Over the last few weeks, we’ve completed the process of determining what you need to work on when it comes to building your very own personalized maintenance/recovery routine. In part one of the series, we talked about what you’ll need gear wise. From there we moved on to talk about analyzing your injury history to determine what your problem areas are and if they point to a bigger problem. Lastly, we talked about looking at your sport and the common problem areas to come with it. In this post we’re going to talk about the nuts and bolts of that program.

By now, this chart should be familiar. We’ve used the injury history and sport specific boxes at the top to mark the appropriate regions. From here, let’s move right on the chart. You’ll notice that the remaining columns are green, yellow, or red in color. Think of this like a traffic light.

• Green boxes: This means that you are truly in “maintenance mode”. Things feel good and you are recovering between workouts. The goal here is to actively monitor the problem areas you’ve checked off. Remember, the early warning signs are subtle. Actual pain and difficulty training/racing comes later as things progress into a full blown injury. In the beginning, warning signs can include stiffness, needing longer amounts of time for things to loosen up during workouts, prolonged soreness lasting more than 24 hrs. All of these are hints that you’re still recovering or not recovering at all if they persist.

You’ll notice in the chart above that there are only two techniques listed in the green         columns- foam rolling and stretching. Save the other columns for when things start
acting up.

• Yellow boxes: While we all wish we could stay in the green columns forever, the reality is that in the endurance world, we’re going to be spending some quality time in the yellow and red columns. As symptoms start to increase, the severity will determine what training modifications you’ll need to make and what you’ll need to start adding in terms of self treatment.

The top priority when you find yourself in yellow column territory is to stop and take the time to address the symptoms. Ignoring things here will only make things  worse. Symptoms here can vary. In the early stage, there may only be pain or discomfort at effort/at the end of long workouts. These symptoms can however worsen to include actual swelling and symptoms during daily activities. In addition to using additional self treatment techniques to get things under control you’ll also want to be making training modifications as well.

Another option to keep in mind is the help of a sports massage therapist,                      chiropractor, or physical therapist. While self treatment will absolutely get the job done, these are the people who can speed up that recovery significantly and give you the hands on care you need to loosen things up and make sure something bad isn’t going on.

• Red boxes: When you hit these columns, it’s time to stop kidding yourself. You are hurt and continued training/racing will only make it worse. Training modifications will play a big role here and all self treatment techniques will be needed in addition to the help of healthcare professionals.

Here’s a chart to break it all down for you and to help you determine which columns you should be using:

** Note: I canʼt stress this enough- use common sense when using this chart. This is not all encompassing and it is not designed to keep you from your healthcare team. If you are experiencing symptoms like numbness/tingling, swelling, scary dark/purple bruising, inability to stand/weight bear, lift your arm over your head, etc etc please call your Doctor. Not sure? Call your doctor. Better to be safe than sorry later when early treatment could have made a world of difference. Thatʼs what your insurance is for. **

So what does your routine look like in terms of the individual techniques?

For this section, I’m going to break this up into the three color sections. In the chart above, you’ll also notice that I’ve assigned “grades” to each level. We’ll be addressing that in this section as well.

Green (Grade 0)

• This level is truly “maintenance mode”. As we stated above, the only two techniques we are using are foam rolling and stretching. As always, we start with the foam roller.
• The goal is 30 seconds of foam rolling per muscle group. Depending on if you have individual boxes checked or a whole chain this can take anywhere from 5-20 min to hit all of the groups on each leg.
• Which order to start in? Pick an end of the chain: either at the ankle or at the low back/hip (if upper chain- wrist or neck/back). Even if you don’t have the whole chain x’ed, pick an end and work towards the other. Personally, I start at the ground and work my way up.
• If you are new to the foam rolling video’s and posts, plan to spend some quality time reading and watching. There are literally hundreds of hours of video on the ATA site and pictures/written descriptions to go along with them. Trust me- it’s time well spent to learn how to truly learn how to use that roller and also to learn the anatomy to know where the common problem areas are to look and focus on. It may mean more work in the beginning, but it will become second nature!
• After the foam roller, the next step is stretching. Again, this is going to involve multiple muscle groups. Shoot for 1×20 seconds each muscle group. If one group feels tighter than the others or sore while stretching? Add a second rep. If not, move onto the next.

Yellow (Grade 1 + 2)

• If you’re in the yellow levels, essentially this means that you’re starting to have symptoms. At grade one, these symptoms are during activity only. At grade two, they’re starting to surface into your day to day activities. That’s a bad sign! It’s one thing to have symptoms only when training or at the end of long or intense workouts, but it’s another thing to have those symptoms while walking around or on the job.
• When you find yourself in the yellow levels, we’re going to open up more of the techniques to use. Relax! That doesn’t mean you’ll need to go through all of those columns on the chart and spend four hours self treating. It just means that they’re there to use as you need them.
• Just like above in the green level, we’re going to start of the foam roller. This time however, I really want you to think of it as your magnifying glass. Pay attention to where those sore spots are and make note of them. Those are going to be what you go after with the deeper techniques.
• Because you’re now having symptoms, you’ll need to shift your attention from the maintenance program above into more of an injury treatment mindset. With maintenance we’re monitoring all of the problem areas on both sides. With an actual injury brewing, we need to focus on where the symptoms are and then on the chain they are a part of (on the affected side only). This is what distinguishes true maintenance work from trying to heal things up and prevent further injury.
• Back to the roller! Because we have symptoms and we’re only working on one side we’re going to bump up the time here. 1-2 minutes per group. As you’re using that roller you should be thinking: What did you find in terms of knots or sore spots? These are the areas you’ll want to go after.
• Following the roller with those spots in mind, the next step will be to break out the tennis ball to do the cross friction and trigger point techniques. Pick the worst three spots and spend 30 seconds on each. If you feel a specific knot, use the trigger point technique, otherwise use the cross friction. For the muscle groups that you didn’t have any bad spots in, skip them and move onto the ones that did have them.
• From there, the next step is to move onto the active and joint mobilizations. Again we’re focusing only on problem spots or muscles that feel tense overall. Start with the muscle mobilizations. 10 reps, nice and easy. From there, follow it up with 5 joint mobs at either end of the chain (for lower extremity that means five at the ankle and five at the hip; for upper extremity five at the wrist and five at the shoulder).
• Once the soft tissue techniques are done, follow it up with stretching. 2×20 seconds each muscle group.
• Optional: in the event that you have swelling or pain, add kinesiology taping to your plan. This can help relieve symptoms and also support the injured/painful area.
• At these levels it is okay to train, but take a look at the modifications to prevent further damage or prolonged symptoms.

Red Level (Grade 3 + 4)

• In these levels you are looking at a true injury. Unfortunately that means that like it not training and racing are at a halt.
• The first priority at these levels is to get some help. Depending on your insurance and location that could be in the form of a primary care physician first or if you have the ability to choose- an orthopedic.
• At these levels, self treatment is minimal and assuming that you have none of the following: numbness/tingling, visible swelling, scary dark/purple bruising, inability to stand/weight bear, lift your arm over your head, etc etc.
• At most, gentle stretching and foam rolling AROUND the injured area only. Avoid any techniques at the site of injury until cleared by MD. Absolutely no deeper techniques close to the injury site as you run the risk of increasing injury and inflammation.

Now that the chart makes more sense, I’m going to leave you with a little homework before next week’s post. Go to the Body Map on the ATA site and start reviewing the links on each of the regions you have checked! Like I said earlier, there is a lot of info in the form of videos, pictures and written content on this site. Get a head start and look at the self massage posts for each region! Next week we’re going to get into the specifics of how to schedule the when and how often for your program.

( *** In case you haven’t downloaded our sheet yet, or you need another, click here to download it. )

So far in our maintenance plan/recovery program we’ve talked injury histories and how to use them to customize your recovery plan. We’ve talked about the idea of looking at our body as one big chain and the importance of treating the chain instead of just what hurts. The next part of this process is to look at your specific sport and to identify what its common problem areas. Ideally we are looking for areas of the body that are kept in a shortened position and stretched only when the opposing muscle group contracts.

Why is this important? Muscles work in pairs that contract and relax in opposition to each other. For example, when your glute muscles extend your hip to help you push off while running, your hip flexors can relax and be stretched. This allows the glutes to contract fully and the hip flexors to relax fully and vice versa. However, if the glutes become fatigued and are unable to contract fully, the hip flexor is unable to relax fully. Instead, it is left in that shortened position where it can stiffen up. While this may not be problematic on any one run, if it happens again and again, the front of the hip will stiffen and the back of the hip (the glutes) will have to work even harder. Over time this can result in muscle break down and injury.

This means that we are looking for two things as we move through the different sports:
The muscles that are the most likely to fatigue and stop contracting fully. The muscles that will stop being stretched when #1 happens and stiffen up/restrict motion as a result of that fatigue.
Let’s start looking at specific sports to give you a better idea of what I mean.

#1 Running

The picture above shows good running form and what I call the Big Three. This means 1) full hip extension with the hips tilted forward and upper body straight, 2) full knee extension, and 3) normal ankle mobility for both shock absorption at heel strike and also push off during the back half of the stride. As these components start to change due to muscle fatigue and tightness, your stride changes and you start to transfer the impact of each foot strike differently. Over time this can result in restricted joint motion and muscle mobility.

Pull out your worksheet and make sure there is an x in each of the three region columns listed in the chart above. Most of you will find that these areas are already checked. Coincidence? If not or you’re missing one, put an x next to it.

#2 Cycling

In the picture above we have an aggressive road bike fit. Yours may not look like this, but it makes it easier to point out what we’re looking for- areas that are stuck in that short position for long periods of time. If the muscles that contract to get you out of that short position tire out/fatigue, you spend more time there making it easier to remain stuck.

One thing I really want to point with the bike is form related. While there’s a ton of stuff out there about run form, there isn’t much in terms of bike form and pedaling technique. Those of us coming into the endurance world later in life, just hop on and pedal without putting much thought behind it. While I’m not going to get into pedaling drills etc etc, I am going to talk about posture on the bike as it’s such a huge part of that pedal stroke.

This is the best video I’ve found to describe the posture aspect.

 

That tilt of the pelvis is key to getting to the glute muscles. It also really helps to engage the big Lat muscles to stabilize the back and keep everything in good alignment. When that tilt/posture goes away two things happen:

1) You lose the power of the glute muscles and instead of pedaling “horizontally” you start pounding the leg by pedaling vertically- meaning you push down and pull the leg up.

2) When you stop using your glutes, you rely on the rest of the leg. This means you just pound your feet, calves and knees. The glutes are the biggest, strongest muscle in the body. They are designed to be USED.

Just like for the runners, pull out your worksheet and make sure there is an x in each of the regions listed in the chart above.  If not or you’re missing one, put an x next to it.

 #3 Swimming

Obviously the problem areas for swimming will vary depending on which stroke styles you swim etc. For the sake of this post and this series, we’re going to focus on freestyle as the majority of our readers are triathletes. In the picture above the key points are the elbow, shoulder, neck and back. Just like with cycling, posture and maintaining good shoulder alignment is key to a healthy shoulder. When everything is mobile and strong, there is plenty of room in that joint. As things stiffen up and lose strength, however, the larger back muscles become unable to hold the shoulder back in good alignment. That slipping forward shifts the workload down into the front of the shoulder and the upper arm/elbow.

Same as above, make sure these three boxes are checked off on your worksheet! If you are a swimmer and have had injuries in the lower body, drop me an email and I can help you fine tune the areas to focus on!

#4 Triathlon

To keep this series from being a billion pages long, I’m going to rely on the above sport specific descriptions. However, instead of saying that you will now need to work on all of the sports above (which would be mean!), I’m going to streamline it for you.
Start with the bike advice. It’s the longest leg of your sport and will take up the most training hours on a weekly basis. While cycling may not be painful or even uncomfortable, it is most definitely a common culprit behind multi-sport overuse injuries. In particular, try to think of it this way- there are three main contact points that connect you to your bike for long periods of time:
Handlebars. This will transmit impact from the road up your arm into your chest, upper back, and neck. Problems here can surely impact your swim, as well as, overall comfort in the aero position.
Seat. Sitting in an aero position requires a strong back/core to allow for proper hip angle and continued hip mobility. This is harder than it sounds when you stack run mileage on top of it. Suffice it to say, your hips should definitely be a point of interest!
Pedals. This transmits impact up the entire leg chain. Problems here can result in calf, knee, and hip injuries upstream.

Just like the sections above, make sure there is a check in each box on your worksheet!

What’s next??

Now that you have a sheet full of x’s, it’s time to start digging into the techniques themselves and what this program will look like.

You’ll notice that on the right hand portion of the chart we have three different colored columns (red, yellow, and green). Think of these as your traffic light. Red means time to stop and start making modifications. Yellow means slow down from the grind of training and take care of things before they force you into that red zone. Green means all is well. The goal of your maintenance/recovery routine should be to always keep you in that green zone. It doesn’t mean that you can sit back and do nothing however. It means that you should be monitoring your problem areas with the foam roller and maintaining that mobility with frequent stretching. The combination of these two is more than enough to catch problems early!

In the next post we’re going to go through this entire chart and show you exactly what you’re program will look like! We’re also going about some general guidelines for training/racing modifications and how to know when to worry and when you can push through.