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Saturday, April 30, 2011

Orthotics for cycling

With a bit of extra time on my hands at the moment I have decided to do a few little podiatry-related blogs which people might (or maybe not) find interesting.  Kicking it off is orthotics for cycling.

Ever get sore feet while riding? Toes or feet go to sleep? How about feeling like you have been burning piece of coal underneath the ball of your foot? Maybe you have knee or hip pain? Or maybe you just feel a bit wonky or crooked on the bike?

Many cyclists will have experienced at least one of the things mentioned above, but not a lot of people know what they can do about it or where to find help.  Not everyone knows that a sports podiatrist can help to solve these problems with a pair of orthotics to go into your cycling shoes.
Orthotics are also known as insoles and are inserts which are placed in the bottom of a shoe to provide extra support and to address any biomechanical abnormalities of the foot or lower limb.  They can be prefabricated (“off the shelf”) or custom made. 
They can either be rigid or soft; made from a variety of materials such as polyethylene, carbon fibre, EVA and plastazote.  They can have modifications added to the rearfoot (back of the orthotic) or the forefoot (front of the orthotic) depending on the issue which they are addressing.

How can orthotics help me on the bike?

Orthotics help to redistribute pressures within the foot, they correct biomechanical abnormalities of the foot and lower limb, and also provide additional cushioning and support to the foot.  They can be used to reduce pain or to improve alignment in the foot and lower limb.

I have orthotics in my running shoes – should I be wearing them in my cycling shoes?

People need orthotics for a variety of reasons and they can be temporary or permanent.  A lot of people mostly associate orthotics with running, however the orthotics used for running and for cycling are quite different as there are different forces placed on the foot with these two activities.  There is a lack of impact in cycling which can neutralize biomechanical abnormalities seen in weight-bearing (ie. running).  Just because a person uses orthotics for running doesn’t necessarily mean that they need them for cycling, and vice-versa.
The most common complaints requiring orthotic intervention for cycling include:
-       -  Numbness/tingling in foot
-        - Arch or heel pain
-        - Knee pain
-        - Leg length discrepancy
-        - Pain/burning under the ball of the foot
-        - Achilles tendon, shin or calf pain
-        - Hip pain
-        - Iliotibial Band pain

If you do not experience any pain or discomfort while cycling then you may not need orthotics, however sometimes by adding in an orthotic which can help to redistribute pressures on certain parts of the foot, people realize that they are far more comfortable with one.  Sometimes you don’t realize that you have been uncomfortable until you try something new. 
Cycling is not supposed to be uncomfortable (it’s supposed to be painful when you are riding hard…) so if you are experiencing any type of pain when sitting on your bike and going for an easy ride then something is wrong. 


So what is the difference between cycling orthotics and other kinds of orthotics?

Cycling shoes are very different to running shoes and therefore the orthotics are very different as well.  Cycling orthotics need to be narrower and have a lower profile to be able to sit comfortably in the shoe and accommodate a foot as well (most important!).  Running orthotics tend to focus more on the rearfoot as this is often the first point of contact, as opposed to cycling orthotics which focus more on the forefoot as this is where the foot contacts the pedal.

Anything else I need to know about cycling orthotics?

Because of the repetitive nature of cycling an incorrect biomechanical pattern will more than likely result in an injury.  It has been estimated that a competitive cyclist performs more than 8 million hip and knee flexions in a year1 – even for a recreational cyclist this number is in the region of 2-4 million.  Therefore it is important to address any foot or lower leg abnormalities before they cause pain or muscle imbalances.
Shoe and pedal combinations, as well as cleat placement, are also factors which can either help or hinder the biomechanics of the lower limb and should always be taken into consideration when assessing for orthotics.
Last and certainly not least, a proper bike fit in terms of frame size, saddle and bar height and saddle position, in conjunction with pedals, shoes and orthotics, are imperative for maximising power transfer and creating a comfortable ride.

 1Schep, et al (1999), Flow limitations in the iliac arteries in endurance athletes. Int J Sports Med.

At least my feet were happy

Monday, April 18, 2011

Big Jo training 11 April - 17 April

I just took this week as it came with my sad shoulder problem.  I started the week taking Tramadol for the pain but it didn't seem to make much difference so cashed in my Codiene prescription which definately didn't help. I went back to the doctor in desperation after having to spend a night sleeping sitting up on the couch because it hurt too much to lie down and got some Prednisone which combined with the Tramadol and some acupuncture seems to be working. I have never taken so many drugs in my life as I have in the last week. 
Drugs anyone?

Prednisone has also been shown (anecdotally...) to help to lessen the extent of the muscle weaknening and to shorten the whole duration of the condition so fingers crossed... My muscle weakness is still about the same and hasn't gotten worse which is good news.  The physio thinks that when the pain has settled if I am able to swim without aggravating it then I should be ok to do so which is very good news.
I'm still hopeful I can do the Raro Tri which is now in just under 3 weeks time, based on the amount it has improved in the last few days I am sure I will be able to wing my way through it... I looked at changing my flight so I arrived after the Tri and wouldn't have the temptation, it would cost about $450 to change my flight which cost me $143 so I don't think that is going to happen...

BIKE

Biking probably hurt about as much as sitting on the couch so I figured I may as well keep riding plus I had pre-entered the CMC club race and didn't want do a no-show so I dragged my sorry ass out to Ararimu to race in the rain.  The rain cleared up a bit for the race and it was a nasty 2 lap course with lots of hills.  I was good on the uphills and would clear out from the bunch pretty easily but really suck on the downhills so needed to get a gap going up so I didn't get dropped going down.  There was a little hill about 300m before the finish so I went super hard up there to try and gap the other girls but didn't have enough grunt on the flat and got pipped by about half a wheel length to come 2nd girl.  Stink.  I tried pretty hard and felt like my intestines were going to burst out and my legs were going to explode but was still pretty dark at myself for letting her pass me.
The rest of the week was just tootling around and nothing too exciting.

RUN

Still just testing out the hip and not doing much, did 4 runs this week with my longest run since IMNZ of 32mins woo-hoo!  Hip seems to be all good, shoulder hurts to run but no more than doing anything else.
I'm looking forward to watching the Boston Marathon early tomorrow where NZ's own Kim Smith will be looking to take it out, go KIM!! I used to race against her when I was at school.  Actually I use the term 'race' a bit loosely - we would run the same course and she would lap me...

IN OTHER EXCITING NEWS

This weekend was the last race in the People's Tri series and a big showdown between Jared, David and Kezzle.  Jared lead Kezzle out the water then Kezzle dropped Jared on the bike and went on to take the title.  Davo was never quite in the race... It was a fantastic performance by Kezzle-Anne who hasn't raced anything shorter than a Half for many, many years.
Davo leading a train of boyfriends, they could recognise a powerhorse when they saw one. Pity no-one could stay on

Post-race muffin time
 PUSSY CAT ANTICS:
Ever get the feeling you are being watched? Go on Murfy... enjoy your dinner...

Tuesday, April 12, 2011

A Sad Little Ironman

Since my last post I started my swim program and knocked out the first 6km session like I was supposed to, a bit of a mission but I got the job done.  My shoulders actually felt tired for once so it must have been good for me.
The next day over the space of about an hour I got this severe aching/throbbing pain in my left shoulder which was relentless.  It was probably some of the worse pain I have ever felt and meant that I couldn't concentrate on what I was doing and no changes in position or pain killers helped.  It settled a bit over the next 24 hours but I was unable to swim the next day because it hurt to lift my arm.  At this stage I thought it was related to the big swim set two days before but wasn't really convinced. 
A few days went and it gradually got better, not the full 100 but on its way and I was able to do an easy 1500m in the pool on Friday.  Saturday came and the severe aching pain started creeping back, probably even worse that the first time. I was at a hen's night and had to go home because the pain was so bad and then I couldn't sleep because there was no position that I could lie in which didn't hurt.  I was pretty miserable.  I managed to get in with a sports doctor on Monday (yesterday) and on describing my symptoms and doing a couple of muscle tests he concluded that I have something called Idiopathic Brachial Neuritis otherwise known as Parsonage-Turner Syndrome.  I didn't really care what was wrong with it I just wanted the pain to go away.
I had never heard of this before so he started telling me the usual course - severe pain in the shoulder/upper arm (check), no trauma or aggravation (check), pain settles over a couple of weeks (thank god), followed by painless atrophy (wasting) and paralysis of the shoulder girdle muscles which can take 6 to 18 months to resolve (HOLY SHIT).  He did a couple of muscle tests and the left side was definately weaker than the right but since I am right handed and pretty much have no upper body strength anyway I am not reading too much into that.
So he has given me some drugs to get me through the painful stage so I can sleep at night (which didn't really work last night anyway) and has said that once the atrophy kicks in swimming will not be a good idea as I will develop muscle imbalances from the unaffected muscles making up for the wasted muscles which could then cause subsequent rotator cuff/impingement type injuries.  Even cycling on TT bars or on my drops could be a problem because you need some control over the shoulder blade when you are in those positions.
I wouldn't say that I am in denial and he is a well respected sports doctor, but it is early days yet and I am trying to stay positive and hope that either he is wrong about the diagnosis or I manage to escape with little or no wasting/paralysis... I did a bit of a google search (as you do...) and unfortunately my symptoms so far fit into the symptoms they describe.
So I am pretty devastated that this is the course that it could take.  At least I will still be able to run and ride my bike but if it is going to take 6 months + then there is a good chance I may miss some or all of the next triathlon season.  And its a pretty scary thought that my muscles are going to waste and maybe become paralysed, not just in terms of triathlon but in terms of everyday life.  Things like tying up my hair and maybe even getting dressed could become a problem if I can't use some of my shoulder muscles.
So at the moment I am just taking it as it comes and running and biking as I can and once the pain settles I will hopefully start on some exercises to help maintain any strength I have.  Unfortunately I have seen too many ongoing shoulder problems so I know what a pain they can be.  Sometimes having too much medical knowledge is a curse especially with my ability to dramatize everything - by the sounds of things things could be dramatic enough.

Life can be a bit more bearable with a fake moustache

The rest of the week wasn't too exciting, did a couple of shorts runs with no hip issues (yay) and the usual riding.  We got caught up in a bunch on Saturday which we couldn't get away from despite a couple of diversions from the route, so eventually gave in and rode with them.  The bunch then got blown apart by the Mechanics Bay bunch and I lasted about 30secs... I did manage to get a new max power of 481w - woo hoo!!
Murfy getting all razzled up by my catnip plant which she is crushing

Tuesday, April 5, 2011

Big Jo training 21 March - 3 April

Lets get ourselves back to our usual format...

SWIM

My hip was still a being a bit fidgey-widgey with kicking and there is only so much PB I can take so I decided to take the last week completely off swimming.  I met with Haydn about my piss-poor swimming and he devised a program for me starting with a 6km session EEK!! So I am hoping a week off will settle the hip enough so I can start with Program Fishy.  Unfortunately my week of swimming meant that I would miss the annual Waikato Five Bridges Swim which somehow increased from 5km to 7.1km despite using the same course, odd.  I was there anyway as the driver and only had a little bit of FOMO. J-Rad razzled the field and led from start to finish while Davo attempted to swam with Jared but only lasted about 200m.
Swimmers waiting to start the big float
J-Rad and Davo in 1st and 2nd
 BIKE

In attempt to become a better cyclist I have turned up to the Counties Manukau club races the last two weekends.  The first one was a complete waste of time with both me and J-Rad puncturing on the first lap ending our races. I thought my puncture may have been karma for not stopping for Jared when I saw him walking back but I figured he would be mad if I sacrificed my race, of course had I have been dropped from the bunch it would have been a different story. But any case I had a puncture of my own about 10mins later and had to pull out anyway. And it rained the whole time so all in all was not a fun afternoon.
The following week was an 80km handicap race in perfect weather. I was on quite a large handicap but the group was too big and after 3 laps out of 5 me and a few others peeled away.  Our new little group got along quite well until some of the faster bunches caught and obliterated us so I ended up sad and alone for the last lap.  But I got there in the end, smug in the fact that out of the 16 people who started in my group only 6 of us finished.
So club racing is to be a permanent fixture on our weekend calendar from now on.
My dear friend Neilio hooked me up with some winter BMW kit.


RUN

First run since Ironman woo-hoo!
Did a series of little intervals with one minutes walking in between and all seemed pretty good, not quite the full 100 but almost there. Going on the flat and downhill is ok but uphill was still a bit iffy.  So I'll just keep it easy and on the flat for now and hopefully we'll come right.
Practicing my walking and enjoying the scenery
IN OTHER EXCITING NEWS
The Serottica enjoying the Thursday ferry ride.

Don't be fooled - its not the Serottica. Davo specializing in bikes for midgets, this is Lesbo's new steed. Nude titanium, nom nom nom