From the Desk of Dr. Donna Fleitz Mitchell
Many athletes struggle with ‘when and what type of bodywork’ to utilize prior to their event. The science says that it takes about two weeks for our body to build muscle, exercise endurance, etc. in response to exercise stress. The goal of the taper is to allow the body to incorporate the fitness acquired during the last week of training and allow for your muscles to acquire maximum glycogen stores. Exercise creates degrees of muscle injury, and as those muscles heal they become stronger. It is important to allow for this process to occur. It also means that any nagging injury or muscle spasm, trigger points or tightness needs to be corrected to allow optimal healing prior to race day.
My personal and professional recommendations are that athletes should increase their utilization of bodywork, whether massage, chiropractic, acupuncture during their last month of high volume training. I usually recommend an extensive overall body treatment at the beginning of the 2 week taper, to allow for the body to heal. Because any deep tissue massage (especially if there is a significant amount of spasm, tightness and trigger points) will also cause some mild tissue trauma and inflammation, I usually recommend that any deep tissue work be performed no later than 5-6 days prior to race day. A lighter ‘get the tissues warmed and blood flowing’ massage can be performed up to the day before.
The same rule goes for chiropractic and acupuncture/dry-needling treatments. It is best to get treatments, at 2 weeks out and then use the treatment the last week to get out any lingering problems and what I describes as setting the tone for optimal race day performance. Speaking specifically about acupuncture/dry-needling, patients respond differently and it is always best to be treated by somebody who has experience regarding how you respond. Many patients can be sore for 24-48 hours, where others perform their best the day after a treatment. In general terms, I recommend to my athletes that their last acupuncture/dry-needling treatment be performed 2-3 days prior to race day. The only caveat being that if there is something that pops up acutely, as in an active trigger point that can be treated up to the morning of the race.
Bodywork modalities are an important aspect of recovery from high exercise stress training weeks as well as from race day itself. After an Ironman event, the muscles are rather severely traumatized, with inflammation and swelling. The swelling is due to accumulation of fluid in what is known as the ‘3rd space”. It is a normal response to any type of tissue trauma. You may also find that once you are hydrated after the race that you weigh more than prior to the race. It takes about 3 days for this “3rd space” fluid to move into the blood stream where it can be excreted from the body. Many of you will note that you spend day 3-4 after the race urinating excessively as your body is eliminating this extra fluid. With that said, it is important for all treatments to be gentle and more about decreasing muscle spasm and increasing blood flow than correcting body mechanical imbalances.
I recommend a gentle massage anywhere from after the race to several days afterwards. Acupuncture can be performed anytime after the race through the next week. Utilizing these treatments within the first several days after a race enhances recovery. For an Ironman event, I usually recommend a follow-up treatment about a week out to further help with recovery and work on some of the muscle imbalances that have developed after the race. This is especially important if you are continuing to train for a later event. Maybe a Kona slot.
For athletes traveling, obtaining treatment prior to their departure is advantageous. I recommend wearing at minimal calf compression while flying or driving back home. Even with our best attempts to re-hydrate our body, fluid balance is usually not normal for several days as our body is trying to re-adjust. We tend to be slightly dehydrated and on a long plane flight the dehydration usually worsens.
After any type of an endurance race, we are thought to be ‘hyper-coagulable’ which is medical ‘speak’ for we tend to clot easier. I will spare you the science (if interested you can find an article on my website), but what it means is that if you are going to be sitting for a long period of time in a car, plane or train you are at risk for developing a blood clot in the lower legs. Being dehydrated can also worsen this risk. I personally use calf compression and take an aspirin the day of travel. The risk goes up as one’s age increases.
Dr. Donna Fleitz Mitchell is a Board Certified Anesthesiologist and has been providing anesthesia care, acute and chronic pain management for the last 30 years. She received her acupuncture training through the Biomedical Acupuncture Institute with extensive mentoring from Yun-Tao Ma, PhD and advanced study in Beijing, China at the International School of Acupuncture and Moxabustion. She is a three-time Ironman finisher, marathoner and an avid skier and cyclist, providing her with a unique understanding of an athlete’s injuries and training requirements.
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