Trigger Point Therapy

This has been the winter of discontent with respect to triathlon training. My right hip flexor was injured in late January, which led to subsequent groin and anterior thigh problems. Specifically numbess, pain, tightness. Worse with flexion. Worse with running. Even worse with stretching. Taking time away from running did not help much. PT started to help, but it would regress once I began running again. Swimming even started to bother me.

After seeing several excellent PTs and an top-notch orthpod, I was told that my flexibilty was quite poor as well... (actually I was told it was about the worst they had ever seen), especially with regards to the right hip range of motion. I became religious about PT, anti-inflammatories and stretching. Again I would get benefit, but as soon as I started to run or swim it would worsen. Frustrating!!!

A good friend then recommended something called trigger point therapry and specifically recommended a company that made kits designed to help people perform this on their own without having to meet with a therapist on a frequent basis.

I am a physician and was pretty skeptical about this, but I bought a kit called the Ultimate 6 Total Body Kit. This is my review...

The customer service was good. I called the toll-free # and was helped by a person who had excellent knowledge of the product. I ordered the product on-line. There are discount codes available on the internet if you are willing to search. Honestly it seemed a bit expensive ($140 USD), but I was frustrated and wanted to give it a try. Free shipping was a perk.

The Total Body kit comes with several items:

1. DVD
2. U6 info book (excellent)
3. Footballer
4. Quadroller
5. Massage Ball
6. Foot block

I watched the DVD first and then read the Ultimate 6 instruction guide. Then I tried to perform the trigger point exercises.

First off, the soleus muscle. The key to the therapy is to do the motions slowly and to breath deeply. This is not a race and the goal is to get the muscles to relax... so as to stop the cycle of pain-spasm. More painful areas are focussed on... the footballer is stopped on the location of any additional discomfort, and then deep breathing is focussed on. The footballer and foot block are used for the soleus.

Next is the anterior upper leg. Quadriceps, vastus lateralis, IT band and more. The key I have found is slow motion back and forth with deep breathing. The manual and video describe these in detail and would defer to these for anyone looking for details.

Following this is the piriformis theapy. It involves using the massager ball and essentially sitting on the ball. I found this one tough, but have improved steadily with it.

Lastly and most critical for me is the psoas therapy. The massage ball is also used. Doing this exercise properly takes deication to the video and manual, as it is really important to do this exactly as they say. Within 4 days of doing the psoas therapy on a consistent basis that I am now able to run without any real problems. I am not 100% yet, but have been using the Trigger Point Kit for only 7 days. I also have had an injection into the psoas bursa as MRI determined that my psoas had a significant amount of inflammation present. The TP Therapy will help with the inflammation, but the steroid is key to settling things down quickly.

My belief is that Trigger Point Therapy is going to help my future development in the sport of triathlon:

1. It will help reduce muscle spasm and imbalances that have hurt me in the past.
2. Thus will hopefully reduce injury.
3. It will increase blood flow to the regions that we stress as triathletes, which will aid in recovery from tough workouts.
4. It will help my flexibility as the spasm will be reduced.

How much do you need to use it? Well here is my strategy... I am going to do it both before and after running. On non-running days I will try to do it within 1 hour prior to bedtime. After conversing with the sales rep, the recommended a morning and bedtime approach, but do what works for you.

Experiences so far (after 2 weeks of use)

1. After 2 weeks of religious use, I have found thisproduct to be very positive.
2. My psoas is far less painful.
3. My piriformis is 10x less spastic.
4. Soleus work right before a run increases stability. The video shows a demo of this, which is amazing, but I can tell you that the soleus muscle is super-important for running.
5. The quad therapy is intense. Start slowly. Amazing.
6. The videos and instruction are very clear.
   

Here are a few disclaimers...

1. I do not believe in miracle cures.
2. Incorporating physical therapy exercises from my PT and dediction to stretching into my daily routine are also very important.
3. I have significant muscle tightness/ lack of flexbility issues and this therapy is very appropriate for me... it may not be for you.
4. There are a lot of causes of groin and anterior leg. Vertebral disc disease, cartilage tears (labral), hernias etc. Trigger point therapy would not be helpful for every cause so you should be pragmatic and careful.

I cannot recommend this product unless you are first assessed by a physician or physical therapist. Why? Because if you do have something serious like a bulging disc or a torn hip labrum this therapy will not only fail, but you might actually worsen the problem. So be SMART!

Bottom Line:
If you have muscles spasm, imbalances, pain and poor flexibity, I would strongly recommend this product!

Endurance as a way of thinking...

What is it that draws us to the endurance sports?
Is it the fact that endurance athletes are simply not good at shorter, faster events?
Is it that endurance athletes are drawn to long events?
Or is it that endurance athletes are somewhat 'addictive' in their personalities and like to delve into heavy long term commitments?... I think this is the answer, it's just my opinion, but let me explain.

Many Ironman focused triathletes fall into a general demographic. Their income is well above average... $160,000 or more. They tend to be a little bit older... in their 30s, 40s and 50s. They tend to be highly successful people. Highly successful people tend to suffer from a little bit of OCD, as this is what leads them to their accomplishments. When I was younger I can remember the desire to be a Doctor. In high-school I was very motivated to do as well as I could in my senior season... I wanted to 'beat' everyone else. I wasn't the best athlete then, I wasn't the most 'popular' or the best 'partier'. I focused on what I wanted down the road, which was to be an MD. When I went to university, the same issues dominated and through hard work I gained early acceptance to medical school. In medical school I actually relaxed a bit, learned the curriculum and did not feel the need to compete until my last year where I competed for what was then a popular residency. Same issues came up in residency. First few years were about learning the ropes, and not so much about competing. By the last few years, I was right back at the competing game, trying to be the best resident humanly possible. The competition was not with others but within myself at this point. There had been a marked change at this point of my life, as the competition was turning inward.

When I landed my first job, there was a similar pattern. Eventually when I established myself I started to look for challenges and competition outside of medicine. Initially it involved running. Never racing, just running. Then it evolved to serious hiking. There was a trip to Colorado and Utah that involved some hardcore activity in this regard. Then I bought my first road bike and started to swim. This was September 2006. The Triathlon bug hit me and and the competition began. There was a competition to place as high as possible in my age group, but more importantly there was the competition to train as consistently as possible and to increase my fitness base.

Initially the training focused on the base training, specifically MAF training per Dr. Phil Maffetone. Then the training progressed to higher and higher volumes. It then progressed to hiring a professional coach and then to detailed scientific reading about improving technique to improve performance. By no means am I under the illusion that I could ever be the fastest triathlete in my age group... but I am competing within myself to be the fastest and best trained triathlete I can possibly be.

So why do I (we) do endurance sports.... well it's complicated! But let's just say it's me :)

Small Keys to Success!

There are some very small things that I have to constantly think about when doing Tri sports. I am writing them down today as a point of reference so when things go wrong later in the season I will hopefully be able to come back to this post and re-group.

I. Running:

1. Landing on the mid-foot seems to work well for me.
2. The key is to land UNDER the center of gravity. Over-striding kills speed!
3. Focus on the foot attempting to kick your butt. This helps keep the pendulum of the leg shorter which allows easier, faster running.
4. Watch out for over-pronation, especially wrt the left ankle.
5. Keep the cadence high... 180 or so.
6. Lean forward from the ankles, but don't slouch the upper body.
7. Increasing the arm pumping action on hill climbing seems to help as well.

II. Swimming:

1. Always focus on the hand sliding over the barrel at the end of the reach just before the pull starts.
2. Watch out for right arm cross-over. Hand entry should be between 1 and 2 O'Clock.
3. High elbows!!! (Which means reaching hand deeper in the water)
4. Rotate... under rotation leads to far less power... and I tend to drift to under-rotating for some reason. By 'popping' your recovery shoulder out of the water in a directed fashion, this helps.
5. Don't let your head get too low in the water... leads to slower times as you are dragging more.

III. Cycling:

1. For an improved efficiency try to focus on scrapping mud of the toes... point the foot down on the down stroke.

Computrainer Update

This is an update on the computrainer and also info on ERG VIDEO. Let's start with the computrainer...

My initial experience with a computrainer involved a borrowed one from a friend/pro triathlete. This is a smart move to determine whether or not ou like using it initially before investing the $$$... I would recommend this move. Mine arrived on December 15th, 2008. My previous blog report on this covers a lot of the set-up and initial thoughts.

Usage... since mine arrived I have rode 19.5 hours on it.... about an hour a day. I don't ride 1 hr every day, but usually 2 rides of 1 hour involving intervals, and 2 rides of 2-4 hours involving endurance work. This is the training focus until February 9th when focused Ironman training begins.

Biggest tip for the computrainer... YOU NEED TO WARM-UP for 10 minutes (usually in ERG mode). The calibration number you get with a cold start i quite different than the number you get with a 10 minute warm-up. The number will be lower after the warm-up, and more accurately reflects your ride.

If you do not re-calibrate after the warm-up, the calibration number will be falsely high and lead you to believe that you are producing more watts than you really are!

It also makes sense to warm-up for a workout especially if it involves threshold work.

Another issue that I came across was connecting the Laptop I use to a TV. For those who are tech-challenged, this can be tricky. Short lesson... go into the DISPLAY PROPERTIES section (found in the control panel usually) and you can set additional monitors up. You will need a connecting cable as well... S-Video works well, but there are many other options depending on your computer and TV.

So what are the different ways to run computrainer software???

1. Standard 3D Mode:

This is a very easy way to run things. Simply click on the 3D program and pick your course. Adjust your rider data and you are good to go. You can choose between numerous 3D scenery courses . One word of caution... uphill gradients are very hard compared to the real world and if your course has a 15% grade in it be prepared to suffer! It can be hard to maintain a cadence over 60 with significant grades, so be careful. I use 3D mode mainly for longer rides or if I want to ride a specific course.

2. Real-course Mode:

You have to purchase a real course video (RCV) to use this. Recently Racermate offered a free RCV for computrainer orders, so I received the Kona course. Essentially you download the course from a DVD and then run the software. You should pick your rider data, and make sure it is in real-time mode. Then start the course. The video is shot on race day (I'm told on the morning of the event during the swim), and the speed of the video follows the speed you are pedalling at. It is fun and a great way to experience a course if you are not able to travel to it before racing. I also like to see the Hawaiian scenery in the dead of Pennsylvania's winter.

My only criticism of the Hawaii course is that there is a bit of camera trouble. During much of the first hour the camera is focused too far to the left... I believe they had problems with their #1 camera, but it is a little annoying. I think RCVs are neat, but I wouldn't recommend getting a whole bunch, as I believe the charm will wear off fast with these...

3. ERG Mode:

This is the simplest way to run computrainer. Simply turn on the computrainer and don't even hook up to the computer. You set the wattage load and start the timer. You will get HR and cadence info as well as power. No matter what cadence or gear you are in, you will have to deliver the set wattage... eg; if you set it to 200 watts and pedal slowly, it will be much harder to move the pedals than if your cadence is high. The computrainer adjusts the resistance to make your effort the same watts regardless of cadence. This is a nice way to do shorter sessions. You can adjust wattage load on the fly, so doing interval work is easy. Drawbacks... a little more boring with no graphics and no data to analyze after.

4. Coaching Software Mode (CS):

CS can be downloaded for free from Racermate. It allows 3 different modes... Spinscan mode, charts mode and ERG mode. You must be in real-time to use the CS mode. (saved mode is used to analyze data after). Spinscan mode allows you to work on the pedalling efficiency, however you can get this screen on the 3D software and also the RCVs, so I don't use this mode much (if ever). ERG mode is similar to the ERG stand-alone mode, except you get a graphics display on your computer and choose between a number of on-screen options. You can show your HR, cadence, power etc, and it will be graphed in real-time. You do not get a spin-scan mode and you don't in any ERG-type mode as a rule.

Charts Mode is by far the best. You pick a pre-designed course in the charts mode. There are some erg courses that will come with your computrainer, but I prefer to design my own. It involves a bit of tech-saviness to write your own erg files, but not that much. I have designed interval session such as 10x1 min at threshold watts, 6x5min at threshold watts. You can design the recovery time interval... essentially you can design anything.

5. ERG VIDEO Mode:

Erg videos are designed to help with your training. They are real videos shot on different locations. I have 2... Lake Placid with a Champ, and Long Threshold Intervals.

You need to run them through Coaching Software or Multi-rider software. I would strongly recommend the multi-rider software for a number of reasons... most importantly is that it allows you to adjust your wattage load in real-time, which can be quite helpful if you made the threshold level too high!

You can design almost anything with the tools provided. You can design the length of the ride, the time in different power zones, the threshold level etc.

The different videos are designed for various things. Some work on base-building, some work on tempo or threshold intervals. One is a designed threshold test. I often ride the Lake Placid course set at Z2 wattage. I have been riding the 4x9min threshold intervals as well... these kick my ass!!! Visiting the ERG Video site will give much more info. Suffice to say this is my favorite mode! Oh and you can also run itunes with the erg player... which is not the case with 3D mode usually.

Tonight's power file. 60 min. intervals.

20 min wu

4x2min FTP

3x5min 95% FTP

Computrainer Article

I bought a new Computrainer Pro model. It is set up and I will describe in words and photos some of my initial thoughts.

The computrainer is many things all in one. It is a trainer, a computer program, an ergometer, a real course virtual simulator and most of all a great training device.

I spent considerable time researching this device and would like to share my initial thoughts.

Set-up is fairly easy. The load generator attaches to the rear wheel of the bike, which attaches not only to a power source, but also hand-controller unit that links to the computer. The yellow tire is a trainer tire... it is supposed to last longer than a regular tire on the trainer and supposed to improve all-around use. You can see from the picture below that the setup is pretty stable. The load generator is pretty smart... it can adjust load based on the course you are riding up to 1500 watts. This is way beyond what most can produce. It also has a fan which keeps it cool... the faster the speed the faster the fan... thus you are cautioned that long hard low rpm climbs can cause over-heating.

On the left rear main-stay is a cadence monitor (magnet on the left carnk). This is helpful for not only cadence, but also the spin scan function. There is considerable controversy regarding the benefits of spin scan, but it definitely gives you feedback if you are favoring one leg over the other too much.

Above is the cockpit set-up for my computrainer. The yellow controller is needed to change everything from the watts you or your pacer will be doing. Different views on the computer screen and for starting and stopping and saving races. You will notice that I have covered the setup with plastic to avoid damage from sweat. The amount this trainer will make you sweat is incredible. There are bike covers you can buy, but moderately think plastic works quite well. On the stem you can also see the Polar remote HR sensor which plugs into the yellow controller.

The software is very nice:

This is from the regular 3D software. You can vary the scenery a lot and even ride cyclocross. Another view you can control via the yellow hand remote is spin-scan, as seen below. The rainbow bar graphs represent different 15 deg angles of the entire pedal stroke of each pedal. Many question this spin-scan, but I think it is helpful so far. One thing that is easily noticeable is that your pedaling is less-efficient when aero as there is less ability to pull up with the pedal and more of the force is from downward pushing in aero.

Here is a spin scan report from a recent short training session.

Racermate also has real course videos. This is a seen from the IM Hawaii course. The screen moves as fast as you are going and is definitely a help from the boredom angle. The vids are $100, but this one came with the computrainer as a freebie.

Coaching software allows detailed review after the training session as seen below. It can also be used for ergo mode and for spinscan alone mode. Ergo mode is very cool, as you set the watts and then you have to deliver them regardless of cadence. I have ordered some erg videos as well, but they have not arrived yet. Here is a CS review of a 92 min ride from December 16th, 2008...

My plan is to ride pretty consistently over the winter to build a base that will help me with tri season... we will see how it all goes.

Friel power-based workouts

Level I: Active Recovery
(60-90 min)
Stay at 55% FTP

Level II: Endurance:
A. 2.5 hrs
Warm-up 56%
Ride 2 hours at 69-75%
Cool down <56%
B. 3.5 hrs
Warm-up 15 min <65%
Ride 3 hrs. 69-75% with bursts q10 min.
(bursts are 8 sec long at 130 rpm at 103%FTP)
Cool down <55%

Level III: Tempo:
A: 2.5 hrs
Warm-up 15 min at <68%
Ride 2 hrs. at 76-90%
Cool-down 15 min <55%

B. 2.5 hrs
Warm-up 15 min at <68%
Ride 40 min at 76-90%
20 min cadence -15rpm 76-90%
Ride 40 min. 76-90%
Cadence +15rpm 76-90%
Cool-down 15 min <55%

Level IV: Sub-Threshold "Sweet Spot"
A: 2-2.5 hrs
Warm-up 15 min <68%
Ride 5 min 100%
2x20 min at 88-94% with 15 min recovery intervening
Ride at 105 rpm+ 10x1 min 85-95% with 2 min recovery intervening
Cool-down 15 min <55%

B: 2-2.5 hrs
Warm-up 15 min <68%
Blow-out 5 min. 100%
Easy 5 min <68%
2x20 min 96-105% (15 min recovery interval)
Cool-down 15 min <78%

C: 2 hrs
Warm-up 15 min 68%
Ramp up to threshold in 20 min 80-100%
60 min hour of power
Should sit up out of saddle q2min for 10 sec for increase in cadence
Cool-down 15 min