Archives for August 2014

Patellofemoral Pain, Chondromalacia and second opinions

kneesmallPatellofemoral Pain or Patellofemoral Pain Syndrome (PFPS) is pretty much pain that is felt in and around your knee cap. It is also known as runner’s knee due to a prevalence in runners. PFPS is a relatively new way of looking at knee pain whereas an out of date consultant may look at your knee and consider it to have degenerative chondromalacia which is basically damage to the cartilage behind the knee cap that wont get better and will only get worse with use.

I only mention this as I have recently had a rather negative experience with a knee orthopaedic surgeon, resulting in a search around for a second opinion and a day out in London yesterday.

The first surgeon listened to my description of the issue and examined my painful knee. He listened when I told him what I did for fun, nodded and said that he has happy to have me as a patient. He then ordered some MRI and X-Ray images which took a couple of weeks to get sorted before I returned for my follow up consultation. This is where it all went a bit wrong. Ultimately I was advised that I had degenerative chondromalacia in my right knee cap, it wasn’t bad enough to merit surgery, and that I should seek some physio. I was told that the issue would never get better, that I should massively reduce my running mileage and that I should wear heel lifts. I was then rushed out of the door, very bewildered, with my entire lifestyle being turned upside down on the whim of this knee “expert.” To say that I was unhappy was an understatement.

When I got home I thought about the matter and the advice simply didn’t sit right with me. It wasn’t just that I had been told news that I didn’t want to hear, but it contradicted the research that I had done into knee pain. The rushed nature of the second consultation also didn’t feel right. I decided that I needed a second opinion but it would have to come from a knee surgeon that was used to dealing with athletes. How on earth would I find one that I could trust?

For me the answer turned out to be quite straightforward. I asked my coach, Neil Scholes of Kinetic Revolution, who turned to his contacts to get me a name. Neil also backed me up fully, provided some valuable insight, and prevented me from panicking about the whole thing. The name that Neil came back with was Jonathan Bell from Wimbledon Clinics who came highly recommended and has the tag line “Keeping the active active” on his twitter feed (@jonathanbell.) I spoke to Bupa, who handle my medical insurance, and they were happy to cover his fees. I made an appointment and yesterday I finally met Jonathan.

Prior to my second opinion I had thought things through multiple times and decided that if Jonathan Bell gave me similar advice then that would be good enough for me. I wasn’t simply going to carry on hunting for an answer that I wanted that didn’t match reality. I was also fully prepared to postpone my running plans for next year if I needed to take the time out to make my knee better for the long term. As it turned out, I need not have worried.

I had a 45 minute slot with Jonathan and straight away his approach was different to the one that I received before. He didn’t look at me as if I was an idiot when I said that I was an ultra marathon runner and iron distance triathlete. He didn’t bat an eyelid when I mentioned that I was planning on running a one hundred mile ultra next year as part of my UTMB qualification. Instead he knew what the UTMB was, as he had frequently been a spectator on it, and he was interested in my problem and wanted to help fix it. Jonathan then examined both knees very thoroughly, asked loads of questions, drilling through my waffle to eek out the information that he needed. He told me his conclusion and explained it fully while we also went over the aforementioned MRI and x-ray images. In short my issue is centred around my knee cap, it is far from irreversible, doesn’t need surgery and should be fixable with a bit of physio.

Jonathan then asked me if I already had a good physio, I didn’t, and he told me that his wife, Claire Robertson (@clairepatella on Twitter) solely focuses on PFPS. I had already decided that I wanted to see the right person to resolve my problem regardless of travel limitations, so we looked at Claire’s calendar to see when she could fit me in. There were gaps next week which suited me, so we headed out to reception to get me booked in. As we walked out the receptionist was just phoning Claire’s 1230 patient who was a no show and I managed to pretty much walk straight into her office. How lucky was that?

Speaking to Claire it turns out that she does a lot of research into PFPS, it is her sole professional focus, and she was exactly the right person to see. Claire was every bit as professional as Jonathan and as we went through the exam it was obvious where I needed to do some extra work. Claire gave my some stretches and strengthening work to do, patiently answered my inane questions and was happy to write to my sports therapist so that she could contribute to my rehab. As we went through the exam it was also obvious to me how many problems I had already fixed through the stretches and strengthening that I was already doing.

I have gone into quite a lot of detail on this and feel that there are several important lessons to take away from it:

  1. Get a second opinion. Especially if you are given advice that is going to significantly impact on your lifestyle.
  2. Stretch now, before it is too late. My issues largely come from having not spent time stretching over the last 20 years.
  3. If you are athletic then see a consultant that specialises in athletes, and don’t take their word on it. Ask around and get an appropriate recommendation from another athlete that has used them.
  4. Consider running away if someone mentions chondromalacia!

In the meantime my plans are now back on track for next year. I will be making a massive effort to stretch and strengthen in the appropriate places through the winter, and intend on being fit, healthy and fast for my ultras next year. I can’t wait and am more excited than ever at the prospect of doing the UTMB at some point in the future.

I am not a medical expert, so any mistake in the above article is mine and mine alone after interpreting the advice that I have been given. If you do notice anything incorrect then feel free to get in touch.

Jurassic Classic Review and tips for a faster sportive time

Jurassic Classic

While I sit here ravenously hungry, due to a massive energy expenditure yesterday through nearly seven hours of cycling, and waiting for the official times to be posted for the Jurassic Classic I thought that I would pen a brief review of the event as well as three tips that will give you free speed during any cycle sportive.

The Jurassic Classic is bought to you by Prostate Cancer UK with the main aim of raising money for a worthy cause. Last year the event had a field of around 1000 keen cyclists, but they discovered that a massive field doesn’t necessarily mean more money raised. This year the field was reduced to 500 entrants, but with entry fees and fund raising requirements that meant hopefully more will be raised to help fight prostate cancer.

I wanted to get an early start, so I was onsite at 0630. There was far more free parking than I expected, and not too many people yet, so parking was easy. Registration was quick and painless, so I nipped to the portaloo and then returned to the car to get ready. There was only one number which cable tied to your handlebars, facing forward so that it would be visible in photos. The timing was done by a chip that attached to the quick release skewer in your rear wheel. I also cable tied it loosely just to be sure that it didn’t go AWOL. With that done I pushed my bike to the start for 7am and was released from the pen pretty much on time with the first batch of cyclists after a short riders briefing.

The first thirty and last ten miles of the course featured the best views, but also some of the worst hills. In general the hills were that double whammy of very steep and pretty long. I was on a twin ring and managed to climb them without weaving all over the place, but it wasn’t easy. I do like hill climbing though, so got a kick out of keeping a steady pace up them before picking up speed over the summits while taking a moment to also look up and soak in the view. With the uphill sections being so hard they were often followed by some pretty technical and challenging descents, which you needed to take real care on. They were also tremendously fun and a great place to make up time on those with less proficient bike handling skills.

As mentioned in the points below, the route signage was simply excellent. I had a route map and hand held GPS with me, but didn’t once need to refer to them.

Good points:

  • There was an Audax feel to the control points. For those of you that know what an Audax is that will probably make sense, but essentially what I mean is locally supported and exceedingly well stocked controls using places like local clubs and town halls. This gives the controls a wonderfully relaxed feel and means enough food for everyone.
  • Relaxed, helpful and friendly staff. These were at the start/finish and on the control points. They were informative, wanted to know how things were going for you, and happy to chat if you had the breath to do so.
  • Exceedingly well signed. The orange tape in the hedgerows at frequent intervals was an excellent complement to the white on blue signage. There was only one turn that I went about 10m past before I realised I had overshot, but I quickly turned around. The fault for that was entirely mine as I was daydreaming along quite happily and not paying quite enough attention, so missed the plethora of signs.
  • The hills and views were challenging and stunning respectively. The flat ish 24 miles that started 66 miles in were most welcome, but it was nice to get back into the hills between Aylesbeare and Exmouth for the stunning views as we swooped down to the finish.
  • Mix your own energy drinks at the controls. I loved this as it meant that I could mix to my preferred strength which is usually far weaker than pre-mixed drinks usually come.
  • Organiser’s emergency numbers on your rider number and on the neatly folded route maps, so that you had contact information immediately to hand if you needed it.
  • The controls were spaced just fine for me. Any closer together and I would have skipped a control as I simply wouldn’t have needed to stop at it.

Points for improvement:

  • Struggling to think of any that really matter.
  • If there were event t-shirts (non technical) available at the end then I would have bought one. They may have been available, but if they were then I couldn’t find them in my exhausted state!
  • Non distance specific medals. The medal was the same no matter which distance you finished which was a bit lame. I had done the Epic course and wanted an Epic medal….
  • Gold, Silver and bronze target times seemed on the tough side giving the nature of the terrain. I am not a bad cyclist and was twenty minutes outside of the silver times after averaging 15mph (moving speed, with an additional 14 minutes stopping at checkpoints to nip to the toilet, topup water bottles etc). After all, there was around 2450m of climbing and most of that was over just 60 miles of the course. Admittedly I was in the middle of a core Ironman Training weekend, so  my legs were far from fresh.

Gain some free speed:

I often see riders in these kind of events making some fundamental mistakes that could shave minutes off of their ultimate finishing time. These are often things that I have learnt the hard way, so hopefully mentioning them here means that you wont have to:

  1. At the start I was caught up and overtaken by quite a few people. I was taking it easy before the hills, wasn’t out of breath and was just enjoying the coastal views. I saw again and overtook most of these people within the first thirty miles of the ride. Their performance had tailed off dramatically and they were already struggling. Believe me when I say that going slow at the beginning will give you a hugely improved finishing time. It gives you a chance to eat and drink properly, doesn’t throw your digestion system out of whack and doesn’t burn through all of your glycogen stores before you can replenish them. If you have a heart rate monitor keep it in zone two. This will feel really slow due to the adrenaline coursing through your system and many riders will whoosh off. Don’t worry, you will see them again. Look slow now to look fast later. Doing this doesn’t cost you anything and the gains are massive.
  2. Tuck in that flapping jacket, use those handlebars to drop yourself lower. For everything that you add to your cycling kit, whether it is on you or the bike, consider how much it can hurt or improve your aerodynamics. In a sportive I sacrifice some aero advantage to carry a bit more food and water, but I use common sense to make sure that my jacket doesn’t flap. I use the drops when going into a head wind. I don’t put anything on my back that will interrupt air flow across my body. I wear a Giro Air Attack helmet which is much more aero than a normal road helmet and is perfectly well vented for UK weather conditions. I also shave my legs for long rides. Did you know that at an average speed of 20 miles an hour you will cover 40km around 80 seconds faster than with hairy legs? This was a real surprise to many people when Specialized tested it in the wind tunnel. This may not actually work out as much on a long slow and hilly sportive, but a few free minutes over the 100 miles are still a few free minutes!
  3. On one downhill section I easily caught up with a couple of guys that had been slipstreaming each other in front of me and had made up around half a mile on me. This required no massive risk taking, no extra pedalling and no particular effort. They had put in all those extra watts on the flat, consumed those extra calories and made good headway, only to lose it due to a lack of bike proficiency on a technical descent. Needless to say I eventually over took them and didn’t see them again. Bike handling doesn’t cost you anything, but it does take some of your time. I spent a winter a few years ago on a mountain bike pedalling trails instead of simply using my turbo. This immeasurable improved my bike handling and descending skills.

To summarise: Pace yourself, consider aerodynamics and learn how to ride downhill. These will give you massive gains over a long ride without you having to expend any extra effort. If you add those in to learning a bit more about hydration and nutrition then you will knock big lumps off of your average speed and your personal best times.

JurassicClassicMap

Conclusion

The Prostate Cancer UK Jurassic Classic is an extremely well organised event, offers a number of different distances, and is on a stunning course. If you like cycling then I would heartily recommend that you give it a go, but be prepared to work hard and if in doubt take the bike with the triple chain set. When I rode it the weather was mostly over cast with a light breeze and intermittent showers. This was just about perfect, but the course is well sheltered for most sections, so would also be perfectly doable if the weather wasn’t ideal.

Another word on bike fitting

TapeMeasure

A GOOD bike fit is crucial to good performance and makes a massive difference to your efficiency on the bike, but when you get a bike fit ensure you get a copy of the measurements and then before each race ensure that you have checked that nothing on the bike has changed.

I have written two previous articles on bike fitting which I have linked to at the bottom of the page, but in the last week the importance of a good bike fit really hit home.

A month or so ago I took part in a middle distance triathlon and my aim was to average between 185 and 205W for the 50 mile hilly ride without exceeding 290W on the climbs. I ultimately managed an average of 195W and it felt easy. Last weekend I took part in a half iron distance triathlon and had the aim of averaging closer to 205W for the ride to see how that impacted upon the following run. In this case I managed 200W for the first hour and then, despite eating and drinking well, my power tailed off and I only managed to average 175W yet my heart rate was high and I could not have gone any harder. I put this down to fatigue and moved on, yet just three days later I did a turbo session where I was easily, relatively speaking, pushing upto 300W for some fairly long intervals. What was going on?

There are a couple of differences between my time trial bike and my TT bike, but ultimately the TT bike was the one that I had the bike fit on and I then replicated that fit onto my turbo bike, or as close as I could get it. My turbo is the Wahoo Kickr and has accurate power measurement. For my TT bike I use Garmin Vector pedals which are also extremely accurate, so I didn’t think it was an issue with the power recording devices. So far one bad race hadn’t caused me to look into the problem, I simply thought that it was one of those things. Yesterday that changed.

I have been feeling strong all week and yesterday I went to do a local ten mile time trial where my aim was to push 240W for the first ten minutes before opening up and charging to the finish with everything that I had left. On paper this was a sound strategy and meant that I should find the first ten minutes pretty easy before having a very strong negative split. In reality my heart rate was maxing out and my legs were burning and I could only just hold 205W for the first ten minutes and had an average power output of 203W for the race. This was still a PB time for me by over three minutes as I hadn’t done a ten mile TT in about 18 months and I am a lot fitter now than I was then. This still didn’t add up. I should have been a lot quicker for the level of effort that I was putting in. Was I coming down with something? Were my expensive pedals broken?

This morning I checked my bike fit. Would you believe that my saddle had dropped by 1cm since getting the original fit a couple of months ago, and not only that the issue had been compounded by the saddle having slipped back by 1.5cm. This resulted in a resulting power output of one fifth of what it should have been and brings me to the moral of this story:

A GOOD bike fit is crucial to good performance and makes a massive difference to your efficiency on the bike, but when you get a bike fit ensure you get a copy of the measurements and then before each race ensure that you have checked that nothing on the bike has changed.

Thanks again to Paul at www.rideplymouth.co.uk who did my bike fit. He pointed out that my Felt B16 seatpost had a crappy bracket on it at the time, and this confirms that his observations were indeed correct. No matter how well I tighten it up it always seems to come loose and needs to be checked before every ride.

Here are my previous articles on bike fitting:

Bike fit part 1 – The Theory

Bike fit part 2 – The Experience

Happy riding. I am here learning the hard way so you don’t have to 😉

Ironman pacing for the beginner

Ironman Wales 2012 Start PanoramaI am about to do my first full Ironman and I thought that some of you might be interested to know how I have come up with an Ironman pacing strategy. I have learnt a lot about pacing from doing a variety of long distance events from cycle sportives to triathlons to ultra marathons and the right pacing strategy can really make your day whatever your level. I also pay for one to one coaching and my coach, Neil Scholes of Kinetic Revolution and Performance Edge, has also been instrumental in getting me into the right frame of mind to avoid disappointment on the day.

For your first Ironman you may have fantasized about qualifying for the world champs at Kona, but let’s be realistic, that is highly unlikely to happen. To achieve such a feat you will have to treat your training plan with military precision and dedicate a year or two of your life, at least, to making it a reality. As a first timer you really need to forget about all of the other athletes out there. At your core you have one goal: To complete the Ironman within 17 hours and hear Mike Reilly declare “you are an Ironman” as you cross the finish line. I would also add that you need to have a bit of fun along the way. If you aren’t having fun and this is your hobby then perhaps you need to take a long hard look at yourself in the mirror and think about why you are doing this.

Primary goal: To complete the Ironman within 17 hours and hear Mike Reilly declare “you are an Ironman” as you cross the finish line.

With your primary goal set you will no doubt have some further expectations on what you can achieve during the swim, bike and run. I would suggest avoiding setting a time expectation as this can easily be thrown out simply by the course being long or short, or the weather being too hot, too cold, or too windy. For the swim I have one goal and that is to finish without unduly tiring myself out, so that I am in a great shape for the rest of the race. Did you know that pushing too hard on the swim may not show so much on the bike, but can significantly harm your running pace at the end? Nobody wins an Ironman in the swim.

Swim tip: Wear earplugs. Most people don’t get seasick in the swim, they just think they do. Most of the time it is the cold water sloshing up and down your ear canal making you dizzy and then sick. Fixed easily and cheaply with earplugs.

You will spend around half of your time in an Ironman on your bike, so hopefully you have spent at least half of your training time on your bike? Pace the bike right and you will have a great run at the end of the ironman, but get it wrong and the marathon will turn into a painful 5-6 hour run/walk/crawl nightmare. This means that you need to start the bike easy and let other folks whoosh off. This is hard to do, but there is plenty of time to catch them later.

If you train with power then your Ironman pace on the bike should be around 65-75% of your FTP (Functional Threshold Power) which you should be able to maintain fairly easily all of the way around. Avoid powering up hills i.e. large spikes in your power output and just ride your own race. The chances are that you will see those folks powering past you now in the run later.

If you train with heart rate then the book “Going Long” by Joe Friel has a great table on bike pacing in it (pg 318 in the 2nd Edition). It also has a load of other good information as well and is worth a read. As a rough guide you should be in zone 2 (aerobic endurance) for the most of it and keeping the exercise as aerobic as possible.

Bike tip: Focus on nutrition and hydration throughout the bike. You need to finish it as well fuelled/hydrated as you can and that means consuming 300-350 calories an hour of something you know that you can digest. You are aiming to start the run as fresh as possible.

Once you get off of the bike you should feel tired but capable of still running a marathon. Here is where pacing the swim and bike right will pay dividends. Many people will have gone too hard and will be feeling awful, it’s just that quite a few of them may now be in front of you. Don’t worry about that as you have 26.2 miles to catch as many of them up as you can and once they start walking you will steamroller on past them.

Start the run as you would any marathon, easily. Focus on your form and cadence, but don’t worry about your speed as you settle into it. Keep the legs ticking over and keep moving forward. If you start to slow then pop a gel in, and remember to grab a mouthful of liquid at each aid station. Swish it around your mouth and swallow. Slow slightly while you do it, then pick the pace back up again. You will still be going fairly slowly, but your rate of perceived exertion will be high due to the swim and bike that you have done beforehand. Just keep moving forward. Focus on the next person in front of you and slowly reel them in. When you overtake then move onto the next one. Steep hill? Feel free to walk, I do, and when you get near the end you will understand why. Now you’ve got to mile 20, and surprise, the wheels haven’t fallen off. You are still creeping forward, you are still overtaking people. You only have 10km, 6 miles, to go. If you feel up to it, now you can start to pick up the pace. This is the point where I start to high five marshals, you should have been high fiving spectators all the way ;). Focus on the next marshal, run to them, high five, move to the next one. Pick those heels up, push those elbows back. Keep moving forward. It hurts, but who cares, you are about to finish an Ironman.

Finally you will see the finish, and as you cross the line: “YOU ARE AN IRONMAN!”

Now look at your watch. I bet you did better than you were expecting, and it was all down to good pacing. If you get it wrong and a man dressed as a harlequin overtakes you in the last twelve miles, then that’s me, so please do come back here and make a donation to my chosen charity. The link is on the right of the page 🙂

On Sunday the 14th September I will be putting my reputation on the line in Ironman Wales, do come back to Bike Run Swim to check out the race report.

Please note that there are other factors to finishing your first Ironman well. Amongst them is your food and drink, doing the right training, keeping your bike fettled, a smattering of good luck etc. But once those are all lined up then the pacing is going to make the biggest difference to your finishing time and enjoyment on the day. Come back and let me know how you got on. What worked for you and what didn’t?

 

Ocean Lava Triathlon – Wales – The Leukaemia Conclusion

Ocean Lava Medal

Yesterday I flogged myself to bits around the Ocean Lava Triathlon course in deepest West Wales. It was centred around Fishguard with the bike route passing through the UK’s smallest city, St Davids. There was some fancy dress involved as I wore my superman pants on the outside of my wetsuit for the swim and donned my charity t-shirt with harlequin hat and leggings, and bells, for the run. I am still fundraising for the Plymouth District Leukaemia Fund, and would appreciate any spare pennies that you may have. You can donate using the Virgin Giving link on the right. I swam 1800m, cycled 56 miles and ran a half marathon in a total time of 5 hours and 42 minutes, sacrificing valuable positions to take the time to get into my fancy dress kit not to mention all of the high fiving that I did on the way around!!

via Ocean Lava Triathlon – Wales – The Leukaemia Conclusion.