Dr.Scott Calzaretta D.C., a national and international lecturer, former Olympic team doctor, founding board member of the World Governing Body of Sports Chiropractic, and consultant to the San Francisco Spine Center has answered many cycling questions below.

We have kept this information on the site, eventhough it's old, in case it may help you. We are no longer accepting new questions.

I have a slight tear in my hamstring. I did it Wednesday, ten days after Ironman Arizona (my 6th IM) probably doing swiss ball hamstring crunches. Can I still ride a bike while I recover (3 weeks?)

Best,

Chris

Chris:
Typically a slight hamstring strain can tolerate cycling with minimal negative effect while some positive benefits are experienced(eg. increased circulation, functional stress to promote functional healing,etc.)

Let common sense be you guide. If it hurts while you do it, change the angle(possibly recombinant..I know, boring to train in the gym, but at least you may be able to train) or find another aerobic activity until you can tolerate the activity. Present for care if it continues to interfere with your activity.

One of my questions to you would be why the hamstring strained in the first place. Is there a muscle imbalance, a low back tightness or spinal fixation that caused a misfire and a strain. That is something with which a sports Chiropractor or Physio could evaluate and assist you.

Best of Health,

Dr. Calzaretta

Date: February 03, 2005

Hello,

I'm so glad I found your website! After riding for 50+ miles, I get an ache directly behind my kneecap and this lasts for a day or two. Is this a common complaint, and what could be causing this to occur?

Thank you,
C

Dear C:
Pain behind the kneecap can be a symptom of irritation to the undersurface of the kneecap. This is where contact to the end of the thigh bone occurs. If there is a muscle imbalance in the quads(thigh muscles) or poor technique during cycling (eg.excessive medial/lateral motion), inflammation and irritation can result. You need to address this issue with a sports medicine specialist (Chiropractor, Orthopedist or Physical therapist should be helpfull) before permanent damage to the joint lining occurs.

Take care and enjoy your cycling,

Dr. Calzaretta

Date: Wed, 28 Nov 2001
From: Ken

Hi Dr. Calzaretta:

I recently bought a new road bike with clipless pedals. For the first 20 - 30 minutes of each ride, my left foot aches in the middle to front of my arch. After this period, I don't really notice much discomfort, but that's not to say the foot feels great either. I am fairly flat footed. I rarely walk barefooted for any length of time because my feet begin to ache. I've tried adjusting the cleat and adding an aftermarket sole insert, but I can't shake the problem. My right foot is fine. The shoes are not expensive (Specialized Comp model). I don't know if there is something wrong with my foot or the shoe. I am starting to increase riding time now, so I feel it wise to address this before I do any harm to my foot. Any suggestions?

Thanks,

Ken

Ken:
Sorry for the delay in my response. My internet provider became another dot com tragedy. As for your foot, it is common that people with fallen arches can develop aches during activity. Several reasons are possible and here are a few...Your shoe is tight(some people have one foot larger or different in shape then the other...you have weak muscles at the sole of your foot...or you may have a rigid foot due to fixations/adhesions where the bones articulate. These are just a few examples but you may want to see a sports doctor in your area to be certain. We have a national/international database of sports doctors so if you forward the town you live in I might be able to recommend someone to you.

Take care,

Dr. Calzaretta

Date: Wed, 3 Oct 2001

Dear Doc,

I just rode in a 100 mile bike ride and was numb in my penile area for 4 days. I have heard, from other cyclists, that this is not unusual but I found it somewhat disconcerting. What can I do to combat this? Do you recommend the anatomical seat with the hole in it for the scrotum??

Thank you.

Mike K

Mike:
This is a common complaint among cyclists. I would recommend that you look into the specialized seat(the one with the center space for your comfort). This seems to take care of the problem for many enthusiasts. Roger Minkow, MD is the inventor and you can get more information about the benefits of the seat through specialized.

If symptoms worsen or other problems persist, please contact your physician.

Good Luck,

Dr. Calzaretta

Subject: Knee injury
Mon, 18 Jun 2001
From: Brownbody@aol.com

Dear Dr. Calzaretta
Do you happen to know of a sports physician/chiropractor in my area who can assist me with recovery from a patellar tracking problem secondary to a herniated disc which has caused my right quadraceps to atrophy? Is there someone in the Greater Detroit area you could recommend?

Unable to ride, Detroit.

Unable to Ride, Detroit

Call 1-800-593-3222. This is a national referral network for sports Drs.who are certified. I don't know of anyone in particular in the detroit area.

Good Luck,

Dr. Calzaretta

Date: Tue, 19 Dec 2000

Dear Dr. Calzaretta,

I am a 35 year old male that up until 4 years ago was very active in USCF bicycle racing. I started racing at 25 and was forced to stop at 31 when I herniated my L-5/S-1 disk. Although the herniation was measured at 9mm, no surgery was undertaken and I am now living pain free, but with a noticable "weak link" that I must make compensation for when lifiting, bending etc... The back injury forced my off the bike for sometime. I made one successful attempt to get in shape with no difficulties as long as I kep't the mileage reasonable.

Speeding up the story.... after another time period away from the bike I decided to get back in shape again and started riding, but this time I was getting what feels like tendinitis right below my knee cap where the tendon resides on both knees. An MRI was performed on the knee and the results showed no soft tissue damage. At that point, I was referred to physicial therapy and was told that I have a muscle imbalance in my quadraceps (biofeedback was performed on the quad muscles). In addition, I was told that my I.T. Band was full on knots. Since then, (2 years) I have been stretching and using a foam roller to work the knots out of my I.T. Band. To
some degree I have been successful, but it seems like I cannot get the muscles to loosen up and if I stop the roller for even a few days it seems like the knots return. I really want to get back to riding my bicycle, but I do not want to damage my knees in the process. Currently, I am riding 15 minutes a day on my trainer with no problem except slightly stiff knees in the morning. I do not have arthritis (blood test showed this to be true). I am desperate to find a doctor that can assist me in overcoming this very frustrating problem.

Thank you,
Joe

Joe:
I am glad to hear of your recovery from a disc injury. Everyday in my practice, I am fortunate to be a part of assisting patients from avoiding surgery. It sounds like there are still some issues that have not been addressed in your problem. A complete kinetic chain evaluation from the feet up is critical. Many of the complaints you are talking about can come from spinal, pelvic, hip and/or foot compensations that
need to be corrected. The nerves that control the leg muscles come from the spine and any injuries can alter function. A pain free nerve test to evaluate thier function may be appropriate. Have you been evaluated for technique and fitting of your cycle? Have you been treated by a Chiropractic Sports Physician?

I would be enjoy discussing your concerns. It appears that you are local to my San Francisco office. Please feel free to contact me.

Dr. Calzaretta

Date: Sun, 12 Nov 2000
From: Elizabeth

Dr: Calzaretta:

At the end of August, I slightly aggravated my left knee on a new spinning bike at the gym. I suspect I had the bike adjusted wrong. Then really injured it on an organized 65-mile ride a couple days later. My doctor said it was a hamstring strain and sent me off to physical therapy.

Today is Nov. 12. It's still not better. I don't get it. Shouldn't I be better by now? Maybe this is not a hamstring strain. Maybe this is something else? I do have an appointment with an orthopedic doctor on the 20th. By then it will be nearly three months since the injury!

I've never had this problem. This is after 1,500 miles of training for the California AIDSRide and completing the Ride itself! I even took July off. The pain was initially localized to right behind my knee (and I mean dead center behind it) and in the top of the calf muscle (not the hamstring), only when I pulled up on the pedal from the bottom of the revolution. The day after the 65-miler, I could barely straighten out my knee, but it didn't particularly swell up. After few weeks, jogging across a street and climbing stairs was still noticeably uncomfortable. Then I tried to ride again on my trakstand in lowest gear. The pain would shoot sharply straight through the knee only when pulling up on the pedals. The physical therapy ultrasound and icing was great. But the home theraband exercises (sitting hamstring curls) were not initially helping and I finally quit doing them. That felt like I kept perpetuating the problem. After about six weeks, the pain was mostly just a dull discomfort still right behind the knee and to both sides where the hamstring tendons come down. Now, there is no more ultrasound, only theraband exercises which feel okay, and ice-massage. But still, just yesterday, I squatted down and the calf muscle felt tender. The tendon of the hamstring on the inner side still felt uncomfortable.

My patience with this healing process is near zero. If you have any suggestions to help me understand what's really going on here, please respond. I appreciate your time and attention. Thanks in advance for your advice.

Elizabeth

Dear Elizabeth:
I can understand your frustration. Many overuse injuries can linger much longer than expected. I appreciate your detail in the description of your pain. It sounds like a tendonitis and there may be several muscles involved. Along with the hamstrings and calf muscles, there is a small muscle directly behind the knee that can also be a problem with cycling overuse. Making a definitive diagnosis without examining your knee would somewhat difficult. I would tell you that after 15 years in practice and working with many professional and amateur cyclists, these injuries are almost always multifactorial. You need a doctor who can address the biomechanics of the low back and lower extremities to make sure your kinetic chain(movement pattern) is correct. Specific therapeutic modalities include manipulative therapy, active release technique to address the soft tissue adhesions that develop, and then proper training increments to prevent further recurrence. I have also seen Acupunture work wonders to reduce inflammation. Natural anti-inflammatory or NSAIDS (non-steroidal)may be needed to interrupt the recurrent inflammatory process on the rare case of someone who is a slow responder to conservative care for this type of injury. A Cortizone injection should be used as a last resort.

If you would like a referral to a specialist in your area, please email me with the name of your city.

Sincerely,

Dr Scott Calzaretta, D.C., C.C.S.P.

Date: Sat, 19 Aug 2000 21:42:37 EDT
From: RS251@aol.com
 
Hey,

I am an Ironman distance triathlete, and for the past months, I've battled a tibial tendon tear. I've gone through rehab, gotten my running style overhauled, and have orthotics prescribed. However, I feel that the bike was a major, if not the, cause of the injury, due to the fact that my foot has a toe out/heel in, and is constantly hitting the rear chainstay. Since then, I've had orthotics made for the bike shoes, and I was wondering if you've had any experience with this injury. Is there certain recommendations? Is there rotational adjustments to be made for the cleats? Thanks for the advice,

Rob

Rob:

I am sorry for the delay in my response, I have been on vacation. I am sorry to here of your injury. A chronic tibial tendon strain can make training difficult. I would have to ask you some specific questions about your injury and the type of rehab you have gone through. There are specific protocols that are quite successful in treating your type of injury. I have worked with many athletes with tibial strains and have great success. I am curious as to why your injury is not resolving. I would welcome a call from you to discuss this in further detail. My number is 415-495-2225.

Sincerely,

Dr. Calzaretta

Dr. Calzaretta,
 
Are you from the Chicago area by any chance? We share the same last name.
 
Dan Dear Dan and Alison:
I am from the Calzarettas on the east coast. My grandfather and all his brothers were from New Jersey. I am from North Jersey. My father said he has relatives in the Chicago area. I know there are several Calzarettas in Chicago. 

There is a Joseph Calzaretta, (a retired teacher now living in Florida), who had put together a family tree. I lost touch with him about 5 years ago, but I will try to track him down on the internet. If you get to him first, please email me any information. Where do you live? Where are you from?  We might even be related!

Scott 

Hey Doc, 
A month ago had voice box removed, want to ride up calif. coast from San Diego to top of state. See any problem with that trip? ken in s.d. ca..

Dear Ken:
I would suggest that you ask your surgeon that question. They would be better able to assess your situation at this time. The answer should be as easy as a phone call. Sorry for the "no answer" but that is the safest answer for you.

Best of Luck,

Dr. Calzaretta

Dear Dr. Scott,
I'm getting a "sleeping" feeling in my feet toes during long cycling. I have very stiff soles in my cycling shoes and also the size is fine. Any advise to get rid of the sleeping toes feeling?
Thanks,
Ofer

Ofer:
I would suggest you re-evaluate your shoes. Some answers to the following questions would be helpful. Has this happened in the past or is this a new occurrence? Did you recently get a new pair of shoes? Did you suddenly increase you mileage or intensity? The symptoms you are describing are common with shoes that are tight in the forefoot. Either by size or the fact that your foot is sliding/jamming into the toe region. This happens with people on the stair master as well, again for the same reasons.

Good Luck,

Dr. Calzaretta

Nicholas asked:

I have been riding pretty seriously for 6 months doing lots of miles a week, I have been getting lower back problems. What is the cause and how do i get rid of this?

Nicholas:
Sorry for the delay in my response. Your message was lost in cyberspace. Your question is common but the answer may not be so simple. Without more of a history, I can only make general recommendations that may or may not be effective for you. first and foremost, get a sports checkup from a sports medicine specialist. You may find an answer to your pain, and some assistance on optimal performance as well.

As for now, several possibilities exist. You may have an improper setup of you bike. You may have shortened low back and/or hamstring muscles.  You may have an underlying disk or ligament problem. The simplest start is to check your bike setup, then do some basic stretching techniques for the aforementioned areas. Many times, low back pain is more noticeable during climbing, and it is suggested that you minimize that part of the training until you are pain free. Again, since back pain during sport can be multifactorial, I would suggest you find out exactly what the issue is before you cause further injury to your body. If you need a referral for your area, please let me know.

Good Luck,

Dr. Scott Calzaretta, D.C.,C.C.S.P., Q.M.E.
Certifed Chiropractic Sports Physician

Hello,
I recently had surgery on my colon. Before the surgery I rode every day and raced on the weekends. It's been about 2 1/2 months since the surgery and I'm having a hard time starting to train. I don't know if it was a shock to go from serious training to couch potato? I didn't have any physical therapy and do not plan on it. I'm a little stubborn. any advice.

Thanks,
Sam

Dear Sam,

Anytime you have surgery, that in itself is a shock to the body. I don't know the particulars of your illness, but hopefully all is well and you can go back to enjoying training. If we assume all of your physical capacities are ok, then it is just a matter of time before you are up to speed again. Start slowly and do not expect to train at your previous intensity until you are feeling the strength and endurance returning. A good general rule is to train every other day for the first two weeks, since getting started is the hardest part. Find someone to train with (at the very least, they distract you and make the ride more enjoyable) You might also want to discuss nutrition with a specialist. 

Good luck,

Dr. Scott Calzaretta, D.C., C.C.S.P., Q.M.E.

Krista asked

 I have been riding and racing for about 3 years now. For some reason, I have never been completely comfortable with my left leg and it seems to be more of a bother lately. While my right leg feels strong and pedals smooth circles, the left leg seems weaker and hits a lot of "dead spots" while pedaling. I've been adjusting my cleat position, but I just can't seem to make this leg feel good. I did have problems with my left knee around 5 years ago when I was a runner. I just wonder if this is something I should continue working on myself or could there be a bigger problem underlying all of this? I would appreciate any advice.

Thank you,
Krista

Krista:
Thank you for your question. "Dead spots" is an interesting description of your problem. Many times with old injuries the body develops compensatory patterns and may continue to do so long after the original injury is healed. So it would be a good idea to get an evaluation from a sports doctor or therapist. 

In the interim, there are two exercises that may be helpful to strengthen the area. On a stationary cycle, put up the resistance high enough to allow you to pedal slowly without momentum and feel the muscle fire throughout the motion (the key is without momentum). Another technique we use is to perform leg presses with 3 seconds up and three seconds down. The slow movement causes the smaller muscle bundles to fire all through the muscle, as opposed to the momentum bypassing some of the weaker muscle bundles. Strive medical line equipment is unique in the fact that you can target load the weak regions of the muscle to correct those problems.

If you would like more information for a referral or were to find the equipment please feel free to contact me.

Good luck,
Dr. Scott Calzaretta, D.C., C.C.S.P., Q.M.E.

Linda asked:

I continue to "annoy" the hip joint bursis on the side apex of my hip. I speculated that it might be a tight illiotibial band (IT) band but stretches for that possibility have not alleviated this chronic problem. I ice it after each ride but would like to prevent irritating it. Any suggestions?

Linda:
This is a common problem with cyclists. The ilio-tibial band should glide comfortably over the hip. Many cyclists and runners develop a shortening of the IT as well as a contraction of the tensor fascia lata (the muscular component of the IT attached to the pelvis). Unfortunately, stretching alone does not always resolve the problem. You have realized that it is not an easy area to stretch. You kinetic chain should be evaluated (feet, knees, hips and low back) as well as positioning on your cycle. Imbalances in these areas can cause IT syndrome. 

Deep tissue or myofascial release to free up shortened muscles and fascial tissue is very effective. I would recommend you see a sports doctor familiar with cycling biomechanics to assist you. We see many patients who were told by their doctor to not train for 8 weeks. We make sure our patients continue to train, while healing.

Good luck and call me if you need a sports referral in your area. 

Sincerely,
Dr. Calzaretta

Michael V wrote:
Can you offer a few stretching and strengthening exercises for the neck. As I improve my body position on my road bike, I find my neck muscles fatiguing sooner into my rides. I find this is not improving as I ride more. The muscles continue to fatigue and I find myself hanging my head, dangerously, for 10 or more seconds. Thanks.
Mike V

Michael:
What you are describing is a common problem with cyclists. The reason for the muscle fatigue may be an underlying neck problem. Since the joints of the neck control the nerve input into the muscles, you would benefit from undergoing a sports evaluation from a qualified sports Chiropractor, Osteopath or Physical therapist. We also find chronic muscle tension can cause shortening of the contractile tissue in the muscles and result in micro adhesions. Both of the aforementioned conditions can result in the symptoms you describe.  I have several exercise sheets that I would be happy to email to you when I return to the office.  Good Luck,
Dr Scott Calzaretta, DC, CCSP, QME