Leg imbalance found after going to physical therapy

Training
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A few years ago I sprained my ankle while hiking. Though I recovered from the sprain itself, I had some occasional lower leg issues, mostly after strenuous hikes. I finally went to a physical therapist.

What I learned from my pt is that, to protect against a repeat injury, I had unconsciously started rotating my left foot toe out. As I’d started to suspect, this was affecting my cycling. When I set up my cleats for the first time a little over a year ago, I just went with how much my feet normally rotated. It turns out that led to over use of certain muscles on the outside/front of my upper leg. Especially if I didn’t stretch carefully, and if there was even a little fatigue in those muscles, it could led to failure in workouts and other cycling issues. While I have some exercises to do to fix the issue for hiking, I just changed the rotation of my cleat, and drastically improved the left leg issues I was having.

However, I am now using other muscles on my left leg that had been neglected, most noticeably the inside of my left leg above my knee. This still feels much better and not likely to cause me to fail workouts. But I did bump my workout down a few watts. I think I’m using the right muscles to the right degree now, but some are underdeveloped, especially compared to the same muscles on my right leg.

I think I have a leg imbalance–though I don’t currently have a way to confirm this. However, during my recent threshold workout, during a later interval, I found it harder to keep up my power and realized that I was using my left leg less–the inner leg muscle burning (I don’t know if this is the best description) I’d been experiencing had gone away. I consciously used my left leg more and fixed that temporarily, allowing me to put out more watts, though that muscle burning came back. So, questions:

1 Will just training as normal fix this imbalance? I would guess so, but I’d love to hear from anyone who has been in a similar situation.

2 Are there any exercises, either on or off the bike that might help speed that?

3 My power meter is spider based (Power2Max NGeco) so there is no way that I could get 100% accurate information about leg balance, but I could buy a software upgrade for 50 € to get an estimate of left/right balance. That data had never seemed worth paying for before, but I’m wondering if it could help confirm and correct any imbalance? Basically, is it worth it?

(Before anyone asks, my PT has given the okay to keep doing all the cycling and hiking I’ve been doing so far. I’ll probably bring this up in our next session, but since she’s not a cycling specialist, I think I may learn more from this forum. If this really is just a muscle strength issue, I don’t think it falls under a PT’s purview)

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I have had a twisted pelvis for 20+ years I’ve consistently had to manage due to a pretty bad crash and the compensatory issues it’s led to.

Everyone is different and every situation is different, but with that said - before you do any sort of adjustment to your cleats, position, shimming, etc, I’d invest in some x rays or other form of imaging that will provide a better picture of whether a leg length discrepancy exists and could possibly contribute to your issues. The absolute last thing you want to do is start messing with your fit without being certain about what’s causing your problems. As you’re likely aware, the sensations your feeling because your neural firing patterns have changed could be very different than what is actually occurring (my left leg appears shorter, but it’s actually slightly longer than my right, but it functions shorter due to the way my pelvis has tilted and rotated).

Other very general guidance would be that doing single leg balancing, strengthening, etc off of the bike and prior to workouts helps quite a bit with very little downside, as does self massage/mobility work.

Lastly, once you’re more certain of the cause of your issues, yes, just normal training should lead to gradual correction. But, if you’ve spent X # of years with an incorrect firing pattern, I’d not expect it to immediately change just because you’ve put yourself in the correct position. As you’ve mentioned, the weak leg is definitely going to fatigue quicker - as that has been my experience

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What did the PT have to say about the imbalance and cycling? I’d start with that. Even if they aren’t a cycling specialist, they might have thoughts.

If you don’t have any pain or obvious issues from the imbalance, I’m not sure I’d worry too much about it. Do the exercises the PT assigned, train normally, and reassess in a few months.

Not sure what the PT assigned, but I’m guessing the normal hip abductor/adductor stuff, and other single leg movements?

My PM does report L/R balance, but I’m not sure how accurate it is (Quarq spider-based PM). It is interesting, in that my balance is 50/50 at endurance efforts AND at sprint efforts, but slips to 47/53 during threshold efforts. I have no idea what to do with that data (if anything).

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I’ll certainly bear in leg length discrepancies in mind. I actually expect that I have a some level of length discrepancy since I have a visible discrepancy in other parts of my bodies–if I put my hands together, the right fingers are all longer. I don’t know though if that is a functional discrepancy though. It’s certainly something to explore if I have issues that remain.

However, my PT was clear from watching me move, and it matches my experience (I had a lightbulb moment while we went over this) that my left foot turns out further than it should and that I need to correct it. Since my foot/pedal interface mirrors my stance, I already changed the cleat position and, as described, it’s already helped considerably–it just isn’t perfect yet. I’ll watch out for side effects, though, in case something else is going on. I really think my training plateued because of the old position, so I’m not going back unless it causes a problem.

The issue that I saw the PT for is actually achilles tendonitis. The upper leg issues have really been secondary so I haven’t talked too much with her about that yet. I was hoping (perhaps somewhat naively) that just fixing that lower leg/foot issue would fix the imbalance on the outside of m left leg. Instead, it’s revealed an imbalance on the inside of my leg, but one that feels more fixable and less like something that will lead to failure. I will bring up the imbalance with my PT in a future session, though.

Because the main issue is achilles tendonitis, my prescribed workouts are actually for ankle, heel, and foot, to try to correct my foot rotation. That said, I’m already doing hip abductor/adductor workouts as part of my pre-existing strength training routine.

I really wish I knew what the leg imbalance is–that’s why I’m pondering pondering paying to get that data. From what I’ve read something like 47/53 is within the normal range. It would be nice to know if that’s where I am, in which case I wouldn’t worry. But I’d like to know if I’m 40/60 or maybe even more. It might be nice to know how much my imbalance is at different times, the different rate of fatigue etc. I could imagine it making some small effects on my structured training (since I’m not currently using TR for training). But it might just tell me where I am at now and then be something that I ignore in the future.

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N=1, not a PT, etc etc.

I’ve had a two pretty meaningful injuries on my left leg, and it’s caused issues that I’m still working through. My power balance is close to 43/57 over endurance durations and a scosche more on sprints. More meaningfully, my back is also imbalanced which causes discomfort over longer durations (3-4+ hrs.)

One of my best friends is a very highly credentialed Dr. of PT, and he’s encouraged me strongly to put work into fixing it. To quote him, “If you don’t do anything about it, it would be like if you stopped brushing your teeth. What would happen? Nothing right away, but sooner or later, trouble is guaranteed.”

Point being: Yes, I would say it’s worth the investment in focus to get that fixed as much as you can.

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Thanks.

This may be very individual, what do you do to work on the leg imbalance?

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Lunges, Bulgarian split squats…any kind of single leg exercises. Make sure your “weak” leg does as many reps as your “strong” leg.

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If the roots of it are physical, IME exercises are an Elastoplast, they relieve it in the short term but it doesn’t fully go away until you address the physical issue. IMC the right leg is marginally longer than my right so the right is shimmed.

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A friend wanted me to check out his Assioma Duos on rollers. I have been using 1 side Stages. I was about 60/40.
Bought my own Duo’s on Black Friday. Of course left leg dominant so that threw off training #'s with Duo’s. Using Garmin Cycling Dynamics, I could see that my R wasn’t activating as early as LS.
Went to fitter, raised saddle up and forward. Suggested dynamic stretches pre-ride, my hip flexors have been tight.
Drills such as 1 leg dead leg as suggested on Fast Talk, Friel drills (9-3, etc.) along with single leg lifts. Particularly having 1 leg elevated on bench while lunging with foot on floor.
Yesterdays 1.5hr Z2 ride close to 50/50. Granted I did do some drills starting and ending with RS.
Hope that helps