Winter Track #3 Shock attenuation

ImageEmerging from my warm car into the darkness, strapping the headlamp on, the rain drops begin. I get a text from Rikki “are we still on?” We are.

I warm up barefoot on the astroturf, at the high school track, joking with Orla (a friend from the auld sod) about Irish weather forecasts: sunny spells and scattered showers (and still it rains for hours and hours). Dawn rises and the familiar landscape of naked trees with streaks of layered grey clouds in the background, dashes of green fields framing the view beyond the track. This bittersweet western Atlantic winter weatherscape is moulded deep in my bones. I have flashback memories of learning to “golf” in the damp fields behind my convent school: whacking golf balls over the ditch from one cow pasture to the next, while our “team mates” collected them and whacked them back to us. We laugh, and warm up with movement correction drills. A skips, B skips. Becoming smoother. 

We play with our running cadence, listening to the increased heel strike force at the lower cadences, popping into higher turnover to keep up with the iPhone metronome beeping out a steady pace in the early light. I give cues, they listen, their feet getting lighter and lighter as the 200’s progress.

Recapping from the running analysis course this weekend in Toronto, I discuss the concepts of stress attenuation in running, and how alterations in footwear, cadence and running technique can reduce forces on the body. We discussed  how appropriate training and footwear alter tensile, elastic and contractile elements, and were fascinated by the amazing capability of the running body to adapt with appropriate “Mechanical Stress Quantification.” Blaise, the course director, and an expert both in running, training and rehabilitation, elucidated this wonder using an example of a Swiss PhD study. These *scientists* investigated a sample of women running while not wearing sports bras, measured pre-intervention resting nipple height and breast jiggle while running, and set them off on a naked running training program. After only a few weeks, they observed  significant adaptation to training with resultant improvement in both boob jiggle and elevated, i.e. perkier nipple resting position. Not so surprising that the tissue adaptations we spoke about, in the posterior chain, the feet, the mechanical stress kinematic changes, also continued up the kinetic chain too.. We recovered from the 400’s laughing hard, and challenged each other to test the hypotheses.

While my track group have cadence drills to work on this week, we resolved to leave the naked running for warmer days ahead.. (or maybe not.. see you at the track!)

 

http://blip.tv/denmarkdk/naked-race-2010-3927386

 

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2012 ING NYC 26.2: the most memorable marathon that I never ran.

You know most of the story by now, the Hyner challenge, the 13.1mi qualifier in central park amongst 10,000 women, the Hamptons Half marathon blazing race this September, and the final push, the 20 weeks of training, the build over the hot summer with four 18 mile runs, three  20 milers, and one twenty-three miler to Montauk Point. The End. Little did I know it almost was the end of my marathon year, that sunny dawn over the ocean last month. A three week taper to my virgin marathon, NYC 26.2, was working as planned. I felt slow, under exercised and antsy. Jen would remind me that this was how I was meant to feel, ready to bolt out of the stable. “The hay is in the barn” my old running coach reminded.

Then Hurricane Sandy hit. Sag Harbor was under water. ImageMy physical therapy office was out of electricity, internet, phones, the ocean beaches were thrown up hundreds of feet inland, boats sank. My cousins in Staten Island, NJ and NYC braved the ravages of the storm, my college room mate lost her Breezy point house. My heart was low all week, as the thought of running through the 5 boroughs was not realistic, rational, ethical, wise or fair. The training, the build up, the camaraderie was so strong, but the desire to race had faded.

There was speculation all day Friday that the race was going to happen but my bag was packed, and I was climbing on board the bus to the city. Then the final call came, as I was standing in the aisle on the Jitney, the driver giving me the hairy eyeball, as seconds before departure, I checked the screaming texts, twitter and facebook messages. The race was off. And so was I. I handed my bus ticket to the confused woman on the sidewalk, drove home, and uncorked a bottle of wine.

Rarely given to self-pity, I initiated a fundraising campaign for the recovery effort on Staten Island, scoured the web for another nearby marathon, and sank a couple of glasses of a very good Bordeaux. Harrisburg, PA would be the final port of call for these sneakers in 2012. A run to recover. Plan B. 

ImageThis past Saturday, the Irish Brigade of Fiachra, Tom and myself headed to PA with their kids in tow. On a spectacular sunny race day, we crossed bridge after bridge over the Susquehanna river, through the trails of local parks, along the banks of the beautiful river and all around the welcoming town. The race directors had made special efforts to accommodate the 1500 extra runners displaced from the NYC marathon , and ensured not just t-shirts and medals for all participants, but more importantly, extra coffee and porta-potties. Signs throughout town welcomed NY runners. A home away from home..I ran my heart out, not paying (much) heed to my numb right foot, that from mile 14 was giving me some jip. “Steady as she goes” was the motto, watching the miles tick away, heeding my many experienced marathon friends as I held the reins back from going out too fast. While it wasn’t all perfect, the pace held more–or-less and I sprung (!) over the last bridge to the finish in 3:15:45. ImageDelighted to score an AG win, I was more delighted to have completed the 26.2 and not blown the plan. One quick “athlete bath” later (i.e. baby wipes, jeans and a clean t-shirt) and I was on the road.

Next stop, my cousin Eileen’s house on Staten Island. I hadn’t seen her in years, and had never met her wonderful kids, my extended American family. Her parents, husband, sisters and their kids, dogs, and spouses all gabbed, yakked, and roared laughing as dinner sprung to life and drinks were poured. I had made it onto the fridge (#5), a badge of honour in my family.ImageFive or six conversations went on simultaneously over the table, yelps of laughter, tears of remembrance as stories recounted loss and survival from 9.11.01 and now Hurricane Sandy. The Staten Island-Irish-American bagpipe playing-fireman-tight-family world. Great stuff on so many levels. If you come from it, you know what I mean.

After a huge feed, extra brownies (for the road) and warm hugs from all, I drove over the Verrazano bridge in the dark. I paused in traffic, looking up at the lights, imagining the non-start of the marathon, and was so glad that it hadn’t happened.Image

Instead of the weight of this event, I feel several different emotions. I have heartache for the survivors of this terrible flooding, the people displaced for the foreseeable future. But I drove east suffused with a warmth for my family, my American family, my cousins. They look like me, they sound like me, they laugh and talk over each other like me, they tear up as I do. In these times, we come closer, the tribe pulls together.. thanks to Sandy, the NYC non-marathon and Harrisburg.

 

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Tales from the human pin-cushion project: “the incredible shrinking feet”

Image

Alice (not her real name) is tall, thin, pretty and stressed. She appears almost as I would imagine a Victorian artist would sketch her, fine long bones, and skin white as fairytale snow. Anxious. Her wispy hair slightly shades her eyes as she tells me about her shrinking feet, and I wonder secretly whether there is a tiny bottle hidden in her hand labeled “drink me”. Twenty one years in practice as a physio, and I still never cease to be amazed at the wonders that present in my sunny office. Alice is P2G2 with UF and OAB; in non-medical parlance, she has a cranky pelvic floor following the normal pregnancy and birth of two children. The shrinking feet seem to be an aftermath of this process, getting tighter, shorter and higher, while her peers in motherhood suffer the ignominy of post-partum foot spread. These feet have steadily shrunk from a US size 9 to a size 7.5 over the past 6 years. Alice has “failed” many trials of orthotics, both custom and over-the-counter, moving from Merrells and Keens, to narrow Nike and New Balances, finally to barely there ballet slippers.

I examine her in standing, her long, thin feet, with their high longitudinal and transverse arches, her skin barely touching my floor. An otherwise normal musculo-skeletal examination passes, we move onto the pelvic floor examination. Her breathing quieted, and she squealed to me as I hit the hot spots in her hypertonic pelvic floor. Unable to relax even with visualization and breathing, Alice recounts how she has always had “tension” here, with a childhood history of constipation. Afterwards, I scrub my hands, she dresses, and we chat about the connections of mind and body, of memory and muscle, of embryonic neural connections long divided and sent to far flung regions, meters away and decades old, but with strong and pertinent contacts remaining. The feet and the bladder. The soles connecting us to the earth, and the internal lock, Mula Bandha. She got it.

We discussed dry needling, how her feet were too tender and hyperaesthetic to needle, but as a volunteer participant for my dry needling education, she was willing to try other parts. We decided on an experiment of n = 1, one leg, shin muscles only. Three needles, 60mm x 0.30mm. Tibialis anterior. Slowly and with some trepidation on both our parts, the needles were inserted, left for 5 minutes while we waited for something a.k.a. “the magic” to happen, and then withdrawn. Alice slid off my plinth onto the floor, gliding from one foot to the next, watching her feet, feeling the ground with her soles. “Amazing” she declared. “One foot feels slippery rubbery and low, and the other like a high, brittle 80 year old foot”. I crouched down to ankle level to watch her medial arch on one limb descend, while the other stood tall and tight. “Amazing” I replied. Thinking she must be making it happen, then realizing that she couldn’t, at least volitionally. Silently, the scientist in me wished that I had made an imprint of her feet before we began.

The next session, we tried each shin, with similarly good and lasting results, and have now included, at her request, her lumbo-pelvic and sacral spine. With breathing, cues for allowing her new feet to accept the floor, gait and posture re-education drills, visualization for pelvic floor relaxation, and lots of patience, we are unraveling Alice’s feet, with the aid of some long pointy filaments of steel. Her bladder is a longer project, but I suspect it too will release its secrets, and relax its hold on Alice before too long.

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Why a PT makes a better fitter.

Part 1. Shoulder pain.

With three plus years into this fitting thing, five years into coaching, and 21 years into my physical therapy career, problem solving is part of my DNA.  Through several fitting programs, with Trek, Retül, FIST, Bikefit, and others, I have learned many things. I am a more competent bike mechanic, I have more options to maneuver bike parts into different positions, I have a boat-load of fancy electronic gadgets, measuring devices and alignment tools to use. I have a nice space in a new shop, and enjoy spending my (very limited) free time working with athletes and bikes in the sometimes challenging search for a better bike fit.

One thing that these bike-fit certification courses cannot teach however, especially to students, is to analyze these fits with the mind of a physical therapist, and not a wrench.  Paul Swift and Kit Vogel are making good efforts in that regard, and have a fit course for medical professionals, but I would venture further, and say that physical therapists are, or have the potential to be, the best bike fitters. Working with athletes who happen to be patients, gives us incredible insight into the mechanics of the musculoskeletal system of each individual, which can thoroughly change the bike fit. Last night after work, was a “tweak” to a tri-fit that I had done earlier in the year.

Triathlete, (and PT colleague) Susan is a competitive triathlon age-grouper, and was complaining of left anterior shoulder pain in her TT/aero position. In summary:

Main complaint: anterior left shoulder pain, upper Bicipital / anterior Deltoid region, 1-2’ into ride.

Injury history: SIJ dysfunction, intermittent, Tibialis posterior tendinitis. Currently under control.

Flexibility: High, global hypermobility

Power: good, improving in early season.

Muscular endurance: Fair, in upper body, Good in lower body.

Fit position: 35° knee angle, 89° shoulder-elbow angle, trunk-shoulder angle 85°, back angle 28°

Review of fit looked good, but Susan felt that her elbow position needed “something”. She has fiddled with her elbow pad position and by widening them 1cm, had released some of the tension in the shoulder.

Theory of “vertical loading” would indicate that she needed to get the shoulder elbow angle to 90° or thereabouts, thus allowing more of the upper body weight (remember, low muscular endurance) to be borne by the skeletal system, reducing load on the “holding” demand of the muscles. However, in this position, Susan’s, globally hypermobile shoulder was sinking into the sub-acromial space, potentially impinging on the Long head of the Biceps.

The solution resulted from the following tweaks:

  Bar-ends tilted up 10 degrees, left one initially, then both matching angle (some riders will be happy with an asymmetrical set-up, this  one decidedly not!). This produced left triceps ache but the anterior shoulder pain was much less evident, coming on after 10 minutes at power instead of 2 minutes.

Elbow pads moved in internal rotation to allow miniscule flare out of the elbows.

 Right bar end and pad moved 2mm laterally to match left (was set up asymmetrically by bike shop after installation of new Di2 shifters)

Bar ends moved forward 7mm, giving a more open elbow angle. Shoulder pain at bay totally, and triceps ache eliminated.

A two-hour process later, I have a pain-free happy athlete, who managed a three-hour TT position ride the next morning with minimal focal discomfort.  By conventional bike-fitting theories, she would have remained in a right angle position at the shoulder and elbow, with excessive compression of her sub-acromial space. Her final position was as follows: 35° knee angle, 109° shoulder-elbow angle, 95° shoulder trunk angle, 28° back angle. My theory is that moving into a more open position, however subtle, increased the muscular activity in the shoulder girdle area, but within the constraints of S’s muscular endurance. Moving the right bar to match the left (correcting the bike-shop asymmetry) allowed more equal loading, however small a balance shift, I think this was important. As she progresses through the season, we will tweak this further, dropping spacers 5mm then 10mm, and dropping the stem from 25° closer to 7°. Her thoraco-lumbar and hip mobility can handle it, her core strength will be able to handle it with some time and work, and her upper body, with practice, training and exercise, will easily be able to handle this more aero position. Her power production is better here in this lower position, but she needs to ease into this position, over the season.  These minor, but important comfort adjustments will be a stepping-stone in getting her there. (some dry-needling to the biceps should finish off the issue..)

While I have worked with many great bike-fitters who come from a shop or bike-racing background, I truly believe that knowing this patient-athlete’s body from a PT perspective, coupled with deep anatomy and kinesiology knowledge, can create a more thoughtful, more complete fitter. As I continue through this season, I will keep you posted on some of these PT fit aspects and I hope you find them both interesting and helpful.

As always, I am available at sinead@bikefitplus.com for Q+A.

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TAMPA 2012 APTA national conference

The APTA national convention is one the largest meetings for the physical therapy profession, and having a poster accepted for presentation was quite the honor. Especially since it was my first one, and I hadn’t the foggiest notion how to go about it. The abstract was submitted months ago online through an electronic clearing-house, despite the fact that neither my committee chair nor graduate program director had seen it. Late nights, and early mornings for the past few weeks before work, I had spent many hours creating the poster. The twilight hours were spent summarizing my literature review and methodology using slash-and-burn techniques to refine text box contents to the barest minimum, stretching and compressing university logos, photo-shopping pictures from generous sponsors such as Paul Swift to create a seamless representation of 3 years of study in a 5’x 3’ non-glossy spread. Dennis generously helped me, late on a Sunday afternoon, with microscopic alignment and create a final proof in grey-scale printed out on his gigantic CAD drafting printer, so all I had to do on the Monday before the conference was to print it out, easy right? Of course not. No Kinco’s or Staples nearby, many of the local printing companies had limited supplies, limited paper types, limited formatting options, no matte paper, no 5’x3’, no no no no no. And now, I had three remaining days before Tampa 2012.

Having learned one solitary thing from the big print on the hitchikers guide to the galaxy, “DON’T PANIC”, I suppressed the urge to panic, and instead caved to my primitive responses to stress, giving in to a deep, deep sleep. The printing company that had designed and built my office sign assured me that they would be able to help, so I packed my bags, lit my mental candles, prayed to the god of stressed-out-first-time-conference-presenters, and went to bed. Leaving everything to the final minutes of the eleventh hour generally has me operating on the edges of my comfort zone, but here I was, driving to the airport, with minutes to spare, stopping to pick up the poster, review it with a fuzzy eyeball (woke with a bloody cornea…stress response anyone?), and drive to McArthur airport to meet Susan. Phew. The flight went well and the first day of presentations was insightful, with most of our interest in the lower extremity biomechanics presentations by Chris Powers and Tom Mc Poil. Heavyweights in the orthopedic and movement dysfunction world, it was heartening to see that our current clinical practices closely reflected the best practices advocated by these hard-hitting clinical researchers. We were giddy in the expo center, spending hundreds of thousands of wish-dollars on our dream equipment list, from the Alter-G gravity defying treadmill, to the Noraxon instrumented treadmill to the Biodex dynamic assessment platforms, and the Hydroworx under-water treadmill. Our movement analysis plans were taking firm shape as we tried out all the “toys”, zipping into the Alter G to run 8.0mpH at only 40% of normal body weight, then monitoring plantar pressure and gait patterns in the instrumented treadmills, then testing motor skills on the balance platforms, then going around again for more ideas, more plans, more pens, candy, ice-packs with sponsor logos. We connected the dots with the Edo and the gang from Kinetacore, and regaled them with stories of the wonderful responses we have had on our willing victims/volunteers with the intramuscular trigger point dry needling that we have recently begun practicing.

I hung my poster on the second day, Susan made sure I had wiped all the convention-pretzel salt off my mouth before she took my pictures by the poster, and got ready for the not-so-general-public. Between presentations, I hung proudly by it as I chatted to interested parties and explained aspects of the dissertation proposal to them. Some were cycling PT’s, some worked with cyclists, some interested in bikes and biomechanics, some were lost and wondering where the sweeties were.

It was 2 fast hours of talking my way around my literature base, my methodology and statistics, and it was good practice to do this in a relatively stress-free environment, with my peers. I guess it serves as some basic preparation for IRB defense, which is pending, and I imagine, will have me with much sweatier armpits than I had at APTA Tampa. I rolled up the poster, popped it back in the tube, and notched off another step on the way to the dissertation and Ph.D completion. At this point, I can look forward to being on the other side of the podium, presenting my own data, and convincing the world that I am not just a bike-nerd with a lot of fancy equipment, but have actually something interesting and valuable to offer my peers, in my overlapping PT and cycling/running/movement analysis worlds. Keep your eyes peeled!

Posted in APTA, bike, bike-fitting, cycling injuries, dry needling, PhD., physical therapy, rocky mountain university of health professions, sinead, stony Brook University, strength training and conditioning for cycling | Tagged , , , , , , , , , , | Leave a comment

on pins and needles..part 2 coming up

Kinetacore started scratching the itch, now I have a full blown addiction to needles, dry needles that is. For years, the deep hard myofascial work has been taking it’s toll, I was reluctant to beat my patients to death using firm foam rolls and hard massage balls, and I always felt there had to be a better way. Well there is. For the past 3 months, I have been recruiting friends and family to be guinea pigs in my attempt to get the requited 200 needling sessions prior to undertaking the final phase of certification in intramuscular trigger point dry needling. Or pins and needles as my peeps call it.

I have hit the sub occipital and Iliac crest boney tissues, the deep multifidus, the superficial fibers of the upper trapezius, and everything north and south of this that is within the level 1 program. My SNT or safe needling technique is down pat, and in no longer drop needles on my unsuspecting volunteers. I have been able to detect the fine differences between the squishy soft adipose (fat) in sub-dermal tissue, and the firmer, less yielding layers of fascia surrounding and between muscles. I can sense the pre-twitch change in muscle tissue as it readies for an involuntary contraction, and steadily increase the pressure of my non-needling hand on the involved limb or body part. I have only been kicked once. I have observed the myriad of sympathetic and parasympathetic responses from mild nausea, to respiratory changes, to sweating. One (male) patient was drooling. Another sweated so much from his hamstrings that I truly thought that he had peed on my table.

Muscles inhibited in lengthening, and inhibited in producing powerful movement have traditionally been massaged, acupressured, muscle energied and beaten to death, then strengthened using exercise programs that smelt of “truthiness”. Many times, in my early career, I felt that I had gotten more of a workout than my patients. Now, I use Functional Movement Screening as a cheat-sheet for dysfunctional movement, and the SFMA breakouts as pre-needling, pre-intervention motion tests. Re-testing after needling gives instant feedback about the neuro-physiological response, with instantly observed deeper squat, higher hurdle, longer SLR (straight leg raise), more comfortable HBN/ HBB (hand behind back, hand behind neck). More specific testing with grip dynamometry, combined ROM positions give more measurable results. My 21 year career happier hands, and my stimulated, inquiring brain, thank me. So do my “victims” (as they like to call themselves).

Now all we need is for NY state education department to review the scope of practice for physical therapists. The Federation of State Boards for Physical Therapy has issued a statement of support. The APTA is en route to doing so also. As a cheap, quick and reliable method of alleviating pain and improving movement, it seems a no brainer. Anyone serious about cost-saving in the health care system, and reforming practice to allow for better outcomes for patients would speed the passage of such a bill. Grumbling patients in pain will vote for it in a heartbeat. As soon as it does, all of my “volunteers” will be first in line at my office, next time, with cash in hand!

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hip hip hooray

hip hip hooray

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another kick in the hyner. coming back for more.

Devil of a drive to PA started the nerves going. Two weeks no beer, one week off wine, 10 days off coffee. The PVC’s had finally settled but the pre-race jitters were in full force. The traffic jams on the cross Bronx and I-80 were interminable, broken only by texts from Ed, Caroline and the other flatlanders in front and behind us. Dennis and I settled in for a long drive. A fitful sleep, early rise for a jolt of java and a light breakfast, and we headed from Lock Haven to the race start. Cutting things tight, as usual, we made the starting line barely in time for the hugs and high fives from our 20 fellow east-enders. GPS on, hydration pack snug, shoes, check, socks, check, I love trail running, so little stuff. We took off like the proverbial whore’s knickers, and headed for the hills. Last years knowledge of the bottleneck had prepped us for the course: we hit the first mile on the road with a vengeance, pulling a 6:30 before hitting the trail, the pack splitting up as we ran single file  on a cliff edge along the backs of the Susquehanna river. No rain this year, dust clouds taking the place of the dense fog and thunder clouds of 2011. Turning the corner at 3 miles, we faced the first climb up Humble hill, a 1000 foot climb looming over us, dragging our running limbs to a screeching halt, and forcing the first power march of the day. Calves screaming, face pouring, lungs sucking, the climb passed with more ease than I remember from last year. Those painful evenings in bootcamp with Ed were paying off. The downhill tested my inov-8’s, on their last legs, this was the swan song run. They should have been retired from last year, but I was squeezing their final run out of them, half-knowing I would be challenged later in the day by my decision. I scrambled, slipped and slid, keeping my 4th place woman by the bottom of the mountain, and headed up Johnson Run, through riverbanks, hopping from rock to rock, over logs, in and out of water, mud, moss. Settling into the front edge of my comfort zone, I was passed by a lass in a red t-shirt. (lesson #34 in trail racing: don’t be so visible to your competitors). While I hadn’t got anything to match her at that point, I knew it was a long race, and we would meet again. The climb had us pass, then fall back, then re-pass in the small group of 8 that were huffing together. The pace fell back as the red kitten led, and I felt my chance come. I knew from years of road and mountain bike racing that there is sometimes only one break chance, where the course would allow a get-away. This was it. I powered ahead, passing on the left, and broke clear of the group, suffering into anaerobic wheezing as I did so, but putting trees between us. The second peak had a magical moss floored forest at the top, and the soft terrain gave the feet a blessed break as the pace picked up. Down again, with a team mate from Team Hops, and on to the switchbacks leading to SOB. I ditched Chris on the climb, then scrambling on hands and feet to the summit of SOB, met Mike, another team mate, about 200 yards from where we had met and passed the prior year. 20 minutes ahead of schedule! He was hobbling, with cramps and aches, but I could give him nothing except encouragement. We split, and I continued the jeep road, up and up and up, to the final peak before the final descent. I had spotted #3 female ahead, 30 seconds at the top of SOB, then 20 seconds by the trail re-entry, but she was a billy-goat on the descent, 2 miles of rocky drop on tired barking dogs, and wobbly braking quads. Here my shoes reminded me that I should have splurged for a new pair, instead of waiting for the 2011 taxes to get paid. I lost #3 in the trees and the rivers of the final stretch, spotting her 60 seconds ahead on the road back to the finish. (Not that I was counting). I pulled a road pace out, and picked up speed, pounding out the last mile and scrambling back 30 more precious seconds. #5 was hard on my heels, and breathing down my neck, but the finish line was a welcome sight, and I was secure as #4 female, 1st in 40-49 AG, and 36th overall from 1000 crazy runners.

The food, the beer, the water, the friends, the fun at the finish line as we waited and cheered for our fellow nutters. 200 feet being the highest point on the east end of Long Island, we flatlanders had raced ourselves proud. While my sneakers made it home before going into the can (had to save the speedlaces), others were not so fortunate! I sympathized with the feet of the unknown runner, who left barefoot rather than taking a solitary step more in the dead kicks. Dennis, Jen and I joined the gang for some group photos, before heading into town for serious refueling. The blisters were not even popped, the delayed-onset-muscle-soreness not even begun to surface, and we were already talking about 2013. Hyner 50k this time. Bring it on!

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Back in the saddle… without having to resort to a nose-job!

Yesterdays NYT article spurs this note as I try to put it in the light of my own cycling experience. As someone who frequently fiddles with saddles, and having spent the best part of the last 15 years sitting at length on one type or another, I feel somewhat qualified to comment.

The majority of the studies to which the article referred, were completed on men, examining numbness and erectile dysfunction. Penile blood flow was examined, and seen to reduce in men using saddles with and without cut-out reliefs in their saddles. All saddles are bad, said the sheep in the media, thus cycling must be bad for men’s sexual health.

Subjects in these studies had pressure biofeedback mats placed under their junk, and sphygmomanometers (blood pressure cuffs in miniature) around their peckers while cycling, and during the night (to measure what happened during cycling dreams no doubt..) No real surprise, but they were seen to have poor blood flow in their penises during cycling. Sitting on a saddle for sustained periods made it worse. Giving them noseless saddles made it better, though many of them returned to regular saddle use after the trial periods.

None of these studies examined the response to different bike fits, all of them used stationary bikes (not the normal activity, since cyclists generally move about on the bike, on and off the saddle, less so on the road, more so off-road). No studies looked at the recovery rate of blood flow or sensation following dismounting. This Nyttimes article referenced a study looking at the same sensation effect in females, but only demonstrated a significant finding in reduction of anterior vaginal and left labial sensation. Hardly stuff to make you quit cycling. The 10 miles a week required for participation in the study widens the inclusion criteria to include relatively inexperienced cyclists, who will not likely have developed tissue tolerance to compression. Personally, reduction in left labial sensation is not detrimental to a long term sex life, but may be mildly bothersome in the short term. Women with true pudendal neuralgia and pelvic pain, (not transient numbness) will not be coming within 100 feet of a bicycle, and when they do, will be the early adopters of the nose-job saddles. I see these women in my clinical PT practice, and can promise you that even when they get the neuralgia under control, biking is not their main concern, or on their radar for a long time.

 Of course, sitting on blood vessels in squishy tissue causes a reduction in blood flow. Since nerves are supplied with blood by their own intricate network of vessels, the vasa nervorum, they will lose function when blood supply diminishes, thus the numbness. Which by the way, is intermittent, and transient. The more you ride, the more tolerant your bits become. The more you ride, the less saddle you need, and the more tolerant your plumbing generally becomes. None of these studies examined the response of the tissues to the removal of the pressure, the norm in A-B-A experimental design, examine the baseline, introduce the variable, remove the variable and re-examine the baseline. Do this a bunch, and you will likely see what we cycling lasses know, the beginning of the season sucks as we suffer numbness (bothersome but transient) and saddle sores (painful but also transient) and as the season goes on, the issues diminish. Do you really think that Kristin Armstrong would continue to race for Olympic gold if her nether regions were on fire with pudendal neuralgia? While Lance’s testicles were discussed ad nauseum over the past 10 years, there was a glaring absence of talk about his erectile dysfunction or numb nether regions. For a reason. This is entirely preventable, and correctable, and is rarely a problem in cyclists who are prepared to make some investment in investigating their “problem”.

A few of the responders to the article noted that the “fit” of the person to their bike is one key ingredient in reducing the initial issue, and minimizing long term saddle problems. Not to toot my professional trumpet as an orthopedics + sport physical therapist and bike-fitter, but this is old news to those of us in the “know” within the cycling world. A good fit will take into account much more than handlebar height. Stem length, angle of inclination, saddle length, shape, angle, height and fore-aft position, all are contributing factors. Add in potential pelvic alignment issues, leg length discrepancies and limb anomalies and you have a serious ball of wax to untangle. This is where a good professional fit can help resolve this issues, and keep the cyclist and his or her love partner, happy and healthy, on the bike and in the sack. No need to cut the nose off the saddle, although these  saddles are becoming increasingly popular with triathletes. These are the athletes most likely to benefit from a nose-job, or the truncated saddle mentioned in the article. This group has a unique biomechanical demand of a forward rotated pelvis, which is limited in its positioning options. There is a finite amount of pressure that one can sustain in this aggressive aero-position, without some serious perineal pressure and friction / compression stress. Been there, done that. (hence my personal move to mountain biking!) 

And besides, if this really was an issue, don’t you think we would hear from the women married to the peleton professionals, all up in arms claiming injury in the courts for the lack of tumescence in their nubile partners?

And what of the women of the peleton? As an erstwhile pro-1-2 field racer, I have suffered through many 5-7 day stage races, hanging in the saddle for up to 8 hours a day, and still managed to tolerate some rumpy afterwards.  While the Transrockies put a halt to my gallop, it was the mix of mud and sand in the shorts that did it, not the saddle pressure.

Discomfort does not equal dysfunction. Athletes are well aware of the difference between discomfort endured during athletic endeavors, and pain resultant from tissue injury. A simple appointment with a qualified bike-fitter will resolve this simple pain in the toosh. Bikefitplus is open for business, fighting pain, resolving problems!

Posted in bike, bike-fitting, cycling injuries, physical therapy, sinead, strength training and conditioning for cycling | Leave a comment

Lab Blab; Talking science with my homies..

With the beginning of the dissertation phase of my PhD @RMU, calling in the friends and favors has begun. I had put a request on FB for some assistance the week prior to going to the lab at SUNY SB, and had been delighted to have a list of people to call on, from the curious cyclists, to my prior Bikefit+ clients, all willing to spend a day covered in electrodes and wires in the name of science.

I picked up Emi bright and early; she was bright, I was early. I was dragging my feet after a night of fitful sleep, somewhat overwhelmed by the long road still ahead. Nevertheless, a cheery friend and a stiff cup of java was helping. Emi climbed in the car and I popped her bike on my rack, we hit the road to StonyBrook. She has been the prior victim of inadvertently reviewing many of my papers in the previous years, as I troweled through tendinopathy reviews and made critiques and analyses of experimental studies. She and I share a love of athletic endurance endeavors, as well as a history of surgery on a cranky Iliotibial band, so we always have a lot to talk about. Her practice as a veterinary physician, and travels abroad, always steer towards a fun conversation of human and canine body parts, rehabilitation and training. We met up with Jen Gatz, another fellow triathlete/coach, and now also a PhD student at SUNY SB in science education. Braniacs all round. Jen and I have has parallel paths through triathlon, into business together with Runners Lab, and now into (more) school. Always fun to share time with. Jen quickly connected with Dr Sisto, director of the research lab, and a few of the research PhD PT’s who teach on the SUNY SB course. Within minutes, they were talking credits, coursework and qualifying exams. Yummy. In the interim, I had my trusty lab assistant (long chinese name prefers the convention of American “Joe”) hook Emi up with a full-body-gait set of reflective markers (36) and many leads for bilateral lower extremity muscle surface EMG collection (16 leads). Emi clambered on the bike and waited patiently while Joe and I calibrated the VICON, the EMG and the high speed DV cameras, then waited again while Nexxus crashed then re-booted, then waited again while I repositioned her sternal  and C7 reflectors.  This humdrum part of the great scientific experiment is not for the faint of heart, as the excitement might be too much. Jen sat patiently as I fumbled though one independent variable (medial wedge on foot-pedal-interface) with 3 levels (control/ no intervention, 3 degree wedge, and 6 degree wedge.  Kudos to Paul Swift who had hooked me up with a kit of 12-18mm long cleat bolts, a pick for getting the muck out of cleats, and to Dennis for “loaning” me his fancy schmancy ratcheting screwdriver which made the process faster and made me look like a tool aficionado. I often have difficulty in my bikefit clinic with switching tools out, and promised myself a toolbelt, to minimize dropping, losing, misplacing the very tools I was looking for. One of my patients gifted me a tool belt designed for women, having heard me complain one day about the hardware store belts dropping from my skinny athlete hips onto the floor when fully loaded. I needed a tool holster, and BarbaraK delivered! Note to self to bring it to RRAMP next time..

Onwards with science: three hours of fiddling, recalibrating, revising commands to my patient subject, and I had collected a sum total of 3 minutes of data. Too much for my 250 gigabyte external hard drive, between EMG, 3-D motion analysis and high speed video. Holy cow. Joe and Dr. Sisto advised me to bring the 2 terabyte drive that I had in reserve, for back up of the back up of the back up. This is apparently a normal process in data collection, in case the computer that backs up the computer that backs up the computer s****s the bed.

Despite the long lab day, I was internally delighted since the night before, I had received notice from the university registrar in Utah, of “unconditionally” PASSING my core curriculum and specialty qualifying exams, and thus was allowed to proceed with CANDIDACY status in the PhD program at RMUoHP. yaaay.The sisyphyean boulder of stress had rolled off my back, as I entered this next phase of the PhD. After today’s arduous process with a single subject, I re-calculated the time that was going to be required to get through the pilot study, then the IRB, then the actual data collection. And figured that I might be using a walking frame and have a long beard by the time I was done with 40 subjects. I planned on reviewing my G*power analysis, doubling down on efforts to refine measurements for increasing accuracy, thus increasing my effect size and reducing the number of potential victim/ subjects needed in order to graduate before the next millennium. Or at least before I qualify for Medicare.

Next step: IRB application. Bring it on. I am strong.

Posted in bike-fitting, PhD., physical therapy, Uncategorized | Leave a comment