For the best ride, consult a professional bike fitter

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: I am writing to you about an orthopedic problem for which I hope you can suggest a treatment. Apparently, not having my bike saddle high enough has caused pain in the right side of my right knee. Cycling is now my primary source of exercise, as I am no longer a runner. The pain occurs when I walk and to some extent when I cycle, but primarily when I walk. I have noticed this within the past few months. Initially, I thought that it was an indication of arthritis. However, I looked up information on how to know if your bike saddle is the correct height, and it addressed pain that can develop in the knee if the saddle is too low. What can I do to mediate the pain? Would a knee brace help? — N.V.D.B. ANSWER: Cycling is a great form of exercise, and it’s generally easier on the joints than running. However, for people who cycle a lot, particularly those who push themselves hard, an ill-fitting bike can cause knee and back pain. Since yours has been going on for months, the problem is likely to persist for a while, even if you correct the situation on the bike. Some rest may be called for. My best advice is to get a professional bike fitter. While you may be lucky enough that your bike shop offers this service, serious cyclists often invest in a thorough fitting of all the adjustments on a bike. The bike will be more comfortable, you’ll have better performance, and you’ll develop less pain. A sports medicine doctor or physiatrist (they may be the same person) can also help evaluate you for any muscle, joint or tendon issues predisposing you to develop pain. *** DEAR DR ROACH: I am taking the blood pressure medications Hyzaar in the morning and atenolol before bedtime. My diastolic numbers are very well under control, but my systolic numbers have been staying in the range of 130-145. What could it mean? — B.S.S. ANSWER: Higher systolic numbers (the higher number, always stated first) tend to indicate stiffness in the large blood vessels. This can be due to an emotional state, like fright or anxiety; from increased muscle tension in the arteries themselves, which is one of the major ways blood pressure is regulated normally; or from calcium in the blood vessels. You are on three blood pressure medicines that form a powerful combination. Hyzaar is a brand name for the combination of losartan — which relaxes blood vessel walls — and HCTZ, a diuretic that takes excess salt and water out of the system; atenolol is a beta blocker, which mostly works by slowing the heart rate down and making it beat less forcefully. The exact best goal for an individual may be difficult to determine. It depends on your risk factors and whether you are having side effects from your medication regimen. If your systolic blood pressure is mostly near 130 and only occasionally gets to 145, most experts would be happy with those results in most people. Some experts push for more aggressive blood pressure goals, such as less than 130, even down to 120. This is particularly important for people at higher risk of stroke and heart attack. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYour-GoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.