Wednesday, August 28, 2013

Delayed Onset Muscle Soreness (DOMS)

Delayed onset muscle soreness (DOMS) is all too familiar for the elite and novice athlete alike.  DOMS results from intense exercise to which the athlete is unaccustomed, especially at the beginning of the season, after some time away from training.  Although it appears to result more from eccentric (weight lowering, running downhill) movements, the exact cause is unknown.  What is known is that the soreness can be debilitating and can lead to a decrease in peak strength, increased in perceived exertion and pain with movement.
Anti-inflammatory medications (Ibuprofen 400mg every 8 hours, started 4 hours before exercise) and Vitamin C (200mg twice a day for 2 weeks before starting exercise) can help to decrease the pain and soreness, the role of massage is less well known, but appears to have some positive effects on recovery.
Exercise is the most effective modality for decreasing pain from DOMS, but the effect is temporary.  Most DOMS will resolve spontaneously in 2-3 days after exercise.
DOMS should not persist with each exercise session and might underlie more serious problems if it persists.

  Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness : treatment strategies and performance factors. Sports Med. 2003;33(2):145-64.
  Farr T, Nottle C, Nosaka K, Sacco P. The effects of therapeutic massage on delayed onset muscle soreness and muscle function following downhill walking. J Sci Med Sport. 2002 Dec;5(4):297-306.
  Hilbert JE, Sforzo GA, Swensen T.The effects of massage on delayed onset muscle soreness. Br J Sports Med. 2003 Feb;37(1):72-5.
  Scott KE, Rozenek R, Russo AC, Crussemeyer JA, Lacourse MG. Effects of delayed onset muscle soreness on selected physiological responses to submaximal running. J Strength Cond Res. 2003 Nov;17(4):652-8.
  Thompson D, Williams C, McGregor SJ, Nicholas CW, McArdle F, Jackson MJ, Powell JR. Prolonged vitamin C supplementation and recovery from demanding exercise. Int J Sport Nutr Exerc Metab. 2001 Dec;11(4):466-81.

  Tokmakidis SP, Kokkinidis EA, Smilios I, Douda H. The effects of ibuprofen on delayed muscle soreness and muscular performance after eccentric exercise. J Strength Cond Res. 2003 Feb;17(1):53-9.

Thursday, July 18, 2013

Fluids and Electrolytes in the Heat

It's hot out.  As Eugene Morris Jerome said in Neil Simon's Biloxi Blues:

"It's like Africa hot. Tarzan couldn't take this kind of hot."

How can someone tolerate this heat better?  The right amount of sodium and water.  In a 2012 research study from Scandinavia (when does it ever get that hot in Scandinavia?), water was compared to water and varying amounts of sodium.

Ninety minutes before exercise, participants ingested 10 mL of water/kg body mass either alone or with approximately one or two teaspoons of salt. Participants cycled  for 2 hours at low-moderate intensity immediately followed by a time-trial. 

After 2 hours of exercise, plasma volume dropped by 10% with 2 tsp of sodium, 12% 1 tsp of sodium 16% without sodium. The drop in plasma volume is likely from sweat loss.

Pre-exercise ingestion of salt plus water maintains higher plasma volume during dehydrating exercise. Sodium and water do not keep the cyclist cooler.  However, the sodium smoothie maintains cardiovascular function and improves cycling performance.

To figure out how many milliliters of fluid you need, divide your weight in pounds by 2.2 and multiply by 10.  A large 24 oz water bottle is approximately 700ml.

Add 1 tsp of sodium from regular salt

Ingest 90 minutes before exercise.

Sunday, March 31, 2013

Top Marathon Training Mistakes

Not Enough Fluid
We’ve all heard it many times, “Hydrate, hydrate, hydrate.”  Especailly in warm weather, the body can dehydrate quickly.  With even 1-2% of the body weight lost as sweat, performance will suffer.  Training should include hydration so that you will be able to drink during the event.  Practice keeping up with your fluid losses, especially for an event that lasts more than 1 hour.  How much should you drink?  That depends upon how much you are losing.  Weigh yourself before and after a 30 minute training session.  The weight you lost equals how much fluid you lose every 30 minutes (one pound equals 16 fluid ounces)

Too Much Fluid
When you become too focused on hydration, it is possible to drink too much.  Excess fluid will cause you to dilute the electrolytes in your body, possibly causing confusion, cramping and even seizures.  

Not enough carbohydrate
When you combine endurance training with calorie restriction, you create a recipe for disaster.  Prolonged endurance workouts require calories from carbohydrates to keep the muscles fueled to work adequately.  If you don’t eat before a long or intense workout, you set yourself up for muscle fatigue and perhaps injury.  If you cramp after eating, consider taking liquid “meals” before training.  Cool, dilute (5 grams of carbohydrate in every 100ml) liquids

Not enough intensity
Endurance event training relies not only on your slow twitch (Type 1) muscle fibers, but also on your fast twitch (type 2) fibers to provide you with power.  Training at an intensity below which the type 2 fibers are used will leave you out of breath when you hit a hill or when you try to pick up the pace.

Inadequate Taper
Training today will take about six weeks to see an increase in fitness.  Training hard in the week before an important event will only maintain fitness, not improve your fitness for race day.  Over the last week to 10 days prior to an important event, decrease the amount of time you spend training by half while keeping your intensity the same.

Doing what the other guy did
One of the biggest problems with training for any sport is following the training plan of a friend or professional racer.  Every person has a different muscle fiber profile and will respond differently to the same plan.  To truly understand what will work for you, a number of variables need to be taken into account—most of which are only determined through exercise testing.

Too much too soon
If you have never tried a particular food before, you wouldn’t stuff your mouth the first time you tried it.  The same is true with training: take a taste before you sit down for a full meal.  Start out slowly and progress.  Make sure that your shoes are comfortable, that your sunglasses fit, you aren’t developing any injuries and any chafing is addressed before continuing to add miles.

Improper footwear selection
The foot has two arches, one that runs the length of the foot and one that runs across the foot.  Different feet need different support for these arches, some feet even need orthotics whether over the counter or custom.  Be sure your footwear selection matches your feet before undertaking large volume training.  A good running store, sports medicine physician or biomechanist can help find a shoe that is right for you.

Running Through Pain
Ignoring aches and pains and letting them progress to chronic overuse injuries is common.  If you want to be pain free and complete your goals, don’t ignore pains while they are still easily treated.  

Forgetting the rest of the body (core)
Although marathon training should involve lots of running, it should also involve core training.  The core, defined as the muscles that stabilize the trunk so that the arms and legs can do their thing, plays a very important role in increasing speed and limiting injuries.  The hip stabilizer muscles in the butt can be strengthened with side planks and lunges.  Training should be functional and based upon weight-bearing exercises (sitting in a thigh-toning machine won’t necessarily help for running).

Wednesday, October 10, 2012

Re-thinking Triathlon Death

During last triathlon season, there were a string of deaths in the water.  Fourteen deaths in races were largely from swimming (one death occurred on the bike)

These unfortunate events led a Washington Post writer to postulate that the deaths during the swim were the result of panic attacks.  I have also heard medical personell postulate that these events were the results of heart attacks and heat stroke.

Of the deaths, the mean age was 44 and 11 were men.  6 deaths were in sprint triathlon (1/4-1/2 mile swim, 12 mile bike, 3.1 mile run), 4 in Olympic distance (1.5k swim, 40k bike, 10k run) and 3 in the longer distances (half Iron distance or Iron distance 2.4mile swim, 112mile bike, 26.2mile run) 

The cause of these deaths has been ruled drowning, but no matter what the cause of death, if it occurs in the water, chances are it will lead to drowning.  Feelings of panic are commonplace in open water, mass start events, but they do not mean that they are panic attacks.

You can feel panicky from too much coffee, a rapid heart rate, feelings that you can't breathe, etc.  It is the things that cause the rapid heart rate and rapid breathing that can lead to metabolic problems which can lead to fatal problems.

Let's examine what happens when you jump into a cold lake.  Most swims are in bodies of water that are at least 10 degrees colder than body temperature.  Cold water immersion leads to a phenomenon known as the Mammalian Diving Reflex.  This reflex decreases breathing and slows the need for oxygen and is life saving for non-swimmers and children who fall into water .  

The more dangerous response is the Cold Shock Reflex. This reflex will cause you to take a deep breath, followed by uncontrolled hyperventilation.  A triathlete who jumps into cold water, or at least puts their face in cold water, will have a temporary breath-holding reflex.  If this same triathlete starts swimming quickly, they would be out of breath before even starting.  Imagine running down the block while holding your breath; you would feel out of breath very quickly.  

Hyperventilation will happen immediately following and is one of the components of feeling panicky.  A rapid rise in heart rate will also accompany the Cold Shock Reflex and can also lead to a feeling of panic.  A tight wetsuit can make breathing difficult as well.  It is these heart and lung changes, not panic, that are responsible for many open water deaths.

In a 2010 review of triathlon swim deaths, 7 of 9 patients were found to have cardiac abnormalities.  However, 6 of the 7 were found to have left ventricular hypertrophy, which is a common finding in endurance athletes and is expected in trained endurance athletes.  One of the patients had abnormal coronary arteries, which may have contributed to the death.  This is not compelling evidence that there is a cardiac cause of sudden death in the water.

Hyperventilation can have a negative impact on the lungs.  It is not uncommon for hyperventilation to have an effect on the airways and lead to coughing or even spasm of the vocal cords.  This makes it harder to breathe and leads to increased hyperventilation.  Which can in turn lead to increased anxiety.  Anxiety worsens the cold shock response.

With repeated cold water immersions (4 days apart), the amount of hyperventilation is shorter and not as much.  Less frequent immersions diminish the length but not the magnitude of the response. One way to reproduce this habituation to the cold shock reflex is taking repeated cold showers at 50 degrees fahrenheit for 3 minutes.

3 minute showers at 50 degrees may save your life

Finally, how can we screen for the ill-effects of the cold shock reflex?  One way is to perform maximum hyperventilation while monitoring lung changes.  This is a regular component of the cardiopulmonary exercise testing. If changes in measured lung volumes or coughing is present, perhaps these changes should be treated.  Standard cardiac stress tests will probably not be useful for screening for the cold shock reflex.  If we are to prevent triathlon swim death, other tests and decreasing the response to cold water are essential.

Saturday, August 11, 2012

Caffeine and Cycling time trials

I'm a big fan of caffeine. A caf-fiend, some might say. It is rumored that ethiopian shepherds first noticed the effects of caffeine after observing energetic behavior in their goats who had just eaten coffee.

Athletes are looking for that same energy.

Two recent studies on caffeine are worth mentioning.  In the first, a caffeine related improvement in performance was seen, but not in everyone.  Although 7 out of 9 individuals had improved performance, the overall improvement in performance was 1.6-1.9%. 

The dose of caffeine used was 5mg/kg, taken 90 minutes before exercise.  Caffeine doses between 3 and 6 mg/kg have also shown improvement in performance.

The same authors also found that caffeine, caused an improvement in cycling performance in trained individuals, which might help explain why only 7 of 9 individuals did better.

Caffeine increases heart rate and decreases mood, two side effects that you might not want.

Caffeine works by increasing adrenaline which, in turn increases circulating fatty acids that can be used as fuel.  If you are using predominately slow twitch fibers, then you will have more of an effect from the caffeine than if you are using predominately fast twitch fibers.  Of course, everyone has a different muscle fiber profile, so if you don't know yours, then it will be hard to determine if caffeine ingestion will work for you.

Some other interesting caffeine facts:
  • Eating green leafy vegetables will lessen breakdown and clearance of caffeine , giving an extra kick (Kale latte, anyone?)
  • Taking Zantac (cimetidine) will also keep the caffeine from being broken down
  • You don't need to withdraw from caffeine to have it make a difference
  • Repeated small doses of caffeine (1-2g/kg) during prolonged exercise can also help


Astorino TA, Cottrell T, Lozano AT, Aburto-Pratt K, Duhon J. Effect of caffeine on RPE and perceptions of pain, arousal, and pleasure/displeasure during a cycling time trial in endurance trained and active men. Physiol Behav. 2012 May 15;106(2):211-7. Epub 2012 Feb 12.

Astorino TA, Cottrell T, Lozano AT, Aburto-Pratt K, Duhon J. Increases in cycling performance in response to caffeine ingestion are repeatable. Nutr Res. 2012 Feb;32(2):78-84.

Graham TE. Caffeine and Exercise; Metabolism, Endurance and Performance. Sports Med. 2001. 31(11); 785-807

Sunday, July 22, 2012

Matty Reed in the Performance Lab: Part 2

The Bike Fit
One of the most important things to remember about bike fit is that power output depends not only upon angles, but also upon the rider’s strengths and weakness and how to make a rider stronger.

After series of single leg squats, planks, and joint mobility measures, it was clear that the position of comfort and maximal power would depend upon further stabilizing Matt’s core muscles.  His aerodynamic position was already  tested in the wind tunnel, so I was more concerned with keeping his frontal area minimized while changing his core stability

Because riding position changes with different power outputs, it is important to use a point on the power curve that approximates race-pace wattage.  The point that we chose was where lactic acid starts accumulating.  By testing the bike fit at this point, we could see how the changes were affecting him.

After a few changes to his elbow pads, we did another trial at race wattage.  His exhaled carbon dioxide dropped, meaning that he was not accumulating lactic acid.  
Moving the elbow pads further forward let Matt use his aero bars as levers to pull back and activate some of his core muscles which gave him more power as he pedaled.  My big concern was that this position might lead to more acid accumulation, since he was using more muscles, but the changes resulted in less lactic acid accumulation, meaning he could pedal harder before the burn of the lactic acid would cause muscle fatigue.

Using stop motion video, I was able to measure and maintain his hip and knee angles that he was comfortably using. 

He had two weeks until his next race the Boulder, Colorado 5150, in which he got second place.

Sunday, July 15, 2012

Matty Reed in the Performance Lab: Part 1

A project about making a great triathlete better.
I got an email about helping out Fuji sponsored rider Matt Reed with a bike fit.  It seems that even though he was having great results all season, including a frigid win in Boise 70.3, he felt as though he wasn’t getting the power output he wanted and it was harder on the bike than in previous years.

Matt came to the Performance Lab following a 5th place in the Philly Olympic Triathlon.  I felt a little bad knowing that he raced just the day before and was now going to be doing a maximal test.  VO2max testing would help us establish his muscle fiber profile and would also give us some good power benchmarks to use for bike fitting.  On the way to reaching VO2max we can figure out how the heart lungs and muscles work together.  By analyzing the data we are able to identify where he maxed out his slow twitch fibers, his anaerobic threshold and his VO2max.

Many of the elite/pro half iron distance triathletes that I have tested have a similar profile, that is they are largely aerobic machines, using their slow twitch fibers to move them.  Once we were done with our testing, I knew that Matt was different--he has a lot more anaerobic fibers than most, which is where he gets his power.  The anaerobic fibers (also called fast twitch or Type II) are 5-10 times more powerful than slow twitch fibers.  The drawback is that fast twitch fibers can fatigue faster.

Once we know where Matt is getting his power, I gave him specific wattage based intervals to use which will help him target his strengths.  On review of the testing I was able to give Matt his nutrition requirements for the different muscle fibers that he is using when he races.
At the end of the test, I asked how he felt.  His answer? “If I knew I was going to be doing a VO2 max test, I might not have had the Ahi Tuna for lunch.”