Sunday, February 28, 2010

The Best LUNA Bar flavor EVER!!!

I just tried a new LUNA Bar flavor - Vanilla Almond. It was sooo goood! I am a chocolate freak, but this is a really nice change! And sometimes I feel guilty eating chocolate so early in the morning, but Vanilla Almond can be eaten guilt free! And they're 70% organic, high in calcium and folic acid, rich in antioxidants A, E and C, and have 9g protein and 3g fiber! What more could you want!

Another new flavor is Blueberry Bliss - which sounds like a good breakfast option too!

Monday, February 22, 2010

Training on the Road

I have not posted in a while because I've been traveling a lot the past two weeks. This has brought up the challenge of trying to train, or at the very least maintain fitness, while on the road. Watching the Olympics on TV just does not count!

Cycling is out of the question, not traveling with the bike. Swimming is a maybe, but doubtful. Today I looked at my hotel pool and it was actually like a 10 yard lap pool! I got excited that maybe I would be able to swim, without having to swim 5 strokes in the shape of a paisly. But before I put on my suit I checked out the water temperature. Nope. Way too hot. Can't do it.

So that leaves running. I'm not brave enough to run outside in the dark in a new city, so that leaves the hotel treadmill. What is it about hotel gyms that are so frickin' hot? The last two I have only lasted 30 minutes before I thought I would pass out. But that's OK. Do an easy run one day, run hard intervals the next, easy run the next day, then a hard hill interval run. Short runs several days in a row is good!

The other thing that is often an option is weight lifting. Even if the hotel gym does not have free weights or a universal gym, you can still get a good strength workout. Sit ups, push ups, planks, walking lunges, side lying leg lifts, etc. You just need to commit to getting it done. 30 minutes of weight bearing exercise and a 30 minute run, better than sitting on your butt!

Wednesday, February 17, 2010

Vegetables in your smoothies

I love adding vegetables to my smoothies. It's a great way to sneak some extra ones in your diet, and we all know that we don't get enough!

Here are some that I add that don't compromise the taste:
frozen spinach (my #1 choice!!)
acorn squash

There are two main smoothies I typically make. Here they are:

The Everything Smoothie
vanilla protein powder
flax meal
frozen bananas
frozen berries
frozen spinach
sometimes I'll add walnuts and other veggies I have lying around

PB&B with Chocolate Smoothie
chocolate protein powder
lots of peanut butter
frozen bananas
water or milk
and if it's early enough in the day I'll add coffee - yum!!!!!

I would love to hear some of your suggestions too!

Tuesday, February 16, 2010

How to Run Downhill

Excellent, excellent, excellent blog on running downhill from Joanna Zieger. This is something I've struggled with, and finally asked my Chi Running friends what to do. They said shorter stride, faster turnover, sit down a little. Good advice, because I was doing the exact opposite.

Check out Joanna Zieger's blog, there is some great stuff in there!

How to Run Downhill

I raced the St. Croix triathlon for the first time in 1999. I started the run neck and neck with the legendary Karen Smyers. She pulled away on the first downhill and I was never able to bridge that gap and lost the race by 40 seconds. It wasn’t until after the 2000 Olympic Marathon trials, 10 months later that I took downhill running seriously, though. A masochist designed that painful course, with undulated hills comprising the last 16 miles leading to a downhill finish. My quads quivered, protesting with every step, until at last I crossed the finish line and lay down on a cot unable to move for an hour. The soreness lasted for days and I decided, with the St. Croix triathlon looming just 2 months away, to make downhill running part of my training.

Running downhill can actually be more taxing than the grind up the hill. The inner quad (i.e. the vastus medialis, the muscle that is HUGE in cyclists) takes the brunt of downhill running, but the hips, ankles and low back are also affected. The eccentric contractions when running downhill are fighting the stretch from gravity; force on the legs is coming from two directions. Downhill running, whether it is extended amounts or just a quick burst down a steep hill, can cause lasting muscle damage.

The key to running downhill quickly without long term repercussions requires good technique and lots of practice. Most people brake when they run down a hill. Approach the hill without fear. Relax and let gravity help you. Always keep your foot plant directly under your center of mass and do not over stride. Glide smoothly down the hill with a shorter stride and higher cadence (get your cadence close to 100, which is a better way to run in general). That will shorten the length of your quadriceps muscles and minimize stress and potential muscle damage.

Incorporate hill repeats into your training, but mix it up. Choose a day where you use the uphill as “recovery” and work the downhill; this is an opportunity to execute good technique and allow you to run faster than normal. If you are running on a “rolling” course, this is also a chance to practice running well downhill. Of course, ease into this type of regimen, with just a few repeats, keep the speed restrained and start with a moderate grade, such as 2%. Over time, as your legs get used to the extra pounding, you can increase not only the length of the repeat but the grade and your pace. Let the downhills become your forte and a place to gain “free” time. Better downhill technique will translate into better overall running performance.

You can ready your body for the rigors of downhill running by doing some specific exercises in the gym or at home. Lunges, with good technique and very light dumb bells, are excellent for stability and strength building. Watch yourself in the mirror to make sure your hips stay level ( ). Plyometric drills, such as box jumps, hops, and bounding are also important for any runner (

In 2000, I returned to the St. Croix triathlon. I exited the transition to the run with Karen and an even deadlier runner, Carol Montgomery. Having spent 2 months practicing the downhills, I felt confident in my ability to run well on this hilly course. Carol made her move early and pulled ahead in the first few minutes. I trailed behind by a few seconds with Karen a few strides behind me. I knew the course well and decided to attack on an uphill and use the momentum from the downhill to extend any lead I might derive. I made my move with 2 miles to go and won the race by 25 seconds.

Monday, February 15, 2010

LUNA Moons are being discontinued

It is a sad, sad, day. I just learned that LUNA Moons are being discontinued.

They were yummy, nicely sized, and 100 calories. Buy them out now before they're gone forever!

Sunday, February 14, 2010

Poo Chi

One more You Tube gem...

Saturday, February 13, 2010

Running Hills

I read something the other day that makes complete sense to me. Hill running is a great way to get a hard workout in, without a lot of pounding on your body. We all know that. What I didn't think about is that the downhill is actually worse on your body. If you're a new runner, then walk the downhills. If you are an intermediate/advance runner, then you can run the downhills. But what I didn't realize, and I can't remember where I read this (Joe Freil?), is that if you're an intermediate/advanced runner, but you have a history of foot/heel/achilles/calf pain, then walk the downhill.

Good advice. Plus, it's too early in the season to injure yourself!

Happy running,

Friday, February 12, 2010

Funny Ad

Ha, ha, ha, this is me and my friend Heather. Well, she is really the evil one. Sorry, I'm on a You Tube kick!

Thursday, February 11, 2010

Clif Bar Commercial - Triathlon Start

This makes me laugh every time!

Wednesday, February 10, 2010

Tuesday, February 9, 2010

Quote for the Day

"Recognize your victories."

I love this quote! Goes with the positive thinking I was talking about. Every victory should be recognized and remembered. So then when things are tough, remember them and know that you can do it! -L

Monday, February 8, 2010

Brain Gain

Here's a blog post I wrote last month for the Corpore Sano Physical Therapy and Sports Performance website. Thought you all might get something out of it! - L

At the beginning of every season I look at what I can do in my training to get faster. Add different speedwork in my running, do more hill repeats on my bike, swim more often. And every year I do see minor improvements, but they could be bigger. What I always forget about training is my brain. It’s already hard enough to fit in everything – work, family, workouts. Taking time to just sit there and visualize? Forget it, I can’t even fit in the stretching I’m supposed to do! My form of visualization is when I’m lying in bed the night before a race, having trouble falling asleep because I’ve gone to bed so early, I start thinking about the race the next day. Unfortunately that just causes me a bunch of anxiety, making sleep impossible. So then I try not to think about the race.

This year I am working on my brain. I had read that professional athletes credit visualization as part of the reason for their success, but I was skeptical. How much of a difference could it really make? But at the Seattle Half Marathon last fall, I had an experience that made me realize it was worth looking into. Here’s the long version of the story. I started consistently running in 1999, and that fall I did the Seattle Half in 2:03. I didn’t do it again because of two knee surgeries over the next 5 years. Once those were healed, I started running consistently again in 2006. I did an half marathon in 2007 with a time of 2:25. I did the Seattle Half in 2008 with a time of 2:18. I was not really surprised my times were slower because I was running slow and working on building my running base. Plus I was almost 10 years older! In 2009 I worked with a coach who felt it was time to add speed work back into my running. That was tough! The plan was to do the Seattle Half again. I did some 5K’s and 10K’s leading up to the race, and saw a lot of time improvement in those races compared to the previous years. Knowing those times and what training I had been doing, my coach set my goal time for the half to be under 2 hours. Under two hours? I was incredulous. She has got to be kidding, I thought. No way can I do that – I’ve never run under two hours, and that would be a 15 minute improvement over last year! Impossible. Not only that, I was really tired, my back hurt, blah, blah, blah.

Now you see how I set myself up for failure! I ran the race exactly according to my race plan. Start out slow, build, don’t kill myself on the hills, go all out the last 3 miles. And you know what, I did it in 2:01. To my surprise I beat my 1999 time, a half marathon PR! And as excited as I was about that, I had the nagging thought that I actually could have ran it under 2 hours. Shame on me for not believing in myself. Shame on me for telling myself I could not do it. Allowing negative thoughts to influence me.

Now I am reading and learning about what I can mentally do to train myself. I’m setting time up every day to mentally train. I’m working on relaxing, visualizing, developing positive words and phrases to use when things get difficult in my workouts. And because I am working on this everyday, I’ll be prepared in the days leading up to a big race. I won’t get anxious, I’ll have gone over the course in my head, I’ll have felt the success of crossing the finish line with a great time. I’ll be totally prepared!

Sunday, February 7, 2010

Training Tip: Preventing Illness

Having been sick most of December and now again in January, this was all good advice! - L

By, from

Nothing makes an ill triathlete as frustrated as looking out the window and watching his or her training buddies or rivals zooming past on their bikes. A gap in preparation and a blank page in the training diary can be mentally as well as physically damaging, so with this in mind ITU brings you ten tips on how to prevent colds and infection.

Tip 1: Get up to speed
The understanding of the common cold is an important part of prevention. The popular name of the illness is misleading: it's not cold that is actually responsible for infection, but viruses. These pathogens require three conditions to attack someone: firstly they must be present in sufficient numbers, secondly they must find a portal of entry into the body, and thirdly they must establish themselves locally to attack the body's immune system.

Tip 2: Stay away
In order to incur a cold you have to be in contact with the virus or bacterium for it to enter your body. Therefore, when your body's immune system needs to recover after a race or hard training session, or during a time of stress, you should avoid large crowds. Colds are especially transmitted in unventilated areas, such as buses, cinemas, nightclubs, or the endless queue at the supermarket. Stay away from sniveling or coughing people!

Tip 3: Sleep through the night
Sleep is the most important function for the body to recover and recuperate. Whoever sleeps well will reap the benefits later on, especially if they have managed to avoid coffee or other caffeine products before turning out the bedside light. Your bedroom should be well ventilated and not too warm as heated air can dry out the mucous membranes in the nose which defend the body against germs. Most people take six to nine hours of sleep per night, and average sleep requirements decrease with age.

Tip 4: Eat a balanced diet
Many of our food ingredients have a positive effect on the immune system. Vitamins A, E, beta-carotene, C, B6 and folic acid can all help the immune system function. Selenium and zinc also protect and strengthen the immune cells. Taking in food straight after exercise is also important to help the body recover and adequate hydration also affects immune response.

Tip 5: Choose the right clothing
There is a saying that there is no bad weather, only bad clothing. During the winter finding the right things to wear can be difficult. Starting off warm and ending up overheating is a common problem; especially as excess sweat can later cool quickly after exercise and weaken the immune system. Clothing should be chosen so that it keeps the athlete warm for the first ten minutes of training, and then from then on until the end of the session makes them feel pleasantly warm, but not to the point of overheating. A cap or hat keeps in the body heat, and gloves can protect the extremities.

Tip 6: Protect your lungs
The main portal of entry for the pathogens that cause colds are the mucous membranes of the upper respiratory tract. To protect yourself against the microscopic enemy you can take some small measures, such as warming up at the beginning of training, thus increasing the blood flow through the airways. Try breathing in through your nose and out through your mouth. In freezing temperatures you should also protect your airway with a scarf over his mouth and nose to avoid hypothermia. With heavy breathing the frigid air reaches deep into the respiratory tract, so you might choose to move training indoors and onto a treadmill or turbo.

Tip 7: Take a break
The highlights of the coming season are still far away so why risk training and getting an infection if you're feeling run down? Overtraining can worsen symptoms and extend recovery times, and as a worst case scenario it can damage the heart muscle. Treat yourself with care and be considerate of your body's need to rest. If you start to feel congestion, stop training or back off.

Tip 8: Recover correctly
After a training session make sure you get yourself warm and recovered as best as possible. A cool down is essential, but think about changing into dry clothing and extra layers, maybe head inside a gym or into a warm pool rather staying in the cold air. Massage will improve blood supply back to the muscles to help recovery, and go easy on the celebratory beer or wine as alcohol widens the blood vessels and increases heat loss.

Tip 9: Make use of the hot and cold
Doses of hot and cold are useful in stimulating the immune system. Sauna sessions are one of the oldest home remedies to prevent colds, although the exact mechanism is controversial. The temperature change has a positive effect on the immune status but make sure you stay hydrated throughout. If you're feeling tough then taking an ice bath increases resistance to the cold as well as helping muscle recovery. Just make sure you wrap up warm afterwards.

Tip 10: Think positively
It's not just physical stress that impacts on immune function; it's mental ones as well. Negativity, such as anger, sadness and aggressiveness can all affect the body's resistance to illness, so be prepared by looking on the bright side of life. If you're feeling down then make sure you talk to friends and try and put a smile back on your face. Do something fun and exciting if training is getting you down, remember that the 2010 season isn't for months and sometimes it's best to enjoy life away from the bike, goggles and running shoes.

Material courtesy of Frank Wechsel

Saturday, February 6, 2010

Build Your Base in 2 Weeks

Rob Wiley never worried much about how he began a new training cycle. He figured it was enough just to stay fit, running the same few miles just about every day at about the same easy pace. Then the 32-year-old project manager of Gurnee, Illinois, started working with a coach, Jenny Spangler. She had Wiley run hills and tempo runs in his base weeks, that six- to nine-week period of time before a formal training plan begins. "I thought, Why am I running hard stuff right out of the gate?" he says. The reason became apparent two months later, when he began stepping up his workouts. "I was strong," says Wiley—stronger than he had ever been entering a training season.

The experience was a revelation for Wiley. Proper base building isn't simply a matter of logging a decent number of miles, he realized. Instead, it serves as a bridge between the off-season's maintenance runs and a race-specific training program. "The purpose of base training is to prepare you for your next phase of harder, faster running," says Spangler, the 1996 U.S. Women's Olympic Marathon Trials champion. If you transition too quickly into the rigors of a training program, your ability to perform and, therefore, benefit from the work decreases while your risk of injury increases.

Because base training comes before you actually begin a training plan, it's often overlooked, says Spangler. In fact, quality work during this early phase is no less important than during your peak weeks. Faster-paced miles and the inclusion of a weekly long run increase endurance and strengthen your muscles, bones, and connective tissues. The improved fitness not only readies your body for the more intense running to come, it also allows you to safely handle tougher workouts, which increases the overall effectiveness of your entire training cycle.

Start Off Strong (Enough)

The key to successful base training is adding enough intensity to boost your fitness, but not so much that you get burned out or feel like you're training at your maximum too early. "There's no need to ever go above 95 percent of your maximum heart rate in base training," says Gordon Bakoulis, coach of Moving Comfort New York and a former 2:33 marathoner. "Fast 400 meters have no place in the base weeks."

Doing one or two quality workouts a week, such as hills, tempo runs, or fartlek sessions, will rev the cardiovascular system and stimulate the fast-twitch muscle fibers. A slightly longer run—of 45 to 90 minutes, depending on your fitness and goals—is also key. (For a two-week base-training program, see the end of this article) Sometimes, Bakoulis's athletes replace a tempo run with a race, which they don't run all out because they're not yet in peak shape. "It helps you retain the mental aspects of racing," says Bakoulis.

During base training, Spangler and Bakoulis both recommend gauging intensity by feel rather than by pace, since the number on your watch may push you to go faster than you're ready for. Gauging your effort allows you to run at the level right for that day. Plus, since much of base training takes place in the dark and cold of winter or early spring, achieving a certain pace becomes all that more difficult.

After Wiley added a few hill charges and 30-minute tempo runs to his formerly "easy" period, he ended up trimming two minutes off his half-marathon personal record. He decided to add quality runs into all his base training, and he ultimately set PRs in every distance from the 5K to the marathon. A little faster in the beginning meant a lot faster in the end.

Laying the Groundwork

Use the base-training plan below to develop endurance and strength prior to starting your next race-specific program. Follow this two-week block with one week of moderate runs. Repeat the three-week sequence two or three times for a total of six to nine weeks of base training. On tempo, hills, or fartlek days, warm up and cool down with a 10-minute easy run.

Day 1
Long run 45 to 90 minutes at what coach Jenny Spangler calls "a slight level of discomfort," or a moderate effort

Day 2
Rest, cross-train, or do a short, easy run

Day 3
Run 20 to 60 minutes at a moderate effort

Day 4
Long fartlek 3 or 4 3-minute surges at a 10-K to 10-mile effort, with 3 minutes easy running between fast segments

Day 5
Rest, cross-train, or short, easy run

Day 6
Hills 45 to 60 seconds at a hard effort; start with 4 repeats, build to 8 to 10; walk or jog downhill between repeats

Day 7

Day 8
Long run 45 to 90 minutes at an easy, conversational pace

Day 9
Rest, cross-train, or do a short, easy run

Day 10
Run 20 to 60 minutes at a moderate effort

Day 11
Short fartlek 10 to 15 minutes of 30-second to 2-minute bursts at a hard effort; recovery is equal to the duration of each fast segment

Day 12

Day 13
Rest or Run 20 to 60 minutes at a moderate effort

Day 14
Long tempo (or race): 20 to 40 minutes at half-marathon to marathon effort; 5-K or 10-K at a brisk but controlled pace.

Friday, February 5, 2010

When to Replace Your Shoes


If you're exercising in shoes that have passed their prime, it's OK to let them go up to shoe heaven. You can harm your feet, and possibly other areas of your body, if you continue to wear shoes that no longer offer the support they once did.

A Shoe's Life Span

As a general rule, most running and walking shoes last up to 500 miles. How and where you use your shoes could alter that number. For example, pavement wears down shoes faster than a track, a trail or gravel. Also keep in mind that shoes with an EVA midsole tend to wear down faster than shoes with a polyurethane midsole.

How to Tell

Here are three guides for determining when you need new shoes.

Do the Press Test

To determine if the midsoles of your shoes are compressed and are no longer providing cushioning, do the press test. Using your thumb, push on the outsole upward into the midsole. With new shoes, it should be easy to see the midsole compress into lines or wrinkles. As the shoe wears down, the midsole compresses less with the same amount of pressure. When the midsole shows heavy compression lines and the press test reveals a minimal amount of compression, there is little or no cushioning left.

Examine How Your Shoes Look

Don't worry about how dirty they are. That's a good thing. It means you've been using them. What you should be concerned with is general wear and tear. Take a look at your shoes. Are the heels stretched out? Are places on the outsoles worn down? Can you see how the shoes have molded to your foot? These are all signs of excessive wear.

Pay Attention To How They Feel

Your body will know when there is little or no cushioning left in your shoes. If you notice any aches or pains in your feet, legs, knees, hips or back after you've worn your shoes, it's a good sign that you need a new pair. Other signs include friction or blisters in unexpected places, which means your shoes have stretched and your feet are moving around too much.

Make Your Shoes Last Longer

Here are some tips for increasing your shoes' life span.

Rotate Two Pairs of Shoes

It's a good idea to have two or three pairs of walking or running shoes that you can alternate using. You'll find they'll last much longer in the long run—or walk, as the case may be.

Take Them Off Properly

If you take off your shoes properly—by unlacing them and removing them with your hand instead of kicking your shoe off with the other foot—they'll last much longer.

Use Them Just for Exercise

Wearing your exercise shoes around the house or around town will wear them down more quickly. Save your running or walking shoes for exercise.

Thursday, February 4, 2010


I totally believe in having a strong back. It seems like most of us athletes have back problems, including me. Plus, in looking at my running form, my posture is the first thing I started working on, and a weak back is definitely a limiter. This article has some good exercises for addressing this. -L

Five essential exercises for improving your posture--and your running.

By Clint Verran

PUBLISHED 10/01/2003

When your lower-back muscles are weak, lots of bad things can happen. Nagging pain, for one. Then there's bad posture, and sub-par running. To keep this critical "core" area healthy and strong, you need to strengthen and stretch the erector spinae muscle group (see opposite page). The following five exercises, done two or three times a week, will do just that. The entire session should take you no more than 10 minutes--and could save you from a lifetime of problems.

1. Back Extensions:

Lie on your stomach on a weight bench. Move forward so your hips are at the edge of the bench, and your torso is hanging over. Have a partner hold your ankles. Keeping your body straight, cross your arms behind your neck, and slowly bend forward at the waist as far as you can while keeping your back flat. Slowly raise your torso until your legs and upper body are in a straight line again. Do not arch your back upward. Do two sets of 10 repetitions. Caution: Don't do this exercise if you have a sore back or a history of lower-back pain. To add resistance, hold a 10-pound weight against your chest.

2. Double Knee to Chest:

Lie on your back with both knees bent. Place your feet on the floor and your arms at your sides. Bring both knees close to your chest and clasp your hands around your legs, just below your knees. Pull your knees to your chest until you feel a stretch in your lower back. Hold for 3 seconds. Repeat 10 times.

3. Seated Rows:

Sit on a large stability ball facing a cable column or an elastic band tied to something stable. (If you don't have a ball, use a stool instead.) Grab the cable or elastic with both hands. Sit tall and upright, and pull the cable toward you. Bring your hands to your rib cage and squeeze your shoulder blades together behind you. Hold for 1 second. Important: Do not bend forward or backward at the waist. Do two sets of 10 repetitions.

4. Press-Ups:

Lie on your stomach and place your hands on the floor near your shoulders as if you were going to do a regular push-up. Slowly push your upper body off the floor by straightening your arms. Keep your hips on the floor. Hold this position for 3 seconds. Relax your arms back to the floor. Repeat 10 times.

5. Ball Bridges:

Lie on your back with your arms at your side and your feet on a stability ball. Slowly lift your buttocks off the ground until your trunk and legs are in a straight line. Hold this position, and squeeze your lower back muscles and your buttocks for 2 seconds. Do two sets of 10 repetitions.

CLINT VERRAN, physical therapist and member of the 2003 World Championship Marathon team, has a marathon best of 2:14.

Tuesday, February 2, 2010

How to Prevent Breast Cancer: Eat Soy (But Not Too Much)

Natural plant-based estrogens in soy may provide healthy benefits in low doses, but may be a risk factor for breast cancer in higher doses.

Monday, February 1, 2010

Know Your Options For Treating Overuse Injuries

There is some interesting stuff in this article, but it is one person's opinion. I have had good luck with ART and highly recommend it. They give Cortisone shot a D, but it has been highly effective for me in dealing with plantar fascitis, but not with my knee pain. From what I understand (and I am NOT involved in the medical profession AT ALL) is that it reduces inflammation and gives the body a chance to start healing itself if you rest properly. As far as NSAID's, I have heard that Advil-type is better then the Aleve-type. But that they are only good for a short time and then they will interfere with the healing process. As the PT says in the article, check with your doctor before trying anything!

Physical Therapist Nate Koch reviews and grades several treatment options for common overuse injuries.

Written by: Nate Koch, PT, ATC

Overuse injuries have been rampant in triathlon since its inception and will continue to do so long into the future. One study in 2003 reported that overuse injuries accounted for 68 percent of preseason and 78 percent of competition season injuries. The term overuse injury can encompass just about any injury in the sport that does not involve a collision. Some examples of overuse injuries are Achilles tendinosis/tendinopathy, plantar fasciosis, anterior knee pain, ITB syndrome and sciatica. The medical terminology that describes the overuse injury and available treatments can be overwhelming.

Recognizing that all injuries and potential treatments cannot be addressed in one article, the most common treatment options for overuse injuries are highlighted below.

Eccentric Exercise: An eccentric muscle contraction occurs when a muscle and its associated tendon have to work while the muscle is being lengthened, such as by doing a negative lift in the gym. A physical therapist or athletic trainer can give you instructions on proper form, resistance and frequency.

Pros: A plethora of high-quality research supports the clinical effectiveness of eccentric exercise over other treatments in the management of tendon injuries. It’s the most low-tech, cheapest and most effective treatment available. It can be done at home in most cases, and instruction by a clinician is covered by insurance.

Cons: Requires a visit to a physical therapist or a certified athletic trainer to receive instruction on technique and proper progression.

Grade: A+

ASTYM: Augmented Soft-Tissue Mobilization is typically performed by a physical therapist, physician or athletic trainer. The clinician must be certified in this technique. Specifically designed solid tools take the place of the clinician’s hands to stimulate healing in abnormal tissue without damaging normal tissue. ASTYM treatment couples the use of these tools with specific exercises designed for each particular injury.

Pros: The treatment provides relatively quick pain relief, which can take between one and 10 visits. Can resume normal exercise immediately after treatment. Covered by insurance. Can be used for prevention, to eliminate weak links and keep old injuries from recurring. Outcome studies provided by the company Performance Dynamics are favorable. Research has shown this treatment does actually change the injured tissue.

Cons: The treatment causes tissue soreness and possibly bruising. You must find a licensed clinician, and more research is needed on humans.

Grade: A

Graston Technique is typically performed by a chiropractor or physical therapist—. The clinician must be certified in this technique. Steel instruments are used to enhance the clinician’s ability to detect adhesions, scar tissue or restrictions in the affected areas. The instruments break up the scar tissue so that it can be absorbed by the body.

Pros: It provides relatively quick pain relief in one to 10 visits. You can resume normal exercise immediately after treatment, it’s covered by insurance and the outcome studies provided by the company, Graston Technique, are favorable.

Cons: The treatment causes tissue soreness and possibly bruising. You must find a licensed clinician. The majority of the research on this technique has been performed by the ASTYM folks, but more research is needed on humans.

Grade: A-

ART: Active Release Technique is typically performed by a chiropractor or physical therapist, who must be certified in this technique. It is a patented soft tissue system/movement-based massage technique. Clinicians use their hands to evaluate the texture, tightness and movement of the soft tissue. Abnormal tissues are treated by combining precisely directed tension with specific patient movements.

Pros: This treatment can provide relatively quick pain relief in 10 or fewer visits. It is non-invasive with no side effects. You can train immediately afterward, and it’s covered by insurance.

Cons: The treatment can be uncomfortable as a result of pressure. Research is limited and frequently has at least one methodological flaw, with most research being case studies and anecdotal reports. Research does not prove a positive change in the injured tissue. Much more research is needed to prove its short and long-term benefits.

Grade: B

PRP: Platelet-rich plasma injections are performed by a physician only. This procedure requires injecting some of the athlete’s own blood directly into the injured tissue. The plasma portion of the blood contains platelets, which release protein growth factors responsible for initiating the body’s healing process. The goal is to restore injured tissue to its normal state, not reduce inflammation.

Pros: While more research is necessary, the current research is encouraging, showing positive change in the injured tissue. It can be done in a physician’s office setting. The injury can improve after one injection, and there is minimal risk for complication.

Cons: Research is limited, and the procedure is not typically covered by insurance. It’s an expensive treatment that must be performed by a physician. Only light exercise is recommended. There can be injection site soreness. Complete healing can take four to six months and may require several injections.

Grade: B

IONTO: Iontophoresis is a localized medication in a patch form delivered directly to the injury location via electrical stimulation. This procedure is typically performed by a physician or physical therapist.

Pros: There are fewer side effects than with oral medication and cortisone injection. It’s typically covered by insurance. It’s a painless procedure that may provide pain relief within the first five sessions.

Cons: The pain relief is only short-term. The research has shown varied and inconsistent results. The treatment does not result in a positive change in tissue.

Grade: C+

LLLT: Low Level Laser Therapy is sometimes referred to as cold laser therapy. It uses low-level lasers or light-emitting diodes to stimulate or inhibit cellular function. The exact mechanism is unknown, and it is theorized that the laser light can penetrate deep into the injured tissue. It’s typically performed by a chiropractor or physical therapist.

Pros: There is no pain or discomfort with delivery of this treatment, and it only takes between two and six minutes.

Cons: Research is limited and is typically done by manufacturers. There is limited agreement among clinicians on the most efficacious dosage and parameter choices. The results are varied and inconsistent. It is typically not covered by insurance.

Grade: C

NSAIDs, or Non-Steroidal Anti-Inflammatory Drugs. You can get NSAIDs over the counter or as a prescription from a physician. Some examples are aspirin, ibuprofen and Aleve.

Pros: They provide quick pain relief and are easily available.

Cons: They provide only short-term pain relief. Some side effects are gastrointestinal distress, increased incidence of hyponatremia in endurance athletes, myocardial infarction and bleeding. They do not result in a positive change in tissue.

Grade: C-

Cortisone Injections are performed by a licensed physician and involve an injection of cortisone directly into the injured tissue. It’s usually mixed with a numbing agent like lidocaine. It’s used to suppress inflammation. The physician may use fluoroscopy (X-ray-guided technology) or a diagnostic ultrasound to determine the best location for the injection.

Pros: It provides quick pain relief and is covered by insurance in most cases.

Cons: The relief is short-term. It comes with a recommendation of time off from training. The side effects are potential fascia/tendon rupture and skin irritations. While it may decrease inflammation, it does not result in a positive change in tissue. Plus, it can be an expensive procedure.

Grade: D

This should be a last resort before looking into surgical options. Definitely consider PRP before taking this step.

Before deciding on a treatment option, it is best to consult a sports medicine clinician. Furthermore, in order to optimize your treatment choice, it is crucial that a biomechanical assessment be performed by a licensed physical therapist to determine the underlying cause of injury. Remember that these treatment tools are only as good as the hands that wield them. Most of these injuries are preventable, fixable and require a team approach to most effectively recover.

My experience treating endurance athletes leads me to recommend ASTYM and eccentric exercise as the most effective treatments of overuse injuries from those discussed above. While ASTYM and Graston are very similar, I give a slight edge to ASTYM since it was developed by a physician and physical therapist, and they continue to advance the research. ASTYM is taught more as a treatment process or philosophy. Our athletes and clinicians prefer an active treatment approach that allows continued training, focuses on normal tissue healing and is backed by research.

Nate Koch is a physical therapist and certified athletic trainer. He owns Endurance Rehabilitation in Scottsdale, Ariz.