Cycling strategies

Hi, I’m new to the forum. Thanks for the vast information you all members have gathered here. It has a great value.

I love bike riding but EM is making it really hard for me. Any of you had developed any strategies to cope with EM while riding?

I’m thinking about drilling holes to my bike shoes (yep, the clipless ones) like this guy.

Knees and feet are the parts that suffer the most

I also swim, which I highly recommend to everyone suffering from EM, but a bad shoulder gives me a really bad time afterward.

All kind of info will be really appreciate it.

You want to stay hydrated. Wear light clothing. Cycle when the weather is cool. Unclothed skin begins to lose body heat when the temperature drops below 68 degrees. Blood will shunt towards your core, away from the extremities, to protect the vital organs in colder temperatures. This can be of benefit to the athlete with EM. Make sure extremities stay warm enough to avoid hypothermia.

Flexibility is important. Most cyclists’ quadriceps and hamstrings will tighten with prolonged riding, and the restricted range of motion is likely to increase the forces around the knee. Patellofemoral pain and associated micro trauma will create an inflammatory response that may exacerbate EM symptoms during and after exercise. (Inflammation is immune mediated erythema and erythema is the primary feature of erythromelalgia.) Stretching is best when preceded by a light warmup. Elevated tissue temperature favors more permanent plastic deformation. You want to pay attention to posture and ensure the proper joint structures are bearing their intended weight. Working with a trainer and doing a plumb line test to check for common postural deficients would be a good idea. Avoiding injury (and subsequent inflammation) is important for the athlete with EM and injury prevention starts with proper musculoskeletal alignment.

Finally, you may want to consider alternatives to carbon fiber soles (or alternatives to a carbon upper if you’re using both). It may not be what you want to hear, but if your feet are telling you no, you should probably listen. Strengthening the muscles in the anterior, posterior, and lateral compartments of the lower leg can help you avoid arch collapse and better maintain power while riding in a more flexible, breathable shoe. If optimal power is of greater importance, drilling holes to increase ventilation would be a logical next step.

Good luck!


Hi Carter,
thanks so much for taking the time to write, really appreciate it! And your feedback has always a lot of value, as I’ve read on other threads.

Definitely summer is not the best moment for us to cycle, so I keep it to the minimum and thinking on getting an indoor training plus a powerful industrial fan, and riding indoors. Probably a Nebulizer too.

You are totally right cycling body types tend to suffer from that repetitive activity and have muscle imbalances. Mine is not exception and I’ve corrected a good deal but keep on it.
I’m pretty flexible and keep doing stretching following my PT advice. I recommend everyone to visit one and go for at least 3 months supervision. Your body will thank you.

Regarding shoes, yes, It’s hard for me (mentally I guess) not to ride without the solid carbon fiber ones, so I’m seriously think of drilling some holes. It might be a good idea to buy a pair of cheap ones a test that solution on them.

It’s a pity I didn’t know this forum before. I used to live in DC, now, back in Spain.

Thanks again!

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