Tuesday, December 23, 2008
Friday, December 19, 2008
I recently worked with John Howard at his Nov. 2008 San Diego FiTTE System Work Shop where he and Ernie Ferrel trained new FiTTE System practitioners. I was fortunate to give presentations on using Dartfish as a video analysis assessment tool.
Check out the above link to learn more about John's FiTTE System protocol.
Monday, December 15, 2008
Cycling and Lower Back Problems
By Richard A. Izzo, D.C., C.C.S.P.
During cycling, unlike running, it’s not just the bio-mechanics of the lower back and leg motion that is important, but the melding of human motion with machine. The biomechanics of cycling requires that the lower back and pelvis move in order for proper coordinated lower extremity motion. The anatomy of the lower back consists of muscles, tendons, ligaments, discs, and joint surfaces. For the purposes of this article we will concentrate on joints and muscles.
Soft tissue can shorten, tighten, weaken, hypertrophy, or be over stretched and strained. Muscles that have shortened can do less work. This is due to the fact that work is defined as force times distance. Thus, if the resting length of the muscle is shortened, the potential power generated is reduced. In cycling, the work is the distance per pedal stroke as measured by bike length traveled per stroke, or the power generated as measured in watts. An example of this is the cyclist whose hip flexors and quadriceps are tightened. Since there is less potential to do work (in this case, lengthen and contract a maximum distance) power is decreased, which means that it is harder to push a big gear. Since hip flexors originate in the lower back, when they tighten they can also cause lower back pain.
To analyze the normal pedal stroke lets use the analogy of a clock. From the one o’clock position to the three o’clock position the quadriceps contract with the downward pedal stroke. Force is transferred from the cranks to the wheels and you travel forward. The next important part of the pedal stroke is from 9 o’clock to 12 o’clock, where the hamstrings pull the crank on the upstroke. If one leg is not pushing or pulling the same as the other you will not have a smooth fluid pedal stroke. This loss of efficiency will affect the quality as well as quantity of motion. This creates “dead” spots in your pedal stroke, which decreases the torque you can produce.
Pelvic misalignment, short leg syndrome, tightened hamstrings, malalignment of the patella, or tightened lower back muscles can be the cause of these dead spots. Pelvic misalignment can cause a short leg syndrome. When one of your legs is shorter, the amount of force generated will not be equal. This can cause the body to compensate by recruiting other less efficient muscle groups to do the job. This added stress could cause overuse, inflammation, and over time, degenerative changes. With joint position being off, motion cannot occur normally due to the fact that more energy is necessary to do work (force times distance). The quality as well as the quantity of motion is decreased. Smooth, fluid, efficient motion, is not occurring, with the result being that your body is working harder than it should. There is a loss of energy to abnormal motion. This causes decreased performance, which comes into play when riding a century or a time trial.
Even when the symptoms of joint and muscle dysfunction are not evident, the problem may still exist, and it should be addressed and fixed before symptoms arise and degenerative changes occur. Chiropractic sports doctors check for these imbalances of the spine, soft tissue and extremities, and treat them with hands-on care, including physiotherapy, spinal adjustments, rehabilitative exercises, and stretching. A good approach for preventing injuries is to get regular checkups for musculoskeletal imbalances before symptoms occur, and follow a regular strengthening and flexibility program. Be sure that the bike you ride is properly fit to you as well as to your budget.
See you on the road.
Dr. Richard A. Izzo is a Board Certified chiropractic sports doctor with a practice in Rye Brook, NY.
During cycling, unlike running, it’s not just the bio-mechanics of the lower back and leg motion that is important, but the melding of human motion with machine. The biomechanics of cycling requires that the lower back and pelvis move in order for proper coordinated lower extremity motion. The anatomy of the lower back consists of muscles, tendons, ligaments, discs, and joint surfaces. For the purposes of this article we will concentrate on joints and muscles.
Soft tissue can shorten, tighten, weaken, hypertrophy, or be over stretched and strained. Muscles that have shortened can do less work. This is due to the fact that work is defined as force times distance. Thus, if the resting length of the muscle is shortened, the potential power generated is reduced. In cycling, the work is the distance per pedal stroke as measured by bike length traveled per stroke, or the power generated as measured in watts. An example of this is the cyclist whose hip flexors and quadriceps are tightened. Since there is less potential to do work (in this case, lengthen and contract a maximum distance) power is decreased, which means that it is harder to push a big gear. Since hip flexors originate in the lower back, when they tighten they can also cause lower back pain.
To analyze the normal pedal stroke lets use the analogy of a clock. From the one o’clock position to the three o’clock position the quadriceps contract with the downward pedal stroke. Force is transferred from the cranks to the wheels and you travel forward. The next important part of the pedal stroke is from 9 o’clock to 12 o’clock, where the hamstrings pull the crank on the upstroke. If one leg is not pushing or pulling the same as the other you will not have a smooth fluid pedal stroke. This loss of efficiency will affect the quality as well as quantity of motion. This creates “dead” spots in your pedal stroke, which decreases the torque you can produce.
Pelvic misalignment, short leg syndrome, tightened hamstrings, malalignment of the patella, or tightened lower back muscles can be the cause of these dead spots. Pelvic misalignment can cause a short leg syndrome. When one of your legs is shorter, the amount of force generated will not be equal. This can cause the body to compensate by recruiting other less efficient muscle groups to do the job. This added stress could cause overuse, inflammation, and over time, degenerative changes. With joint position being off, motion cannot occur normally due to the fact that more energy is necessary to do work (force times distance). The quality as well as the quantity of motion is decreased. Smooth, fluid, efficient motion, is not occurring, with the result being that your body is working harder than it should. There is a loss of energy to abnormal motion. This causes decreased performance, which comes into play when riding a century or a time trial.
Even when the symptoms of joint and muscle dysfunction are not evident, the problem may still exist, and it should be addressed and fixed before symptoms arise and degenerative changes occur. Chiropractic sports doctors check for these imbalances of the spine, soft tissue and extremities, and treat them with hands-on care, including physiotherapy, spinal adjustments, rehabilitative exercises, and stretching. A good approach for preventing injuries is to get regular checkups for musculoskeletal imbalances before symptoms occur, and follow a regular strengthening and flexibility program. Be sure that the bike you ride is properly fit to you as well as to your budget.
See you on the road.
Dr. Richard A. Izzo is a Board Certified chiropractic sports doctor with a practice in Rye Brook, NY.
Knee Pain and ITB Syndrome
By Carl Petersen, PT & Catherine Fussel, PT
Iliotibial Band Friction Syndrome is one of the most common causes of knee pain. Though frequently found amongst runners, it is also seen in tennis players, cyclists and occasionally in skiers, weight lifters and soccer players.
The iliotibial band (ITB) is a thickened strip of fascia, or outer casing, of a muscle that runs up the outside of the thigh. It extends from the outside of the pelvis, above the hip, to just below the knee joint into the tibial bone. Two muscles insert into the ITB where it begins at the pelvis - the tensor fascia latae muscle and the large gluteus maximus muscle. The ITB's primary function is to stabilize the knee and hip during walking and running.
During its course from the pelvis to the knee, the ITB crosses over a bony prominence on the outside of the knee known as the Lateral Femoral Epicondyle (LFE). A bursa, a fluid filled sac that reduces friction, lies between the ITB and the bone. As the knee bends or flexes past 30 degrees, the ITB slides over the LFE and the bursa. As you straighten or extend the knee, the band slides back over the bony prominence. It is this repetitive sliding back and forth that causes irritation of the ITB and the underlying bursa causing Iliotibial Band Friction Syndrome.
ITB Friction Syndrome is an overuse injury. Pain results from inflammation of the iliotibial band itself and/or the bursa. Inflammation of the periosteum, the outer covering of the bone, can also occur, causing pain as well.
MECHANISM OF INJURY
Although ITB Friction Syndrome may simply be due to training errors like too rapid an increase in running distances, it is also commonly due to faulty biomechanics. The ITB spans two joints, the hip and the knee, making it susceptible to stress from a multitude of causes. For runners, these may include leg length discrepancies, often secondary to a rotated pelvis, excessive "bow-leggedness", over-pronation (flat feet) or excessive supination.
Over-pronation of the foot causes the tibia to turn inwards, tightening the ITB and putting it on extra stretch. While excessive supination of the foot decreases the foot's ability to absorb forces during running and walking transferring increased stress to the knee.
Common training errors that may lead to ITB friction syndrome include persistent running on uneven or canted surfaces and increased knee flexion from over striding such as during downhill running. Cyclists may have their cleats positioned so that they are turned in too much or their seat height may be too high.
Mal-alignment problems of the pelvis, knee and foot need to be assessed and corrected or else, despite your best efforts, ITB Friction Syndrome can become a chronic injury. Talk to a reputable physiotherapist or sport medicine practitioner to determine if your IT Band symptoms are being exacerbated by mal-alignment.
Lastly, although this syndrome is commonly caused by over-pronation or leg length discrepancies, it is often the fact that the iliotibial band itself is tight and short. As well, the muscles that insert into the ITB are weak and tight. This tightness, combined with the other factors, leads to excessive rubbing and irritation of the ITB and the underlying bursa and bone.
SIGNS & SYMPTOMS
Iliotibial band Friction Syndrome will usually present itself as pain and tenderness on the outside of the knee. It is probably the most common cause of lateral knee pain. However, because of the length of the ITB, pain may occur anywhere from the hip to the knee, with pain occasionally radiating down the leg to the ankle. Most sufferers cannot often pinpoint the exact location of the pain.
The amount of discomfort ranges from a dull ache to a sharp stabbing pain that is intense enough to stop an athlete half way through a run. The pain comes on most frequently mid-way through a run, often after climbing a hill, or after a run. The pain is most noticeable when descending stairs, walking or running downhill getting out of a car or rising from a chair.
KEEPING THE ITB HEALTHY
Physiotherapists at City Sports and Physiotherapy Clinics in Vancouver have suggested the following set of guidelines for treatment, rehabilitation and prevention to help regain and improve flexibility of the iliotibial band. Upon initial signs and symptoms of ITB friction syndrome follow the PRINCE rules; Protection, Rest, Ice, Non-steroidal anti-inflammatory medication, Compression and Elevation.
PREVENTION
It is important to choose appropriate foot-wear that is suited for your foot type. Either ask your physiotherapist to make sure your shoes are correct for you or go to a reputable running shoe store that can help fit you in the right shoe. Shoes tend to lose their cushioning and shock absorbing ability after approximately 500 miles. If you run regularly this can be as soon as 4-6 months, so keep track of your mileage and replace the shoes when necessary. Most importantly, in order to prevent the recurrence of ITB friction syndrome, it is essential that stretching is done daily, even on your rest days.
TRAIN SMART
Maintain a year-round fitness program to avoid sudden changes to your activity level. For acute ITB Friction Syndrome reduce the mileage by at least one-half or up to the point of pain for two weeks and ice regularly after each run or cycle. Runners should avoid hills. If you run on a track or even on the side of a cambered road, make sure you change directions to allow your leg to alternate canted surfaces. Cyclists should pedal easy (80 rpm or less) with little resistance for at least one week. Gradually increase the amount of activity. Runners should not exceed increasing their mileage or their run duration by greater than 5-10% per week.
STRETCH & STRENGTHEN
Fortunately, iliotibial band Friction Syndrome is probably the best example of an injury that responds well to stretching. However, because the ITB is a relatively in-elastic tissue, stretching must be done regularly and consistently even when symptoms have subsided. It is also equally important to remember to stretch the tensor fascia latae and the gluteus maximus muscles as they come together and form part of the ITB. As well, the hamstring and quadriceps muscles should be stretched as the fascial tissue connections contribute to IT Band tightness. Cyclists should stretch extra long since cycling tightens up the lateral quadricep and iliotibial band.
STRENGTH SMARTS
Strength is also an important factor in controlling Iliotibial Band Friction Syndrome. The tensor fascia latae and the gluteus maximus muscle, as well as the surrounding hip and knee musculature must be kept strong. Exercises such as the straight leg raise, mini squats and step-ups are good exercises. The gluteals are multipurpose muscles that not only extend and abduct the leg but also include a component of rotation.
WARNING SIGNS
Always listen to your body. At the first sign of Iliotibial Band Friction Syndrome, stop. By stopping activity and spending a couple of minutes stretching out the ITB you may be able continue running or cycling for a few more kilometres. Ice and stretch again after activity. If stretching does not ease the pain don't try and push through it – you can't.
If identified and treated early ITB Friction Syndrome may only delay your training for a week or two. However, if the pain in not heeded this can very quickly turn into a chronic injury that may take several months to heal.
SURGERY
Surgery is the final option if conservative methods do not work. Make sure you are seen by a skilled orthopaedic medicine specialist who is familiar with the condition. Unfortunately there is no guarantee that surgery can relieve all the symptoms and return an athlete to pre-injury level.
A couple of things to remember: first, if you have any doubts about your current fitness level, consult a physician before beginning any exercise program. Secondly, stretches for all muscle groups should be part of your routine.
Carl Petersen is a Partner at City Sports & Physiotherapy Clinics. He is Physiotherapist for the Canadian Alpine Ski Team, and Fitness Coach to ITF & ETA players.
Iliotibial Band Friction Syndrome is one of the most common causes of knee pain. Though frequently found amongst runners, it is also seen in tennis players, cyclists and occasionally in skiers, weight lifters and soccer players.
The iliotibial band (ITB) is a thickened strip of fascia, or outer casing, of a muscle that runs up the outside of the thigh. It extends from the outside of the pelvis, above the hip, to just below the knee joint into the tibial bone. Two muscles insert into the ITB where it begins at the pelvis - the tensor fascia latae muscle and the large gluteus maximus muscle. The ITB's primary function is to stabilize the knee and hip during walking and running.
During its course from the pelvis to the knee, the ITB crosses over a bony prominence on the outside of the knee known as the Lateral Femoral Epicondyle (LFE). A bursa, a fluid filled sac that reduces friction, lies between the ITB and the bone. As the knee bends or flexes past 30 degrees, the ITB slides over the LFE and the bursa. As you straighten or extend the knee, the band slides back over the bony prominence. It is this repetitive sliding back and forth that causes irritation of the ITB and the underlying bursa causing Iliotibial Band Friction Syndrome.
ITB Friction Syndrome is an overuse injury. Pain results from inflammation of the iliotibial band itself and/or the bursa. Inflammation of the periosteum, the outer covering of the bone, can also occur, causing pain as well.
MECHANISM OF INJURY
Although ITB Friction Syndrome may simply be due to training errors like too rapid an increase in running distances, it is also commonly due to faulty biomechanics. The ITB spans two joints, the hip and the knee, making it susceptible to stress from a multitude of causes. For runners, these may include leg length discrepancies, often secondary to a rotated pelvis, excessive "bow-leggedness", over-pronation (flat feet) or excessive supination.
Over-pronation of the foot causes the tibia to turn inwards, tightening the ITB and putting it on extra stretch. While excessive supination of the foot decreases the foot's ability to absorb forces during running and walking transferring increased stress to the knee.
Common training errors that may lead to ITB friction syndrome include persistent running on uneven or canted surfaces and increased knee flexion from over striding such as during downhill running. Cyclists may have their cleats positioned so that they are turned in too much or their seat height may be too high.
Mal-alignment problems of the pelvis, knee and foot need to be assessed and corrected or else, despite your best efforts, ITB Friction Syndrome can become a chronic injury. Talk to a reputable physiotherapist or sport medicine practitioner to determine if your IT Band symptoms are being exacerbated by mal-alignment.
Lastly, although this syndrome is commonly caused by over-pronation or leg length discrepancies, it is often the fact that the iliotibial band itself is tight and short. As well, the muscles that insert into the ITB are weak and tight. This tightness, combined with the other factors, leads to excessive rubbing and irritation of the ITB and the underlying bursa and bone.
SIGNS & SYMPTOMS
Iliotibial band Friction Syndrome will usually present itself as pain and tenderness on the outside of the knee. It is probably the most common cause of lateral knee pain. However, because of the length of the ITB, pain may occur anywhere from the hip to the knee, with pain occasionally radiating down the leg to the ankle. Most sufferers cannot often pinpoint the exact location of the pain.
The amount of discomfort ranges from a dull ache to a sharp stabbing pain that is intense enough to stop an athlete half way through a run. The pain comes on most frequently mid-way through a run, often after climbing a hill, or after a run. The pain is most noticeable when descending stairs, walking or running downhill getting out of a car or rising from a chair.
KEEPING THE ITB HEALTHY
Physiotherapists at City Sports and Physiotherapy Clinics in Vancouver have suggested the following set of guidelines for treatment, rehabilitation and prevention to help regain and improve flexibility of the iliotibial band. Upon initial signs and symptoms of ITB friction syndrome follow the PRINCE rules; Protection, Rest, Ice, Non-steroidal anti-inflammatory medication, Compression and Elevation.
PREVENTION
It is important to choose appropriate foot-wear that is suited for your foot type. Either ask your physiotherapist to make sure your shoes are correct for you or go to a reputable running shoe store that can help fit you in the right shoe. Shoes tend to lose their cushioning and shock absorbing ability after approximately 500 miles. If you run regularly this can be as soon as 4-6 months, so keep track of your mileage and replace the shoes when necessary. Most importantly, in order to prevent the recurrence of ITB friction syndrome, it is essential that stretching is done daily, even on your rest days.
TRAIN SMART
Maintain a year-round fitness program to avoid sudden changes to your activity level. For acute ITB Friction Syndrome reduce the mileage by at least one-half or up to the point of pain for two weeks and ice regularly after each run or cycle. Runners should avoid hills. If you run on a track or even on the side of a cambered road, make sure you change directions to allow your leg to alternate canted surfaces. Cyclists should pedal easy (80 rpm or less) with little resistance for at least one week. Gradually increase the amount of activity. Runners should not exceed increasing their mileage or their run duration by greater than 5-10% per week.
STRETCH & STRENGTHEN
Fortunately, iliotibial band Friction Syndrome is probably the best example of an injury that responds well to stretching. However, because the ITB is a relatively in-elastic tissue, stretching must be done regularly and consistently even when symptoms have subsided. It is also equally important to remember to stretch the tensor fascia latae and the gluteus maximus muscles as they come together and form part of the ITB. As well, the hamstring and quadriceps muscles should be stretched as the fascial tissue connections contribute to IT Band tightness. Cyclists should stretch extra long since cycling tightens up the lateral quadricep and iliotibial band.
STRENGTH SMARTS
Strength is also an important factor in controlling Iliotibial Band Friction Syndrome. The tensor fascia latae and the gluteus maximus muscle, as well as the surrounding hip and knee musculature must be kept strong. Exercises such as the straight leg raise, mini squats and step-ups are good exercises. The gluteals are multipurpose muscles that not only extend and abduct the leg but also include a component of rotation.
WARNING SIGNS
Always listen to your body. At the first sign of Iliotibial Band Friction Syndrome, stop. By stopping activity and spending a couple of minutes stretching out the ITB you may be able continue running or cycling for a few more kilometres. Ice and stretch again after activity. If stretching does not ease the pain don't try and push through it – you can't.
If identified and treated early ITB Friction Syndrome may only delay your training for a week or two. However, if the pain in not heeded this can very quickly turn into a chronic injury that may take several months to heal.
SURGERY
Surgery is the final option if conservative methods do not work. Make sure you are seen by a skilled orthopaedic medicine specialist who is familiar with the condition. Unfortunately there is no guarantee that surgery can relieve all the symptoms and return an athlete to pre-injury level.
A couple of things to remember: first, if you have any doubts about your current fitness level, consult a physician before beginning any exercise program. Secondly, stretches for all muscle groups should be part of your routine.
Carl Petersen is a Partner at City Sports & Physiotherapy Clinics. He is Physiotherapist for the Canadian Alpine Ski Team, and Fitness Coach to ITF & ETA players.
Pelvic Malalignment and Neck Disfunction
Neck dysfunction due to pelvic malalignment
Recently I treated a road cyclist who has had a couple of years of persistent neck pain. This prevented him from reading the paper and made computer work and time-trialing on the bike uncomfortable. He had had a severe car accident 20 years ago where he had been knocked unconscious as well as suffering from a fractured jaw. 4 years ago he had a motor bike accident. 2 weeks prior to seeing me had had been on holidays at the beach where he had been doing a lot of boogie boarding, touch football and generally playing with his children when severe left sided neck pain occured.
Movement restrictions in his neck were left rotation 1/2, right rotation 2/3, left lateral flexion 2/3, right lateral flexion 1/2, all of which were restricted by pain and muscle spasms. Flexion was restricted to 3/4 and extension was unremarkable. Palpation revealed a right shifted C2 with countershift/rotation/lateral flexion of C1, as well as some stiffness in the thoracocervical junction and mid thoracic regions. Additionally, the scalene muscles and levator scapulae were in spasm and the sternocleidomastoid muscle was dominant. Generalized atrophy of the trunk muscles (trapezius, serratus anterior and pectorals) were present. However, the biceps, triceps and deltoids were well defined.
Treatment consisted of joint mobilizations to the upper C/S, thoracocervical junction and mid thoracic regions. Additionally, soft tissue work (massage and dry needling) was performed to the trapezius, levator scapulae and scalenes. Exercises for scapula stability were given in addition to supine bridging soccer ball rolling for his T/S kyphosis, (deep neck flexor endurance and trunk stability), as well as Mulligans techniques for self mobilisation of the thoracocervical junction. This resulted in overall improvement of the acute condition, however the underlying chronic condition was still present after 6 treatments.
The client had only taken up road cycling in the past few years, and hence I decided to look at his posture on his bike. What became immediately obvious was reduced left hip flexion with concommitant left anterior ilial rotation, which resulted in significant flexion and left rotation of the lumbar spine. This continued up into the thoracic spine with over-reaching of his left arm as a result of the pelvic poisitioning. Such over-reaching created significant instability in the scapula, which in turn caused reduced serratus anterior - external obliques, latissimus dorsi - transverse abdominus function.
Interestingly, the anterior rotation of the ilium was potentially a contributing factor to reversed gluteal-hamstring timing as well as premature fatigue and cramping of the hamstring muscle. However, palpation of the lumbar spine revealed tenderness and stiffness at the L3/4 levels on the left. On further questioning the client then revealed an episode of severe low back pain several years ago. Straight leg raising (SLR) with dorsi-flexion (DF) was reduced to 60 degrees (versus 80 degrees on right). Prone knee bend was reduced to 120 degrees. Both iliopsoas muscles were highly activated in sitting, but responded somewhat to lateral diaphragmatic breathing. The left piriformis was tight and the right SIJ was tender.
Treatment consisted of muscle energy techniques (MET's) to the pelvis and lumbar spine, as well as yoga poses of 'down dog', 'the triangle' and a modified 'warrior pose' incorporating lateral flexion and lateral breathing. Dry needling techniques were applied to the piriformis and quadratus lumborum. Rotation MET's were specifically directed to the L3/4, L4/5 region, as well as MET's to the left hamstring for the anterior ilial rotation. A combined MET of L3/4 rotation and hip external rotation (Piriformis-Iliopsoas) was performed which corrected the ROM of the SLR as well as improved cycling posture. Additionally, an immediate improvement of C/S rotation and lateral flexion was noted to what I would describe as hypermobility (chin over shoulder and ear to shoulder ROM). This was remarkable even for me. Due to the large improvements in ROM seen, I added global as well as specific stabilisation exercises which included a modified 'plank' and modified sideways body lift with 'the clam'. The modified plank included 'scapula push-ups', small amplitude stepping and hip abduction. Deep abdominal and hip stabilisation exercises were introduced where the differentiation of iliacus from psoas major, and superficial from deep stomach muscles was emphsised in a functional manner. Additionally, diaphragmatic breathing - pelvic floor synergy was practiced in sitting, standing, and during cycling. Additionally, the Alexander technique of 0/C1 elongation was used to enhance diaphragm - scapula function as well as to improve overall posture. Stretching of the low thoracic spine into extension was introduced into a cycling exercise. The 4 point kneeling position was used to practice pelvic rotation whose aim was to improve deep hip rotator activation as well as achieve thoracic spine rotation with scapula stabilisation.
Finally, it was also ascertained that he was right eye dominant. Hence, one leg balance exercises whilst juggling a rolled up newspaper keeping his right eye shut was introduced for occulomotor - cervical co-ordination function. Additionally, some occulomotor tracking as well as stabilisation exercises were given as a self assessment and treatment technique.
Functionally, his time trialing has improved from 46 minutes 3 seconds to 42 minutes 36 seconds. After 2 years of not being able to read the paper his ability to read the paper has improved from 5 minutes to painfree status. Computer work had been restricted to 30 minutes but was also now painfree. Hence, evidence based practice was attained as the values and beliefs of the client were satisfied.
Copyright Martin Krause 1999 - material is presented as a free educational resource however all intellectual property rights should be acknowledged and respected
Recently I treated a road cyclist who has had a couple of years of persistent neck pain. This prevented him from reading the paper and made computer work and time-trialing on the bike uncomfortable. He had had a severe car accident 20 years ago where he had been knocked unconscious as well as suffering from a fractured jaw. 4 years ago he had a motor bike accident. 2 weeks prior to seeing me had had been on holidays at the beach where he had been doing a lot of boogie boarding, touch football and generally playing with his children when severe left sided neck pain occured.
Movement restrictions in his neck were left rotation 1/2, right rotation 2/3, left lateral flexion 2/3, right lateral flexion 1/2, all of which were restricted by pain and muscle spasms. Flexion was restricted to 3/4 and extension was unremarkable. Palpation revealed a right shifted C2 with countershift/rotation/lateral flexion of C1, as well as some stiffness in the thoracocervical junction and mid thoracic regions. Additionally, the scalene muscles and levator scapulae were in spasm and the sternocleidomastoid muscle was dominant. Generalized atrophy of the trunk muscles (trapezius, serratus anterior and pectorals) were present. However, the biceps, triceps and deltoids were well defined.
Treatment consisted of joint mobilizations to the upper C/S, thoracocervical junction and mid thoracic regions. Additionally, soft tissue work (massage and dry needling) was performed to the trapezius, levator scapulae and scalenes. Exercises for scapula stability were given in addition to supine bridging soccer ball rolling for his T/S kyphosis, (deep neck flexor endurance and trunk stability), as well as Mulligans techniques for self mobilisation of the thoracocervical junction. This resulted in overall improvement of the acute condition, however the underlying chronic condition was still present after 6 treatments.
The client had only taken up road cycling in the past few years, and hence I decided to look at his posture on his bike. What became immediately obvious was reduced left hip flexion with concommitant left anterior ilial rotation, which resulted in significant flexion and left rotation of the lumbar spine. This continued up into the thoracic spine with over-reaching of his left arm as a result of the pelvic poisitioning. Such over-reaching created significant instability in the scapula, which in turn caused reduced serratus anterior - external obliques, latissimus dorsi - transverse abdominus function.
Interestingly, the anterior rotation of the ilium was potentially a contributing factor to reversed gluteal-hamstring timing as well as premature fatigue and cramping of the hamstring muscle. However, palpation of the lumbar spine revealed tenderness and stiffness at the L3/4 levels on the left. On further questioning the client then revealed an episode of severe low back pain several years ago. Straight leg raising (SLR) with dorsi-flexion (DF) was reduced to 60 degrees (versus 80 degrees on right). Prone knee bend was reduced to 120 degrees. Both iliopsoas muscles were highly activated in sitting, but responded somewhat to lateral diaphragmatic breathing. The left piriformis was tight and the right SIJ was tender.
Treatment consisted of muscle energy techniques (MET's) to the pelvis and lumbar spine, as well as yoga poses of 'down dog', 'the triangle' and a modified 'warrior pose' incorporating lateral flexion and lateral breathing. Dry needling techniques were applied to the piriformis and quadratus lumborum. Rotation MET's were specifically directed to the L3/4, L4/5 region, as well as MET's to the left hamstring for the anterior ilial rotation. A combined MET of L3/4 rotation and hip external rotation (Piriformis-Iliopsoas) was performed which corrected the ROM of the SLR as well as improved cycling posture. Additionally, an immediate improvement of C/S rotation and lateral flexion was noted to what I would describe as hypermobility (chin over shoulder and ear to shoulder ROM). This was remarkable even for me. Due to the large improvements in ROM seen, I added global as well as specific stabilisation exercises which included a modified 'plank' and modified sideways body lift with 'the clam'. The modified plank included 'scapula push-ups', small amplitude stepping and hip abduction. Deep abdominal and hip stabilisation exercises were introduced where the differentiation of iliacus from psoas major, and superficial from deep stomach muscles was emphsised in a functional manner. Additionally, diaphragmatic breathing - pelvic floor synergy was practiced in sitting, standing, and during cycling. Additionally, the Alexander technique of 0/C1 elongation was used to enhance diaphragm - scapula function as well as to improve overall posture. Stretching of the low thoracic spine into extension was introduced into a cycling exercise. The 4 point kneeling position was used to practice pelvic rotation whose aim was to improve deep hip rotator activation as well as achieve thoracic spine rotation with scapula stabilisation.
Finally, it was also ascertained that he was right eye dominant. Hence, one leg balance exercises whilst juggling a rolled up newspaper keeping his right eye shut was introduced for occulomotor - cervical co-ordination function. Additionally, some occulomotor tracking as well as stabilisation exercises were given as a self assessment and treatment technique.
Functionally, his time trialing has improved from 46 minutes 3 seconds to 42 minutes 36 seconds. After 2 years of not being able to read the paper his ability to read the paper has improved from 5 minutes to painfree status. Computer work had been restricted to 30 minutes but was also now painfree. Hence, evidence based practice was attained as the values and beliefs of the client were satisfied.
Copyright Martin Krause 1999 - material is presented as a free educational resource however all intellectual property rights should be acknowledged and respected
Neck and Back Pain Due to Malalignment
By Dr. Chad AsplundMar 4, 2003, 15:18
Neck and back pain are very common in cycling. Many riders experience occasional or recurrent neck and back pain related to their riding. Neck and back pain are especially common in the early season when riders are increasing both their mileage and time in the saddle. In order to avoid early season overuse injuries, riders should initially ride at high cadence and low resistance and only increase training mileage by 10% weekly, gradually building to goal mileage.
Neck pain can be exacerbated by several factors to include riding position and technique. Riding in drop handlebars for long periods increases the load on the arm and shoulders as well as hyperextension of the neck, leading to pain. If the virtual top tube length (top tube plus stem length) is too long for the rider, or if aero bars are used, hyperextension of the neck is further increased.
Prolonged hyperextension of the neck and associated muscle strain may lead to trigger points in the muscles of the neck and upper back. Trigger points are small rubbery knots that form in muscle and adjacent muscle sheaths (fascia), which may send pain signals to the brain and contribute to a pain-spasm-pain cycle. Trigger points are frequently caused by direct blunt trauma, or by repetitive micro trauma, as is seen in overuse athletic injuries.
Riders suffering from neck pain should inspect the fit of their bicycle. One way to reduce neck hyperextension is by raising the handlebars, or using handlebars with a shallower drop. Another method is to reduce the virtual top tube length, by using a stem with a shorter extension. Moving the saddle forward would also reduce virtual top tube length, but the rider should be cautious as improper fore/aft saddle position can lead to knee pain.
Changes to riding technique can also help with neck pain. Rigid riding position transmits more shock directly to the neck and shoulders. Riding with unlocked elbows and changing hand position (i.e. from drops to brake hoods) can alter neck posture minimizing pain. The rider may also alter his head position during the ride, in essence stretching the neck muscles while riding.
Back pain is also very common in cycling. Cycling position leads to prolonged back flexion, resulting in muscle pain in the unconditioned back. The low back is the primary muscle group generating power and controlling the movement of the bicycle. If the back is not well conditioned and flexible, muscle fatigue and strain will lead to pain.
The virtual top tube length, and the amount of spinal flexion in the riders back should be investigated in cyclists with back pain. If the handlebars are too low, the flexion (lordosis) of the spine is exaggerated resulting in increased pressure in the lumbar spine. If the top tube length is too short, the sacral spine will flex, increasing pressure on the interspinal disks. Ensuring that the handlebar height and top tube length are correct should help minimize back pain.
Pelvic position also contributes to back pain, as a malaligned pelvis will cause strain to the back musculature. Tight quadriceps will tend to pull the pelvis forward, while tight hamstrings predispose to backward pelvic tilt. Also, the strength of the abdominal muscles is critical to maintaining stable pelvic positioning. Pushing large gears, or extended hill climbing may fatigue the gluteus and the hamstrings, causing the pelvis to tilt backwards, aggravating the back musculature and causing pain. Core muscle group strengthening and lower extremity stretching will help with proper pelvic positioning and should lead to pedaling efficiency.
Frequent changes of riding position can help with back pain. Moving hand position from the drops to the brake hoods to the top of the handlebars allows for changes in posture, reducing strain on the back. When climbing or pushing a big gear, moving slightly back on the saddle will decrease strain on back. Back pain while sprinting can be helped by moving slightly forward on the saddle.
Riders whose neck or back pain is refractory to the above techniques should decrease their weekly mileage by 10% until the back pain disappears. During this period of mileage reduction, they should also avoid climbing and sprinting, and use a high cadence, low resistance spinning technique. Ice and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, may be used to provide pain relief. NSAIDs should be taken with food, and if the pain is not resolving within 1 week, medical evaluation is recommended. Medical management may include continuation of NSAIDs, trigger point injections, and possible a referral for physical therapy to improve core strength and flexibility.
In summary, although neck and back problems are very common, they can usually be managed by a combination of bicycle adjustment, technique change, and minor medical treatment.
Chad Asplund, MD
Neck and back pain are very common in cycling. Many riders experience occasional or recurrent neck and back pain related to their riding. Neck and back pain are especially common in the early season when riders are increasing both their mileage and time in the saddle. In order to avoid early season overuse injuries, riders should initially ride at high cadence and low resistance and only increase training mileage by 10% weekly, gradually building to goal mileage.
Neck pain can be exacerbated by several factors to include riding position and technique. Riding in drop handlebars for long periods increases the load on the arm and shoulders as well as hyperextension of the neck, leading to pain. If the virtual top tube length (top tube plus stem length) is too long for the rider, or if aero bars are used, hyperextension of the neck is further increased.
Prolonged hyperextension of the neck and associated muscle strain may lead to trigger points in the muscles of the neck and upper back. Trigger points are small rubbery knots that form in muscle and adjacent muscle sheaths (fascia), which may send pain signals to the brain and contribute to a pain-spasm-pain cycle. Trigger points are frequently caused by direct blunt trauma, or by repetitive micro trauma, as is seen in overuse athletic injuries.
Riders suffering from neck pain should inspect the fit of their bicycle. One way to reduce neck hyperextension is by raising the handlebars, or using handlebars with a shallower drop. Another method is to reduce the virtual top tube length, by using a stem with a shorter extension. Moving the saddle forward would also reduce virtual top tube length, but the rider should be cautious as improper fore/aft saddle position can lead to knee pain.
Changes to riding technique can also help with neck pain. Rigid riding position transmits more shock directly to the neck and shoulders. Riding with unlocked elbows and changing hand position (i.e. from drops to brake hoods) can alter neck posture minimizing pain. The rider may also alter his head position during the ride, in essence stretching the neck muscles while riding.
Back pain is also very common in cycling. Cycling position leads to prolonged back flexion, resulting in muscle pain in the unconditioned back. The low back is the primary muscle group generating power and controlling the movement of the bicycle. If the back is not well conditioned and flexible, muscle fatigue and strain will lead to pain.
The virtual top tube length, and the amount of spinal flexion in the riders back should be investigated in cyclists with back pain. If the handlebars are too low, the flexion (lordosis) of the spine is exaggerated resulting in increased pressure in the lumbar spine. If the top tube length is too short, the sacral spine will flex, increasing pressure on the interspinal disks. Ensuring that the handlebar height and top tube length are correct should help minimize back pain.
Pelvic position also contributes to back pain, as a malaligned pelvis will cause strain to the back musculature. Tight quadriceps will tend to pull the pelvis forward, while tight hamstrings predispose to backward pelvic tilt. Also, the strength of the abdominal muscles is critical to maintaining stable pelvic positioning. Pushing large gears, or extended hill climbing may fatigue the gluteus and the hamstrings, causing the pelvis to tilt backwards, aggravating the back musculature and causing pain. Core muscle group strengthening and lower extremity stretching will help with proper pelvic positioning and should lead to pedaling efficiency.
Frequent changes of riding position can help with back pain. Moving hand position from the drops to the brake hoods to the top of the handlebars allows for changes in posture, reducing strain on the back. When climbing or pushing a big gear, moving slightly back on the saddle will decrease strain on back. Back pain while sprinting can be helped by moving slightly forward on the saddle.
Riders whose neck or back pain is refractory to the above techniques should decrease their weekly mileage by 10% until the back pain disappears. During this period of mileage reduction, they should also avoid climbing and sprinting, and use a high cadence, low resistance spinning technique. Ice and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, may be used to provide pain relief. NSAIDs should be taken with food, and if the pain is not resolving within 1 week, medical evaluation is recommended. Medical management may include continuation of NSAIDs, trigger point injections, and possible a referral for physical therapy to improve core strength and flexibility.
In summary, although neck and back problems are very common, they can usually be managed by a combination of bicycle adjustment, technique change, and minor medical treatment.
Chad Asplund, MD
Saturday, December 13, 2008
Thursday, December 11, 2008
Knee Tracking By Adam Baskin, October 17, 2007
Have you ever felt like something just wasn’t right with your position on the bike? Have you been fitted multiple times but still have a nagging injury?
While most bike shops and fitters are more than capable of putting you on the right size bike, and possibly even able to accurately dial in your seat height and fore-aft saddle placement, chances are that some aspect of your fit was overlooked. The most commonly overlooked aspect of bike fit occurs in the frontal plane – or perpendicular to the bike.
The aspect to which I am referring is knee tracking. If you commonly ride with other people or watch cycling on TV, you’ve probably noticed the variances in different rider’s pedal strokes. Some athlete’s knees come out at the top of the pedal stroke, while others dive in toward the bike at either the top or bottom of the pedal stroke. In an ideal world, the second toe, the patella and the head of the femur should all be in the same plane, for the entire pedal stroke. While many ride for years with improper alignment, more than likely, it will eventually catch up with them.
There are a number of ways to correct improper knee tracking. Cleat wedges, shoes inserts and Q-factor adjustment may be required to fine tune your mechanics. If your knees come out at the top of the pedal stroke, chances are that you have insufficient Q-factor. Q-Factor is defined as the lateral distance between the pedal mounting surfaces and the crank-arms. Insufficient Q-factor basically means that your feet are too close together. It may also be the cause of pressure on the lateral edge of the foot, or a sensation of pedaling with the side of one’s foot. The easiest way to correct this would be to move your cleats in. If your cleats are already moved all the way in or your cleats/pedals have no lateral adjustability, additional spacing can be added between the pedal and crank arm in the form of washers. Two to three millimeters of spacing can safely be added to each side without compromising the amount of pedal threaded into the crank arm. If your bicycle has an ISIS, Octalink or square taper crankset, a longer bottom bracket axle can also be used for the same result.
For knees that come in at the top of the pedal stroke, cleat wedging may be required. Cleats wedges (available from http://www.bikefit.com/) come in one degree increments and can be used with most pedal systems. Wedges are stackable and one to three wedges are typically used per side. Use of more than three wedges may make pedal engagement more challenging.
If your knees rotate in toward the down tube on the downstroke, in shoe orthotics, or insoles with arch support may be required to limit pronation and/or internal rotation of the tibia. Shoe inserts can be used in combination with cleat wedges if further correction is needed.
If you feel that you may need to try one of these strategies to correct your mechanics on the bike, seek out a certified bike fitter to assist you. Video analysis may utilized to better diagnose the issue.
While most bike shops and fitters are more than capable of putting you on the right size bike, and possibly even able to accurately dial in your seat height and fore-aft saddle placement, chances are that some aspect of your fit was overlooked. The most commonly overlooked aspect of bike fit occurs in the frontal plane – or perpendicular to the bike.
The aspect to which I am referring is knee tracking. If you commonly ride with other people or watch cycling on TV, you’ve probably noticed the variances in different rider’s pedal strokes. Some athlete’s knees come out at the top of the pedal stroke, while others dive in toward the bike at either the top or bottom of the pedal stroke. In an ideal world, the second toe, the patella and the head of the femur should all be in the same plane, for the entire pedal stroke. While many ride for years with improper alignment, more than likely, it will eventually catch up with them.
There are a number of ways to correct improper knee tracking. Cleat wedges, shoes inserts and Q-factor adjustment may be required to fine tune your mechanics. If your knees come out at the top of the pedal stroke, chances are that you have insufficient Q-factor. Q-Factor is defined as the lateral distance between the pedal mounting surfaces and the crank-arms. Insufficient Q-factor basically means that your feet are too close together. It may also be the cause of pressure on the lateral edge of the foot, or a sensation of pedaling with the side of one’s foot. The easiest way to correct this would be to move your cleats in. If your cleats are already moved all the way in or your cleats/pedals have no lateral adjustability, additional spacing can be added between the pedal and crank arm in the form of washers. Two to three millimeters of spacing can safely be added to each side without compromising the amount of pedal threaded into the crank arm. If your bicycle has an ISIS, Octalink or square taper crankset, a longer bottom bracket axle can also be used for the same result.
For knees that come in at the top of the pedal stroke, cleat wedging may be required. Cleats wedges (available from http://www.bikefit.com/) come in one degree increments and can be used with most pedal systems. Wedges are stackable and one to three wedges are typically used per side. Use of more than three wedges may make pedal engagement more challenging.
If your knees rotate in toward the down tube on the downstroke, in shoe orthotics, or insoles with arch support may be required to limit pronation and/or internal rotation of the tibia. Shoe inserts can be used in combination with cleat wedges if further correction is needed.
If you feel that you may need to try one of these strategies to correct your mechanics on the bike, seek out a certified bike fitter to assist you. Video analysis may utilized to better diagnose the issue.
About the Author
Adam Baskin holds a degree in Clinical Exercise Physiology and is a Serotta Certified Bike Fit Technician as well as a USA Cycling Elite Coach. He works at the National Training Center in Clermont, Florida, conducting sports science tests including bike fits, LT and VO2 max. Baskin is also a Category 1 rider on the road and track.
Adam Baskin
National Training Center
1099 Citrus Tower Blvd.
Clermont, FL 34711
Wednesday, December 10, 2008
On The Bike Exercise To Help Improve Muscle Imbalance
ON THE BIKE EXERCISE
It is important to note that neglected muscle groups can result in muscle imbalances and greater asymmetry that have an impact on the cyclist’s performance and comfort on the bike.
The detection of muscle imbalances and correcting them before injury occurs is critical to cycling longevity and performance. Most cyclists develop muscle imbalances due to over use of the hip flexors (mobilizers) and under use of weak gluteus muscles (stabilizers). This type of muscle imbalance can cause the pelvis to tilt upward and extend the lumbar spine causing a lordotic tilt (arched lower back) of the pelvis.
Cyclists should conduct periodic screenings for muscle imbalances and correct the abnormalities of muscle strength and length to prevent musculoskeletal pain and irregular function. Evaluating muscle length is not difficult via standardized tests. However, evaluating muscle strength can be more challenging. The primary focus on evaluating muscle strength is to be able to isolate the action of individual muscles. The majority of muscle strength evaluation concentrates on testing the mobilizers (hamstrings, adductors, hip flexors and abdominal recti) because they are easier to isolate than stabilizers (transversus abdominis and posterior glutei mediae). If the cyclist is unfamiliar with muscle imbalance testing they should look for a professional to evaluate them and make sure a protocol is established to assess both the mobilizers and stabilizers.
As discussed earlier, muscle imbalances can cause a lordotic tilt of the pelvis. The tilt of the pelvis can also be more pronounced on one side of the body due to asymmetry where one side of the body is more dominant than the other.
There are many factors to consider when addressing muscle asymmetry. However, there are two primary factors that cause muscle asymmetry while riding the bike. The first is bike fit and proper rider positioning on the bike. Muscle asymmetry will become more pronounced if the rider is on the bike incorrectly. The cyclist is on their bike correctly if he or she is able to engage their core muscles while sitting on the saddle of the bike. If the cyclist cannot engage their core muscles, there is dysfunctional stabilization and no lumbopelvic stability. When the cyclist lacks core stability he or she will be pedaling outside their natural alignment and more muscular effort is required to recover to a stable position. In short, while pedaling long distances the dominant side muscles groups begin to work more than the less dominant side muscle groups, thus causing more muscle asymmetry.
The second factor to consider when addressing muscle asymmetry is the cyclist’s riding habits. For example, reaching down for a water bottle with the same hand reinforces muscle asymmetry. Another example is while stopping at an intersection and extending the same leg to the ground while the other leg remains contracted reinforces muscle asymmetry. A third example is looking back over the same shoulder when checking for traffic reinforces muscle asymmetry. To test your level of asymmetry do what I call “the one-armed interval.”
To do the “one-armed interval” all you do is ride your bike for 10 minutes with only one arm on the handle bars at an easy pace. Then switch arms and ride another 10 minutes with only the other arm on the handle bars. If you are right side dominant, you will notice while riding with your right hand on the handle bars and your left hand off the bars, your left glutes (stabilizers) and left side core muscles will be working harder than when you were riding with the left hand on the handle bars. When your left hand is on the handle bars and you are right side dominant, your glutes and right core muscle groups are not nearly as taxed.
There is no easy answer to eliminating muscle imbalances. The only way to prevent or eliminate injuries is to learn where you have muscle imbalances and adjusting them with the correct strengthening and flexibility exercises. Once you understand more about your muscle imbalances begin a daily stretching and strengthening routine. Doing yoga and/or pilates is a great way to strengthen weak muscles and lengthen tight muscles. To effectively address muscle asymmetry, first ensure you are on the bike correctly. Second, avoid doing everything on the bike only in a one-sided manner… mix it up. Third, do “one-armed intervals” to condition your weaker side.
It is important to note that neglected muscle groups can result in muscle imbalances and greater asymmetry that have an impact on the cyclist’s performance and comfort on the bike.
The detection of muscle imbalances and correcting them before injury occurs is critical to cycling longevity and performance. Most cyclists develop muscle imbalances due to over use of the hip flexors (mobilizers) and under use of weak gluteus muscles (stabilizers). This type of muscle imbalance can cause the pelvis to tilt upward and extend the lumbar spine causing a lordotic tilt (arched lower back) of the pelvis.
Cyclists should conduct periodic screenings for muscle imbalances and correct the abnormalities of muscle strength and length to prevent musculoskeletal pain and irregular function. Evaluating muscle length is not difficult via standardized tests. However, evaluating muscle strength can be more challenging. The primary focus on evaluating muscle strength is to be able to isolate the action of individual muscles. The majority of muscle strength evaluation concentrates on testing the mobilizers (hamstrings, adductors, hip flexors and abdominal recti) because they are easier to isolate than stabilizers (transversus abdominis and posterior glutei mediae). If the cyclist is unfamiliar with muscle imbalance testing they should look for a professional to evaluate them and make sure a protocol is established to assess both the mobilizers and stabilizers.
As discussed earlier, muscle imbalances can cause a lordotic tilt of the pelvis. The tilt of the pelvis can also be more pronounced on one side of the body due to asymmetry where one side of the body is more dominant than the other.
There are many factors to consider when addressing muscle asymmetry. However, there are two primary factors that cause muscle asymmetry while riding the bike. The first is bike fit and proper rider positioning on the bike. Muscle asymmetry will become more pronounced if the rider is on the bike incorrectly. The cyclist is on their bike correctly if he or she is able to engage their core muscles while sitting on the saddle of the bike. If the cyclist cannot engage their core muscles, there is dysfunctional stabilization and no lumbopelvic stability. When the cyclist lacks core stability he or she will be pedaling outside their natural alignment and more muscular effort is required to recover to a stable position. In short, while pedaling long distances the dominant side muscles groups begin to work more than the less dominant side muscle groups, thus causing more muscle asymmetry.
The second factor to consider when addressing muscle asymmetry is the cyclist’s riding habits. For example, reaching down for a water bottle with the same hand reinforces muscle asymmetry. Another example is while stopping at an intersection and extending the same leg to the ground while the other leg remains contracted reinforces muscle asymmetry. A third example is looking back over the same shoulder when checking for traffic reinforces muscle asymmetry. To test your level of asymmetry do what I call “the one-armed interval.”
To do the “one-armed interval” all you do is ride your bike for 10 minutes with only one arm on the handle bars at an easy pace. Then switch arms and ride another 10 minutes with only the other arm on the handle bars. If you are right side dominant, you will notice while riding with your right hand on the handle bars and your left hand off the bars, your left glutes (stabilizers) and left side core muscles will be working harder than when you were riding with the left hand on the handle bars. When your left hand is on the handle bars and you are right side dominant, your glutes and right core muscle groups are not nearly as taxed.
There is no easy answer to eliminating muscle imbalances. The only way to prevent or eliminate injuries is to learn where you have muscle imbalances and adjusting them with the correct strengthening and flexibility exercises. Once you understand more about your muscle imbalances begin a daily stretching and strengthening routine. Doing yoga and/or pilates is a great way to strengthen weak muscles and lengthen tight muscles. To effectively address muscle asymmetry, first ensure you are on the bike correctly. Second, avoid doing everything on the bike only in a one-sided manner… mix it up. Third, do “one-armed intervals” to condition your weaker side.
Friday, December 5, 2008
Bike Fit 101: Great Info From My Friends John Howard and Ernie Ferrel
The Range - the Fit - the Power
As in any sport, range of motion is the primary component of performance in cycling.
Flexibility, Strength, and PositioningI will discuss in detail the method of position analysis, explain bike set up, and also the priorities for strength training. When I analyze a cyclist on the bike I visualize the ideal position for optimal efficiency, higher power output, and greater comfort and safety. A cyclist with flexible hamstrings, smoothly operating hip rotators and strong hip flexors is going to be able to tuck lower, put out more wattage, and stay comfortable for longer than a rider who has addressed none of these issues. If both riders have the exact same oxygen carrying capacity, which one do you think is likely to go faster?
To collect the relevant data, we take the cyclist to the anaerobic threshold on the CompuTrainer. Pushing to threshold causes moderate muscle fatigue, which highlights both biomechanical flaws and the consequences of improper bike positioning. Based on our observations, we offer recommendations tailored to the individual.
We record baseline details about the rider and his/her bike on a position analysis form. We record all existing data about the bike on the form before making any changes in the position. As we make changes, we log them on the form and test them on the CompuTrainer Spin Scan program. With a record of all alterations, we can provide each client with a detailed chart showing how the set-up changes have impacted the pedal stroke.
Since problems are usually interconnected, Dr. Ferrel and I first look for obvious problems. We identify specific muscle groups and soft tissue that are "misbehaving." We start by identify flaws in foot/cleat placement. The first step is to make sure that the pedaling platform is flat. This entails analyzing the proper canting and camber of the shoes and feet, ensuring that the body's musculo-skeletal system is efficiently connected to the bike's pedal system. We look at the alignment of the ankles to the feet. If the alignment is off, we shim the cleats to improve alignment, thus achieving a more efficient pedaling stroke. We log even the slightest changes for future reference.
One of the most obvious problems is knee splaying. When the knees are splayed out (the bow-legged cowboy look) the forces of pedaling are not in a linear plane. This creates biomechanical inefficiency and the likelihood of repetitive stress injury. Knee splay is usually caused by tight hip rotators (See Flexibility First). In some cases, bike set up is the problem, and the solution might be a different length stem, or a seat post which offers greater fore/aft reach.
Saddle height, fore/aft and tilt adjustment
The correct saddle height depends on each individual's range of motion. This is extremely important. We have seen successful cyclists and triathletes with widely varying saddle heights, but Dr. Ferrel and I favor a higher seating position than most, as it allows for a slightly increased plantar flexion (toes pointing down at the bottom of the stroke). This promotes increased action potential of the smaller leg muscles including the gastrocnemieus and soleus in the pedaling stroke. We strive to get more muscles firing efficiently for a greater length of time, which optimizes the recovery phase of the stroke.
We look at the cyclist sitting on the bike pedaling, analyzing the angle of extension of the left vs. right leg. Using the Spin Scan helps us balance out the right and left sides, thus eliminating the little power spikes that indicate a lumpy, inefficient stroke. We observe torque for the left and right sides, percentage of wattage and overall efficiency score. We use a goiniometer to test the actual leg extension at the 6:00 o'clock (bottom) position. We center the middle lines of the goiniometer with the tibia and the femur. At the bottom the lines should intersect the ankle bone and at the top the greater trocanter. Make sure the hips are flat with no side rock, and the foot is in a slightly leading, toe down position. Individual range of motion, especially hamstring flexibility and degree of effective plantar flexion, determine the proper extension. Based on the individual's range of motion, we'll look for knee bend at dead bottom center of roughly 34-37 degrees. By checking both legs, we are able to determine leg length discrepancies. If we discover a difference in leg length, we want to first determine if it is muscular or anatomical. This is accomplished with a soft tissue adjustment to the insertion point of the hamstring. We have found that in many cases these leg length differences vanish after this adjustment.
Next, we focus on the fore/aft position of the saddle. The fore/aft adjustment is determined by using a plumb line. At the attachment of the patella is the tendon of quadriceps femoris and our reference point. If you reach down and grab the patella with your fingers - leg straight - you will be at the exact point of contact for the plumb line. You know you are there because there is a slight indentation both inside and out. The line should fall directly through the ball of the foot and the pedal axle. A common mistake by most coaches is to use the front of the knee as the fulcrum for this line. This places the seat too far back and add to the tension on the knee, a big problem for ultra cyclists. Adjusting the fore/aft saddle position should conform to this plumb line standard.
The saddle tilt is individual, best determined through experimentation. If the nose is too low, the rider will slide forward, thus subjecting the quads to extra abuse. Too high, and the body will never be able to comfortably achieve the correct lordotic curve we discussed earlier.
Upper Back and Positioning on the BikeThe upper thoracic area is often problematic due to a too low aerodynamic position. Our objective is to balance and strengthen the posterior, upper thoracic muscles such as the traps, levator scapulae and rhomboids to increase the biomechanical efficiency and aerodynamics of the individual. Using Spin Scan, we are able to see torque curves change and the point where power is either gained or lost. This process, though sounding simple, is very complex. Remember that every body part is connected to another, so the analysis must take interactions into consideration.
The Relationship of Core Muscles and HandlebarsComfort is a key element to bike positioning. Handlebars come in different widths to order to accommodate different body types. All too often the cyclist's handlebars are either too wide or too narrow. With wider shoulders, naturally one would want a wider bar. Within this comfort zone we recommend the narrowest bar, which gives the aerodynamic advantage but does not compromise good biomechanics. Bars should be turned up slightly with the lower hooks just off parallel with the ground. The brake hoods also need to be up slightly from the parallel. We see a lot of cyclists with their brake hoods too low or too high, thus affecting their overall position on the bike. When the brake hoods are too low, one has to reach with the forearms in a straightened position, thus lifting the head, tilting the pelvic girdle back and locking up the core muscles. If the hoods are too high, the body is pushed too upright. When we achieve good hand and back positioning, the elbows flatten out naturally, and the head drops a couple of inches. With the proper angle of bent elbows we start to get good spinal lordotic and kyphotic curves. The pelvic girdle then tilts forward instead of back. This pelvic tilt is critical. When the butt is up, the back flattens. This allows us to access the all-important core group.
The core muscles are the forgotten movers in cycling. Most racers basically train only the gluteals, hamstrings and quadriceps. By isolating and strengthening the abdominals, obliques, erector spinae and quadratus lumborum muscles, cyclists can gain more power along with the ability to sustain it for a much longer period of time. (See Low Back, pt. 3, in the March, 2002 UltraCycling. Ordering back issues ) In climbing, we teach our athletes to keep their elbows bent, to flatten the back, and to slide back in the saddle. This produces a stronger, more efficient pedaling stroke. By strengthening the ancillary core muscles, cyclists delay the onset of lactic acid buildup in the primary muscles. This functional position starts a whole new series of events, including more efficient breathing and the consequent activation of the parasympathetic nervous system.
Proper Breathing Many times we see an athlete gasping for air under exertion. These air-sucking in-breaths activate the sympathetic nervous system, thus generating the high stress "fight or flight" response. Through our work with BreathPlay author and Zooming CD creator Ian Jackson, we have learned that overcoming the air-sucking in-breath habit and focusing instead on the air-pushing out-breath skill activates the parasympathetic nervous system, thus generating the relaxation response. The primary BreathPlay skill of active out-breathing gives the endurance athlete several important advantages. It increases endurance by improving cardio-pulmonary function and building core strength and also generates deep relaxation to go along with this power boost. In addition, the odd-count breath cycles central to BreathPlay technique ensure that the pedal stroke ending each out-breath switches from one leg to the other. This switch-side breathing helps to bring about bilateral balance. Using BreathPlay techniques, American Alexi Grewal earned a gold medal in the 1984 L.A. Olympic Games road race. Many of our pro and elite cyclists also use this technique.
After the recommended equipment changes are made, we examine specific areas of the body that need help. After determining each person's idiosyncrasies we develop specific stretches and then begin strength training. Some of the stretches in Flexibility First must be done prior to each strength training session. As with the stretches, we start by waking up the core muscles and elevating body temperature. We begin with a series of floor exercises. Later, the progression is into a gym, and finally onto a bike. This sequence is extremely important. If muscles are strengthened before their range of motion is sufficiently increased, their power output may be significantly limited.
Fine tuning a body on a bike for a particular type of competition is not a perfect science. Often, optimal change occurs slowly over a period of time as the body becomes more limber and the strength training has the effect of increasing leverage. For this reason, we sometimes allow months to make changes in a particular individual's position. The following strength exercises are in priority order, beginning with core strength and progresses into hip flexion, and hamstrings. As with the stretches, these serve as a clear guide for better conditioning. Still, they may not all be appropriate for each individual. Proceed with caution.
Training for Cycling: Flexibility First
How to use the CompuTrainer to analyze power output in endurance cyclists. Recommended stretching to improve range of motion so ultra cyclists can go faster with less fatigue.
by John Howard and Dr. Ernie Ferrel
One of the bittersweet ironies of life is that we use it up learning how to live it. By the time we've matured into what we hope is deep wisdom, there's not much time left. We've all heard variations of the "if only" statement: "If only I'd known, at age 20, what I know today." This irony plays out in an athletic career as frequently as it does in life itself. Many aging athletes, who take up the challenge of the metabolic barrier too late, end up singing the "if only" blues. The performance boost they begin to enjoy brings the realization, too late, that if they had used flexibility training to challenge the barrier at the beginning of their athletic careers instead of at the end, their performance achievements would have been far greater.
Increased performance gains are harder and harder to come by over time. With each small improvement, there is an increased cost. Ramped up metabolic training offers slight gains in cardiovascular efficiency, but with a significantly greater potential for overuse injuries. This is especially true at the elite level.
With flexibility training, improvements in range of motion will produce a more powerful pedaling stroke. In our next article, we will discuss how that improvement in pedal stroke translates into a more effective set-up for ultras. For now, let's dial in some greater range of movement.
Analyze then Mobilize In cycling, if you go five miles an hour faster, from 25 miles an hour to 30 mph, the increase in energy output is enormous. Yet a cyclist going 30 miles per hour only produces enough energy to fire a row of light bulbs. The solution is greater efficiency. How is this achieved? In the previous article I presented Ian Jackson's breakthrough BreathPlay Zooming CD Ultrazoom. Here I'll take a different but complementary approach.
Air resistance is a huge limiting factor to speed, so aerodynamic considerations are often critical. Many times the most efficient aero positions come into conflict with the individual biomechanics of the body. A cyclist who is stiff, with limited range of motion in the joints, will either be unable to attain an efficient aero position or unable to maintain it. The information we are presenting is based on years of personal experience and experimentation. We'll give you a detailed overview of our process so that you can apply it to yourself.
In looking at the body it is important to determine the individual's strengths and weaknesses. We start with the athlete's bike on the CompuTrainer, utilizing the Spin Scan program to get data about the athlete's power stroke. We ask about patterns of pain that may have become chronic, and whether the pain is constant or intermittent, localized or diffuse, etc. Many of the causes of these cycling problems will be obvious from watching Spin Scan on the CompuTrainer.
The color bars on the CompuTrainer Spin Scan bar-graph start bobbing as soon as the athlete starts pedaling. We warm our riders up and then take them to perceived anaerobic threshold, say 10-15% below max heart rate. At this level of exertion we get an accurate picture of their pedal stroke. We watch the lower valleys on both right and left sides, noticing the percentage of watts for each. A common problem is a lack of muscular force, and a lack of consistent force at the bottom of the stroke. We define this area as the recovery portion of the stroke, at roughly 6 to 12 on the clock face. This tells us the hip flexors muscles, primarily the Psoas and Rectus Femoris, are not holding up their side of the muscular equation. The solution is to systematically stretch, then strengthen them with single side isolated pedaling or better yet, Power Cranks(tm). As the muscles become more flexible and stronger, and the neuromuscular pathways are reinforced, a smoother more powerful stroke will result.
A related problem is the pattern of power spikes on the right and left sides at the peak of the stroke. If the color bars are higher or wider at the peak on one side this indicates a lack of smooth force to the pedals. This problem is usually brought about by a splayed knee, a tight external hip rotator, and or a tight I.T. band.
Corrective Program Once we analyze the athlete's muscular imbalance, muscular weakness, or leg length discrepancy, we formulate a corrective program. We provide a set of prioritized stretches that initially look like they have little to do with riding the bike.
Most of our clients are pro and amateur triathletes and cyclists. Some of them have either not stretched at all or have stretched very little. Many of those who have been stretching have actually increased their tightness by improper technique; hence, our first priority is teaching correct stretching technique. We begin with some introductory movements to "wake up" the core muscles and elevate body temperature. This reduces both the exacerbation of old injuries and the creation of new ones.
We begin with a series of light active and passive isolated stretches that are derived from works of Dr. Ferrel, Bob Anderson (note his cycling series in the his book Stretching) Arron Mattes and his series of active isolated stretches, massage therapist Doug Thralls, and Chris Maund, of the C.H.E.K. Institute in Encinitas, CA. These are followed by a strengthening program, which is initially based on floor exercises using foam rollers and a large ball. Later, we progress to a gym, and finally to the bike. This sequence is critical: if you make the mistake of strengthening the muscles before exploring their full range of motion, you are potentially limiting your power output. This work is an individualized form of training, and it begins with understanding the initial position analysis on the bike. The athlete must start with a pre-training stretching program. The best time to start this is immediately and it should be maintained for life. Inflexibility should be understood and treated before we start strengthening the muscles. Cyclists have some common flexibility issues, and the following stretches address these. Still, each person is an individual with slightly different needs, so the generic program is never fool proof.
The Importance of Hip Flexors and Quads Following the bio-kinetic chain, the first muscles we look at are the hip flexors and quads. One of the strongest hip flexors is the Psoas muscle. When the Psoas is properly engaged, it adds tremendously to pedaling power. The same is true when the Vastus Medalius is properly engaged. A stretching and strengthening program to mobilize and strengthen these muscles should be a priority. Simple exercises such as walking lunges replicate the precise motor response of pedaling. Take care to place the knee in front of the ankle. In the gym, isolating the hip flexors (and hamstrings in the reverse position) with lower pulleys is a great way to power up the body for improved turn over. On-bike drills, including a series of specific hill repeats, integrate the muscles for a more effective transfer of power into pedaling. Along with the Vastus Medalis, the other quadriceps muscles need to be trained through isolation exercises. If you can train these ancillary muscles, you may or may not see dramatic increases in power and performance, but you will sustain more power for a longer period of time.
There are a few mechanical devices available that improve the pedaling stroke by activating the hip flexors. Dr. Frank Day's Power Cranks are probably the best.
Hip RotatorsIt is important to activate the hip flexors, but for the majority of cyclists, the five-muscle group that externally rotates the hips is probably the most troublesome, since it causes splayed knees. This problem is exacerbated by various causes, such as poor body biomechanics, bad habits and trauma. Their chronic contraction causes splayed knees and a consequent loss of power in the most powerful arc of the pedaling stroke. Splayed knees also create poor aerodynamics and a decrease in stability, especially on descents. A seat that is too low will also play a part in this condition. The ideal is to have the legs come straight up and down, like pistons in an engine, with the proper amount of flexion to maximize your power safely.
Weak Vastus Medalius Obliques. The v.m.o. muscles are one of the primary quad muscles involved in smooth pedaling action. When the v.m.o. are weak, the knee joint can no longer track smoothly, thus contributing to knee pain which can quickly accelerate to chronic degeneration if left untreated. This problem is common among runners who take up cycling with no corrective strength training. An effective way to treat this problem is with short arc quad extensions. Do repetitions with one leg bent only 10-20 degrees, toes pointed in. Repeat with other leg. Very gradually increases in weight.
Weak Core muscles. Abdominals, Obliques, Erector Spinae and Quadratus Lumborum. The Q.L. starts going south under pressure from big gears and low aero positions. Eventually the Q.L. fades out with an accompanying dull ache in the low back area that seems to never go away. The remaining core muscles are also compromised and become less effective. When this happens the Glutes begin to tire rapidly, and speed and power drop significantly.
More on Stretching Stretching needs to be a part of your life style. It is most effective right after a ride and just before bed. As we age, poor postural habits, past injuries, and increasing stiffness, sneak up on us. Finally, we can no longer deny what has happened to us. We move with a certain rigidity and we're prone to injuries that are slow to heal. Recommended stretches
Resources John Howard has been a competitive cyclist since 1965 and a cycling coach since 1982. His School of Champions athletes have won over 150 national and world titles including RAAM. Howard is a three-time Olympic cyclist with 15 national championships and an Ironman Triathlon victory to his credit. He is also a member of the USA Cycling Hall of Fame. Howard has written four cycling books: The Cyclist's Companion, Multifitness, Pushing The Limits and Dirt! For additional information on his camps, contact him at http://www.johnhowardschool.com/ or http://www.multisports.com/ for coaching. His email is jhschool@aol.com
Dr. Ernie Ferrel is the past Vice President of ACA Sports Council, Director of Chiropractic Services for USAT, Certified Elite Cycling coach and creator of Dynamic Motion Therapy. He can be reached at (805) 963-3232
Stretching for Ultra Cyclists
Stretching to improve range of motion is an important part of a cyclist's training, which will increase power and comfort during long-distance bicycle rides and ultra races."
by John Howard and Dr. Ernie Ferrel
Do the stretching at least five days per week. Make time for stretching before or after riding your bicycle, convince yourself to look forward to it and make it fun!
Ian Jackson's Zooming CD utilizes a specific breathing technique critical for activating the parasympathetic nervous system. Activation promotes a relaxed muscle release and blood flow, thus greatly improving the quality of the stretching. The technique will also add a surprisingly pleasant sensation to your stretching.
#1 Trapezius/sub occipitals.
Our objective is to balance and strengthen the posterior, thoracic muscles such as the traps, levator scapulae and rhomboids to increase the biomechanical efficiency and aerodynamics of the ultra cyclist. Tuck the chin, find the bony lump at the base of the skull, and pull gently to the side. After several seconds, decrease the pull, and lift the opposite shoulder. Repeat 8-10 times for both sides before riding. An excellent companion stretch is to hang from a chin up bar, both over and underhanded for 15-30 seconds for each grip.
#2 Foam Roller across spine.
Stretching to flex the spine, open up the intercostal muscles of the chest, and help avoid stooped posture from long hours riding the bicyle. Work the roll from T4-T12, spending 10-15 seconds per five sections of the spine. When finished roll off the side and avoid doing a crunch.
The other four stretching exercises are performed lying on the back.
#3 Tight External Hip Rotators.
Their reduced range of motion is one of the main culprits for splayed knees while cycling and a loss of power in the most powerful arc of the pedaling stroke. Splayed knees also create poor aerodynamics and a decrease in stability while cycling, especially on descents.
While on back, bend the knee and use a strap or rope to pull the foot across the body with the upper leg at 90 degrees. Run the rope under the calf to support the knee. Do 8-10 reps, both sides, before the ride.
#4 I.T. bands.
With torso and lower body straight run the strap under the calf to support the joint. With the hips flat on the floor, bring the leg low across the body and keep the toes pointed at the ceiling. 8-10 reps, with a slow extended out-breath on each rep, both sides, before and after cycling.
#5 Bilateral piriformis stretch.
Bring the knees together very slightly with the feet as far apart as possible. This is a passive stretch held for 15-30 seconds before and after the ride.
#6 Tight Hamstrings.
When these guys are tight you will have a limited forward bend at the hip. The pelvis is pulled into a posterior tilt, thus countering your ability to flatten the back and sit low on the bicycle. Tight hamstrings also rob horsepower while cycling.
With a rolled up towel in the small of the back and the non-stretched foot straight against a wall. Anchor the strap around the ball of the foot and pull back 8-10 times with a slow extended out-breath on each rep, both sides before and after the ride.
As in any sport, range of motion is the primary component of performance in cycling.
Flexibility, Strength, and PositioningI will discuss in detail the method of position analysis, explain bike set up, and also the priorities for strength training. When I analyze a cyclist on the bike I visualize the ideal position for optimal efficiency, higher power output, and greater comfort and safety. A cyclist with flexible hamstrings, smoothly operating hip rotators and strong hip flexors is going to be able to tuck lower, put out more wattage, and stay comfortable for longer than a rider who has addressed none of these issues. If both riders have the exact same oxygen carrying capacity, which one do you think is likely to go faster?
To collect the relevant data, we take the cyclist to the anaerobic threshold on the CompuTrainer. Pushing to threshold causes moderate muscle fatigue, which highlights both biomechanical flaws and the consequences of improper bike positioning. Based on our observations, we offer recommendations tailored to the individual.
We record baseline details about the rider and his/her bike on a position analysis form. We record all existing data about the bike on the form before making any changes in the position. As we make changes, we log them on the form and test them on the CompuTrainer Spin Scan program. With a record of all alterations, we can provide each client with a detailed chart showing how the set-up changes have impacted the pedal stroke.
Since problems are usually interconnected, Dr. Ferrel and I first look for obvious problems. We identify specific muscle groups and soft tissue that are "misbehaving." We start by identify flaws in foot/cleat placement. The first step is to make sure that the pedaling platform is flat. This entails analyzing the proper canting and camber of the shoes and feet, ensuring that the body's musculo-skeletal system is efficiently connected to the bike's pedal system. We look at the alignment of the ankles to the feet. If the alignment is off, we shim the cleats to improve alignment, thus achieving a more efficient pedaling stroke. We log even the slightest changes for future reference.
One of the most obvious problems is knee splaying. When the knees are splayed out (the bow-legged cowboy look) the forces of pedaling are not in a linear plane. This creates biomechanical inefficiency and the likelihood of repetitive stress injury. Knee splay is usually caused by tight hip rotators (See Flexibility First). In some cases, bike set up is the problem, and the solution might be a different length stem, or a seat post which offers greater fore/aft reach.
Saddle height, fore/aft and tilt adjustment
The correct saddle height depends on each individual's range of motion. This is extremely important. We have seen successful cyclists and triathletes with widely varying saddle heights, but Dr. Ferrel and I favor a higher seating position than most, as it allows for a slightly increased plantar flexion (toes pointing down at the bottom of the stroke). This promotes increased action potential of the smaller leg muscles including the gastrocnemieus and soleus in the pedaling stroke. We strive to get more muscles firing efficiently for a greater length of time, which optimizes the recovery phase of the stroke.
We look at the cyclist sitting on the bike pedaling, analyzing the angle of extension of the left vs. right leg. Using the Spin Scan helps us balance out the right and left sides, thus eliminating the little power spikes that indicate a lumpy, inefficient stroke. We observe torque for the left and right sides, percentage of wattage and overall efficiency score. We use a goiniometer to test the actual leg extension at the 6:00 o'clock (bottom) position. We center the middle lines of the goiniometer with the tibia and the femur. At the bottom the lines should intersect the ankle bone and at the top the greater trocanter. Make sure the hips are flat with no side rock, and the foot is in a slightly leading, toe down position. Individual range of motion, especially hamstring flexibility and degree of effective plantar flexion, determine the proper extension. Based on the individual's range of motion, we'll look for knee bend at dead bottom center of roughly 34-37 degrees. By checking both legs, we are able to determine leg length discrepancies. If we discover a difference in leg length, we want to first determine if it is muscular or anatomical. This is accomplished with a soft tissue adjustment to the insertion point of the hamstring. We have found that in many cases these leg length differences vanish after this adjustment.
Next, we focus on the fore/aft position of the saddle. The fore/aft adjustment is determined by using a plumb line. At the attachment of the patella is the tendon of quadriceps femoris and our reference point. If you reach down and grab the patella with your fingers - leg straight - you will be at the exact point of contact for the plumb line. You know you are there because there is a slight indentation both inside and out. The line should fall directly through the ball of the foot and the pedal axle. A common mistake by most coaches is to use the front of the knee as the fulcrum for this line. This places the seat too far back and add to the tension on the knee, a big problem for ultra cyclists. Adjusting the fore/aft saddle position should conform to this plumb line standard.
The saddle tilt is individual, best determined through experimentation. If the nose is too low, the rider will slide forward, thus subjecting the quads to extra abuse. Too high, and the body will never be able to comfortably achieve the correct lordotic curve we discussed earlier.
Upper Back and Positioning on the BikeThe upper thoracic area is often problematic due to a too low aerodynamic position. Our objective is to balance and strengthen the posterior, upper thoracic muscles such as the traps, levator scapulae and rhomboids to increase the biomechanical efficiency and aerodynamics of the individual. Using Spin Scan, we are able to see torque curves change and the point where power is either gained or lost. This process, though sounding simple, is very complex. Remember that every body part is connected to another, so the analysis must take interactions into consideration.
The Relationship of Core Muscles and HandlebarsComfort is a key element to bike positioning. Handlebars come in different widths to order to accommodate different body types. All too often the cyclist's handlebars are either too wide or too narrow. With wider shoulders, naturally one would want a wider bar. Within this comfort zone we recommend the narrowest bar, which gives the aerodynamic advantage but does not compromise good biomechanics. Bars should be turned up slightly with the lower hooks just off parallel with the ground. The brake hoods also need to be up slightly from the parallel. We see a lot of cyclists with their brake hoods too low or too high, thus affecting their overall position on the bike. When the brake hoods are too low, one has to reach with the forearms in a straightened position, thus lifting the head, tilting the pelvic girdle back and locking up the core muscles. If the hoods are too high, the body is pushed too upright. When we achieve good hand and back positioning, the elbows flatten out naturally, and the head drops a couple of inches. With the proper angle of bent elbows we start to get good spinal lordotic and kyphotic curves. The pelvic girdle then tilts forward instead of back. This pelvic tilt is critical. When the butt is up, the back flattens. This allows us to access the all-important core group.
The core muscles are the forgotten movers in cycling. Most racers basically train only the gluteals, hamstrings and quadriceps. By isolating and strengthening the abdominals, obliques, erector spinae and quadratus lumborum muscles, cyclists can gain more power along with the ability to sustain it for a much longer period of time. (See Low Back, pt. 3, in the March, 2002 UltraCycling. Ordering back issues ) In climbing, we teach our athletes to keep their elbows bent, to flatten the back, and to slide back in the saddle. This produces a stronger, more efficient pedaling stroke. By strengthening the ancillary core muscles, cyclists delay the onset of lactic acid buildup in the primary muscles. This functional position starts a whole new series of events, including more efficient breathing and the consequent activation of the parasympathetic nervous system.
Proper Breathing Many times we see an athlete gasping for air under exertion. These air-sucking in-breaths activate the sympathetic nervous system, thus generating the high stress "fight or flight" response. Through our work with BreathPlay author and Zooming CD creator Ian Jackson, we have learned that overcoming the air-sucking in-breath habit and focusing instead on the air-pushing out-breath skill activates the parasympathetic nervous system, thus generating the relaxation response. The primary BreathPlay skill of active out-breathing gives the endurance athlete several important advantages. It increases endurance by improving cardio-pulmonary function and building core strength and also generates deep relaxation to go along with this power boost. In addition, the odd-count breath cycles central to BreathPlay technique ensure that the pedal stroke ending each out-breath switches from one leg to the other. This switch-side breathing helps to bring about bilateral balance. Using BreathPlay techniques, American Alexi Grewal earned a gold medal in the 1984 L.A. Olympic Games road race. Many of our pro and elite cyclists also use this technique.
After the recommended equipment changes are made, we examine specific areas of the body that need help. After determining each person's idiosyncrasies we develop specific stretches and then begin strength training. Some of the stretches in Flexibility First must be done prior to each strength training session. As with the stretches, we start by waking up the core muscles and elevating body temperature. We begin with a series of floor exercises. Later, the progression is into a gym, and finally onto a bike. This sequence is extremely important. If muscles are strengthened before their range of motion is sufficiently increased, their power output may be significantly limited.
Fine tuning a body on a bike for a particular type of competition is not a perfect science. Often, optimal change occurs slowly over a period of time as the body becomes more limber and the strength training has the effect of increasing leverage. For this reason, we sometimes allow months to make changes in a particular individual's position. The following strength exercises are in priority order, beginning with core strength and progresses into hip flexion, and hamstrings. As with the stretches, these serve as a clear guide for better conditioning. Still, they may not all be appropriate for each individual. Proceed with caution.
Training for Cycling: Flexibility First
How to use the CompuTrainer to analyze power output in endurance cyclists. Recommended stretching to improve range of motion so ultra cyclists can go faster with less fatigue.
by John Howard and Dr. Ernie Ferrel
One of the bittersweet ironies of life is that we use it up learning how to live it. By the time we've matured into what we hope is deep wisdom, there's not much time left. We've all heard variations of the "if only" statement: "If only I'd known, at age 20, what I know today." This irony plays out in an athletic career as frequently as it does in life itself. Many aging athletes, who take up the challenge of the metabolic barrier too late, end up singing the "if only" blues. The performance boost they begin to enjoy brings the realization, too late, that if they had used flexibility training to challenge the barrier at the beginning of their athletic careers instead of at the end, their performance achievements would have been far greater.
Increased performance gains are harder and harder to come by over time. With each small improvement, there is an increased cost. Ramped up metabolic training offers slight gains in cardiovascular efficiency, but with a significantly greater potential for overuse injuries. This is especially true at the elite level.
With flexibility training, improvements in range of motion will produce a more powerful pedaling stroke. In our next article, we will discuss how that improvement in pedal stroke translates into a more effective set-up for ultras. For now, let's dial in some greater range of movement.
Analyze then Mobilize In cycling, if you go five miles an hour faster, from 25 miles an hour to 30 mph, the increase in energy output is enormous. Yet a cyclist going 30 miles per hour only produces enough energy to fire a row of light bulbs. The solution is greater efficiency. How is this achieved? In the previous article I presented Ian Jackson's breakthrough BreathPlay Zooming CD Ultrazoom. Here I'll take a different but complementary approach.
Air resistance is a huge limiting factor to speed, so aerodynamic considerations are often critical. Many times the most efficient aero positions come into conflict with the individual biomechanics of the body. A cyclist who is stiff, with limited range of motion in the joints, will either be unable to attain an efficient aero position or unable to maintain it. The information we are presenting is based on years of personal experience and experimentation. We'll give you a detailed overview of our process so that you can apply it to yourself.
In looking at the body it is important to determine the individual's strengths and weaknesses. We start with the athlete's bike on the CompuTrainer, utilizing the Spin Scan program to get data about the athlete's power stroke. We ask about patterns of pain that may have become chronic, and whether the pain is constant or intermittent, localized or diffuse, etc. Many of the causes of these cycling problems will be obvious from watching Spin Scan on the CompuTrainer.
The color bars on the CompuTrainer Spin Scan bar-graph start bobbing as soon as the athlete starts pedaling. We warm our riders up and then take them to perceived anaerobic threshold, say 10-15% below max heart rate. At this level of exertion we get an accurate picture of their pedal stroke. We watch the lower valleys on both right and left sides, noticing the percentage of watts for each. A common problem is a lack of muscular force, and a lack of consistent force at the bottom of the stroke. We define this area as the recovery portion of the stroke, at roughly 6 to 12 on the clock face. This tells us the hip flexors muscles, primarily the Psoas and Rectus Femoris, are not holding up their side of the muscular equation. The solution is to systematically stretch, then strengthen them with single side isolated pedaling or better yet, Power Cranks(tm). As the muscles become more flexible and stronger, and the neuromuscular pathways are reinforced, a smoother more powerful stroke will result.
A related problem is the pattern of power spikes on the right and left sides at the peak of the stroke. If the color bars are higher or wider at the peak on one side this indicates a lack of smooth force to the pedals. This problem is usually brought about by a splayed knee, a tight external hip rotator, and or a tight I.T. band.
Corrective Program Once we analyze the athlete's muscular imbalance, muscular weakness, or leg length discrepancy, we formulate a corrective program. We provide a set of prioritized stretches that initially look like they have little to do with riding the bike.
Most of our clients are pro and amateur triathletes and cyclists. Some of them have either not stretched at all or have stretched very little. Many of those who have been stretching have actually increased their tightness by improper technique; hence, our first priority is teaching correct stretching technique. We begin with some introductory movements to "wake up" the core muscles and elevate body temperature. This reduces both the exacerbation of old injuries and the creation of new ones.
We begin with a series of light active and passive isolated stretches that are derived from works of Dr. Ferrel, Bob Anderson (note his cycling series in the his book Stretching) Arron Mattes and his series of active isolated stretches, massage therapist Doug Thralls, and Chris Maund, of the C.H.E.K. Institute in Encinitas, CA. These are followed by a strengthening program, which is initially based on floor exercises using foam rollers and a large ball. Later, we progress to a gym, and finally to the bike. This sequence is critical: if you make the mistake of strengthening the muscles before exploring their full range of motion, you are potentially limiting your power output. This work is an individualized form of training, and it begins with understanding the initial position analysis on the bike. The athlete must start with a pre-training stretching program. The best time to start this is immediately and it should be maintained for life. Inflexibility should be understood and treated before we start strengthening the muscles. Cyclists have some common flexibility issues, and the following stretches address these. Still, each person is an individual with slightly different needs, so the generic program is never fool proof.
The Importance of Hip Flexors and Quads Following the bio-kinetic chain, the first muscles we look at are the hip flexors and quads. One of the strongest hip flexors is the Psoas muscle. When the Psoas is properly engaged, it adds tremendously to pedaling power. The same is true when the Vastus Medalius is properly engaged. A stretching and strengthening program to mobilize and strengthen these muscles should be a priority. Simple exercises such as walking lunges replicate the precise motor response of pedaling. Take care to place the knee in front of the ankle. In the gym, isolating the hip flexors (and hamstrings in the reverse position) with lower pulleys is a great way to power up the body for improved turn over. On-bike drills, including a series of specific hill repeats, integrate the muscles for a more effective transfer of power into pedaling. Along with the Vastus Medalis, the other quadriceps muscles need to be trained through isolation exercises. If you can train these ancillary muscles, you may or may not see dramatic increases in power and performance, but you will sustain more power for a longer period of time.
There are a few mechanical devices available that improve the pedaling stroke by activating the hip flexors. Dr. Frank Day's Power Cranks are probably the best.
Hip RotatorsIt is important to activate the hip flexors, but for the majority of cyclists, the five-muscle group that externally rotates the hips is probably the most troublesome, since it causes splayed knees. This problem is exacerbated by various causes, such as poor body biomechanics, bad habits and trauma. Their chronic contraction causes splayed knees and a consequent loss of power in the most powerful arc of the pedaling stroke. Splayed knees also create poor aerodynamics and a decrease in stability, especially on descents. A seat that is too low will also play a part in this condition. The ideal is to have the legs come straight up and down, like pistons in an engine, with the proper amount of flexion to maximize your power safely.
Weak Vastus Medalius Obliques. The v.m.o. muscles are one of the primary quad muscles involved in smooth pedaling action. When the v.m.o. are weak, the knee joint can no longer track smoothly, thus contributing to knee pain which can quickly accelerate to chronic degeneration if left untreated. This problem is common among runners who take up cycling with no corrective strength training. An effective way to treat this problem is with short arc quad extensions. Do repetitions with one leg bent only 10-20 degrees, toes pointed in. Repeat with other leg. Very gradually increases in weight.
Weak Core muscles. Abdominals, Obliques, Erector Spinae and Quadratus Lumborum. The Q.L. starts going south under pressure from big gears and low aero positions. Eventually the Q.L. fades out with an accompanying dull ache in the low back area that seems to never go away. The remaining core muscles are also compromised and become less effective. When this happens the Glutes begin to tire rapidly, and speed and power drop significantly.
More on Stretching Stretching needs to be a part of your life style. It is most effective right after a ride and just before bed. As we age, poor postural habits, past injuries, and increasing stiffness, sneak up on us. Finally, we can no longer deny what has happened to us. We move with a certain rigidity and we're prone to injuries that are slow to heal. Recommended stretches
Resources John Howard has been a competitive cyclist since 1965 and a cycling coach since 1982. His School of Champions athletes have won over 150 national and world titles including RAAM. Howard is a three-time Olympic cyclist with 15 national championships and an Ironman Triathlon victory to his credit. He is also a member of the USA Cycling Hall of Fame. Howard has written four cycling books: The Cyclist's Companion, Multifitness, Pushing The Limits and Dirt! For additional information on his camps, contact him at http://www.johnhowardschool.com/ or http://www.multisports.com/ for coaching. His email is jhschool@aol.com
Dr. Ernie Ferrel is the past Vice President of ACA Sports Council, Director of Chiropractic Services for USAT, Certified Elite Cycling coach and creator of Dynamic Motion Therapy. He can be reached at (805) 963-3232
Stretching for Ultra Cyclists
Stretching to improve range of motion is an important part of a cyclist's training, which will increase power and comfort during long-distance bicycle rides and ultra races."
by John Howard and Dr. Ernie Ferrel
Do the stretching at least five days per week. Make time for stretching before or after riding your bicycle, convince yourself to look forward to it and make it fun!
Ian Jackson's Zooming CD utilizes a specific breathing technique critical for activating the parasympathetic nervous system. Activation promotes a relaxed muscle release and blood flow, thus greatly improving the quality of the stretching. The technique will also add a surprisingly pleasant sensation to your stretching.
#1 Trapezius/sub occipitals.
Our objective is to balance and strengthen the posterior, thoracic muscles such as the traps, levator scapulae and rhomboids to increase the biomechanical efficiency and aerodynamics of the ultra cyclist. Tuck the chin, find the bony lump at the base of the skull, and pull gently to the side. After several seconds, decrease the pull, and lift the opposite shoulder. Repeat 8-10 times for both sides before riding. An excellent companion stretch is to hang from a chin up bar, both over and underhanded for 15-30 seconds for each grip.
#2 Foam Roller across spine.
Stretching to flex the spine, open up the intercostal muscles of the chest, and help avoid stooped posture from long hours riding the bicyle. Work the roll from T4-T12, spending 10-15 seconds per five sections of the spine. When finished roll off the side and avoid doing a crunch.
The other four stretching exercises are performed lying on the back.
#3 Tight External Hip Rotators.
Their reduced range of motion is one of the main culprits for splayed knees while cycling and a loss of power in the most powerful arc of the pedaling stroke. Splayed knees also create poor aerodynamics and a decrease in stability while cycling, especially on descents.
While on back, bend the knee and use a strap or rope to pull the foot across the body with the upper leg at 90 degrees. Run the rope under the calf to support the knee. Do 8-10 reps, both sides, before the ride.
#4 I.T. bands.
With torso and lower body straight run the strap under the calf to support the joint. With the hips flat on the floor, bring the leg low across the body and keep the toes pointed at the ceiling. 8-10 reps, with a slow extended out-breath on each rep, both sides, before and after cycling.
#5 Bilateral piriformis stretch.
Bring the knees together very slightly with the feet as far apart as possible. This is a passive stretch held for 15-30 seconds before and after the ride.
#6 Tight Hamstrings.
When these guys are tight you will have a limited forward bend at the hip. The pelvis is pulled into a posterior tilt, thus countering your ability to flatten the back and sit low on the bicycle. Tight hamstrings also rob horsepower while cycling.
With a rolled up towel in the small of the back and the non-stretched foot straight against a wall. Anchor the strap around the ball of the foot and pull back 8-10 times with a slow extended out-breath on each rep, both sides before and after the ride.
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