Moving forward

Frustratingly my injury has still not cleared. It is a whole lot better but I still have a nagging pain that is stubbornly refusing to shift. This means that I’m rather stuck in limbo. The rehab plan has been sketched out, but we can’t put this into action until my knee is 100% pain free. So I’m waiting patiently. I found a hand cycle at the gym and have added this to my 'survival' techniques. It’s amazing how tough an hour of this exercise is; not only does it work arms and shoulders but it also challenges core stability and requires the recruitment of the majority of trunk muscles to maintain posture. This, together with swimming and a couple of upper body routines in the weights room have provided sufficient variety to keep me motivated.

All the upper body training has also produced a transformation. Let's face it, endurance cyclists are not well known for their upper body muscle (why put on extra mass that has to be lugged up climbs and which adds zero to the ability to produce power?). I’m no exception to this rule. Yes, I have always been toned with quite distinct muscle definition, a throwback to the days when I was a ‘circuit training queen’ but no bulk and I was definitely more Olive Oyl than Popeye. However, in recent weeks the growth in my arm muscles has been quite spectacular. As part of my lymphoedema management, I measure the girth of my legs in several places on a daily basis. Upon reflection it would have been really interesting to a numbers geek like me to have been doing the same to my arms and seen what the difference is. These pictures probably tell the story best though! Anyone for an arm wrestle?

Mentally, I’ve also moved on. One of the favourite sayings that I grew up with was “worry about things you can change”. My Father has many of these mantra’s (some of them of more questionable perspicacity than others), but this is an adage that has much merit. I’ve processed the stress and disappointment that my injury generated and armed with the knowledge that I can’t make it mend any quicker, I’ve progressed to accentuate the positive. The silver line to my injury cloud is that I’ve been able to research and acquire a shiny new toy.

One of the common characteristics of cyclists and triathletes is that we all adore new gadgets and equipment. Magazines are full of ‘tech’ sections with glossy pictures of new components, shiny bits and pieces and freakishly light parts. Even a non-mathematician will appreciate that two race bikes and eight wheels don’t quite add up when I can only ride one bike and two wheels at any one time, but I absolutely consider all this equipment to be totally essential. Half the fun of ‘buying’ is the research that goes into making the ‘right’ decision. And with time on my hands, I’ve been able to secure and try out a new piece of kit, the NormaTec MVP.

To be fair, I’ve known about this equipment for some time. I read it about it when the pro-cycling team Garmin blogged about the MVP (“Most Valuable Pump”) back in July 2008, http://www.slipstreamsports.com/2008/07/11/our-secret-recovery-weapon. Coach Helen and I started researching this in more earnest though once I got the diagnosis of Lymphoedema. One of her contacts at British Cycling opined that by far and away the most effective way of reducing oedema was through the use of a pneumatic compression device, and time and time again our inquiries and investigations kept leading us to NormaTec.

The reason why the MVP is so directly applicable for me is that it was developed initially as a medical treatment for lymphoedema (www.normatecusa.com) but has also successfully transferred as a sports-specific recovery-aid; a double plus for an athlete with lymphoedema. I made contact with the company and sparked up a great relationship with Gilad Jacobs, who leads NormaTec's Sports Medicine division (www.normatecsports.com). Knowing that Gilad’s degree was in communication, I’d expected his delivery to be extremely professional, and it certainly was. But what I also noticed from a lengthy chat with him via Skype was a real passion for the product, the company, and his total belief that the NormaTec MVP would truly help me. It really wasn’t just marketing hype. He was especially interested in my unique position as a ‘hybrid’, someone who can benefit from the MVP from both a medical and athletic perspective. It probably helps that NormaTec is a family run company and that they have all bought into the mission of improving the lives of patients; it feels like they do care.  I got a great vibe from our contact and, thanks to some generous support from Gilad, a deal was struck.

This is the thrilling news that I alluded to a couple of weeks ago. As part of the decision making process I’d asked around for other athlete’s viewpoints. Luckily enough, thanks to Si (my go-to man), I got in touch with Chrissie Wellington, triple World Ironman Champion in 2007, 2008 and 2009 and NormaTec user. This is what she said about the NormaTec MVP, “They are really good. They compress really well, and also pulsate with peristaltic movements up and down the leg. I rate them, although obviously it’s hard to isolate one thing as being the cause of improvement (athletically at least).” It was with great excitement and trepidation that I unpacked the box a few weeks later,

Although the use of the MVP was scheduled as part of the Lymphoedema management plan, when this was shelved as a consequence of my injury, so too was the timetable for introducing this management tool. Helen and I decided that with the anecdotal evidence of its efficacy we should press ahead and start using it anyway; we could always revisit the testing protocol at a later stage.

Fully aware that the NormaTec MVP is neither a cure nor a panacea for all the lymphoedema ills, that is certainly doesn’t replace any of the other management techniques such as compression and SLD, what I can say from the initial results is that I am VERY impressed. Its early days but I really believe that this piece of equipment can make a real difference. It has produced a massive boost to my state of mind and the sun is shining again. Much more on this in blogs to come.

Limping Along

Time has stood still and I remain cast adrift; all a result of the persistence of my knee injury. The Lymphoedema management project has been shelved, for now at least, and all my energies have been directed to my knee. The injury has proved far more pernicious than I first thought or hoped, and has really tested my mental resources. Although by nature I have a definite “glass half-empty” character, when it comes to what I believe I can achieve, I am the eternal optimist. If this means nailing a tough session, I always believe I am equal to the task; if this means ‘healing myself’, I have faith that I will be cured within a few days. Positive self-talk is a marvellous attribute but is unfortunately not always foolproof, and inevitably I am left disappointed. Ten days on from the first stab of pain, I am not healed and it is desperately tough.

The initial visit to the physio over a week ago was a relief as she diagnosed a tracking problem that should have been relatively easy to fix, no cycling or running but cross training was an alternative. Thankfully I have access to a well equipped gym and I duly trotted out an hour here and another hour there, at least feeling that I was salvaging some remnant of fitness and controlling my lymphoedema. I became fully acquainted with the delights of daytime TV pumped through a bank of TV’s to the audience of middle-aged, middle-classed masses – what a strange world, but that’s another story.  But the pain has persisted and after pushing through a painful final 20 minutes of a one hour cross training workout earlier this week, I conceded defeat and stopped all lower body exercise. Back to the pool I went, pull buoy and hand paddles at the ready.

A huge amount of upper body work in recent days has allowed me to keep my spirits up for the most part but this too is starting to take its toll and has its own problems, such as developing shoulder issues and weariness. It would be just like me to throw myself into something that in reality I’m totally unconditioned for, and then create another injury! Going from zero kilometres of swimming back to my old levels of 10K-12K in one week sounds like a recipe for swimmers shoulder!

A visit to my Sports Med Doctor today has shed more light on the problem, and I should be pleased that it is not serious, it is patellofemoral pain most likely caused by tightness in my quad (rectus femoris) muscle. But the prognosis is rest, stretch, rest, stretch and more rest, stretch. Repeat, until the pain has vanished. Not what I wanted to hear. I already stretch religiously and can quite easily get my head round doing more. Far harder is dealing with more rest, but this is what I know I have to do.

Coach Helen and I have discussed the options over our usual latte this afternoon. I always put a considerable amount of faith in the fact that she will be able to help; she has the uncanny knack of getting straight to the relevant point and knows me almost as well as I know myself. We are very similar in outlook and very often I get a virtual mirror image straight back of what I project out. Perhaps that’s why we get on so well? So another plan has been hatched, just to get me through the next week before I return to the physio. I will continue to swim, even though my aversion to the water is every bit as strong. Encouraging tweets from triathlon queen, Tamar, have spurred me on in the pool. And, at least while I trawl up and down the lane I feel that in some small way I am doing something positive to preserve a small element of my fitness and manage my lymphoedema. Right now this is all I have to hold onto, but it will do!

Wipe-Out

Just as nature abhors a vacuum so I have a deep loathing of swimming. Not because I can’t swim (in my triathlon days I used to average around 12K of swim training a week) but because I really do not enjoy it.  I’m not blessed with natural talent in the pool and I really suffer from the cold. I guess I just don’t have the body composition that is suited to hours in the water. Swim sessions were a means to an end back then, essential in ensuring that I was still in with a chance to claw back lost ground when I came into my own on the bike and run sections of a triathlon. Unfortunately, today I’ve have to resort to the same philosophy. Those who know me well will fully appreciate that something quite serious must have occurred to force me back into the water, and yes it has. I have a knee injury. Without being too much of a drama queen, an injury really is an athlete’s worst nightmare. In surfing terms this is equivalent to a calamitous wipe-out.

There I was rolling along, managing my lymphoedema carefully and meticulously, recording all the data and completing every workout exactly as prescribed. In previous blog posts I’ve already mentioned my zeal in following the plan that Coach Helen and I had devised, this is one of my strengths, but can also be my downfall as I become wedded to it. One of the risk factors of a testing sample of just one, is that it needs that ‘one’ to be able to fulfil the all the requirements of the testing protocol; illness or injury was always going to be a threat, and lamentably the worst has happened.

Without any prior notice, last week I suddenly felt a sharp pain in my right knee; it felt like I’d been kicked right on the tip of the knee cap. It was hard to work out what had happened and for quite a few days I continued to train. Although for many sufferers Lymphoedema is completely pain free, for others it can be quite excruciatingly painful. I wondered if this was the explanation behind my soreness, especially as just the day before I had started to wear compression during exercise in addition to general day-to-day use. There was swelling around my knee, but then there has been quite a lot of swelling around my knee for months, a consequence of the Lymphoedema. I ignored the warning signs and kept pushing on, but eventually the pain was too much and my knee was getting noticeably more swollen. I knew already in my heart, but it was just too overwhelming to admit, that I had to stop IMMEDIATELY. Thankfully the sound advice from my good friend Fi on Monday evening finally made me take notice.

Had I suffered this sort of pain pre-Lymphoedema, I would have stopped training at once, but this time I allowed myself to get duped into believing that I didn’t have an injury. In the rational light of day this seems to be utter madness, but I know why; the ‘Lymphoedema Management Plan’ has been my lifeline, it’s enabled me to feel that I’m in control of it, not it of me. To stop and admit that I had an injury that would ‘break’ the plan just wasn’t an option I was prepared to consider. Ceasing to train would have a massive impact on the rigour of our study, and would invalidate the data we are so carefully collating.

Once the decision to stop was made, I was suddenly cast adrift, and that pathetically sorry feeling washed over me again and again and again. Yes, there were tears, but I’m getting better at dealing with this and processing my self-pity, so it hasn’t lasted too long! Two days of rest, ice and ibuprofen gel have made a difference and the pain has lessened somewhat. Tomorrow I see Alison at Sportswise for a physio appointment and am sure that she will get to the bottom of the problem. Then I’ll just have to enact a new plan, a rehab plan. For now, the Lymphoedema-management plan has been delayed but not forsaken.

Missing Out

Today my Coach and good friend Helen flew out to Mallorca to set up her annual training camp venue. On Saturday she'll be joined by my fellow PBscience athletes. This is the first year that I've not been able to attend. Over the last couple of years her training camp has been a vital part of my early season schedule; a time to really focus on training and to plan the competitive season. It is a first-class springboard for the build up to the National Time Trial competitions that take place in May and June. Aside from this it's a fantastic opportunity for the amateur to experience the lifestyle of the pro cyclist if only for a week; to remove the stresses and strains of normal life, and to concentrate on little else other than training, recovering, eating and sleeping. I have found it invaluable in focussing my mind on what it takes to succeed and to get the best out of the limited time I have for training when back in the real world.
 
This year though, my real world has changed. Pre-Christmas, I had deferred the decision on whether I would attend the camp this year until I got to the bottom of the problem that was causing the swelling in my leg. Once I got the diagnosis of Lymphoedema, I must admit that attending a training camp was far from my mind. After Helen and I held our council of war though and concocted our ‘Lymphoedema Management Project’, we revisited the decision about whether the training camp was a viable option. My heart said ‘yes’ but unfortunately the call of wisdom was far more vociferous and my head won through. There were two main factors behind the decision; firstly we are employing a flat training structure during the current 12-week testing phase while we evaluate the efficacy of the various management techniques. This means keeping the training stress even. This would be daunting to achieve on camp when there is the opportunity to train harder, longer, and generally push out the boundaries. To have gone and not participated fully would have been frustrating; to have gone and trained harder would have invalidated the findings; a no-win situation. The other factor is the impact of flying. Although having Lymphoedema does not preclude me from flying, it certainly has an impact on the swelling and will require broader and more embracing management. Introducing this additional stress during the testing period would have biased the results and made it hard to interpret them. So, with a heavy heart, the decision not to attend this year was made. Helen and I both knew that this was for the best, but still I feel that I am missing out.  

Nevertheless, I would like to wish all my fellow PBscience athletes the best of time on camp. Embrace it for what it is, make the most out of every minute, and enjoy a superb trip. I understand that even the weather is going to be nice for you!