Form & Fitness Q & A

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Fitness questions and answers for February 12, 2003

Riding during pregnancy
Tennis elbow
Intensity vs Endurance
Reader responses: Patella-femoral syndrome

Riding during pregnancy

I am a 30 year-old female Cat II racer, and have been racing for 6 years. I am two months pregnant, and have been researching the best training methods for pregnant women. Most of the articles I've found recommend to continue exercise, but at more moderate levels. But in the next line, it says that there is no evidence to suggest that more intense exercise can cause harm to the fetus.

I would like to continue my intensity and duration of rides, until it becomes impossible to do so. Is it ok to be getting my heart rate over 170? How about 180? How long of rides are safe to do? 2 hours? 3 hours?

I know it's probably not good to bonk, and I plan on taking lots of food with me when I ride.

Thanks!
Christina

Kim Morrow replies:

Good question. As you have already discovered, there are various opinions on this issue. Ultimately, you and your doctor will have to make these decisions, keeping in mind your unique health condition and the gestation age of the fetus.

The American College of Obstetrics and Gynecologists (ACOG) offers some good guidelines for exercise during pregnancy. These guidelines apply to healthy women with normal pregnancies. They also offer a guide to exercise prescription during pregnancy. These exercise prescriptions(which include the type, intensity, duration and frequency of exercise), describe what is appropriate for 3 levels of maternal fitness: sedentary women, recreational athletes & regular fitness exercisers, and elite athletes. I encourage you to check them out and discuss this with your own physician.

Please keep in mind though, that the issue of high-intensity endurance training among elite athletes is still being debated. Ultimately, it is important to minimize risk to the developing fetus. The longest duration of exercise that I have seen recommended in any of my research is 60-90 minutes.

A few other thoughts to consider:

1) Be careful not to overheat, especially during the first trimester. Avoid outdoor exercise during the heat of the day.

2) Stay well hydrated before, during and after exercise.

3) Stop exercising when you are experience pain, fatigue or shortness of breath.

4) Non-weight-bearing exercises, such as cycling and swimming, are often recommended and allow for the continuation of exercise during pregnancy.

5) Avoid exercise in the supine position, due to the decreased cardiac output associated with this position.

6) There are greater energy demands during pregnancy. Make sure to eat an adequate amount.

I wish you the best during your pregnancy.

Tennis elbow

I am a 30year old male of medium fitness with a condition known as tennis elbow what can I do to rid myself of this injury short of letting the doctor jab me with a needle or cut open my elbow.

Neal Wallace

Kim Morrow replies

I'm not sure if you got the problem that you are referring to as "tennis elbow" (lateral humeral epicondylitis) actually from playing tennis? Many people use this term broadly, but can get it from playing any racket sport actually, even from playing golf. It is a repetitive stress injury in which the pain is manifested in the outer knob of the elbow (the lateral epicondyle).

I would suggest that you see your physician about this injury, but let me offer a few comments:

1) Deal with this issue early. Don't let the problem linger.

2) Determine the cause of this problem. For example, a racket with a small grip or a racket that is too heavy may cause tennis elbow. An improper swing/form may add stress to the elbow joint. Let your doctor diagnose this for you.

3) Stop any activity that aggravates this problem.

4) Ice massage is often an effective treatment. An anti-inflammatory may be prescribed for the pain and inflammation.

5) After your physician gives the ok, begin a strength and flexibility program to address this specific problem.

The clients that I work with who have had this problem (or who are trying to prevent this problem) engage in a strength and flexibility program that focuses on the muscles and ligaments surrounding the elbow joint. The extensor and flexor muscles in the forearm muscles are developed through wrist curls, for example. I also suggest exercises for the bicep, tricep and shoulder muscles.

Intensity vs Endurance

With respect to the reply to Andrew Gannon, I am sure I have read of studies which indicate intense interval training brings benefits in terms of endurance. My own training over the past 5 months (off season) has involved a lot of track work, typically 1.5 - 2 hours total ride time with flat out efforts interspersed with steady tempo, usually twice weekly and one night of Track racing which again is roughly two hours total ride time consisting of four efforts at or very near my limit for 10-20 minutes. I have done very little road work over this winter period with the exception of a few 3 hour rides and a couple of 5 hour rides at a fairly high tempo. I will be competing in road races of 2-4 hours duration and haven't in the past had any problems with endurance. I would say that my weaknesses would be recovery from over the limit efforts, but this tends to disappear after 3-5 races in the early season, and making sprint efforts after riding near my limit for long periods. Is this a result of my off season or would you suspect these are just weaknesses anyway. Could I expect to see better results by following a more traditional build up of steady tempo riding for longer distances. With the season a couple of weeks away is there little chance to remedy any weaknesses.

Phil

Dave Palese replies

First we should make some clarifications. Endurance, in my vocabulary, can be defined as an athletes stamina (how long can the machine run before it starts to breakdown). Endurance was not the subject of my response to Andrew. What I refer to in my response to Andrew, and suggest that he focus more attention on in his training, is the development of the Aerobic energy system. My intention was to illustrate that for an athlete to develop his or her abilities with a certain amount of depth he or she must focus on all of the energy systems in the body, there being three major systems: ATP-CP, Lactic Acid and Aerobic, the Aerobic being the system in question. I am not saying that you should only perform workouts focused on the Aerobic system, but rather there should be a balance to your training, and that that balance will be weighted in different areas at different times of the year.

Development of the Aerobic system, usually characterized by long steady rides at about 65-70% of your max working heart rate, carries many benefits that will increase efficiency at higher intensities when engaging the other energy systems. Some of those benefits include: increase capillary density, and increase in mitochondria in the muscles and increased stroke volume resulting in increase cardiac output. It's when training this system that your body can concentrate on putting in place all the things that will help it to run more efficiently when the pressure is on - bridging the gap to that break, attacking on a that hill and so on. When a particular energy system runs more efficiently, the results is often higher output at a given intensity, and quicker recovery after and between hard efforts.

What I see very often is that riders want to feel like they are getting a workout, and may not feel that riding at such a low intensity carries any benefit. It takes a lot of self-control to perform a solid block of training focused on developing the Aerobic system.

You mention having a difficult time recovering after hard efforts during your races. I believe that a solid, structured block of training focused on the Aerobic energy system will go a long way to helping you recover after such efforts. Your track events will also benefit. Your recovery after sprints in the points race will increase. Your ability to retain control over your situation while holding a good position in the miss-and-out will increase. You will likely see faster times in your endurance events like pursuits and the kilo. It's a win-win situation.

Reader responses: Patella-femoral syndrome

Editor's note: we're not intending to turn this section into a discussion forum, but we received the following excellent letters from readers about knee pain and patella-femoral syndrome. The advice and anecdotes that follow are not necessarily supported by our fitness panel, but are presented on the basis that shared experience may be useful to anyone suffering this not-uncommon problem.

Cartilage rebuilding

As a cyclist myself, I sympathise with Liam's inability to train due to your patellar-femoral joint problem. I have had a personal experience of my own with this problem and have found a strict regime of glucosamine and chondroitin sulphate daily very beneficial. These compounds are the building blocks of cartilage and are readily available from sports nutrition or health supplement shops. They usually have a loading phase and in my opinion, must be taken diligently and for a while before their benfits become apparent.

The logic goes as such. When I suffered from the problem, I experimented with most things eg reduction of training, raising of saddle, stretching etc. However, cartilage wear is a factor of synthesis and wearing down/degradation. You haven't mentioned in your letter an abrupt increase in the amount of training so the latter probably hasn't changed. Furthermore, the remedies mentioned so far target only the latter and thus may not actually solve the root of the problem. Therefore, I think the fault may lie with your intrinsic biochemical synthesis of cartilage. Research has shown that aging and glucosamine-6-phosphate dehydrogenase (G6PD) enzyme deficiency results in a reduction in glucosamine synthesis and so this limits your synthesis of cartilage. Thus, an extrinsic dose may help you get around the problem.

This is only my 2 cents worth but I guess there is no harm in trying.

David Low
Singapore

Deep tissue massage

I was diagnosed with a very similar condition about 5 years ago. I was told to quit riding and start developing my inner quad to create the balance required to pull my knee cap back in alignment. I tried this - diligently - for an entire off season (which in Milwaukee is a long time) - but w/ no luck.

I also tried new pedals (back to Looks with bigger platforms) and superfeet inserts - both helped some, but did not completely fix the problem.

I got lucky and had a friend diagnosed with the same problem and had deep tissue massage recommended on the IT band - and IT band stretches done in conjunction. He had relief in a week, though his girlfriend is a PT so he gets massage daily. I found a professional who has worked mild miracles for me in only a few sessions.

I know everyone is different - but it seems there are a lot of IT band / knee pain issues out there, and a lot of physicians saying "build up that inner quad..."

One vote for deep tissue work - combined with stretching to loosen the IT band.

Ken Lutze
Milwaukee

Cleat position

I am a 29 year old cyclist who competes primarily in road races with the occasional mtb race. Typical training volume is approx 400km/week.

I was diagnosed with patella-femoral syndrome after suffering from re-occurring right knee soreness after hard or long rides. Rest, anti-inflammatories and stretching exercises were prescribed by a sports doctor however the effect of these actions was minimal and I was becoming concerned my cycling days might be numbered.

Eventually, via a process of trial and error, I figured out I was twisting my right knee slightly (primarily given away by slight scuff marks on the crank arm). Repositioning my cleat by approximately 2mm and concentrating on keeping my pedaling action central and smooth eliminated the pain within a couple of weeks.

I present my story more to give encouragement to other cyclists to keep trying when sometimes an injury may seem insurmountable. I am not advocating "DIY" type diagnosis although I seem to have been lucky in that regard.

Adrian Vizzari
Melbourne, Australia

Not just the knee

As a physiotherapist with a great deal of interest and work performed on patellofemoral patients and good knowledge of the existing body of research, I would like to add a comment to your experts' opinion. Patellofemoral dysfunction is truly multifactorial and each portion of the kinetic chain must be examined. Very often the patella is simply the 'victim' for rotational/torsion 'culprits' located above and below the knee. These can include excessive pronation, excessive tibial varus/valgus, increased Q-angle, and hip mobility dysfunctions. There are numerous research articles that both support and question the effectiveness of patellar taping - I seriously question the effectiveness of the tape maintaining an altered position of the patella through thousands of pedal strokes when there are research articles that show it does not result in an altered position even at rest.

My personal treatment plans include possible orthotic use, fit evaluation, careful pedal selection (I think that Speedplay-type 'endless float' pedals actually exacerbate this problem by allowing unlimited LE torsion), ice massage and mobilization of the medial and lateral structures that surround the patella, and aggressive iliotibial band/ hip external rotator stretching.

Dave Fleckenstein
Australia

Prevention by stretching

I'm 28 and I have been cycling for 15 years and am currently a professional with Sierra Nevada/Clif Bar. Twice in my career I have been sidelined up to 2 1/2 months without any riding at all due to chronic knee pain, very similar to what you have described. Experience and trial and error have taught me how to overcome chronic knee ailments. Prevention is what you (k)need to work on. With a proper stretching routine and a consistent riding regimen you can learn how to work through this.

While resting, massage with your fingers around the patella to stimulate blood flow, if you get a lot of swelling, use some ice and anti-imflammatories to reduce the swelling and pain. STRETCH!! This is the single most important thing you can do to reduce the pressure under the patella. The key is balance the stretching between the quad and the hamstring, as well as the IT band and the muscles on the inside of the thigh. The hip-flexor and the glut are also in the equation as well. Stretch often, before the ride, during the ride, after the ride, before bed. And learn to listen to your body. In my opinion it is not an overuse issue (as my doctor's advised me) rather, it is a lack of the mind-body connection.

Justin

...and use the small ring

Bottom Line: what you have will go away.

You need to:

1) stretch your quads
2) pick an anti-inflammatory medicine and take the proper dose
3) ice twice a day for two weeks
4) back off on hills, stay in the small ring for at least 3 weeks

Again, this is treatable and it will abate.

J. McGillicuddy, M.D.
Orthopaedic Surgeon

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