I'm a cyclist. What good is Sports Massage for me?

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As a cyclist, you know about spending money on getting a better bike, lighter components and more aerodynamic wheels. It all makes you go faster.
That's all defined by materials and mechanics, if someone else buys the same thing as you, they can go just as fast. What if you could get something unique that could make you go faster and be a more efficient and less injury prone cyclist?

No, I'm not talking about EPO, I'm talking about Sports Massage.

We know that the pro's use it on a day to day basis - and they know the performance enhancing benefits that it brings- so lets just break it down a bit to give you an idea of why they use it, and how it can be used to benefit you.

The general complaint I see from cyclists - as with runners is pain running down the ITB, there have been a few of the more hardy souls who want it "stripped" so that the pain goes away- which is particularly painful, and is something to do if you want quick relief, but not actually treat the cause of the pain. If you have ITB syndrome then there is a previous blog post that you might want to have a look at.

Cyclists are generally plagued with overuse injuries. It's not generally a sport in which something suddenly hurts, and hurts badly - (unless you hit a tree), it is a sport in which things gradually ache, you get used to them, and then, over a long period of time, you start breaking down. The main areas are knee pain, foot and ankle injuries, neck and back pain, hip pain and hand and wrist injuries. I'm not going to include fractures and impact injuries, though they do happen, and massage can help the recovery of them in the long term... but it's not really a modality which stops you from blunt force trauma. I'm not going to talk about correct bike set up, though a badly fitting bike can  lead to all kinds of issues.

Maintenance massage- what does it do?
Much like checking over your bike for wear and tear, the drive-chain, the gears, brakes, bearings etc, everything needs replacing from time to time. A maintenance massage is just that. Checking over the various muscle groups throughout the body for excessive tension, inefficient muscles, imbalances which make your body more prone to fatigue, flushing waste products through muscles and generally assessing the well being and health of the body for the ongoing challenge that is cycling.

Imbalances? Are you saying I'm unbalanced?
Yes. but not mentally. obviously.
Muscles work on a reciprocal basis - agonists and antagonists. When one of those is being used, the other is neurologically inhibited (it automatically relaxes). So when you use the quads, the hamstrings will automatically relax, its hardwired into your nerves to do that. This is great - until you consider something else, all the time the quads are engaged, the hamstrings CANNOT switch on - they are neurologically inhibited by the nerves. If you have huge quads and they are constantly tight - always switched on even when you "relax", the resting tone of your hamstrings is very lax. They become wasted and inefficient and you become over reliant upon the muscles at the front of your legs. That's just a brief example of a muscle imbalance - and it can happen anywhere in the body - which will affect posture and your ability to pedal for long periods of time - so muscle imbalances are something to look out for.

Ok - so what other muscles might be affected?
Well, we've already talked about quads and hamstrings, another contender for most ignored muscle of the year award for cyclists is the glutes. Gluteus maximus, medius and minimus, all working around the hips and hip joint to stabilise the pelvis and make sure the leg - and by extension - the knee - are working in harmony. Again, its the quads which can end up being very dominant, and the glutes end up wasting away, not being called upon to do what they are meant to do. This may not have much effect on the power of your pedalling, but if the muscles don't work in terms of their stabilising role, the legs are going to start being less efficient in their stroke, excess side to side (lateral) movement may result and over time, that chronic overuse injury to the knee may well result. Not a good thing.
The same could well be said for the Piriformis muscle - not being stretched out - ends up with a chronically over tight lateral rotator, and then hip is thrown out of whack - ending up with - you guessed it, an overuse injury at the knee.

Funnily, the glutes are connected with another issue - the back. As they get weaker and more atrophied, the movements which rely on Glute power (one of the biggest, if not the biggest muscles of the body) begin to find other muscles to use in order to make movements which it is used to. Raising the leg behind you is meant to use the Glute max as a prime mover - in a number of back ache cases, the Glute max isn't being used in that capacity - its the lower back muscles which are being used as the main muscles, followed by the hamstrings, and THEN the glutes. No wonder their backs hurt! Small muscles which are meant to be used for postural changes are being used by the body to power movement - because the glutes are lazy - which has come about because the quads are permanently too tense.

All of a sudden, your lower back pain is being indirectly caused by tight quads. What about that.
Might it be worth getting those quads looked at - see if they need a maintenance massage?

Hours of sitting on a bike can cause havoc with the upper body posture - especially when its combined with the average "desk jockey" position. A great aerodynamic position is with the shoulders tucked in. Elbows in, head down and looking - in essence - up. Pectorals are shortened, Lat dorsi is shortened, trapezius is short, scalenes and SCM (muscles in your neck) are tight and holding the head at an angle which is definitely sub-optimal for muscular endurance - however, all these muscles are also having the same things done to them as you sit at your computer at work. Your glutes, which aren't working on the bike so much, barely get a look in when you are sitting down, and it's the quads which are mainly used in the action of standing up and sitting down.

So all the things that are bad for you at work (if you're predominantly sitting at a desk) appear to be compounded by riding the bike.

Yes, riding is a fantastic and very healthy thing to be doing, but its not actually getting your posture any better, and it's not giving your body a break from the position its in all day anyway.

A final note about efficiency of muscles.
We all know that when we exercise, the muscles break down. It is during rest that the muscles build back up again and become stronger. They do this through tissue being laid down in a haphazard fashion within the muscles. This haphazard pattern becomes aligned to lines of stress.
However, the tissue that is laid down in the muscles is a sticky collagen substance - it's so sticky that it doesn't just lay down in individual muscles, it forms cross-bridges between them - and without care, can bind muscles together - which will make them perform sub-optimally.
Imagine if your quadriceps (sorry to keep going back to them, but they are generally a pretty good example) which are 4 individual muscles, which contract at different rates and different times according to what you want them to do were bound together - forming what is essentially a single muscle - a unicep if you will - each time an individual muscle wanted to contract, all 4 of them have to do so, using up valuable energy, sapping your power instead of that one muscle working efficiently, and leaving the others to rest until they are needed. (simplistic and, in this case slightly unrealistic, but I hope you see my point). If your muscles are bound together they are inefficient and are wasting your energy.

How can I stop this?
Get a foam roller, do some intelligent stretching (to counter the effects of the cycling posture) and book yourself in for a massage.
Foam rollering going to hurt the first few times you do it, but the more it hurts the less efficient your muscles have been - and the more you need it.
I know there are more reasons and more things to talk about, but I think I've drivelled on enough for the moment.

By request - Recovery Techniques

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So. I ache. I was out flipping tyres and throwing medicine balls around yesterday, and although I warmed down a bit, I didn't really do any recovery - hence, I ache.

Generally at the end of a session it's common to think that you can't be bothered to do a cool down, or you don't have time - you shoot off and do something else, and it's not until the next day that you curse yourself for a fool as you wander around the house trying to make a coffee with what feels like battery acid coursing around your veins.

After the post on DOMS which seems to have generated some interest, I received a couple of missives to ask what kind of recovery practices are good in order to minimise the pain, and are there any diet changes that can make a difference - like chugging protein after a workout etc.

Ice Baths-
or - if you can't get any ice - really cold water bath. The colder the better, the more ice the better - within reason. The idea of this is that the ice has an anti-inflammatory effect - the muscles have already been over-heated from the exercise you were just doing- you need to cool them down. A general guideline is filling the bath up as high as it need go to cover the muscles you have been using, and try to accumulate 15- 20 mins in total. It doesn't need to be all at once, you can have several shots at it for a few minutes. (I find that heating a flannel and using it to cover slightly more sensitive areas for the duration of the bath makes it slightly more bearable).

If you've just been for a fell run and there is a nice, ice cold stream to lie in - that will do the job nicely. Just ignore the weird looks from other people - you'll be feeling fresh as a daisy tomorrow.

Recovery shower -
Start warm to hot - massaging muscles for a few minutes (less than 5), then slowly turn the heat off until its properly, ridiculously cold. Unbearably so.
Man up.
for 5 minutes.
Turn the heat back on for a couple of minutes. And repeat at least twice, finishing with cold water.
Remember, 5 mins of cold water is better than feeling stiff as a board for the entirety of the next couple of days.

Foam roller -
I've mentioned these a couple of times in various blogs - use foam ones, expensive ones, pressurised coke bottles, beer bottles, slosh pipes, anything that is cylindrical and solid. You use the roller over muscle, which has the effect of stretching and separating muscle and fascia, breaking down cross fibres which make muscles less efficient. The pain you will feel is an indication of the muscles that are bound together (a bad thing), so the more it is hurting, the better it is for you, and the more you need it.

Also, the more you use a foam roller, the easier it will be for a massage therapist to treat the areas that actually need treating as they won't have to waste time getting through all the superficial knots and tension to get to the structural issues which may be causing inefficiencies in the way you use your body.

What should I eat?
Back in the day when I was primarily an indoor climber, I used to chug protein shakes on the way back home from a climbing session. They tasted lovely, but I was heavier than I needed to be because I really didn't need any of the extra stuff that I was pumping into my body. No matter how much protein you take on board directly AFTER a session, it will make no difference to the immediate recovery of muscles. The protein already in your system is what helps...
they keys to recovery after workout are twofold
1- a pre-workout snack - or taking on food before the work out - and
2- the replacement of Glycogen after the workout.
At this point in time, sports nutritionists are recommending 3:1 or 4:1 ratios of carb to protein- but at best this is a generalisation. (chocolate milk has an approximate 3:1 ratio. That's just normal chocolate milk - not some fancy expensive shake. It's what I use when I need a quick recovery drink at the end of a hard work out and I know that I won't be getting proper food for a while...) It will depend on the kind of effort you are expending.
Short intense workouts need little more than water, and a normal meal, up to 120 mins at a moderate pace may need up to 250cals followed by a normal meal (note, the numbers are not gospel, it will depend on your body and what you, as an individual needs), and long, long efforts will need up to 900 cals. You will know when you have got to that point. There will be no doubt.

The most important of the food advice I can possibly give is eat a balanced and intelligent diet. Eating crap, and then having energy bars and protein shakes will not get you anywhere near as good as just eating decent food. I'm not going to get into one type of diet versus another, because that is all secondary to the quality of food. Spend money on decent food. Your body is one of the best things you can invest in.

Other recovery methods -
The main one is long term cross training. If you are a triathlete you bike, run and swim - this, however, is not cross training for you. There will be massive imbalances between your quads and your glutes which will inhibit your ability to go faster - find another activity to do which will help keep the non-tri muscles working.
If you just lift weights- find something else to do,
you get the picture... the reason for this is if you constantly and consistently train for a single sport imbalances will develop and the muscles that you are using will get more and more tired.

Sleep -
Most important. Good quality sleep. I hate people that say sleep when you are dead. That's like saying you can have a drink while you're drowning. Sleep time processes toxins that you have accumulated in the day - poor quality food, water, air, alcohol etc. If you suffer from poor sleep quality or quantity, do something about it. Black out curtains, music, etc. Magnesium extract is a good sleep preparation dietary addition.

Maintenance massage -
Yes - regular massage can of course help - not just from a soothing and remedial point of view, ridding muscles of toxins, increasing muscle length and reworking myofascia via myofascial release to give better range of motion, but it is a time in which the therapist can see which muscles are healthy and are working in conjunction with others, and which are not taking on responsibility for their movements- and are contributing to inefficiencies in your daily life and sport. By discovering this, you can take pre-emptive care of your body, using the information to correct muscle imbalances before they become too ingrained, and your quality of life suffers from pain. The longer you leave muscles to become inefficient, and build up pain, the longer it will take to get you back into working order.

I think I've covered most of the things here - if only in quite a cursory way, but in enough detail for you to go away and have a think about how to recover better.

For those of you that keep a training diary - add a section- a recovery diary. Take note of what you are doing on a daily basis to help your body to recover.

If you are taking a lot out of your body with exercise, but not putting enough back in - not recovering enough, there is only one way you are heading- and that is to breakdown and injury.

Your choice, spend a bit of time doing recovery every day, or spend a lot of time out with injury and pain. I know which one I'm choosing.

ITBs (Illotibial Band Syndrome)

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ITB syndrome is relatively common among the runners and triathletes that I have treated. It's described variously as a sharp pain on the lateral (outside) edge of the kneecap, so painful that its like someone is poking a hot pin in there and twisting it around. It can also be felt further up the Band, toward the hip, but for this article, Im going to concentrate on the knee problem.

The distal (bottom) part of the ITB, and potential painful spot.

As you would expect, this tends to have an effect upon running style, generally a pronounced limp, followed swiftly by a walk, and then a phone call home to get picked up.

For those who don't know, the Illiotibial Band is a wide strip of collagen fibre stretching from the hip down to the knee. It attaches at proximally (at the top) to the fascia around the hip and (more importantly) to a muscle called the Tensor Fascia Latae (hereafter known as TFL). The TFL is kind of embedded in the fascia as opposed to being the controlling muscle of it.
Distally (at the bottom), the ITB attaches to the fascia around the kneecap on the lateral (outside) of the knee. It is here that the pain from ITB syndrome usually hits.

The ITB (in blue) and the TFL (in Black)

Why does it happen?!
I'm going to have to split this up into 2 sections, Fire and Smoke.
Fire-
The actual underlying reason this happens is based in the gluteal region, (your bum). As you walk/ run, there are a series of 6 muscles called the Deep 6, (or lateral rotators), their job is to keep the leg in the optimal position with the hip. In effect they act like a guy rope to keep the leg in line.
Just for reference, these muscles in this group are the Piriformis, Obturator Externus, Obturator Internus, Quadratus Femoris, Gemellus Inferior and Gemellus Superior.

The Deep 6 (the observant of you will notice I have only drawn 5 on there, the Obturator Externus is best drawn on from the front- and a bit more difficult to visualise from the back- so to prevent confusion, I refrained from drawing it.)

 Other muscles involved in this action are Gluteus Maximus, Gluteus Medius (both in your bum), also Psoas major, Sartorius and Iliacus, but we shall skip over the last few for the time being.

Now, if these muscles are not working as they should, ie. they aren't strong enough, or they are inhibited (as most of the triathletes I have seen), they are not able to stabilise the leg in the correct position as you walk/run. The only thing that the body can really do at this point is use the ITB - a length of non-contractile tissue - to hold the leg - and therefore the knee - in the right place.

So instead of a group of 10 or so muscles keeping the leg in line, the body is relying on a single piece of collagen - whose original job is to keep the knee-cap in the right place - to keep the whole leg in line with the hip.

All the muscles around your bum. Its quite packed in there, if they aren't working properly, or are inefficient, its pretty obvious that something is going to have to give. Generally, its going to be the ITB.

Smoke
We know that the ITB is now doing the vast majority of the work because of the inefficiencies of the muscles in the bum. The ITB is made up of collagen - which is an awesome substance. It responds to stress by getting thicker and tighter. So, as you pound your way down the road (or the fell), the ITB is getting thicker and tighter all the time, if it is that tissue that you are relying upon to keep the hip, leg and knee in line, it's going to get tighter. As it does so, it begins to pull the kneecap laterally (outwards), and can have the effect of making the kneecap track incorrectly - wearing out the inside of the kneecap - but the beginnings of pain are generally the feeling of tightness on the lateral (outside) edge of the knee- just where the ITB attaches to the fascia.

Treatment

A lot of people swear by foam rollering, or "stripping" the ITB, which is as painful as it sounds. If it has gone far enough, the collagen has plasticised (my words) itself into a form that is supporting the knee and the leg. The stripping of the band is necessary to re-educate the collagen so that it loosens off and doesn't pull on the kneecap anymore.

A foam roller of the foam variety

The problem with this is that its taken a few years to get into this state, and just rollering it a few times isn't going to make it just go away. You have lengthened it a bit, but as stated, its like plastic. It needs a long time to go back to the way that it was. If you have ITB pain, you are going to need to be using that roller for quite some time before it gets educated to go back to the way it should be.

A foam roller of the improvised variety. It doesn't NEED to be Rescue Ale, but it benefits Woodhead MRT if it is.

 If you do go to someone and they start digging into the ITB in a way that makes your eyes bulge and your throat go hoarse, they should also be looking at that muscle we spoke about earlier- the TFL- its a small muscle, embedded in the ITB up toward the hip. This muscle helps create tension in the ITB, and if the collagen band itself is being treated, the muscle which assists it should definitely be looked at as well. 

However.
If you just get the ITB "stripped" thats just the start. The Lateral Rotator muscles need to be trained to work better. If they don't do their job, the ITB will continue doing more than it should be doing, and hey presto, it will come back, and you'll do the whole thing all over again.
If you see a physio/massage therapist who just does your ITB and sends you on your merry way, get another one. They are using you as a cash cow.
They should be looking at the musculature around the hip, the muscles may be weak/inhibited, they may be biomechanically inefficient and need stimulating massage as well - (just as a warning, this may be as uncomfortable as the ITB stripping). They should also give you ideas as to what to do to strengthen the muscles in order to help reduce the pain in your knee.

Examples of things you could use as a Roller for your ITB. (I didnt have a 2 litre coke type bottle, but you could use one of those as well, even better if its pressurised and you don't have to drink it)

Golden Rule 1
If you have ITB syndrome, get it seen to by a professional, the quicker you get it sorted, the quicker you will be running pain free, and the less chance you have of the injury compounding.

Golden Rule 2
If you talk to a professional about knee pain, and you HAVEN'T hit your knee - but they only look at the knee, go to someone else. If there hasn't been a contusion to the knee structure itself, the issue is far more likely to be in the hip or the foot. And if these are not looked at in some detail, well, thats a bad thing.

I hope thats been a decent intro into Illiotibial Band Syndrome, what it is and why it happens. If you have any comments, I'd be happy to hear them.

A portrait of the artist hard at work

Enter the foam roller

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Having had a day off yesterday- which may have included a little wandering in the hills, and a small amount of climbing, - nothing serious, and nothing that could be construed as physical training- my legs are still feeling a little heavy.

After some consideration of posture, and reading up through some muscle balance and myofascial books I have recognised that I appear to have a small amount of what some body workers would call "Lower Cross Syndrome".
Basically, my Pelvis is being anteriorly rotated- in effect giving me increased curvature of the lumbar spine, the impression of a slight belly, and the apparent inability to touch my toes because of short hamstrings.
Now, the reason for all this is tight quads.

My quads are quite strong, and it would seem, do not like switching off- when I sit, when I stand, when I do anything, they are constantly on- Rectus Femoris - the main one which crosses both the knee and the hip joint is the main culprit. As it is on all the time, a Reciprocal Inhibition effect causes my glutes and my hamstrings to switch off- causing the tiliting of the pelvis.

The result of this over years and years appears to be that the thorocolumbar fascia - the fascia that connects around the lower part of my back has gradually been shortening and tightening - helping to keep my pelvis in this position so as to take the strain off the rectus femoris (and, probably psoas as well). Isn't the body wonderful at adapting- even when you dont want it to.
Net result, I can't touch my toes, not because of short hamstrings, but because of an anteriorly tilted pelvis- the result of tight hip flexors- rec fem and psoas.

What to be done? Apart from long and continuous massage - which although nice, would not necessarily be time or effort efficient, I shall be using the foam roller with a veangeance for a while. My Rec Fem needs some severe work being done on it, and that can be done most efficiently with various massage techniques. However, I can make my time on the table more productive by foam rollering my quads on a daily basis. Not exactly steamrollering them into submission, but if I can help them relax, and roll out the adhesions between the muscles, loosening off the fascia around them, it will mean that the therapist doesnt have to spent 20 mins of their time each time I see them. They can concentrate on the important stuff which will actually help me rather than try to to maintenence on my legs which I can quite easily do on my own.

Right I'm off to find the roller.

Tim