Friday, June 6, 2014

Conquering the Cramps

During endurance races, it's not uncommon to pass someone stopped on the side of the trail stretching, moaning and sometimes doubled over with leg cramps. Post-race campfire stories inevitably include guys comparing where along the course the cramps started, how long they lasted for, and how those muscles are still tender to touch. So for this post, I decided to look at what can be done to prevent and treat these dreaded leg muscle cramps.

Why do muscles seize up?
There are 2 theories as to why muscles cramp. The first has to do with dehydration-electrolyte imbalance. Because athletes exercising in hot and humid conditions experienced muscle cramps, it was thought that a combination of the heat and resulting dehyrdation/electrolyte loss from sweating might explain why muscles cramp. It is true that a correct electrolyte composition is important for muscle relaxation. Too much potassium, low sodium, low magnesium and low calcium levels can all cause muscle cramps. However, evidence for dehydration-electrolyte imbalance theory is lacking. In studies of runners, fluid losses, sweat rates and blood electrolyte compositions were exactly the same in those runners that cramped and those who did not. Furthermore, when given proper hydration, carbohydrates and electrolytes during exercise, cramps still occurred in 69% of athletes, suggesting that simple hydration and nutrition is not enough to prevent attacks of the cramp monster.

The second theory of why muscles cramp has to do with the communication between your muscles and your nerves (neuromuscular theory). There are 2 main sensors that send feedback to your brain about muscle contraction. The first are called muscle spindles. These sensors are in your muscle and detect muscle length. When you lengthen or stretch your muscle, they send a signal to your brain (via sensory neurons) to immediately contract that muscle so that the muscle doesn't tear. The contraction signal is carried back to your muscle by the motor neurons. The second sensors are called Golgi tendon organs, and these are located in your tendons, which connect the muscle to the bone. These sense muscle tension, so when your muscle is contracted, these sensors are activated and motor neurons from your brain tell the muscle to relax. In short: muscle spindles tell your brain to contract muscles. Gogli tendon organs tell your brain to relax them.

Muscle cramps usually happen when the muscle is contracting in an already-shortened position. For example, bend your knee and point your toes to the floor - this shortens your calf muscle. Now actively contract that muscle. That is the position your calf muscle is most likely to be in when it cramps up. In this position, there is not a lot of tension on the muscle for the Golgi tendon organs to detect, so there are no "relaxing" signals being sent to your brain. In addition, studies have found that fatigue causes the muscle spindles to be more more excitable and the Golgi tendon organs to be inhibited, meaning that your brain receives a lot more "contract, contract" signals and not enough "relaxing" signals. As a result, your muscle seizes up uncontrollably.

Is there a way to treat muscle cramps in a race?
Most of the riders I've talked to recommend just pedaling through the cramps. After 2-3 minutes of excruciating pain, the cramps go away. The experts in the literature recommend stretching. Stretching a contracting muscle puts more tension on it and gets the Gogli tendon organs firing, which tells your brain to relax that muscle. Here are some ways to stretch your muscles without getting off the bike.

For your calf muscle: put the crank in 4-6 o'clock position, slide back in the saddle, lock your knee straight and slowly drop your heel as far as you can get it to go (or think about pointing your toes towards your nose).

For your hamstring muscle:  put the crank at 4-5 o'clock position, slide back in the saddle, bend forward at the hip, and lock your knee straight (don't point your toes down, but don't pull them up either). Pull down on the pedal stroke in the 3-4 o'clock range.

For your quad muscles: Unclip, reach down and grasp your ankle or the heel of your shoe. Keep straight at the hip and use your hand to pull your heel to your butt. If you inside thigh is cramping, bring your heel a little to the outside of your thigh. If your outside thigh is cramping, bring your heel up a little to the inside.

Jeff informed me the other day he was going to start taking quinine for his leg cramps. The anti-malarial drug, I asked questioningly? Apparently, quinine was once prescribed off-label for treatment of leg cramps. However, in 2006, the FDA issued a news release on risks of quinine use linking it to serious side effects such as cardiac arrhythmias, low blood counts and 93 deaths. I think I would rather suffer through a couple minutes of leg cramps than risk some of these.

Vitamin E, magnesium sulfate and magnesium citrate have also been studied as possible treatments for leg cramps, but the studies showed no improvement over placebo. There is weak evidence that 30 mg per day of vitamin B6 or 30 mg of a calcium channel blocker, such as diltiazem, may reduce the number of muscle cramps, but these studies included only a small number of patients so more research is really needed before any drug regimen can be recommended.

Is there a way to prevent muscle cramps in the first place?
The best prevention strategies are ones that make common sense. Good conditioning and proper hydration appear to have the best results. If you are going to be racing in the heat, train in the heat. Same for the mountains. And despite the lack of direct evidence, maintaining hydration and adequate electrolyte levels is still important. During training, your body adapts to the work load and the way it processes fluids and electrolytes so that cramps become less of an issue.

Other prevention techniques target the Golgi tendon organs in an effort to delay neuromuscular fatigue. Plyometric exercises may be beneficial for increasing the efficiency of Golgi tendon organ firing and delaying the onset of Golgi tendon organ fatigue. These exercises involve combinations of explosive jumps, squats or short duration all-out sprints on the bike with the goal of having muscles exert maximum force in as short a time as possible. If a particular muscle is prone to cramping, exercises aimed to increase that muscle's strength and flexibility may also help prevent cramps during races.

Finally, there may be a biomechanical cause to leg cramps during cycling. If your bike is not set up correctly, some muscles may have to work harder than others when you are riding, and those muscles may be more prone to cramping. It can't hurt to get a proper bike fit.

Tuesday, June 3, 2014

Mohican 100 Race Report

What a great weekend and race! Mohican 100 was the second NUE race that Jeff and I signed up for this year. It takes place in Loudonville, Ohio, about 6.5 hours west of Baltimore. The race starts on the main street of Loudonville and finishes at Mohican Adventures campground where a lot of race participants camp out, including us. Jeff and I headed down on Friday morning and arrived around 3pm. We camped at a wooded, mosquitoey site with our teammate Chris and one of his friends, Matt, who flew in from Boston for the race. After setting up our tents and watching Matt expertly reassemble his full suspension MTB, we headed to race check-in and then out on the trails for a quick spin to stretch our legs and see what the singletrack trails looked like. The trails were really fun: they were dry, fast, and twisty with enough technical roots and rocks to keep Jeff and Chris happy and me constantly on my toes. Riding dry trails is somewhat of a novelty for us this spring because we have had so much rain in Baltimore. We were having so much fun on our pre-ride we joked we should just keep riding into the evening and forget about the race the next day!

We did eventually turn back and hit up Trail's End restaurant for our pre-race dinner of pizza, burgers and chicken wraps. We also invested in some fire wood and bug spray, which worked miracles back at the campsite. At some point in the middle of the night, Jeff woke me up. "Do you here that?" He sounded very concerned. "There is a wild animal right outside our tent." I listened groggily, but didn't hear anything, so I rolled over and went back to sleep. Matt was also awake though. He and Jeff got out of the tents to investigate.

Matt: I heard that too. It was definitely attacking something.
Jeff: Yeah, that was scary. What was it? I think I can still hear it breathing on the hill behind our tents.
Matt: I know. Is there any food out? Should we get rid of the trash here?
Jeff: I don't know. I think you can hang it from a tree. 
Matt: Do you think it was a fox? What does a fox sound like?

I don't know guys, but I'm pretty sure that's a song.

On race morning, we were up at 5. We left our campsite to cycle to start line just as the sun was peeking through the trees. It promised to be a beautiful day. There were 600 racers lined up on main street as both the 100k and 100 mile racers started together. My goal for the start was to stay upright. I did not want to get caught up in a crash on the road. That happened to 2 riders last year:

The start was fast because there was a $200 prime for the first rider to reach the top of the first big hill climb on the road. I was well back in the pack, but felt good on the road. There were a few bottlenecks once we hit the trails but generally the line of cyclists in front of me moved along well.

The first 30 miles of the race was all singletrack trails. I rode them decently. I went over my handlebars on one steep downhill section but both body and bike were fine so I just kept right on going. I'm not very smooth or flowy through the trails. This is how things usually go for me: pedal, pedal, pedal, oooo tricky corner, brake, use lots of energy trying to get over some roots...ok, now remember to stay relaxed....omg rocks, I'm going to die, brake, pedal, pedal, pedal to catch up back up. It's very draining. Chris captured some of the trails on his GoPro:

After 30 miles, we exited the trails onto a road. I was able to eat, drink, and generally relax so much more. Now I felt like I was racing! I think maybe this is a sign I should concentrate more on road racing next year.

I stopped at aid station 3 for some food and refilled my camel pack. My Garmin was reading about 48 miles and just under 5 hours. This was going to be a long race. I mentally prepared myself for another 5 hours on the bike.

Luckily, the second half of the course was a lot faster. It was a mix of paved and fire roads with some steep but short climbs and a 10 mile section of relatively flat rail trail. I pulled into aid station 4 at mile 72 and downed a Red Bull and some watermelon. Jeff was getting ready to go just as I was pulling in. I said hello and watched him disappear up the hill in front of me. My legs were feeling starting to feel pretty tired.

Somewhere along the trails between aid station 4 and 5, I hit a mud bog. My front tire sank in and came to a complete stop. I couldn't unclip in time and fell over sideways into the mud. Gross. I sloshed my way out and cycled along the road by a river. There were families floating down on yellow rafts. I wanted nothing more than to jump into that river and join them. I daydreamed about floating downstream to the finish.

I came to the last aid station which was supposed to be at mile 92. The last few miles were all singletrack trails. If anyone had been watching me ride those trails, they would have questioned whether I had ever ridden a bike before. If there was a root or rock in my way, I got off my bike and just walked over it. I pushed my bike up some of the hills and even walked some of the rocky downhills. I was mentally finished with riding in the woods. After about a mile into the singletrack, a rider passed me.

Rider: Get on my wheel. We can still break 9hrs.
Me: You have to be joking. We have miles of singletrack left.
Rider: Not true. There are only 2-3 more miles left.
Me: Seriously? That is best news I've heard all day.

I didn't break 9 hrs, but I finished that race and actually came in 2nd place despite all of the singletrack riding. I was beyond exhausted, but happy to have my finishers growler in hand. It was only later in the evening, after 2 lbs of chicken breast, refried beans, pasta salad, oatmeal cookies, 2 slices of pizza and 2 cups of beer, that I finally started to feel better. The next day, I was still pounding calories. A McGriddle from McDonalds, a full breakfast of eggs, sausage and grits from Cracker Barrel, beef jerky from a gas station rest stop - I think I ate more meat that day than I have in a very long time!

Here is Jeff's race report:

Never having ridden this course before, I again should have listened to the advice "push on the road to get into the singletrack with a good group." Our pre-ride on Friday at a peppy-fun pace was a hair faster than the pace of the giant single-file line of bikers. Any rider's bobble would slow the long conga-line down. But maybe it was a blessing in disguise. As Carla described, there was LOTS of single track in the first 45-50 miles. It took me about 5 hours to make it to mile 50. A finishing time of 10 hours did not sit well in my mind.

But then I hit the flat rail-trail, road and double track sections and really picked up the pace. You could see the miles ticking away on the GPS. I was very happy about this.

The conservative pace upfront left me with legs for the last 40+ miles of road, ups and double track. I really felt great ascending. Given how I had been feeling this season, I needed this confidence boost. If you follow Carla's musings, you know that I think I have Lyme disease or some sort of illness, but it is more likely a case of the lazies and beers-ies. But on Saturday, I finally found my race mode.

The inner thigh cramps and hamstring cramps came around mile 80, but I have learned that if I just keep pedals and ignore them, then go away in a few minutes. They did.

Back in the final single track I did some quick math, and I knew I could break 9 hours if I kept pushing. So I was on it, as hard as my legs could push me. There were lots of 100k riders finishing up on this same stretch. Most of them heard me coming, or heard my "rider back" warning and cleared away. However, there was one tricky rock spot on an uphill corner. There were 3 men standing there with bikes... there was room for me to squeeze between them, but not with a good line choice. Of course I bobbled, could not unclip, and tipped over slow-motion style directly onto one of them. It was hugely embarrassing, and lying there I could not muster the energy to get up. "Could you help me stand up?" My beet-red face uttered "I'm so sorry" about 4 times before continuing on. Funny how picking myself up off the ground was impossible, but back on the bike I felt good again. Back to the goal: beat 9 hours.

I did it. 8:52:33. 40th place. I could not be happier with that. At the finish, race volunteers immediately stop you and say "good job! Growler or Pint glass?" I asked if I could come back to get them, because if I stopped, the legs would surely lock up. After a quick spin around the campsite to move the good blood into place, I picked up the growler. I saw my teammate Chris Lane, and he said he had just come in a few minutes before me (8:46:49). Knowing how strong Lane is, I was super psyched to finish near him. Matt also did well too, crushing all of us and finishing in 8:18:24 despite getting lost and riding some extra miles.

Chris, Jeff and my muddy bike on Saturday evening

Like Carla wrote: amazing post-race dinner, great course, amazing weather, great camping and love hanging out with Lane and Williams. This is the most fun of the 100's. Most FUN (by far, not the most challenging). Now, on to more training for PTAP100: the hardest MTB race in the universe.