No Pain, No Gain?

My Spine (September, 2013)

That vacation was a lot longer than I had anticipated.

My cycling hiatus started back in July, about a week before my prior post; a post which has served as marvelous a place marker as any while I kept a safe distance from cycling and the insanity it can generate in a non-cycling cyclist.

Over the past couple of years I had been oscillating between cycling activity and inactivity largely due to a recurring bout of medial knee pain. I would treat the pain with R.I.C.E. as well as massage therapy, and then get back to training for some event or another. It has been very frustrating to gain a high level of fitness and then to throw away months of work with a few weeks off the bike due to soreness.

I had gone to great lengths and expense to diagnose and treat the knee issue, and each time I would have promising results… only to see my hopes dashed again by a new twinge in the knee.

With all this focus on the knee and little help from medical personnel, who would prescribe rest and shrug when I would ask for a possible cause, I had not paid too much attention to the "knot" I was feeling in my lower back.

I would chalk it up to lack of fitness after resting the knee and it would go away with increased riding.

Last July, after building back from another knee flare-up in preparation for the ride over the Central Mountain Range, I had been trying to stretch my back out a bit more and see if I could undo the knot. I was assuming I had a muscle that has gotten out of sorts and simply needed to be put back in a more relaxed position through stretching. I was in my office and I raised my arms toward the sky. Zap! A blazing bold of electric pain shot down my back and into my foot. I was totally unable to stand upright or put any weight on my right leg.

I had assumed I could massage the pain away and stretch myself into riding shape… and I did… I thought.

I completed that majestic ride through the mountains and then within a couple days I was on a plane to the United States, where I planned to spend a month off the bike to recover.

The pain persisted, but subsided somewhat with rest on an American box spring bed, and I was hopeful I would be able to return to Taiwan ready for some all-out, methodical, serious training.

By the time I returned in late August, the pain in my back had been reduced to a dull ache that would occasionally flare up if I tested it. I did what any cycling fool would do, and I got on the bike thinking a little strengthening work would pull the last bit of soreness right out.

I did one last ride with my old riding buddy, Dom, and stretched the back out all the way.

The next morning I could hardly get out of bed. I needed to roll onto my elbows and push my feet off the edge of the bed to even stand up. The second day was worse. I tried sleeping at the foot of the bed without the dip where I normally sleep hoping the firmness would help. I could hardly move. At work I could stand for no more than five minutes before grabbing the edge of a desk or cabinet for support. I was bent and hobbling and in agony.

A trip to the doctor revealed some very bad news.

A muscle imbalance had led to minor scoliosis and a herniated disk. The goo squirting from the disk had aggravated the sciatic nerve and thus I was in incredible, unrelenting pain, and would be for a number of weeks.

After six months of complete abstinence, I am finally cycling again.

What happened?

I am not entirely sure and I can only guess. My theories are:

A: I had been stretching less while building strength in my muscles and my fit changed. I did not notice or adjust for the change and, as a result, I developed a muscle imbalance that was aggravating my sciatic nerve and thus triggering knee pain. I would treat the knee (symptom) and not the cause. I also allowed my core strength to deteriorate as I had less time to devote to training… forgetting the rule that much of cycling performance comes from training, diet, rest and preparation off the bike. Whoops! The prime suspect would be the Illiopsoas muscle group (hip flexors) in my right hip. I developed a slight dip in my stroke to compensate and, with the repetition over my notoriously long rides, my spine was pulled and disk deteriorated. That is one theory.

B: An over training injury in my left knee led to my favoring the right over the left. I am already prone to favoring the right side (I was a goofy foot skater back in the day), so it is a possibility. The over strengthening led to a wobble that led to a total breakdown of my stroke and disaster.

Chicken or Egg?

Now, as I start back up again I have:

1. A perfectly sized and custom fit bike.
2. A new mattress on the bed.
3. A body that has rested for six months so I will have no real base to speak of and must start from scratch.
4. I healthy fear of lapsing from good habits and some healthy added perspective.
5. Fat that needs to go.
6. A stretched spine and strengthened core.

Nothing is more debilitating that a serious back injury. It makes almost all types of exercise impossible.

Now, as I head back onto the roads… I think I may need to see where I can pick up some aero carbon fiber training wheels.

Cycle safe. Cycle smart.

Beware! Take care!

Take time for all the little things or it can lead to lots of time away from something you love.

Missing Time

A few TiC readers may be aware that I took a bit of a sudden and unannounced hiatus from blogging after the first week of April. I have only just started blogging again. It isn't that there wasn't anything to blog about. A few great stories came and went during that time.

Regretfully, I was unable to write much during that time and I missed some good stuff. Oh well, that's just life-- the life of so many cyclists working to balance employment, family, health, weather and the sport we love. 

Things were looking really promising as I gained strength and stamina during February and March. My speed and recovery times improved dramatically in the weeks of climbing leading up to the Sanlinxi race, where I put in a respectable time for a guy still climbing back from an idle Winter of knee recovery.

The knee.

Every time I think I have it figured out.... it flares up again. I build my fitness up, and just as I start to push myself a little bit harder... it brings me back down to zero. This case of missing time is not related to space aliens, magnetic fields or crop circles. This is entirely about the knee. The goddamnedfucking knee!



On April 7 I embarked on my annual Taichung to Kaohsiung ride in honor of the Paris-Roubaix race. I was joined by Ryan, a fellow expat and a bicycle industry guy.

I felt I could make it as it was a flat route that would simply take a bit of endurance. I've suffered through worse and with all the hill training I had done, I figured I could just spin the crank at an even 32-34kph. In December I had done a pretty strong ride to Tainan, and then another to Kenting the next day. We rode hard both days, so I figured Kaohsiung would be that, plus a few more kilometers.



Ryan and I made pretty good time. We both favor titanium bikes and he is a very strong rider. Small talk chewed away at the hours and we felt pretty confident we could make it as long as we kept consuming caffeine and calories.



At one point I lost energy for about 20min. as there was a gap in my fuel intake.... whoops! I still felt pretty good. A little itchy in my calf as a lingering effect from the Sanlinxi race.



Just after Tainan my knee started to feel a little "fuzzy" and then achy. I was less than 50km from our destination and fought on despite the soreness.

We circled around the Zuoying HSR Station, like the velodrome in Roubaix. We were tired, but in pretty good spirits. We had made it in about 9 hours, which is a pretty typical time for experienced riders. Not bad. Done. In the bag.



I then had commitments from work that filled the next sunny day. I was really swamped with work anyway, so no blogging. It seemed all the days when the weather was nice enough to ride, I had commitments. On the days I had reserved for riding... torrential rain. This continued for eight weeks.



By the time I finally got onto the bike, my knee started to hurt after 50km. I limped home. I rested and stretched, and hoped for an improvement.



I joined Michael and Dom for a short ride a week or two later, and I had a flare up. 



I limped home and tried more ice and rest. 



I knew I had a ride up Wuling planned, so I rested and then delicately tried out the knee with a lower saddle height. 



I went out to search Bagua Shan for some hidden roads and found an amazing little climb. Some of the back roads were too slick and I was forced into the dirt to avoid a crash. 



I tried to rest and do my Wednesday night climb. 



Then hoped for the best on Hohuan Shan. Hope doesn't heal knees. To make matters worse, my camera broke and I am stuck using my iPhone, which isn't exactly the machine best suited for blog inspiring shots. 



This is when I decided to do a refitting and possibly get to the root of my problem and stop treating the symptoms. I am tired of missing time doing the things I love. 

RETUL-ing My Fit: A Session With Central Taiwan's Most Detailed Fit Studio

As many of my regular readers know, I have been dogged by occasional knee problems since February 2011, while on a loaner bike before my current frame arrived.

The process of dealing with this issue has been a painful one.

It is not simply a matter of soreness flaring up, but it is also a matter of life quality. Before the knee trouble I had worked and trained myself into a state of fitness that resulted in some rides that still amaze me.

I had gained speed and endurance enough to expand my day-rides to include much of western Taiwan. I felt like there was no place on the map I couldn't ride in a day or two. The thrill was in choosing harder, more challenging routes to cover... and be home by supper.

Since that time, it has been an endless cycle of rebuilding and regaining lost ground. For every recovery and rebuild that seems to be sticking, there is a eventual fall back to zero.

Doctors would shrug and prescribe rest or to ride no more than 30km because it was such long distance.

Problems like these are tricky and it can often be like owning an old Volkswagen. The problem can be one of a dozen things, so it is usual to start with the cheapest solution and work upward.

For me, I started with a new bike that was custom made to fit, and it works very well, rides very well, fits very well, and I had alleviated the issue for several months of hard riding, but the pain eventually returned.

I began to suspect that either my fit had changed for some reason or another, or I was suffering through a serious imbalance. Whatever it was, it was vexingly elusive.

That is why I finally decided to see a fit specialist.

I have known of the Retul fitting system and I have been following Winston Tam's work at his Friday Fitness fit studio in Taipei. It was an intriguing idea, but the price tag was a little steep for me at this time, so it would be impossible to justify to the wife.

As I sat in the bus last weekend nursing my knee, another rider who had done the Retul fitting with Winston in Taipei, passed on the info that there was now a Retul technician in Taichung who was charging quite a bit less for a double-sided evaluation and fit.

I got the ok from home and was booked for an appointment within a couple days.



What is Retul?

Here is how their website describes their fitting system:

Retül bike fit technology incorporates three main data points in fit theory:

1. Bike Fits Must be Dynamic

• Using motion capture technology, Retül records the rider's positions in motion, therefore creating the most realistic picture of the rider's actual pedal strokes and body positions when out on the road and trails.

2. Measurements Must be Accurate

• Measurements made by traditional tools are subject to human error and therefore can be devastatingly inaccurate. 
• Slight inaccuracies can drastically change the rider's feel after a ride.
• The Retül system is accurate to within less than a millimeter, creating true objective data which can be utilized by the fitter for the perfect biomechanical fit.

3. Biomechanics are Best Assessed in Three-Dimensional Space

• Fit data collected in a traditional two-dimensional plane (i.e. video-based systems) is fairly limited because the fitter can only look at one view at a time, and those views stand as independent reference points.
• In order to make the best fit recommendations, the fitter must realize that the front and side views are actually interdependent reference points.
• In other words, the front and side views must be viewed simultaneously in three dimensions in order to see how all the applicable movements of the body are working together.
• Retül uses a 3D motion sensor to simultaneously gather data on multiple angles of the rider.

In Taichung the Retul technician is Cienne Wang at Little Tree Fit Studio (小樹自轉車). The studio is just off of Xitun Rd. about a half a block from Fuya Rd. (福雅路) near several of the bike stores at the base of the climb to the top of Dadu Shan.

As I entered the studio I could see several pieces of Retul equipment situated around the room, including their iconic fitting rig.

Mr. Wang and I chatted for a little while and then got down to the fitting. We first discussed my riding style and some routine particulars, and then I underwent a physical evaluation to determine my strength, flexibility, muscle balance, leg length, and foot position.

It was finally time to attach the sensors and root out any anomalies I might have in my fit.




The full Retul fit tests both sides of a rider's body to more accurately assess a rider's asymmetric needs. Most of my numbers were fine. Some of my numbers were a little off. A couple others numbers were anomalies.

Many of the adjustments followed my intuition, but I never felt confident enough to follow through. Hard data made it far more assuring to make adjustments rather than basing any change on gut instinct with the danger of making things worse.

We then moved my position forward and a bit more stretched out. This felt a little strange on the trainer, but once I hit the pavement it all made a bit more sense.

We spent over two hours adjusting and refining my fit.

I was provided with a report derived from the data that I can use for any future bike. Retul also has a database of bike frames they can match to a particular rider.



It will still be a matter of time before my muscles readjust to the new position and I can transfer more of the load more evenly around my legs to repair some of my imbalance.

I highly recommend every rider should have a detailed fitting done at least once, if simply for the data or to improve your performance. If you are a rider with knee or back pain, the solution is even more pressing.

My session at Little Tree, which included a follow up fitting and further readjustment, was not cheap. It cost me NT7500 for the dual sided evaluation. A single sided fit runs NT4500. When you see the tiny adjustments being made it might seem an awful lot of money for a few millimeters. The price IS cheap when you consider an error of a few millimeters amplified over hundreds of thousands of revolutions and tens of thousands of kilometers. The price is minuscule when considering the hours of lost fitness, health, joy, and overall quality of life.

Mr. Wang was an excellent fit tech. He speaks English quite well and as a dedicated father of a little girl, he and I had a lot to talk about. It was easy to relax and get into the fitting.

I will keep everyone informed in regard to my progress, and I hope to encourage more riders to not wait as long as I did before getting a detailed fit. Life it too short to waste it recuperating.

If you are looking for one of the most detailed fit systems on the planet, Little Tree has what you are looking for. This is Taichung's best equipped fit studio for cyclists.

Special thanks to Cienne Wang for his attention to detail. Excellent!




Information:

Taiwan Retul Fitters

Little Tree Fit Studio:
台中市西屯區西屯路三段宏安巷1-3號, Taichung, Taiwan 4070976 568 890By Appointment Only

Friday Fitness:
Lane 13, Yǒngkāng Street, No. 16-4 Daan District Taipei City, 106
Tel: 886.929.623.311 (Taiwan 台灣) 

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Rehab Ride #4: 20km to Daya and Back

For those of you who have been following my slow recovery from my leg injury, I am pleased to report that I have made great improvements over the past two weeks. Even since Sunday's ride I am feeling a lot better. I hope my ordeal can be helpful to others who may be suffering the same thing, or who don't want to suffer the physical pain and the pain of having to sit out while everyone else has all the fun.

My treatment regimen has been as follows:

1. Rest: I have spent very little time on the bike, concentrating on short, slow rides that simply get the muscles warmed up and balanced. I have been focusing on my pedal stroke and technique.

2. Stretching: Every day, several times a day, I find an opportunity to stretch my leg muscles. Anything from using the side of a desk or a wall to stretch my calves, or doing some standing IT band stretches.

3. Massage: A couple weeks ago I bought a tennis ball to help me with some massage. The tennis ball is hard enough to provide appropriate resistance, and the roundness can really concentrate on a smaller point on the muscle. The ball can be used as a roller along the IT band, or I can simply roll it up and down my muscles. I worked out a lot of the pain in my calf with this method.

4. Ice: Every day after the tennis ball massage, I have been icing my calf and knee. I will wrap the ice bags tightly around the trouble spots for 20 min. at a time under pressure while elevating the leg. Usually before bed, so I can avoid standing.

Last night I went for a short 20km ride out to Daya without pain. I was spinning on the small ring, but I was able to work between 40-70% of my potential power. For the first time I was able to really generate some speed and work out of the saddle, which is the hardest on my calves. My wife joined me on this ride to push me along the route.

It will still be a little while before I can start planning more ambitious projects beyond my backyard, but things are looking up.

And:

Here is one more Paris-Roubaix video that really shows why this is such a brutal race. Many of the riders use cyclocross bikes to better handle the conditions.

Treating My Illiotibial Band (IT Band)

Where My Pain is Located

As many of you may already know, I have been down with a bit of an injury that had been dogging me for over two weeks.

After writing a little bit about this problem, which has been aggravated by a new bike sitting in my house, I have received several messages regarding riders who have experienced knee and IT band pain.

What is the IT Band?

The iliotibial (IT) band is a tough group of fibers that run along the outside of the thigh. The gluteal muscles and the tensor fascia lata muscle attach to the top, and the lower part attaches to the tibia, just below the knee. It functions primarily as a stabilizer during running and can become irritated from overuse. Runners will usually describe pain on the outside part of the knee or lower thigh, often worsened by going up or down stairs, or getting out of a car.

For me this is the second time I have dealt with this issue, and I have found some treatments to be more effective than others. In extreme cases a doctor may use steroid treatments or procedures to deaden the nerves to make full motion more bearable.

The first stage of treatment is R.I.C.E. (Rest. Ice. Compression. Elevation). This helps reduce acute pain and allows for the second stage of treatment to become bearable.

From my experience, the most effective way of reducing this type of pain is from stretching. There are numerous stretches that can be done to reduce friction and pull on the IT band.

For some people, the location of the pain may be a symptom of an imbalance elsewhere. Knee pain may be due to an imbalance in the hip or an IT band that has tightened further up the leg.

In my recent case, the problem was a calf muscle that had tightened and started pulling on the lower part of the IT band. For this I have been doing calf stretches as well. These stretches have had immediate results.

Aside from stretching, I have also been using forms of massage to help the muscles relax. I find if I spend a little time in the shower using my knuckles to really work the leg muscles, the soreness subsides. This is probably just a good habit anyway if you are a regular athlete.

The last part of how I have been dealing with my knee issue is looking back at what happened leading up to the injury.

As athletes, we tend to over do it. We push ourselves to be stronger, faster and better. This can push us over the edge to injury. We often bite off more than we can chew.

For a few of my riding partners, I have seen them move too fast into long rides. It takes a plan and preparation to build the strength necessary to do all the rides you want to do. It takes patience as well.

For my own injury it may be a combination of factors.

First, I have not been as active after my bike broke. My fitness may have waned and then like a junkie going back to the regular dose after a stint at rehab, I suffered. I am not sure this is the case.

On the day my knee flared up, I felt a light cramp in my calf after a brisk morning ride to our scheduled meeting place. I wanted to hammer out there to get there early and have breakfast. The cramp never fully materialized and I rode 70km before the pain started in. It seems a small cramp had actually materialized in my calf and I later discovered a small ball of tight tissue that felt tender under pressure. Bingo!

I had also been riding a different bike with a different geometry that what I was used to. This may have changed how I ride and which parts of the muscles I was working.

I noticed my pedal form had changed with the borrowed bike and I needed to shift my cleats. I have always hated finding the right cleat position. I used to get all kinds of cramps as I dialed in my former position. It never felt right.

I recently learned a new guideline to find a good position for the cleat.

One Suggested Fit Method

Find the bumps before the big and little toe. Then find the center point between them. This is a good indication of where your cleat should be centered. This has helped me tremendously.

At this point my knee feels great.

I hope some of you other riders out there who are experiencing similar issues can benefit from my experience.