Fitness In June

If anyone out there is looking to build in June, here is a bit of perspective that I find myself in again.

One of the most difficult things to do in any sport is enter the season midstream and perform. I always dreaded the when one of my athletes had an injury at the beginning of the season and had to get back into racing in June/July. It is very difficult to replicate game/race intensity in training. Additionally, there is a rhythm to get back into of how the bike moves, how the race plays out, etc. Then comes the first few races for the athlete, where they find themselves suffering and not placing well.

So this is where I find myself. I discussed my training camp to kick it back in and I have now been consistently getting on the bike. I raced last Tuesday and had mixed results. I didn’t finish last, but I didn’t finish 1st either. The race is on a course that I have had plenty of success and I haven’t finished out of the top 10 in a long time, years. And I often have contended for the win or won. This week I finished out of the top 15. Two days later I hit up the Bus Stop ride and did a bit better, winning the intermediate sprint and getting 2nd in the final sprint. Unfortunately, there weren’t too many super fast folks on the ride, so those results are with a grain of salt.

I have a lot of holes right now in my fitness.
1.Endurance : I would say my endurance is at a 7 out of 10. I have good tempo endurance, but not as big of a base as I should have this time of year.
2.Climbing: 8 out of 10 (which is like a 5 out of 10 for most folks). I am climbing well for me, but that doesn’t really help me out too much in my racing.
3.Speed: 6 out of 10. This is a big weakness right now. I just don’t have the high end. It is an odd feeling because this is usually where I am strongest. I love the 53×11 roll and I am struggling with how uncomfortable I am when the pace is high.
4.Sprinting: 7 out of 10. I can almost always uncork a fast sprint, no matter my fitness. However, repeatability is quite low. I have 1-3 good sprints in me on a ride. I need to both improve my speed and my ability to recover quickly. Another previous strength.

So what am I doing about this? For one I am completing a balanced training plan that will have me overreaching and playing with overtraining. I will be working on the endurance and speed portions on the list the most. Long rides, extended race pace efforts, and repeating high intensity efforts. The balance of pushing myself, and not going over the edge, in an effort to improve to quickly will be the difficult part of the equation.

There is also the mental portion of this, I have to have confidence I’ll get there. It is so odd to have the elements that are usually your go to strengths not be there in June. One advantage of being a “seasoned veteran”(code for old guy) is that you have been there before and there isn’t too much panic. I know that if I put in a solid month and do the critical training that I will be at 9 out of 10 quickly. I’ve simply gone through it enough times.

Just excited to get something posted on my new road bike. I’ll get in to depth more when I get some time. Summary: Best riding bike I’ve ever ridden.






I am trying to keep a set interval for posting about my knee since when I looked for any information there wasn’t much out there that was first person. Sure, I found plenty of 8-12 weeks for _____, but not much from the patient side. Since I am a huge believer in patient directed care, having some independent research is always a good thing when talking with the Doc and other providers.
So here I am, at 43 days in and feeling MUCH better. I can now run a bit without any pain and I can ride my bike pain free. I was able to play tennis with the kids without much of an issue. I will say, my knee definitely gets sore after most any activity outside of biking. It feels very stable and just has a sharp pain every now and again, often not even around my MCL area. I think my knee is beginning to figure out that it is back in action and the little muscles and other support mechanisms are getting back up to speed.
I still have trouble sleeping. Anytime it is in one place for too long it gets sore. So I have a fare amount of pain at night and have to move quite a bit to keep it from getting too freaked out. The more activity I have had that day the worse this seems to be.
My range of motion is about 80% without any pain and 90% pushed. I think the last 10% will be hard to get to, but I suspect it will come naturally if I stay active.
Where would I say my recovery is? I would say I am about 80% as good as I used to be with that knee. It still limits my activity and I wouldn’t be able to play a soccer game if my life depended on it, however I can get out and play around with the kids with confidence. I think that if I could train hard that I could be back racing my bike pretty soon. My knee doesn’t seem to be the limiter there, more my fitness. Although the most I have ridden is about 2 hours. The cool thing is that my knee feels the best after a bike ride. It seems to get everything moving quite smooth in there and really frees up the motion. It feels the worse if I don’t do anything or if I stand still for a long time (working on building bikes.) It seems to have mixed reviews from tennis or any other running/jogging. Sometimes it feels great, others it is sore. Swimming is actually a great strength workout for my knee and it can feel pretty worn out after swimming. That seems to be the most strenuous, but not impactful activity I do.
My gut is telling me that soccer is out for the summer, but possibly back on in the fall. I think I could be riding pretty far pretty soon if I can get my fitness back up. I also think that I could mountain bike now since it feels quite stable. Running long distances seems a bit much now and I think I’ll have to start running very slowly at first to see how that feels.

As I mentioned, my magician massage therapist (www.rainingfaith.com) recommended no ice for my knee. I did a bit of research and found this which is much closer to my personal beliefs. (movement is better than immobilization and exercise is an important part of recovery) The website I pulled this from is: http://www.caringmedical.com/sports-injuries/meat-vs-rice-treatment/

MEAT vs. RICE Treatment

MEAT Treatment vs RICE TreatmentTraditional modern medical treatment for acute injuries, such as those that occur during active sports, usually receive the RICE protocol. In fact, it’s become a standard for sports injuries and pain management. RICE, by the way, stands for Rest, Ice, Compression and Elevation. A “P” is occasionally added to the equation. It stands for Protection, and consists of bracing or taping the area. In addition, most injured individuals are also encouraged to take anti-inflammatory medications. Unfortunately, in order to help heal injured ligaments and tendons, there couldn’t be a worse approach. Read on to find out how the RICE protocol came about, why it’s counterproductive to healing and why the MEAT (Movement, Exercise, Analgesics and Treatments) protocol is the best way to heal weakened and injured ligaments and tendons.

The RICE protocol
Ligament sprains are often accompanied by quite a bit of painful swelling, also called edema. A key premise of the RICE treatment is that this swelling is harmful to the tissue and needs to be minimized. In fact, sports medicine specialists and athletic trainers have fallen into the trap that muscles are like tendons and that tendons are like ligaments. Yet that couldn’t be further from the truth. Understanding the difference between ligaments and muscles is crucial to understanding why the RICE treatment is totally inappropriate for healing tendons and ligaments.

Comparison of Muscles and LigamentsMuscles, because of their good circulation, heal quickly and rarely cause a long-term problem, whereas ligaments, due to their poor blood supply, often heal incompletely and are the cause of most chronic sports injuries and pain. And while the accumulation of fluids, or edema, can in fact be harmful to muscles in the form of compartment syndrome, this does not apply to ligament and tendon injuries. Compartment syndrome occurs when swelling due to an injury places pressure on the muscle tissue, which decreases circulation and healing, which cause further swelling due to fluid accumulation, which decreases healing even more. This vicious cycle can lead to permanent muscle, nerve or circulation damage, which is why the RICE treatment has become an established protocol for muscle injuries, but unfortunately has inappropriately been applied to ligament injuries as well, which operate under an entirely different set of circumstances.

Ligaments are the small and mighty bone binders – they bind together bones at the joints. They are made of collagen, one of the strongest substances in the human body. Ligaments normally receive blood vessels from small arterial plexuses from the joints, but they themselves have essentially no blood vessels. If the blood vessels from the small arterial plexuses are sheared as the result of an injury, the limited blood supply that ligaments get is completely cut off. Furthermore, the blood supply to the ligaments is the poorest at the point where the ligament attaches to the bone, called the fibro-osseous junction. This point is also the weak link in the ligament-bone complex, and the area most commonly injured during sports and responsible for most lingering sports injuries. And this is the exact site where Prolotherapy is administered! But we’re getting ahead of ourselves. Let’s briefly review why the RICE protocol is inappropriate for ligaments.

Why RICE prevents healing
MEAT vs RICE treatments chartAll of the components of RICE – rest, ice, compression and elevation – are designed to decrease swelling, and pain, by decreasing the circulation to the area, which is exactly what ligaments need to heal faster. Rest, compression and elevation, that is, immobilization, is extremely detrimental to joints and ligaments. It lowers the metabolic rate in the area. Ligaments heal slowly by nature, and they take twice as long to heal if immobilized. The fibro-osseous junction, the principal site of Prolotherapy treatments, heals even more slowly. Ice has a similar effect. And while lowering the temperature of an area is critical for certain surgeries and limb-salvage operations, where a lowered metabolism can mean the difference between success and failure, this is not so for injured ligaments. Ice leads to lower temperatures, which leads to lower metabolism, which leads to slower healing! And to make matters worse, injured athletes often continue their activities after getting “relief” from RICE, making themselves susceptible to further injury. Here’s why. The colder a ligament, the less force is needed to deform it, which is one of the reasons many athletic injuries occur in cold weather. In summary, anything that decreases the metabolic rate or blood supply to ligaments, such as rest, immobilization and ice, will further promote the decline of the ligaments, and profoundly delay their healing.

The MEAT protocol, and why it promotes healing
The more conservative, and effective, treatment for acute injuries to ligaments and tendons is the MEAT protocol. As mentioned earlier, MEAT stands for movement, exercise, analgesics and treatment. While immobility is detrimental to soft tissue healing, movement is beneficial because it improves blood flow to the injured area, removing debris. One of the effects of movement is the generation of heat, which increases blood flow. This is why the application of heat is also recommended for ligament and tendon injuries. Gentle range-of-motion exercises also help improve blood flow to the injured area. Natural analgesics, or painkillers, such as proteolytic enzymes, which break down proteins, aid soft tissue healing by reducing the viscosity, or stickiness, of the extracellular fluid. Examples include bromelain (from pineapple), trypsin, chymotrypsin and papain (from papaya). Reduced viscosity of the extracellular fluid in turn increases nutrient and waste transport from the injured site, reducing swelling, or edema. In other words, natural analgesics decrease the painful swelling of soft-tissue injuries but do not stop the natural inflammatory reactions that lead to healing, unlike anti-inflammatories, which can actually hinder healing.

Narcotics such as codeine may also be prescribed short term for very painful injuries. In the short term, they are very helpful because they relieve pain without interfering with the natural healing mechanisms of the body. In fact, our bodies produce our own narcotic, called endorphins, which are released in response to an acute injury to reduce pain. Other options for pain control include pain relievers that are not synthetic anti-inflammatories, such as Tylenol or Ultram. They help relieve pain without decreasing inflammation, a critical part of the soft-tissue healing process.

And finally, treatments are used to increase blood flow and immune cell migration to the injured area that will assist ligament and tendon healing. Treatments include physical therapy, massage, chiropractic care, ultrasound, myofascial release and electrical stimulation. All improve blood flow and help soft tissue to heal. If the treatment has not healed within 6 weeks, more aggressive treatments, including comprehensive Prolotherapy, should be considered. Of course, we treat many athletes at Caring Medical where time is of the essence. In these circumstances, we utilize comprehensive Prolotherapy as an effective treatment for acute pain, particularly in the case of acute sports injuries. In summary, the MEAT protocol is more effective and expedient than the RICE protocol when it comes to healing ligament and tendon injuries.

Normally I wouldn’t think I would need to post again so quickly, but there has been quite a bit of progress in the last 9 days.
The first big difference is that not having the locked leg has allowed day to day activities to become part of my recovery. I can now walk up the stairs using my bad leg and it helps work the joint to become both stronger and more flexible.
I went to a PT and a Massage Therapist in the week after my appointment and I have begun more aggressive ROM at home.
Brian at ESPR was great to fit me in on very short notice and gave me a comprehensive education on rehabbing the injury. Due to my schedule, I will have to do quite a bit of the rehab on my own and his information is critical in learning how to do that at home or during travel.
Gibble at Raining Faith is always my go to miracle worker and he was able to work on my knee, but also give me a lot of recovery advice. One aspect he mentioned is that he has gone away from icing injuries. As I have posted in the past, I have been using ice a lot on my knee. So this last week I have limited the ice usage to see how it feels. I need to look up a few of the articles he was quoting to learn more. Since I trust Gibble explicitly, I am going no ice for a while.
What am I doing?
• I am swimming 3-4 times a week. Aggressively. No letting my leg hang anymore. I am also incorporating treading water with a running type motion.
• Hiking. My brother and his family came to visit and we went for a pretty steep and rocky hike. The leg felt pretty good and was aided by the fact the little kiddos kept the pace pretty slow.
• Walking. I did a 3 hour walk at one of my project sites on Monday night. That helped a lot.
• Biking. I was able to get out a ride for 30 minutes yesterday. With my original bike seat height. It was great. It is actually pretty easy to do now, but my knee area feels numb and swollenish. I can get the ROM OK, but engaging the muscles in my leg and around my knee is pretty hard to do. I went about 10 mph and my leg was pretty tired afterward. Not cycling tired. Just tired.
How does it feel? Very stiff in the mornings still. I have been swimming in the mornings and it feels better afterward. It feels very reliable, but I can have pain occasionally that surprises me. I don’t feel like it is going to give out at all. It does feel a bit loose sometimes, just for a split second. It is usually when I am lifting my leg to go up a step or something similar.
One thing I want to make note of – It usually feels worse after any type of ROM or exercise. The knee doesn’t feel like it is making any progress, then one day it suddenly makes a big leap. So it has been 2 days for frustration, then 1 day of elation, followed by 3 days of frustration, etc… I think it is important to think about the recovery like you would any other type of adaption. You actually get faster/better/healed during the recovery periods. I am the type of person to just work it to death and keep trying to make it better faster. But I am realizing that resting it is just as important. So I am trying to find that balance for myself.

It has been quite a roller coaster ride, but I am finally feeling some progress. I had my check up with the Doc I was given permission to begin range of motion exercises after 24 days of wearing my brace. He was extremely pleased with my progress and gave me a 1-2 months until I can start doing whatever I want. Of course with the caveat that it can take much longer and that it isn’t something they can provide an exact day of recovery. Regardless, I was walking on air after the appointment. Initially, I was told it could take up to a year, so this was quite good news.
The plan at this point:
1. Adjust the brace. The brace is unlocked and so it really is just support and doesn’t restrict movement too much. I was told to wear it for another 10 days or so.
2. Range of Motion. 2-3 appointments a week with a Physical Therapist to start on ROM. The Doc put on the prescription 4-12 weeks.
3. At home PT. ROM work several times a day with ice, etc. still a part of recovery. Start riding a bike immediately. (Although there is NO way that is possible since I can’t bend my knee hardly at all)
How does it feel? Not great my leg is still pretty sore and it does NOT feel like it will get better that quickly. It feels solid. But I can’t move it much and it aches all night. It is pretty hard to find a good sleeping position. In my gut: I won’t be riding for several weeks and I won’t be ready to do whatever I want in a month or even 2 months. This thing feels like a long haul.

MCL Update

I am now 12 days into my recovery. My knee is feeling much more stable and I am just starting to be able to walk close to normal. I still have a fair amount of swelling around my knee, but it is ½ of what it was before.
The biggest challenges currently are:
1. The brace needs to be tight to keep my leg locked in place; however it definitely can affect my circulation. I’ve had much more pain with swelling than I have had with the actual knee. I try to get up frequently and keep moving as much as possible.
2. The brace keeps my knee at a 30 degree bend and requires me to walk quite strangely. This has a great potential to cause muscle strains and other ligament issues due to the supper odd way of getting around. I’ve had a few Achilles and calf issues that have popped up.
3. Sleeping is still difficult. I have to adjust my brace for circulation issues or my leg gets really sore.
4. Mornings are painful due to stiffness. This has been getting much better the last few days. But my knee is definitely tight still, just not completely locked in place.
I do feel like I am making progress. Enough that I tried talking my doctor into letting me start range of motion exercises now. Unfortunately, he didn’t go for it. My biggest concern (outside of having a permanent knee issue) is that my recovery will take forever due to a lack of mobility. Since my knee is locked at 30 degrees with the brace on, which is 95% of the time, it is also locked at 30 degrees with the brace off. I’ve seen varied reports on this online. I am hoping mobility comes back quickly and it is mostly a swelling issue.
My current plan is:
1. Ice 3-5 times a day.
2. Keep it elevated as much as possible.
3. I am walking around a bit. Quite slowly.
4. Swimming. I tied to swim 7 days in and it didn’t work out. I was able to put an hour in the pool yesterday and it felt pretty good. Only 10 times did it bark a tiny bit on the MCL area. I went to swim this morning, but decided against it. I don’t want to do too much too quickly.
5. Stretching. I am trying to stretch a lot. I can actually do a fair amount of stretching with the brace on and not put any tension on the MCL. I hope this prevents any secondary injury and helps keep my legs somewhat strong.
6. Lifting. I was given the OK to do whatever upper body workouts I want. I don’t do a lot of upper (any) body work usually. Just core and swimming. So I got out a few weights and knocked out a few pushups. It was OK. Not as fun as riding or trail running, but it was a workout at least. I guess I’ll keep it going as a way to stay a bit fit while I am recovering.


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