25 June 2015

Back in Chamonix

I am back in Chamonix for this year’s first race – Mont Blanc 80 km. Feel quite unprepared for the start 4 am tomorrow morning, in five hours, as I flew in today. No drop-bag for this short race, which makes the bag quite full at least in the beginning of the run. The weather is great and looks to stay the same tomorrow – will be almost too warm down in the valleys I fear – and the course amazing. Testing some gear and will report later here.

Mont Blanc and Lac Leman viewed from the flight. Great summer weather.

The feet are prepared for tomorrow morning.

Too much gear for a day´s run

15 June 2015

I am a runner…

…and not a cyclist. And neither any longer a swimmer, somewhat to my surprise. And, I have clearly during the last few years focused on long endurance training for mountain ultramarathons and not shorter distances. So, afterwards, it is almost funny to think that I had quite high expectations before my first triathlon. Uppsala Triathlon was an Olympic distance competition, for those like me who until recently do not know what this is it is 1500 meters swimming, 40 kilometers cycling and 10 kilometers running. Certainly not Ironman distance, but a good beginners distance I thought. The race was in my backyard in central Uppsala where I live and perhaps that was what made me sign up for the race. Or perhaps it was the fact that my wife had tricked me into believing I was a better cyclist than I really am. 

Or perhaps it was the fact that I now in fact finally had a road racing bike for the first time in my life and during the past weeks put in some serious mileage in cycling that made me sign up for the race. If someone had said to me that; ”Hey, I have bagged some serious mileage and vert during the last few weeks and now I am ready for a mountain trail run” I would probably silently, but kindly, have laughed and given the advice to come back next year with at least months instead of weeks in the legs. And swimming; “Hey, I swam a lot in my youth, so I certainly know how to crawl and now I have been to the gym much lately so what could be the problem – I do not need to train at all”. “That it is open water swimming upstream in a freezing cold river? No problems, I just have to get a wetsuit”. What was I thinking?? Well, I guess I this weekend learned that I am still one of those boys who do not learn that the plate is hot until I have been burned. I also learned that my mantra of race specific training is even more true when talking about biking and swimming.

The swim has started. I am still over the surface, but not for long. Picture from UppsalaTriathlon Facebook page

So, starting with the good experiences:

·       The event was excellently organized and for a beginner it felt extremely safe all the time. There were plenty of volunteers out this early Sunday morning in rain and 12°C (53.5°F) to make sure in particular the road crossings were free from cars when cyclists arrived. The race was held in central Uppsala with a lot of logistics and I am really impressed by the organization – hats off!

·       My secret recipe of carbohydrate loading worked extremely well. The fundaments are, among other things like pre-loading gels, blueberry soup and peanut butter sandwiches, and despite cold weather and rain my stomach worked perfectly the whole race.

·       I have switched to liquid drinkable gels and when I in a race like this did not have to carry them over some mountain summits they were perfect. Together with the carbohydrate pre-loading and some sips of sports drink during the running I could not have been better fueled and I am happy my muscles did not complain either.

·       Biking is fun. I felt really strong going uphill and either passed or could keep the same pace as other, much better, cyclists, during the climbing sections. I also got gradually better, or more daring, during the steep downhill sections on the wet slippery asphalt and towards the end of the race during the last two laps out of five I was quite fast there as well. It is fun to go fast.

·       Not considering the swimming where it felt like I struggled to even stay over the surface of the water from my first stroke I am clearly more trained for longer distances as both the bike and cycling events felt way too short and I could have continued in the same pace for much longer.

·       I am a runner. Despite literally not feeling my feet for the first 3.5 kilometers of running as they had frozen cold during the previous events and despite feeling excruciating pain in my feet for 1.5 kilometers after that when the blood returned it felt really good to run. It felt like I was going slowly the whole run, but I passed numerous runners all the distance and looking at my watch I was at my target speed of 4 min/km most of the time. I was surprised it went so fast each time I looked at my watch as it felt that I was going much slower. I am therefore quite happy with my time of 41.50 as it really felt like I had been running conservatively and had much more to give, both in terms of speed and as it felt like I could have continued for at least twice the distance at this still very conservative speed. I had neither done any taper whatsoever for this race as my first “real” race of the season – Mont Blanc 80 km, is less than two weeks ahead.

But there were certainly some bad experiences:

·      The first time you swim in a wetsuit, ever, should never be in your first triathlon race, at least not on an Olympic distance swim of 1500 meters.

·       I do not know anything about wetsuits, but I would not recommend a quite thin wetsuit designed for swimrun when it is 14°C (57°F) in the water and 12°C (53.5°F) in the air. Looking around me at the start I noticed that all other athletes had long and thick suits and some even had extra clothes under and two swimming caps. I guess I was tricked by the word “swimrun” that was on the outside of the suit as it appealed to me as a runner. I also got it cheaply on sale two days before the race.

·       That you were a reasonably good swimmer 20 years ago does not mean that you are a good swimmer today, at least if you have not trained swimming at all during the past 20 years.

·       Training your upper body and core in a gym does not help you in the water.

·       It is different to swim in open water in the form of a dark cold river than in a 50 meter pool. I quickly realized this when looking down to try to orient myself and just saw murky water and occasionally, at least in the beginning of the swim, a foot from a competitor, and occasionally, in particular towards the end of the swim when I was really tired, some slimy water vegetation when I drifted off too close to the riverbank.

·       Surprisingly, despite being a river through central Uppsala, you appear to be able to drink the water of Fyrisån without getting sick as I inadvertently drank plenty of its water during my swim.

·       Your feet risk freezing after spending close to 40 minutes in cold water and, surprisingly, they will stay frozen during over one hour of biking.

·       A short triathlon is different from an ultrarun and it is not OK to spend over 4 minutes at the base station between the swim and bike section. You will never make up that time during 10 kilometers of running.

·       Having owned a road bike for three weeks does not make you a road cyclist – neither in terms of technique nor in terms of physique.

·       Unless you are in the leading group, in a triathlon lap race with 5 bike laps, and with a mix of competitors on different distances, you will never know your position and might be misled to think that you are going fast when you pass other cyclists, but in fact you are still going miserable slow. It is most likely the mind rather than the muscles or lungs that inhibit you.

·       Finally, I now know for sure that I regretfully are not, and newer will be, Peter Oom. Perhaps it is easier for a long-distance triathlete to become a really good ultrarunner than vice versa as it is more difficult to add sports to your training and skill set than focusing on one thing after being good in several sports. Whatever, if I had admired his accomplishments before I understand now even more fully that he is one of the best athletes in Sweden. At the age of 40.

Overall, my first triathlon was however a good experience and the best thing about it is that I have a very good starting position for improvement. It should come quite effortlessly I hope as I only need to swim once before my next race and I will have trained 100% more than I did before this race. Joking aside, will I try this again? Yes, probably, and I am still dreaming to sometime try one of the mountain triathlons like The Norseman, Swissman and Celtman. However, before even having such dreams I realize painfully now that I need to be a swimmer, again, and a cyclist, and not only a runner. And for now it still is so much more fun to run in the mountains than to swim in murky waters.

08 June 2015

Massage and foam rolling in mountain ultramarathon running

For an ultramarathon runner it is obvious that training is damaging for muscles, soft tissues and bones and that it is necessary to balance the training with the right amount of recovery in order to improve the muscle strength and endurance. This balance quite often, at least for me, feels like walking on a knife-edge or a very thin ridge and by just losing the balance a little bit you could end up with a more serious injury like a stress fracture, a muscle strain or a more severe inflammation in a particular tendon or soft tissue. On the other hand, too little training for a period of time is also risking to fall of the knife edge or ridge as it not only mean less improvement, but also that the risk of injury might increase when ramping up and trying to catch up the lost training later on.

The past month I have been on the wrong side of the edge as I have had problems with my left leg. It started with the usual ankle and Achilles tendon pain I have had repeatedly the past few years – nothing worrisome and even though I hesitated a little bit I took the decision to run two back-to-back 20 mile trail runs on a weekend in the beginning of May – the last of those two runs with Hokas with a slightly more drop than usual. As I often have experienced my Achilles pain actually disappeared after these runs, the first time this happened I was quite surprised, but now I have learnt that this certainly could happen. The following week, when I focused more on hill repeats combined with strength training in the gym and some quite long road bike rides with my wife, I instead started to feel a numbing and pain in my left hamstrings. As always, it was initially quite difficult to distinguish “real” pain caused by some kind of stress or injury from muscle soreness, but after a while I realized that this probably was something more serious. In the middle of all of this I, quite embarrassingly, sustained a fall with my new road bike as I was not used to the pedals and cleats – it is indeed amazing how much you could damage yourself just by falling of a standing bike and I can still two weeks after the accident show some quite impressive abrasions on my left arm and knee. I might also have landed on my left buttock as I had a bruise there as well. The following days I referred the pain I felt, in particular after downhill running, in my left hamstrings and gluteus also to this fall. However, the past few days the pain in the hamstrings has finally subsided, but I am instead now feeling quite intense pain in my left buttock. Not the best thing to experience when sitting on numerous flights as I have been doing the past week. A few days ago I tried a foam roll for the first time in my life with the guidance of my PT and I could clearly feel that I have some kind of trigger point in my gluteus. It is likely only a slight muscle strain and it felt much better after releasing by the massage by the foam roll. But, I think it still too early to rule out the possibility of a more serious injury like a bone bruise or a pelvic stress fracture. As I do not have an MRI machine in my living room I will continue to walk on the knife edge until the pain has subsided or gotten even worse and when that happens I am quite sure I will instead have pain somewhere else, perhaps in my knee – it was a long time since I had that now when thinking about it.

This was a long introduction to the topic I was going to write about and that is massage and foam rolling for mountain ultramarathon running. I have actually never been had a massage and I have not until now used a foam roll, so clearly I am probably personally biased against the benefits of these activities as I otherwise would have used them. The reason I decided to write about them anyway was that I read a new article about massage during Tor des Géants (TDG) and those who has followed my blog knows that I have covered all scientific articles written on this race since I ran it myself in 2013. The article actually covers the year when I ran and I remember being offered to receive massage as part of the study at the life base in Donnas close to halfway around the 330 km tour of the Aosta valley. The article entitled “Effect of massage on DOMS in ultramarathon runners: A pilot study” is written by Lorenzo Visconti and colleagues and is in press in Journal of Bodywork & Movement Therapies. In the study, a total of 231 patients (210 males and 21 females; >45% of subjects were between 40-50 years old) were enrolled and treated with a 20-minute massage in the area that the subjects were complaining of symptoms. The area where the symptoms were most common was, not surprisingly, the lower extremities, with 60% of subjects complaining of leg problems, 23% complaining of thigh problems and 8% complaining of knee problems. The most common symptom of the delayed onset muscle soreness (DOMS) in >95% of participants was pain. To measure the effect of the massage the participants scored the degree of perceived pain intensity before and after treatment on a numeric pain rating scale (NPRS) from 10 to 0. Another scale, called the Patient Global Impression of Change scale (PGIC), which has been used in previous studies on massage effect, was also administered. Not surprisingly, immediately following the massage the level of pain measured by both scales were significantly reduced. This decrease in NPRS averaged 3.6 points (Standard deviation 2.1) and there were no cases that showed an increase in the NPRS scale after treatment. The PGIC values also improved after massage with values greater than the “much improved” in 80% of cases and was unchanged following treatment in only one case.

All of this is of course fine and might on a first quick (really quick) glance support the use of massage, but regretfully, this is not telling us anything about either the efficacy or the safety of massage during a mountain ultramarathon as obviously this study has major flaws. First of all, the selection of participants is greatly biased as it was done based on symptoms and willingness to try massage for those symptoms. I would personally have done anything to relieve my muscle soreness at the lifebase in Donnas, but as I did not believe massage would help me more than a short while I elected not to receive it. Quite interestingly, but in line with all other placebo effect research, the belief in massage has been shown to influence the perception of benefits also in running (Moraska “Massage efficacy beliefs for muscle recovery from a running race” Int J Therap Massage Bodywork 2013; 6: 3-8). Secondly, the study did not use a comparison with subjects not receiving massage. Thirdly, the effect measurement was done by the same persons performing the treatment. Fourth, the effect was measured immediately after treatment and there is no indication whether the effect was sustained even after the next climb up to Refugio Coda. Fifth, the massage was given after long downhill section of the race which had been relatively fast and easy to run with some road sections so the muscle soreness was probably at its peak at this point. Sixth, no information is available on the use of NSAIDs or other pain relieving medications. Seventh, no information is available on the previous use and experience of massage. Eight, no objective measurement of DOMS such as biochemical or other laboratory parameters were used.  I could probably find even more flaws with the study, but will stop here. I am not too concerned by the author’s statements that the massage had some positive immediate effects on DOMS, but I am more disturbed by the fact that they are claiming that the massage was completely safe without following the outcome of the runners for the rest of the race.

The study is interesting as a pilot experiment, however, and shows that it would be possible to do a proper prospective randomized controlled scientific study during this long race with a large number of participants. It is also an interesting study as it discusses some of the current knowledge in the area. However, also in this aspect the study has some major flaws as it leaves out plenty of the negative studies indicating lack of effect of massage for DOMS and performance in association with running (for instance Dolgener & Morien “The effect of massage on lactate disappearance” J Strength Cond Res. 1993; 7:159-162; Dawson et al. “Evaluating the influence of massage on leg strength, swelling, and pain following a half-marathon” J Sports Sci Med. 2004; 3: 37-43). A good, but somewhat old, review article is Brummit “The role of massage in sports performance and rehabilitation: Current evidence and future dirction” North Am J Sports Phys Therapy 2008; 3: 7-21. More recent review articles about massage for DOMS are Nelson “Delayed onset muscle soreness: is massage effective” J Bodyw Mov Ther 2013; 17: 475-482; Torres et al “Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: systematic review and meta-analysis” Phys Ther Sport 2012; 13: 101-114; Tejero-Fernandez et al “Immunological effects of massage after exercise; A systematic review” Phys Ther Sport 2015; 16: 187-192. I will not review all of this literature here, but just point out that 1) there exist to my knowledge no other studies of massage for ultramarathon running; and 2) that most of the studies of massage as a treatment for DOMS and for improvement of running performance has the same design flaws as the study by Visconti and colleagues and more and proper research is clearly needed.

In summary, the question whether massage and foam rolling is effective and safe in reducing muscle soreness and other issues in association with mountain ultramarathon running is still unanswered and open. However, personally, since I started to write this post it has passed some days and the pain in my left buttock is markedly improved so at least I will give foam rolling more of a try in the future now.