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?)
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
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,
Date: February 03, 2005
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?
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
Take care and enjoy your cycling,
Date: Wed, 28 Nov 2001
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
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
Date: Wed, 3 Oct 2001
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??
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
If symptoms worsen or other problems persist,
please contact your physician.
Subject: Knee injury
Mon, 18 Jun 2001
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.
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.
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.
Date: Sun, 12 Nov 2000
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.
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.
Dr Scott Calzaretta, D.C., C.C.S.P.
Date: Sat, 19 Aug 2000 21:42:37 EDT
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,
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.
Are you from the Chicago area by any chance? We share the same
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!
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..
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,
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
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
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?
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.
Dr. Scott Calzaretta, D.C.,C.C.S.P., Q.M.E.
Certifed Chiropractic Sports Physician
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.
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.
Dr. Scott Calzaretta, D.C., C.C.S.P., Q.M.E.
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 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.
Dr. Scott Calzaretta, D.C., C.C.S.P., Q.M.E.
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?
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.
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
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