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 September 11, 2008

Pain in the knee
Tibialis anterior pain
Riding and hypertension treatments
Right leg weakness
Gender differences in training
Adaptation to Aero position

Pain in the knee

This is another knee-pain/ache query, but I think this might be slightly more complicated than it first appears.

Basically, after some 4 months off the bike (moving house, changing jobs), I have returned to the bike, but appear to now have significant horizontal/laternal knee 'wobble' at the top of my right leg's pedal stroke - especially at medium load at 70-95rpm. This movement looks to involve the knee moving inward towards the frame at the start of the power stroke, and outward at the top of the return stroke.

Typical scenarios of medium load are: - accelerating while seated, after being stopped at lights - maintaining speed over a slight drag or into a wind - trying to maintain 80+ rpm on a slightly steeper drag

However, it does not occur all the time:

At 100rpm+ and light load there is no significant lateral knee movement - At heavy load at < 70rpm (i.e. 'lazy' climbing) there is no significant lateral knee movement - When out of saddle it is normal; the problem only occurs seated - When using the clipless pedals of an ergometer in the gym with my trainers, there is almost no lateral knee movement - in any rpm range, and from 140-270 watt outputs. My 'natural' rpm range is 95-100rpm.

I have done some CAT4 road racing in the year before my time off, and this knee movement was not present.

This 'wobble' coincides with a near constant ache starting "in" the right knee; off the bike or otherwise; it doesn't appear to be muscular (pain/ache is constant on or off the bike, and even after 3-4 days rest). If anything, the pain is located on the outside of the knee, and slight towards the back. Sometimes the very top of my kneecap is sensitive. Sitting at work it is more noticeable, and I have to make conscious efforts to sit perfectly and not tuck my feet under my seat.

I've adjusted the cleat nearly a dozen times (I've used the same shoes for years), but still can't stop the lateral knee movement. I've tried small changes, and big changes. My cleats have 0' movement. I've even used a shoe which has a cleat position at least 3yrs old, with no improvement. Though if the injury was "set" before I tried it, I imagine that doesn't mean anything.

Root cause is unclear; I'm not conscious of any damage or activity which might have started this knee movement.

My concern is that the large knee movement at medium loads is damaging my knee, even if I'm only riding 4-5hrs a week. The pain is nagging, rather than outright pain, but it is at a level where painkillers are tempting - and this is not a course of action I wish to pursue.

My Physiotherapist thinks there's an imbalance in my hamstrings, and I need to retrain my style to bring the knee in before starting the power stroke to eliminate the 'wobble'. He notes that I have good hip flexibility and good flexibility in the knee itself. There is no 'roughness' in the knee's normal operating range, though he was slightly concerned about the resistance to vertical rotation/flexibility of my lower leg (though range itself was fine).

However, this re-training is monumentally difficult to do and replicate, and frankly, I'm not convinced this is a proper fix either

I can reduce the wobble by either:
Consciously pushing my right knee outward or
'Scrapping' my feet at the bottom of the power stroke.

This is difficult to maintain, mentally on a commuting run, and does not always fix it anyway.

It should be noted that since returning to the bike, I have only ridden my commuter (mtb with slicks), not my dedicated road bike; I've been worried about this knee before starting the big miles. I currently ride to work (23 miles each way) 2-3x a week + 1 weekend run.

I need to find a proper fix soon; I need to start some proper training now if I'm going to race again next year.

Euan Ramsay

Steve Hogg replies:

This may be quite simple. The most common reason for the lateral knee movement you describe is when the rider drops the opposing hip during the pedal down stroke of that side. Picture this - left leg extends on left side pedal down stroke while at the same time the left hip drops; in other words, the entire pelvis cants down to the left on the left down stroke. This coincides with the upstroke and outward movement of the right knee. Then on the start of the left side up stroke, the left leg unloads and the pelvis rebounds to the centre line coinciding with and causing the inward movement of the right knee at the start of its down stroke.

The most common causes for this are:

1. Too high a seat height will always cause the rider to favor one side over the other. If you are favoring the left side, the right side is the one that will suffer.
2. Too much seat setback results in posterior pressure on the hips and again, almost all riders will then favor one side over the other.
3. Bar height that is too high or too low will destabilize the rider and will exaggerate any existing asymmetries or tendency to asymmetry
4. A psoas that is too tight on the left side.

I tend to discount 4 because your problem isn't apparent on the gym bike. I suggest that you measure and duplicate the seat height of the gym bike as a first step. If that doesn't work for you, then consider seat setback. As a guide, seat setback needs to be the minimum that allows a largely un-weighted upper body. It would also pay to consider your bar height and the reach to the bars.

Tibialis anterior pain

I'm a 36 yr old male, 168 lbs, 6ft, short inseam relative to my height (about 31 inches) (stop laughing), ride a 54cm framed Felt in a fairly race-oriented set up, wear Shimano R300 shoes, and ride about 2-3/week. 2 is my usual. The midweek ride is about 20 miles. The weekend ride is about 50-70. I do a good amount of climbing, mostly in the saddle.

I've started to develop some slight pain in my tibialis anterior muscle in the right leg. I also feel some tightness in my right ankle while riding. Not sure the proper name, but it's generally the outside part of my right ankle between the big outside ankle bone and the tibia.

I don't have any other issues. No significant back issues, no left leg issues. I suspect that I may sit on the saddle slightly unevenly.

Can you help me understand what may be some causes of this sort of pain? I haven't read other letters on your site that address this. Thanks for the help!

Richard

Steve Hogg replies:

If as you suspect, you don't sit on the seat very squarely, that will play at least a part in the problem you have. If you are dropping the right hip (probably 90+% do at some level) and under extending the right leg, then one response to that is to excessively drop the right heel. This can cause problems like yours and is even more likely if your cleat position is too far forward.

The first step towards a solution is to move your cleats back further than they are now and you will need to experiment with just how much is ideal. The second step would be to identify and work to resolve what causes you to sit asymmetrically.

Riding and hypertension treatments

At 41 I am relatively new to riding and thanks to my genetics have suffered from hypertension since my teens. Over the years there have been a variety of blood pressure medication types taken to manage this condition. Each style of drug has its own issues in terms of effects on the cardio vascular system, retention of fluids, absorption of minerals, etc.

Recently on a 100k plus ride, I rode through severe cramping for about 40k's. In the memory bank is something about the drug I am taking effecting potassium levels within the body and may explain the cramping - though it was after a particularly severe climb.

Riding has become a passion and it is enjoyable taking on ever increasing challenges. However, the last thing I would want to be on a medication that is restricting the ability to take on the challenge or creating an avoidable situation that makes the challenge harder.

As the rides get longer and climbs get harder I am wondering what are the cycling implications of various blood pressure medication types and should certain types be avoided for riding?

Damian
Melbourne, Australia

Scott Saifer replies:

I hope one of our more-expert experts will jump in with details, but the short answer to your question is yes, absolutely, many blood pressure medications will adversely affect your ability to perform on the bike. Your doctor or pharmacist (chemist) should know which ones have what side effects.

The most important thing is of course to control the blood pressure, but there's a good chance that if you push him or her, your doctor should be able to come up with a combination of medications that lets you ride as much and as hard as you like. (As fast as you like depends on training and other aspects of your genetics).

Right leg weakness

I am a 5'9" 155lb 45 year old male CAT 4 racer who has only raced 5 times this year with "finish with the pack" results. I ride about 200+ miles/week fairly consistently mostly as group rides with slow/moderate/fast groups to vary the workouts. Most week day rides average 1.5 to 2 hours regardless of pace/terrain. Weekends are mostly solo rides of 2.5 to 3.5 hours of mixed intensity or the occasional 4 hour group ride. On the long group ride I will do 3 to 4 extended pulls (5 to 10 minutes) to up my intensity.

First a bit of history; I have been riding for ever but have increased mileage/intensity for the past 3years after finally buying a newer bike. Getting the new bike setup to where I felt most comfortable and strongest took 2 seasons. I started out with a low seat position and had gradually raised it to where it is now (on numerous occasions I had been told that my seat looked low). After raising my seat it took a week or so for my body to adjust.

I would get knee pain behind my left knee that I did not get in the lower seat position. This season I have not adjusted any positions and have been riding outside since March with improving form until August when I took some time off. Despite no bike setup changes this season I had been noticing that after the long group rides where I spent a significant amount of time in as aero a position as I could (forearms on bars or hands on hoods/forearms parallel to the road pushing a big gear at 90+ rpm) I would develop a pain behind my left knee. Normal paceline riding for me is comfortably spinning at 95 to 100 rpm on the flats. Having ultra-poor hamstring flexibility (even though I stretch before, during and after and then stretch more I cannot touch my toes), I attributed this to a both the poor flexibility and a poor cleat position. After reading an excerpt on cyclingnews fitness about knee pain/cleat position I moved my cleats back a few mm, more so on the left leg, and this has greatly alleviated that problem.

What is at issue now is on my last weekend ride that was a solo effort of 4+ hours I developed a right leg problem. The ride was 70 miles out and back. The 35 out was with the wind and mostly down hill for the 1st 15 miles and relatively flat from there. I took full advantage of this and after warming up pushed a big gear at 90 to 95rpm. Upon the return into the wind I continued to try to push the biggest gear I could stay on top of at 90 to 95 rpm while getting aero to minimize the strong headwind. After 10 miles of this my right kneecap started to hurt along with my right quad from the kneecap running to the outside of my hip. I am wondering if I have just over did it or if I have a fundamental setup issue. I wear size 42 specialized BG pro carbon shoes. I am fairly bowlegged (about 2.5 inches of open space between my knees standing straight-legged, feet together). I use 1 specialized wedge in my right shoe to compensate for the bow-leggedness (this seemed to work best after trial and error). My right knee/leg/ankle has a tendency to wander (wobble) and the knee will trend towards crossing the top tube (tore up the right knee running x-country in high school many years ago). I use Keo sprint pedals with the red arc cleats. I would consider my cleat setup a bit behind the ball of my foot. My right foot is nearly a 1/2 size longer than my left foot. I realize that there is probably not enough info here to go on but thanks for any help or suggestions you can give me.

Tom Shoemaker

Steve Hogg replies:

Firstly an explanation and then I'll get to your specific problems. You mention that you are really tight in the hamstrings. Hamstring flexibility is a major determinant of seat height in an individual sense. During the pedal down stroke, the hamstrings contract in part while they extend as a whole. That places a practical limit on seat height because if the seat is too high, it is usually noted first in the hamstrings when under load, though the exact location is an individual thing. Some riders feel it more just below the glutes and others behind the knee. What I'm saying here is that instead of listening to the various 'expert's who've told you that your seat has been too low, learn to listen to your body as it is a more reliable guide. You've noticed in the past that efforts in an aero and / or stretched position make this worse. That's because the hamstrings are more heavily loaded as you lean forward and down.

The niggle behind the left leg indicates that the seat height is too high. The area where you have now developed right knee pain probably, but not certainly indicates that your seat is too low. . The most likely set of circumstances that account for that is this. You favor the right side in the sense that you drop or rotate that hip forward. This is a very common thing with 90% or so of riders. Only the degree varies. If the rider is functionally okay, then this tendency can be nearly imperceptible. If they are ordinary, then it is quite obvious. As to why you may be doing this, there is a host of possibilities. Some of the more common reasons are:

1. A measurably or functionally shorter right leg (and the substantially longer right foot that you have often correlates with a leg that has been falling further and hitting harder during a persons development)
2. A longer right leg with an anterior iliac crest and restricted sacro iliac joint that can accompany this.
3. Tighter right side hip flexors.

There are other possible reasons too, like poor liver function and neurological asymmetries but the thing you need to do is arm yourself with knowledge as to your own condition. I'd suggest that you find a really good structural health professional; manipulative physiotherapist, chiropractor or osteopath. To me a really good one is one that will give you information, remove structural 'road blocks' and educate you to the point that you don't need them or only occasionally need them once a course of treatment and advice has been completed. Unfortunately people like this aren't as common as they should be so don't be deterred if the first few you try aren't up to scratch. It's a numbers game.

In the meantime lower your seat to the point where your left knee isn't a problem. I would also suggest and X ray or scan to determine whether there is indeed a measurable leg length difference. If the right leg is longer, you may need to shim up the left cleat.

To confirm (or otherwise) what I've said above; set your bike up on a trainer and pedal under load with your shirt off in an aero or extended position. Have someone stand above and behind you on a chair or stool and ask them to see whether you drop or rotate the right side of your pelvis. If you don't, please get back to me for Plan B.

Tom replies:

Thanks for the prompt answer. I will perform the trainer observations under load to look at my hip. You answer has prompted me to give a bit more information. I do have tight right hip flexors. I have had right hip flexor tightness to the point of significant pain during running which has been made better by stretching but not eliminated. I guess the best course of action for me at this point is to find that good structural health professional. Thanks for the help.

Steve Hogg replies:

Those tighter right side hip flexors make it certain that you are dropping your right hip or pulling it forward on each right side pedal stroke which explains your situation. The question is why are they tighter than the left?

The answers could be a difference in leg length, a sick liver, and the after effects of a crash or heavy impact that knocked you out of alignment and has been present for some time; a lot of possibilities.

Are you right footed in the sense that the right foot is the foot you would kick a ball with?

If you are, the tighter right side hip flexors and noticeably larger right foot may indicate that you have a measurably shorter right leg so don't forget to tick that box by getting an X ray to determine bone lengths. Is the arch of one foot significantly lower than the other or do you pronate significantly more on one foot?

Gender differences in training

I've read some abstracts and papers from the medical literature stating that there are differences in the way men and women utilize glycogen. That got me wondering, because I'm trying to build my base miles, lose weight, get strong, and get into randonneuring. I've been cycling and car free for several years, am 52, and relatively fit, though I need to shed about 15 pounds.

I ride most days of the week, but because of my schedule, cannot ride more than 1.5 hours on most days at a moderate level of intensity (hilly country, with my routine rides having a total altitude gain of about 600-700'). Yet when I go on rides of more than about 2.5-3 hours, I begin punk out. I drink water and energy drinks while underway, and snack every 15 - 30 minutes or so on oatmeal and fig bars, pretzels, and bananas. So, I wonder if I need to something differently to keep from feeling as if I'm on the slide to bonking. My guides in the past are all written with men in mind. Is it a mistake to assume that following advice written for men (as in the book Serious cycling by Edmund Burke) will work for me?

Tam

Scott Saifer replies:

I also have seen some materials suggesting that men and women handle glycogen differently, however I've also been putting men and women on very similar training plans for years, and both the men and the women have been winning medals at nationals, completing double-centuries and doing all that sort of stuff that makes you think that training is working. So, in my experience at least, training advice for men generally applies to women cyclists as well.

Now one of the essential elements of training plan development for men or women is adjusting the plan to make it work for the individual.

There are several possible reasons for your wearing out at 2-3 hours. You may not be eating or drinking enough. You may be riding harder than your body is ready to handle. You may not be eating enough carbohydrate off the bike. Any decent coach should be able to help you sort through the possibilities and come up with a plan to get you past this problem.

Adaptation to Aero position

Following on from your aerodynamics questions, my question is "how long does it take to adapt to the aero position"?

My son is doing the NZ Ironman in March. He last did the event on a road bike, but now has a specific triathlon bike with an aggressive aero position. I believe the early part of his training can be done on his standard road bike, particularly for hill work. He could then adapt later to the aero position. He believes all his training should be done in the aero position. Who is correct? And if he can use his road bike how should the progression to the aero position work? When and for how long should he use which bike?

I look forward to your answer.

Dave

Steve Owens replies:

How long does it take to adapt to an aero position? First I think you have to define 'aero'. Aero is typically referred to as low and bent over, but that isn't necessarily always the case. No matter what the position is, I would recommend riding the TT bike 3-4 days per week, with about 14-16 weeks of riding the TT bike as such prior to competition. Focus on riding position, head position and relaxing the hips so they are neutral and not rotated forward. You want to create a more open hip angle so you can develop power. Head position often gets neglected, and can account for quite a large percentage of overall drag. You can still develop climbing power and time trialing power on separate machines - it just takes practice and dedication to each.

Good luck to you and your son Dave - hope that's helpful.

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