Currently Viewing Posts in Uncategorized

You have a blood clot!

Thoracic Outlet Syndrome (TOS) Awareness, Part I

Unlike any normal story, I’m going to start in the middle. “You have a blood clot” might be one of the scariest things I’ve been told. That was on a Friday afternoon… Friday, July 27th to be exact.

July 23rd was an otherwise ordinary Tuesday morning: coffee, walk the dog, then head to the gym.  During my swim warm up, I felt shoulder tightness that typically subsides as I warm up. However, on this particular morning I experienced an ache in my upper arm that seemed to get worse the more I swam.  After 1200m, I decided to call it a day and as I exited the pool I realized my right arm was swollen and slightly numb.

Coach, DPT, and husband just happened to be swimming a couple of lanes over.  Stopping him mid-set (to which he was overjoyed NOT), I asked him to examine my right arm. Less than thirty minutes later, we were in the emergency room. The doctor performing intake told me, “things are about to get weird”. I was immediately sent for a CT scan, blood was taken, and an MRI was ordered.

After ruling out a stroke, the ER doctors were reluctant to believe that there was anything life threatening given my history and optimal health.  I was discharged with instructions to follow up with my family doctor in a week. In hindsight… YIKES!!

We did not wait a week.  We knew something was not right.  Matt, suspecting a blood clot, advised me to rest my arm and keep it elevated.  Three days later I saw my family doctor and she immediately ordered an ultrasound. That’s when the blood clot was confirmed in the subclavian vein (between my neck and shoulder).

I was admitted to the hospital and put on an IV of heparin (blood thinner).  Two days later, a venogram (dye injected into the vein via a catheter to show how blood flows), catheter-directed thrombolysis, and angioplasty were performed to identify and dissolve the clot and widen the vein to restore blood flow.  During the procedure, my surgeon discovered that the subclavian vein was occluded and I was diagnosed with thoracic outlet syndrome.  My options were 1) blood thinners forever, 2) surgery.  

Three days after the initial procedure, I was again admitted to the hospital to undergo thoracic outlet surgery, a surgical decompression of the thoracic outlet, which entails the removal of the first rib, partial removal of the anterior and middle scalene muscles, and decompression of the brachial plexus.

The Rib

While my condition, venous thoracic outlet syndrome or Paget-Schroetter syndrome, is very rare and is often spontaneous, it did raise our awareness to the potential for athletes to overlook symptoms indicative of the more common neurogenic thoracic outlet syndrome which can often be successfully treated through physical therapy. Don’t ignore numbness or tingling during activity and if you suspect something is wrong, be your own advocate.

Rib Resection Recovery

Part II (coming soon) will cover the TOS from a physical therapists perspective.

I’m USAT Certified!

Since I had any knowledge to share, I’ve been passionate about helping others find their personal success in swimming, cycling, running, or triathlon. From the moment I was introduced to this sport, I have loved it and the accompanying lifestyle. In the early 2000’s I led a local women’s ride to help teach other women how to safely ride in a group while building confidence and endurance. I loved being able to share my experiences and witness those ladies build courage and strength while creating lasting friendships.

In 2007 I was diagnosed with a back condition that, at the time, was unmanageable. The hard training became too much and I backed off of triathlon and focused on work that paid the bills. Since then I have ‘dabbled’ in the sport but stopped coaching or participating in group training. My involvement in the sport since then has been minimal.

After spending 2018 away from my family chasing a career path that paid the bills, I decided I wanted a relationship with my first love again… triathlon. It’s been a little bit of a bumpy road this year (more on those details another day), but I recently completed what I hope to be the first step of a rewarding journey. I finally became a Level I USAT Certified Triathlon Coach! I’m so excited to get started helping others live their best athletic life!

Training Slower

We’ve talked before about spending time training at low intensity. It’s difficult to execute. It’s common to ask each other how fast we run or ride during training. Training at low intensity forces you to train at your own pace and put ego aside when training with others, or when posting workouts on strava. If you can get past others thinking you are “slow” when training, there are great benefits to spending most time training at low intensity.

What do we mean by “slow”?

Typically low intensity is defined by lactate threshold or by ventilatory threshold. This is usually about 80% of your max heart rate. There are benefits to training slower than this, but typically we need to maintain 50-60% of max HR to properly stress the system. Other than ego, a pitfall to maintaining low intensity is the inability to gauge intensity internally. For this reason we recommend training with a heart rate monitor and/or power meter daily.

Benefits of Training at Low Intensity

There are several physiological adaptations that occur when training aerobically. Some call these adaptations building your “aerobic engine” and this is why many athletes train at low intensity with increased frequency during the offseason.

  • Increased aerobic capacity – ability to process oxygen
  • Increased cardiac output – stronger heart pumps more blood to body
  • Increased blood volume
  • Increased oxidative capacity of the muscle – increase mitochondrial number and size, capillary density, oxidative enzymes
  • Increased fat metabolism – theoretically if we train aerobically we become more efficient at using fat for energy
  • Increase in recruitment of type IIA muscle fibers – these fibers are “fast twitch” fibers that can act like “slow twitch” fibers if trained.

To be clear, each level of intensity has an aerobic component but as intensity increases, % aerobic decreases. The goal is to maximize these physiological adaptations in order to become your most efficient self on race day.

How do I know my “zones”?

The most accurate way to determine your training zones would be to get a metabolic test or a blood lactate test. I spent some time learning with Dr. Cameron Garber at Body Smart physical therapy in Utah. He specializes in metabolic testing. Here are the results from the first of several tests I did while at the clinic:

The images are the same. The second image is zoomed in to show my actual numbers that represent calories burned per hour at each heart rate. If you notice the hand written numbers, column #2 is the % fat I am burning at the corresponding heart rate listed, then the final column is fat calories burned per hour. I have been training aerobically for a long time, so I am a pretty good fat burner throughout. Often with athletes that train at higher intensity, their fat burn rate will drop pretty dramatically with an increase in heart rate. Pretty good case to train at lower intensity levels for endurance athletes.

While metabolic testing is pretty cool and very accurate, it can be hard to find a place to be tested (I only know of one place local to Charleston, SC). There are ways to estimate your training zones. I found personally that the methods we use are pretty accurate. For example, my “moderate zone” from the picture above is 139-155 bpm, and prior to my metabolic test I had calcuated my moderate zone to be 146-153 bpm. Keep in mind there is a bit of an art to establishing your training zones.

When we put together a training plan, it is with an end goal in mind. Each workout is like a building block towards that goal. When an athlete chronically trains slightly above aerobic intensity, they are constantly adding extra fatigue to their body. This fatigue builds and can hinder performance on race day. We have found that the most effective way to train happy, healthy, and to race fast is to train slower.

Need help establishing your training zones? Shoot us an email. We are happy to help!

Swim workout of the day:

  • 400 swim WU
  • 200 pull WU
  • 100 kick WU
  • 6×50 swim w/: 20 rest (descend 1-3, 4-6)
  • 100, 200, 300 with :30 rest (all swim – moderate effort)
  • 300, 200, 100 with :20 rest (all pull – moderate effort)
  • 4×50 w./:15 rest (25 right arm/25 left arm)
  • 200 cool down
  • 2600 total

Current playlist:

  • Out of the Black – Royal Blood
  • Beloved – Mumford and Sons
  • Cherchez LaGhost – Ghostface Killah
  • State of Love and Trust – Pearl Jam
  • Happy Now – Zedd
  • Op Opa – Gaullin

Suggest some new songs to listen to!

References:

Fitzgerald M, Warden D. 80/20 Triathlon: Discover the Breakthrough Elite-Training Formula for Ultimate Fitness and Performance at All Levels. New York, NY: Da Capo Press; 2018.

Giles SM. PT Exam: the Complete Study Guide. Scarborough, ME: Scorebuilders; 2018.

Seiler S. What is Best Practice for Training Intensity and Duration Distribution in Endurance Athletes? International Journal of Sports Physiology and Performance. 2010;5(3):276-291. doi:10.1123/ijspp.5.3.276.

Our training philosophy

“Let us begin, what, where, why or when will all be explained like instructions to a game” -KRS-One

At Ad Astra Endurance Project we believe a training plan should be customized for the athlete.  We don’t think premade training plans work for most athletes.  Most of us are not professional triathletes, we have jobs that are pretty important, we get sick, things happen, etc.  This can lead to a lot of big swings in training when athletes try to make up for missed workouts.  We think a training plan should very specific and be incorporated into your life in a way that fosters consistency. Generally, if time permits, we do trend towards the polarized training model.  What does this mean?  Well, to us it means having a specific plan to reach your goals.  This is not just an overall framework for the season, then week by week mileage (we do that too).  It also includes the prescription of very specific training intensities for each workout you do.  This may seem a bit picky, but once you get an understanding it doesn’t take much thought at all. What is polarized training? The basic idea behind polarized training is to do all of your workouts either at low or high intensity and nothing in the middle – hence the name “polarized”.  Typically when talking about a polarized training model the vast majority of workouts are done at “low” intensity.  This is usually at or below aerobic threshold (easy to moderate or about a 13 or under out of 20 RPE).  The remaining workouts are done at “high” intensity.  This is typically defined as above anaerobic threshold (hard to max effort or about a 17 or above out of 20).  The intensity between aerobic threshold and anaerobic threshold is often referred to as “junk miles”, or “the grey zone”, or “no man’s land”.  Basically these workouts are too hard to gain the benefits of low intensity workouts and too easy to gain the benefits of high intensity workouts. Below is a summary of the intensity breakdown of population training models: Why polarized training? Several studies have shown the polarized training model to be at least as effective as a more traditional threshold training model while potentially decreasing instances of overtraining, physical injury, and psychological burnout.  A poorly designed training program has been shown to result in decreased physical performance, general fatigue, loss of motivation, insomnia, change in appetite, irritability, restlesness, anxiety, body weight loss, loss of concentration, and feelings of depression (citation).  A study comparing the 4 common training models listed above showed greatest improvements utilizing the polarized model with subjects increasing VO2 peak, peak power, and power output at 4mM blood lactate more than other models during testing.  While, the body of literature on polarized training is relatively small, the evidence is promising for its effectiveness. How can we help? At Ad Astra Endurance Project we will help you establish a well designed training program.  With our SMART coaching philosophy we listen to your story, then we utilize testing measures and analyze them to create training parameters that are specific to you.  Once those parameters are set, we work with you to establish a training schedule that fits your lifestyle and aligns with achieving your goals.  We believe polarized training is one way to keep you healthy and motivated during your race season. Feel free to respond below or email us directly with questions or comments. Resources Great presentation from one of the leading researchers of polarized training, Stephen Seiler: https://lecturecapture.brookes.ac.uk/Mediasite/Play/3b951db65dd44082a876060aab67f5c51d  

References: Hydren JR, Cohen BS. Current Scientific Evidence for a Polarized Cardiovascular Endurance Training Model. Journal of Strength and Conditioning Research. 2015;29(12):3523-3530. doi:10.1519/jsc.0000000000001197.

Muñoz I, Seiler S, Bautista J, España J, Larumbe E, Esteve-Lanao J. Does Polarized Training Improve Performance in Recreational Runners? International Journal of Sports Physiology and Performance. 2014;9(2):265-272. doi:10.1123/ijspp.2012-0350.

Rosenblat MA, Perrotta AS, Vicenzino B. Polarized vs. Threshold Training Intensity Distribution on Endurance Sport Performance. Journal of Strength and Conditioning Research. 2018:1. doi:10.1519/jsc.0000000000002618.

Stöggl T, Sperlich B. Polarized training has greater impact on key endurance variables than threshold, high intensity, or high volume training. Frontiers in Physiology. 2014;5. doi:10.3389/fphys.2014.00033.

The Ad Astra Endurance Project

What’s with the name?  
Ad Astra is Latin for “to the stars”. We want to help people achieve their fitness and wellness goals and experience the amazing effects that happen when we know that we are more limited by our minds than our bodies.

What’s up with the Latin?  
Truth be told… we’re geeks. We felt that using the Latin phrase communicated that we are committed to using data and current science to help our clients achieve their goals. If it doesn’t jive with you, don’t hold it against us.

What can I expect from an Ad Astra coach?  
No matter what your fitness or wellness goal, we have a working philosophy that guides our committment to you. We call it SMART Wellness Coaching™.

  • Story We always strive to understand the client story. We feel it’s important to understand your history, where you started, and your journey to better fitness and wellness.
    Measure Remember… we’re into data. We want to measure anything we can to help our clients acheive their best outcome.
    Assess All that data we want to collect… we’re into analyzing it too.
    Review After we gather and assess your data, we review it. This review (with the client) helps us tweak your personal path.
    Train This is where you come in. Go capture your dreams!

I’ve actually read all of this and I’m interested in becoming part of the Ad Astra family. How do I get started?
YES! We are excited to work with you. Email Coach Matt or Coach Tracy directly or fill out our Get Started form.