Every once in a while a client falls into my lap who I know is going to become a teacher. If I’m honest my first reaction is a sense of dread and responsibility. I can tell immediately from their history that they are seeking solutions, journeying towards a better understanding of their body and themselves. That journey has often taken them to several specialists before they get to me, and I’m keen to avoid making promises I can’t keep. Equally though, I really want to help. As cyclists, these clients present as someone having a lot more trouble getting comfortable on the bike than your average rider. Someone looking to the bike to fix a problem which is more about the body. I know that these clients aren’t going to respond to a quick fix, and the broader holistic approach beyond the bike fit that is needed can seem like a hard sell.
Rob was one such client who came to Le Beau Velo in April 2015 when I was working on a collaborative bike fit alongside Mal Pires. Rob already knew a lot about the fitting process and had been through multiple fits with reputable experts, as well as completing fairly extensive rehabilitation with a team of physios connected with one of these businesses. The issues he presented with were frustrating aches and pains that affected his training and riding. Sometimes pain was along the distribution of the ITB towards the knee, and at other times it was around the lower and upper back or into the shoulder blades. There was no clear pattern of provocation or alleviation and no obvious clues as to the root cause.
Perhaps fortunately, both Mal and I felt Rob’s cycling position could be much improved by lengthening and stretching out his long torso and arms to facilitate a more optimal position. In one sense this was the first piece of bad news to deliver – that Robs existing bikes (which were all set up exactly the same) were less than ideal. In fact Rob would have to look hard for an ‘off the peg’ frame that would be more suitable.
Under Mals advisement and with my encouragement Rob took this news on board and started to make an ongoing plan to tackle the bike situation, switching to a ‘better’ old frame before looking for longer term options. I felt sure though that this was just the beginning and that even with the right set up, there were factors at work contributing to Robs experience of chronic pain problems.
Another clue that this would be a longer term project was that Rob had a history of digestive issues. He frequently experienced bloating and gut pain which also impacted on his riding which he had taken significant steps to try and tackle himself by modifying his diet. He had experimented with cutting gluten, using a ketogenic diet for a period, had recorded food diaries to try to identify irritating foods, and had used various supplements and home grown kefir to try to boost the health of his digestion. In short, Rob had already tried some of the obvious solutions with conviction, and yet little success.
In my experience, both personally as well as professionally, digestive or hormonal problems are often a red flag priority that might be referring pain and problems out to the musculo-skeletal system. In the simplest of terms, an inflamed digestive system inhibits correct engagement of the core muscles (hence the ‘shut off’ appearance of a bloated stomach), making core ‘strengthening’ and corrective exercise approaches less effective. Abnormally high levels of body fat in an active person who eats well is another clue that the body’s metabolism is under some stress and that there are deeper concerns at stake. It was not that Rob was fat when I first met him, but for the amount of effort he was putting into his diet he was not particularly lean.
In spite of all this going on in the background, I was keen to get Rob back on the bike as soon as possible and see what we could achieve with some intelligent off the bike conditioning to support and alleviate his musculo-skeletal system. Thankfully Rob trusted my approach and we embarked on a process of physical assessment, exercise program design, and ongoing review as we reintroduced cycling with caution and monitored closely Rob’s response. Integrating on and off the bike work and diarising/scoring feelings of pain as well as mood allowed Rob to make some progress through the winter, but by February 2016 we felt it was time to look more closely at the cause of his gut discomfort.
I recommended Rob have a ‘Gastro-Intestinal panel’ test with a functional diagnostic clinic I had a long relationship with at that time. Under the guidance of their resident nutritionist to educate me about the results, these tests take a snapshot of the situation in the gut using saliva and stool testing. They look for obvious food intolerances (gluten, dairy, soy, egg), various digestive markers (such as the secretory IgA present in the sample, enzyme levels and inflammatory markers), and the presence of any parasites or bacteria in levels considered pathogenic or unhealthy.
When the results came in the findings made it clear why Rob was struggling with such changeable issues. He had a handful of parasites resident in his gut that could cause a lot of what he’d been experiencing. Removing these then became the obvious priority. Herbal and dietary based protocols were suggested and followed, and through the summer of 2016 Rob was able to ride consistently and maintain his conditioning using strength circuits of exercises he already knew well, and the key pre and post ride stretches that we had worked out through the preceding year.
A clinical retest in the autumn showed the anti-parasite program had been ineffective and so Rob pushed forward into a different round of herbal supplements to make another attempt to begin to clear his gut.
At this point I was pretty gutted that Rob wasn’t getting the results that we were hoping for that I knew would be the turning point in his training. I had used these ‘alternative’/holistic approaches with other clients with some success, and although it was always a process, Rob really didn’t seem to be getting what he deserved for the effort, and frankly the money that he was throwing into it.
In spite of these ongoing issues, through the winter of 2016 into early 2017 Rob’s conditioning had reached impressive levels. He was getting stronger every week, lifting more weight in the bar bell staples of squats, deadlifts, and lunges etc. and had come a long way from the monotonous early preparatory exercises where pre-habilitation was the emphasis.
Though I knew this meant progress in some sense, after another failed round of an anti-parasite regime I felt we were running out of resources to pursue the matter further. At this stage my nutritionist colleague recommended a medical facility that offered a triple anti-biotic protocol for parasite infections unresponsive to more alternative methods. Though it meant more expense, after several failures with a non-pharmaceutical approach Rob decided to go for it, embarking on yet more tests and plans and dietary restrictions.
Managing a diet that is predominantly about your health while keeping half an eye on performance is a difficult thing to do, and something most people don’t manage easily. But Rob is not most people, and with a no sugar, low carbohydrate diet plan Rob enjoyed some of his best riding yet last summer. Since then his metabolism had adapted further and Rob takes very detailed and prescriptive dietary protocols in his stride.
This winter, Rob has been managing his own training, using detailed power data, heart rate, and his Cycling experience. He has integrated the conditioning programs we have developed over the last couple of years that have now become part of his training vocabulary. I recently caught up with Rob to chew over some of what he’s continuing to do with the medical clinic, as well as fine tuning his bike position and his approach to his cycling training. Although Rob doesn’t race as such, his power numbers are becoming impressive. He is looking leaner and healthier than I have seen him and his training and mood are consistently good.
Rob is enjoying his riding, and he’s riding a lot.
I’m aware that there is still a way to go before Rob’s digestive health is where it should be, but I don’t doubt he will be able to do what he needs to give himself the best possible chance of success. For me I’ve learnt a lot working with Rob, and I will continue to learn as he moves forwards in his training. At this stage I am less of a coach and more of an equal, and that for me is a true success.