Typically, when we hear the words “strength training,” we think of going into the gym, slapping some plates on a bar, and seeing what we can lift. The more, the better.
But there’s a lot more to strength training than that, especially for those of us focused on endurance sports. Strength and conditioning is also about maintaining proper function, training neural patterns, and preventing injury.
Sports like cycling, by nature, cause imbalances. If all you do is ride your bike, an overuse injury is nearly guaranteed for your future. We also believe that weight training aids performance on the bike. Regardless of your position, as Coach Connor likes to point out, no matter what you believe, race performance will suffer if you’re sitting on the sidelines with a bad back or painful knee injury.
So, in this episode of Fast Talk, we’re going to discuss four of the most common overuse and imbalance injuries in cyclists and how to address them with off-the-bike work and proper bike fit.
- Patellar tendinitis, or pain at the front of the knee. Cycling is a quad dominant sport. Keeping balance and doing some loaded eccentric work can help prevent this very common pain.
- Pelvic obliquity, a broad term for imbalances and asymmetrical movements in the hips.
- Back pain. A proper bike fit and learning to rely on your glutes and hamstrings instead of the postural muscles of the back can go a long way towards preventing this all-too-common issue.
- Thoracic kyphosis, a fancy term for a slouched back, which is common among cyclists. Regular exercise to open the chest will help you improve posture off the bike.
Our guest today is owner of Tag Performance and University of Denver faculty member in Human Performance and Sports, Jess Elliot.
You’re going to hear a lot of technical terms in this episode; we hope you walk away with an understanding that effective strength training is about more than creating a list of exercises then going to the gym and giving it your best shot.
Proper movement, ensuring you are activating the correct firing patterns, and lifting an appropriate weight are all crucial. To help out, Jess is posting videos of most of the exercises we discuss on her website.
Along with Jess, Trevor talked with Charles Van Atta, the head biomechanist and fitter at the University of Colorado Sports Medicine and Performance Center.
There’s no point in doing the off-the-bike work to resolve an over-use injury if a poor bike fit is promoting it. Charles addresses each of our four injuries from a bike fit perspective.
Primary Guests Jess Elliott: Owner of Tag Performance and University of Denver faculty member in Human Performance and Sports
Secondary Guests Charles Van Atta: Head biomechanist at the University of Colorado Sports Medicine and Performance Center
Episode Transcript
Intro 00:00
Welcome to Fast Talk, the VeloNews podcast and everything you need to know to ride like a pro.
Chris Case 00:13
Hello, and welcome to Fast Talk. I’m your host, Chris Case, co-founder of Fast Labs joined by a rather fit, rather strong and by golly, injury free Coach Trevor Connor. I can’t believe it. It’s not every day I get to say that. But well, Trevor, taking a break from riding. He’s all in one piece, at least for now, and it’s a good day. Today we’re joined by one of our favorite guests strength and conditioning expert, Jess Elliot. Check her out. She’s previously been on the Fast Talk podcast in Episode 32. A great episode. Now, typically, when we hear the words, strength training, we think of going into the gym, slapping some weights onto a bar and seeing what we can lift. The more the better, right? Well, there’s a lot more strength training than that, especially for those of us focused on endurance sports. Strengthen conditioning is all about maintaining proper function, training neural patterns, preventing injury. Of course, sports like cycling by nature, cause imbalances, and if all you do is ride your bike, well, an overuse injury is nearly guaranteed for your future. We also believe that weight training aids performance on the bike and regardless of your position, as Coach Connor likes to point out, no matter what you believe race performance will suffer if you’re sitting on the sidelines with a bad back, or painful knee injury. So in this episode of Fast Talk, we’re going to discuss four of the most common overuse and imbalance injuries in cyclists and how to address them with off the bike work and proper bike fit. First of all, patellar tendinitis or pain at the front of the knee, very, very common in cyclists. Cycling is a quad dominant sport. keeping balance and doing some loaded essentric work and help prevent this very common pain. Easy enough, we’ll dive in. Second, we’ll talk about something called pelvic obliquity, a broad term for imbalances and asymmetrical movements in the hips. We’ll address what causes them and how to treat them or prevent them. Third, we’ll talk about the very common back pain seen in cyclists. So a proper bike fit and learning to rely on your glutes and hamstrings instead of the smaller, weaker postural muscles of the back can go a long way towards preventing this all too common issue. And we’ll discuss and dive into that as well. And finally, we’ll talk about thoracic kyphosis. Now, you’ve probably seen every pretty much every World Tour pro curled up in a ball on the bike, arched back kind of looking like a caveman on the bike and then low and behold, they get off the bike and voila. Wait a second, they’re still curled over, they still look like a hermit. What the heck is going on? Well, that’s thoracic kyphosis. It’s a fancy term for slouched back. So common among cyclists. What we’re going to teach you is that regular exercise to open the chest will help you improve posture off the bike so you won’t walk around like a hermit. As I mentioned earlier, our guest today is owner of TAG performance and University of Denver faculty member in human performance and sports, Jess Elliot. We’re very happy to have her back on the show. She has a wealth of knowledge. In fact, Jess recently taught half day workshop on strength training for endurance athletes at the training peaks endurance summit. And for those of you in the Colorado area, because of the popularity of that workshop, she’s hosting it again, on December 7. So go to our website at TAGperformanceco.com/events. To sign up, use the code Fast Labs to get a $25 discount. That is TAGperformance co.com/events. Well, today you’re going to hear a lot of technical terms in this episode. But we hope most importantly, you walk away with an understanding that effective strength training is about more than creating a list of exercises then going into the gym and giving it your best shot. Proper movement, ensuring you’re activating the correct firing patterns, and lifting an appropriate weight are all critical. To help out Jess is posting videos of most of the exercises we discuss on our website. Along with Jess Trevor talked with Charles Van Atta, the head bio mechanist and fitter at the University of Colorado Sports Medicine and Performance Center. Of course, there’s no point in doing the off the bike work to resolve an overuse injury if a poor bike fit is just promoting it. So Charles addresses each of our four injuries from a bike fit perspective. And with that, let’s make you fast.
Chris Case 04:59
You know Trevor, I’ve been using these new aftershokz headphones and I got to say the new sound quality of these things is really amazing.
Trevor Connor 05:08
Yeah, I actually I’ve had a set of the titanium which is two models ago, for years. And if I ever had one criticism, it’s that sound quality obviously isn’t as good as if I put on a nice pair of Sony noise cancelling headphones, but it was worth it to be able to go on the ride and oh, I could, I could hear the traffic. But this new model, I was actually really surprised by just how nice the sound quality is like I actually sit and just listen to music. When I could be having my noise cancelling headphones.
Chris Case 05:36
Right. Well, that’s because small transducers rest in front of your ears not inside or on your ears like most headphones and then send mini vibrations through your cheekbones to your inner ear, bypassing your eardrums.
Trevor Connor 05:49
Boy Chris, were you reading that?
Chris Case 05:54
Yeah.
Trevor Connor 05:55
This episode was sponsored by aftershocks the award winning headphone brand best known for its open ear listening experience. Powered by patented best in class bone conduction technology. Aftershokz headphones sit outside your ear so you can hear your music and your surroundings. Aftershokz is a must have headphones for cyclists providing the ultimate level of safety and comfort without compromising sound quality. To learn more and save $50 in aftershokz bundles, visit aftershokz.com that’s aftershokzed.com. And yes, I’m using the Canadian Zed
Chris Case 06:32
Z for all of you Americans out there.
Trevor Connor 06:35
And use code Fast Talk, that’s Fast Talk.
Jess Elliot’s Background
Trevor Connor 06:48
I think one of the things that has been very beneficial to me and has kind of maybe set me up to speak uniquely about this is that I wasn’t one of those coaches that, you know, kind of came out of the gate and said, “Oh, absolutely no, I’m going to work in strength and conditioning.” You know, I have a background where I wanted to be an orthopedic surgeon, I worked as a medic in a hospital in the emergency room for a number of years worked in emergency medicine. And so I kind of have a lot of different background and contexts that I’m trying to bring to the table to help coaches have more tools in their toolbox. So yes, ideally, the idea behind out of our discussion today is to say, “Okay, we have some pretty common dysfunctions and imbalances that we’re going to see how are some very quick ways quick and easy ways that we can maybe go through a process of elimination. If not flat out saying yes, I can point my finger and say this is exactly what’s going on here. It can at least maybe help coaches go through kind of that algorithm that that process of elimination saying, Okay, well, let’s go through this quick assessment. Let’s check this. See if this muscle is overly tight. Let’s see what their body position is doing this movement. Oh, it looks good. Check that there proceed to the next. That’s kind of the idea. But I definitely don’t want to set it up to be a very simplistic, you know, black and white, pass, go collect $200. This is what’s wrong with your athlete?
Chris Case 08:08
Yes, yes.
Training When You’re Hurting, What to Do?
Trevor Connor 08:09
No. And that’s certainly not something I would ever accuse you of. I’ve seen you work with athletes, and you’re not the “get in the weight room, pump as much iron- iron as you can give you get in here, one time before you leave” the type trainer, you are very much that I want to see your form, I want to know what’s going on with you, you can see that medical side of you understand that done right, this can make you very healthy. Make it functional, it can make you strong. Done wrong, this can lead into injuries, make them worse.
Trevor Connor 08:40
Exactly. The biggest thing is we never want to train further into dysfunction. And so I think that’s kind of one of the largest missed opportunities is that kind of referencing back to that sports specific training, don’t train them further into their dysfunctional pattern, if anything the weight room is, it doesn’t seem like it. But the weight room is in fact, the controlled environment whereby we reset the body and bring it back to balance. And I think that’s the biggest lens that we need to kind of shift how we’re seeing the weight room. Because yes, we’re still going to build strength, etc. But really, we’re trying to undo a lot of the damage that life and our sports do to our body as well.
Chris Case 09:17
Nice. We wanted to address four of the big ones today. So maybe you could list those four. And then let’s just dive into those issues and the causes of them an explanation how to prevent them, how to address them if they’ve become you know, to a level of an injury and exercises that you use. Do you remember what we talked about?
Trevor Connor 09:43
I do,I was kind of peeking over the table at the notes for all the listeners who can’t see that. So yeah, kind of the the list that I put together based off of a lot of what I’ve seen working with endurance athletes, primarily cyclists, is patellar tendinitis. So addressing kind of very common knee pain complaints, pelvic obliquity. So a lot of pelvic imbalances, whether that’s tilting, you can have anterior posterior pelvic tilt. Alot of the times one side is going to be doing something and the other side is going to be doing the opposite. But it can also be tilting and shifting kind of upwards versus downwards, lower back pain, huge topic there, we could probably do a show just about lower back pain, but we’ll try to talk about a couple of the common causes. That’s certainly not an entire comprehensive list of all the causes, but kind of the most common ones that I’ve seen. And then finally, thoracic kyphosis. So kind of that mid to upper back when we start to get that anterior displacement and we get this rounded shoulders. That’s kind of addressing that and also how the neck can kind of get out of place as well.
Chris Case 10:46
I remeber, we had Dr. Pruitt on the show, he says, I can always recognize a cyclist from the kyphosis. You walk out of a building, they’re just kind of hunched over, they look like they should be carrying a club.
Jess Elliot 10:56
Yes.
Chris Case 10:56
They have that, a hard time.
Trevor Connor 10:58
Oh my gosh, right. It’s so true. If there’s one movement, I could just teach all of cyclists it would be to, well, I mean, in addition to releasing the anterior chain, it would just be to teach them how to hinge so that they don’t need to compensate through the shoulders and through the thoracic spine. So but that’s what we’ll dive into that.
Chris Case 11:16
Let’s dive right into patellar tendinitis, whoo.
Chris Case 11:20
And the only thing I’m going to add to this, I’ve said this on the show before, but when it comes to knee pain, the exception here is you get hit by a car, and then yeah, you got a knee injury. But for the most part, I always say knees are the victim. When you have pain in the knee it’s usually because you have an imbalance or an issue somewhere else that’s led to that knee pain. That’s about all I have to contribute.
The Colby Pearce Fan Club
Trevor Connor 11:44
Great contribution. Well, and to kind of segue off of the great contribution. I actually just recently when I was doing a hike, I was listening to your podcast with Colby Pearce. I just love hearing everything that he has to say he’s just completely fascinating to me.
Chris Case 12:02
Colby, did you hear that? So he’s actually he has been on our show more than anybody else.
Trevor Connor 12:07
I heard that. I was gonna say, I remember that being that being a highlight in his podcast as well.
Trevor Connor 12:15
I love that you bring that up, because we never know what the answer is gonna be with Colby. Well ask him question. Sometimes he’s like, yeah, I went into the mountains and meditated for a while on that. Or you could turn around and just like pull out the deepest scientific term.
Jess Elliot 12:28
I was gonn say, yeah-
Trevor Connor 12:29
He can go either way, I love it.
Jess Elliot 12:30
He really can, I just I absolutely love picking his brain. Our conversations are some of my favorite ones. Pretty much every conversation that we have, I think I walk away with at least three to five book recommendations from Colby. So yeah, he’s just incredibly knowledgeable. I love how opinionated and how passionate he is. But I’m sorry, I could talk about how phenomenal of a human being I think that Colby is, for days on ends. But to reference back to the podcast that you had, I loved that, during your conversation, you guys, we’re talking about being on a trainer specifically, and how unnatural that is and how on a bike, unlike other sports, you’re kind of grounded and locked in and all four points of contact, and so force. So when we think about biomechanics of the sport, the wave force is being generated and then absorbed and transmitted throughout the body, it doesn’t really have a lot of places to go. And so a lot of that can get rechanneled back through the body and it can get stuck in places like the knee or in the hip, or in the low back. A lot of places where we don’t necessarily want it to go because we are constantly anchored to the bike. And then would it be in kind of that winter training season now being on a trainer even more so because the bike isn’t going to move and sway as naturally as if you’re riding outside. So I thought that was just a stellar, stellar point that you guys made.
Trevor Connor 13:49
I don’t remember that. But thank you. I can’t give a lot of thought to that I don’t know.
Patellar Tendonitis
Jess Elliot 13:57
But yeah, so so in thinking about that, and kind of branching off of that to talk about patellar tendonitis, knee pain is definitely a very, very common complaint and hip pain as well. And so when we think about patellar tendinitis, a lot of what causes this has to deal with the repetitive nature of cycling. And if we think about it, it’s very much a quad dominated sport, and we’re also being locked into a bike the entire time. And so you’re kind of locked into a certain degree of hip flexion with alternating repetitive knee flexion over tons and tons of miles. It’s just an excessive amount of volume. And so-
Chris Case 14:33
Excessive, Trevor.
Jess Elliot 14:34
It is excessive.
Trevor Connor 14:37
No, no it’s not.
Chris Case 14:39
Just right.
Jess Elliot 14:40
I was gonna say coming from my background where anything over a mile seems pretty excessive. I would definitely use that term. But when we think about the muscle that’s commonly affected with patellar tendonitis, so we talk about the quadriceps muscle group, so it’s a series of four different muscles. The main culprit tends to be the rectus femoris. Now what some people might may or may not know about this muscle is that it crosses two different joints. So not only does it cross your hip, but it also comes down to right above the knee where it forms the quad tendon. And then it passes the knee where it forms the patellar tendon, and then it attaches onto the tibia. And so because it crosses two joints, you have to think that it gets kind of twice as much load and twice as much action as some of the other quadricep muscles. Also, based off of the line of poll, it’s more kind of sagittal oriented. And so it’s going to play a huge role in that repetitive kind of cycling movements. And so it’s very, very easy for that to get inflamed over time, based off of that nature. And a lot of that has to do with tightness. So when we think about muscle contraction, what’s happening is that the muscle is shortening. And so what can happen over time when we think about endurance sports, replacing a ton of load on shortening the muscle, but how much time do we spend actually bringing the muscle back to balance and resetting it to its normal length? Well, I see a lot of people that will say, “Oh, well, I take yoga, maybe once a week, or maybe even twice a week”, that that tends to be more rare. It’s like, okay, so you’re telling me you cycle maybe, on average, 10 to 15 hours a week, and then you work a desk job. And so you’re sitting in that same position, where kind of that proximal attachment of the rectus, more so at the hip is it’s flex, so it’s contracted, it’s being shortened. And then you go out and you ride an additional 10 to 15 hours a week. But that’s okay, because you do yoga one hour out of the week, and that’s going to reset the damage caused by the-
Trevor Connor 16:37
Of course.
Jess Elliot 16:38
-55 hours.
Yoga, Is It Beneficial to Injuries or Not?
Chris Case 16:39
Yoga is the wonder drug.
Jess Elliot 16:41
It is?
Chris Case 16:42
And it isn’t.
Jess Elliot 16:43
It is that it isn’t, I should say I recently got into yin yoga, which is a very cool thing. But we kind of digress and talk about that later.
Trevor Connor 16:51
We actually have to do a yoga episode at one point.
Jess Elliot 16:54
Yin yoga is phenomenal.
Chris Case 16:57
My thing with yoga is when I actually do it, I hate it.
Trevor Connor 17:01
Oh yeah.
Chris Case 17:01
But I love how it makes me feel afterwards. So it’s a challenge.
Jess Elliot 17:06
I think it’s I probably compare it not that I have any reference point to this. But from what I hear, it kind of sounds very reminiscent of like childbirth. Where the actual like process itself is very uncomfortable and kind of horrible and not something you really want to think about. But then afterwards, you kind of leave almost like with that runner’s high kind of feeling like “Oh, I feel so blissful and wonderful”,that you forget about the excruciating pain and the positions that they kind of put you in. I’m just making like a stellar advertisement for yoga by the way.
Chris Case 17:35
My yoga experiences have been nothing like that. I don’t think that there’s supposed to be any pain involved.
Trevor Connor 17:41
I don’t see any yoga stuid- studio saying come do yoga. It’s like childbirth.
Chris Case 17:46
Yeah, that’s-
Jess Elliot 17:48
Like, you get very different more westernized. But it’s so as opposed to kind of the more flowly or like vinyasa type yoga is where you’re flowing through a lot of movements. It’s you’re holding positions for an extended period of time for like minutes. And it’s specifically to work into kind of more like the joint capsule and connective tissue, as opposed to just the muscle belly. And so to try to work through a lot of that chronic tightness, that’s like locked into the joint capsules, you have to hold those positions for an extended period of time.
Trevor Connor 18:20
Now, we’re going on tangent here, but I think this is an important point to bring up. Because this is going to relate to everything you’re talking about. A lot of people when they have on these injuries, they’ll notice that muscles tight. So their solution is to stretch. But you have to think often those muscles get tight because your body senses that it is on the verge of an injury, and the muscles tighten down to protect the joint. So if all you do is stretch without any sort of strengthening work, your prevent- you you’re basically opposing your body’s mechanism of preventing that injury. So the stretching can actually allow the injury to happen, or make it worse. And so one things I like about yoga was and a lot of my athletes do yoga is it has a stretching component, but also as a strengthening component.
Back to Patellar Tendonitis Talk
Jess Elliot 19:05
It does, and kind of the segue off of that, and kind of loop back to our initial topic of like patellar, tendonitis, Chris’s like yes thank you. So one of the one of the problems with stretching is if we take just a very common like quad stretch, where you can be laying on the ground on the side, and you’re kind of like bending your leg backwards to try to stretch out that quad. The thing is, is that not all stretches are going to be created equal. And so even though you’re stretching that muscle, it’s not distributed evenly across the muscle and the tendon. So it could be stretching one area of the muscle a little bit more than the other. And so the bulk of the stretch could actually be targeting a part of the muscle that is totally fine. And so one of the interesting ways that I learned to deal with chronic tendinitis, particularly tendinitis is through a couple different techniques and I actually learned about these through chiropractors and massage therapists. And so one of them is loaded essentrics. And so it kind of works on a similar premise as dry needling. Not to be confused with acupuncture. So essentially, with dry needling, you’re, you’re going into kind of a muscle or tendon that has some chronic inflammation, or maybe some chronic issues, and it’s just not healing. And so by going in there with a needle, you’re intentionally causing micro trauma, just like we do in the weight room, we’re causing micro trauma. And so what that does is it signals to the body, hey, wait a minute, there’s some healing that needs to take place here, because for whatever reason, the body is just not diverting enough resources to heal that particular area. Which can occur with things like patellar tendonitis. So as opposed to having, you know, needles stuck in various locations of your body, you can also do what’s called loaded essentrics. So the essentric part of the movement has to do with lengthening under load. And it’s a term loaded essentrics. So for a lot of athletes bodyweight is sufficient. And so doing something like a stationary lunge, or we call it a split squat a lot of times and then doing a very, very slow essentric load keeping that knee at 90 degrees. So making sure we’re in the correct biomechanical position, we’re going to maximize the amount of stretch through that patellar tendon under load. So it’s going to do the same exact thing that dry needling is going to do where we’re going to cause specific micro trauma by utilizing and implementing essentric loading. So we’re kind of taking the adaptations and benefits of the weight room to use it to facilitate healing in that process.
Trevor Connor 21:31
Yes, I’m actually really glad you brought that up. Because that’s an important point about cycling, when people talk about building resilience or getting in the weight room and building that resilience to injury to damage. The way to do that is with the essentric work. So essentric work is actually very damaging causes a lot of micro tearing that your body then repairs in the show. First time you do some sort of you essentric work, you’re gonna have a lot of downs, you’re gonna have a lot of pain a couple days later. But the second time, you get very little like your body actually becomes very resistant very quickly.
Jess Elliot 22:04
It does, it’s one of the best ways to facilitate adaptation, and you kind of get more bang for your buck. But like you properly said, the very first time you do it, definitely expect some muscle soreness.
The Importance of Eccentric Activity in Training
Trevor Connor 22:16
The unique thing about cycling is cycling has no essentric activity. It’s all concentric. So again, that’s the argument for doing some of the strength training because if all you ever do is get on the bike, well, you can build some strength you don’t you essentially become very weird. From a muscle standpoint, males become very fragile.
Jess Elliot 22:35
You do and and kind of an interesting point to bring up too is it’s not even enough to say get into the weight room. It because if we think about most weight room exercises, let’s take something as simple as a squat, what do we tend to queue? Well, we’ll queue that up, we’ll say “Oh, be explosive on the way up”. And so similar to the sport, how cycling is pretty much all concentric and repetitive, concentric. We train the concentric part of the movements, but we forget that most movements are triphasic in nature. And so because of that, we never train that essentric component, and we also never trained that isometric component as well. But, that’s actually where we get a lot of the remodeling and a lot of the tissue adaptations that we need to build resilience so that we do ward off injury within our sport.
Trevor Connor 23:21
My old coach who was big on making sure none of us had any sort of knee issues, and I’ve always really appreciated that. In the winter, he would get us is in the gym once once a week. And his favorite exercise was that split squat with a jump-
Jess Elliot 23:35
Oh, nice.
Trevor Connor 23:36
-to really bring in some essentric action. And so we would do that for the first time towards the end of October. And all of us would just be absolutely miserable.
Jess Elliot 23:46
Oh, yeah.
Trevor Connor 23:46
After the first session, cause for a week, we couldn’t walk.
Jess Elliot 23:49
Oh, yeah. It’s that deceleration the body forgets how to absorb force. But one of the interesting things is that you can only really generate as much as you can absorb. But we never train to absorb force, let alone absorb it rapidly, like you do in plyometrics.
Treatment and Prevention for Patellar Tendonitis
Trevor Connor 24:04
Yup. So I think you’ve covered a lot of it. But what are some good exercises for both prevention and treatment of patellar tendonitis?
Jess Elliot 24:13
Sure. So when it comes to patellar, tendonitis, I tend to look a lot at athletes positioning, because usually when they’re dealing with patellar tendonitis, they tend to take a very quad and knee dominant position. So in a lunge, you’ll see that forward inclination of the tibia as opposed to kind of pulling it back and keeping more of a vertical tibia, which is going to activate more the posterior chain, so you’re going to get more hamstring and glute recruitment. They’re usually pretty guilty, whether they’re lunging or doing step ups or squatting. They tend to be guilty of letting that knee drift forward a little bit too much, which it’s not necessarily a bad thing. It’s just we need to reference back to kind of that needs analysis and say, “Well, wait a minute, where are you already spending a lot of time what positions are you already in for the bulk of your time. Let’s not give you more of that, let’s reverse it.” And so since they’re already going to be spending a lot of time in a quad dominant position, I want to reverse that and spend more time with their hips back in a more vertical shin. And then we’re going to do some loaded essentrics. So whether that’s a single leg squats, a single leg to box squats, split squats, lateral lunges, lateral side lunges, reverse lunges. Pretty much everything that I do with cyclists is going to take a 90 degree knee position with a vertical shin angle. And that’s just to help stretch out that patellar tendon as well. So he centric loading, a great thing to do as part of kind of your GPP phase training phase. So right now is like the perfect time of year to start hitting on a lot of that essentric training in the season.
Trevor Connor 25:46
Sorry to interup, GPP?
Jess Elliot 25:48
Oh, yeah, so general preparedness phase.
Trevor Connor 25:50
Okay.
Jess Elliot 25:50
So kind of your base training phase, it kind of depends on what literature you look at, it’s going to call these differences seasons, different things. So GPP, your kind of offseason training, base training, etc, where we’re really trying to facilitate anatomical adaptations. And so this is kind of the time of year for cyclists where we want to start laying down that foundation. And then really in season, I would only start using loaded essentrics here and there just to kind of maintain residual training effects, so maybe like a week or two here and there just to make sure that we’re maintaining those adaptations. Otherwise, I would use it more as part of a treatment plan. So if somebody actually does develop patellar tendonitis in the middle of their season, then I might reference back either to loaded essentrics, or a method that’s known as tacking stretch. It’s also kind of the foundation for ARD, which essentially, when we talked about muscle tightness, and stretching out a muscle or even a tendon. We kind of talked about how you can be in a stretch position, but that stretch is not necessarily going to distribute evenly across the muscle or the tendon. So the tack and stretch method for patellar tendonitis, I actually prefer to do this in combination with loaded essentrics in that split squat position. And so with the split squat, so it’s a stationary lunge, so their feet are not moving, I’ll do a slow essentric load, so slow on the way down, maintaining that 90 degree of the forward shin angle and the knee. And I’m going to implement tack and stretch where if they’re having knee pain, and it’s kind of, I can isolate it to that patellar tendon. I’ll usually use my thumb has like a pin, or is that tack to kind of apply pressure now you can either apply pressure right at the point of pain, or kind of right above it. And then when we add in that slow essentric loading, what it’s doing by placing that tack or that pin, you’re saying, “Oh, no, I want to stretch right here.” So you’re actually directing the location of the stretch. And so then I can make sure that when we’re doing that loaded essentric, I’m specifically stretching out the patellar tendon, as opposed to just stretching out the quad, because the muscle belly itself might be fine. It may be the tendon itself, which is more often the case, what needs to be stretched. And so I like to combine both methods for maximum effectiveness.
Trevor Connor 28:03
So that’s not something somebody could do on their own, they would need somebody to come and help them and apply that pressure.
Jess Elliot 28:08
You know, I’ve actually done it all myself a couple of times. So it is definitely possible. It’s just something that it’s beneficial if you’ve seen it, or you just kind of know what to do, but it’s definitely something that’s very easy to do by yourself as well.
Trevor Connor 28:22
Wow, wow okay.
How Flexible Are Tendons?
Chris Case 28:23
And how much can tendons stretch. I don’t know that a lot of people think of tendons as stretchable things like muscles.
Jess Elliot 28:32
Sure, well, they definitely need to stretch, I mean, you think about your Achilles tendon. So we need to have a certain amount of mobility in our tendons, because ultimately, tendons are what’s caused locomotion is what causes movement, because those are the anchor points from muscles onto bone. So in order for us to move at all, we need to have a certain amount of mobility within the tendons. And I think one of the issues that causes a lot of tendinitis, or in a lot of cases, we take the Achilles tendon, this can transfer down into the plantar fascia underneath the foot and cause plantar fasciitis, is that we’re not properly mobilizing those tendons afterwards. So they definitely can stretch and there is a certain amount of mobility that you should have at each tendon. And a lot of that can be assessed through kind of modified functional movement assessments.
Trevor Connor 29:20
Jess might shake your head at me here. But my understanding is if you took a muscle out of the body, and you took it out of it says it’s surrounded by a fascial sheet that gives it shape, if you took it out of the fascial is an elastic band. You can really, really stretch a muscle. So when you’re talking about stretching and improving flexibility, it’s not actually the muscle that you’re really trying to work on. It’s the tendons and the fascial tissue.
Jess Elliot 29:44
A lot of times that’s accurate. So a lot of people you know, they just think, oh, it’s my muscles are just chronically tight. Where a lot of times it’s a connective tissue, specifically fascial issue or getting down into the tendons. And really when we think about tendons since those are the tissues that pull on the bones and that cause movements. Those are the areas kind of of the musculoskeletal system that are getting the most load and the most use, and so while the muscles still contracts, the tendon is kind of what’s doing a lot of that load bearing and a lot of that work essentially. And so we need to make sure that we’re taking care specifically of the tendons and our connective tissue and fashion as well.
Chris Case 30:24
Very good.
Trevor Connor 30:25
I recently caught up with Charles Van Atta to address these common cycling issues from a fit perspective. Charles has worked at the CU sports medicine and Performance Center for five years and four years before that a BCSM under Dr. Andy Pruitt, the inventor of the Retool fit system. Charles approaches fit not just from a performance perspective, but from a proper function and health perspective. Yeah, so I will admit my four years living in Toronto, everybody asked me who’s a good fitter in Toronto, who do you see? And my response was always I’m embarrassed to admit there’s I’m sure there’s good fitters in Toronto. I don’t know because whenever I need to be fit, I brought my bike down to Colorado, and you have always fit me.
Charles Van Atta 31:07
Well, I appreciate the loyalty there.
Trevor Connor 31:10
You have kept me functional, which, judging by the number of times you and Dr. Pruitt are just shaking your heads and my x-rays.
Charles Van Atta 31:19
Yeah well.
Trevor Connor 31:19
That’s a hard task.
Charles Van Atta 31:21
I think you’re you’re a great example that, you know, your bike fit is not just a reflection of what you want to do with the bike, but of who you are as a physical being. And, you know, meeting yourself with the best ability to meet those goals.
Addressing Injuries From the Bit Fit Perspective With Charles Van Atta
Trevor Connor 31:42
So well, speaking of that, speaking of injuries, and issues that people have on the bike, we have several here that we’re going to talk about today. And so what we really want to ask you about is addressing these issues from the bike fit perspective.
Charles Van Atta 31:59
Yeah, I would say if you did all the exercises to resolve your issue, and then climb on a poorly fitted bike, you’re right, you’ll see that issue reccur. You get on your bike comfortable, and then pretty soon, you’re uncomfortable because you’ve you’ve put yourself in a strenuous spot.
Trevor Connor 32:15
So let’s talk about the first tier, which is a really common one with cyclists, which is patellar tendinitis.
Charles Van Atta 32:21
So that certainly a common injury, probably more so a couple decades back, before bike fit became as prevalent as it is, and people were getting generally a better fit. Patellar tendinitis specifically, mainly comes down to having proper plumb line and proper saddle height such that you can maintain a reasonable knee angle through your pedal stroke. That said, it also is going to come down to it’s great if you can get that you know when I’m holding the goniometer up to you and encouraging you to stay in place on your bicycle. But is your, is the remainder of your fit set up in such a way that you stay in position. So in other words, have we kind of accounted for the rest of your bike fit around the fact that we do want you to achieve that relatively modest knee angle. So 35 to 40 degrees of knee flexion in a dynamic fit is pretty safe. But people with really tight hamstrings, they may have to air on the side of going up 40 or a little bit higher. You know people with a pretty flexible hamstring, typically you’re going to see them opened up a little bit more in those dynamic numbers. And then you also may see things like they may have one leg slightly different than the other, etc. So you’re you’re sometimes balancing those issues out. Other things come together with the general principles. But yeah, that that one, I mean, the most common thing you look at is are they in the proper saddle height? Well, we certainly can get, well knee issues, there’s a lot more than patellar tendonitis in there. So a lot of the knee issues we see these days have to do with poor stability from the hip, poor alignment in the foot or the cleat, poor support under the foot I guess is what I was getting out of alignment there. So getting the support of the foot right and then as you talked about off bike, well am I prepared? Could- am I stable in my ability to stand in a lay down power through my foot? So some of that we can build from the bottom up with the bike fit and the shoe setup. And then of course, off bike work. I think that’s it is important to acknowledge that the best that you can have is probably not enough to keep you completely safe with cycling as 100% of your exercise-
Trevor Connor 34:55
Right, you still need too.
Charles Van Atta 34:57
Salutely are going to need some other work. And yeah, knee issues are one of those areas where stability is going to be really helpful with patellar tendinitis, quad dominance, that could be based on the position. If you’ve got your seat too low, if you got your seat too far forward or your knee is tending to go too far forward, maybe it’s only because you’re reaching too far on your bike, you put your handlebars so far away, that even though in theory, you could sit back on your seat and be fine, you’re not there, you’re actually scooting up towards the front of the bike, adding the angle, pushing your knee out in front of the pedals, maybe even twisting off to one side as you go forward. And all of a sudden, no, I’ve got patellar tendinitis, even though in theory, my seat is in the right place.
What Can You Do Short-Term For an Injury if Bikers Are Away?
Trevor Connor 35:44
So the question I have for you. I mean, obviously, if you’re having these sort of issues, and it’s a fit thing, you want to go and get a proper fit. But let’s say athletes gone out and they’ve traveled Europe, they’re doing a week long bike tour, and they start getting some patellar tendonitis pain, what are things that they can experiment in the short run to hopefully get through the camp before they get home and go see their bike fitter?
Charles Van Atta 36:11
So yeah, I think our classic response to that is perhaps your seat is too low or too far forward. And I would say, you could compound that by saying perhaps you are sitting too low or too far forward. In other words, are you are you even staying on your seat is part of the question that I’m asking. And then thinking about, well, why am I not staying on my seat? If my seat is perhaps okay? Am I reaching too much, are my hamstrings getting super tight, because of the long days that I’m doing in this tour camp or whatever. So basically, raising your seat up several millimeters, let’s say, three to five millimeters, that’s probably something that you can accommodate fairly easy without changing much of the rest of your fit. But do be cognizant of where you then are sitting. In other words, if you raise your seat up, and you find that you’re always out on the nose of your seat, that’s probably going to be a self defeating change. But if you raise your seat up, and you’re like, oh, the knee feels better, I feel fine, my back doesn’t hurt. Okay, you probably you probably found at least a good temporary solution to that problem of the patellar knee pain.
Trevor Connor 37:28
Emphasis being temporary. Come back and address this.
Charles Van Atta 37:31
Certainly worth looking at the big picture. Yeah, in the long run for sure.
Trevor Connor 37:35
Yeah. And with that, let’s get back to our next common cycling issue.
Chris Case 37:38
Yeah, well, let’s skip ahead to pelvic obliquity
Trevor Connor 37:39
All you.
Chris Case 37:39
What, what, yeah, tell us tell us, tell us what that is. And what causes it typically.
Pelvic Obliquity Injury
Jess Elliot 37:50
Sure. Um, so, pelvic obliquity is kind of a catch all term, essentially, saying that the pelvis is out of balance. A lot of times it has to do with rotation, that’s where we get kind of that term obliquity, it can also deal with hip shifting. And so when we think about the pelvis, we think a lot about it, I think most commonly, people think of it as being stationary, something that doesn’t really move, like our arm or leg, which has a lot of motion. Well the pelvis, in and of itself actually can move quite a bit. And so a lot of times what can happen, especially when you’re stuck in a saddle, is that your hips can get stuck in one position versus another. And so that can be you know, your right side maybe drops a little bit, it could be shifted a little bit lower, or could be shifted up, or it could be anteriorly, or posteriorly rotated, and usually the sides of your pelvis. Unfortunately, are not doing the same thing on both sides the way they should be. And so that’s something that’s a very common dysfunction, a lot of causes can be from muscle tightness and imbalance there, where we’re just, we’re using one side, maybe a little bit more than another. Most of the cyclists that I work with, they tend to have kind of a power side. And so because of that, they might be generating a little bit more force through the right side versus the left. Because of that, they might have a little bit more muscle tightness, which could shift them into a slight anterior pelvic tilt. Or it could be something as simple as a fall. I think a lot of times we’ve fallen in one way or another, whether in sport or just in life. And all of a sudden, you’re like, oh, like my hip feels off, like I can kind of feel like my hips just feel out of alignment or my back feels a little bit wonky. And a lot of times it’s just because of that impact that causes something to shift or even get stuck in a given position. And that’s those are some very common causes of pelvic obliquity or imbalance.
Trevor Connor 39:40
One important thing to point out here, since we’re a bit of a cycling focus show is when you talk about a bike fit, often people will go in and see a fitter and the fitter will say, “Well, you have a leg length discrepancy.” You have to be really careful because sometimes that is the case. Sometimes that’s because you have this obliquity and you your hip might be pulling up on one side that makes it look like a leg length discrepancy. So when you go and see a good bike fitter, they’re they’re almost going to do this medical evaluation on you beforehand to see, are you on balance? Are your hips moving right?
Jess Elliot 40:14
Yeah.
Trevor Connor 40:14
Because what you don’t want to do is if you have that imbalance in your hips, so then say you got a leg length discrepancy let’s shim you. And again, let’s lean into an injury.
Jess Elliot 40:24
Yeah, exactly. And it’s something that can be very easily fixed, for the most part. But yeah, the biggest thing is assessing it properly. And like you said, not leaning into that dysfunction, kind of adding a crutch on top of it or fitting the bike into the dysfunction. But rather addressing that issue, bringing the body back to balance and then doing a bike fit based off of their body in that more balanced state.
Chris Case 40:46
What are the fixes?
How to Fix Pelvic Obliquity
Jess Elliot 40:47
Well, it’s, it’s simple to fix. It kind of depends on what pelvic obliquity you have, essentially. And so a lot of times it can be if the pelvis is stuck in a given position, we want to try to mobilize that in a given way. And so there are some manual techniques where you can actually move the pelvis and try to get it unstuck. A lot of people who have SI joint pain, or if we do kind of a-
Chris Case 41:17
What’s SI?
Jess Elliot 41:18
So your sacred iliac joint, and so-
Trevor Connor 41:22
Much clearer, thank you.
Jess Elliot 41:24
So kind of where your sacrum attaches onto the pelvis, essentially. And so very, very common place of discomfort for a lot of people, especially cyclists. Because you’re kind of locked onto that saddle for such an extended period of time.
Chris Case 41:38
Excessive amounts of time.
Jess Elliot 41:39
I know, to me, it’s so excessive.
Trevor Connor 41:41
Why do you keep saying my name?
Jess Elliot 41:45
And so you know, if something stuck, then we want to mobilize it. If something’s tight, we want to release it. It’s just a matter of kind of taking the body through enough diagnostic tests and assessments to see okay, is this muscle at its normal resting length? Can the body achieve this position? What’s the degree of mobility here? And so as we’re kind of checking through things, once again, it’s that process-process of elimination. And then we can kind of say, “Okay, well, let’s put some hands on the body.” Let’s use kind of the ASIS, which is your anterior superior, iliac spine. So if you, if you kind of feel this is essentially your hip bones, the ones that protrude on the front side, you can do this on yourself by looking at a mirror, or you can have somebody else kind of do this if you’re okay with somebody kind of touching you. And so you want to place your thumb kind of in that drop off point right below that anatomical marker that, ASIS so Google it, if you can. And so ideally, the thumb should be level with one another. And so what we don’t want to see is an imbalance. And then similarly, we can check the posterior side. So the first thing we look at is on the front and say, “Okay, is there an imbalance?” Whether it’s up or down? It doesn’t really matter. You’re just kind of saying, “Okay, is there an imbalance are my thumb’s level with one another?” Okay? Whether the answer is yes or no, you’re still going to check on the backside. So the posterior side, and so just how you have an ASIS, on the anterior side, you have a PSIS, so posterior superior iliac spine. And so same thing, you kind of want to go just below those drop off points. Now on the posterior side, it’s going to be a little bit different, because you want to add in some motion. So you’re going to have them standing on both legs, and then you’re going to have them pull one knee up into like a high knee position. And what you should see is the thumb on the PSIS should drop. Okay, as you go into that knee up position, you should get a little bit of posterior pelvic tilt, so the pelvis should tuck under, which is what causes that thumb to drop, on that side. And then you would check the other side to see if you have the same response. And so what that’s checking is mobility of the pelvis. So is it moving the way it should? And you’re also comparing the two sides to say, “Okay, are they equal? Are they level? Are they both moving the way they should?” And so if it’s not moving, so if your thumb stays in the exact same place, even as they’re doing that leg race test, then it’s a sure sign that that pelvis is stuck, and we need to mobilize it in some way.
When Someone Has a Pelvic Issue, Will They Feel Pain? How Do They Know This Is Happening?
Chris Case 44:11
I have a question before we get there actually. When somebody is dealing with one of these issues, are they feeling pain? What are how would they know that this is happening?
Jess Elliot 44:21
I think a lot of times, one of the most common kind of complaints that I hear from athletes is that they just feel like their their hips are off, they feel imbalanced in the saddle. And so it can cause knee pain, or excuse me hip pain, particularly if there’s impingement of a nerve at some point in time. And certainly if left long enough, that can be the case, but a lot of times I just tell athletes to trust their body because usually what they’re feeling is correct. And so if they feel like I just feel like I’m locked up on one side, or “Yeah, like my left side kind of hurts. I have some like left low back pain or my hip like when i when i squat, if I do a bodyweight squat. I just don’t feel balanced or when I’m riding on a bike like my hips just feel wobbly, I feel out of balance.” Usually they notice that something is not right. Very rarely is it somebody, in fact, never hasn’t been someone who’s like, “Oh, yeah, I feel awesome. There’s absolutely nothing wrong with me.” And I’m like, “Oh, yeah, p.s, you have this very significant pelvis, obliquity we need to fix.”
Trevor Connor 45:18
Going back to what we said about knees are a victim, this is a place that can be a source of these issues. Because if you’re on the bike, and let’s say your your left hip has kind of locked up and raised up a bit, your bike that’s no longer right, on the one side. And so now potentially, on that side, your saddles too high effectively, and that’s eventually going to lead to some knee pains, knee issues.
Jess Elliot 45:44
It can. When we think about kind of the major joints of the body, if you take a look at kind of Dr. Janda, he kind of has this idea of alternating joints and mobility versus stability. And so the knee is supposed to be a joint of stability. So it only moves sagittal plane, so you get flexion extension. But above it, and below it are the ankle and the hip, which are mobility based joints. And so there’s excessive range of motion. So yeah, if you have one of those on either end that’s completely locked up all of that force that should be able to be dissipated kind of through either the proximal or distal ends to the hip and hip or the ankle, it’s all going to get stuck in the knee. And that’s what can then cause a lot of cartilage problems if force is not being channeled through the joint properly over time, you can have things like cartilage issues wearing away at the cartilage of the meniscus a little bit unevenly. So it can definitely lead to some long term wear and tear issues.
Ways to Address Pelvic Obliquities
Chris Case 46:38
I know there’s a lot of these pelvic obliquities, but can you give us some some ways to address it in a general sense?
Jess Elliot 46:46
Sure, it’s almost difficult to know where to start. Because there are a lot of common things that I see. One of them tends to be kind of a lower crossed syndrome. And very rarely does it present on both sides. Usually, there’s one side that’s anteriorly displaced, whether that’s from a fall or whether that’s from-
Chris Case 47:06
So it’s just angled more forward than it should be.
Jess Elliot 47:09
Yeah. So when, if you think about a pelvis kind of being neutral, you guys can’t see my hand positions. Anterior pelvic tilt is just that it’s shifting to the anterior. And so if we think about the low back, it’s going to cause a little bit more tightness in that lumbar spine, which can also set you up for low back pain, you’re probably going to have more hip flexor tightness on that side. So that’s kind of characteristic of lower cross syndrome. So if we think about the muscles kind of working in a crossed fashion, on the, lemme see, on the front side, it’s easy. I feel like I need to draw a picture here. Okay, so on the one side-
Chris Case 47:44
You’ve gotta put this stuff on YouTube later, you know.
Jess Elliot 47:46
We’ll need to. So kind of on on one diagonal of if we if we were to right across. Oh my gosh, it’s happening.
Trevor Connor 47:55
Can we?
Jess Elliot 47:57
Sure.
Jess Elliot 47:57
So if we if we take kind of-
Chris Case 47:59
Can you talk to the mic too?
Jess Elliot 48:01
Yeah, yes, I promise. Hold on.
Trevor Connor 48:04
I’m making her very uncomfortable, I’m taking a picture of this.
Jess Elliot 48:07
Now, now
Jess Elliot 48:07
I’m standing. Now. I’m standing. Okay.
Chris Case 48:07
Video, video.
Trevor Connor 48:08
Want me to take a video? Okay.
Jess Elliot 48:11
Oh, wow, this is getting awkward. All right, trying to trying to multitask. Okay, so talking into the mic. So if we imagine kind of a cross, and we’re drawing an X kind of right here, essentially. So on this diagonal, if we think about the muscles, and I’m going into anterior pelvic tilt, okay, so pelvis is displacing forward. Okay, so kind of on this diagonal, here, I have my low back, and then also my hip flexor muscles. So typically, you will see tightness or overactivity of these muscles, and then on the opposite diagonal, this way, we have kind of the rectus abdominus, and also the glute max. And so what you’ll see is that the muscles on this plane are going to be tight, the muscles on this diagonal are going to be stretched out and therefore inhibited. And so it’s kind of a balance between releasing the muscles that are tight, and and also activating the muscles that are inhibited so that we can bring the pelvis back to a neutral position.
Chris Case 49:06
That all makes sense.
Jess Elliot 49:07
Okay, hopefully, it’s the visual.
Chris Case 49:09
I believe that when you did an assessment on me years ago, this was one of the issues that I had. Where I had this lower-lower cross syndrome I that’s a term that I remember you saying often to me.
Jess Elliot 49:23
Yeah, so it’s definitely
Chris Case 49:24
You must see this a lot.
Jess Elliot 49:25
I do. And like I said, it very rarely presents on both sides simultaneously. Usually it’s on one side. And it can be maybe more on that power side where you’re generating a little bit more power. So we’re getting a little bit more of a forceful muscle contraction. So maybe we have a little bit more muscle tightness on that side. But if we think about the volume, notice I didn’t say excessive that time. Over time, it’s just going to as that muscle kind of continues to contract over and over and over again and we think about the volume of contraction versus the volume of release and resetting that muscle over time. It’s just going to pull that pelvis a little bit forward. And then on the opposite side of things, which similarly can cause a lot of similar symptoms, is posterior pelvic tilt. So sometimes when we’re queneing this because sometimes you do want to go into posterior pelvic tilt for certain movements. We’ll call this, like the Michael Jackson, kind of tilting your pelvis and tucking it underneath. So that, yes. It’s a very easy way for a-
Chris Case 50:23
Hip thrust.
Jess Elliot 50:23
Exactly, for people to say, “Oh, okay, that that’s what posterior pelvic tilt is.” So on the opposite side of things, and we see this a lot with patients, I see this more in men than women, women tend to have a tendency to go into anterior pelvic tilt. Whereas men typically tend to go into more of a posterior pelvic tilt. And so with that, it’s going to be the opposite. So the lower back muscles, instead of being shortened, are going to be stretched out and lengthened, and the hamstrings are going to be super, super tight. So doing something like a hamstring, like just the FMS, leg raise, hamstring test, functional movement systems. Great screening tool, it’s not an end all be all. But it’s something that’s very quick and easy for a lot of coaches to implement. It is a little subjective, so there is that. But you can do a straight leg raise test with your athlete just laying on their back, both like straight down, take kind of a dowel or PVC pipe or a rod. And so they’re just going to one at a time lift their leg, keeping the knee straight as high as they can. And you’re going to kind of mark with the dowel where-where their ankle is essentially, so how far up their leg went. So ideally, we want that to fall like mid thigh or higher range. I’ve seen some people that can’t even get it past the knee because their hamstrings are so tight. Usually, we see that in patients with posterior pelvic tilt. And that can also cause low back pain, but for a different reason, because that muscles been stretched out so much.
Chris Case 51:52
I think in my case, I’ve worked in the past with a massage therapist. And it was usually in cyclocross season when I would start to notice issues on my left side. And we tended to to agree that it might have had something to do with dismounting the bike and planting that left leg repeatedly, and in a forceful way. So people out there that that are into cyclocross, they might have these issues. It could be from something as simple as that, and-
Jess Elliot 52:23
Oh, absolutely. Yeah, that’s actually the minute that you said like, on your left side, I was like, oh, that has to do with how you’re mounting and dismounting from the bike. And so that’s the thing is, it’s not necessarily injuries, when we think about imbalances that occur. It’s something is similar, or excuse me, as simple as repetitive motions. Things that we don’t even think about, they’re not even kind of registering on our radar that can cause those imbalances.
Trevor Connor 52:46
Damn, you don’t think about those other things.
Jess Elliot 52:48
Oh, absolutely, it’s gonna cause tightness, stability on one side versus another. I mean, as a female, something as simple for me as just the shoulder that I always carry a bag on. So when I’m carrying a purse, I carry it on my right side. And so because of that, it’s it’s high up on my shoulder. And so it’s actually the left hip that needs to stabilize that. So my left side, super, super stable, but my left side is also on the side, that tends to get a little bit too locked up where I tend to have-
Chris Case 53:13
How heavy is this purse?
Jess Elliot 53:15
I mean, it’s actually kind of heavy. I tend to put textbooks and-
Chris Case 53:21
Yeah.
Jess Elliot 53:21
-laptops and things like that in it.
Trevor Connor 53:23
Let’s hear what Charles has to say about pelvic obliquity from a bike fit perspective.
Pelvic Obliquity From a Bike Fit Perspective
Charles Van Atta 53:29
It’s, it’s good to be aware of how you interact with your seat. That said, sometimes you might have to ask your friend about how you interact with the seat. You guys have probably seen the little meme or cartoon that’s like the little dog in his room that’s on fire and the dogs like this is all fine. That’s, I think that’s how we are about our our saddle position sometimes. We might be sitting really cockeyed on the saddle, we’ve got the left hip forward, the left knees jutting in towards the bike. And where it comes to your actual position of your hips, you are not square on your saddle, and you feel like everything is totally normal and you’re sitting straight. Yeah, I grab onto your hips in the bike fit scenario, and I pull you into a straight position. And you would say, “Whoa, this feels really, really crooked.” And I would say “Nope, your your whole proprioception of where you’re where you belong on the saddle is built around this other issue.” Or it’s built around something something is driving you there, whether that’s a tight hamstring on one side, spinal alignment. There are so many things that could put your pelvis-pelvis in an oblique position. Some of which, if it’s because one leg is longer than the other, we have some great things to accommodate for that. We can scoot the longer, the foot forward on the longer side, we could lift up the foot on the shorter side. If it has to do with your upper body or say spinal alignment is overall rotated, maybe we put your hands in slightly different places. So we’ve definitely done that where we’ve run the the hoods on people’s road bikes at different heights in order to help square up their entire body so that their pelvis is not so rotated. Sometimes your pelvis is just following. So we talked about your foot collapsing, and maybe that driving your knee towards the top tube. Well, if your foots collapsing and your knees getting driven towards the top tube, it’s not too hard to imagine your hip then following that around and all sudden your pelvic obliquity is all about the fact that one foot is collapsing significantly more than the other. And then you’re rotating around that.
Trevor Connor 55:45
Right.
Charles Van Atta 55:45
So but there can be trickier for me as a bike fitter, who’s not a medical practitioner, if your hips are just attached to your body unevenly, I can’t necessarily unwind that. I might say, “Hey, it looks like this is going on with you. Send yourself to the physical therapy department and go see if they can unwind some of this stuff.” Or here’s what we can do. You know, I do see a little bit of that. Here’s some reasonable things we can do on the bike that don’t seem to have negative impacts elsewhere. You know, again, is it that leg length difference? Is it something about shimming your shoe, and all of a sudden we’ve taken away 30 or 50% of the problem. Or the maybe we shouldn’t even call it a problem. We’ve taken you know, a significant portion of that rotation out and all sudden you look pretty good.Go try that out and see if you’re comfortable.
Trevor Connor 56:40
Oh, sounds like you’re talking about there’s a difference between you’re born that way like you have a leg length discrepancy or something like that. Which is just that’s that’s the way you are versus, for example, I had pelvic obliquity. But that was because I had a bad back. And whenever my back was bugging me, it would lift up my left hip. So on the one case you use, it sounds like you’re saying you would need to shim it. And the other case, you want to address the issue because you don’t want to lean into supporting an injury or a problem.
Charles Van Atta 57:10
Right. Yeah, if there is if one leg is clearly longer than the other is very likely that you’re setting up the feet asymmetrically to accommodate the fact that the legs are different. But somebody that has one leg longer than the other and a spine that is completely soaking most of that up, it might be a smaller adjustment than you think. The adjustments generally for leg length are about half of or I would say max out at about half of the length difference itself. So one centimeter longer, left leg would be a maximum of five millimeters of shims under that right foot or a five millimeter shift in the position of that right cleat.
Trevor Connor 57:53
In our bodies, almost nothing works in isolation. Getting back to our conversation with Jess, you’ll see how some of these issues related to pelvic obliquity also lead to our next injury, back pain.
Back Injuries
Chris Case 58:04
Ever since I heard the story about the person putting their back out by brushing their teeth, I switched that up. I tried to go left hand one night, right hand next night. I’m totally joking.
Jess Elliot 58:18
I’m going to try that. That’s gonna be my test when I get home today.
Trevor Connor 58:22
But one thing I like to see is it’s now cool again to wear a backpack and both shoulders, which is what you should do, because a heavy backpack always on the same shoulder.
Chris Case 58:31
Yeah.
Jess Elliot 58:32
Absolutely. And so that was, you know, one of the things that kind of inspired me to go down that route was actually my work with firefighters. Because they’re actually taught whether you’re right or left handed for consistency. And because you’re working as part of a crew, they always want you to cap carry on your right shoulder, whether it’s a hose pack, whether it’s ladder, because, you know, a lot of times with ladders you’re gonna be carrying with another person. And so for consistency, they always train that right side. But because of that, they consistently had lower back issues on that left side, the left side that needs to stabilize it and that constant state of contraction is what causes chronic muscle tightness. And then a lack of mobility over time, which can then lead to low back pain.
Chris Case 59:14
Yup
Jess Elliot 59:14
So.
Trevor Connor 59:15
We got a great segue right there.
Chris Case 59:17
Let’s talk about lower back pain.
Jess Elliot 59:19
That was completely unintentional.
Common Causes for Lower Back Pain
Chris Case 59:23
What are the common causes for lower back pain? I’m, there’re probably 1000. Like you said, we could have a whole episode on just this, but what are the most common?
Jess Elliot 59:33
So kind of referencing back to what we just talked about that pelvic obliquity because we do. We tend to have one side that’s a little bit better for stabilization. One side it’s a little bit better maybe for power, fine motor skills, my comparison and is to a hammer with a nail. So if you think about it, one side is good at stabilizing the nail. The other side is good for the precision needed to execute fine motor control to use the hammer. If you’re trying to switch that up. It would be be a mess for most people.
Chris Case 1:00:01
Smash your fingers.
Jess Elliot 1:00:02
Yes, and that’s true for many people, I would argue even most people, there are a few that are fairly ambidextrous. But generally speaking, most people have a side that’s better for stabilization and a side that’s better for fine motor control. It’s why when you kick a ball, you usually kick it with the same side, or you have a preferred or dominant side, and the other one’s going to plant and stabilize. And so just thinking about that dismounting, it’s kind of the same thing. Usually, when you’re mounting and dismounting is always going to be in that same direction over and over again. So repetitive movements, kind of how we’re loading the body, how we’re carrying things referencing back to like backpacks or purses, those things are going to cause different imbalances. Because the back ultimately, when we think of the muscles that make up the lower back, usually the major culprits are going to be the erector spinae muscles. So those are three stabilizer muscles that run parallel on either side of the spine. They’re meant to keep you up, right, they’re not meant to do heavy lifting. But that’s kind of our next point that we’ll talk about. You also have the qL on either side, which is attaches from the lowest rib and then on to the pelvis. And so it’s involved with lateral flexion, or side bending on either side.
Jess Elliot 1:01:11
What’s qL stands for?
Jess Elliot 1:01:12
Quadratus lumborum.
Chris Case 1:01:14
There you go.
Jess Elliot 1:01:15
And then finally, is going to be the multifidus or the multifidi, because you have it on either side. So those are kind of the major culprits when it comes to low back pain. So not only are a lot of the low back issues caused from just volume, repetitive movements, so how we’re carrying things, how we’re loading things, how we’re getting in and out of cars, or getting on and off the bike throughout our daily life. It can also kind of stem back to glute activation, which is a big thing. So one of the first things that I’ll test with low back pain is I’ll do what’s called a prone hip extension test, so prone being laying on the stomach. And so as the coach, I’ll have my athlete lay on their stomach on the ground. I want their head to be resting like on their hands on the ground, because if they’re too far up, it’s actually going to cause some tension in their erector spinae muscles, and I want the muscles completely relaxed. So you want them completely flat on the ground. And then I’m going to place one hand on the low back, so I can feel either side of the musculature. And then I’m going to have, I’m going to test one side at a time the left leg and the right leg, I’m going to have one finger kind of my index finger usually on the glutes, and then my pinky finger is usually going to be on the hamstrings. And I’ll just have them lift a leg and back down to the ground, I might have them repeat that. And so what I’m looking for is their muscles sequencing pattern or their muscle activation sequence. And so according to Dr. Janda, there actually is a proper sequence for hip extension. So power should be generated proximal to distal. So in that prone hip extension test, the order should be the glutes firing first, on the side that you’re testing followed by the hamstring, then the contralateral so the opposite side low back to help stabilize. And then finally the ipsilateral or same side, low back muscle should fire to help engage. Now usually the dysfunction that we see is that the low back whether it’s on the contralateral and ipsilateral side fires first. And so most people when they’re trying to get into hip extension, as opposed to utilizing the glutes and hamstrings, kind of the heavy hitter muscles, they’re actually utilizing those stabilizer muscles. And so that can also be a huge issue when it comes to low back pain. Is that we’re just not using the right primary movers and we need to do a little bit of neurological reprogramming to shift it back to where it belongs.
Trevor Connor 1:03:29
I just got to say how extraordinarily impressed I am here because the most miserable course of my life was kinesiology and to memorize all those muscle names, and I’m pretty sure I had forgotten 90% of the muscles in the body by the time I left the exam room exam. And you’re just sitting here just rattling off these muscles nine realizing Oh yeah, most people wouldn’t know what QI.
Jess Elliot 1:03:52
Well a lot of that’s Chris for like keeping me on my toes with the with the quizzing. But actually a quick credit to my first and definitely most influential mentor-mentor Loren Landau. He’s now the director of strengthen conditioning with the Denver-Broncos. But as an intern, we were kind of definitely always expected to be on so to say. So throughout the day, you know, we’d spend 40 hours a day coaching alongside him and learning from him just-
Chris Case 1:04:17
40 hours a day?
Jess Elliot 1:04:19
I have 40 hours a week. It’s still it’s still very-
Trevor Connor 1:04:22
That’s a long day.
Jess Elliot 1:04:23
It’s very early folks. And so he would actually quiz us, he would say,
Chris Case 1:04:28
Oh, wow. You had to be on your toes.
Jess Elliot 1:04:29
Yeah, he’d be like, Jess name all the muscles of the rotator cuff, or what are all the bones of the foot or, so I mean. It’s just-
Chris Case 1:04:36
Wow, yeah.
Jess Elliot 1:04:37
You needed to be sharp, and it was definitely a good thing that I was in my senior year of college at the time.
Trevor Connor 1:04:42
Well I gotta say I’m impressed. And I will say to the listeners when you hear somebody talk like this, and they’re not even aware that they talk like this, and that is rattling off ipsilateral and all these other terms. You generally have somebody who has a very good understanding of how the body functions.
Jess Elliot 1:04:57
Hopefull, or they just read a lot of textbooks.
Chris Case 1:05:00
That’s both probably.
Jess Elliot 1:05:01
i was going to say probably in my case, a little bit of both.
Trevor Connor 1:05:04
But I’ve read a lot of textbooks, and when I go into the weight room and people say what muscle I’m working, I’m like, that really long one on the front of your leg.
Jess Elliot 1:05:12
But then people know what you’re talking about.
Trevor Connor 1:05:14
That’s fair.
Chris Case 1:05:15
That’s true.
Jess Elliot 1:05:15
That’s my excuse. I’m like, I won’t give you the name because you won’t know what that is.
Trevor Connor 1:05:19
I’m just going to describe it.
Jess Elliot 1:05:20
I don’t want to confuse you. Oh, good.
Chris Case 1:05:24
So how do people prevent all of these things from happening? These imbalances, these tightenesses, these things going on in their back?
How Do People Prevent These Imbalances
Jess Elliot 1:05:33
Oh, my goodness.
Chris Case 1:05:34
So many people struggle with this.
Jess Elliot 1:05:36
They do. And so really, in addition to the workout in and of itself, one thing that I place a lot of emphasis on is actually a thorough active dynamic warm up, and actually preparing the body for work. And not just for the weight room, I think one of the trends I’ve noticed is very few endurance athletes let alone cyclists perform a thorough active dynamic warmup before getting on the bike, let alone before going into the weight room if they’re going into the weight room. And so I think I need to take a moment to kind of talk about the importance of an active dynamic warmup, because not only are we trying to prepare the body for work, whatever that may be, whether it’s sport or strengthen conditioning work. But also, that’s the period where I work in correctives, for my athletes, and also the time period where we do strict muscle activation, whether it’s kind of from that neural activation, and kind of that rapid firing sequence activation that we’re going for. So trying to get your central nervous system or your brain fired up and ready to communicate with your body and your muscles. So in addition to priming the body, kind of like restarting booting up your computer at the beginning of the day, I also want to go in and specifically prime or prepare certain muscles. And so when we talk about muscle activation, one of the sequences that I tend to spend a lot of time with for cyclists is that glute activation sequence, because over time, once you stop training it, the body forgets what it’s supposed to do. And then you spend an excessive period of time kind of in seated positions where the low back muscles get maybe stretched out. And then over time, they become inhibited or turned off, essentially. That communication pathway between the brain and the muscle gets compromised. And so we actually need to deliberately go back in and reinforce that pattern through quote, unquote, activation type work. And so a lot of what I see most endurance athletes do, including cyclists, is they have started using minivans to a great degree, which is phenomenal. But one thing that I do want to kind of caution people on is you can take the proper movements, and you can take a great exercise, but you can surprisingly, still be using the wrong muscles. So I have had a number of athletes, not just in an endurance community, but across multiple sports, they’ll execute a movement. Let’s say it’s a deadlift. And it doesn’t have to be super heavy weights, the technique and their body position will look spot on. But if I actually put some hands kind of on their low back, it’s the low back, it’s doing all of the hip extension work. So you can still be in the right position. It doesn’t necessarily mean that if you’re using the low back, you’re in a hyper extended position of the lower back. You can be in the exact proper position and the wrong muscle can still be firing. So we still need to go back in and kind of do some of that neurological reprogramming, and that belongs in the warm up. Because remember, we don’t want to train into dysfunction. So part of that warm up is resetting the body to make sure that the muscles have returned to kind of a normal resting length, our bodies are primed, they’re prepared to take on load whenever that may be.
Trevor Connor 1:08:37
So the only thing I can add to this is let’s just say a connoisseur of back pain.
Chris Case 1:08:44
Aficionado.
Trevor Connor 1:08:45
Yes, there are a lot of different causes a lot of different sources as you’ve been pointing out. So the right solution for one person isn’t necessarily the right solution for another person. So for example, with me, what causes my back problems is if when if you look at me on a bike, I have a very rounded back. Which I try to work on, but I tend to go in that direction. So what really helps me is that opposite motion. So you probably noticed this, when you walked into my apartment, I have a back extension bench right as you walk in. And I get on that every morning, when I do that religiously, my back is fine. And it’s literally like it’s about 10-11 days, if I go 10-11 days without the back extension, I wake up and there’s my back pain.
Jess Elliot 1:09:29
Yup, so that kind of just reinforces that we need to spend a lot of time reversing those bad positions that we tend to put our body in, in order to reset the body and prepare us for physical activity.
Trevor Connor 1:09:40
But the other thing I will say is so I have a friend up in Canada, who is very, very good at this sort of work and injury prevention. I told him what I did, he just went, really? That would kill most, like some people with back problems that would make things significantly worse.
Jess Elliot 1:09:57
Sure.
Trevor Connor 1:09:58
So it’s really you have to know your source, your exercises.
Jess Elliot 1:10:02
You do. And I definitely should take a moment to kind of plug that if you actually are working with something structural, like, let’s say you have a disc injury. That’s definitely something that anything that you’re doing, your coach, if you’re working with a strength and conditioning coach, in addition to a sport coach, really your entire medical team needs to be kind of in the know and communicating with one another about what you can and can’t be doing what you shouldn’t shouldn’t be doing. But also to keep in mind that there are very conservative practitioners of sports medicine, and there are some that are a little bit more liberal with their methods. And so it’s kind of about finding what works best for you as the athlete, you need to kind of advocate for yourself and make sure that you’re working with professionals that are going to advocate kind of for you as well. But generally speaking, if something feels like you shouldn’t be doing it, still do it, like that’s very, very basic rule of thumb. But honestly, our bodies are trying to tell us something a lot of times, you know, I’ll see somebody who has tendinitis, maybe it’s of the elbow, maybe it’s at the knee. And a lot of times, I kind of see them like rubbing into kind of their quads or kind of rubbing into their tricep a little bit. And it just shows that the body kind of knows what it needs to feel better, and so you need to trust that. And so if you’re saying, hey, going into that extended position actually helps. That’s great. And so I think it’s okay to say, to recommend certain things to athletes. But as the athlete, they should always defer to themselves and kind of what feels right for the body. If it feels like it’s wrong, it probably is. But if it feels like it’s beneficial, if it actually feels like it’s relieving something, it’s probably doing that as well.
Trevor Connor 1:11:43
I’ve talked to a few chiropractors say they love working with athletes, because when I have a sedentary person come in that’s kind of, “Well, I’m sort of experiencing this”, and they’re kind of and they have spent a lot of time diagnosing it, they’re like, high level athlete comes in, they’re like, this is bugging me, here’s the issue, this is what we need to do. Get on the table.
Jess Elliot 1:12:03
Pretty much.
How To Minimize Strain on Our Lower Back When on the Bike
Trevor Connor 1:12:05
Sitting at the bike position is simply not gentle on our backs. But let’s hear for Charles and things we can do to at least minimize that strain.
Charles Van Atta 1:12:14
Lower back pain. That’s a big one. So again, I would get at, if this is lower back pain strictly, when I ride my bike, or after I ride my bike, I have lots of lower back pain. The rest of life, you know, putting books away on shelves and doing other daily activities, I have no back pain whatsoever, and it hurts when I’m on my bike. Okay, all of a sudden, we’re really want to delve into what is it about your bike position that puts your back at risk. It’s very common for people when they sit down on a bike, we’ve got this little triangular seat that has a nice nose, that helps us realize if we’re leaning far forward or falling forward. But it can also kind of hit us right where we wouldn’t want to be struck. So you want to make sure that the way you interact with your saddle isn’t causing you to roll your hips backwards and put a lot of strain through the low back that way. Much more rare, occasionally, we have people who want to lean their hips so far forward that they’re actually overdoing, they’re creating too much lordosis. So lordosis being that curve. Yeah, that’s normal in our low back. So normally, that low back kind of curves towards our belly button a bit. We want to see something close to that if your back is curving the opposite way. There’s a very obvious sign that something is wrong with the setup of your bike. So again, selecting a saddle that supports underneath your sit bones and doesn’t hit you right up the midline. That’s going to be key. Maybe that’s the saddle you have maybe the saddle you have is designed for that but somehow for you does not achieve that goal could be too narrow, could just be something about the shape doesn’t quite let you sit right. So yeah, it’s it’s looking for an align posture from the spine. What I often remind people of we’ve you know, we’ve already been through in the fit process, we have checked out where their handlebars are, we’ve looked at the saddle shape, and we’ve actually matched sorry, we’ve mapped the pressure that is happening against their saddle and found a saddle that allows them to put pressure at the sit bone locations or on their ischial tuberosity. Or sorry, sit bones ischial tuberosities or even on to the pubic rami my a little bit coming forward, but they’re on bone structures, the weights off the middle. They can sit well on the bike, but I see them kind of fall into that rounded back position. And I remind them, think about from your hips through the top of your head, you’re just extending out and lengthening yourself. What you’re doing when you do that is engaging your core and aligning your back. Once you’ve done that, you should be able to let your shoulders come down away from your ears and have your elbows relaxed, and sit there with your core engaged. And the beauty of that is your low back then gets to be comfortable, your hips have gone from being sort of poorly reacting to the fact that you’re going to push down on the pedal, in other words, wobbling away from your push down on the pedal and actually participating in powering your drive train as well. So when we get that engaged and extended body, we tend to protect our low back, as well as help ourselves create power. And that’s really important.
Trevor Connor 1:15:39
I still remember I brought an athlete into you who was having pain, particularly in her back. She had been a skier, high, very high level skier and had a couple of severe crashes that cause injuries. And you were trying to help her with the pain, and I remember she was in here a good two, three hours. And you put her through, I think nine saddles.
Charles Van Atta 1:16:02
Yeah.
Trevor Connor 1:16:02
At one point, you sent me down to the store to get us out of this really rare saddle that he didn’t have in stock here. And finally, you found the right saddle for her. But, it was a lesson and there is no one best saddle, there is the right saddle for each individual.
Charles Van Atta 1:16:18
Yeah, and there are, I think there are some that are successful for within the fact that some of these saddle designs come in different sizes. You know, there’s probably two or three saddle designs that 70% of the population is quite happy on. But I don’t want to kick out that 30% and go well, you’re just weird.
Trevor Connor 1:16:40
Right.
Charles Van Atta 1:16:40
Just go away. Yeah, we do have to have a lot of options out there, and testament to this, one of our own employees had a saddle design that had worked great for her for years. And then this past year started to be a problem. We tried out a different saddle design, the mimic saddle that came out from specialized, really made a big difference for her, but then brought out a different problem. And so then we had to kind of find, okay, well now how do we find our way in between those two, things? So yeah, it was it was a it can be a real challenge the saddle. I mean, it’s it’s sort of the foundation of fit, is what are your hips going to be on? You know, that’s, I mean, it’s this giant bone structure that is clearly the eminence of our body. You know, our legs come out of it, our torso comes out of it, if we can’t hold it up reasonably. One-one illustration I like when we talk about the saddle is, if we didn’t have the saddle, what would cycling be? It would be those goofy little treadmill bikes, things that you’ve seen. Where you’re holding on to your handlebars, and you’re running on a treadmill. That is not cycling.
Trevor Connor 1:17:53
Right.
Charles Van Atta 1:17:54
The saddle is a huge part of what makes cycling, cycling. But we’re trying to fit something into our pelvis or rest our pelvis on something that our pelvis isn’t per se designed for. So yeah, it’s a tricky thing to find something that fits into that space, allows us to inter-interact with it, and yet does not cause problems at the same time.
Trevor Connor 1:18:20
It’s a tough challenge.
Chris Case 1:18:21
All right, well, let’s tackle the last one that we had on our list for today, thoracic kyphosis. What is it? What causes it?
Jess Elliot 1:18:29
Sure.
Chris Case 1:18:30
Jess.
What Causes Thoracic Kyphosis?
Jess Elliot 1:18:31
So thoracic kyphosis. So the thoracic spine, let’s see, you have kind of your cervical spine, your thoracic spine, your lumbar spine, and then finally your sacrum and toxics. So the thoracic spine is kind of that mid to upper back area, essentially. It’s where most of your ribs are going to be attaching to kind of give you just a general idea. And so kyphosis is where we start become very, where we start becoming very anteriorly displaced so that the rounded shoulders kind of that hunched posture is kind of what that thoracic kyphosis is. Where we start getting caved in and a little bit hunched forward, our shoulders kind of rotate forward. And then on the opposite side of things, if we’re thinking about our scapula, or shoulder blades, those tend to pro tracks as opposed to getting pinched together, they get pulled apart. So everything shifted forward, our shoulder girdle rotates forward, it can lead to a lot of neck pain as well. Sometimes you can actually have a little bit of forward, lean and reach with the neck. So as opposed to being nice and upright, the cervical spine can start to lean forward as well and get pitched forward.
Trevor Connor 1:19:35
And obviously you think about your position on the bike.
Jess Elliot 1:19:38
Yes.
Chris Case 1:19:39
Seems like if you slammed your stem, you’re asking for a thoracic kyphosis to kick in because you’re just reaching and stretching.
Trevor Connor 1:19:49
I wish I got a pull up picture of that. Chris just looked like a little quasimodo.
Jess Elliot 1:19:55
Where’s the video of that? I think that needs to be added in-
Chris Case 1:19:56
Just watch any pro tour, world tour race. You’ll see 90% of the guys are in this position, honestly, like-
Jess Elliot 1:20:06
It’s true. And I think something that I plugged like right at the start of today was talking about if I could teach one physician for cyclists to learn, it’s that hinge position. And the problem is, is that when we lack mobility, we kind of compensate and cheat and our body gets it elsewhere. And so when we’re thinking about trying to get into maybe like that arrow position, on a bike, a lot of people don’t have the hip or back mobility to get into a hinge where all of that flexion truly is coming from the hip, and your back can be nice and flat.
Trevor Connor 1:20:39
Right. I was talking about how I have that issue.
Jess Elliot 1:20:42
Yeah.
Trevor Connor 1:20:42
Found it. So I have issues with kyphosis. Since I have issues with, back problems.
Jess Elliot 1:20:46
Exactly, and so in lieu of getting into kind of that nice hinge position, which is what we’d want to see. Where then the musculoskeletal system can be nice and stacked and in balance. We default into this kyphotic position. And that can cause a whole slew of problems for our bodies as well. And so very, very common posture seen in cyclists based off of your position on the bike, and the amount of hours that you’re going to be spending in that position as well.
Trevor Connor 1:21:12
I can tell you, just to this is useful or not, but emphasize how important this is, we’re in October right now. I just got back into the weight room several times a week, and yes. And I was there yesterday, and I kid you not like towards the end of the the workout, it’s like, “You know, I should probably do a leg exercise.” But I was in there, all I was working on was opening up the the upper back the chest working on my lower back. Really just posing all this imbalance that I developed in my upper body during the cycling season.
Jess Elliot 1:21:46
Oh, absolutely.
Trevor Connor 1:21:47
It is so important.
Jess Elliot 1:21:48
It is, and like we were saying, you know, you never want to add strength on top of dysfunction. And so it’s so good, especially at this time of the year, kind of when we’re in that winter training phase to reset the body. That’s part of what that active recovery phase is, not just psychologically kind of taking a break, but also taking time to reset our body from our competitive season. And so just like you were saying, it’s, it’s, about taking time to do the opposite. So when I was working in emergency medicine we kind of had this saying that really summed up trauma kind of very well, it was see a hole, plug a hole needle hole, make a hole. So essentially, like in emergency medicine, whatever the issue is do reverse. Well, strength and conditioning is not that different. And so when we think about thoracic kyphosis, we think about that tight anterior chain, so the muscles on the front side of the body. And so the first thing that we need to do is we need to release that. I see a lot of people, they’ll tell me like, “I just need to go to a chiropractor, I’m having low back pain or like my, my shoulder feels a little bit wonky.” A lot of times with that thoracic kyphosis, you can also have subluxation of your rib heads. And so if anybody has ever had kind of that sharp, piercing, like chest pain, anytime you inhale it almost like you kind of think you’re having a heart attack, essentially, but sharp pain, a lot of times that can be a ribhead, that’s subblocks. So it’s it’s not a dislocation, it’s just slightly shifted enough to make it very uncomfortable. So the joint isn’t articulating or coming together the way it should, which causes that extreme discomfort and pain. And so that kyphotic position can cause that. And so a lot of people will say, “Oh, it’s okay, I’m going to be with my chiropractor.” Oh, okay, great. So yeah, he can pop something back into place. But let’s remember that muscles pull on bones. And so unless you release the muscle, and the connective tissue, it’s just going to pull it right back out of place. So don’t want to discredit chiropractors, and what they do, but we need to think about while there’s the other side of the coin, where we need to look at our connective tissue. And as long as those are tight, we’re going to continually pull ourselves back into that position. So first step is releasing all of that on the anterior side. But when I think about the athletes that I’ve seen, I don’t know if I could say that there’s one that’s more tight versus lengthens. I think anytime the muscle is not at resting length, for whatever reason, whether it’s too short, or kind of too long, it becomes inhibited, because it can’t contract and function the way it should. And that’s going to give the appearance of weakness essentially. So a lot of times, people might say like, “Oh, I just have like a weak back.” So they’ll get on a back extension machine and they’ll start training their low back. It might not be muscle weakness because it’s week it could be positional. Whether the muscle fibers if we think about kind of the muscle cells, like the actin and myosin filaments and how they kind of overlap, at length, or at rest, their length should be slightly overlapping. And then there’s still room for them to pull together during contraction, but then also pull apart as we’re lengthening kind of during that eccentric phase. So either end of the spectrum if things are too, too contracted, so they’re too tight, they can’t contract any further. And so if you’ve ever had an athlete get into a position of extreme flexion, where they’re like, I can’t contract any further, I feel like I’m going to cramp. A lot of times, it’s because the muscle, it can’t actually contract any further, there’s no further room for those crossbridge heads to pull together, because they’re already at their max overlap. Or on the opposite side of things, if they’re not overlapping at all these filaments, then they can’t actually pull together. So the muscle becomes inhibited kind of on either end of the spectrum.
Trevor Connor 1:25:31
A lot of people know that they’re having an issue, they’ll kind of rub the muscle go, “Boy that muscles tight,” so they either will stretch it, or they’ll go to the chiropractor and try to get itself but you’re not. In either case addressing the the the, the actual source of the issue.
Jess Elliot 1:25:48
Let’s see if we think about muscle actions. So usually, let’s let’s take a bicep curl is something that’s very easy to kind of see and visualize. So if I’m doing a bicep curl, the agonist muscles are kind of the primary mover is that bicep muscle on the front side. And so it’s shortening during a contraction, and then on the opposite side of the joint is the tricep muscle. So in order to allow the bicep to shorten, the opposite side has to lengthen, and so yes, that can be a flexibility thing. But also to it can be, it can be a strength issue, in a sense, because the muscle needs to feel strong enough to go into vulnerable positions. Otherwise, it’s going to feel a little too much tension. And then based off of our proprioceptors, it’s going to shut down essentially. And so there’s definitely a certain amount of strength that is required, in order for a muscle to feel safe going into certain ranges of motion.
How Can One Release the Tightness Causing Thoracic Kyphosis?
Chris Case 1:26:46
It sounds like a lot of this thoracic kyphosis is caused by tightness or the interior musculature is just needs to be released. So how does that, how can someone go about doing that?
Jess Elliot 1:26:58
Sure. So there are a couple different ways. Usually one of the first things that I start with, so we think about releasing on the anterior side, and then we’ll need to wrap it up with activation on the posterior sides to kind of pull things back into place. On the front side, one of the first things I like to do is I’ll take a full size foam roller. So if you only have half ones, you can kind of try to stack two together. But, you want to lay parallel to it so that it runs the length of the spine. And you want to make sure that the hips and the head are supported. So you’re laying on your back on top of the foam rollers running parallel to the spine, and I kind of have them start with their arms in kind of a field goal position, or a 90/90 stretch position. And so just laying there, opening up the chest and using gravity to kind of open things back up. And so we’ll focus on some deep belly breathing, it’s a great time to to kind of add in some recovery so that you’re getting more bang for your buck, but one just using gravity to open up the chest. And then from there, we’re going to add in some movements. So sometimes static stretching alone is not enough. So we need to add in a little bit of movement to loosen up some of the more restricted and stubborn areas of the body. So a lot of people see what’s called wall slides. Where you’re standing up against the wall, and you’re going through various arm positions, keeping the back of your arm in touch with the wall. Well, it’s kind of taking that same movement and that same position, but doing it on that foam roller, so still having the assistance of gravity to open up the chest. So the first one that I start with is kind of an arm reach. I call the whole series just arm slides. But the first one is an arm reach, where they’re going to tuck the elbows right to the side of the body to start. Palms facing up towards the sky, and they’re going to reach so extending up into shoulder flexion as high as they can. But they want to try to keep the arms as close to the ground as possible to really try to open up the chest. So I’ll usually start with 15 repetitions at a time. Nice and slow, making sure that their belly breathing and deeply breathing throughout the entire movement process. And then from there, we’ll transition into snow angel arms. So just like it sounds, making snow angels essentially with the arm. So it’s working that abduction and adduction through the glenohumeral joint, so your shoulder. But same thing, you want to try to use gravity to pull that arm back as close to the ground as possible. So we’re trying to force open that chest and force over that capsule a little bit. So that’s kind of the first series that I start with. And I’ll usually do that two sets of 15, very rarely do I need to go to 15. From there, depending on where the restriction is, sometimes I’ll talk to my athletes as they’re going through this series. And maybe their flexion looks okay, maybe it’s the abduction where we’ll start to see their arm bends because they can’t keep the elbow straight all the way through the movement. Or maybe they can’t come up into full flexion you should be able to have 180 degrees of flexion and adduction of the shoulder joint. And so I’ll ask them, where do you feel that it’s tight? And so a lot of times people will feel that tightness up in the traps kind of the muscle that shrugs our shoulders, or they can kind of feel it somewhere in that thoracic spine, around the shoulder blades. So remember, in that kyphotic position, our shoulder blades get pulled forward. And so because of that, we can get a lot of trigger points, a lot of knots, a lot of adhesions, kind of within that tissue. And so that can also prevent the shoulder blades from moving throughout their full range of motion. So usually I’ll take either an accupoint ball, it kind of looks like a peanuts, you can also take two tennis balls or two lacrosse balls and kind of figure eight, tape them together. And then you’re going to put that so that the spine is kind of centered right in the middle of it, kind of aim it right where they’re feeling, maybe some of that restriction, usually between the shoulder blades, and up into the neck is where I’m going to focus that and then have them repeat that same series of arm reaches. So bent, arms to straight, and then finally the snow angel arms. So usually those are the two things that really helped to release a lot of adhesions in those positions. And then once we restore a certain range of shoulder mobility, then we want to keep everything in that position. So we’re saying, okay, let’s release it back so that you’re in a better position. But then we need to strengthen the muscles on the posterior side or activate them to kind of get it to stay in that position. So then I’ll usually take resistance bands, you can do, they’re either called band pull apart, or tease, but essentially holding a resistance band, pulling it apart. So the arms, you’re going to do straight arms going into a T position. So we’re trying to pinch those shoulder blades together in the back, trying to pull everything back to its normal position.
Chris Case 1:31:37
Simple.
Jess Elliot 1:31:38
It is pretty simple. Hopefully, that could be sarcasm.
Chris Case 1:31:42
No, it wasn’t. I feel like that is a pretty simple thing for people to do, especially just starting out, if you’re talking about laying on the ground, essentially on a foam roller, and you’re letting gravity do its thing. That’s, that’s more than a lot of people do.
Jess Elliot 1:31:57
it is and what’s nice is, it’s you know, it’s something that it seems like a lot of steps, a lot of that’s just to try to articulate it kind of over the air so that people can get your visual of what to do. But honestly, it’s something that can be done within five minutes or so. And so just laying on the ground, getting a couple pieces of simple equipments, things that you’ll find at any gym, and just taking some time to yeah, release the front, activate the back, it’s really just those two steps.
Why Does Every Professional Cyclists Suffer From Thoracic Kyphosis?
Chris Case 1:32:22
So this is perhaps a backwards way of thinking about it. But if this is so important for cyclists, then why do why does every professional cyclist suffer from thoracic kyphosis? Just the amount of time that they spend on a bike and they’re young, and they don’t need to deal with this problem yet.
Jess Elliot 1:32:40
You know, so I’m actually not going to reference back to quote unquote, excessive volume for once. I mean, it definitely doesn’t help, right, when you’re spending a lot more time in a less than optimal position. I think a lot of it just stems from not being able to get in the right position to start. And then we take things like bike fits, and as opposed to putting them into an optimal position, they’re kind of putting them in the position that they need to perform with how their body is at, at that moment, as opposed to saying, well wait, let’s fix all the dysfunctions with your body, and then fit your bike according to that. Instead, we’re kind of moving people further. And then it’s like, oh, I spent so much time in this position. And now I need an updated bike fit because I’m further into this dysfunction. And then it’s kind of, it’s almost like, we think about like a cast, if you break your bone, you put it in a cast to kind of get it to heal in the right position. Well an, a bike fit to put you in an improper position where you’re at as opposed to fixing your position, it’s kind of splinting you into that dysfunction. And then as that dysfunction continues, we readjust the bike fit. And so then we’re putting you in an even worse position for an extended period of time. So I think a lot of it actually stems from just never being trained to get into the right positions from the start. And then as we get older mobility is kind of a use it or lose it thing. And, you know, kind of like we said before, you know, you spend a lot of time on the bike. And so it is going to take a lot of time to correct some of those things. But, the good news is that the minute you decide to start investing that time, it’s a high initial investment. But once you actually take the time to get into those better positions and start working on it, it’s gradually less and less time that you spend in a position to maintain it. You need to start by actually training it and being deliberate about getting into the right positions from the get-go.
Trevor Connor 1:34:31
And likewise letting yourself get into that state of dysfunction. Then there’s a lot of work to get out of it.
Chris Case 1:34:37
Right, right.
Jess Elliot 1:34:38
It is. So it’s a lot of undoing of things. So it’s just it’s kind of a time investment. It really is.
The Biomechanist Perspective on Kyphosis
Trevor Connor 1:34:45
Let’s hear one more time for Charles to get the biomechanist perspective on kyphosis.
Charles Van Atta 1:34:50
So, so we have lordosis. That’s that curve, low back towards your belly button. Kyphosis is the fact that our ribs kind of stick out in the back and we have that curve that goes from our mid back, outward, and then in towards the neck. So when we let that when we kind of go into that teenager slouch and let our shoulders drop down, we’ve got a huge kyphosis. Some people, the dowager hump, you know, that’s kind of the fixed version of kyphosis. Yet, some, that’s a reference to like older women that have, have really gotten that hump locked in. So we should have that curve. That curve is a normal part of our back, and we do want to look at what each person individually has as they stand up. So if you have a lot of kyphosis in your spine when you’re standing, normally, I expect to see some of that when you get on the bike too. But if I see the maximum that you can do when you get on the bike, in other words, you’re curved and kind of slumped down, then I know we’re going to have a hard time getting you looking out head, seeing where you’re going. Probably going to have to raise your handlebars a little bit. Or again, that same exercise starting at your hips moving through your, your core, and extending upward, you may flatten that right out, and maybe it doesn’t take a whole lot of change in your bike, but a little bit of reminder of how to sit. But quite often, you know, when we see an excessive kyphosis. And we’ve already gone through the effort to find a saddle that we can roll our hips forward on, it’s a little bit more handlebar height. Um, and width road bikes, especially, I mean putting your hoods up high enough for you to sit comfortably on, that’s not the end of the day. Now you can go down to those drops and use those a little bit more frequently. So if you look at your bar tape on your road bike, and you can see that all of the dirt is up there, on those top corners, and you hardly ever touch your hoods, or you hardly ever get down to your drops. Well, you just wasted 50% of your handlebar.
Trevor Connor 1:36:59
Right.
Charles Van Atta 1:36:59
You know. So if you’re having those upper, those neck issues that come from an exaggerated kyphosis. In other words, if you’re curving your back into a slouched position, your head just wants to look down at the ground, then when you try to look up, you’re really straining your, your cervical spine in trying to look back up again and the muscles around that. So we would want to see you bringing things up a little bit extending out, opening up.
Trevor Connor 1:37:28
You know, that brings up a really good point when you’re talking about riding, and that it is important to be aerodynamic on the bike at points. You’re breaking away, you’re in the crit, there’s certain points where that’s gonna make a big difference. So a lot of times when you’re sitting in the field, or you’re just out riding with friends or doing intervals where aerodynamics just isn’t that important. So instead of slamming your bars down as far as you can, you have that option if you can make a comfortable going down the drops, and you need to be aerodynamic. But keeping the bars a little bit higher, you can be up in those hoods or up on the bars a little more upright and not have as many of these issues have it certainly be a little more comfortable.
Charles Van Atta 1:38:07
Right, yeah, if you would, if you would consider your hood position to be quite aerodynamic and worthy of you know, finishing a crit. If that’s where your hoods are, well, the whole rest of the event, you just spent time in a position that was unnecessarily low and strenuous. And thus, I would argue you probably diminished your performance at some point earlier on in the day. Because you asked so much of yourself just to sit in that mean, you know, I’ve got control of the whole bike position on hoods.
Chris Case 1:38:45
Well, you’ve been on the show before Jess, so you know that we like to end each episode with our 60 second take homes, I’m going to put you on the clock first. So 60 seconds, try to encapsulate
Trevor Connor 1:39:00
With our five minute timer?
Chris Case 1:39:01
With a five minute timer, we got to do 60 seconds. Let’s wait here for four minutes before? No, that’s enough. What are the most important things people should take away from this episode?
Jess Elliot’s Take Home Message
Jess Elliot 1:39:12
I think the biggest thing that I’d like people to take away is just an overarching awareness of some of the positions that they’re putting their body in throughout the course of a day. And then using that to help facilitate the discussion of what do I really need out of a training program? So remember, we kind of talked about that needs analysis, and it’s going to change it’s going to vary whether it’s, you know, each training cycle, whether that’s a mezzo or micro cycle, or whether that’s from season to season. And so I really want people to start to think about what is it that I need? What are the dysfunctional patterns that I put myself in when I’m stretching? What are the areas of the body that tend to be tighter than the others? Do I have a side that’s tighter or a specific joint where I tend to have more issues? What’s my injury history? You know, how do I feel when I’m on the bike, when I’m performing in my sport? And to really take a hard look at their body, but also to kind of their activities, not just related to their sport, but activities of daily life that could be potentially reinforcing some of those positions. And then thinking about, okay, what are maybe some adjustments, whether it’s wearing a bag on an opposite shoulder or switching to a backpack, where you can have those straps on or walking upstairs with a different lead leg. So just thinking about the patterns that you’re putting your body in and ways to overcome that/
Trevor Connor 1:40:29
Early in my own cycling career, I was very much in the mindset of yeah, weights are important, but going to the weight room, get on the clyde machine, see how much weight you can put on it, and sit there and just pound the weight. And that’s gonna make you stronger in the bike. And I had that mindset to it. I have, I hope, evolved a lot, and I think, what I hope all our listeners got out of this listening to this absolutely fantastic expert on this subject is it’s not that simple. We couldn’t just give you a here’s nine exercises, go do them. But how important this is? Staying functional on the bike is critical. I’ve been asked before, why am I doing these exercises? How does this improve my time trial performance, and I go, “Well, it might not improve your time job performance.” But as somebody with a bad back, I can tell you what happens, your time out performance when your back is out. And these things build and they build on one another. So invest in the time to learn how to do this right, to learn where you’re protecting particular imbalances and issues are and then finding the right exercises and learning how to do them right is something you are not going to regret.
Chris Case 1:41:42
There’s a lot of complexity to what we’re talking about here today. And I think people can take what we have talked about and do a lot of good for themselves. But unfortunately, I think they can also do some harm if they don’t do things correctly, or if they have poor form or technique or, or do something that’s a bit inappropriate for what their issue is. And that’s why it’s not a necessity. But I would encourage people to work with somebody who’s an expert in the field, and Jess is someone we’ve had on the program before you can look up other episodes we’ve done with her. They’re excellent, this this episode, I hope you’ll find that to be excellent as well. And I essentially I’m setting Jess up to tell us how people, coaches specifically I think, can get in touch with her if they have more questions about any of this stuff, because that’s really what you hope in plan to do is educate coaches to spread this knowledge further and wider. So more people are able to benefit from it.
How to Contact Jess and Learn More About Fighting Injuries
Jess Elliot 1:42:41
Absolutely. And thank you, Chris, that was a great set-up there. But yeah, I mean, as one person, you know, if you think about me trying to operate as a coach, there’s only so many hours in the day, so many athletes, I can see realistically. And I want to try to make sure that coaches have the tools that they need to effectively coach their athletes through a lot of these chronic issues that we tend to see in cyclists. And so I would encourage people to reach out. Hopefully, the information presented here has at least sparked some conversation, I guess, around some of these different topics. But I would encourage people and coaches athletes alike to reach out to me, I have my websites, tagperformanceco.com, I’m on pretty much all forms of social media, primarily, I do have a Facebook page, I would say Instagram is kind of a little bit more common. So tagperformanceco is my Instagram handle, and that I’m also on LinkedIn, I would say just find a way to reach out if you have questions. Like I said, I want to be a resource for other coaches, because I can only be in so many places. And I’m certainly not somebody who has all of the answers. There are a lot of a lot of different methods out there. But I can certainly present a case for everything that I’m saying. And if I don’t know the answer to something, then I certainly can find the resources at the right direction to point coaches or athletes, so please reach out. I’m just really excited that we’re getting this information out there. And hopefully we’ll we’ll start some good conversations and spread some good knowledge.
Trevor Connor 1:44:06
So I’m going to put you on the spot here, but you gave excellent descriptions of a lot of good exercises and what to use those exercises for. So putting you on the spot, would you be willing to put together a few videos showing proper technique for these exercises?
Jess Elliot 1:44:22
Yeah.
Trevor Connor 1:44:23
It’s always hard to understand it just on the mic.
Where To Find Videos’s of Jess’s Exercises
Jess Elliot 1:44:25
It is and I apologize for listeners. I feel like our descriptions or my descriptions I should say probably got a little lengthy trying to be thorough. But yes, my Instagram page does have a lot of videos I’ve been admittedly very poor about updating that as of late as with a lot of my kind of other responsibilities at present. But, I will definitely in the upcoming days and weeks. If you go to my Instagram page, I’ll post some videos specifically related to these four different issues that we talked about today. So different exercises, but also stretches. Kind of that tack and stretch tech- technique that we talked about. Try to get some videos up there so that people can actually see how these techniques are performed, kind of in real world application as well.
Chris Case 1:45:08
And that was another episode of Fast Talk. Again, if you’re interested in learning more, don’t forget about Jess’s workshop here in Boulder on December 7th. Again, go to tagperformanceco.com/events and use the code Fast Labs to get $25 off. As always, we’d love your feedback. Email us at our new address fasttalk@fastlabs.com. As always, we love your feedback. Email us at our new address fasttalk@fastlabs.com Check out our survey to help us improve the quality of our episodes, fastlabs.com/survey. Subscribe to Fast Talk on iTunes, Stitcher, Spotify, SoundCloud and Google Play. Be sure to leave us a rating and a comment. Fast Talk is a joint production between VeloNews and Fast Labs LLC. The thoughts and opinions expressed on Fast Talk are those of the individual for Jesse Elliot, Charles Van Atta and Trevor Connor. I’m Chris Case. Thanks for listening!
