amplifies symptoms. In general I find that cyclists who have similar symptoms have significant hip girdle flexibility restrictions that force them to preferentially flex at the lumbar spine rather than flex through pelvic rotation. Flexing maximally at the lumbar spine places the disc and posterior ligaments at risk.

4. Approach fitting your bike cautiously, preferably choosing a fitter who understand pathology as well as cycling mechanics - this means someone with medical experience or someone who will work with your therapist. The ability to place your back in a protected position rather than in a "pro" position is essential to returning as quickly as possible.

Side to side knee movement

I am 38 year old male, who occasionally races. I ride about 200+ miles a week with a lot of climbing (4k+ per ride).

I have recently noticed that when I pedal both of my knees move side to side at the top of the stroke. I have also read that over time this can lead to knee problems. I have been fitted to my bike by my local shop though I am guessing they either did not notice the issue or did not know how to fix it. I am curious what I can do about it?

Sam

Steve Hogg replies:

Is it fair to say that you are tight in the hips and lower back? If it is, that is the root cause. A seat that is too low or too far back (which yours may or may not be) can exaggerate the side to side movement.

If you are as tight as I suspect, time to find some flexibility. Yoga, Pilates or similar are a good way to start as is "Stretching and Flexibility" by Kit Laughlin.

David Fleckenstein replies:

There are couple of issues that can lead to the "drifting knee" and, interestingly, the knee is not the cause.

The knee lies in a vulnerable position in the kinetic chain - below the pelvis fixed to the saddle and lumbar spine, and above the foot fixed to the cleat. Thus errors at the foot and hip can be transmitted up or down the chain and are often realized as symptoms or aberrant motion at the knee.

Starting at the hip I would look at four things. First make sure that you are not too flexed in your position. Second, if you can find an PT, chiropractor, or orthopaedic physician, have them take evaluate your hip internal rotation. Cyclists, in my opinion, must have a minimum of 20 degrees of hip internal rotation for normal pedaling mechanics to be present, and this is the most overlooked cause of this problem. If this motion is absent, due to tightness or hip pathology, riders externally rotate their hips at the top of the pedal stroke, which causes the knee to drift out. I have treated numerous cyclists who had gone through orthotics, manipulation, stabilization, etc.. and nobody examined their hips, which had intrinsic damage and simply wouldn't move into full flexion. Third, have your hip stabilizing musculature evaluated- glut medius and minimus, hip IR, and hip ER evaluated as weakness within these muscles will not guide the femur through a correct pedal stroke. Finally, look at your hip girdle flexibility, paying particular attention to your IT band.

Looking at the foot, it is important to have your pronation mechanism evaluated both on and off the bike. Excessive pronation can cause the knee to track through a "figure 8" in the pedal stroke.

I'm sure that Steve H. will have additional insight on the pedaling mechanics and fitting of this common problem, just don't forget that if you have concerns like those above off the bike, they won't get better on it!

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