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Source: Sheila Plemich
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Which Machine Are You Talking About?

Most of us are used to getting the oil changed and the tires rotated on our cars regularly. We may also get a full tune-up every few years, and of course we take our cars in for service when we hear strange noises or experience body damage or other physical wear and tear. And then some of us go further and pamper our cars by getting regular washes, waxes, detailing, etc. Cars that get driven thousands of miles per year need regular maintenance if we expect them to work well for many years.

Now what about the machine that is your body? Are you giving yours the same regular attention as your car so that it provides you with a good experience when you are using it in your sports? �I don�t have time,� you might say. Try applying that attitude to a car and see what happens if you don�t change the oil for a few years. Or don�t get that brake job when you feel the brakes not being as responsive as you know they should be.

This article is about my experiences in maintaining my machine�my body�and my recommendations for things you might want to consider in maintaining yours. I think that anyone can find something in this article that can help them take a little better care of their machine.

Please read the Disclaimer at the end of this article, if you are interested in my personal experiences with injury and biomechanical issues.

Overuse?

There is a body of individuals out there that likes to call pain that we experience during training an �overuse injury.� I think that�s a misnomer. Face it, if you are running 3-5 times a week, swimming 3-5 times and biking 3-4 times (or whatever your sports may be), you are �overusing� pretty much everything! While there are times when pain or injury are a result of merely �overdoing it� or acute trauma, usually something has gotten slightly out of whack, which led to something else overcompensating for it, which led to�that pain. And while we tend to accuse our training of being the culprit most of the time, often it�s our personal lifestyle habits and biomechanics combined with the additional strain we put on our bodies through training that begin the chain reaction resulting in pain. I describe routine aches and pains as �my body is talking to me.� Much like a car making noises or pulling to one side or not feeling like it�s giving a smooth ride.

I will address here things that I believe help ward off pain and injury and then what you can do if you do experience them. How many/much of the preventive activities you can fit into your schedule need to be balanced against the time, and in some cases, money, you have available. Over time, you will come to understand what works best for your body. I believe that the more training you do, the more critical these �extras� become, and certainly if you are trying to be highly competitive in your age group, then it�s to your benefit to explore whether these things can help you gain that extra �edge.�

INJURY AND ILLNESS PREVENTION

The following are things I consider important to any athlete�s maintenance program. Often times, when we think about training for a specific competition, we only focus on the time needed to do workouts. In reality, successful competition performances rely just as much on the things we do besides the workouts, but unfortunately, these are the things that get short-changed when we are strapped for time. Then when we experience pain or become truly injured, we consider using these techniques as curative procedures, when in fact we need to find a way to incorporate them into our overall training program. So when you are thinking of doing that longer distance race or increasing your annual training hours, remember that the more working out you do, the more overall stress you are putting on your body, and consequently, these things become even more important to preventing pain and injury.

Sleep and Rest

You become stronger by resting and sleeping after workouts, not during them. When you become sick or injured, the affected body part(s) needs to be rested, and since our bodies repair themselves mainly while we are asleep, it�s especially important to get sufficient sleep when sick or injured.

Good Posture

Yes, your mom was right�sit and stand up straight! One of the fallouts of the post-industrial society is that a lot of us have desk jobs and consequently spend a lot of time sitting (myself included). The mere act of sitting can be bad for your back, glutes, hips, and all down your legs. So if you sit a lot, sit with good posture, feet flat on the floor (no crossed legs), and chair height adjusted so that your knees form a 90-degree angle, and if possible, use a lumbar support. You can also sit on a stability ball, which if used properly, will encourage good sitting posture.

Also remember to get up and move around when you can to give your tightened muscles a chance to relax. When you stand, it�s also important to stand straight, and especially to not lean on one leg more than the other, creating a �high hip� condition. If you do this chronically, you end up with one side of your back overly tight and jacked up and this can be the beginning of a whole host of biomechanical issues.

If you drive a lot, it�s a good idea to take breaks for the same reason you would if you were sitting at a desk. It�s also a good idea to set up your car seat so that it�s as ergonomically close to a perfectly set up desk chair as possible. If your car has bucket seats, a cushion will help put your back in the proper position, and you might want to consider a lumbar support there as well. Another problem created while driving is letting the left leg flop over towards the door, which causes problems in the hip of the left leg and all down through the soleus. Either become conscious of correcting that leg�s position or use a block of foam to keep your leg in line with your spine. Tpmassageball.com has a set of tools that includes such a block, but I�m sure you can get some heavy foam cut for this purpose as well.

Flexibility

Improving your range of motion has the ability to affect your training and racing performance. Swimmers need flexible shoulders to achieve a good reach; cyclists need flexible backs and hamstrings to achieve their most aerodynamic position; runners need flexibility to enable good push-off and rebound.

Flexibility can be tackled using a combination of static and dynamic stretching, yoga, Pilates, etc. I have found that I do best utilizing a brief (5 minute) warm-up routine that I lifted from The Core Performance by Mark Versteggen (Movement Prep) followed by a combination of yoga poses plus static stretches, with extra focus on my lower back, hamstring and calf areas. It�s fairly easy for me to keep my quads flexible; the backs of my legs and back are prone to much more tightness.

If you don�t currently stretch but want to start, set a reasonable initial goal�like 5 minutes per day. Once you start to feel the benefits, you might consider spending more time at it. Ideally, I would stretch after every workout, but in reality, I do some stretching first thing in the morning, and then when I have time, I will do a few minutes (2-5) after my last workout of the day. It�s easy to find 5-10 minutes while zoning out in front of the TV. I also use time spent waiting in lines (at the doctor�s office, grocery store, post office, DMV, airport, etc.) to stretch. It relaxes me so I don�t focus so much on the fact that I�m waiting, and a bonus is that I�m doing something good for myself. If you spend a lot of time on airplanes, it�s a good idea to get up periodically (which is why I always request an aisle seat) and do some stretching.

Strength Training

There are differences of opinion as to whether strength training actually prevents injury, but I strongly believe in it, and here�s why. Triathlon sports essentially operate in a single plane of movement. We don�t generally move sideways or do much twisting. If nothing else, a well-rounded strength program will get some of the muscles moving in different ways than the triathlon sports. We were meant to use everything in all planes of movement! Before we all became desk bound, there were daily activities that took care of this; that is not true for most of us now.

If you are like me and have special biomechanical issues, chances are you need to do special strengthening exercises to account for them. Over the years, I have had physical therapy for my legs and shoulders, and continue to do these exercises preventatively. But, if you don�t have the time for a full-out strength program, one thing I firmly believe is that core work is not optional! A strong core is just a good thing to have for daily living. It will help you to carry and lift things without causing back strain. It will make yard work less stressful. But it will benefit your sports greatly. For swimming, you need a strong core to rotate effectively and kick properly. For cycling, a strong core helps you hold that aero position for a long time and promotes more effective hip drive in pedaling. For running, a strong core again helps with your hip stability and leg turnover. A core program need only take up 30 minutes of your precious time per week.

If you have time for additional strength training, then work with someone who understands the demands that triathlon places on your musculoskeletal system and can design an effective routine for you that works on your personal muscular imbalances while addressing �trouble� areas such as shoulders and hips.

A bonus from strength training is that it helps maintain your muscle mass and bone density, which is especially important for women and older athletes like me. Another bonus can be a 6-pack that you wear rather than drink!

Massage

Massage is a luxury for many athletes, since it costs money and requires setting aside yet another block of time in their busy schedules. I get one weekly, and here�s why I think it�s a good idea. When I notice something is not right, my massage therapist can help me evaluate whether I�m on target or not. He can also point out potential trouble areas that I didn�t know I had, and when I have identified a trouble spot myself, I can direct him to work on it a little extra.

If you are going to get massage, be sure to use someone who really knows sports massage. Sports massage is very different than �fluff �n buff.� Sports massage might include assisted stretching, deep tissue work, cross-fiber work and work on muscles most fluff �n buff�s wouldn�t go near (but that need work on triathletes) like the iliopsoas (hip flexor) and QL (quadratus lumborum). Plus, a sports massage therapist knows the muscles. If you are cash strapped, at least try and get a good massage a few days after a major competition, and definitely investigate if there are any massage schools nearby, as you can often get a really good deal by having students work on you.

Biomechanical Assessment and Performance Testing

Biomechanical assessment is a luxury item. However, if you find yourself succumbing to repeated pain or injury in the same area, this service may be worthwhile. The purpose is to help you understand where you have weak muscles that need strengthening, short/tight muscles that need lengthening and other genetic issues (such as flat feet, Morton�s foot, leg length discrepancy). If you have known biomechanical issues like me, a qualified person can prescribe special exercises and/or equipment adjustments that will help you compensate for those limiters.

Performance testing can help to make sure you are training appropriately to prevent overtraining as well as provide periodic benchmarks to assess training progress. There are a wide variety of tests that can be performed, and most of them aren�t specifically geared towards injury prevention. However, the one thing I feel strongly about is that if you intend to train by heart rate, then you should find out what your true maximum heart rate is. Formulas just don�t cut it for most people. There are ways to measure it for free in the field, or you can have it measured at a gym or university.

Nutrition

Why do I consider this part of injury prevention? Simply because if your muscles aren�t fueled properly when you ask them to do work, it can lead to overextending yourself. Similarly, if you do work but then fail to provide nutrients to aid in muscle repair and recovery, you are building a vulnerable system. When you sustain muscular injury, add to or increase your strength training routine or you are trying to lose a few pounds, it�s generally advised that you increase your protein intake slightly to aid in muscle rebuilding and repair or maintenance. Feeding yourself poorly is no different than putting an inferior grade of gasoline into your car. Garbage in�garbage out!

Body Composition/Weight

The lighter you are, the less stress you put on your joints while running, and the easier it is to climb on the bike. It�s not that excess weight itself causes injury, but over time you can suffer more wear and tear to cartilage by subjecting it to higher than necessary loads, especially in the hip and knee joints. For me, given I am already missing cartilage, I plan on staying as light as possible to minimize further wear. The bonus to improved body composition and/or lower weight is that you will gain free speed running and biking. It is always better to pursue a non-training method of performance improvement. I know for myself that when I really began focusing on my body composition, it enabled me to train harder more easily, if that makes sense.

Know Something about How the Machine is Put Together

I have a chart of the muscular system in my home office that I got from Anatomical Chart Company. So if something feels sore, the first thing I do is try to identify which muscle it might be. You can also use the Internet to do research on muscles. A good site for identifying strengthening and stretching exercises for specific body parts is http://exrx.net/. When you know the specific muscles involved in a problem, you can have a better experience when working with your massage therapist or other healthcare provider. Of course, pointing at something and going, �It hurts HERE� also works, but hey, you�re an anal-retentive triathlete, and it�s more fun to say, �My rectus femoris is sore all the time.�

A great book that can be both a muscle reference and a pain diagnosis tool is The Trigger Point Therapy Workbook.

Stress Reduction

Training creates additional stress on your body and mind. If that is not balanced by appropriate stress reduction in other areas of your life, you become more susceptible to illness and injury. Some of the other techniques mentioned above can be considered stress reduction techniques, such as massage, sufficient sleep and rest and even flexibility work. If these aren�t doing the trick, however, you might want to consider a form of meditation. For some people, their spiritual or religious beliefs help out greatly in this area.

Don�t forget the value of having a support network around you, not just to help you in your athletic goals, but for your daily living. It�s always good to have others in your corner so that when things go wrong (and they will!), you have a sympathetic ear or set of arms to give you a hug and/or a kiss.

If your non-training stresses become too large, and unless you can control those other things, something is going to have to give, and that will probably be your training. It is wise to proactively reduce your training load before you become sick or injured. If the added stress is temporary, you may be able to return to full training faster than you thought. If it�s permanent though, it�s a good time to evaluate what�s going on and how training fits into your life.

Equipment and Safety

Use equipment that fits you properly. Poor bike or running shoe fit can lead to all sorts of trouble.

Maintain your bike (or have someone do it for you) and its associated gear in good working order, and monitor your running shoe wear. Worn tires, brake pads and chains on bikes are not good things to be riding on, and running in worn shoes is an invitation to injury.

When cycling outdoors, either carry more fluid and nutrition than you think you might need, or know where you can stop along the way and purchase some. You can put yourself into a nice recovery hole by not fueling properly on a long ride. Check behind your butt periodically if you use a saddle mounted cage system to make sure you haven�t launched bottles. Always carry spare tubes and/or tubular tires and an inflation device. This is not injury prevention, but I figured this is as good a place as any to say it�always carry your driver�s license, a credit card, some cash and your cell phone when out riding, and then hope you don�t need it. Unless you are very skilled at riding with no hands, pull over when using the phone!

Ride safely and courteously, and use lights when necessary. Obey traffic signals and drivers (some of them, anyway) won�t hate you.

Run with awareness�if you are going to run on roads like I do, make sure you can hear the traffic around you and that you have a sufficient shoulder to operate with. Watch your footing, and if you run on cambered roads, make sure you switch sides (run with or against traffic) so that both sides of your body are equally abused by the tilt. Some individuals are predisposed to injury from gait alterations on one side of their body; if this is you, try and avoid road running altogether or do it only close to an important race.

Reasonable Training Program

If you know what you are doing, you can create your own training program. If you don�t know what you are doing, it�s quite easy to build a program that leads to illness and/or injury. One classic idiotic combination is an Ironman program that has lots of volume and lots of intensity. I did this to myself a few years ago and was rewarded with major problems.

You can buy training programs, too, but you will need to be honest with yourself about meeting the minimal requirements of the program. For example, if you are doing your first Ironman and you choose an �advanced� program, then you may be overreaching. Ultimately, though, you will be accountable for making sure the program is appropriate for your current fitness level and goals.

Finally, you can utilize a coach to create a custom program that is just for you. If you�ve done the right setup work with the coach, the resulting plan should be something that you can execute 80% or better of the time and make reasonable fitness gains without jeopardizing your health.

Ultimately, though, whatever version of training you choose requires commitment, consistency and honesty. Oftentimes injuries occur due to an athlete stopping and starting training, and our bodies just aren�t made for that. It�s the proverbial �weekend warrior� syndrome. How many people do you know who only play basketball or some other sport on weekends and how often do you hear about their injuries? It�s no different if you don�t train consistently in triathlon.

If you have a plan, but you aren�t honest with yourself about your ability to execute it, you are creating additional stress on yourself which will ultimately impact your ability to train and recover effectively.

Warm Up Before Exercising

This sounds like common sense, but sometimes we forget to do it. Always start out your exercise session with a slower, gentler rate of exertion and work into your �main set.� Muscles do not like abrupt changes from inactivity to full steam ahead. This goes for racing, too. You should build into your race pace or target effort level for a given training session.

Cold Therapy after Training

After long runs, road races or long rides, you can speed your recovery process by soaking your legs in cold water from 5-10 minutes (as tolerated). During warm weather, some athletes will stand in a garbage can outside and fill it from the hose. Or, you can get in the tub and fill with cold water to cover your legs. You want to do this as soon as possible after you finish the workout, but make sure you get your recovery nutrition taken care of first.

Another less invasive cold therapy I like is relaxing on the couch with ice packs on my knees (you can use bags of frozen vegetables, too) with legs slightly elevated for 10-15 minutes. This feels especially great if you�ve done a lot of climbing on the bike or after a long run.

Resilience

No matter how well-thought out your season is and your training program, life will get in the way periodically. So it�s important to cultivate resilience so you can deal with these things effectively and not get freaked out.

How do you do this? You practice controlling what you can and letting go of what you can�t. Then when you get thrown a monkey wrench, you calmly look at the situation to figure out what you should do next. You consult with your support network and you look deep inside and figure out what�s best for you right now. And then you do it.

When you are faced with injury, it�s OK to cry about it for a few days. But then you need to redirect your energies to the healing process. If you can be as focused about getting back on track as you are about your training, odds are you will come around more quickly.

Regular Physical Checkups

Depending on your age, there are different things you should be getting looked at proactively, and I�m not going to go into those things. But just because you think you are He-Man or She-Ra and impervious to common ailments because of your outstanding fitness doesn�t give you the right to ignore these things.

I am having regular blood work done on myself every few years just to make sure the machine is running smoothly. When I first asked my doctor to do this, she thought I was a little crazy. But now she understands that I consider this necessary and healthful.

You might run into trouble convincing an HMO to pay for this, but all I can say is be creative and work with your doctor. For example, if some relative has diabetes or heart disease (most of us have someone in the family), you are just following through on a concern for your own health.

Remember, that even if you eat right and exercise, you may have a genetic predisposition to things like elevated blood pressure, high cholesterol, etc., and it�s in your best interests to find out about these things so you can get them under control. Being highly fit doesn�t change your genetics!

INJURY DIAGNOSIS

If you succumb to an acute injury, such as falling off your bike, you will pretty much know whether you need immediate medical attention, so I am not going to address those things here. Rather, what happens when you start to feel an ache or pain and what do you do about it?

Over the years, I�ve found that the following things will speed up the diagnostic process and subsequent recovery.

Keep Track of Stuff

Things that are good to keep track of include your training hours by sport, the actual workouts you did, how much sleep you got per night and how many miles are on your bike and running shoes. I also keep track of the time I spend stretching so I can correlate that to how well I execute my workouts. Some people track other objective or subjective measures of their well being such as stress levels or mood.

For women, I think it�s a good idea to note your monthly cycles in your training log, so that if there is a pattern to your performance as related to your cycle, you can see it and plan accordingly. Another tip I can offer women is that if you are willing to manipulate your cycle through the use of birth control pills, it can relieve stress knowing that you won�t have your period on a weekend when you might be racing.

Tracking your workout volume and intensity is important because sometimes the cause of a seemingly acute problem is related to a too quick increase, a particularly stressful single training or racing event (such as your first 20-mile run, a marathon or other race), or an incomplete recovery from a significant training or racing event.

Another reason to track your workouts is so that if you start using personalized coaching services, the coach can look at what you�ve done in the past and be sure that he/she doesn�t set you up at too high a level of volume or intensity.

Tracking your sleep is important since a lack of it can manifest itself in injury when you continue training beyond your ability to complete it safely and then recover.

Aside from actual tracking, it�s important to be aware of your daily non-training activities that can significantly impact your musculature. This comes in handy more when you need to seek professional medical attention, since if all you focus on is your sports, you may be missing something significant. How much time do you spend standing, sitting and driving, and what is your posture while doing so?

Don�t Panic

When something starts to hurt, the last thing you want to do is immediately panic, because this will set up a stress chain reaction. If the pain comes on while you are exercising and it�s not severe, I usually keep going and see if it remains. I notice that I sense things during my warm-ups (which is an important reason to do them, if nothing else) that magically disappear once I keep going. If the pain continues, but it doesn�t significantly change your form, it is up to you whether to continue the workout. This is something you will learn with experience.

Have a Reference Source to Make a Guess at the Problem

Some people will post to an online forum the minute something hurts, without doing an iota of homework. That�s certainly one approach.

Ultimately, you will get more help from the online or medical community if you make an effort to identify more specifically where the trouble is. I use my book The Trigger Point Therapy Workbook. I like it because it differentiates where you feel pain from where it is being generated (the concept of �referred pain.�) It gets into the specific muscles and also lifestyle issues that may contribute to the problem you are having. If you are unable to treat the pain yourself, at least you will have some idea of where it is coming from. If you use something like this to self-treat, be sure that you compare the injured side of your body to the non-injured side, so you know what healthy should feel like.

Make an Objective Assessment of the Situation

Can you point to training errors, stress factors, equipment issues or illness as causal factors? If you can identify a causal factor, then obviously you do what you can to eliminate that problem, and sometimes just resting is all that�s called for. Whether or not you can, though, you probably have some upset muscles that will need special care until you sort out the other things.

Know When to Seek Professional Help

This can be a judgment call or simply the result of failed attempts at self-treatment. I have assisted others who were convinced they had a tendon strain understand that it may just be the muscle that it originates in that is causing the trouble, and other times when a physician visit is warranted. A lot depends on the severity of the pain, which may in turn depend on how long you have been ignoring it!

Many simple myofascial issues can be mistaken for stress fractures, tendonitis or even muscle tears, but if you are ever in doubt, go ahead and seek professional help. But remember that in addition to being able to relate what you do for a hobby, that you report what you do for a living, as they are usually all a part of the picture.

RECOVERING FROM INJURY

If you choose to or need to use professional assistance (massage, assisted stretching, physical therapy, chiropractic) be sure and detail your lifestyle�sports and other�since treatment may need to work on the entire you.

The more you know about your injury, the better you will be able to supplement professional assistance (if required) with self-treatment. Typically, we have some number in our heads about low long we are willing to rest before returning to an offending activity, but you really need to listen to your body, and when in doubt, act conservatively.

A positive mental outlook is critical for successful recovery. Sure you may be angry at yourself because you did something stupid, but what�s done is done, and now it�s time to focus on the present.

Triathletes are fortunate in that injuries don�t typically affect all 3 sports at once. So if you can�t run, you might be able to bike and/or swim more (within reason!). But if you can�t bike or swim, adding running is probably not a good idea. Remember that you can maintain your aerobic fitness with the other sports. But also remember that when coming back to a sport you have eliminated for a few weeks, that you need to come back conservatively�your aerobic system will be plenty ready, but those muscles, tendons and ligaments that are primarily used by that sport won�t be.

If you reduce your training load, remember to reduce your calorie intake accordingly. There is nothing worse than coming back from an injury with extra pounds! It�s like the double whammy. Downtime is an excellent opportunity to focus even more on good nutrition.

It might pay to do some more of other things you don�t normally do enough of when you have downtime, like stretching, strength training or using the time to learn more about something, even non-triathlon related stuff. Every time I have been injured has been an opportunity for me to capitalize on something new.

Sometimes it�s only through injury that we learn that we need to take better care of ourselves. If you are proactive about your self-care, hopefully you will experience very little downtime, and you will be able to weather disruptions easily!

Train Hard and Healthily!

Disclaimer
I am not a physical therapist or a doctor, nor do I play either one on TV. However, so you believe I�m credible in discussing this topic, I hereby list my personal biomechanical issues:

I have no ACL in my left knee (skiing accident at age 28�back then, you were given a weird brace to wear but no corrective surgeries had been invented)

My left MCL is forever loose, having been torn off the bone and reattached (same skiing accident as the ACL).

I have a herniated disk (L5-S1), on my left side. This may or may not be related to the left leg issues. It may or not be healed. It was discovered on MRI in April, 2005. It may or may not be related to my triathlon training and racing�more likely, it�s just a result of aging.

I have Morton�s Foot (second metatarsals are longer than the first). This is congenital.

I am strongly right-handed and right-bodied. When I shovel snow or rake leaves, I am noticeably more tightened up on my right side. Also congenital.

I�m told that I�m double-jointed. I know I�m more flexible naturally than most people, and I can do a few contortions, but not to the extent I�ve seen others.

I have experienced the following classic runner/triathlete problems:
    Patello-femoral syndrome in both knees
    Chondromalacia (left knee only)
    Iliotibial band syndrome (left and right legs)
    Sciatica (left and right sides)
    Swimmer�s Shoulder (right side only)

I also regularly hear from muscles and joints that aren�t happy for whatever reason, and they let me know by popping, clicking, aching, hurting or refusing to move through their normal range of motion. Recently (1/7-1/8/2006) I participated in the Goofy Challenge in Disney World, where I ran a half marathon and a marathon on consecutive days. Aside from the predicted inability to walk normally for 2 days and one black toenail, I was rewarded with a sore upper right foot and pain under my right kneecap. I am happy to report that through self-diagnosis and trigger point work on myself (and supplemental work by my massage therapist), I resolved those issues in 2 weeks, with no impact to my training. No doctors or physical therapists were seen or harmed in the process!

Because of the volume of triathlon training I do (I have averaged 13-16 hours per week year round for the past 5 years) I have a lot of first-hand experience with unusual pain or acute injury discovery and the process of diagnosing and then getting medical help where warranted. It�s not something we want to go through, but it�s an occupational hazard of stressing the machine regularly. I have found that a holistic approach to self-maintenance is the only way to get through this training in one piece, especially since I plan to continue doing it for many years. I will be 50 this fall, and I enjoy the triathlon lifestyle now and plan to continue the good habits I�ve developed as a result of the lifestyle for many years to come. While some of you have never sustained an injury that permanently changes your biomechanics, it�s probably just a matter of time, and maybe you can learn from my experience.

Sheila Plemich is a self-proclaimed "pathological athlete" (sometimes known as Kona, Crackhead or FeFe) who focuses on Ironman-distance training and racing. She's completed 5 Ironman-distance races, with a personal best time of 13:21. You can follow her training and racing diaries on her blog at http://crackheadfe.blogspot.com