Monthly Archives: May 2007

On Selecting Sports Medicine Help

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Selecting medical help is a tough thing. You’d expect that all physical therapists and doctors are the same and that they can all deal with our Ironman training problems. Boy was I wrong.
Not All Practictioners Are Created Equal!!!
If any statement could summarize everything, that would be it. What I’ve discovered is that pretty much everyone can treat the symptoms. That’s what they go to school for. The study the symptoms and related treatments, take lots of hard tests, graduate, and there you go. You go to them and say you have a sore ankle and they can 9 times out of 10 get you back to a pain-free state.
However, things diverge greatly from here. There are a lot of practictioners that don’t work on pro-athletes. They concentrate on the masses, whose requirements differ greatly from pro-athletes. Pro-atheltes make their livelihood by getting up every day and going out to abuse their bodies and can’t sit on the sidelines for long. They need to be in top physical condition to do it over and over again, and to snap back from injury as soon as possible to get back in the game. You can say to the common working man to layoff jogging for 3 weeks while a knee pain heals, but you’re not doing a pro-athlete favors by saying they’re going to miss 5 games over the 3 weeks by not being able to play.
Simply not having the experience of knowing what is going to get someone back in the game in the shortest amount of time possible makes them less desirable to the athletic individual.
Then the next level is whether or not the practictioner actually participates in the sport or not. If they do not race triathlons, I have seen a marked difference in knowledge in treatment. They can still treat symptoms, but they cannot give advice on prevention and ultimate elimination of what causes the problem in the first place. So the risk increases that even though you may get a problem treated and healed, that without proper knowledge you’ll go out and just do the same activity in the same way to get you injured again.
What to Look For
Since I arrived in the Bay Area in 1987, I have had many injuries ranging from my back to knees to all over my body. I have visited many practictioners in a wide variety of areas and have thoughts about selecting the right practictioner for sports medicine. Here they are:
1. Do they work on pro-athletes? This is the first hint that the practictioner is able to understand the needs of an athlete who wants to get back in action as soon as possible, and is able to deliver. However, I would caution that this is often deceptive as Bay Area athletes often go to many facilities seeking treatment, and practictioners will often advertise this fact to get more patients. It does not singularly guarantee that the practictioner does a good job at getting athletes back in action, although it is the first clue.
2. Does the practictioner perform the sport in which you are participating? Nothing replaces intrinsic knowledge about injuries and prevention than having the practictioner actually perform the sport himself. It is like learning the theory but having no practical experience. True insight comes when the practictioner is out there physically training as well as observing athletes and treating them. Then, the practictioner can have a deeper understanding of what creates problems, knows how to treat them, and how to prevent them.
3. Do you get along with the practictioner? I have walked into offices of pompous, arrogant practictioners and never gone back. Why go to someone whom you don’t like or trust? You don’t want to dread going back to someone who is goig to be your partner in sports success.
4. Do they listen to you and try to learn from you? Back to 3, so many think they know everything and they don’t think there is any other way but what they know. They have to realize that not everyone responds to training and sports in the same way, and that treatments will vary across age, experience, fitness level, etc. They have to listen to what you tell them, be able to assimilate that information, are willing to ask more questions, and then formulate treatment for you.
5. Are they only after your money? I have also experienced practictioners who have making money on the mind. They will tell you to keep coming back even though you don’t need to come back just to get an extra bit of money from insurance companies. They treat you, but they don’t really care about you as a person. They just want to make more money off you.
6. Referrals aren’t perfect. But they are a better starting point than the phone book. Be aware that you still need to check them out, as your friends or coaches will have favorite practictioners, but they may not be right for YOU.
7. Stay away from HMOs. They attract only practictioners who are generalists and aren’t specialized enough to deal with a serious athlete’s problems.
8. Do they subscribe to the latest theories in sports medicine? Some thoughts below:
a. Do they immediately jump to “you need surgery” to cure a problem? Very bad. Everything else should be tried first. In the old days, practictioners would seek surgery as a way to cure many problems. Nowadays, therapy can take care of a huge amount of issues. Never let anyone cut you open before getting another opinion!
b. I am a big believer in ART and Graston. I would highly recommend seeking practictioners of both of those techniques, as their communities are rich in sharing the latest knowledge and treatments.
c. Does the practictioner talk about the kinetic chain and treatment based on that? A lot of practictioners will only treat the local problem. Your ankle hurts, so you treat the ankle only and hope that the problem goes away, which it probably will…for a while. Often the problem is not just local to where the pain is. It can be caused my a host of problems in muscles all along the chain of movement. For example, I had a recent ankle problem which was caused by tightness up my lower leg and into the calves. Kinetic chain treatment doesn’t just address the ankle, but worked my peroneals, my calves, the Achilles tendon, etc.
d. Does the practictioner talk about prevention? For example, running poorly will create a host of problems that will continually come back unless running form is addressed. Is the practictioner knowledgeable enough to make suggestions on the performance of activities in the sport itself to help prevent further injuries?
Get Smart, Don’t Be a Victim
Do your research as much as possible into the latest techniques. Learn as much as possible. Do not be a victim to poor and outdated treatments. Find someone who can get you back in the game as fast as possible and who will be as important a partner in your training as your coach.

Ironman Brazil: Coming Down to the Wire

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As I come down to the wire for Ironman Brazil, I once again reflect on my training and what I’ve learned over these last few months preparing for the event. Some notables:
1. I noted a definite need for strength building in my training, so I dramatically raised the number of hilly courses that I would run and bike on. I would do hill repeats and try to accelerate on them towards the end. I am hoping that this will make a difference in my ability to maintain speed on hills. I did these hill repeats to the exclusion of doing more tempo rides to cement high intensity for long periods of time. I feel that preventing strength loss, which ultimately leads to cramping towards the end of the race, is more important than tempo training at this point.
2. My recovery period following long, intense sessions has lengthened. I have trained myself to listen to my body and not fight the longer recovery period, or feel anxiety because of it. As a result, I believe that I have made improvements despite not needing to train hard every day. It’s just a realization that as I grow older, my body responds differently to stress and its recovery needs are much different than either younger athletes or those that are more highly trained.
3. I discovered SportLegs pills as a supplement. Not believing they would work, I now take them regularly and they seem to definitely help in mitigating the burning sensation in my legs during hard training sessions. I believe that the lack of burning, and hence the production of anaerobic by-products is also helping with my cramping problems.
4. I bought a Louis Garneau aero helmet, and am slowly accounting for those things on my bike which reduce aerodynamics. It was a pleasant surprise to feel a definite lowering of effort in windy conditions.
5. I will be racing on Roval aero wheels, whose unique spoke assembly creates a narrower spoke profile without the need for carbon fiber wheels. Originally I bought them for simply their narrow spoke profile, which I hope will pack nicer in my Ritchey Breakaway suitcase. Previously, I have bent the spokes on my Zipp 404s because their spoke profile was so much wider than the normal wheels that Ritchey designed their suitcase for. Now I hope that the Roval narrow spoke profile will allow for lower stacking, which should reduce the chance of damage to the wheels. But I also hope that their claims of aerodynamics are true, and that they are really as aero as Hed carbon 3 spoke wheels.
I am optimistic for a great race on May 27. More later, as I enter the taper period.

Constant Propulsion Swim Method

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A while back I took a Total Immersion Course. I thought it was really good but it only gave me half the solution to swimming fast, which was to maintain a good body position while in the water to ensure minimal slowdown due to drag.
The other half had to do with stroking.
You’d think that by swinging your arms through the water, that all you’d have to do was cycle them faster and then you’d go faster….right?
Well, I found out that there are so many little details with the stroke that make a whole LOT of difference in your speed.
One of them was introduced to me by Marc Evans during a swim session in a endless pool. Basically, you never having one hand pushing against the water. You never stop stroking and just glide like Superman. As one hand almost finishes its stroke and has reduced pressure against the water, the other hand was already be beginning its stroke and continuing the pressure against the water. This is so that this hand has already begun its stroke before the other hand exits the water.
It took me a long time to master this even a little bit. Now, I can keep it up for short periods, but I am doing tempo sets at distance to practice maintaining this constant propulsion stroke for longer periods of time. When I get tired, I can’t keep the other hand from starting its stroke fast enough before the other hand loses its propulsion. I start getting back into small periods of time where I am doing a Superman glide and then my other hand begins its stroke. This is undesirable because as I glide, I slow down, whereas if I have at least one hand pressing against the water, I can keep my average speed higher.
I also found that when I do this, I can actually swim a 100m interval faster with less arm cycles and be less stressed aerobically. My arms definitely get tired more, but I am not gasping for breath like when I am just speeding up my arm cycles in an attempt to gain an extra few seconds in speed but with exponential energy expenditure.
I really could see the effect of constant propulsion swimming when the other week I was swimming with a pull buoy and paddles. As I set out on the interval, I noticed as I looked down on the black line on the bottom of the pool that my speed was pulsing as I stroked. I would speed up during a stroke, but as my other hand began to enter the water, my speed would slow until the other arm began its stroke. I realized that I was gliding too much and waiting too long between strokes, and not really creating constant propulsion. So I altered my stroke to begin a lot sooner and all of a sudden, my pulsing speed became less and I was moving with more consistent speed. Very interesting!
So now I practice constant propulsion speed while swimming with pull buoy and paddles to fine tune my timing on the stroke, and take that neuromuscular training to swimming without tools. When swimming with the pull buoy and paddles, I can really see the effect of constant propulsion swimming versus gliding too much due to the amount of water I can catch with the paddles. It’s a great way to get visual feedback on whether or not your arms are moving with the right timing to create constant propulsion.
I added this training to my tempo training with constant propulsion stroke, starting with reps of 100m and increasing that both in reps and in distance over time.

Recovery Time Lengthened

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This year training for Ironman Brazil has been really interesting from a recovery perspective. My high intensity climbing sessions on Old La Honda along with my jump to long rides with 3 hour interval sessions in the middle have really taxed my system more than I have experienced in the past. Chalk it up to increasing intensity, but also my age makes me recover slower.
My recovery after my long Saturdays is taking a full 3 days before I can ratchet back up to normal paces and intensities for my normal weekly workouts. Now, I am taking SportLegs supplements and jumping in an ice bath post my Saturday long sessions. Sunday is an off day, Mondays consist of short form swims of about 1500m, and then I run a form run on the treadmill lasting about 20 minutes. I can only swim/run recovery workouts as I can feel my body reaching LT very quickly during the workouts. It just isn’t worth risking overtraining or burning out by attempting to keep to normal weekly intensities. Tuesday morning I’m on my bike trainer, but either I am doing a pedaling efficiency workout for recovery or reduced wattage normal workout, as I cannot sustain normal wattages. My quads are still tight and I do not want them to seize up and wreck the rest of the week’s workouts. By Wednesday morning, however, my body seems back to normal.
Listening to my body is crucial. My fitness level, my recovery ability and my age are all factors in how I recover and I have to really accomodate that or else I could really tank my race preparation.