I arrived home after Ironman Western Australia thinking about compression. Compression socks and tights both for during competition and recovery. It was something that seemed to be gaining in popularity now.
This year’s Ironman World Championships in Kona saw Torbjorn Sindballe wearing an all white outfit. It looked rather funky but apparently was a product of research that showed the white outfit would reflect heat and keep him extra cool in Kona. He had on one white glove, into which he puts ice cubes, and knee high white compression socks. He sure looked unusual, but he did get second place so there must be something to that outfit. To hell with fashion!
At Ironman WA, there were people also wearing compression socks. Afterwards, a number of competitors wore compression tights for recovery, as I saw them lounging around in them. I vowed to get some as soon as I got home.
My first order was for some traditional compression socks at Magellans. These socks are made for more mature people, who potentially have the danger of deep vein thrombosis (clotting in deep blood vessels which can lead to stroke) and developing varicose veins. Research has shown that compression socks can help prevent these very serious conditions from happening, especially while sitting for a long time in these awful plane seats on extended trips.
I wore these for a while and they worked pretty darn good at keeping the blood from pooling in my legs and making them swell. Plane seats are notoriously bad for me. They are often too high and put extra pressure on the back of my legs, causing numbness and the swelling as circulation is prevented. Wearing compression socks really helped this and virtually eliminated the swollen feeling in my lower legs and feet. What bothered me a bit about these socks were that they were full socks, and that I had to wash them every time I wore them so that they wouldn’t become smelly.
I switched to Zensah compression socks, which allowed me to wear a pair of normal socks while wearing these socks. Zensah socks aren’t really full socks; they only cover your lower leg from your ankle up to your knee. I find that I don’t have to wash these every time because they aren’t covering my feet. Since I fly so much, I wear these every time and have fallen in love with them! (By the way, getting up in a plane and walking around every hour works wonders as well.)
You might think that wearing knee-high socks could work just as well. Apparently, they don’t have the same effect. Compression socks are made to have a graduated compression effect upwards from the ankle to the knee. Regular knee high socks aren’t made for that. Sorry, you can’t go to Target and just buy some athletic tube socks!
Will they help performance or recovery? The jury is still out but promising in the areas of formal research. Informally, it seems that their popularity does say something about their effectiveness. So I find this post is really Part I in my own experiences with compression. I now know that Zensah compression socks are required equipment for flying and keeping my legs fresh on both short and long flights. I bought a pair of 2XU compression tights to see what happens when I wear them after a long, hard workout. I will test this later on this year as I build for Ironman Florida. Also, I am considering wearing my Zensah compression socks during the run of Ironman Florida. Silly looking? Potentially. Gain a few minutes or more…not bad! Avoiding cramps during the run…priceless!
Both the Zensah socks and 2XU tights I bought at my favorite online tri-shop, Trisports.com.
If you want to find out more at this stage, Joe Friel has a great post on compression and tried to find some current research on the topic. I expect there will be more formal research released as the year goes on.

The other week I went to my physical therapist and in a sudden moment of inspiration wondered why I couldn’t do Graston at home. I asked him if other patients had pondered this, and also remembered when my other physical therapist once told me that she had done Graston at a race with a butter knife. It seemed possible, and that between visits to their offices, Graston would be an effective way to manage tightness and getting the muscles to calm down in case they get really over-tight during workouts. So after my treatment, I took a picture of a typical set of Graston tools:

This trusty set cost over $4000! And is only available to licensed practictioners of Graston. Well, I wasn’t going to get a set that way for sure. Undaunted, I headed down to Westfield Valley Fair Mall and checked out Williams-Sonoma. There were plenty of kitchen gadgets there for sure, but nothing seemed sturdy enough to mimic Graston tools. I then went over to Pottery Barn and found what I was looking for in their dinnerware section. The utensils of various sizes and shapes were perfect! And even more perfect was the fact that there was a holder full of single utensils; I didn’t have to pay big bucks to buy a 4 place setting set! I could buy singles. So I selected a bunch to try:

Graston’s set: $4000+, my set: $22!
The hard part is seeing if you can get the same effect with the shape of the utensil, as you can with a Graston tool. Through experimentation, Graston tools were organically derived for many purposes by a physical therapist who was also a metalworker. So I started applying these tools to my body to see which ones would work best.
My favorite is the one at the bottom of the picture. It is the spoon which has a square-ish shaped handle. I also bought a butter knife with the same handle and the back of the blade is actually pretty good, but just a bit dangerous when you’re using force against your muscles; butter knives are much duller than steak knives, but you can still cut yourself! Still, I may try to file down the blade so it is less sharp. For now, the spoon works great. (By the way, spoons are allowed on carry-on luggage unlike butter knives so I can bring this around with me when I travel.)
It is the edge that is the secret. If it’s too rounded, you can’t dig into your muscles enough. And if it’s not sharp enough (with a broken/not-razor edge), you can’t feel the vibrations of the tool which signal you passing over adhesions in the muscle. If you examine Graston tools, you’ll find that their edge is actually a (small) rounded edge with a bladed area of about 45 degrees. It allows you to make these “slicing” motions into the muscle, as if you were trying ot shave off a chunk of flesh.
One downside of the spoon; it is too small to get a good grip on to really start digging into your muscles. Graston tools are much more beefier and you can get your whole hand around it to really apply some force to your muscles. When the tool is not so beefy, it is hard to really get force. Maybe that’s ok; I am still gunshy about really putting lots of scraping force into my muscles for fear of screwing myself up! But hey, what’s life without some adventure?
What I’ve learned about applying Graston to yourself in the privacy of your own home:
1. Get Graston done on you first. Don’t attempt this without watching someone who knows what they’re doing and feeling it done to yourself. It’s the best way to learn about how it should feel from the patient side. Plus, you can watch and remember the motions and strokes, and how to apply the tool to yourself. You need to learn the various methods of moving or not moving your muscles during application, what to be careful of and what is ok. You can also get a sense for how much force should be applied, and also most importantly, learn what adhesions in your muscles feel like.
2. Develop a sensitivity for feeling adhesions and knots in your muscles with your fingers first. Take some lotion (I use Aveeno) and rub it on the muscle. Then run your fingers across the muscle. If it feels relatively smooth, it has little or no adhesions or knots. But if it does, it can feel like a surface of small potato chip crumbs as it makes this crinkly kind of feeling when you move across it. It can also feel like a bunch of nodules, or it can be one big harder area.
Then develop the sensitivity with the tool itself, as it scrapes across muscles. It will feel as if you’re running the edge across a surface of small gravel sometimes, or just a rough surface. Try also running it across other muscles, like your forearm which, for me, is pretty smooth. Then you’ll know what non-adhesion filled muscles feel like. Another way to find adhesions and knots is to use a foam roller. This is especially good for larger muscle groups. When you roll onto a big knot, it will feel like a big hard lump and will be painful when you hit that area with the roller.
3. When apply my spoon, I generally keep to the larger muscle areas and shy away from joints. I don’t like the thought of accidentally affecting the tendons or hitting a nerve bundle or bone. That would not be a good thing.
4. I usually start off lightly and slow in the stroke. I can gauge how my muscle feels with the spoon being applied and make sure there aren’t bruises or some kind of acute pain there as I move the spoon across the area. I don’t like to overtreat areas as that may cause greater damage. I also keep away from areas that are bruised, either by me, or from a professional ART or Graston session. You gotta let bruised areas heal; it’s not good to keep bruising them up. Bruises tend to restrict motion.
If, after the lighter and slower strokes, I do not feel too much extra pain, I apply more pressure to get deeper into the tissue. Sometimes I increase the speed of the stroke and sometimes I keep it slower. There is definitely an upper limit to speed and I think that extra speed does not work well. It seems to be more the pressure and amount of strokes than stroke speed.
After a few strokes, I feel the area with my fingers. I almost always feel a smoothing out of the area as the adhesions get broken down. I then do another set of strokes, feel the area again, and maybe I’ll do it once more. I don’t have a set amount of stroke-and-inspect sets to do; it’s kind of something I just know that I should stop or go one more. Definitely doing too much is a bad thing.
5. After scraping the muscles, I often will get some more lotion and apply some long, massage strokes to clear out some any fluids that may have accumulated and to help blood flow into the area.
6. I also vary my muscle condition, scraping it in stretched and contracted positions. I also sometimes flex the muscle to really tighten it as I scrape; very tough since it hurts a lot! But varying muscle condition sometimes exposes adhesions which are not apparent while in a rested condition.
7. I find that results are often immediate. Certainly, after a few hours, many aches and pains and tightness magically go away. Wow! All from a spoon and some lotion!
8. You’ll find that you’ll never be able to use as much force as another person scraping your muscles. You really don’t need that much anyways.
9. I also know that there are areas I can’t self treat because I can’t reach them, or I can reach them but I can’t apply enough force on the spoon to make a difference. These are areas like my lower back and my hamstrings. Bummer!
By the way, I can’t recommend this to anyone. If you do something wrong, you could really hurt yourself. Treat this article as a curiosity and for knowledge purposes only. Go find a great Graston practictioner and get treated the right way.

After Pac Grove, my left adductor/groin muscle really started to act up. That tightened up and swelled against my hamstring, preventing that from moving freely and thus made that start to tighten up, and then both of those pulled upward on my calf making that all nice and tight as well.
For 2 weeks I thought I was dead. I went to both ART and Graston but nothing seemed to calm it down. But then I finally gave it some rest. I stopped all leg training for about 4 days, but the muscles didn’t unflex; they remained very tight and TPMassageRollers and foam rollers both did nothing for them. Graston finally saved the day as rigorous scraping of the muscles caused them finally to stop firing and relax. Kinesio tape was applied to the area and the next morning, I went out for a track workout and amazingly came back with little pain.
That afternoon, I go for more Graston and ART and get re-taped. Then the next day, I go for a 4:55 bike ride and my left adductor/groin muscle doesn’t have even a squeak of protest! The Kinesio tape provided some strange, neuromuscular form of support as well as actually supporting the muscle itself. Somehow, I felt more…secure…because the tape was there against my skin in an area which was giving me problems. Also, I was taped to help the muscle remain extended more, so as to help prevent over-contraction and thus cramping. It seems to have also helped it to stay more relaxed!
I hate to use a crutch like taping, but man, I have two more races before the end of the year and if taping is going to get me there, I’m gonna tape up to the NYC Marathon, and then all the way through Ironman Western Australia.
Just ordered some more tape from Kinesio-Tape.com; can’t run out of this magic stuff!

Note to self: Need 3 bags of ice in the summertime.
The temperature of “cold” water is now much higher, as well as the ambient room temperature. This causes the ice to melt faster in an attempt to lower the water temperature. 2 bags of ice ran out at about 8 minutes. I think 3 would be just right.

Ow ow…tight tight..ow ow…
Those were the words I expressed when I got up this last Thursday morning. My hamstrings were really tight, probably in part due to the strained poplitiuses (poplittii?) on both legs, with my left poplitius being the worst for wear. But having taken the day off on Wednesday, I knew it could not be tightness or soreness from a previous day’s workout. I knew it had to be the dreaded spontaneous formation of adhesions.
I got up and went downstairs and both hamstrings were not loosening up at all. I got into my running clothes and tried to stretch, but stretching could not make the tightness go away. I knew there was only one thing to do. And that was to RUN. I got on the treadmill and warmed up. Both hamstrings took a while to loosen up, but once I got going, things felt better. I did a form run on the treadmill and ending with some accelerations at the end. When I finished, I got off and stretched and felt much better.
I talked to my physical therapist about spontaenous adhesion formation. These adhesions seemingly come out of nowhere and most annoyingly when you’re either in taper or in recovery. You get these knots, tightness, and soreness just from sitting around doing nothing. Apparently, there is a natural shearing action of the muscles to break down adhesions as the muscle fibers are working and moving against each other. So when you’re working out a lot, adhesions form, but many of them get broken down by you working out. Once you stop working out, like during taper or recovery, your muscles seem to want to bunch up at times and sometimes you think you’ve really hurt yourself.
I joked with my physical therapist about the fact that once you start racing Ironman, you can’t stop ever racing Ironman if simply to avoid the soreness and tightness of spontaneous adhesion formation. It’s sometimes worse after a race because your muscles seem to knot up all by themselves in absence of hard work. The only way to get rid of this is to keep training. Race on!

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.

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.

Aaaah….an ice bath after a hard run today works wonders. But how to get into that bathtub of freezing water? Here is Dave’s patented method of successfully performing an ice bath:
1. Prepare. No, not just mentally, but get 2 bags of 7lbs. of ice from 7-Eleven, a towel, something to drink if you want, a watch or clock to time yourself. If you can, get something warm like coffee or tea. Put the ice bags on the ground next to your bathtub. Put the watch/clock, drink, and towel within reach.
2. Get into the bathtub and sit in it empty. Mistake #1: Filling up the bathtub and dumping ice cubes in it and THEN trying to get into it is near impossible. I guarantee it. Just try it. I have never done it without screaming. Try my way; it’s better. So get into the empty bathtub and sit in it.
3. Turn on the cold water. The water will slowly fill up and your body will adapt to the cold water much easier than if you were to jump into a tub full of it instead. I would recommend not moving too much; too painful with cold water sloshing onto exposed body parts!
4. Keep filling it up until it crests over your thighs. Yes your private parts will be freezing by now. Don’t worry; it’s only for about 10 minutes or so. It will still work.
5. Turn off the water. Then carefully reach over and grab one ice bag. Rip it open and dump the ice cubes into the water. Push the ice cubes around until they are all around the tub. The coldest areas will be nearest the ice cubes.
6. When the first bag of ice nearly melts away, which is about 5-7 minutes, take the second bag of ice and dump it in.
7. You can time yourself about when the water crests your thighs. SIt in there at least 10 minutes but probably not more than 15. You don’t need to prove that you’re a real man. Just enough to get the restorative effect on your abused muscles.
8. Time’s up! Get out of the tub and run to the shower and take a nice, long hot one. The hot water blasting against your body will causing a flushing effect to remove the iced toxins and exercise by-products away from your muscles. Great job!
Now that I’m peaking for Ironman Brazil, it’s critical that I recover fast enough to get to the next workout. So I plan on using ice baths after both long run and long bike. Believe me it works great. Enjoy!