ISSN NO: 2397-6632 MAY 2017 | NUMBER 364 | BY SUBSCRIPTION ONLY

Great Britain’s Alyson Dixon celebrates finishes the 2016 women’s race as the first placed Briton

SWIMMING TECHNIQUE RACE STRATEGY THE KICK PACE INSIDE YOURSELF WHY A PASSIVE KICKING COULD A FAST START BE APPROACH IS NOT BEST THE KEY TO A NEW PB? FOR TRIATHLETES

BASE ENDURANCE SPORTS INJURY TRAINING LOSING IT! BREAKING STRATEGIES TO POINT PREVENT DETRAINING AVOID THE PERILS OF DURING A LAYOFF STRESS FRACTURE IN THIS ISSUE In this issue ISSN NO: 2397-6632 MAY 2017 | NUMBER 364 | BY SUBSCRIPTION ONLY

Great Britain’s Alyson Dixon celebrates finishes the 2016 women’s race as the first RACE PACING placed Briton 03 The science and art of successful pacing for runners THE TRUTH ABOUT DETRAINING 09 What happens when you stop training and how can you minimise fitness losses during a layoff? PUTTING IN THE LEGWORK 16 Why triathletes shouldn’t try and ‘save their legs’ during the swim section of a race TECHNIQUE RACE STRATEGY THE KICK BREAKING POINT PACE INSIDE YOURSELF WHY A PASSIVE KICKING How runners can identify the early signs of stress fracture and COULD A FAST START BE APPROACH IS NOT BEST 21 THE KEY TO A NEW PB? FOR TRIATHLETES reduce their risk of injury BASE ENDURANCE SPORTS INJURY TRAINING LOSING IT! BREAKING STRATEGIES TO POINT PREVENT DETRAINING AVOID THE PERILS OF PEAK PERFORMANCE HOTLINE DURING A LAYOFF STRESS FRACTURE 26 Intense warm-ups/dangerous overload/parachute swim training

ANDREW RICHARD JOHN TREVOR HAMILTON LOVETT WOOD LANGFORD Editor Contributor Contributor Contributor

Andrew is a Rick Lovett is a John is an ex- Trevor worked in sports science writer US-based international pool professional sport as a and open-water swimmer with 16 and researcher, specialising coach based in Portland, Oregon. physiotherapist at Middlesbrough years’ of teaching and coaching in sports nutrition and he has Rick is USATF-certified and Football Club for 6 years and for works with a range of runners, experience. Having become an worked in the field of fitness and the past 4 years, has run a private including Olympic trials and age-group triathlete, he now runs sports performance for over 30 physiotherapy clinic in Durham. national-level athletes. Rick has his own coaching company, writing years, helping athletes to reach Trevor’s specialism is to understand also co-authored two training training plans for endurance athletes their true potential. Andrew is the needs of a top level athlete from books with Olympic coach and doing technique training for also a lifelong endurance athlete and ex-marathon world record swimmers and runners. John works a physiotherapy perspective, and himself. As well as his role as holder, Alberto Salazar. As well with athletes of all abilities, from then to help athletes attain their editor of Peak Performance as being a keen runner, Rick has complete novices and people scared goals. He regularly presents his he is a scientific consultant to also cycled solo across the USA of the water to high level athletes post-graduate research findings at a the fitness and sports nutrition on a 5,400-mile trip, carrying his such as Andy Lewis, Paralympic number of national and international industries. own camping equipment! Champion at Rio 2016. sport and exercise conferences.

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EDITOR JUNE 2017 | NUMBER 365 | BY SUBSCRIPTION ONLY Coming up in the next issue Andrew Hamilton [email protected] Race strategy: using mental MANAGING DIRECTOR strength for better pacing Andrew Griffiths Sports nutrition: do CUSTOMER SERVICES keto diets really work for Duncan Heard endurance athletes? [email protected] MARKETING Sports psychology: Gina Edwards returning to sport after a [email protected] lengthy layoff To subscribe to Peak Performance Sports injury: overcoming www.greenstarmedia.net/ call +44 (0)1483 892894 short hamstrings for better © Green Star Media Ltd. performance All rights reserved.

2 PEAK PERFORMANCE ISSUE 364 RACE PACING Pace yourself In the first of a two-part series, Rick Lovett looks at the science and art of race pacing for runners

AT A GLANCE

This article: ● Explores the most successful pacing strategies used by elite runners ● Looks at the benefits of a ‘fast start’ pacing strategy and how it relates to the body’s energy systems ● Provides examples of a fast start pacing strategy in action

hen I was young and chasing Warming up the pace personal bests at my favorite The ‘still-warming-up’ concept probably distances, my strategy was works best for the marathon, where pre- Wsimple. I’d go out for the first race warm-ups are minimal and pace is half of the race at PB pace – and then try to relatively slow. But the world’s best splits speed up in the second half. If it worked, that at shorter distances seem to validate was great. If not, I figured that a PB wasn’t Salazar’s wisdom. According to posts on to be found that day, no matter what I did! letsrun.com, when ran the Later, I wrote two books with Alberto Salazar still-standing 5,000-metres world record – ex world record holder for the marathon (12mins:37.35secs) in 2004, his kilometer and now Mo Farah’s coach - who told me the splits were as follows 2:33.2, 2:32.2, 2:31.8, best strategy for his marathon events, was 2:30.5, 2:29.4—a remarkably steady speed-up similar: go out conservatively for the first (see figure 1). half, and then speed up. As he put it, “For the When he again set a world record first half of the marathon, your body is still in the 10,000 metres, five years later warming up.” (26mins:17.53secs), his splits were 2:39.85,

FIGURE 1: KENENISA BEKELE’S 5,000-METRE PACING STRATEGY

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FIGURE 2: KENENISA BEKELE’S 10,000-METRE PACING STRATEGY

2:35.78, 2:37.59, 2:36.96, 2:39.21, 2:35.47, and 98.3% in the third, then sped back up 2:39.32, 2:40.67, 2:40.46, 2:32.44 (figure 2). to 99.7% in the fourth (see figure 3). This is These were a bit more variable than for the remarkably similar to what the South African 5000m, but also showed a different strategy: study found for 5,000 and 10,000-meter he ran the first six kilometers at very close to runners. his average pace, and then slowed slightly Only twice Yet another study examined the pacing in the next three kilometres as he gathered did someone strategies of competitors in the 2009 energy for a fast finish. manage IAAF Women’s Marathon Championship, to set an comparing their speeds through the race Elite studies 800m world to their average paces in their PB races(3). Bekele and Salazar are only two runners, but record on a The top quartile (25%) of finishers pretty the scientific literature contains a number much followed Salazar’s advice, although in of studies that have looked at other elite negative split a slightly more complex pattern. Compared competitors. In 2006, for example, a team of to their overall PB paces, these women ran South African researchers examined lap times the first 10 kilometers slower than any of the in 92 world-record performances at 800m, other groups. Then they sped up, and sped 5000m, and 10000m, from 1912 to 2004(1). up again after 35kms, finishing faster than They found that the 800-meter runners almost always started fast, typically running the first lap 2.4 seconds (4.6 percent) faster FIGURE 3: 2000M RACE SPLITS FOR ROWERS than the second one (positive split). Only (EXPRESSED AS % OF AVERAGE SPEED)(2) twice did someone manage to set an 800m world record on a negative split. However, at distances of 5,000 and 10,000 metres, record-setters tended to go out fast in the first kilometer, slow a bit in the middle, then speed back up in the final kilometer—not what Bekele did in either of his races. Another study looked at national and world-championship-level rowers over a distance of 2,000m, which at the elite level takes about 6 to 8 minutes (slightly less than a 3,000m run on the track)(2). Researchers tabulated the 500m splits for nearly 1,000 racers, which included both men and women, as well as various-sized crews. The results showed that rowers at this level went out at 103.3% of average speed for the first 500 meters, fell off to 99.0% in the second 500m

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any other group. Runners in the other three of the so-called aerobic energy system, quartiles started comparatively faster but although the anaerobic system is useful for finished slower, indicating that even World- finishing kicks, and also comes into play Championship competitors can be swept in races like the 800m and 1500m. But up in the moment and rediscover that the there are two other systems more better marathon is an unforgiving event! known to sprinters: stored ATP (adenosine triphosphate, the molecule the body uses Free energy to store metabolic energy for all purposes) These three studies basically show what and stored creatine phosphate (another coaches have long preached; at the marathon high-energy molecule). distance, you absolutely must have a Standing at the start, your body has reasonable assessment of your target pace, recharged both of these to their maximum or you will pay a big price late in the race. In levels—Nature’s gift for a fast start. They’ll shorter races, you can go out a bit faster, but help carry you for somewhere between you need to tame it quickly and ‘settle in’ to 10 and 30 seconds, depending on what something close to your target pace. study you read. That’s not far, but it’s 10 Part of what may be involved in shorter to 30 seconds in which you can surge, races is what I once heard described as ‘free’ with limited need to pay the piper later energy. Although this term is not used in the on. Most likely, this is why the best 800m scientific literature, the concept is simple. The runners generally start fast. In longer track body has several energy systems that kick into races, it also helps runners get to the gear in different-length races (see figure 4). inside rail quickly, which in world-record At the Distance runners tend to think mostly in terms attempts is important. marathon distance, you Figure 4: Schematic representation of contribution over absolutely time of the body’s energy systems must have a reasonable assessment of your target pace, or you will pay a big price late in the race.

Pink = ATP system; blue = CP system; green = lactate system; black = aerobic system. The ATP and CP systems can be thought of as Nature’s gift for a fast start!

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Treadmills & stationary bicycles faster. After the first mile, the runners were So far, the studies we’ve discussed all deal then turned loose to run whatever paces they with elite runners, in front-of-the-pack picked. conditions. However, there’s no reason to be The results were startling. Eight of the certain that what works there also works for eleven runners ran their fastest times after the rest of us. In an effort to deal with this, Eight of the the super-quick first mile at 6% faster pace. another British team had seven good but not eleven The other three did so when they started 3% elite male cyclists perform 10-mile time trials runners ran faster than baseline. Nobody scored their on a cycling ergometer(4). The experiment their fastest best result by starting out at baseline pace was primarily designed to test the effect of times after (see figure 5). The researchers concluded simulated headwinds and tailwinds, but in the super- that in order to optimise 5km performance, the process, it found that the best time-trial runners should start the initial 1.63 km of a results came from a constant pacing strategy, quick first 5km race at paces 3-6% greater than their as measured by power output. mile at 6% current average race pace. Another study, from , had 24 men faster pace For a 21-minute 5km runner, running the run 10K time trials on a treadmill, dividing first mile 6% faster means doing the first one- them into groups based on performance(5). third of the race at a whopping 15 seconds per The slowest group averaged about 41 km faster than your pace history says you can minutes; the fastest was somewhere around sustain! “That could cause oxygen debt that 32 minutes. What they found was that the would make the [rest of the] race seem really fast runners surged in the first 400m then gradually slowed, until they reached 2 km. They then ran a steady pace until the final Figure 5: Super-fast race start and PBs 400m when they kicked again. The slower runners also started fast, but steadily lost pace all the way to the last 400m, when they too managed a kick. Once again, the basic lesson from these two studies is what you may have already heard or experienced yourself - if you start too fast, you’re going to die! The best results come from fairly even efforts (with appropriate adjustments for terrain and wind). Negative splits are fun but positive splits are death marches. Game changer But there’s another study, and it’s potentially a game changer for runners racing over short distances. It comes from a team led by Amy Gosztyla (then of the University of New Hampshire) and Robert Kenefick of the US Army Research Institute of Environmental Medicine(6). The researchers began by recruiting eleven moderately trained’ female distance runners (average 5km time around 21 minutes). They then put these women on treadmills and, over the course of several weeks, had them run five separate 5km trials on five separate occasions. The first two trials, the runners picked their own pace and simply ran as fast as they could to determine their baseline pace. But for the next three attempts, the researchers set the pace for the first mile (1.63 kilometers). The sequence of these time trials varied, but on one occasion, the first mile was set at the average pace from the runner’s faster baseline time trial. On another, it was 3% percent faster and on another, it was 6%

6 PEAK PERFORMANCE ISSUE 364 RACE PACING tough,” says Bob Williams, a Portland, Oregon, Henry Rono: one of the greatest runners of all time coach who has worked with everyone from average athletes to US national champions. Paul Greer, coach of the San Diego Track Club, agrees. “When coaches tell their athletes not to go out too fast, this is exactly what they are advising them not to do.” So what’s going on in this study? Two-time U.S. Olympic Team Trials marathon competitor Amanda Rice (see case study) thinks a lot of it is psychological. She calls it ‘throwing the spaghetti at the wall’. In cooking lore, the way to determine if spaghetti is perfectly cooked is to throw it at a wall and see if it sticks. If it does, it’s al dente. If not, it isn’t. Modern cooking websites dismiss this as myth, but the point is that sometimes runners need to throw caution to the winds. I myself discovered this when I ran my lifetime mile PB. I’d joined my training group planning a normal track workout. But Henry Rono, one of the first great African runners, happened to be in town and joined us. At the time he held the world records for the 10,000m, 5,000m, 3,000m steeplechase, and 3,000m flat! Intimidated barely begins to describe how I felt. If Rono turned on the jets, I was in serious danger of being lapped in a four-lap race. My response was to run the first three laps like a frightened rabbit. For 1200 meters, all I wanted was not to get lapped. Only then did I realise that I was well ahead of my PB mile pace, though I no longer had the brainpower to figure out by how much. I struggled through the last lap - desperate now simply to hold on - and lowered my mile personal best by a whopping seven seconds. Later, I learned that I was not the only one in my club to set a PB that night. Sometimes, if you throw yourself out there, especially in a shorter race where the consequences of overcommitting aren’t as dire as in a marathon, sheer determination and the desire not to embarrass yourself may get you something you’d normally have seen as impossible. Knowing you are being watched may also contribute to this effect. The 5km treadmill runners in the study above knew not only her own coach, but two other elite their performances were being monitored. So coaches were timing her. “There were three when they were sent out at what looked like a watches on me. I felt ‘Oh my God, you better suicidal pace, they would have felt a powerful Sometimes the give it your all.’ I think having an audience is motivation to hang on — more powerful, best lessons crucial, because it takes someone with a lot of possibly, than most of us feel in an actual race. come from mental strength to do it all by themselves.” Rice compares it to the time when she What does this mean? Sometimes the decided to run a 1-mile time trial, in an effort race plans that science doesn’t matter. Sometimes you just to see if she could lower her PB to under 5 don’t pan out have to run, because breakthroughs occur minutes (she ran 4:57), even though the mile by taking chances. And if the breakthrough wasn’t her distance. “I literally thought I was doesn’t occur? Sometimes the best lessons going to die,” she says. But she also knew that come from race plans that don’t pan out.

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CASE STUDY Amanda Rice Amanda Rice is a dentist from Portland, Oregon who didn’t take up serious competition until her last 15 months of dental school. One of her strongest racing memories is her one and only indoor 3,000m race, which she ran on a 307-metre track near the end of her first year of competition. “My experience was the 5K, and I was trying to figure out the pacing,” she says. “I knew I was trained and competitive, so I took it as ‘run as fast as you can and try to hang on’!” She pushed hard in the first lap in order not to get boxed then settled into a fairly even pace until two laps before the end, when she heard someone yell, “One lap to go!” She sprinted to the lead, crossed the line, stopped - and watched her rivals speed by! Shocked and mortified, she dashed back into action and managed another lap nearly as fast as the one in which she’d thought she won, finishing in 9mins:54.57secs. She later estimated she’d lost about six seconds standing around at the finish, but the experience of having to sprint an extra lap at the end of an already tough race taught her how hard she could run if needed. In the ensuing months, she won Portland’s most prestigious road race, ran a 2:38:57 marathon, a 1:14:36 half-marathon, and was top American in the Army Ten-Miler, which is a 20,000-runner race in Washington, D.C. “I keep going back to the expression ‘throwing the spaghetti to the wall’ she says. “Sometimes you don’t realise what you can do until you’ve accidentally cornered yourself into finding out.”

References 1. Int. J. Sports Phys. & Performance 2006. 1(3), 233-245 2. J. Sports Med 2005. 39:39-42 3. J Sports Phys. & Performance 2013. 8(3), 279-285 4. Ergonomics 2010. 43(10), 1449-1460 5. Eur. J. Appl. Physiol 2010. 108: 1045-53 6. J. Strength Cond. Res. 2006. 20(4), 882–886

8 PEAK PERFORMANCE ISSUE 364 BASE ENDURANCE TRAINING Losing it: the truth about detraining

What really happens to your endurance fitness if you’re forced to take an extended break from training? Andrew Hamilton takes a trip down the detraining pathway and shows how you can mitigate your fitness losses

AT A GLANCE

This article: ● Explains the physiological and biochemical processes that cause detraining ● Provides a timeline showing what changes in fitness you can expect when stopping training for six months ● Gives practical advice for endurance athletes seeking to minimise detraining during an enforced layoff

ccording to the fitness mantra, 2). The total blood haemoglobin (a measure you either have to ‘use it or lose of oxygen carrying capacity of the blood) fell it’! It might be a bit of a cliché, by 3.1% and bodyweight rose from an average A but it turns out that this saying of 75.1 to 77.1kgs. Taken together, these perfectly sums up one of the key principles physiological changes would certainly result in of fitness – reversibility. So long as you a performance decrease in the average runner, train, you can maintain and (hopefully) build cyclist or triathlete. your fitness levels. However, stop training and your fitness levels will steadily decline. The obvious question that you might ask FIGURE 1: DECLINE IN MAXIMUM OXYGEN UPTAKE therefore is: ‘how much fitness will I lose if I (VO2MAX) FROM 10 DAYS BEFORE TO 30 DAYS decide to take a break or I’m forced to stop AFTER AN ULTRA-DISTANCE RACE training because of injury, illness or other circumstances? And how rapidly will this fitness loss occur?’ VO2max (L/min) 4.85 How much loss? Unfortunately, there’s surprisingly little 4.8 published research on the actual fitness losses during an extended period of detraining. This is perhaps to be expected; after all, it’s very 4.75 hard to recruit athletes who take training seriously and then ask them to stop training 4.7 for a month or more! However, a fascinating study on detraining in triathletes looked at the cardiovascular and body composition changes 4.65 in nine recreational triathletes over a 30- day detraining period (during which training 4.6 volume was reduced by 87%) following an ultra-distance triathlon(1). The researchers found that after 30 days 4.55 of detraining there was a 4.7% decrease in maximum aerobic capacity from 4.83L/min 4.5 to 4.61 litres per minute (L/min - figure 1). Meanwhile, skinfold thickness totals (a measure Before After of body fat levels using callipers) rose 28%, from an average of 43.9mm to 55.1mm (figure

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FIGURE 2: INCREASE IN SUM OF SKINFOLDS Of particular note in the detraining study (left) was the increase in skinfold thickness, FROM 10 DAYS BEFORE TO 30 DAYS AFTER indicating a significant rise in body fat AN ULTRA-DISTANCE RACE – something that has been observed in swimmers. One recent US study found that Skinfold thickness sum (mm) five weeks of detraining in eight swimmers 60 resulted in an average increase in fat mass of 1.8kg and an average waist circumference increase of 1.1cm(2). Meanwhile, maximum 50 aerobic capacity fell nearly 10% from 46.7mls/kg/min to 43.1mls/kg/min.

40 Components of fitness To properly understand how detraining affects fitness, it’s important to understand 30 that there are several different components of fitness including muscular strength, muscular endurance and cardiovascular 20 (heart, lung and circulatory) endurance – see box 1. Stop training and the performance decline in each of these components will 10 take place at a different rate. So let’s take an imaginary well-trained cyclist and observe what happens to his or her body over a 0 period of six months following the complete Before After cessation of training. Let’s assume that all training stops on May 1st 2017 and track the changes that would occur.

This is your last training day for six months. After today’s ride, you store your bike away, hang up your cycling shoes and join the bulk of folk who do no regular vigorous exercise whatsoever!

After three days of inactivity, you might expect that your fitness has already begun to decline. In reality however, the losses at this stage are very minimal. In fact, if you had been training hard prior to day zero, after three days of rest, your cycling fitness is now probably enhanced! That’s because in those three days, your muscles have had time to fully recover; muscle carbohydrate stores (glycogen) have been topped up, muscle fibres damaged during hard training have been fully repaired and favourable metabolic changes in the muscles (see box 1) have had time to occur. Indeed, this peak in performance after a few days of rest is exactly the reason why tapering works and why you shouldn’t train right up to the day of a big event.

After a week’s complete inactivity, changes begin to occur in the body that result in fitness losses. For example, after three days, your blood volume can be reduced by 5-12%(3). This means a decrease in amount of blood your heart can pump – both in terms of amount of blood pumped per beat and total blood volume per minute. The result is that your heart has to work slightly harder to maintain a given workload on the bike. There are some metabolic changes too; after six days or so, muscles begin to become less efficient at ‘soaking up’ glucose (the body’s premium fuel for exercise) from the bloodstream(4,5). This means that during exercise, you need to place more reliance on your (limited) muscle glycogen stores and also that you become less efficient at building up those glycogen stores after exercise. A third change is that your muscles start to become less efficient at coping with lactate accumulation during sustained efforts of hard cycling(4). The upshot is that you won’t be able to sustain quite the same exercise intensity before having to back off because of the burning sensation in the legs and laboured breathing!

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At this point, your maximal oxygen uptake (VO2max – the prime measure of your aerobic fitness) will have declined by anything from 4-20%(4-7). Part of this stems from reduced cardiac output – not helped by the fact that the muscle mass in the pumping chambers of the heart can decrease by almost 20% after three weeks of inactivity! It also arises because of changes in muscle physiology and biochemistry that are beginning to take place. For example, the fine network of muscle capillaries built up with endurance training begins to decline. As a result, oxygen uptake in the muscles can decline by up to 8%(7).

All of the detraining changes outlined above continue to progress but fundamental muscle changes are now becoming prominent. By now, your muscle capillarisation will have returned to your pre-training baseline (however is that it’s still likely to be higher than that in people who have never trained(7,8)). In addition, alterations are taking place in your muscle biochemistry. In particular, the biochemical pathways that help your muscles burn fat for energy start to become less efficient, making it harder to burn fat while you ride, which in turn reduces your endurance capacity(9,10). On top of that, not only is your overall muscle mass declining (reducing your maximum power and strength), muscle fibres known as Type IIa (used during high-intensity sustained efforts) start to revert to Type IIx fibres, with greatly reduced endurance capacity. In short, your ability to maintain a full-out effort (for example, a sprint to the finish line) diminishes dramatically.

After two months of inactivity, your heart is noticeably less muscular, with the thickness of the muscle walls that comprise the pumping chambers reduced by as much as 25%(11). The muscle mitochondria are also becoming less efficient at using oxygen to produce energy in your muscles. This efficiency can decline by 25-45% up to twelve weeks after training cessation(12,13). After three months, you also begin to undergo ‘hormonal detraining’(12). Hormones are chemical messengers that regulate the body’s biochemistry; as you become detrained, more stress hormones are released during exercise, which basically means that the same exercise intensity becomes more stressful for the body, which in turn increases recovery times. Figure 3 shows how these changes add up to impact your aerobic fitness.

By six months, your fitness declines have mostly stabilised. However, there are still undesirable changes taking place. For example, the actual volume of mitochondria per unit volume of muscle is declining, further reducing your ability to utilise oxygen during exercise(14). In addition, while you’ve lost muscle mass, you’ve almost certainly gained body fat due to a lower daily calorie burn and reduced muscle mass. So while you may not have gained weight on the scales, you will have almost certainly become ‘fatter’, with all the health risks that involves.

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FIGURE 3: TYPICAL % DECLINE IN AEROBIC FITNESS OVER 84 DAYS OF INACTIVITY (15)

The 0

dimensions -2

of the heart VO2 max (ml/kg. min) -4 muscle Cardiac Output (L/min)

also decrease -6 with inactivity as does % -8

respiratory -10 function, caused -12

by weakening -14 of the muscles in -16 the ribcage. 0 12 21 56 84 Aerobic capacity (maximum oxygen uptake) is shown by the red line. Cardiac capacity (pumping capacity of the heart) is shown by the yellow line.

BOX 1: THE DECLINE OF FITNESS COMPONENTS DURING DETRAINING There are a number of components of fitness that become ‘detrained’ when you cease training. These include:

Muscular detraining In your cycling muscles, the density Metabolic of capillaries (tiny blood vessels that Over time, your muscles will find it carry oxygen to muscles) decreases harder to produce energy from your and the concentration of enzymes in muscle mitochondria (the ‘aerobic Cardiovascular fat stores. This effectively decreases your endurance since carbohydrate energy factories’ within cells) used Stop training and your blood volume stores – the other major fuel source to release energy from oxygen also falls, which means there is a decrease during exercise - are quite limited decreases. Also, muscle fibres shrink in the total amount of blood your whereas energy from fat stores is in cross section and cell-signalling heart can pump during exercise. virtually unlimited. Also, something hormones involved with gaining/ The dimensions of the heart muscle called ‘insulin sensitivity’ is reduced, maintaining strength decline, leading also decrease with inactivity as does which means your muscles find it to strength losses. respiratory (lung) function, caused harder to take up glucose (muscle by weakening of the muscles in fuel). Moreover, a less efficient oxygen the ribcage. All of this reduces the metabolism means that for a given amount of oxygen you can transport effort level, higher levels of fatiguing to your working muscles, which blood-lactate are produced in your means your maximal performance will muscles, making it harder for you to decline. maintain high training intensities.

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CASE STUDY The decline of Miguel Indurain

Hailed as one of the greatest cyclists ever, ’s Miguel Fourteen years of inactivity later, Indurain’s body mass had Indurain was the dominant Tour rider in the 1990’s with five increased from around 80kg in his competitive years to consecutive wins (1991 through 1995) in the Tour de 92.2kgs and his maximum oxygen transport capacity had , and two wins in the Giro d’Italia (1992 and 1993). fallen to 5.3 litres per minute. Meanwhile his maximum Indurain was also the first to win the time trial when it was oxygen uptake capacity had also declined to 57.4 ml/kg/ introduced in the Olympics in 1996, having already bagged min. the World Championship Time Trial in 1995. The magnitude of Indurain’s decline (over 20% per During his racing years, Indurain’s stats made mightily decade) in one of the most genetically gifted cyclists ever is impressive reading: His heart/lung system enabled him to far greater than that typically observed in studies on transport around 7 litres of oxygen around his body per ordinary cyclists who continue to train as they get older minute, compared to 3–4 litres for an ordinary person and (under 5% per decade), and points to his inactivity rather 5–6 litres for his fellow riders. His maximum cardiac output than simple ageing per se as the main factor. was measured at 50 litres a minute (a fit amateur cyclist’s is While Indurain is undoubtedly blessed with superior about 25 litres per minute) while his maximum oxygen cycling genetics (and perhaps maintained more fitness than uptake capacity was reputed to be around 88ml/kg/min - in would be expected in lesser cyclists), the results suggested comparison, Lance Armstrong’s was ‘only’ 83.8 ml/kg/min! that the bulk of his fitness loss was due to detraining, which When Indurain retired, he gave up cycling completely. was exacerbated by his significant weight gain.

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Bad and good news at producing fitness (and halting its decline). The bad news is that our detraining timeline The best way of performing short burst of makes for fairly depressing reading. Stop intense training is without doubt to perform training and your fitness begins to decline high-intensity interval training (HIIT). A quite soon after, continuing to fall away number of recent scientific studies have the longer you stay away from training, shown that per unit of time invested, HIIT is until after six months of inactivity, you’ll more effective at producing the necessary be a long way behind in the fitness stakes. changes in muscle biochemistry for fitness and There is good news however; although you’ll performance gains than training at a constant, lose plenty of fitness, you’ll likely maintain one-speed pace (steady-state training). For a higher baseline of fitness than someone example, a 2006 study demonstrated that who’s never trained. In particular, studies 2.5 hours of sprint interval training produced have shown that the muscles of previously similar biochemical changes in muscles to trained people who become detrained are 10.5 hours of endurance training and similar better at coping with lactate accumulation and endurance performance benefits(17). have better capillarisation and mitochondrial If you need or There’s also evidence that HIIT can density than lifelong couch potatoes. are forced to improve maximal oxygen consumption (VO2 If you need or are forced to (eg as a max – the best indicator of aerobic fitness) result of injury) to take a short training break, take a short more effectively than doing only traditional, there’s more good news because research training break, steady-state long aerobic workouts(18-21). Even shows that a relatively short break (two there’s good better, evidence suggests that HIIT can also weeks or so) is generally not considered too news because increase your muscles’ ability to utilise fat disruptive providing the previous training research for energy, which not only means they can adaptations have been achieved over a shows that a conserve precious glycogen, thus extending period of at least twelve weeks or more(16). endurance, but can also help those who Yes, there are fitness losses, but at this relatively short are trying to lose some excess body fat(22)! point, you can still regain them very easily. break (two This is significant as gains in body fat due to But what about if training becomes very weeks or so) is reduced activity is one of the changes that difficult for long periods of time – for example generally not inevitably occurs during detraining, and which because of travel, injury, work etc? Is there any considered too has a detrimental effect on aerobic fitness. reliable way of stemming the fitness losses? disruptive But just how time-efficient is HIIT? Well, Well, there’s further good news because there’s studies have looked at the benefits of HIIT evidence that even very small volumes of the providing using very short intervals of 30 seconds or right kind of training can reduce detraining the previous less and come up with astounding results. For to a minimum. In particular, research shows training example, a 2010 study found that performing that reducing your training volume very adaptations 7 x 30-second sprint intervals was just as significantly won’t harm your fitness provided have been effective at increasing markers of aerobic you include some very intense work such achieved fitness as 3 x 20-minute hard efforts despite as high-intensity intervals in the training the fact that during long intervals, the total you do undertake. The key to stemming over a work performed was eight times greater these fitness losses with just a very small period of at and the exercise duration seventeen times volume of training seems to be to perform least twelve longer than during the sprint intervals(23). some very high-intensity interval sessions. weeks or more Meanwhile, a Canadian study found that a HIIT programme consisting of six intervals HIIT to stop detraining of just 10 seconds sprinting performed Many people who experience long-term three times a week produced significant detraining do so not because of serious injury gains in measures of aerobic fitness(24)! or illness, but because of their circumstances. Think about this; the 7 x 30-second Work commitments, travel and ongoing protocol performed three times a week family emergencies are just some example of involves just ten and a half minutes of training circumstances that cut into the most valuable per week; the 6 x 10-second protocol amounts asset anybody has – time. When time is in to just three minutes of training per week – yet extremely short supply, many endurance both had a profound positive effect on aerobic athletes tend to assume that only five or ten fitness levels. Of course, no coach or exercise minutes of training here or there is pointless, physiologist would recommend the exclusive which can lead to long periods of no training, use of small amounts of HIIT as the basis of an resulting in substantial fitness losses. However, endurance programme. But what it can do is research has shown that even a few short bursts to stem the degree of detraining that would of intense exercise can be remarkably effective otherwise occur during complete inactivity.

14 PEAK PERFORMANCE ISSUE 364 BASE ENDURANCE TRAINING

References 1. (Int J Sports Med. 2012 Apr;33(4):253-7.) 2. J Strength Cond Res. 2012 Aug;26(8):2087-95) 3. J Appl Physiol. 1986. 60: 95-99 4. J Appl Physiol. 1994. 77: 1532-1536 5. J Appl Physiol. 1996. 80: 240-244 6. J Appl Physiol. 1985;59(3):853-9 7. J Appl Physiol. 1984.17: 230-237 8. Acta Physiol Scand, 1981. 113: 9-16 9. Med Sci Sports. 1972. 4: 91-95. 10. J Sports Cardiol. 1986. 3: 35-45 11. Circulation. 2002 Feb 26;105(8):944-9 12. J Appl Physiol. 1985. 59: 853-859. 13. J Sports Med. 1986. 26: 92-100 14. Annals N. Y. Acad. Sci. 1977; 301:431-439 15. J Appl Physiol. 1984, 57:1057 16. Peak Performance 2006. 223; p4-6 17. Journal of Physiology, 2006; 575 (3): 901–911 18. European Journal of Applied Physiology, 2003 89 (3–4): 337–43 19. J Strength Conditioning Res, 2007; 21 (1): 188–92 20. Med Sc Sports and Exercise, 2007; 39 (4): 665–71 21. Journal of Science and Medicine in Sport, 2007; 10 (1): 27–35 22. J Physiol 590.5, 2012; pp 1077–1084 23. Eur J Appl Physiol. 2010 Oct;110(3):597-606 24. Eur J Appl Physiol. 2010 Sep;110(1):153-60

PRACTICAL ADVICE FOR ATHLETES TO OFFSET DETRAINING • If you’re a seasoned athlete the other hand, should run! to prevent the performance- foods. It differs from the (training consistently over • If time is tight, maximising blunting effects of increased standard food guide a period of a year or more), convenience and body fat. It’s beyond the pyramid however, in don’t worry about taking opportunities to train scope of this article to go that carbohydrate intake a training break of up to is key. A ready set up into detailed nutrition but (breads, cereals, rice two weeks; your fitness stationary bike, turbo a useful approach is to etc) is not prescribed losses will not be too large, trainer or treadmill in follow a ‘modified food at 6-11 servings per day and you will regain them the house or garage can guide pyramid’ approach (the foundation of the relatively rapidly. However, make all the difference. (below). This emphasises pyramid) but can be fitness losses for novice • During any period where fruits and vegetables, high trainers or those with a you drastically cut down on quality proteins, whole reduced somewhat to low fitness base will be training volume, remember unprocessed carbohydrates allow for the fact that proportionately greater you will also need to curtail and minimises the sugary, levels of activity are much and harder to recoup. your calorie intake in order fatty, or processed lower than normal. • For breaks of over two weeks, you’ll need some kind of intense MODIFIED training stimulus such FOOD GUIDE as HIIT to avoid a bigger PYRAMID decline in your fitness. • There’s no hard and fast rule, but studies on HIIT suggest six to eight 30-second intervals at around 90% of your maximum effort with two to three minutes recovery in between is very effective yet not too hard on the body. For even shorter intervals (6-10 seconds), up to ten intervals at maximum effort, with a recovery of one to two minutes are recommended. • Perform any interval training in a manner that most closely replicates the type of event you’re preparing for (sometimes referred to as ‘specificity of training’). This means that if you’re a cyclist, performing intervals on your bike will give you the best adaptation and fitness gains. Runners, on

15 PEAK PERFORMANCE ISSUE 364 SWIMMING TECHNIQUE Triathlon: putting in the legwork John Wood explains why a passive approach to kicking during the swim leg of a triathlon might not be best for triathletes, and provides practical solutions to enhance swimming performance

AT A GLANCE

This article: ● Explains why the advice commonly given to triathletes to ‘save the legs’ when swimming is flawed ● Shows how triathletes can optimise their swim kick ● Provides a number of kicking drills to improve performance

ecause it can be difficult and frustrating to develop an effective FIGURE 1: BODY ROLL(5) kick, the solution for the majority Bof triathletes has been to simply abandon it. Many triathletes are told to “save their legs” during the swim portion of the race because kicking wastes energy. Indeed, kicking is sometimes seen as counterproductive. This might be partly because previous literature has suggested the primary role of the leg kick is to maintain an optimal body position, stabilise the trunk position and minimise drag(1-4). A large proportion of triathletes will steer away from any kicking at all because they have poor kicking technique and don’t know how to improve it; rather than seeking help and change, they look to avoid. As a result, many find that they swim Data from USA Swimming shows that the best freestylers rotate their shoulders to quicker with a pull buoy (ie with the legs either side about 30 degrees from the surface(5). This means that they never even rotate halfway onto their side (which would be 90 degrees). If you are rotating above still) than when they kick their legs. As a 60 degrees, you are probably over-rotating, and most definitely over-rotating if you coach, I have even seen people travelling are closer to 90 degrees. The hips should rotate roughly the same amount as the shoulders - if not less. If the hips rotate too much, it becomes very difficult to maintain backwards as a result of poor leg kick and a steady kick. body position, so it is totally understandable why some might wish to avoid it! Factors such as limb length, body Proactive kicking technique composition, neuromuscular coordination A good efficient kick can help promote and ankle flexibility can all influence how optimal body roll (see figure 1) and rhythm, a swimmer uses their kick, along with optimise underwater wrist trajectory the physiological state of conditioning. (vertical forearm/high elbows), and even For example, the use of leg kicking help generate more propulsion. I believe would be limited when the athlete is less that the main role of the leg kick can be comfortable in the water, which could any of the aforementioned roles and is resulting in frantic and knee led kicking. dependent on the individual swimmer. The kick is also important for the

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maintenance of momentum during the energy and concentration keeping their legs velocity fluctuations within a stroke cycle. taught than by being relaxed. Additionally Maintaining momentum within each stroke this may also result in the body sitting cycle and between multiple stroke cycles lower in the water, and creating more will lead to a more energy-efficient swim, frontal drag, which has to be overcome. because the swimmer is not constantly More anecdotally, from my own swimming wasting energy re-accelerating their and coaching experience, a good kick body through the water. It is, of course, can help stretch out tight hip flexors. By ideal to also have the stroke timing as stabilising the core through the trunk and optimal as possible. This is so that the kicking both up and down, it can lengthen leg kick (which requires a substantial out muscles that get tight from being sat in portion of the total available energy) does day jobs – and also for triathletes who spend not have to work as hard to maintain hours on the bike closing up the hip joint. velocity by compensating for potential Kicking can actually benefit your bike and run. decelerations within the stroke cycle. If an athlete Freestyle leg kick is propulsive overall - has a natural Best kicking technique even if it is not the most efficient (assuming propensity What is the best kicking technique for reasonable technique). This means that to kick their triathletes – ie one that balances out even if swimmers just kick (no arm legs they will maximum swim speed with energy efficiency movement) at an incredibly slow rate - for be using more and conservation? First and foremost, example using a 2-beat rhythm using a each athlete will have their own rhythm stroke rate of 30 cycles per minute - the energy and - something that suits each individual. swimmer will still be propelled forward, concentration Whether they prefer to kick two beat which shows some extent of propulsion. keeping their (one kick of each leg to each individual In studies carried out to determine legs taught arm pull – ie 1 to 1), four beat (2 to 1) or six metabolic costs of kicking within the swim than by being beat (3 to1) will come down to feel and stroke, swimmers (albeit trained swimmers) relaxed preference, and fitting the kick in with their were between 10 and 15% quicker while using stroke and cadence. That being said, the their legs in conjunction with their arms days of just telling triathletes to kick as than they were without kick - regardless little as possible should be numbered! of the intensity they were swimming at. Freestyle leg kicking should be a full Additionally, and possibly surprisingly, leg movement, from the hip joint down to there was no higher total metabolic/ the toes (see figure 2). Less experienced/ energy output(6). Clearly this suggests more nervous swimmers tend to kick more that, provided that the kick technique is from the knee (ie the thigh stays relatively sound, having the legs kick at least a little still), which will result in a more dorsiflexed is more beneficial than not kicking. (right angled) ankle. This ankle position Indeed, keeping the legs still could can also be seen in people with ankle actually reduce the efficiency of someone’s injuries or with a long running background. stroke; if an athlete has a natural propensity Either way, 90 degree ankles are very to kick their legs they will be using more counterproductive for an efficient kick.

Note the slight knee bend and nicely plantar-flexed ankles (toes in line with shin)

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With well conditioned core muscles, it backward and the speed or acceleration should be relatively easy to have a full up of that area. Both of those require strong and downward sweep of the leg from the hip leg muscles and good ankle flexibility. joint. The way I like to frame it for swimmers is to think of your leg ‘like a diver’s fin’ – long Kicking drills to and flexible, and a smooth arc from hip to For swimmers improve technique toe. For swimmers who bend their knees who bend When I was swimming competitively, I was a lot, a good cue is to try and keep the leg their knees a 1500m swimmer swimming 70-80km per relatively straight. However, there should be a lot, a good week, and I kicked with a 6-beat kick. My a little bit of flex in the knee to allow the top coach went by the maxim that 40% of my of your foot to face backwards. This is where cue is to try training on average should be kick training! you want to push water to gain propulsion. and keep For triathletes however, a more appropriate The amplitude of the kick – distance the leg rule of thumb is to incorporate 5-10% of your from top to bottom – should be between relatively training volume as kicking or kick-based drills. 8 and 12 inches, and your heels (but not straight The upside of this is that not only is kicking the whole foot) should break the surface. technique and efficiency improved, but it also The lower under the water your legs are, helps hone your body position in the water the more frontal drag you will encounter during normal swimming as well. If you are and less propulsion you will create. The going to incorporate kick training into your amount of the force you can produce sessions, you can split it into the warm up or depends on the surface area pushing cool down - it doesn’t have to be in one block.

1. Streamlined kicking - A good kicking drill is ‘streamlined kicking’ on your front (see figure 3). Very rarely do I use a kickboard for practise as it is detrimental to body position and there are no real proven benefits to using them. Focus on bracing your core and keeping your spine long, and if you can bring your arms together in front of you then do. Squeeze your ears between your biceps (dependent on shoulder mobility). Kick along, and when you need to breathe, push your chin forwards, then return to looking down. You can also do this on your back and then breathing isn’t a worry.

FIGURE 3: STREAMLINED KICK DRILL

2. Modified streamlined kicking - If you are someone who predominantly kicks from the knee, a modified streamlined kick drill can be of real benefit in helping to reduce this tendency (see figure 4). Rather than having your arms streamlined in front of you, try keeping your arms by your sides and pressing your thumbs into the sides of your glutes (buttock muscles). If your glutes feel like they are working as you kick then you are doing it right! If the muscle feels soft, then your knees are bending excessively and doing too much work. Try it standing up first, kicking one leg to see how it feels. This physical feedback can make a big difference to your technique. It can also aid keeping your ankles plantar-flexed.

FIGURE 4: STREAMLINED KICK DRILL WITH ARMS BY SIDE

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3. Side kicking - Side kicking is a good way of nailing body position and a balanced kick at the same time (see figure 5). It forces you to kick up and down – or in this orientation forwards and backwards. Try this: • Swim with your right arm extended, 3-4 inches below the water. • Keep your left arm by your side, and twist your body from your hips to face your left hand side. • Ensure that your hand is pointing where you want to go - it’s acting as your rudder.

FIGURE 5: SIDE KICKING DRILL

My preference is to look down, as it helps keep the hips high; then all you need to do is turn FIGURE 6: FINS/SNORKEL KICKING DRILLS your head/neck to breathe. If you find yourself drifting one way or the other focus on making sure that your kick is equally strong in both directions. For instance, if you drift towards your front, kick harder forwards. If you are drifting towards your rear, make sure that your hamstrings are working and kick back harder.

4 - Fins and snorkel kicking - Kicking with fins and/or a snorkel can be beneficial to focus on smooth kicking and getting used to lengthening the ankles whilst not having to worry about breathing (see figure 6). Try switching between having fins on and taking them off to improve your ankle flexibility and mobility.

To start playing around with rhythm and the amount that you kick within your stroke, you can do six kicks to one pull or six kicks to three pulls (some swimmers may know this as 6-1-6 or 6-3-6). Start in the side-kicking position from above, and do six kicks, then take one stroke and roll on to the other side. To do six kicks to three pulls, take three normal full strokes between sets of six kicks.

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Other conditioning techniques (rear things) will have real benefits. Squats Ankle mobility is something that can be real and deadlifts will improve your general limiter to the output of your kick, so it’s good power – and have obvious transfer over to to work on that. A beneficial side effect will bike and run as well. Single leg variations like be better ‘ankling’ motion on the bike. You lunges, Bulgarian split squats and single leg can work on this with basic ankle circling, deadlifts will have equal benefits, especially sitting back on your ankles (maybe in front given that freestyle kick (and cycling and of the TV for a few seconds at a time at the running) are very much ‘one leg at a time’ end of the day), or PNF (resisted) stretching. activites. A combination of single and double- From a strengthening point of view, any leg exercises will help improve power and exercise that strengthens your quads (frontal strength through the hip area, but also the things), hip flexors, glutes and hamstrings stability of the alternating leg actions. CASE STUDY Tom Cooling

Tom Cooling is a triathlete that I have worked with. Tom has a super strong bike (sub-6 hours at IM Nice and Wales) and run, but has a relatively poor swim – around 1hr.10mins for both when the fastest athletes are leaving the water in around 50 minutes. Having looked at Tom in the endless pool, we determined that there were two main issues – firstly that his hips were low because of poor head positioning and core control, which meant he was dragging against a lot of resistance. Secondly, his leg kick was nonexistent, primarily because he’d tried to minimise it. Being a runner, his ankles were also quite rigid and fixed, so we had to work around that also. Tom went away with some of the drills above and worked on both his body position and more importantly his kick, doing some leg work in every pool session and getting away from his reliance on his pull buoy. The progress has been marked. In January (when I first saw him), he was swimming comfortable sets of 10 x 100m at around 1min.50secs/100m. Now he’s swimming sets of 20 x 100m at between 1min.35secs and 1min.40secs/100m - not only around 10% quicker but swimming easier and longer too. Tom’s main goal this year is to race well at l’Alpe d’Huez triathlon in July, and to be out of the water in less than 33 minutes for the 2.2km swim – which works out at 1.30/100m. I believe that he’s well on the way to doing that, in large part down to improving his kick.

References 1. Eur J Appl Physiol. 1999;80:192-199 2. ‘Contribution of the legs to propulsion in front crawl swimming’. In: Ungerechts B, Wilke K, Reischle K, eds. Swimming Science V. Champaign, IL: Human Kinetics, Inc; 1986:39-43 3. Watkins J, Gordon AT. ‘The effects of leg action on performance in the sprint front crawl stroke’. Biomechanics and Medicine in Swimming; 1983 4. Eur J Appl Physiol. 2000;83:487-491 5. http://www.usaswimming.org/ViewNewsArticle.aspx?TabId=0&itemid=4101&mid=8712 6. Eur J of Appl Physiol, 2016;116(5):1075-1085. DOI: 10.1007/s00421-016-3372-4

20 PEAK PERFORMANCE ISSUE 364 OVERUSE INJURIES Breaking point: when stress gets too much Trevor Langford looks how runners can identify the early signs of stress fracture, manage and injury once it has occurred and most importantly, reduce the risk of stress fracture before injury occurs!

AT A GLANCE This article: ● Shows how runners can minimise the risk of stress fracture and ● Describes the signs, symptoms and common causes of stress provides rehab advice for those who are recovering from a stress fractures in runners fracture injury

tress fractures are a commonly A ‘hop test’ is often included in a clinical diagnosed injury in physiotherapy assessment to determine the intensity of clinics, with studies suggesting that pain and how much load if any the patient is stress fracture accounts for 16% able to withstand(5). In this test, you stand on S (1) of all running related injuries . Research one foot (of the leg that hurts) and hop. As a has also ascertained that 80-90% of stress very rough (but unscientific) guide, if you can fractures occur in the lower limbs(2) and that hop on it, it is probably not a stress fracture stress fractures are becoming more common (if it is a stress fracture, the pain will not be with increased exercise participation, and A stress tolerable). However, a hop test would not be (3) occurring at an earlier age too . The purpose fracture of carried out on someone who had severe pain of this article is to help you identify the early on walking and ascending/descending stairs. signs and symptoms of a stress fracture the lower and effectively manage this type of injury. leg typically Common causes This shouldn’t replace the diagnosis of a presents Box one highlights a variety of the factors physiotherapist or a doctor of course; rather with swelling, that are known to be associated with stress it is designed to help guide you in the right redness, heat fracture. Athletes, and sometimes coaches direction. and pain, alike, often take the approach to ‘push through pain’ – either because curtailing Signs and symptoms which is training may be perceived as a sign of A stress fracture can occur when bone cell aggravated weakness or because they are unaware of the depletion outpaces the laying down of new by running or implications surrounding it. Muscle fatigue bone cells, which results in a weakened bone loading, and is to be expected following a heavy training structure(4). This can happen when someone which eases session, and this should be managed using begins a new activity, but can also arise in with rest or recovery strategies. However, pain affecting experienced athletes too, when the load is a bone should be very carefully monitored. dramatically increased. reduced load Ignoring the onset of a niggle (perhaps It is essential to be aware of what to look because a big event is on the horizon), can for if you suspect stress fracture. A stress be a common reason why a stress fracture fracture of the lower leg typically presents is sustained. If a niggle does present, it’s with swelling, redness, heat and pain, which is essential to manage it appropriately using ice aggravated by running or loading, and which and soft tissue release around the involved eases with rest or reduced load. Tenderness bone - but most importantly by modification at the bone site is present on palpation of bone loading. (pressing). Barefoot running or minimalist footwear

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BOX 1: RISK FACTORS ASSOCIATED WITH THE OCCURRENCE OF A STRESS FRACTURE(1-3)

Intrinsic factors • Females - Irregular menstrual cycle in females and use of a contraceptive pill. • Age – Older athletes being at greater risk. • Race – White athletes are more at risk than black athletes. • Anatomy – high foot arches increase risk compared to lower foot arches. • Gait – Poor running gait increases stress fracture risk. • Bone – Reduced bone mineral density (BMD) and reduced bone width. • Aerobic fitness – slower runners at greater risk of stress fractures due to increased foot contact. • Nutrition – deficits in certain nutrients can predispose to stress fractures. • Sedentary lifestyle – those living an inactive lifestyle prior to starting running. • Smoking • Previous injuries – Those suffering previous stress fractures are at greater risk of subsequent fracture.

Extrinsic factors • Type of sport – Runners are particularly susceptible to stress fractures. • Physical load – Those who cover higher mileage are more likely to be diagnosed with a stress fracture. • Footwear – Age/mileage of training shoes (older/high-mileage shoes increase risk). • Training / playing surface – Hard surfaces increase risk.

(see figure 1) is a big topic of discussion among the running community, and one FIGURE 1: MINIMALIST FOOTWEAR that often raises questions about stress fracture risk. In terms of the stress fracture incidence, it is an important factor to consider when weighing up the benefits. A relatively recent study used a questionnaire to ask 509 runners with experience of barefoot running their feedback(6). The results showed that 55% of the respondents had Achilles tendon or forefoot pain initially, and of these participants, 47% reported that their pain subsided relatively quickly. It was also reported that the incidence of stress fractures to the metatarsal bones of the foot as a result of barefoot or minimalist footwear is comparatively rare. However, other recent research suggests that higher volumes (20+kms per week) of minimalist shoe training – particularly in heavier runners (85kg plus) – can increase the risk of injury(7).

Commonly affected locations Vibram ‘Five Fingers’ minimalist shoes A stress fracture can occur in any one of a number of locations throughout the body and excessive repetition of an exercise can the fibula bone (also in the lower leg) being up predispose to bone failure. However, due to to 23%. The navicular bone in the foot has an the constant repetition of the foot striking the incidence of 17.6%, the metatarsal bones in the ground during running, it is easy to understand foot 16.2%,the femur (thigh bone) 6.6%, and the how stress is directed to the lower limb - more pelvis just 1.6%(1,2) (see figure 2). so than in the hips, pelvis or the spine. The Tibia-related stress fractures are most tibia of the lower leg has been reported to commonly sustained on the inside of the larger be the most commonly affected bone with a bone in the lower leg, nearest the foot(1). It is stress fracture incidence rate of 23.6%, with less common for a stress fracture to occur in

22 PEAK PERFORMANCE ISSUE 364 OVERUSE INJURIES the mid part and at the front of the tibia bone FIGURE 2: STRESS FRACTURE – RISK BY LOCATION in runners. Recreational runners are more susceptible to sustaining a stress fracture on the inside of the tibia bone nearest to the ankle(1). Tibial stress fractures affecting the mid shaft of the tibia bone at the front are much less frequent and can be running career threatening injuries. Furthermore, stress fractures at the front of the tibia bone may arise from jumping actions or activities involving a variety of movements such as trail running with uneven ground(1). Stress fractures can occur in the spine as well as the legs but these types of injuries tend to occur mainly in sports involving single-sided loading with rotation such as football, cricket, rowing, gymnastics and tennis. As running is an activity that provides equal loading to both limbs, a spinal-related stress lesion is much less likely in runners. Management and prevention It is essential to manage a stress fracture correctly, and the very first thing to do is reduce physical loading to the involved area. This can be achieved firstly by stopping the aggravating activity - ie running. It is important for runners to realise that delayed action is likely to lead to a more prolonged injury and a greatly delayed return to running(5). If you feel pain when walking, then loading should be reduced further by using crutches to relieve some of the weight from the lower limbs. During the acute stage, when swelling, heat, redness and pain are evident, ice should also be used hourly for 15 minutes at a time to reduce the signs of FIGURE 3: EXAMPLE OF AIRCAST BOOT inflammation. During this stage, you can maintain cardiovascular fitness by doing upright water running, stationary biking or upper body biking. Analgesic such as acetaminophen (Paracetamol) or non-steroidal anti- inflammatories (NSAIDs) may be prescribed for pain management. However, caution is required as there is some evidence that NSAIDs could inhibit fracture healing(5). Fracture healing can take between four and twelve weeks before a return to training is possible. During this time, you will need to be reassessed every two to three weeks in order to monitor pain intensity and level of functioning. As pain reduces, loading can be gradually increased in a controlled manner. There is some suggestion that by using a pneumatic brace or ‘aircast boot’, (figure 3) return to training can be significantly faster, These boots reduce loading by providing a semi-rigid shell that helps support but more evidence is required before we can the limb while absorbing and dissipating shock. be sure of this(5).

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Warning signs data can also be a really helpful tool for A stress fracture often builds over a period a physiotherapist to study. Sometimes of time, and can often appear as a ‘niggle’ when a stress fracture presents – for over an area of bone. These minor niggles example at the hip joint - there may are often brushed off as nothing, and training It is essential be referred pain into the surrounding is continued while the ‘niggle’ evolves into to not assume structures. It is essential to not assume something more prominent and longer lasting. that pain that pain in one area automatically means It is at this point that an athlete (who can be in one area that the problem resides in that area. someone starting a ‘couch-potato to 5km fun If a stress fracture is suspected, it is run’ programme or an Olympic athlete - they automatically essential to obtain a form of imaging are both challenging their body, just at different means that either through an X-ray or MRI scan. An intensities) should listen to their body. the problem MRI scan will provide much greater detail It is a wise approach to keep a log of resides in than an X-ray but X-ray scans may be the your running distances, times, dates, and if that area preferred option initially, because of their pain appears, rate it using a pain scale (zero low cost and increased availability. Either being no pain and 10 being high pain). This way, a scan will help the physiotherapist can help a physiotherapist identify a trend in to formulate a rehabilitation plan based on a training plan where an overload has taken the clinical presentation and where pain place. Using an online app for recording this presents in addition to imaging report.

References 1. Saudi J Sports Med, 2017, 17, 1 - 6 2.Open Access J Sports Med, 2015, 6, 87 – 95 3.Sports Health, Nov, 2014, 6, 6, 481 – 491 4.Epidemiol Rev, 2002, 24, 2, 228 - 247 5.Am Fam Physician, 2011, Jan, 83, 1, 39 - 46 6.J of sport and health sci, 2014, 3, 131 – 136 7.Am J Sports Med. 2017 Jan 1:363546516682497. doi: 10.1177/0363546516682497 8.The J of the Malta Coll of Fam Doc, Dec, 2015, 4, 3, 6 – 10

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CASE STUDY FIGURE 4: FRACTURE OF THE FIBULAR BONE IMMEDIATELY POST-RACE, Stress fracture in an elite INDICATED BY RED POINTER cross-country runner

A relatively recent report proceed. The symptoms were right leg ,similar to the was taken at nine weeks, documented a stress fracture aggravated by running, and feeling of ‘being kicked in the which indicated bone healing. in an elite cross country were alleviated by rest. A shin’. She managed to Although she was given a runner with nutritional physiotherapist was complete the race and had a medical history form to deficits(8). An adolescent consulted who advised sprint finish over 500 metres complete upon selection, her female runner selected by adapting her running gait, at the end too. On crossing nutritional deficits were not the Maltese Olympic team using strapping and the finish line, the athlete taken into account. While she (name withheld for performing calf stretches. noticed that she had a maintained a balanced confidentiality reasons) was However, these had no effect significant amount of nutritional intake, she lacked due to race in a 3.5k run six on the pain. The pain was at swelling on her lower right in dairy and meat products months later. During the its most intense just a few leg. A sports doctor (especially red meat) and six-month period of intense days prior to the 3.5k suspected a stress fracture took no supplementary training, she ran up to four competition and she didn’t based on her symptoms and products. She was hours per week, much of want to seek further medical an X-ray indicated a prescribed calcium which was interval training. advice for fear of being complete fracture of the (important for bone health) During the first three withdrawn. During this lower right fibula (figure 4). and iron tablets and advised months of training, the runner period, she had some The patient’s lower leg to eat foods rich in calcium noticed lower leg shin pain persistent swelling on the was immobilised in plaster and iron nutrients. She was on the inside of both her lower right leg on the inside for six in which a review was also measured for some right and left sides. The pain of the tibia bone. carried out. After six weeks orthotic insoles to help was described as nagging During the race itself, she there was evidence of reduce further stress to the but it didn’t limit her training recalled feeling a sharp delayed union of the bone foot. She eventually went on and she continued to increase in pain in her lower and therefore a further x-ray to make a full recovery.

25 PEAK PERFORMANCE ISSUE 364 LATEST RESEARCH PP hotline: Intense warm-ups/dangerous overload/parachute swim training Andrew Hamilton presents some of the latest findings from the world of sport performance science

As well as measuring the cyclists’ 4km time trial The power times for each warm-up condition, the researchers of warm-ups also looked at the cyclists’ blood lactate Previous research (reported here in Peak concentrations and their power outputs over each Performance) has shown that including some very 500m split. high-intensity resistance exercises such as high- when the load leg presses in a warm up procedure before a cyclists The findings subsequent 20km time trial, can produce a dramatic performed the The key finding was that when the cyclists increase in cycling performance. How is this so? Well, PAP-inducing performed the PAP-inducing warm up containing the most likely answer lies in something known as warm up, they the three high-intensity 10-second bursts, they ‘post-activation muscle potentiation’, which is a well- completed the time trial significantly faster established phenomenon in sport. Post-activation completed knocking just under two seconds off and averaging potentiation occurs in fast twitch (high power) the time trial five extra watts of power. These performance muscle fibres, and its main effect is to enhance significantly benefits were particularly evident during the first muscle force at sub-maximal activation levels for faster 1500m of the time trial, which led the researchers a short duration of time following previous intense to conclude that this kind of warm-up protocol can muscle activation. indeed produce a PAP effect, which can enhance But while the science of post-activation cycling performance. potentiation (PAP) is sound, the problem for most J Strength Cond Res. 2017 Mar 25. doi: 10.1519/ would-be cyclists about to embark on a time trial is JSC.0000000000001908. [Epub ahead of print] that stumbling across a leg-press machine or barbell and squat rack at the start line of a race is highly unlikely! With that in mind, researchers have been PP VERDICT exploring whether a more practical cycling-specific This is not the first study to show that PAP can help endurance performance. warm up applying the same principles could be an As we mentioned above, the use of leg press exercises ten minutes before a time trial has been shown to produce performance gains of 6% in a effective alternative – and the results look promising. 20km time trial(1). Also, studies have shown that harnessing post-activation potentiation can be helpful to other athletes such as sprinters(2). What is The research different about this study are the practical implications; any cyclist can turn In this study, a team of British researchers from the up at the start line of a time trial and apply this technique – not just elite University of Chester looked at whether they could cyclists awaiting to head out onto the track. More research is needed – for example, the best combination of burst intensity, length and recovery interval induce PAP in the cycling muscles, not by using - but for now at least 3 x 10 seconds seems a good place to start. weight training loading, but instead by using some short but high-intensity bursts on the bike during a PRACTICAL SUGGESTIONS warm up procedure. To do this, ten well-trained male • For a PAP-inducing warm up, try adding three 10-second bursts in your endurance cyclists (an aerobic capacity [VO2max] of warm up routine. around 65mls/kg/min) performed two 4km cycling • Start with five minutes at low to moderate intensity pedalling then add in time trials on two separate occasions. However, the bursts. • Ensure the bursts are performed at the end of the warm up and that no the warm up procedure used before each time trial longer than ten minutes elapses between the end of your warm up and differed: the start of the time trial or race (as the PAP effects will fade after this • Before one time trial, the cyclists simply pedalled time). for 6.5 minutes at a constant intensity of 60% of • Use a relatively high gear for your bursts – this will increase the force and their VO2max – ie a low-to-moderate intensity. involvement of fast-twitch muscle fibres in your legs, which will enhance the PAP effects. • Before the other time trial, they pedalled for 5 minutes at 60% VO2max but then added 3 x 10-second bursts at 70% of peak power (very References intense) interspersed with 30-seconds recovery 1. J Strength Cond Res. 2014 Sep;28(9):2513-20 2. J Sports Sci. 2013;31(10):1117-24 after each burst.

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Dangers of they also looked at the rowers’ eating patterns, to see whether their nutritional overload needs were being properly met. Recovery is vital to performance. If appropriate recovery is not provided during The findings periods of hard training, you can experience What the researchers found surprised them. a downward spiral in which continued Firstly, the on-water rowing performance heavy training creates diminishing returns, over 5kms worsened significantly after the and performance levels worsen. Functional just four 4-week period. Also, the pacing strategy overreaching is the normal process of differed in that the rowers struggled to fatigue that occurs with sustained periods weeks of finish as strongly as they had done at the of heavy training. Although these periods of heavy training start of the heavy training period. As well as hard training cause short-term impairments decreased more fatigue, the rowers also experienced in performance, this effect is reversed with performance a significantly lower mood state together a relatively short pre-planned recovery and induced with a poorer sleep quality. Perhaps most period and you can quickly return to a weight loss surprisingly, the rowers didn’t increase their level matching, and ultimately exceeding overall calorie intake during the increased your initial level of performance. This is the and substantial training load period, which meant that on intended purpose of hard training – to get fatigue average, they lost around 2kgs of body better! However, train a bit harder for a bit mass. The researchers concluded that just longer and you can become non-functionally four weeks of heavy training decreased overreached. This is a more severe level of performance and had induced weight loss fatigue reached when your performance and substantial fatigue, likely related to an and energy are not restored after a planned imbalance between energy intake and output. short-term recovery period. As a result, PLoS One. 2017 Mar 15;12(3):e0173807. you may still feel fatigued following your doi: 10.1371/journal.pone.0173807. planned recovery period. eCollection 2017 Determining precisely when the ‘excessive training’ line is crossed is very difficult. This is because the symptoms PP VERDICT of overreaching are highly individualised What’s interesting about this study is that it demonstrated even elite, and varied, which can include increased highly experienced athletes do not necessarily ensure that they are perceptions of exertion/fatigue during adequately fuelled during periods of intensified training. The shortfall exercise, decreased movement economy, in energy availability over a 4-week period – evidenced by the weight slower reaction times and impaired loss - may well have contributed to reduced recovery and performance. performance times. To make things worse, This suggests that during periods of more intense or higher-volume a state of excess fatigue is usually only training, endurance athletes need to pay special attention to how they diagnosed with the benefit of hindsight. In feel and how they are performing. This means making every effort other words, by the time you know, it is too to ensure that the day-to-day diet is optimised for recovery and the late to handle it in the optimal manner (ie increased energy requirements to fuel the heavier workloads. backing off beforehand)! And now a new study suggests that overstepping the mark PRACTICAL SUGGESTIONS could be easier than you think. Short periods of enhanced training intensity and load can bring benefits but caution is needed. Here are some useful tips: The research • Limit the duration of increased training load periods to no more than a The subjects of this study were ten week to ten days, and always follow with an easier week or two. national-level rowers, who completed a • Pay special attention to your nutrition; increase your intake of four-week period of intensified training – ie carbohydrate – not just during exercise (bars, drinks gels etc) but also in a level of training load that was sustained your day-to-day diet. above their baseline training load. The • Don’t forget your recovery nutrition; consume 20-30g of whey protein researchers sought to analyse how the along with 40-60g of carbohydrate immediately after training. Follow rowers responded to this increased load up with a balanced meal containing 20g of protein and 60-80g of both physically and mentally so before and carbohydrate within 90-120 minutes. after the period of intensified training, they • Monitor your fatigue state using other tools such as HRV monitors and by measured the rowers’ performances and recording your resting heart rate upon rising. pacing strategies on the water, their body • Don’t ignore your mental state; if you feel tired and irritable, that’s a composition (muscle and body fat), and signal that you are becoming overreached. Ask your friends and family to their sense of psychological well being using provide feedback – if they notice a decline in your demeanor, take note! standardised questionnaires. In addition,

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Parachute to success intervention program, the best performance In the quest for performance, swimmers of both groups at 50, 100 and 200m front typically cover thousands of meters in the crawl swimming were assessed. Also, the pool with nothing more interesting to do movement patterns of each swimmer’s than look at the ceiling or bottom of the stroke were calculated during a 50-metre pool. As with other endurance sports, some front crawl sprint at maximal intensity carefully targeted strength training may and the results analysed. This was to be a better addition to a swim training see whether the resistance training had plan than simply adding another couple negatively affected the stroke pattern in of thousand metres, and this explains any way. the popularity of ‘land-based’ strength any strength programmes for swimmers. The problem training for The findings with land-based training however is that swimmers When the results were number crunched, swimming in water requires a different set the data showed that there was a significant of motor skills than training on land. This needs to improvement (around 3.2%) in the best is why any strength training for swimmers be highly performance at all the swimming distances needs to be highly specific and transferable specific and - but only in the experimental group. In – ie the additional strength and endurance transferable the control group, there was no such developed has to transfer across to improvement. When the stroke kinematics swimming performance in the water to be were analysed, no significant changes were of any use. observed in the stroke length, the stroke One way to achieve this specificity and rate, and the duration of the propulsive and transferability is to perform swimming- non-propulsive phases in either group. The like resistance training exercises not on only difference was the swimming velocity land, but in the water while performing in the resistance-trained group, which your normal swimming stroke. Paddles are increased by 2.2%. one way of achieving this but even this J Strength Cond Res. 2017 Mar 8. doi: method is criticised by some coaches as 10.1519/JSC.0000000000001879. [Epub encouraging different motor firing patterns ahead of print] in the muscles – and increasing the risk of shoulder injury. One way to get round this is to use a water parachute (see figure FIGURE 1: SWIM PARACHUTE 1), which increases drag and resistance but doesn’t interfere with the stroke pattern in any way. Now a newly published study provides further evidence that a swim parachute could be a worthwhile investment for swimming performance. The research In this study, Greek researchers set out to assess the effect of an 11-week resistance training programme in twelve female swimmers. The resistance training was performed in the water, with the resistance supplied by an in-water parachute while the swimmers performed their front crawl stroke. Twelve swimmers were The FINIS swim parachute comes with an eight and twelve inch chute providing lower and higher resistance levels respectively. matched in pairs according to their best performance at 50m, and were then randomly assigned to an experimental or to a control group. Both groups followed exactly the same swimming training program. The only exception was that the experimental group performed a sprint- training section with increased resistance pulling a water parachute, while the control group performed the same section without parachute. Before and after the

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PP VERDICT The results of this study are supported by previous findings on devices that increase swimming resistance in the water(1). What’s really encouraging however is that the kinematic analysis of the swim stroke show absolutely zero change when using the water-parachute, which indicates that the transference of the additional strength was near perfect. This is in contrast to many land-based training programmes, which either produce strength gains that are not transferred to the water, or produce gains that are offset by a less efficient swim stroke as a result of altered motor firing patterns.

PRACTICAL SUGGESTIONS If you want to try using a swim parachute, here are some tips: • Choose a swim parachute that includes a stabilisation buoy. This can be adjusted to allow the parachute to float at varying depths, which affects the level of resistance you will experience. • Don’t combine a swim parachute with other devices such as fins or paddles. The idea is to increase resistance without altering any other of stroke technique. Also, the combination might provide excessive resistance. • Use the parachute for short, high-quality, bursts of high-speed work. Remember that you are trying to build swimming-specific strength while retaining optimum technique. Don’t use it all the time for your base endurance training.

References 1. J Strength & Conditioning Research; 20 (3): 547–554, 2006

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