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Concussions in Cycling

Concussions have been interesting to me for several years for both personal and professional reasons. This article is meant to put together some of the learning I have had over the years, as well as more recently with enhanced concussion education in Ontario and through working through concussions with my coaching clients.

I have sustained many head injuries in my life but I have been fortunate not to experience symptoms beyond perhaps 24 hours at most. I do spend time wondering about long term consequences, given findings around frequent impacts and football.

Beyond my own head injuries, I interact with many cyclists and athletes each year through my coaching, skill sessions, training-camps, and races. It strikes me that more cyclists are experiencing these prolonged symptoms after a head injury (called post-concussion syndrome). It is possible we are all more aware of the risks of head injury or that we are seeing more participation at higher levels by people with existing risk factors for post-concussion syndrome. This interesting study from 1992 describes the condition and some of the controversy around it. These symptoms are quite debilitating and, while ‘invisible’ from the outside, can be life-changing for those affected and their loved ones.

Early foundations of position and pumping on a ‘beginner’ pump track that is straight, wide and regular in frequency and size at Joyride 150 in Markham Ontario.

I wrote this article in 2015 talking about things I felt like we might do to reduce crashes in general. I wrote about risk-taking and gradual exposure because I felt like some of the injuries (at the time and in my estimation) were happening in younger athletes, especially females, quite frequently. I surmised that these young athletes were being forced to catch up to the new, technical features on ‘Olympic cross country’ courses and that athletes and coaches were taking undue risks by rushing proper progression and not analyzing the risk: reward adequately.

What is a Concussion?

“A concussion is a brain injury that *can’t* be seen on x-rays, CT or MRI scans. It affects the way an athlete thinks and can cause a variety of symptoms.” (page 29 in the Canadian guidelines)

brain

WHAT CAUSES A CONCUSSION?

“Any blow to the head, face or neck, or somewhere else on the body that causes a sudden jarring of the head may cause a concussion. Examples include getting body-checked in hockey or hitting one’s head on the floor in gym class” (page 29 in the Canadian guidelines)

In cycling, we might suspect this with any dents, scrapes or dirt on the helmet and certainly with any injury to the face. Remembering that we do not need to hit the head but also might experience extreme forces (think whiplash or sudden stops) and so if there is a crash it is likely wise to stop training for the day.

What to Do If You Suspect a Head impact

Recognize and act – this is a quick guide to knowing when to call for an ambulance versus remove from play. The guide includes questions to ask and symptoms to watch for.

Follow these three steps if you — or someone you know — experiences a blow to the head, face, neck or body and you suspect a concussion. Call 911 if you are concerned the injury is life-threatening, such as the person is unconscious or they had a seizure.


1) Recognize signs and symptoms of a concussion and remove yourself or the athlete from the sport/physical activity, even if you feel OK or they insist they are OK.
2) Get yourself or the athlete checked out by a physician or nurse practitioner.
3) Support gradual return to school and sport.


https://www.ontario.ca/page/rowans-law-concussion-awareness-resources#section-2

Mistakes I keep seeing

In the last year when I have seen more males and masters aged clients getting concussions with lasting symptoms and it seems that with a very high frequency the following two overarching rules are not followed:

  1. Stop playing if you hit your head (or crash as per above). This may mean calling for a ride home or not finishing a race or group ride.
  2. Don’t do much, if anything, including work/screens/exercise in the  24 hours after the head impact. Don’t go ‘test’ your body/brain out in that period. It isn’t a bad idea to go to the doctor!

Return to Sport / Work

Essentially you have a 24-48 hour period of low to no symptoms with no activity (typically you would get medical clearance from a doctor), the first step, which is detailed in the below return to sport link, is to do some light activity around the home, if symptoms do not worsen in the next 24 hours then you might progress to something like indoor cycling for 10 min at a very light exertion (low recovery zone) and again wait 24 hours before progressing to the next level, which again will add volume, intensity or extra variables (other people, outdoors, offroad etc.)

When Recovery Takes Longer

Post Concussion Syndrome is when there are symptoms that persist for weeks, months and even years after the initial injury. Below is a quote from a client whom I coach who dealt with symptoms for several months after a concussion.

“I think that two of the lessons that I’ve learned that I would not have known before are that every concussion is unique. It’s unique between people […] So healing takes its own path and is not linear. That was very challenging to wrap my head around. Secondly, for many people the expectations need to change from days to weeks and months and sometimes even years. It’s easy to say these words, but living through the pace of healing is extremely frustrating and patience is so critical. “

Should you experience prolonged recovery it is worth asking (and asking again) about options to be assessed for neck musculature, vestibular/vision dysfunction and other possible causes/factors in a prolonged recovery. This can be missed if you are with a practitioner not familiar with the latest concussion protocols and strategies. (more here)

In Ontario, the concussion protocols have been formalized and mandated by the Ontario government. Anyone working with athletes under 25 likely needs to confirm their understanding of the protocol and submit a document to their sports organization. Really anyone in sport should review this up to date information on what a concussion is and how to deal with one when it happens both immediately and when symptoms persist. 

Thank you for reading!

Hopefully, this is a helpful compilation of links and summary of ideas, please let me know as this becomes outdated or if any information is not accurate!

Take Action on Tired Legs

Take Action on Tired Legs

This is a post from the Smart Athlete Newsletter – Get all the articles and updates on clinics – upcoming events and podcast info by signing up here

We are through some of the first big races and anyone who was stranded indoors in the ‘suffer-festival’ has been freed for long enough to accumulate some fatigue.

If you haven’t balanced your hard and/or long training with sufficient nutrition and/or recovery than your body will rebel in a number of ways, often resulting in that feeling of tired legs. It may be you haven’t increased your nutrition to match increased training or that your life has not provided sufficient sleep and down time to absorb your hard training.

Here are 3 things that you can TAKE ACTION ON to ensure your season stays on track:

1) Add Protein and Carbohydrate to each meal – if eating 3 or less meals add 1 more meal with a whole protein and carbohydrate source. MyFitnessPal is an app that can help you quantify your rough numbers but I prefer clients work from their ‘normal’ and try a week eating a bit more at each meal OR adding a meal.

2) Take 2 days per week completely off and walk for at least 30 minutes. Plan your hard training the day after so you are well rested.

3) Sleep – This is becoming almost as cliche in the media as ‘sitting is like smoking’ but if you are having trouble with energy, tired legs, heart rate depression or similar symptoms try going to bed 30 minutes earlier in a dark room with ear-plugs and an eye-shade. Those that listen never go back and see huge difference – TRY IT!

Coping w. Injury, Numb Hands and Frustration with Training

This episode of the Consummate Athlete Podcast (you can listen or download below) answers a few listener questions. Check out the show notes on HERE on the podcast page.

Coping with Injury

When you are injured and unable to do your sport, or to do your sport as much or as aggressive as you would like, it is very hard! Sometimes you wonder what you will do with all the free time and the tendency is definitely there to sit around and get sad about missing races. This time off can be a gift to change our focus and train differently (or recover harder), to learn new things like cooking, meditation and strength training (master pull-ups?). This time off can also be a good gut check on how we are doing with our off-bike lives. See friends you haven’t seen, spend more quality time with family and loved ones.

Numb Hands

A Listener had numb hands that persisted for a few days after a long mountain bike race. On the podcast, we discussed possible things to try including checking on how hard you are gripping, how many fingers are used for braking and also considering more padded gloves and grips.

Frustrated During a Workout

This one was near and dear to my heart as a coach. It is not uncommon for anyone regardless of experience to get frustrated in a workout if it doesn’t work out as we expected or how it ‘should’. We work through a few questions to ask yourself (especially if you are indoors on a virtual trainer program like Zwift). In general, aim to get the workout done and follow the concepts of 80% is a passing grade (read this post on this concept) and 90% of life is showing up.

Starting Strength and Does Form Matter?

A listener had been feeling like they couldn’t get started because there were lacking confidence in form. We discuss the benefits of getting going, even without weight and progressing your workouts weekly. We also discuss the value in even a single session with a coach or trainer to get some touch-ups on form and some ideas on workout routine/exercise selection. Check out my Anywhere Core for some quick exercises to start on today!

Cyclocross – Rain clothing, Toe Spikes and should you use Heart Rate

The latest Podcast Episode discusses some big questions and concepts that might help your racing and rides in the fall, winter and anytime the weather gets rainy, muddy or snowy!

  • Rain Gear
  • Setting up your car for success
  • how/if to use power/hr / speed in workouts
  • race and pre-ride etiquette
  • tubular, tubeless vs. tubed tires
  • hacks and gear to boost your performance

Listen to the episode

Training Happy – Dealing with Injury and Failure

Megan Roche is a professional runner, coach, and doctor! She was a guest on the Consummate Athlete Podcast which you can listen to (or download) in the below player (or at www.consummateathlete.com )

Key Take-a-ways

  • Injury – dealing with setbacks – Megan had a very serious hamstring injury recently and she discusses coming back after and being patient.
  • Failure – expect and embrace these! Molly talks through our ‘failed’ attempt at the Kilarney FKT (see her post here on that) and Megan discusses her injury and different failures she has had and how we deal with it after.
  • When, how, if you should get off the couch and go run/train
  • On being a happy runner when things aren’t going well. (which is relevant for all athletes) – their book “the Happy Runner” is worth a read!
  • TECHNICAL RUNNING – Uphill and downhill tips

Off-Season, Burnout and Should You Take Time Off

Fall can be tough if you have raced or ridden all year. In many areas, you can race or ride a bike all year thanks to Cyclocross, track, fat bike and indoor smart trainers. I get many questions about burnout, motivation, and questions like ‘what does it all mean and do I have to race Cyclocross?’ this time of year. This episode of the Canadian Cycling Magazine podcast asked me about ‘what if you just aren’t into cyclocross’

If you are asking if you should take time off, struggling with motivation, nursing an injury or feeling slow/low-energy … take a week off (or two!). Yes, even if the weather is great.

My strategy does not need to be yours but I offer it as a way that has let me race moderately well for many (too many?) years and one that I see modeled by the best/most consistent athletes I work with.

In September after the last race (often provincials) I don’t ride for a week, no bikes no matter the weather. After this last week off, I want to be REALLY motivated to ride. This full week off maybe 1-4 weeks off depending on if I am sick, injured or really drained from a long season of racing. When in doubt take more time completely off the bike.

Great shot of a wallride I was doing at Blue Mountain captured by Marc Landry

What do you do with the time away from the bike?

It is very hard to go from a routine of riding, training and working hard. We all get hooked on the feeling of finishing a ride, run or workout. There is also a matter of how you fill your day! Sometimes these weeks away from the bike are a good barometer on how we are doing on the other aspects of life (that are important). Spend time on family, friends, getting doctors checkups, nap/sleep more, go for walks and catch up on your bike maintenance! Remind yourself daily that it is good to be bored!

Ease back – really slow!

Then in the 2-4 weeks after the time completely off the bike I will ride but will not do intervals, all rides are fun rides with no pushing of motivation, energy, or duration. These rides are best with friends and also guided by technical aspects I want to improve. These also often include Cyclocross practice, cyclocross coaching, and downhilling, which are great fun and often leave me wanting to train more. Often there are a few fun events that are more social, like the Pulse Racing 8-hour relay (~2hrs riding spread over the day) with Trek Store for fun.


@dorisxiaoting photo of the 2019 Fall 8-hour By Pulse Racing at Hardwood Ski & Bike

I also ease into strength and running more to prepare to be consistent during the bad weather ahead and make sure to respect any injuries or health concerns I had during the year. I have an ‘anywhere core’ routine that I start many athletes with that is low on gear, quick to do. See Anywhere CORE video.

gym work!

I work on cleaning up and prepping my equipment and selling anything that needs to be sold. I read a bunch and spend some time reflecting on the season and what is next with racing and training … and life. With clients, this can be a formal season assessment and goal setting process and/or a phone consult or in-person meeting to go over these concepts.

Fuel Your ride is a great book to read in the off-season and make some small tweaks to your strategy for on and off the bike https://amzn.to/2kCQgQK

I spend time on eating good food reducing any supplements/high-calorie food since the training load is lower. Fuel Your Ride is a great book for off-season reading to make some small tweaks to your nutrition strategy. We eat mostly at home but also some extra date and social nights. We also watch a lot of Cyclocross racing!

So all that to say … have fun this fall and make sure you take some downtime. It is an important part of your year.

If you need help fitting it all in and balancing training/racing/work/ family that is what I have done with Smart Athlete Coaching for the last 15 years – Book a phone Consult to discuss your personal situation and goals

Nutrition for multi-day events + hydration

The latest Consummate Athlete podcast goes into details about fueling for multi-day track, charity and similar events where you have to be ready to ride for many days but you also must deal with stoppages and different patterns in riding and food. What have you done? What are your goals? One key is that most […]