The clearest correlation to running related injury appears to be training error, which is estimated to account for 60-70% of injuries. But less clear, as this paper digs into, is which variable is most at play: volume, duration, frequency, or intensity? In an attempt to quantify “training error” and provide some guidelines, we have what’s come to be known as the 10% rule. The basic premise here is that you shouldn’t increase your weekly running volume by more than 10% over the previous week. But the 1st rule about rules is that there are no rules. So, this is more guidance than gospel. 

What might be closer to a rule is that injuries happen when the load that’s placed on the body exceeds the body’s ability to tolerate that load. In this equation, we can modify load via training parameters like the variables that the article above attempted to dissect: weekly volume, duration of runs, frequency of runs, and intensity (speed and/or elevation gain and loss). We might further modify running load via surface (pavement vs dirt), footwear quality, and running form (more on that in a minute). On the other side of the equation, we can modify the body’s ability to tolerate load via exercise and preparation for the demands of running (much more on that in a few minutes).

Just like there is no perfect skiing technique, there is no perfect running form. However, in both sports we do have an optimal range, and when movement patterns fall outside of that range they become inefficient. Decreased efficiency equals both decreased performance and increased load, neither of which are desirable. Inconveniently (again), it’s very hard to define what proper running form looks like. It’s maybe easier to define what it doesn’t or shouldn’t look like. Even then, there are only a handful of moderate correlations between aberrant running form and injury. 

At the top of the list is overstriding, aka landing with your foot well out in front of your body’s center of mass. (This is not to be confused with heel striking—landing with initial foot contact through your heel as opposed to mid foot or forefoot. Heel striking isn’t necessarily overstriding though most overstriding does tend to be characterized by heel striking.) The primary issues with overstriding are an increase in peak/impact forces and a decrease in control of the knee, both of which are going to increase load on the body. Without diving too deep into the rabbit hole, the best way to correct an overstride is to increase the cadence or steps per minute—more steps at the same speed equals a shorter stride length. To train this, you need to be on a treadmill at a fixed speed (if you try to increase your cadence outside, you’ll likely just run faster) with your steps timed to the rhythm of a metronome. The target is to increase your steps per minute by 10%, which has been shown to effectively decrease loading rates.

Next up is a lack of pelvic control or what’s often called hip drop or femoral adduction. This occurs when the muscles of the stance leg are overwhelmed and unable to control the hip, and therefore the pelvis. As a result the pelvis drops on the opposite side, altering knee kinematics in the process, and frequently causing knee pain. We look to correct this through exercises targeting hip strength, coordination, and control as well and balance and stability in single leg stance. Conveniently (finally), this would be all of our ski-specific dryland exercises and drills. If you are a FasterSkier regular, then you’ve already seen numerous exercise suggestions here, here, here, here, and here, all of which are quite appropriate for running injury prevention.

That’s a great segue into the other side of the equation: the body’s ability to tolerate load. To paraphrase Geoff Burns, PhD from a recent Science of Sport podcast on running biomechanics, It’s not any one component—joint or muscle—that correlates with injury or performance, but how the system behaves as a whole. We must behave like pogo sticks. More force in equals more force out. But the body must be able to withstand these forces and be able to direct them appropriately. 

Essentially, Dr Burns is saying that running is an inherently high load activity and the body must be adequately prepared (strength, stability, mobility, etc) to handle these loads. Despite Instagram posts proclaiming Five Exercises Every Runner MUST Do! there is no magic exercise. I literally asked three different colleagues, all running injury specialists, What are your top three exercises for preventing running injuries? Inconveniently (here we go again), I got three different answers. 

Not to use that as a cop out, or get away without including pictures of my bald head and yellow-walled basement, here are MY top three exercises for runners (and skiers). These, plus all of your other strength training and pay-to-play maintenance exercises, should be in the mix two or three times a week. As with any exercise, the goal is to challenge or nudge the body in order to get the desired adaptations. This, as with all training, is a bit of a Goldilocks thing: too hot and the body is unhappy and let’s you know about it; too cold and nothing happens. Please be aware that these exercises (and the ones in my previous articles linked above) may not be your Goldilocks. If you are currently dealing with a running related injury (or any musculoskeletal pain), please visit your friendly, neighborhood physical therapist instead of searching for an internet cure.

Triple Extension

This is a classic running form drill to promote pushing through the hip, knee, and ankle. The shape–the ability to fully extend the hip and knee while going high on your toes–is arguably more applicable to sprinters than distance runners; however, it makes my list due to the work done by the calf muscles which are major players in running.

• Stand on one foot about 3 feet away from a wall. Hands are on the wall at about shoulder height. Imagine the wall is falling on you and you need to push it back upright. At the foot, your weight is biased toward the front of the foot so the heel is just high enough off the ground that you could slide a credit card under it.
• Still holding up the wall, drop down into a low squat with your opposite leg trailing behind. 
• With a quick push, stand as tall as you can. You should have equal weight from the inside to outside of the foot, and the knee and hip should be straight, but thinking about getting tall often accomplishes the task.
• If doing this exercise on one leg is too challenging, you can do it both legs together.
• Aim for 2-3 sets of 10x on each side. This is also a good running warm up.

Bulgarian Split Squats aka Trail Leg Lunges

These work the glutes and quads more than squats due to the staggered stance and place more load (and balance demand) on the front leg than traditional lunges. More bang for your buck! The version I’m showing uses a hip strategy/hip hinge/trunk lean to increase the work done by the glutes.

• Feet are staggered with the back foot on a step, box, chair, or bench. 
• To determine the placement of the front foot, sit on the front edge of the step, box, etc. Straighten the working leg out in front of you. Keeping the heel on the floor, stand up onto that leg. Then place the back leg on the step with the sole of the foot vs top of the foot.
• As you drop into the lunge, your hips should go straight down.
• Aim your fingers for the sides of your ankle. This will promote the forward trunk lean.
• The knee will move forward a bit but shouldn’t be going past your toes.
• Shoot for 2-3 sets of 10x. You can make it harder by adding weights or increasing the height of the furniture. It can be regressed by keeping your back foot on the ground.

Side Planks

Typically thought of as a core strength exercise, which it very much is, these also do a lot to  work gluteus medius, a major stabilizer at the hip (see the bit on pelvic drop above).

• Lying on your side, prop yourself up between the outside of your bottom foot and your elbow/forearm.
• Ankle, knee, hip, and shoulder are in a straight line, and your body should be vertical like a wall, not sagging or twisting to one side or the other.
• This is a timed hold. 30 seconds is a win. A minute is a gold medal but is getting boring and ready for some progressions (try it from your hand instead of elbow, add moving the top leg up and down, or twist like you’re reaching the top hand under your armpit). An easier version is to go from the knees instead of the feet (still keep your knee, hip and shoulder in line but bend at the knees so your feet are behind you).

Part 1 of this story details Eliška’s experience coaching through pregnancy and the birth of her son. Keep reading to learn about the challenges she, like many women, experienced during the postpartum recovery process, and what it took to navigate year one of life on the road with baby Viggo.

Expectation versus reality. 

When preparing to interview Eliška Albrigtsen about her experience pairing NCAA coaching with new motherhood, I expected the challenges she faced during her transition to primarily be focused on the balancing act of managing a demanding job with frequent travel and a new baby. Maybe a few relatable stories of airport meltdowns, sleepless nights in hotels while on the road with the team, and inopportune timing of diaper blowouts. Or any number of other ways societal systems in the US seem to be structured in opposition to new moms in the workplace.  

But Eliška’s passion for her job and dedication to her athletes were abundantly clear throughout the conversation; coaching is where she thrived. Her grit and energy allowed her to problem solve bringing baby Viggo on the road with the team – perhaps paired with the added fortune of a husband whose skill set includes waxing and ski testing and a well placed mother-in-law eager to help care for her grandson. And the team embraced its new member without hesitation.

In reality, the biggest challenges Eliška faced in returning to coaching postpartum were connected to the physiological impacts pregnancy and delivery had on her body. In short, it was a discussion on the shortcomings of our healthcare system and the myriad of ways the current standard of postpartum care falls short of what many women require to restore their body to full function.

Her story highlights a few key takeaways for programs looking to support women coaches surrounding pregnancy; in particular, there’s much more to the return to coaching than navigating who will care for your child while you’re out training with athletes and traveling to races. Respecting the timeline of a slow return, and perhaps offsetting the costs of postpartum physical therapy, may be an essential component of an improved and holistic support system.  

Postpartum Recovery

A theme of Eliška’s narrative of her perinatal experience was the ways in which her “athlete mindset” served and hindered her ability to roll with the punches. 

While women like Kikkan Randall, Marit Bjørgen, Aino-Kaisa Saarinen paved the way for women looking to begin their family before retiring from professional skiing in many ways, Eliška said that the ease with which they outwardly seemed to rebound beyond their previous levels of fitness was, in some ways, a disservice to women like herself who did not experience as smooth a return. In her mind, she had expected a comparable experience given her athleticism and good health, but quickly learned that women might be better served using caution when extrapolating from outliers. 

“You see these professional skiers having babies and then coming back and winning gold medals at [the] Olympics,” she said. “And you’re like, ‘Oh, yeah, that’s gonna be me.’ But no one really sees the giant support team they have behind them.

“They have professional doctors, physical therapists, and strength and conditioning [specialists] to go through their pregnancy with them, monitoring everything, having them at the birth, and then jumping right into the recovery. As a coach, you don’t get that. You probably have the same amount of on-ski hours as professional skiers – not the same quality of course, but you can’t do your job without being there. So I think that’s how most of our ski community sees pregnancy – so easy and you are an even better athlete afterwards, because all these women did it…

“For me, it was the opposite. It was hell. I can’t wear the clothes that I wore when I was pregnant because I have extreme PTSD from that… it was such a, not just physically but painfully, impacting experience.” 

Though expectation and reality could not have been more different, her drive to recover from the injuries sustained from pregnancy and birth, and the creativity required to adapt during the recovery process, mirrored her general approach as an athlete more broadly. 

“I think the athlete mindset in me was, ‘Okay, I had this baby. Now I put myself through physical therapy, and I’m gonna recover’… Just like after having a shoulder dislocation or having a torn iliopsoas, all those pretty crazy injuries – I knew that eventually you get better, and you get back to yourself.”

What Eliška identified as the biggest physical challenge she faced after the birth of her son was the repair of a condition called diastasis recti (DR), which is a separation and consequential loss of function and strength of the rectus abdominis muscles. 

During pregnancy, as a woman’s belly expands to accommodate the growing baby, the muscles of the abdomen are forced to stretch. The deeper muscle layers, known as the transverse abdominis, are structured like a corset wrapping around the belly, giving them a greater capacity to expand. However, the rectus abdominis muscles, better known as the “six pack” muscles, run vertically while connected by fascia, and have significantly less ability to adapt to the expansion. 

Instead, the outward pressure and growth of the belly causes the rectus abdominis muscles to separate, thinning and weakening the fascia as it stretches, or in extreme cases, tearing it.

“When I was the most pregnant, my six pack was under my armpits.” 

This connective tissue cannot simply snap back to its original state after delivery. As fascia lacks the blood flow of muscle tissue, it is slow to heal, leaving many women with a gap between muscles known as a diastasis. All women experience some amount of ab separation during pregnancy, but if the gap of two or more finger widths between the muscles persists postpartum, she is diagnosed with DR. 

Because of the combination of her stature, a short torso, and the size of her baby, Eliška found herself with an extreme separation. 

“Basically, you could stick your whole fist into my stomach. That was the biggest problem for me because I basically lost my core. And my core was a big part of me as an athlete – not just as a skier, but as an athlete. So that was really hard.” 

As she hopes for a second child down the road, any surgical repair options were contraindicated, and instead, Eliška dedicated herself to a physical therapy regimen. She felt lucky to have access to a Fairbanks-based Osteopathic medicine expert, Dr. Todd Capistrant, who specializes in the Fascial Distortion Model and was therefore primed to help Eliška improve her diastasis. 

“I saw him basically on a weekly basis.”

She also met regularly with a pelvic floor physical therapist, both to work on the diastasis, and to restore appropriate function to the muscles of her pelvic floor. Her PT identified that her pelvic floor was hypertonic, meaning the muscles carried tension chronically, rather than contracting and relaxing in functional patterns. Like holding a flexed arm hang and then being asked to knock out a set of chin-ups, this chronic low-level tension leads to fatigue in the pelvic floor muscles, preventing them from outputting the strength and tension required to support the organs sitting inside the pelvic girdle and interact appropriately with surrounding musculature when recruited during activity.

With the guidance of the PT and a set of progressive exercises to relax and engage her muscles appropriately, Eliška saw progress, but it took time for her muscles to function in coordination subconsciously.

“It took me probably around eight months to incorporate the mental [and neuromuscular] connections back. I was able to [engage the muscles] when I wanted to, but all the muscles of the pelvic floor, everything that’s sitting in the pelvis, they were not working with the rest of my body.”

She expressed feeling lucky to have access to high level care in Fairbanks, including her therapist who could incorporate a variety of techniques to help her recover, including deep tissue massage, cupping, electrical muscle stimulation, and biofeedback.

“I think biofeedback for athletes just works the best. Because we’re such strong willed people. Like, if we see it happening, we can really focus on making it happen more.” 

An unexpected benefit of time and resources being placed into learning how to strengthen and reintegrate her deeper core musculature trickled down to her athletes. She recognized that several of her athletes, who had complained of back pain surrounding core workouts, were not sufficiently engaging their transverse abdominis muscles, instead relying too heavily on the outer rectus abdominis or other smaller core muscles. Teaching the techniques she learned through PT helped improve the form of her athletes, relieving the back pain they had experienced previously. 

“It definitely deepened my understanding of how the core should work, and how we use it when we ski.”

As she navigated her own challenges, she became aware through talking with friends of how common these experiences are amongst mothers. Describing herself as “someone who says everything”, she felt it was important to both be open regarding the challenges she’s faced, and the resources and options available for women to make progress toward recovery, rather than accept the conditions as permanent. 

Most women only receive one postpartum checkup, approximately six weeks after delivery. As my own pelvic floor PT described it, these visits typically only check to see that the tissues have healed and that there are no visible pelvic organ prolapses, but most midwives and OB/GYN practitioners do not have the depth of knowledge to assess muscle function, hence the need for an evaluation from a pelvic floor PT. However, quality pelvic floor physical therapy is not universally available, and as it is not always covered by insurance, making it cost-prohibitive for many women to continue care long enough to make sufficient progress.  

“I think the most tragic experience post-pregnancy that I had was the realization that women are left being damaged from bringing life to the world.”

As she discussed her own experience with the women in her community, in turn, many of them shared that they continued to suffer from the impacts of ab separation or pelvic floor dysfunction from pregnancies, including friends who were more than ten years postpartum. Some of these women had given up activities they had enjoyed previously, like running, because they felt as though they were “spilling their guts” out of their bellies due to a lack of core function. 

“How is this okay for women to live this way? That was just mind blowing to me.”

Imparting the knowledge she gained in the process, and advocating for women to find their own ways to make it work, she offered up suggestions.

“I was just like, ‘Hey, if you can’t go to physical therapy, this is how you tape your belly, so at least you can start hiking fast.”

At roughly 13 months postpartum at the time of the call, Eliška recognized the improvements she’s made, while still acknowledging she has not fully recovered. 

“It’s [been] more than a year, and I feel functional. I still have pains and I would not go and enter a race, because my brain can push much harder than my body can, so I know I would hurt myself. But I’m so much better than most of my friends that, you know, [had to] just give it up…”

As she worked with athletes through the fall and winter, Eliška found ways to adapt her ski technique to avoid putting unnecessary strain on the musculature she was working to rehab, and work instead with the muscles that already had the necessary strength. In particular, she needed to change her doublepole technique.

By returning to the older style of doublepoling, which involved less of a crunch through the abdomen than modern technique, instead increasing the bend at the waist and relying more heavily on the arm and shoulder muscles. 

“I don’t have the strength there anymore [to crunch]. My muscles are two three packs, they’re not connected. So I go into doublepole and I tighten my  lower belly, but then I pull my butt up kind of like into downward dog instead, and work with my arms again.”

Another lingering problem she has experienced is a result of the endocrinological changes experienced surrounding pregnancy. To allow the body to grow during pregnancy and a widening of the hips for delivery, the body releases an aptly-named hormone called relaxin, which acts on cartilage and other soft tissues to allow expansion and increased joint mobility to occur. The production of relaxin typically declines after delivery, but remains higher than normal for the duration of breastfeeding.

While beneficial for pregnancy, it also puts perinatal women at a higher risk of joint instability and consequently injury. 

Eliška shared that she seems to produce an above average amount of relaxin, which has continued to affect her postpartum as a nursing mom. She experienced joint pain, particularly in her pubic symphysis joint at the front of the pelvis, with unexpected movements – like slipping on ice or mud. “And it’s always slippery here. Like 10 months out of the year.”

“On skis, I don’t have a problem. Because everything’s gliding and I already have the natural anticipation of gliding. But walking and slipping – I try to catch myself and my muscles, my joints, my tendons are just too loose.” 

Reflecting on her journey through the first year postpartum, the lack of care available to most women remained at the forefront of her mind. The impact of these types of conditions, which linger if left untreated, affects more than just the level of activity a woman can enjoy. As those who have experienced it (waves hand) can attest, the emotional toll affects quality of life more broadly. 

“I would absolutely fight for every woman to be able to have a year of free PT [after pregnancy]. You just need your life back.”

Life on the Road

There’s a commonly used phrase when it comes to raising children: “It takes a village.” This resonated as Eliška shared insights into what support was necessary to allow baby Viggo to travel with the team through the competition season.

While children under two-years-old are typically able to fly for free on their parents’ laps, the travel of the person who would care for Viggo while Eliška was working is not. Fortunately, her husband Tobias was already incorporated as a volunteer assistant coach, and had both the skillset and the NCAA certifications to play a variety of roles during travel, which also got him on the payroll to offset travel costs.

“I’m lucky that my husband’s quite good tester and waxer as well. And traveling with a full team this year, six [women] and six [men], I knew that we will need more than two coaches to wax.”

And, conveniently, Tobias’ mother is based in Boulder, CO. “She was able to actually drive to all the races and babysit when we were ski waxing and racing.”

For US Nationals, UAF collaborated with other Alaskan clubs to wax, but it was still useful to have an extra driver to bring athletes back and forth to the venue. Consequently, they paid out of pocket for the flight, but Tobias was able to get a per-diem salary as a driver. “So we got at least the food covered,” she laughed.

For other RMISA and SuperTour races where UAF was only waxing for their own athletes, Tobias could have his travel expenses fully covered in exchange for his work. It’s perhaps a model that’s hard to replicate for other mom-coaches, but still demonstrates that with some creativity and determination, bringing the family along for the ride is possible. 

“We call it the primary. He’s the primary on the baby when we have training days, where me and my assistant go with athletes and train. And then when we were testing and race waxing, grandma was the primary. And oh my God, bless her heart — she paid for all of her gas and her accommodation and food. She would just come to the house where we were staying when we had to leave and just babysat for us… So that’s the way that we made it work, but it’s a very, I think, exceptional situation.”

Was traveling back and forth from Fairbanks to Colorado and Utah challenging with a toddler? Yes. But Eliška knew it was something they would need to navigate as a family regardless of her career. 

“I know living in Alaska, he’s gonna fly anywhere he goes. That’s just what it is. So that was just like one thing that we were like, ‘Yeah, there’s no way around it.’ We did have to travel with more things. Because you have to have the car seat, we have to have the crib, we had to have a bunch of diapers with us.”

The system worked for the first year, but it will need to be modified for next season. The full RMISA calendar has not yet been set, however, the regional championships will be held in Anchorage, which will make at least one competition easier to travel to. 

From there, it will be running the calculus on what makes sense financially. She laughed that Viggo is already a squirmy baby to keep on their laps on the plane and will need his own seat next year, but she is also not sure whether he will still be nursing, which may make it easier for her to leave him behind with Tobias.

In terms of the impact to the team, better worded as the lack thereof, Eliška felt Viggo’s presence on the road improved the atmosphere. Rather than lamenting their littlest teammate, they found humor and joy in his presence. 

“When you’re stressed before the race, and you’re having breakfast and you’re barely putting the oatmeal into your mouth [because of nerves], and the baby in front of you is just like throwing the food and laughing… I think that it helped with the team atmosphere, for sure.”

In addition to helping distribute the weight of ski, wax, and baby gear when navigating through the airport, the athletes also served as an extra set of eyes in the team house. 

“The team, in general, was super helpful as well. When we would be waxing in the garage, they were playing with Viggo, and he believes they’re all his brothers and sisters, I’m pretty sure.”

Reflections on the Experience Thus Far

Praising the community in Fairbanks, Eliška was grateful for the help and support she received through her perinatal journey, which allowed her to not only continue as head coach, but help the team to new heights this season. Rather than holding her back, becoming a mother enhanced her ability to lead the Nanooks program. 

“I also feel like my season was so much more successful this year because I really wanted to go home to my baby. So I was really trying to work smarter and more efficiently, and I think the athletes probably had that push too.”

While some might fault a woman who shares that her priorities have shifted since having a child, Eliška explained the number of ways this desire to optimize practice time served her team. 

“I was always driven for success – I love being successful. But now it’s more like, ‘Yes, I will be successful so then I can spend more time with my child.’”  

As to whether there was anything she would have done differently, Eliška’s answer was more focused on reducing barriers to mom-coaches as a group surrounding pregnancy. 

“I think the side that no one ever talks about is: how fit coaches should actually be able to do their job well.”

Because her insurance cycle was aligned with the school calendar, her deductible reset in July. Having maximized her out of pocket expenses with prenatal care and delivery, this meant the physical therapy treatments she needed were essentially free for the first four months. However, after the plan turned over for the new year, each pelvic floor PT visit cost $60–70, and she was looking to go twice per week to continue to make steady progress. This adds up quickly, particularly for a family relying on one salary, which happens to be a ski coaching salary. 

While nationwide free postpartum PT for all women would be the ideal, Eliška proposed that these costs should, at minimum, be offset by the school or program.

“That is something I would definitely fight for women coaches. Talk to your boss, or whoever, and tell them, ‘If you want me to come back to the same level of coaching, you need to pay for occupational therapy for me to recover.”

At 24-years-old, Hannah Halvorsen recently announced that she is ending the pro-skier chapter of her life, but it’s not the only transition she has on deck. This past weekend, Halvorsen also graduated from Alaska Pacific University (APU) with degrees in cognitive psychology and business administration. As a senior capstone project, focused on the psychology side of her studies, Halvorsen chose to research a topic she has been invested in throughout her time as a student-athlete: eating disorders in sport. 

Given the size and scope of the topic, she began to explore ways to narrow the lens. She chose to focus on cross-country skiing to leverage her extensive experience as an athlete, but was still initially unsure of where to begin. 

“I didn’t want to look at just, ‘how do we get them to go away?’ because I just don’t think that is feasible with the resources and education we have right now,” Halvorsen explained in a call.

Ultimately, she chose to consider the topic from a perspective she had not encountered previously: that of the coach.

“Not every nordic athlete has access to a dietician or to a counselor, depending on their insurance, depending on their family culture, their family support… But the majority of athletes have a coach and that’s a frequent person that they’re interfacing with. So I thought, ‘This is a really unique link that a lot of people have. How do we utilize that?’”

Rather than trying to identify a “solution” to a nuanced and multifaceted mental health condition, Halvorsen looked to collect a “broad perspective on what coaches think, what coaches feel, [and] what coaches see… I wondered what it looks like for them because they see athletes come and go all the time, and they see all different types of athletes.” Utilizing connections in the sport both internationally and domestically, she contacted coaches from the junior level through the World Cup.

Looking to avoid factual answers that may just be regurgitated onto a survey from a basic Google search, Halvorsen sent coaches a list of four prompts, and asked them to submit their response as a video. “I wanted to see their mannerisms and their body language and the inflection in their voice when they were responding. Essentially, where they were at with [the topic].”

Specifically, the questions were as follows:

1. How do you see issues with eating disorders manifest in athletes who may or may not be struggling? What types of behaviors do you see that you associate with this problem? 
2. What are some of the pressures or contributing factors that you either notice or athletes tell you are the reasons that an athlete starts down the path of an eating disorder?
3. What do you see as the challenges with reducing the amount of eating disorders in sport? What types of obstacles make it hard for an athlete with an eating disorder to recover?
4. Do you see a difference with eating disorders between male and female skiers? Such as prevalence, the root cause, how it manifests, or anything else.

Setting her expectations low on what she would receive in return, Halvorsen was amazed as videos rolled in, and suddenly found herself with over three hours of thoughtful and in-depth responses. Some of the participants included: US National Team coaches Matt Whitcomb, Kate Barton, and Jason Cork; the Italian and Finish National Team coaches and Norwegian Women’s Team coach; current and former NCAA coaches like Cami Thompson Graves (Dartmouth), Maria Stuber (College of St. Scholastica), Marine Dusser (Univ. of AK Anchorage); elite post-graduate coaches Erik Flora (APU) and Andy Newell (BSF Pro); and junior level coaches Anna Schultz (Craftsbury), Molly Susla (Crested Butte), and Kris Hanson (Stillwater, MN).  

The challenge then became condensing this footage into a concise and effective 15-minute montage, fit to a “script” that would connect the perspectives without redundancy or losing the attention of viewers. “I wanted to have this artistic effect of being [shorter] sound bites, so people would stay engaged.”

The final project: Hannah Halvorsen’s senior project video.

As she reflected on what she heard from coaches, Halvorsen identified some of the important themes that resonated with her and aligned with what she had learned through her studies on the subject.

“There were some very noticeable overlaps. A lot of [coaches] said, ‘I’m not a medical professional, I’m not qualified in eating disorder rehab or therapy or treatment. I am not the person for that. It’s not appropriate for me, it’s not something I have the skills to do, and it’s unethical for me to be doing it.’ And it was honestly really nice to hear that at all different levels, coaches do know that this isn’t their job or role…

“I also noticed that a lot of them talked about how eating disorders weren’t just about sports performance, or wanting to perform in sport. A lot of the coaches pointed out how it often came at a time where the athlete has a lot of other stress in their life, and this is just something that they have found control over, which is also something that I’ve researched and learned about in preparing for this video.”

Halvorsen pointed out that this is a key distinction. While negative body image and a preoccupation with one’s physical appearance can be symptoms of eating disorders, the root cause is typically much deeper. In the endurance sport realm, an unhealthy need for control can run parallel to the type-A, perfectionistic mindset that may also contribute to athletic development and progress in sport.

In her advocacy work in the eating disorder space, Jessie Diggins has often used the phrase “Genetics loads the gun, but the environment pulls the trigger.” Or, as Andy Newell put it in Halvorsen’s video, eating disorders are “stressful habits that manifest themselves as eating habits.”

“Another big takeaway that I would describe more as a tangible lesson from this,” Halvorsen continued. “And the coaches kind of led to it – is that the right role for a coach is to be in touch with athletes and be aware and there for them, so that if they do notice a change in behavior, they can be that link that helps the athlete get connected with the help that they need as soon as possible. They’re not the one to fix that problem, but they might be the first person who sees it. The first person who checks in with [the athlete] and says, ‘Hey, you should see someone about this.’ That, I think, is where I stand on the issue right now.”   

Reflecting on her experience as a World Cup athlete and the responses of international coaches she received, Halvorsen indicated that she did not notice any significant differences in trends compared to the US, though this was an aspect she was looking to investigate. 

“‘Does it vary culturally in how we see it, how it manifests, how we talk about it?’ Overall, I would say, the problems seem to come from the same issues. They seem to be similar in the way that athletes want to hide it. It’s kind of taboo to talk about it. It’s largely more taboo to talk about an eating disorder if you’re a male athlete. Those trends seem to hold very similar.”

While the pervasiveness of eating disorders and disordered eating across genders in sport is a challenging project to take on, Halvorsen indicated that she left feeling positive about the direction progress is heading.   

“Something that surprised me is that I didn’t give coaches enough credit for how in tune they are and how much they care and their capacity to communicate about this. There’s so much talk about how eating disorders are uncomfortable, they’re very secretive, no one wants to talk about them. And that was why I thought, ‘I’m gonna have to send this to 200 coaches because I’m going to maybe get five who are willing to talk.’ And that wasn’t the case at all. They talked in depth about it and I think that surprised me, and made me feel really optimistic, too, because coaches are willing to have this conversation and to be very authentic and real about it. And I left feeling a little bit more optimistic that people can get in touch with the help that they need, if they’re ready or wanting that help.”  

Another aspect that Halvorsen pointed out was the development that has happened surrounding eating disorder research over the last decade. She noted a shift away from pigeon-holing the disease as a women’s issue – for example, the change from Female Athlete Triad to Relative Energy Deficiency in Sport (RED-S) – and stated that there are notable differences in studies that were conducted within the last two years, in comparison to those published five or ten years ago.

“It needs to be acknowledged that there has been progress. There’s a lot more conversation about it. There’s a lot more training, there’s a lot more education and understanding of it. That needs to continually be part [of the solution].

“We need people, particularly coaches and older teammates and people in the nordic community, to identify as lifelong learners… because it’s gonna keep changing and we’re gonna get better and better at knowing how to support athletes and how to make the environment better. And so I think committing to having an open mind and staying that way is really important.”

While it was not a focus of the questions posed to coaches, Halvorsen discussed her perspective from her experiences and research on what still needs to change in cross country skiing. 

“I think that there is a subconscious cultural emphasis put on being lightweight, and that was being affirmed and validated and encouraged in subtle ways. Even if we’re saying the right things, athletes and kids and everyone is still aware of what is validated and when is affirmed and when is celebrated.”

She discussed the overt messages a coach could give to athletes, such as an instruction to lose weight for performance or complementing a leaner aesthetic, however, she felt that more covert messaging is pervasive and perhaps more harmful. In particular, she identified aspects of traditional ski training that may skew focus and praise toward athletes with smaller body-types.

“Every time I went to a summer training camp growing up, there was an uphill run test that, I think, held a lot of weight.”

Halvorsen called the test “iconic” and expressed how the test felt like a measuring stick, both for one’s merit as a skier and as a basis for a social hierarchy among the athletes attending the camp. “There’s just a lot of, ‘That’s the cool athlete who can run uphill.’ And it holds for men and women.”

Simultaneously, there are the challenges of a sport whose athletes race in lycra body suits throughout the winter, put in the most training hours during the heat of the summer.

“That means a lot of shirtless time, a lot of shirtless social media, and a lot of emphasis put on doing things uphill. Uphill rollerski time trials, bounding intervals, uphill running time trials, mountain running races. I think all of that plays [into developing good fitness for ski racing], and I’m not saying ‘let’s get rid of it all, don’t do it.’ It just gets validated in a way that a doublepole time trial does not… There’s never quite as much emphasis being put on someone who’s really good on their skis, or really powerful, or really tactically gifted.”

This leaves coaches in a catch-22; should they abandon a measuring stick that has served programs at all levels, both in the US and internationally, or are there alternatives?

“[The uphill run test] is a good marker of fitness, and if there was a way that you only compared to yourself and didn’t use weight loss as a way of improving your times, you would be able to track your fitness. But there’s just no comparison. You could be a better skier than someone and if they’re a lot smaller than you, they probably are going to beat you in that. And no matter what your age is, it’s hard to not see that.”

Denying the inextricable connection between size and uphill performance is not the answer in Halvorsen’s mind, as athletes will “see right through it.” Rather, she believes that an intentional shift in culture toward placing equal value on the myriad of athletic qualities that are less correlated with body size. 

“How do you shift the weight to ‘it can still be valued, it should just be valued the right amount’? Like, ‘It’s one marker that we use, but we also want to see you improving on the doublepole tests. And if you lose a bunch of weight, you’re not going to. We also want to see you improving in speeds, and if you lose weight, you’re not going to improve in speeds.’ I think just giving it a little more balance is the only realistic, well-rounded solution that I see.” 

Halvorsen described herself as “a little bit blunt” and “pessimistic” as she continued to discuss systemic changes she’d like to see in the future, namely, whether athletes at U16 and U18 training camps should be allowed to go shirtless. 

“The kids who go to [U16 and U18] camp are the kids who are really cool and fast on their local teams. So every kid who’s on the local team is looking up to them, and looking at the pictures that they post, and I think that they help set the trend for their local teams. They bring home that culture.” 

She proposed that instead organizers ensure that tee shirts and tanks that athletes receive at those camps be made of light weight, breathable material that remains comfortable even when training in heat and humidity. 

These ideas are rooted in her own experiences as a junior. Attending her first U18 camp was Halvorsen’s first exposure to the unhealthy culture permeating sport, which interrupted the otherwise healthy and unencumbered relationship she had with food and her body, developed through her family culture. Diggins has also acknowledged the disordered eating she witnessed at junior camps as a triggering example she later followed once her eating disorder took hold.

For Halvorsen, this led to a year of fixation on shrinking her body, with an aftermath of self-image and body dissatisfaction highs and lows that have persisted to the present.

“People were talking about what they eat and their weight, and I put it all together and kind of became obsessed with it… I just spent all my energy and time obsessing over what I could eat and when, that I couldn’t see anything else. Making sure to time it so that people would see me eating so that they would hopefully not know that I was doing this. It made me so miserable. It wasn’t sustainable.”

While plenty of change and education remains necessary to improve the climate surrounding athlete health, eating disorders, and RED-S, Halvorsen expressed optimism in the trends across sport culture and the outlook for future generations of athletes.

“It’s such a difficult issue and I don’t know that it’s ever going to totally go away… We’re at a point right now where it’s becoming common knowledge this is an issue and a lot of people are open to having that conversation and learning about it and it’s not as secretive. And that’s huge, because now we have enough people on board that we can start to think, ‘So what are we gonna do about it? I don’t think that we only know. I think we’re flailing a little bit. I think we’re looking, we’re asking the right people, we are trying to figure it out, and we care and we want to make this better. But I don’t think that we’ve figured out exactly what to do and put that into action yet… 

“But I feel optimistic because I think I see a lot of energy being put into, ‘We can’t just ignore this. This issue is huge. And we’re willing to spend the money and the time and energy even if it makes us uncomfortable to figure out what what that is that we need to be doing.'”

Halvorsen is soon headed back to her home state of California for an internship in Berkeley that she described as “more on the business side” of her academic experience. However, she remains passionate about advocating for better education, support, and resources for coaches and athletes, and hopes to return to this type of work in the future. 

“I just think there’s something so central about it, because it’s your body. It’s you. It’s so important. And I think everyone deserves the right to feel good in who they are. I don’t really care if people are good, medium, or slow at skiing, I just want them to feel good in their bodies. Skiing should be a way to feel good, not something that makes you feel bad about your body.”

This pain is especially bad during and after sitting at work, and it gets even worse when you go for your evening classic ski, although you first noticed it during bounding intervals up that monster hill this fall. When you swing your leg through to set the kick wax there is pain right at that spot; it started as a dull ache but has become progressively sharper and has started traveling down your thigh. You didn’t think it was a big deal when it started, but now it’s really starting to interfere with your training. 

If this sounds all-too-familiar, you might be dealing with proximal hamstring tendinopathy, a common pathology that affects runners. It is no surprise that a similar motion – i.e., classic skiing – would also aggravate your symptoms. Here are some tips and exercises you can try to help decrease your symptoms and get you back to striding up hills Klæbo style (skip to 1:50).

But first, what actually is hamstring tendinopathy? 

Tendinopathy is an umbrella term that refers to any tendon pathology characterized by pain and decreased tolerance to exercise. (1)  It encompasses both tendonitis, which occurs during the acute inflammatory phase and tendinosis, the term for a chronic, non-inflammatory state of degeneration a tendon undergoes due to repetitive strain without proper healing time. Whether your hamstring pain is technically a tendonitis or tendonosis, it is still a form of tendinopathy with a root cause of mechanical overload and repeated stretch of the tendon. (2) 

This stretch occurs as you swing your leg through during the knee extension phase of running or classic skiing. It is also known as an eccentric contraction, during which the hamstring muscles lengthen to decelerate your leg and prepare for your next stride. Eccentric contractions produce the highest force; with repetitive loading, this force results in stress that is transferred to the hamstring tendons. (3) Decreased pelvic stability and weak hamstrings that are not yet accustomed to the high force generated by repetitive eccentric contraction can thus lead to tendinopathy that causes your symptoms. (2) 

So, the question then becomes: how do you increase pelvic stability and strengthen your hamstrings to tolerate the high eccentric loads ski training requires? Here are a few of my top hamstring exercises to accomplish these goals — be sure to read the cues below, in addition to viewing the video.

1. 90-90 Active Stretch (Before training!)

This dynamic stretch can be great prior to exercise to help increase blood flow to your hamstrings through full range and help warm up your muscles. Lay on your back and lace your hands behind your knee; slowly extend your knee and hold for 2-3 seconds at end range. Perform this exercise 8-10 times before you ski/run!

2. Heel Dig Isometric Hold (Before AND after training!)

There is evidence that isometric contractions, or those in which the muscle neither shortens nor lengthens, can have an analgesic effect for at least 45 minutes.(4) Try this exercise both directly before and after your workout to maximize pain relief. Lay on your back with your knees slightly bent. Lift your buttocks off the ground by digging your heels into the ground and hold for 45-60 seconds 3-5 times. You can progress this exercise by progressively bringing your feet closer to your buttocks or only leaving the affected leg on the ground (lifting the other leg up to make it a single leg exercise).

3. Hamstring Bridge Liftoff

Have your legs elevated on a bench or chair and lift your hips up into a bridge position. Lift one leg off the bench and hold for 5 seconds. Just make sure to keep your pelvis level (i.e. don’t let the hip of the opposite leg drop towards the ground).

4. Hamstring curl with physio ball/foam roller/sliders 

Start with your heels digging into a physio ball or foam roller and your knees bent to about 90 degrees. Slowly (key to eccentric load training) straighten your legs while keeping your hips lifted off the ground. Hold for 5 seconds then bend your knees to bring the ball/foam roller/slider back towards you into the start position. You can progress this exercise to single leg as well, just don’t let your pelvis drop! (Pro-tip: you can even use large yogurt container lids as sliders!)

5. Resisted B-Skips

This exercise mimics the motion of classic skiing and running well. Secure a theraband around your ankle; again, the emphasis is on slow, controlled motions. Start with both feet on the ground and bring your knee to your 90 degrees before fully extending your knee (keep this controlled; don’t let the resistance band pull you quickly) and bringing it back to the start position. This is another great exercise to strengthen your glutes of the stance leg.

6. Tipping Bird / Single leg RDL

Start with the foot of your affected leg on the ground and your opposite leg off the ground. With the knee of your planted foot slightly bent, hinge at the hips while reaching your hands towards the ground and extending your leg out behind you. It is important to keep your core engaged and prevent your pelvis from rotating to provide pelvic stability. You can progress this exercise by holding a weight. You can also add variation to this exercise by outstretching your arms and bringing your knee to your chest, or reaching your opposite arm up towards the ceiling and then to the floor for an added challenge (see video). This exercise also challenges your glute musculature, which serve as powerful hip extensors. If your glutes are weak, then you rely more on your hamstrings to compensate and cause overload, leading to tendinopathy (this may be even more of an issue during skate skiing). 

7. Nordic Curl, or Modified Nordic Curl

Of course, this exercise had to be thrown in – not only because of its name but because of how it eccentrically loads the hamstrings. You can have a partner hold your ankles or find another way to secure them as you slowly lower yourself towards the floor while maintaining a straight line from your head to your knees. Then engage your hamstrings to help return to your start position. Feel like your hamstrings might cramp? (I did – see video.) Try rolling out with your arms on a physio ball instead first. 

8. Kneeling Hip Flexor Stretch

Although you may feel a constant need to stretch your hamstring, it’s important to resist this temptation! Stretching can actually lead to compression or shearing of the hamstring tendons against the bone, which causes further irritation. Instead, try this hip flexor stretch, which prevents your pelvis from tipping forward into an anterior pelvic tilt (see picture). This anterior pelvic rotation places your hamstrings on stretch, which can irritate your hamstring tendons; it is also part of a postural pattern that can place excessive stress on your lumbar spine and contribute to low back pain.  When you perform this stretch, try to keep your core activated and “tuck” your tailbone; this will stabilize your pelvis and ensure that you stretch the proper musculature. Perform for 45-60 second holds 3-5 times. 

9. Half-Kneel Heel Raise 

Set up an object behind you and lift your back heel towards your glute, lifting up and over the object. This exercise emphasizes concentric contraction (in which the hamstring muscles are shortening). While eccentric training plays the biggest role in decreasing tendinopathies, your hamstrings also contract concentrically during the initial swing phase of running to bend your knee. Thus, it is important to strengthen both eccentrically and concentrically during rehabilitation. 

10. Jumping Lunges

This exercise places plyometric load on your hamstring tendons. These types of contractions, which consist of a quick eccentric contraction followed by a concentric contraction, place a large demand on your tendons. Therefore, it is really important to build into this exercise gradually; perform exercises 1-9 for a few weeks before jumping into this. You can also start with standard lunges to help progress. Try to keep your knee behind your toes to prevent excessive knee flexion. It is also important to take adequate recovery, so take 2-3 days (at least 24 hours) (5) between this exercise to give your tendons a break. 

References:

1. Millar NL, Silbernagel KG, Thorborg K, et al. Tendinopathy. Nat Rev Dis Primers. 2021;7(1):1-21. doi:10.1038/s41572-020-00234-1
2. Hamstring Injuries in the Athlete: Diagnosis, Treatment, and Return to Play. Accessed January 21, 2022. https://oce-ovid-com.libproxy.unm.edu/article/00149619-201605000-00016/HTML
3. Hody S, Croisier JL, Bury T, Rogister B, Leprince P. Eccentric Muscle Contractions: Risks and Benefits. Front Physiol. 2019;10:536. doi:10.3389/fphys.2019.00536
4. Rio E, Kidgell D, Purdam C, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277-1283. doi:10.1136/bjsports-2014-094386
5. Cadore EL, Pinheiro E, Izquierdo M, et al. Neuromuscular, Hormonal, and Metabolic Responses to Different Plyometric Training Volumes in Rugby Players. The Journal of Strength & Conditioning Research. 2013;27(11):3001-3010. doi:10.1519/JSC.0b013e31828c32de

***

Hi Ned,

I have been dealing with bilateral Achilles tendon soreness (midsubstance, several cm proximal to insertion) since an over-zealous hill bounding session in October.  When ski season arrived in December, and the soreness persisted, I made the assumption that skate skiing would cause less irritation to the Achilles than classic skiing.  However, after recently reading about the importance of plantarflexion force during the push-off phase in skate skiing, I have been reconsidering my assumption.  Additionally, my experience over the past month has demonstrated more aggravation from skate skiing than classic skiing, even at low intensity.  Does this make sense to you?  How would you guide a skier with Achilles tendinopathy regarding selection between skate and classic skiing?

FYI, I am under the treatment of a local PT, working on stretching and eccentric ankle work

Skate skiing is more leg and balance intensive, so it doesn’t surprise me that it’s more irritating than classic. It’s a simple matter of the body being overwhelmed by the load being placed on it. Classic skiing is exhibiting less load on the Achilles, so it doesn’t elicit a pain response. The load with skating exceeds your Achilles’ threshold or comfort level so it starts yelling. Your brain interprets this as pain, which is a pretty good defense mechanism for getting us to stop doing whatever it is that’s being perceived as a threat to our survival.

The follow up question is a matter of load management. Since load is the culprit, we don’t want too much of it. However, it doesn’t need to be avoided altogether. (And from an exercise/rehab perspective, we very much want load, just in the right amount.) 

As long as the pain is 4/10 or less and subsides within a couple of hours, you are ok to proceed. This is green light territory. Yellow light is a bit more challenging to navigate. Here in Utah, a yellow light means speed up and a red light really isn’t red for the first 4-5 seconds… but it should mean proceed with caution. So if pain is 5-6/10 or is less but doesn’t subside quickly, I wouldn’t push it any further. You were ok with that activity, but I’d probably want to back it off a little. Pain that exceeds 6/10 is definitely a red light and should be an indication that you need to pack it up and go home. (Admittedly, this guidance becomes much more foggy when the pain presents after, not during, the activity.)

So balancing the volume and intensity of skating would first be a matter of fitting into the stoplight paradigm. But you can also make a lot of your outings into skiathlons: skate until the pain begins to escalate then switch to classic. Or ski most of the time on classic then switch to skate for the last few kilometers. If you’re able to skate for a full session within the green light zone, it is a good idea to have a day or two of relative recovery before your next day of skating. This recovery could be classic skiing, cycling, or strength training, as long as pain levels remain quite low. You just don’t want to be constantly irritating the tendon.

Though not specifically addressed in your query, there is the greater question of what caused the overloading of the tendons in the first place? I know the pain began after a bounding session, but was it an issue of volume or intensity, weakness, compensatory patterning, range of motion deficits, or a culmination of your training up to that point?

In diagnosing musculoskeletal issues, we deal very little in known causation and almost exclusively in correlations. We know that large and sudden increases in training volume tend to cause injury. If the quads or glutes are not doing their share of the work during forward propulsion with bounding or skate skiing, then the gastroc and soleus (and thus Achilles) will have to do more. If ankle joint mobility is restricted, the Achilles might see higher loads. If you recently switched to a running shoe with less heel drop, the Achilles will see more load.

Hopefully, you and your PT have gained some insight into the potential underlying causes. Eccentric exercises are a very valid way to address tendon irritability, but I would highly encourage an exploration of the root cause, if that hasn’t been teased out – or at least hypothesized – already.

Happy skiing,

Ned Dowling, PT

Related Reading: Building a Better Skier Part 3: Single-Limb Stability

Author’s Disclaimer: The advice given in this article is the sole opinion of the author except where other media is cited. FasterSkier and the author’s employer (University of Utah) should not be considered accountable. As with any medical advice acquired on the internet, information presented in this article should not take the place of proper examination and treatment from a licensed Physical Therapist or Physician. If symptoms are severe or worsening, please do yourself a favor and seek appropriate medical attention.

“In a sport that has so many women with massive shoulders and thighs, Diggins looks like a sprite in her racing suit, and it’s not clear exactly where she gets her power. But the power is there, as she flies up hills, and comes off climactic turns with a burst. On the downhills, she tucks low and cuts through the air,” writes Matt Futterman in his February 8th New York Times coverage of Nordic skier Jessie Diggins’s historic bronze medal win at the Beijing Olympic Games.

A former college teammate of mine sent me a screenshot of this excerpt with an outraged, “We are past commenting on women’s bodies in sports!!” 

In a response to Futterman, sportswriter Lori Nickels wrote a piece in USA Today documenting such reactions from female athletes and wondering at their intensity, when men’s bodies are so frequently fodder for sports analysis. 

As a female athlete and a former collegiate nordic skier, I would like to offer an explanation to Nickels and Futterman and anyone else who may be wondering why this seemingly commonplace commentary is such a big deal.

Athletics can be an amazing tool for teaching women how to use their bodies effectively and powerfully; knowing how to become healthier, faster, and stronger is information that our society has historically neglected to teach women, to our great detriment. On the other hand, we are simultaneously receiving programming from nearly every direction that smaller is better, that women with muscles are ugly, they look too much like men, that men won’t find our shapes attractive. And in an appearance-oriented society where women seem to be valued especially for their ability to fit into an idealized category, that is no small thing. Growing up, even as they powered activities that brought me joy and self-worth, my pronounced muscles (“massive shoulders and thighs,” if you will) felt like blemishes. Some days they still do. 

And that is only half of it. Nordic skiing is a sport in which strength to weight ratios play a role, albeit a small one. However, when so many other factors feel out of their control, that single, tiny factor can loom large in the minds of both male and female competitors. I know all of us have fielded comments from performance-obsessed coaches, our own parents, and often other parents concerning our body types, weights, and emphasizing the advantage of a low body mass. This adds up to a complex of emotions and ideas surrounding food. Endurance athletes are particularly susceptible to disordered eating given their tendency towards self-discipline and performance.  

I am not saying men and male athletes don’t suffer from similar or analogous notions and prejudices – in fact I would love to open that conversation – but they do display a different level of intensity and contain fewer contradictions. Female athletes really sit at the nexus of a particularly overwhelming complex of ideas and judgments surrounding our bodies. And that is even before mentioning the pressures of sex and the constant threat of sexual assault that every woman feels. It makes us unsure who our bodies really belong to. 

I am lucky that this dissociation with and antipathy towards my body was relatively mild, and never developed into an eating disorder like it has for many. Regardless, years out of adolescence and competitive racing, I am still trying and often failing to inhabit my own body and trust that it is beautiful no matter the form it takes, that it is my own by right, and that I can’t let others decide how I feel about it or what I do with it. And I am finally learning how hard my teammates, role models, and competitors have also had to fight to avoid this disassociation, to preserve the vital relationships to their bodies that is at the heart of their love for athletics. 

Ironically, Jessie Diggins herself has been one of the fiercest supporters and advocates for those suffering from eating disorders and has been a key player in raising awareness of the issue. In her memoir, Brave Enough, she writes about her struggle to overcome an eating disorder, which threatened her health and prevented her from competing, culminating in outpatient treatment. She is hardly alone in the work. My high school teammate Julia Burnham, also an eating disorder survivor, is the co-creator of a podcast called Bodies in Motion, chronicling the stories of those – especially female athletes like Jessie – who have experienced eating disorders. A clear and consistent take-away from her discussions is that we need to stop commenting on each other’s bodies. No matter how positive or negative, direct or indirect, these comments generate the feeling that how our bodies look is more important than what we do with them or that what we do with them is more important that the relationship we have with them. 

This is not meant to be an attack on Futterman. His words were poorly chosen, but we have all made similar comments regarding fellow bodies. I know I have, and I regret them all, for I have felt acutely so many times the detrimental effect of such words. Comments like Futterman’s may have sent my ninth grade self into a well of negative feelings about my body and a bout of obsessive eating. It is sensitive terrain, which means we are all responsible for being aware and careful. 

So to everyone who may be reading this – and I really mean everyone – if you are ever tempted to make a comment about someone’s body, consider keeping it to yourself. Please. 

About the Author:

Ivy Spiegel Ostrom grew up skiing in the mountains of Leavenworth, Washington. She went on to ski for Williams College where she majored in English and Environmental Studies. Since graduating in 2020, she has been living in her hometown, indulging in her other favorite sport of rock climbing while learning how to farm and live sustainably.

As endurance athletes, and especially as cross country skiers, we like to suffer. We enjoy a sport that takes place in the coldest months of the year and requires both strength and endurance to climb big hills and descend on skinny skis with no edges. We like to breathe hard. Most of us are in it for the suffering and the healthy dose of chemicals that our bodies release when the heart rate goes up and the muscles begin to burn. The runner’s high, an endorphin rush, pick your preferred phrasing. 

Hopefully, we’re smart enough by now to know that we can’t go hard all of the time, at least not without consequences. The really smart among us are able to listen to their bodies and know intuitively when they can step on the gas and when they need to back off. But the rest of us could probably benefit from some type of external governor besides the voices in our heads egging us on, or constantly available Strava competition taunting from inside our pocket.

If life was just eat, sleep, and train, the calculus of easy/hard or short/long might be pretty easy. But work, school, kids, relationships, global pandemics, and social media bring no shortage of life stressors. And, physiologically, these life stressors can load the body just the same as an interval session. Stress is stress, and stress takes a toll on the body. 

So, your training plan might call for a hard session, but what if work was crazy, the kid kept you up all night, and you made the mistake of reading the news headlines this morning? Is your body in the right place to make the workout productive? (Or at least not detrimental?) How do you know?

I think the honest answer is that we don’t always have an answer, but there are some metrics that can help us shape a well-informed guess. 

Since Polar introduced the first functionally useful heart rate monitor in 1984 and Garmin gave us the GPS watch in 2006, wearable training technology has evolved considerably. Current wearables can track — and thus quantify — everything from steps to sleep to intensity. I don’t dare dive into that vast sea except to highlight and discuss what metrics might be the best at answering our question, “How hard should I push myself today?”

But before we even get there, it’s worth having a quick refresher on some principles of training, exercise, and activity. Depending on your goals, Nordic skiing can be an activity that simply gets you out in nature, a tool to maintain fitness for other sports like cycling or running in the winter, or it can be a year-round focus with time on snow dichotomized into either training or racing. In any of these scenarios, the cumulative load on the body is a very important variable to manage. 

Too much load and we stop having fun, plateau or lose fitness, and begin to risk injury. Too little load and we don’t progress, but I doubt that’s an issue with the majority of us. We must also remember that the basic recipe for improving strength and fitness is load + recovery = adaptation. Or as Brad Stulberg and Steve Magness phase it, stress + rest = growth.

Our bodies respond to load by making adaptations, but if we go too hard too often, and/or take too little rest and recovery, the equation becomes out of balance. We lose out on adaptation, and thus our capacity for improvement stalls out. 

Strategies like polarization and periodization aim to apply the load/recovery equation to maximize the training adaptations and improvements. Briefly, polarized training is the division of activities into either “hard” or “easy” intensity in roughly a 20:80 ratio. There is no “moderate.” The premise being that moderate efforts are neither hard enough to stimulate adaptations nor easy enough to allow to develop aerobic pathways or for active recovery — putting in “junk miles”, as it’s often described. 

In a periodized training program, polarization is taken a step further with hard and easy sessions layered together over longer cycles (think weeks and months). A periodized training plan builds progressively toward a goal race, followed by a period of time following the event that is focused on rest and unstructured training.

During that macrocycle, the split of your weekly training might stay roughly at the 80/20 ratio, but every third or fourth week might be recovery-focused, with a lower volume than the previous weeks. This three to four week block might be called a microcycle. On average, the easy-to-hard ratio is the same, but the overall load of the week is lower, allowing the body to adapt and repair. (And you can catch up on your laundry.)

These fundamental concepts should be incorporated in any good training strategy, whether it’s a week-by-week homemade plan or a comprehensive annual program from a coach. But, just because the plan is intended to provide a roadmap for loading and resting doesn’t mean we will always get the implementation right. 

This is not the coach’s fault. It’s life’s fault. A training program is written to balance training load and frequently doesn’t account for the additional stressors of work, school, or family. Stress is stress, regardless of the source. We can’t achieve the intended balance in training if we are over-tired from traveling for work, have been chasing our kids around all day, or burned the midnight oil trying to get our work done when our kids’ school is shut down. Similarly, pushing too hard when we should be going easy leaves us over-cooked before an interval session, deeming it unproductive. But how do we gage the load our body’s have been under?

(If you read the previous paragraphs and said, “This is stupid, I just want to ski” I don’t blame you. I don’t think everyone needs a rigid or even dichotomized workout schedule. However, if all of your exercise is at a hard intensity your risk of injury is increased so you might consider rethinking your strategy. If all of your exercise is at moderate intensity, then you’re just unlikely to get faster. For a lot of people, that’s not a priority, which is perfectly fine and you shouldn’t be judged or dissuaded. Go have fun!)

There’s an old proverb in bike racing about burning matches. Everyone on the starting line starts with the same number of matches. During the race, matches are burned quickly by riding at the front, attacking, covering attacks, and just riding above one’s threshold. At the end of the race it’s often not the strongest rider who wins but the one who burns the least matches (the 2021 men’s Paris-Roubaix is a perfect example). 

We, too, start the day with a set number of matches that we’ll burn up with road rage, frustrations at work, frustrations at home, social media FOMO, and of course training. The number of matches we get each day is directly related to how rested and recovered we are heading into the day, both mentally and physically. Exactly how many matches are in the box goes back to recovery, and, once again, to our original question: “How hard should I push myself today?”

If your matches are burnt up before you head out to train, the answer might be “Not very,” regardless of what the training plan says.

One of the earlier attempts to answer this analogue question with a binary “hard or easy”, was resting heart rate. It’s a simple concept: Take your heart rate every morning for a few weeks and calculate an average. If your heart rate has increased by more than 5 beats per minute from the average, then your inventory of matches is not fully replenished. While this article won’t go deeply into the details, there is some research to indicate that resting heart rate doesn’t correlate that well with fatigue levels. This article from Marco Altini goes into significant detail on the topic. (If you follow that link, you’ll find that you’ve arrived on the last of a five part series on Heart Rate Variability. Dr Altini is one of the leading experts and innovators in the field, you may find his articles to be more robust than one you’re currently reading.)

Relative Effort, TSS, EPOC, PTE, CTL, ATL, are all metrics generated by modern wearables to quantify training load and, therefore, stress on the body. These numbers are based largely on heart rate and duration: the higher your heart rate and the longer you keep it there, the more points you score. This is certainly useful information, especially with regards to periodization and keeping track of hard vs easy training sessions; however, it only gives you one number in the load + recovery = adaptation equation. 

We still haven’t answered the question, “How hard should I push myself today?”The same device or app that gave you a training load score will likely give a number for recovery status or a time needed to recover; this evaluation is typically still based on average heart rate during training and the overall duration of the previous session(s). It does not take into account the other life stressors. Enter Heart Rate Variability (HRV).

In a nutshell, HRV is a measurement of the time between heart beats rather than the number of beats itself. More specifically, HRV looks at the inconsistency of timing between heart muscle contractions. 

Heart rate is governed by the autonomic nervous system, or the division of the nervous system that is responsible for body functions that happen automatically. This is the same part of the nervous system that controls things like temperature regulation (sweating and shivering) and digestion — bodily functions that we don’t have to consciously think about to make happen. 

The autonomic nervous system is influenced by the sympathetic nervous system — the “fight or flight” mode that upregulates the body to prepare for battle (heart rate increases, armpits get sweaty, digestion gets turned off, etc.), and by the parasympathetic nervous system, which calms the body down. Our bodies are programmed to seek homeostasis — that happy place where everything can function optimally. The sympathetic and parasympathetic systems work to maintain that balance. 

HRV attempts to quantify that balance between the parasympathetic and sympathetic systems, and thus the measurement is a gauge of how the body is down-regulating versus up-regulating — homeostasis. 

Somewhat counterintuitively, a higher HRV, which indicates more variability and less consistency in the time between heartbeats, is indicative of greater parasympathetic versus sympathetic influence on the autonomic nervous system. Looked at another way, the greater the stress on the body, the greater the influence of the sympathetic system, which decreases the variability in time between heartbeats and therefore equals lower HRV. 

These days, there are many options for recording and tracking HRV: Whoop is a 24/7 wristband with an LED sensor that measures a gazillion things, but specific to HRV, the measurement is taken every night during sleep. The Oura Ring, which is used by some members of the U.S. Cross Country Ski Team, also contains an LED sensor and records automatically during sleep. HRV4Training has an app that turns the camera and flash of your smartphone into a recording device much like a pulse oximeter. EliteHRV uses a device that goes on your finger very much like a pulse oximeter. Firstbeat, who use a proprietary ECG style sensor, were one of the first commercially available HRV trackers on the market (as mentioned in a Nordic Nation podcast with Jim Galanes and in this old article from Zach Caldwell, which also discusses HRV in all the detail you’d expect from Zach).

With all platforms, consistency in recording is key so you can recognize patterns over time. The devices that record automatically during sleep (Whoop, Oura, and Firstbeat) have the advantage in being the no-brainers as long as you’re wearing the gizmo, but they have the disadvantage of being the most expensive. Both HRV4Training and EliteHRV require you to take the recording daily at a consistent time and in a consistent way. Ideally this is first thing in the morning (I go to the bathroom first then immediately sit down and record). I’m a creature of habit and since building this into my morning routine, I’ve not had much trouble incorporating the one minute it takes to record a daily HRV measurement. If consistency is going to be a challenge, invest in one of the automated devices.

This brings us to the utility of HRV: tracking the body’s response to stress over time. The emphasis here is over time. HRV can help answer our question, “How hard should I push myself today?”, but it’s not exactly a stoplight. Waking up to a low score doesn’t necessarily mean you should go easy if you still feel good, but waking up to a seven day average with a negative trend means you should probably skip the hard workouts until your HRV stabilizes. For example, both this paper and this paper found benefits to using HRV to modify training vs strictly following a periodized schedule.

From what we know about the metric so far, the primary goal is to keep HRV stable. If your training plan is appropriately balanced, you’re keeping life stressors in check, and your body is responding favorably, then HRV will remain fairly uniform, even after a hard workout. (A low HRV score after a hard session is definitely not a goal or badge of honor.) But if your HRV becomes unstable, especially a downward trend over at least a few days, that is when it really has the potential to catch an issue while it’s small, whether that’s due to training load, illness, or life stressors. Anecdotally, I’ve heard of notable dips in HRV with people just prior to illness (especially COVID) and after the vaccine. These are situations where maybe you’ve not yet become symptomatic — your body hasn’t started yelling at you — but it is already enduring stress, and the additional load from hard training is not going to be welcomed.

Ultimately, HRV is just another tool in the box. It’s not necessarily there to change what you do on any given day, at least not without subjective input on sleep quality, soreness, emotional state, and how much you drank last night. It’s best viewed as a safety device like anti-lock brakes on your car: if you’re always looking down the road and anticipating what’s to come, you might never need them. But sometimes, when we’re training hard and emotionally invested in our goals, it’s like driving through a snowstorm to make it home for Christmas. It can be easy to focus on the objective outcome and wanting to get there as quickly as possible, rather than slowing down and proactively adapting to the road conditions. Chances are, you’ll make it to your destination unscathed, but in the event that a deer runs across the road or you hit a patch of black ice coming into an intersection, the antilock brakes might help you stop and reset rather than crash.

As Jason Cork, World Cup Coach for the US XC Ski Team, put it, “I think it has some utility as long as you’re honestly also taking into account how you feel, how long you slept, energy, etc. I guess an analogy is if your HR at L3 is usually 180, and you’re super tired, it might be incredibly easy to hit 180 at an L1 velocity or incredibly difficult [to hit all-out velocity because HR is suppressed]. But the question really should be, ‘If you’re tired, why are you doing intensity?’”

Author’s disclaimer: I have no affiliation with any company that tracks HRV. I personally use the HRV4Training app, a Suunto watch, a Wahoo chest strap, and Strava, all of which I have paid for without discount.

Spinning past the autumnal equinox into fall, the West looks back on a summer marred by wildfire smoke. Here in Colorado, the Aspens have dropped their golden leaves, snow encrusts the high peaks, and I’m struck by the beauty of my backyard, which spent the majority of June, July, and August muted by smoke that — thankfully — blew in from elsewhere. 

Over the last six weeks, checking AirNow before training has been phased out of my morning routine, and there is a palpable sigh of relief within my community as rain and high country snow frequent the forecast. The fire danger is not gone, but the threat feels less omnipresent.  

While regions like California, the Pacific Northwest, and Montana perhaps faced the longest durations of acrid high-AQI haze, cross country ski communities nationwide experienced its effect. As particulates from these fires were swept across the country, even air quality in the Northeast dipped into unhealthy zones for periods of time. 

This phenomenon is not new, and as the planet continues to heat up, the West will be faced with longer and more devastating “fire seasons”. While sport might seem insignificant relative to the scale of issues at play, learning more about the modifications teams and athletes might consider can support the cross country ski communities overall health and wellbeing. 

FasterSkier connected with coaches from areas heavily affected by fires and smoke to hear more about how they managed the impact in terms of protocol and adjustments to training with their athletes. Coaches also spoke to the increased frequency that these decisions will need to be made as climate change progresses. 

First up is Andy Newell, head coach of the Bridger Ski Foundation Pro Team in Bozeman Montana. 

“Air quality and training is definitely a concern particularly because there’s not a ton of research about how smokey air affects high level athletes. We know a little bit about the short term implications but not much about long term exposure for athletes. The reality is this is something a lot of western clubs have been dealing with for a while but now we are seeing a lot of smoke in the midwest and even the east too.

“On a typical year in Bozeman we usually don’t see smokey air until August and even then it’s not as bad as many other parts of the Northwest. This year we saw smoke earlier than ever, around the middle of July and early August, but much cleaner air than normal in the last few weeks. It really depends on wind, the jet stream, and where the big fires are burning. So far this year we have had to adjust about 3 workouts to bring athletes indoors when the air was bad. I’d say that’s about average for us, 3-6 workouts per year disrupted because of smoke.” 

Newell continued by discussing the tools his program has used for decision making with regard to air quality and athlete safety. 

“One of the things I have learned is that air quality can change very quickly and iPhone readings are not always accurate. We use the VisualAir app for forecasts and to find training areas that might provide better air for training. In this app you can see which sensors are gathering data from satellites and which ones from the ground. We’ve found obviously that the ground readings are a lot more accurate. Another thing we notice here in Bozeman is that the air quality can be very different even within the same region depending on high or low pressure, inversions, etc. So if you notice poor air at low elevations we might modify training and go up into the mountains and this can make a big difference.

“We do use general guidelines at BSF to keep the athletes safe. If the AQI is above 100 we’ll start to monitor things and potentially modify training. If we are between 100-150 we will cut out L4 training or consider bringing athletes inside on treadmills for aerobic training. Also in this 100-150 range we’ll consider using KN95’s while out for easy distance training. Luckily we’ve only had to do this once this year so we’re hoping we make it through fire season without much more disruption.”

A long-time advocate for climate policy and spokesperson for Protect Our Winters (POW), Newell closed with a statement on the impact of an ever-warming planet. 

“As an athlete that has worked on a lot of climate issues this is definitely a scary reality, it goes to show you we are all affected by climate change.”

Heading Southwest, FasterSkier also corresponded with Will Sweetser, Director of Nordic Programs for Sugar Bowl Academy (SBA), northwest of Lake Tahoe. The Tahoe region was struck hard this summer, as the devastating Caldor fire ripped through nearly 220,000 acres and destroyed over 1000 structures. 

Now 98% contained, the Caldor fire remains active, over two months since it began on August 14th. It has burned over 220,000 acres, an area larger than the state of Rhode Island. Although the fire is still active, most evacuations and closures have been lifted. 

Sweetser first outlined the nuts and bolts of air quality considerations. For those unfamiliar, AQI considers the concentration of fine particulate matter in the air. Particulate matter, like wildfire smoke, that is 2.5 microns or less (PM 2.5) is most concerning, as it can penetrate deeply into the lungs. 

“Train as usual if school is in and AQI is between 0-60; offer optional/slightly modified training — consider shortened length first, and reduce continuous intensity — when AQI is between 60-120. Optional training is reduced, and outdoor training is only recommended for healthy, unaffected individuals when AQI is 120-150. Sessions are capped at 1 hour, and intensity capped at L2.”

While indoor recreation amidst the COVID-19 pandemic poses its own set of complications, Sweetser explained that indoor training is preferred when the AQI is above 150. To support the health of its athletes, SBA has integrated air purifiers in every indoor space on its campus, including classrooms, common areas, dining halls, and the gym. These filters help maintain an indoor AQI of 25 or below. 

“In heaviest smoke events, we encourage families with the capacity to travel to cleaner air for the week to do so within the confines of school requirements. If we are in a remote schooling period, which was precipitated by Tahoe area evacuations last week, many families simply move to second homes in the Bay area or elsewhere in CA. We write individual suggestions for each athlete to meet the training options in that area. Our general week plan (MON–OFF, TUE-WED-THU–heavier training 1-2x daily, FRI–recovery, WEEKEND–high training load/family outings) readily allows families to take weekends away for cleaner air.”

When Sweetser was first contacted in late August, he responded that he was with the team on the coast enjoying a training block in fresh air. In his email afterward, he included the purpose of this camp. 

“Last week, we utilized our first planned smoke escape team training weekend. It was in the school travel calendar. Teachers prepared some work in advance. The entire team went to the north coast of California for FRI-SUN. We had 5 excellent training sessions, including 1km L4 repeats, pure speed double pole session, 2 technique sessions and a 15-20-kilometer run. AQI in the Mendocino area varied from 8-43 during that time and was a great reset for us. Extremely valuable to get to clean air, sea level and group training in a pretty stressful time. We are lucky to be able to do so with just 4-5 hours driving.”

When the team is not able to travel and air quality is poor, Sweetser explained how they approach indoor training to achieve similar stimuli to those they’d seek in “normal” conditions outdoors. 

“When we are on Donner Summit with poor AQI, we utilize gym time and treadmill/SkiErg sessions to offer modified indoor sessions that still reflect each athlete’s goals — often these sessions are shortened and feature slightly more L2, or intermittent work, than we might normally do outside — although looking at HR data, the planned intermittent nature of these sessions is not totally different than sending the crew for a trail run through rolling terrain.”

Sweetser also reflected on the learning curve for appreciating how quickly AQI can change based on wind and weather patterns. He recalled leading an OD training run with a couple of his athletes and assistant coach David Sinclair that began at a borderline AQI of 120. As they progressed toward the objective, Hawks Peak, the air quality plummeted.

“We could see smoke pouring in from the north as we headed across the ridge… We called parents for pick up and dropped down as quickly as we could.”

By the time the athletes reached their pickup point, the AQI was over 400, which is considered emergency conditions.

“What I keep in mind is that we are really training for a healthy body and mind for the long term. That no one day, week, month, or even whole season is so critical that we potentially sacrifice our long term health for a short term result. In this sport, any short term results we achieve are very unlikely to bring us any benefit other than good health. Cold weather injury is a serious consideration in skiing. Regular exposure to air pollution, wildfire smoke included, is just as — and I would argue more — serious.

“You don’t know what sort of interruptions you will face in a year. Modifications to training happen for conditions all the time. It is built into our sport. Weather, lack of snow, too cold, not cold enough, smoke. Add sickness, a hard semester, family needs, and so on. For those reasons it is always a good idea to work ahead. When it is good you go and that way when conditions are bad you don’t have too. You don’t need to feel the pressure to make up for something you didn’t do.”

The MBSEF programs had been following similar guidelines to SBA, however, Watts responded that after the World Health Organization’s release of new air quality guidelines at the end of September, the program further tightened its tolerance of poor air quality. With mounting evidence of the increase in all cause mortality risk due to prolonged exposure to pollutants, the WHO drastically reduced the acceptable levels of PM2.5 and other pollutants individuals should be subjected to in both short and long term settings. The 300 page document also calls for a global response to air quality improvement. 

Taking a step back, here’s a condensed version of the complex physiological process that is energy metabolism surrounding exercise: Carbohydrates are the body’s primary source of energy during exercise. When carbohydrates are consumed, the body breaks them down through digestive processes into simple sugars, which are then converted into circulating blood glucose. The more complex the carbohydrate, the longer it takes for the body to break it down into its smaller building blocks.

At rest, the body stores chains of glucose in the form of glycogen, primarily in the skeletal muscle and liver, to be called upon during exercise. Through aerobic and anaerobic processes, the body converts glucose into cellular energy in the form of adenosine triphosphate (ATP), which allows muscle cells to contract and thus power the activity. However, the amount of stored muscle glycogen is finite and depends on the volume of skeletal muscle on an athlete’s body. As muscle glycogen becomes depleted, blood glucose begins to drop, and the athlete quickly trends toward the fearsome “bonk”.

Therefore, an athlete should supplement with carbohydrate sources — the simpler the better — during training sessions or races longer than 60-90 minutes to enable the body to maintain sufficient blood glucose levels and thereby keep their muscles fueled throughout the session.

After the activity is completed, the hormone insulin helps draw glucose out of the blood stream to replenish muscle glycogen stores. Readers may be familiar with the 30-60 minute window of opportunity after exercise during which the body is more sensitive to insulin and therefore can replace the depleted muscle glycogen more rapidly by taking in a post-workout snack containing carbohydrates.  

There’s a lot more to this, but for the purpose of this article, here’s a key takeaway from “Fundamentals of glycogen metabolism for coaches and athletes”, posted in an April, 2018 issue of the journal Nutrition Reviews:

“It is now widely accepted that consuming a diet sufficient in carbohydrates, along with ingesting carbohydrates during and following exercise, can improve performance and speed recovery… It is also well established that beginning exercise with ample muscle glycogen stores is an important contributor to improved exercise performance; further, restoration of glycogen stores is essential for complete recovery and the maintenance of subsequent exercise capacity.”

Bringing it back to continuous glucose monitoring: By monitoring blood sugar and striving to keep it within an optimal range, athletes can become more informed about their body’s response to nutrition and training in order to dial in performance fueling, stabilize energy levels, and promote faster recovery. Peaks and valleys can promote inflammation and impair recovery and sleep, so stability is your friend.

The Supersapiens CGM technology is not yet commercially available in the US, though they are already available in the U.K. and Europe. As such, Supersapiens — a direct-to-consumer American based company — is holding off on media interaction until the products can reach their target user base. FasterSkier will follow up with representatives to learn more about the product itself as this changes.

However, among the American athletes taking part in an observational wear trial is Gus Schumacher, with whom FasterSkier connected to learn more about how he has used the CGM thus far and what he has learned in the process. At the time of the call on August 9th, the 21-year-old Junior World Champion was in the throes of high-volume summer training in Anchorage, AK, with a handful of “the boys”, i.e., fellow top U-23 athletes Noel Keeffe, JC Schoonmaker, Johnny Hagenbuch, Sam Hendry, and more. 

Schumacher started working with Supersapiens, alongside a dietitian from the U.S. Ski Team, to incorporate the CGM into his training in late May during the team’s on-snow camp in Bend, OR. 

“At first, the biggest benefit was that I did research about fueling and [nutrition] through the resources with the U.S. Ski Team,” Schumacher explained. “And that just taught me a lot more about how I should be fueling during training and after training. So stuff that I sort of knew, but didn’t really focus that much on previously.”

While some of the concepts may not seem particularly novel to those versed in nutritional practices for athletes, Schumacher explained that watching his glucose levels helped him understand the importance of fueling surrounding his training sessions and ensuring that overall, he was consuming enough food to meet the high demands he places on his body.

 “Now, I use it more for  the recovery side of things, like making sure my overnight glucose levels don’t drop too low,” Schumacher said. “I mean, part of it is — I can tell when I’m under -fueled, like if I get hungry in the morning or something.  But [using the CGM] is kind of a nice way to double check, because it’s hard to always trust your [hunger] cues when you’re when you have to eat a lot more than normal for big training days and adjust [how much you eat] to each training day. So you can be a little more secure about whether you’re eating enough.”

The biggest change Schumacher has made has been in his fueling surrounding training sessions. He explained that he used to rely primarily on large meals between sessions with little fuel during the session, leaving him depleted and feeling like he needed to “bomb” himself with food at lunch and dinner. He also typically carried plain water for hydration the majority of the time, incorporating sports drink for the electrolytes only when it was hot. After seeing the spikes and drops on his blood sugar and learning from dietitians, he now spreads his intake out throughout the day for more stable energy.

“Now, I’m eating more snacks and keeping the meals like a more normal size. So — finishing [a session], having a protein heavy snack and then eating a meal within an hour, and then having a balanced snack before the next training session. And making sure to just take in carbs during that session, so I always have sports drink now and I usually also have some bars or fruit or gummies during training sessions. That’s the biggest thing I learned — even during easy sessions, you can oxidize up to 60 grams of carbs an hour roughly something like that. That’s the goal that I shoot for.”

So is it making a difference?

“Yeah, actually — especially on my high volume weeks. I noticed that it just seemed easier to get out the door as those sessions built up. Like, I still would eat a big lunch and stuff, but it didn’t seem like I was, like, fully come back from depleted after every session. I would finish and not feel super hungry. It just seemed a little quicker to come back to normal.”

While his U.S. Ski Team dietitian provided the guidance on the types of foods he should incorporate and nutrient timing, the team at Supersapiens helped him understand the data he was collecting with the CGM. Specifically, they helped him through the learning curve of understanding normal and optimal blood glucose levels for different types of sessions. 

“I would ask stuff like, ‘Why does my glucose not get that high during this session?’ Because all the information on their website shows, ‘You, will you want to figure out what’s good for your performance.’”

While he was seeing in the Supersapiens information that higher blood glucose levels were important for intensity sessions, he was noticing that his levels would be on the low side during easy distance sessions.

“I asked them about that, and for that particular instance, when you’re going easy, you’re not necessarily oxidizing a ton of glucose [and your body can rely more on breaking down its fat stores], so blood glucose can stay pretty low.”

He also started to consider his overnight blood sugar levels to ensure he was recovering well while sleeping. 

“[They recommended] experimenting with having a snack with a decent amount of protein and fat before bed to see if that stabilizes overnight glucose.” 

Improving fueling and keeping blood sugar is all well and good. But, we live in a world where diet culture is rampant and the emphasis on power-to-weight ratio in endurance sports can cause athletes to develop disordered eating habits and an unhealthy body image. Skiers are already typically hooked up to a heart rate monitor and a GPS watch to collect a plethora of training data. At what point does it become too much or lead an athlete to be overly meticulous about their diet at the expense of their mental health?

In terms of data overall, Schumacher explained he finds it interesting, and his coaches are “super into data”, but he is able to hold it lightly and not read too much into it. 

“I think at this point, I’m still very open to trying anything — any new data collection is kind of cool… So I kind of embrace it, and if it ever feels like too much, I’m pretty good about going back to my instincts. I feel like I can fall back on that intuition pretty easily.”

Schumacher felt similarly about monitoring his blood glucose. He has gained more awareness about the foods that he consumes and how they impact his blood sugar, but he explained when pitched the question of whether he could see the use of GCM technology leading him to place an unhealthy emphasis on eating specifically to stay within a particular range that ultimately, he knows to trust his body.

“I think that’s a good point, because sometimes when I eat something that I think is pretty good,  like a balanced meal, and [my blood sugar] spikes really hard, the knee jerk is to be like, ‘What’s going on? Why did that happen? How do I fix that?’ But, more and more as I’ve had [the CGM] on, it’s just like, sometimes that’s just like, normal. It’s whatever. So that’s when I fall back on my intuition, like, I feel satisfied.”

To meet the energy demands of 20-30 hours of training, a pro skier needs to eat a proportionally large volume of nutrition. Endurance sports are about the long haul, and ensuring that the overall lifestyle is sustainable is essential in allowing an athlete to develop and achieve their potential. Schumacher elaborated on keeping his relationship with fueling and blood glucose in a balanced place.

“I think it’s possible that having that data around your food can make it not that fun, like if you’re really just trying to make those numbers look good. But I think it’s important to use [the data] as an overall thing. And just use it to try to make sure your resting levels are high enough, and you’re getting enough during your training, but not worrying too much about the micro things because there’s a lot that goes into that.

“Or [understanding that] you don’t need [the data] to be perfect to be fueling perfectly. And I think it’s fun for me to know more about performance fueling and be able to implement that day to day and feel like it’s making a difference and not have it be overbearing, because part of performance feeling is still eating stuff that makes you happy in general. So yeah, I think it’s important to have a pretty holistic view of all of it, but it’s also fun, I think, to have the eating be part of your training and to know that it matters for how you feel and just making sure you feel good all the time.”

As this technology becomes commercially available, athletes of all levels will need to make similar considerations in the calculus of determining whether this technology and the information if provides is worth the investment (currently around £113 in the U.K. for a one month subscription, including two pods that last 14-days each). 

To provide athletes interested in CGM technology with guidance, FasterSkier connected with Registered Dietitian Kylee Van Horn. An accomplished runner herself, Van Horn helps endurance athletes across a variety of sports dial in their nutrition to support their training and overall wellbeing through her business, FlyNutrition.

Van Horn recommended a targeted approach, cautioning against the aforementioned possibility of becoming too focused on the data and potentially compromising the athlete’s mental health. She knows, perhaps too well, from her clients the propensity for under-fueling in endurance athletes of all levels.

“I think there is going to be some level of risk,” said Van Horn in a call. “The more data you have — and especially within the endurance sports world, for people to tip into the restrictive eating pattern.”

However, she expressed that using glucose monitoring to focus on key areas of nutrition could help athletes improve their overall fueling. In particular, focusing on balanced meals and snacks that provide sustained energy in and out of workouts, that also keep eating and preparing food both enjoyable and sustainable. 

“I personally wouldn’t want to use it long-term with an athlete, but I think as a short-term, using it to dial in some specific things could be really beneficial… Dialing in what would be a really good pre-workout breakfast or meal option for [the athlete] that’s not going to cause a rebound hypoglycemic effect where we’ve got a big spike and drop in blood sugar and then we’re seeing this big energy spike and drop part way into the activity or race.”

Van Horn also envisions a more informed version of trial and error to maintain energy levels during workouts, particularly in longer sessions or races. This could be particularly useful with athletes who have sensitive stomachs, as spikes and drops in blood sugar could exacerbate these issues.

“The intra-workout fueling, in my opinion, would be really interesting. Because we do know that some foods do affect people differently in regards to how much they spike their blood sugar and drop it and how quickly.”

Van Horn shared that a coach and professional triathlete who she partners with, Matt Hanson, has also been a member of the pilot group. Hanson is a three-time national champion at the Ironman distance and is the current world record holder in an Ironman event (7:39:25). 

Hanson shared with her that he has found a lot of value in using glucose monitoring to better understand his body’s response to his pre-workout meals, because he had been experiencing big swings in energy levels. The CGM has helped him adjust these meals to foster more stable energy. He also found value in playing with the types and timing of different sports nutrition products he was consuming during his training to maintain better glucose levels and energy throughout.

Lastly, because sleep is an essential component of an athlete’s recovery and overall health, Van Horn explained that, like Schumacher noted, a pre-bed snack that contains protein and carbohydrate can be very valuable in supporting recovery and stable blood sugar during sleep, in particular for athletes training at high volumes or early in the morning.  

“If you’re eating a snack with too high of carbohydrate or eating certain foods before bed, that can impact your recovery and cause micro-awakenings, which impacts sleep quality, so that might also be something that you could address [by monitoring].”

This is Part 4 of a series delving into how biomechanics and movement patterns affect skiing technique. If you haven’t already, start with the introduction, Part 1 which introduces the concept of a neutral spine posture, Part 2 which describes spine stability and mobility, and Part 3 on single limb stability.

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Upper body power is a major contributor and perhaps even a determinant of cross country skiing performance. Poling accounts for up to 60% of propulsion in skate and classic diagonal and, obviously, 100% with double pole. For those who train for skiing year round, upper body work is an essential part of the routine. However, for those whose summers are focused on running, cycling, or hiking, arm strength is often forgotten once the snow melts.

Let’s take a closer look at the structures and muscles involved in the upper body during the various poling motions of skiing. 

The muscles that comprise the shoulder girdle can be roughly divided into two groups: the stabilizers and the movers. Coordinated motion requires “dynamic stability”, i.e., for the two groups to together such that the stabilizer muscles control extraneous joint motion while the movers perform the primary action. 

The shoulder has a tremendous amount of motion available and relies heavily on the coordinated effort of multiple muscles to maintain proper alignment and movement of the joint. At the same time, it is capable of generating large amounts of power, whether that’s throwing a 90mph fastball, hammering a nail, or repeatedly pushing on a ski pole.

The shoulder stabilizers can be further divided into those acting on the glenohumeral joint (the primary ball-and-socket shoulder joint) and those supporting the scapulothoracic joint (shoulder blade on the ribcage). 

The rotator cuff is a group of four muscles — supraspinatus, infraspinatus, teres minor, and subscapularis — that attach to both the scapula and humerus in close proximity to the joint. They are not particularly strong muscles, but they play a vital role in coordinating the movement of the glenohumeral joint. 

The only rigid or bony attachment of the arm to the body is via the collarbone. This small bone is not enough to support the load of push ups, pull ups, or double poling. The base of support truly lies in the muscular attachment of the shoulder blade to the ribcage. For the sake of the simplicity of this article, we’ll limit the discussion to four muscles, one of which doesn’t count. (Side note: a classic physical therapy trivia question is to name all 17 muscles that attach to the scapula–clearly I’m skipping a few here.) 

The primary stabilizers of the scapular are lower trapezius, middle trapezius, and serratus anterior. I’ll contend that the upper trapezius is a stabilizer but doesn’t count because it tends to exert force in the wrong direction (and is frequently overactive so needs little in the way of direct strengthening).

As with any dynamic stability in the body — abdominal muscles for the lumbar spine, glutes for the hip, or the aforementioned muscles in the shoulder girdle — strength is important but intermuscular coordination is key. This is especially true at the shoulder due to its wide range of available motion and corresponding muscular complexity. 

The following are exercises targeting the stabilizers, both at the shoulder joint and scapula.

Exercises for the Stabilizers:

(The intent of these exercises should be thought of more as activation drills and less about the heaviest weight you can find. Yes, we are looking to induce some fatigue but the emphasis is not on power.)

Side Lying External Rotation: Lie on your side. Keep the top elbow bent at 90° and against your side. Rotate about the shoulder until your forearm is at about 45° to the horizontal. Try not to pull with your shoulder blade. A little bit of weight goes a long way.

External Rotation + Uppercut: With a resistance band anchored on the opposite side, elbow fixed at 90°, and forearm against your belly. Rotate the forearm away from the belly to a neutral position (knuckles pointed forward). Then raise the arm by spinning through the shoulder. Again, the elbow should stay at 90° throughout. Only raise the arm to shoulder height. Motion should be isolated at the shoulder joint — don’t let the shoulder blade move. Finish by lowering the arm down and rotating the forearm back to the belly.

Scaption: Raise both arms up your sides at 45° (not in front, not to the side, but halfway in between). Stop at shoulder height. Keep the shoulder blades fixed down and back. Start with light weights.

Wall Slides: Loop a very light resistance band around both hands and stand facing a wall. Place both hands on the wall at about shoulder heights with elbows bent and palms facing inward. Stretch the band by squeezing your shoulder blades down and back, not just pulling from the arms. Keep the shoulder blades pinned down and back, band tensioned, and slide your hands up the wall until your elbows are at about shoulder height. Slide back down to the starting position. Ideally, the shoulder blades stay retracted throughout the set of repetitions, but you can stop and reset them between reps or as needed.

Serratus Punch: The serratus anterior muscle attaches to the ribcage, inserts on the scapula, and, acting alone, protracts the scapula, or pulls it forward. As a stand alone movement, this scapular protraction is not especially functional unless you are a boxer hitting with a jab. However, the serratus anterior is a team player and becomes very functional when co-contracting with the posterior scapular muscles (especially middle and lower trapezius) to stabilize and coordinate movement of the scapula. The exercise will work the serratus anterior independently. 

Lie on your back holding a dumbbell in each hand. Knees are bent and elbows are straight. Push the dumbbells towards the ceiling by moving the shoulder blades forward on the ribcage. This is the opposite of the motion described in Wall Slides. The neck and thoracic spine stay relaxed. This can also be done with a resistance band.

Rows: The emphasis of the rowing motion is on squeezing the shoulder blades down and back as you pull the resistance towards you. This is the same motion described in Wall Slides and the opposite of the Serratus Punch. There are multiple means of adding resistance to the movement: resistance band, cable machine, single dumbbell/kettlebell, TRX, etc. 

In the propulsive phase of poling, the prime mover at the shoulder joint is the latissimus dorsi — often referred to as the “lats”. This big, broad muscle extends the shoulder, pulling an outwardly extended arm to the side as in freestyle swim strokes and pull ups. The lats are aided by the posterior portion of the deltoid muscle and teres major. 

The elbow joint is also involved with the triceps playing a rather complex role. This muscle, or more technically speaking, this group of muscles has a common insertion on the ulna and acts to straighten the elbow. However, the long head of the triceps, attaching to the scapular vs the humerus, is also able to play a role in shoulder extension. I say the triceps play a complex role because motion about the elbow varies with technique and terrain. In Skate V1 and V2 alternate and in Classic striding, there is a fair amount of elbow extension. However, in V2 and uphill double poling, there is very little motion at the elbow. 

Notice how little motion takes place at the elbow during V2.

A clinical case study: (Disclaimer: the subject of this case is the author, a potential duplicity that is frowned upon in academia.) In the lead up to ski season, I began doing “budget SkiErg” workouts double poling with resistance bands. After several weeks of twice a week workouts, I began to develop left posterior elbow pain. It didn’t take much to figure out I had irritated the insertional tendon of the triceps. So I stopped the workouts and focused on eccentric strengthening of the triceps, which has become the standard of care in the treatment of tendinopathies. 

Come ski season, I could skate without any problems, but I continued to have elbow pain with more than about 45 minutes of classic. One night at dinner I was venting to my wife about my now chronic elbow pain. Ever the voice of reason, she asked what I would do if I was seeing myself in the clinic. What would I, the PT, do differently for a patient who is not responding? I replied that I would examine, biomechanically, how the patient is poling. So I started to think about how I was doing what I was doing. 

My hypothesis was that I was using my triceps too much to generate shoulder extension. I started doing shoulder extension exercises with my elbow fixed at 90°. I focused on leading the motion with the back of my elbow, not my hand. Within a couple of weeks, the elbow pain was gone. The lesson from my mistake is that functional movement patterns often require a high degree of coordination. Because of our bodies’ anatomical redundancy, it is easy to fall into a suboptimal pattern that is inefficient in the best case and in the worst has potential for injury.

Interestingly, the biceps appear to be very active during double poling, which seems counterintuitive since the action of the biceps is in the opposite direction of the propulsive phase of poling. The biceps do contribute to shoulder flexion so they are likely involved during the return phase. But, more likely, the majority of their action is co-contraction with the triceps to stabilize the elbow and hold it in the desired position. Perhaps this is rationale to include some biceps strengthening for more than just filling out the sleeves of your cycling jersey.

Exercises for the Movers:

Shoulder Extension: This is most easily done with a dumbbell, but a resistance band will work as well. As described in the case study, keep the elbow locked at 90° and focus on spinning at the shoulder joint by leading with the back of the elbow.

Strengthening the Triceps: Like with Rows, there are numerous ways to work the triceps with no single exercise being the best. Resistance band, cable machine, dumbbell, push ups, and dips are all appropriate.

Strengthening the Lats: The basic lat workout is pull ups. If these are too difficult to do at least 3 reps, then put your feet on a chair or on a long resistance band loop attached to the pull up bar (just make sure the band stays on your feet and not in between them!). Lat machines in the gym are a great alternative as you can select resistance that is lighter than body weight (or more than body weight if you can whip out 10+ regular pull ups)

Epilogue: The goal of the Building a Better Skier series has been to identify some key biomechanical and kinematic components of cross country skiing and to provide exercises with the specific intent of facilitating these movement patterns and strength requirements. By no means has the depth of these articles been exhaustive. Nor have the lists of exercises covered all possibilities. Hopefully, these articles have been easy to follow and the exercises have been included in your twice weekly strength/dryland/pay-to-play routine. Even better, I hope the work done now will pay dividends when the snow falls this winter. Best of luck with the remainder of summer (the heat, the smoke, the pandemic), the glorious autumn, the struggles of shoulder season, and the winter we’ve all been waiting for.

The ability to balance and be stable on one leg is where the rubber meets the road (or ski hits the snow). True, we generate propulsion with strength and endurance, but if that power is not transferred into glide, it becomes wasted effort. This is quite literally what separates the efficient from the inefficient. Or, the fast from the not so fast.

This study set out to quantify the difference in glide between elite and sub-elite skiers (national vs regional skiers). As expected, they found that the higher caliber skiers did, in fact, glide better. In trying to quantify the why, fitness aside, they found that the national level skiers had a different pattern of foot pressure in the boot. Where the regional skiers only pressured the medial side (big toe side), the national skiers loaded their feet across the whole foot. 

What’s really happening here is that the national level skiers were better at shifting their weight over the glide foot/ski. This “commitment” to the glide ski is one of the hardest things to master, especially for adults learning to Nordic skiing later in life. 

When standing on two feet, your center of gravity falls in the middle between your feet. If you want to balance on one foot, your weight has to shift. You can’t just pick up one foot. To achieve this weight shift, you can lean your trunk, which will allow you to balance, but it is not a stable or powerful position. If you shift your pelvis to the side of the stance leg, you can accomplish the requisite weight shift AND place your body in a position where muscles are engaged and ready to roll .

The skiers in this video are fine examples of appropriate, hip-centric weight shifts. Notice how the upper body stays very quiet and still. There is no side to side movement. The pelvis, however, can clearly be seen moving side to side to move the skier’s center of gravity fully over top of the glide ski.

This is all easier said than done. Go stand in front of a mirror — a bathroom vanity mirror is fine because you only need to see your shoulders. Balance on one foot. Do your shoulders stay level? Now move the opposite leg to the side and back a few times. Are your shoulders still level? If they are not, then it’s unlikely that you are shifting your weight appropriately. If you are struggling with balance on a smooth, flat floor, you can appreciate the challenge of finding stability while gliding down an undulating track on a toothpick of a ski.

Another major component of single limb stability is the coordination of joint flexion at the hip, knee, and ankle. Anyone who’s had a ski lesson has heard the phrase nose, knees, and toes —  or that the shin and trunk should be parallel. These cues are all about getting the ankle, knee, and hip to flex together. The goal is to put the body in a position that is both inherently stable due to muscle activation and preloaded for propulsion. This is what I’ll be referring to as the basic shape.

The next experiment requires a partner. Balance on one leg staying very upright with your knee and hip straight. Have your partner push you (gently!) from each side. Did you maintain your balance? Now aim for the nose, knees, toes position and have your partner push on you again. Which position was more stable? (If you had difficulty finding this position, there will be more cues with the exercises below.)

If the distribution of foot pressure and coordinated joint flexion are two major components of single leg stability — which has been shown to be a major component of skiing efficiency — then it seems highly rational that we should strive to perfect these traits on dry land before we expect ourselves to do it on skis (including and arguably even more so on rollerskis). We must be able to form the basic shape.

Adequate strength of the gluteal muscles is a prerequisite. If you don’t already incorporate glute exercises in your strength program, you can get some great ideas from previous FasterSkier articles here and here.

Foot and ankle mechanics are also a primary contributor. In the basic shape, we are asking the ankle to flex forward at the same time that the foot has to accept our full weight. Insufficient or excessive flexion, or poorly controlled mobility through the foot and/or ankle can force the tibia (shin bone) to rotate inward, taking the knee with it. Lack of glute strength and control can have the same effect from the top down. With this extraneous  motion coming from either direction, the result is an increased valgus (medially-directed) force on the knee, which equates to increased loads in both the tibiofemoral and patellofemoral joints. Clinically, this is the most common cause of knee pain with Nordic skiing.

If the prescription for controlling top-down motion is glute strength and coordination, the bottom-up is addressed through strength of the muscles in the foot and ankle. Conveniently, these can often be addressed by simply working on single limb stability — as long as you pay attention. Quality control is mandatory!

A note on orthotics: In many circles, custom orthotics have fallen out of vogue especially since studies like this one have found them to be no better than exercise at helping knee pain. But the demands on the ankle joint are quite different in Nordic skiing than with walking or running, which are more commonly studied. Skiing generally requires a much greater amount of dorsiflexion. As mentioned above, we want this dorsiflexion to happen without internally rotating the tibia. The addition of external support to the foot has the potential to control this aberrant motion. I am a strong proponent of at least some upgrade of insoles in ski boots (and cycling shoes for the same reason). Most stock insoles are terrible, even the ones that came in my very expensive carbon boots. Out-of-the-box options from Superfeet, Sole, Powerstep, and Curex are all quite good and far less expensive than custom. For some, these might not provide enough support and custom orthotics with a strategic build up of additional material would be better. 

How do you know? A quick test I do in the clinic is to have my patient balance and do a couple of single leg squats while barefoot. Then I have them do the same thing with a more supportive insole. Then I place a piece of ¼” (4mm) thick folded cardboard under the insole at the ball of the foot and have them repeat the balance and squats. I’m looking for whether they become “easier,” “less painful,” or appear better controlled to my eye. If the extra material under the insole made for improvements, then we talk about custom orthotics. If it made no difference, then I just advise an upgraded insole. Ultimately, we are looking to improve both the alignment of the knee as the ankle dorsiflexes AND improve balance.

All of that said, here are my top three exercises/drills for ski-specific balance–the basic shape. Ideally, these are done barefoot, without the additional support of an insole and shoe (opposite of the previous conversion), so the muscles have to work harder and get stronger. The basic cues are the same for all three:

• Tripod Foot: A tripod gets its stability from three legs and we want three primary pressure points on the foot–the ball of the foot, the pinky side ball of the foot, and the heel. Weight should be slightly biased forward off of the heel. The toes should be on the floor but relaxed and not gripping for dear life.
• Nose, Knees, Toes: My preferred way of thinking about this is if snot is dripping from your nose, you want it to land on your shoe not down the front of your shirt. Bend at the ankle, knee, and hip to accomplish this. 
• Weight Shift: comes from the pelvis/hip not leaning the trunk. Park yourself into the hip. If your glutes aren’t burning, you’re doing it wrong (or the exercise is too easy).
• Posture: neutral spine is the goal. Forward trunk lean occurs through the hips, not the spine.
• Forward Gaze: Avoid staring at your feet. You’ll need to keep your head up to look down the track while skiing, so best to get used to it in training. It will also remove some visual dependency and help with maintaining a neutral spine.
• Quality vs Quantity: the emphasis is on how you do the exercise, not just going through the motions. 

Start by forming the basic shape. If this is challenging to maintain, then do not progress until it becomes natural and thoughtless.

Exercise #1: Step Ups

Stand sideways on a step (preferably the bottom, not top, step). Lower your outside foot towards the floor. As you lower, you should be going into the basic shape. Return to the tall starting position. Don’t worry about trying to fully touch the floor–that’s not the goal. The goal is to move up and down, in and out of the basic shape. For added challenge, hold a dumbbell in the outside hand. 2-3 sets of 10-15 reps should be adequate to bring on some fatigue and challenge your balance.

Exercise #2: Single Leg Series with Band

Loop a long exercise band around one ankle and face the anchor point of the band. Than, assume the basic shape standing on the unbanded leg. While maintaining the basic shape, pull straight back against the band to bring the foot in line with the standing leg, then follow through to kick the foot a few inches behind. Turn your body 90 degrees in either direction and repeat the process; extending the banded leg outward to work the gluteus medius muscles of the outer hip, or pulling the banded leg toward the standing leg to stimulate the inner adductor muscles. Ultimately, you will face four different directions but the force against the band is always in direct opposition to the anchor point of the band.

If you can only source a “mini-band” loop, put it around both ankles and skip the pulling-in motion. A little resistance goes a long way with this exercise. Aim to perform 10-15 repetitions in each direction and do two laps on each leg.

Exercise #3: Lateral Hops

Form the basic shape on your right leg. Step onto the left leg, shifting your weight from the pelvis, and again form the basic shape. Progressively increase the distance between steps, turning it into more of a sideways hop than step. Keep the unloaded leg extended to the side as if skiing — do not let it flag behind the stance leg unless you are a speedskater.

Keep it honest: make sure you are sticking the landing and holding your balance for a second or two on each leg before pushing off to the next side. This is meant to be a balance exercise, not plyometric strength work. The next progression is to hold a resistance band anchored from the side. I prefer to base this exercise on time (1-2 minutes) vs repetitions so there’s no question of whether that botched one was good enough to count.

Notably absent from this article is the neurological component of balance. Many of my PT colleagues would absolutely berate me over this; however, I wanted to stick to the basic kinesiology and this article is long enough already. The brain receives massive amounts of information from vestibular, neural receptors in joints and soft tissue, and vision. In fractions of a second, it processes this information and directs muscles to act. If any link in that system is compromised, so too is your balance. If you think about the difference between skiing on a sunny, bluebird versus flat light or a storm, you can quickly appreciate how vision affects balance. There are certainly ways to challenge and train these systems, but that is beyond the scope of this article. However, an excellent way to progress any balance exercise is to do it with your eyes closed. 

This is Part 2 of a series delving into how biomechanics and movement patterns affect skiing technique. If you haven’t already, start with the introduction and Part 1, which introduces the concept of a neutral spine posture.

There are many ways to conceptualize biomechanics, but they all need a starting place. If we think about ski technique, where do we want to start? On the glide leg? With the poles? At the hips? For this series, I have opted to start with the core and work outward. I could have started with the foot and moved upward; however, I see posture as an integral part of any movement. If the posture is compromised to begin with, then that deficit permeates the activity. 

As was emphasized in Part 1, posture exists on a bandwidth of acceptability–everyone is a little different. But postures that fall outside of the bandwidth, especially when occurring within a dynamic activity like cross-country skiing, compounds load on the body. In the best case scenario, this increased load is inefficient and bleeds power. Worst case scenario, the additional load can exceed the body’s tolerance and lead to musculoskeletal injury.

And yet the spine does move. Perhaps one of the best examples is the thoracic rotation that occurs with running. The shoulders do not stay pointed straight ahead. As the right leg and left arm swing forward (with the left foot on the ground) the shoulders are going to rotate to the right. This should be a product of rotation in the thoracic spine. If the thoracic spine has limited mobility, the motion will occur elsewhere, most often in the lumbar spine which has less motion available and will likely be less tolerant of this load. A case in point may be this recent study which found that the addition of thoracic mobility exercises decreased the incidence of low back pain in cross country skiers. 

If you’re not already, sit with a neutral spine posture. Cross your arms with hands-on opposite shoulders. Rotate your body to the left and to the right. Make a mental note of how these movements felt. Now let your back flex forward in a slumping position. Try the same rotation to the left and right. I suspect they felt different. When the thoracic spine is flexed, its ability to rotate is decreased.

Use it or lose it. Our bodies are use it or lose it machines. If we do not stretch a muscle to its full length, it will tend to shorten. If we do not move a joint to its end range of motion, it will tend to stiffen. As we get older, this becomes even more pronounced. If you are of Masters age, you should probably think of stretching and mobility exercises as more about maintaining what you have versus expecting to gain flexibility. The older we get, the less pliable our bodies become. But there’s a lot to be said for maintenance.

Here are my three favorite thoracic mobility exercises – (aim to do these daily–1 or 2 minutes on the foam roll, 10x to each side with the rotation).

Foam roll thoracic extension: lie on your back with a foam roll perpendicular to your spine. Support your head with your hands. Drop your shoulders towards the floor. Pause here for a few seconds then return to your starting/neutral position. Scoot on the floor so the foam roll moves up your spine. Repeat the extension motion dropping the shoulders towards the floor. Continue this process until you have worked the length of your thoracic spine. Avoid going into the lumbar spine as the fulcrum of the foam roll tends to be too sharp. On the upper end, once the foam roll is under the shoulder blades, it’ll be tough to get much motion. This exercise can also be done with an exercise ball.

Book openings: Begin lying on your side with your knees bent and hands behind your head. Rotate your trunk like you are trying to get the top shoulder down to the floor. Pause here for a second or two and return to the starting position. This should be done on both sides.

Lower Trunk Rotation: Lie on your back with both knees bent. Cross one leg over the other. Let the legs drop towards the floor to the side of the top leg. Pause here for a few seconds and return to the starting position. Do this on both sides.

Stability could be defined as the opposite of mobility. If we are striving to maintain available mobility of the thoracic spine, perhaps it makes sense that we are striving to maintain stability at the lumbar spine. Anatomically, the body is well equipped to stabilize the lumbar spine. We have multiple layers of abdominal and back muscles that create a stable platform for the arms and legs. While the lumbar spine is lacking in rotary motion, it has quite a large range of available motion for bending forward, backward, and to the sides. Depending on the activity, this available motion needs to be either locked out like keeping a rigid trunk with skating V1 or well-controlled while bending over to put on your socks.

If we are working under the assumption that neutral spine is the ideal, then it makes sense that our core strengthening or stability work should be done in neutral spine. Traditional sit-ups that involve considerable lumbar flexion are great for building those six-pack abs that look good on Instagram, but the exercise itself only contributes to a greater tendency to over-flex the spine during activity. “Flatten your back into the floor” is a frequent cue with core exercises. While this cue, and the associated posterior pelvic tilt, is effective at recruiting abdominal muscles, it also has the effect of training the body to rely on a flexed position for muscle activation. 

Lie down on the floor with your knees bent and feet on the floor. Your lumbar spine will now be in its neutral position. If you slide a hand under your low back, your hand will likely have a bit of wiggle room between the floor and your back. This is the natural lordotic curve, and we want to maintain this during exercise (and activity). It’s easy to feel the increase in pressure on your hand when you tighten your abs and flatten your back. Conversely, if you tilt your pelvis in the other direction, arching your low back, you will have much more wiggle room. This excessive lordosis tends to be less stable since the abdominal muscles are in a lengthened, disadvantaged position for dynamic stability with much of the burden placed on the static stability of the joints.

If you had a hard time controlling movement or differentiating between the flat, neutral, and arched positions, the following exercises can be helpful to train your awareness and coordination.

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Lumbar spine proprioception

Pelvic tilts: Lie on your back with both knees bent. Start by trying to tilt your pelvis towards you. Think of trying to flatten your low back into the floor or of shortening the distance between your ribcage and pelvis. Now tilt the pelvis in the other direction like arching your back away from the floor. These motions should be isolated at the pelvis and lumbar spine–your legs shouldn’t feel like they are doing any work.

Cat/Cow: This involves the same pelvic tilt motions but without the feedback of the floor. Again, the idea is to isolate the motion at the lumbar spine not by arching the upper back.

A quick Google search for “core exercise videos” brings up over 66 million results. Clearly, we are not lacking in the number of possible exercises. But what about quality? In the treatment of chronic low back pain, there is no best exercise. From the perspectives of performance enhancement and injury prevention, while there is an argument for simply being strong, there is perhaps a better argument for incorporating exercises that help the body meet the specific demands of the activity or sport. If good ski technique demands maintenance of a relatively neutral spine, then exercises should be performed in a neutral spine. If the sport includes load through the upper extremities, like poling with skiing or weighting the handlebars with cycling, then core exercises that include weight-bearing through the arms should be included. Skate skiing places a large rotational force through the core; thus we ought to have exercises that train the body to counter-rotation. Conversely, running and classic diagonal stride involves thoracic rotation so it makes sense to train the body to perform lumbar stability and thoracic rotation simultaneously. 

Here are my Top 3, best-bang-for-the-buck-exercises in each category. Remember, the goal is to maintain neutral spine. If you are unable to control the motion, then the exercise represents too much resistance/load and needs to be regressed. These are quality-intensive exercises. A reasonable program would include 2 or 3 sets of 5 to 10 repetitions (depending on fatigue) of each exercise. Doing the routine twice a week should be adequate.

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Stability exercises: these will challenge your ability to maintain a neutral lumbar spine

Femur arc progression: Begin by lying on your back with knees and hips bent at 90°. Your back will be in its neutral position, which you are striving to maintain (there will be a little wiggle room between your low back and the floor–the amount will vary by the individual but the goal is the same). The basic femur arc is performed by lowering one foot to the floor while keeping the knee bent at 90°. The motion is isolated at the hip. There should be no motion in the low back–it will have a tendency to want to arch away from the floor as the leg goes down. Return to the starting position and repeat on the other side. Continue alternating legs. Progressions include straightening the knee as the leg lowers, lowering both legs together with bent knees, lowering both legs together with straight knees. 

Mountain Climbers: These can be done with frisbees on carpet, socks on hardwood or tile, or with a TRX. The goal is to move alternating legs back and forth with no motion in the low back. There will be a tendency to flex as you pull a leg underneath you. This should be controlled by the core but also recognize that if you are trying to pull the leg through too far, you will run out of hip range of motion and be forced to flex the spine.

Roll Out: Start on hands and knees with your hands on frisbees or a laminated placemat on the carpet, a towel on hardwood, TRX, or an old-school ab roller. The roll/slide-out motion will be a combination of shoulders and hips, but the spine stays in its neutral position.

***

Anti-rotation exercises — as the title would imply, the resistance will try to twist your spine and your goal is to fight it

Plank with Shoulder Tap: From a straight arm plank with shoulders, hips, and knees in line, tap a hand to the opposite shoulder. There will be a bit of a weight shift that needs to happen to maintain stability, but this should be in the form of a side-to-side movement of the pelvis, not a rotation. This can be made easier by doing from your knees. Make it harder by substituting the shoulder tap with a dumbbell row. 

Paloff Press: The Paloff Press is a great lesson in the physics of levers. Stand using both hands to hold a resistance band or handle from the cable column weight machine. Push your hands straight out in front of you. As your arms straighten, the length of the lever increases and the resistance will exert more rotational force. Fight the twist. For more of a challenge, other than just increasing the resistance, stand with your feet together or in a lunge (with the band coming from the opposite side of the front leg).

Lunge with unilateral shoulder extension: Go into a static lunge with a resistance band in the opposite hand of the lead leg. Keeping the elbow straight, pull on the band until your hand is just past your hip. This can also be done with a cable column weight machine.

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Combination lumbar stability with thoracic rotation: simply put, the lumbar spine stays still while the thoracic spine rotates 

Seated Unilateral Row: This is a twist (sorry, bad pun) on a standard one-arm row. Sit on an exercise ball or chair facing the resistance band’s anchor. As you pull on the band, bend your elbow so your hand aims for the side of your ribcage, and rotate your chest and shoulders towards the band. Your butt should stay firmly planted and not rotate.

Lunge Rotation with Band: Stand with the resistance band coming from one side. Go into a lunge with the opposite foot forward (band from the right = left foot forward). Keep your hips pointed forward while your upper body rotates against the resistance. 

Seated Rotation (aka Russian Twist): This exercise gets a bad reputation because it’s very easy to do incorrectly, potentially placing a lot of load on the lumbar spine. It is often done in a V-sit position (like the photo but with the feet off of the floor), which is very difficult to maintain without collapsing into lumbar flexion. Add the potential to rotate through the lumbar spine and the combined motions create high loads. But we’re going to keep the lumbar spine neutral and isolate the rotation to the thoracic spine. The key points are attaining and maintaining a neutral spine while sitting with your knees bent and feet on the floor. Think about the rotation coming from the shoulders. Your belly button should stay pointed straight ahead. You can start without weight and progress to a medicine ball, dumbbell, or resistance band coming from the side. 

Notably absent in this list are exercises that target the glutes. As the primary stabilizers of the hip joint, the gluteal muscles should not be ignored in any “core” routine. However, for the sake of organizing this series, the glutes will be addressed in Part 3 on single-limb stability. If you want a head start, this Faster Skier article includes some excellent exercises. 

Building a Better Skier is a multi-part series born from the inquisitive mind of a physical therapist and late-blooming Nordic skier. (You can find the intro to the series here.) The objective is to explore how biomechanics and movement patterns affect skiing technique, and more importantly how you can apply these concepts to improve your skiing. To cover this topic thoroughly would likely require a hefty book, so apologies in advance if these articles lack depth or specificity. Please feel free to email the author with any questions: ned.dowling@hsc.utah.edu.

Posture is loosely defined as our body’s position or the way we hold ourselves. We tend to think of posture only in a static form like sitting or standing. But posture can be observed with dynamic activities like running, cycling, or skiing. Truly, we can talk about posture with anything the human body encounters. 

The primary influencers of posture are mobility and awareness. (It could be argued that strength plays a role in posture, and that is true for many sedentary people, but the readers of FasterSkier are far from sedentary.) 

The mobility or range of motion that is readily available through joints and soft tissue (muscle, tendon, ligament, and fascia) will affect our posture simply because we will always default to moving through the path of least resistance. If a joint is stiff, we will find a way to move around it. If a muscle is tight, it changes the position and efficiency of its associated joint. But also, if the ligaments around a joint have become loose like with recurrent ankle sprains, the muscles and associated tendons will have to work harder to maintain stability. Like with skiing technique, and posture in general, mobility occurs along a bandwidth. There is no single optimal measure, but there is a range that if exceeded on either end will lead to inefficiency. The old saying that everything in the body is connected is not an understatement, but it is a bit of an oversimplification. That everything in the body has the potential to affect everything else in the body might be more appropriate. 

The awareness of our body’s position in space is called proprioception. This is a broad concept that simply relates to the incoming signals the brain receives from the body so it knows how to move the body—how far, how fast, how powerfully—across multiple joints, muscles, and tendons. The brain receives this information via nerve receptors in our muscles, tendons, joints, and arguably even skin and fascia. It is what allows you to close your eyes and touch your nose without poking out your eye. Also without looking, you know that as you read this your left elbow is not fully straight and could tell us the angle of the joint with pretty good accuracy. 

So if we put the two concepts of mobility and awareness together, the former will dictate what shapes the body is capable of making and the latter will determine how accurately those shapes are made. If you are trying to make a hypothetical circle but a joint is restricted, you’ve only made an oval. If your mobility is good, but you are lacking in awareness, then you’ll be making squares or pentagons because you can’t smooth out the motion required for a circle.

While I’ve just made the case that posture is a product of the whole body, it is commonly thought of as related to the spine. As the foundation of our movements and literally the center of the body, the spine is an ideal place to start. 

The human spine itself consists of 24 vertebrae with a skull on top and ending with the sacrum and coccyx. That stack of bones is held together by countless ligaments. Between each vertebra is a disc that acts as a spacer, a shock absorber, and as a pivot point for motion. The vertebrae articulate with each other through small sliding joints located bilaterally. The orientation of these joints, which changes with the region of the spine, will determine the available motion and optimal movement pattern. Running through the center of the spine is the very precious spinal cord. Simplistically, the spinal cord is a superhighway with on and off-ramps between every vertebra. It carries information both to and from the brain. Movement and dynamic stability are provided by numerous muscles, which we will get to in more detail shortly. 

Basic anatomy having been covered, perhaps the more important implication for posture is the architecture of the spine. Contrary to the instructions to “sit up straight,” the spine, when looked at from the side, is not straight. (It’s not always straight from the front either, but the functional implications of scoliosis are beyond the scope of this article.) The spine, in fact, curves in a bit of an S from the head down in what is referred to as neutral spine. The cervical portion, comprising the 1st seven vertebrae, makes a concave curve. The next twelve vertebrae in the thoracic region have a convex curve. The last five in the lumbar are again concave. 

The appropriate amount of curve in each region is also on a bandwidth; however, the curve in one region can have profound effects on another such that they cannot be looked at in isolation. Stop reading for a moment and “sit up straight.” Now tilt your head and look up at the ceiling. Make a note of what that felt like or what you saw on the ceiling. Next slump down like a texting teenager. Look up at the ceiling again. Any difference? You probably noticed that it was much harder to look up from the slumpy position. This is because the increased flexion or convex curve of the thoracic spine changes the starting point for the extension (looking up) motion that occurs in the cervical spine. Think about how this might affect your neck when sitting on a bike. You can do the same experiment with your arms. Sit up tall and raise your arms overhead. Then repeat in a slumped position. Much easier when done in a neutral spine. 

A functional application here is how easily (and quickly) you can get your poles up to begin the next stride.

So what exactly does “good posture” or a neutral spine look like? Remember that a neutral spine occurs along a bandwidth of variability. Just as we all share the same basic anatomy, we all come in different shapes and sizes. However, the ears, shoulders, hips, knees, and ankles should generally line up while standing. Sitting is the same with a straight line connecting ears, shoulders, and hips. Again, there should be an inward curve at the low back and an outward curve through the mid to upper back. The neck will also tend to have an inward curve. 

In clinical practice, the majority of postural deviations appearing outside of bandwidth tend to fall into two categories: excessive thoracic kyphosis (to much flexion or outward curve in the upper back) or too much lumbar lordosis (excessive extension or inward curve at the low back). It is also worth noting that in clinical practice, the research would tell us that there is no evidence of “poor” posture causing musculoskeletal pain and is merely correlated with pain—not everyone who slumps all day has neck pain; not everyone with “sway back” has back pain. 

But posture that falls outside of the bandwidth creates an increased load on the body. The majority of nontraumatic musculoskeletal injuries arise as a result of an imbalance between load that is placed on the body and the body’s ability to tolerate load. So from a clinical perspective, improving posture is unlikely to be the Holy Grail, but it may be part of the solution, especially when a change in posture creates a change in pain levels.

Thoracic kyphosis tends to be an issue of mobility and/or awareness, at least in static postures. With dynamic movements, the complexity of the task may outweigh either the neuromuscular coordination or simply the requisite strength to maintain a neutral spine. Both of these scenarios will be discussed further in the next article. 

Excessive lumbar lordosis that is observed in standing, but decreases in sitting, tends to be much more complex. A simple explanation may be that the knees are hyperextending while standing. This has a simple solution: Stop hyperextending your knees! But this is way easier said than done. 

This is a pattern that has developed over years and is a tough habit to break. A much more complex pattern is one of relatively tight hip flexors along with relatively weak glutes and hamstrings. This effectively tilts the pelvis forward thereby increasing the curve in the lumbar spine. Again, this scenario might not be an issue with static posture but will be exacerbated by activities requiring hip extension such as running and skiing. This will also be covered further in the next section. 

Sitting is the new smoking. If you spend long hours sitting in front of a computer, STOP! Not your job, but the prolonged sitting. Height adjustable desks have become much less expensive and allow you to move frequently between sitting and standing. My typical advice is to change positions every 20-30 minutes. Standing is likely better, but put in one position too long and we’ll still get lazy with posture. If you don’t have this option, getting up and moving every hour can help. 

With both sitting and standing at the computer, keep your elbows at your sides and bent 90 degrees or a little less. When sitting, keep your pelvis vertical and all the way back in the chair. You should be on your sit bones. If you roll back onto your tailbone, it’s all over. The pelvis needs to remain vertical (or horizontal from front to back) in order to maintain a neutral spine. A lumbar support, or even a folded towel, placed in the small of the back will make it easier to maintain this position.

Maintenance of neutral spine with dynamic activities is no different, just harder. Again, posture falling outside of bandwidth equates to increased load which equates to inefficiency. Cycling is the easiest, at least conceptually, to transfer the ideals of sitting posture. It just requires tilting the pelvis forward on the saddle. “Bellybutton to the top tube.” Bike fit and hip mobility will both have a significant impact on how comfortably this can be accomplished. 

Running, swimming, and classic skiing get more complex due to the inherent rotation involved; however, a neutral spine as observed from the side remains ideal. A full discussion of form and technique for these sports, excepting Nordic skiing, is well outside the scope of these articles. It should also be noted that the human spine is fully capable of motion in all planes. It should not be inferred that the spine should be forever fixed in neutral. 

Stay tuned for the next part of this series which will dig deeper into spine mobility, stability, and proprioception.

Cross country skiing is hard. Very hard. Not only does it require a well-tuned cardiovascular engine, but technique can make the difference between a Ferrari and a Ford. Whether you’re a podium contender, looking to get some off-season training, or simply schussing about, we are all looking to propel ourselves efficiently. 

Technique in any sport exists on a bandwidth. Everyone skis a little differently, just like everyone runs or swings a tennis racquet in their own personal style. If the technique falls within the bandwidth, where it is accurate, powerful, and efficient, then all is good. But when it falls outside of the acceptable range, the cost becomes prohibitive. From a performance perspective, this means bleeding power. From an injury prevention side, this equates to increased load on the system

So what do we do when that efficient technique evades us? When balancing on the glide ski seems like a tightrope over the Grand Canyon? When that elbow angle never seems to satisfy your significant other? If you worked on it all winter and it still didn’t click, then it might be time to look at this technique thing a little differently. 

A while back, FasterSkier interviewed Canadian World Cup skier Katherine Stewart-Jones and her coach at the time, Erik Bråten, to discuss the apparent improvement in Katherine’s technique, which led to some of the best results of her career. Sadly, they did not disclose any magic bullets or secrets to speed. However, there was a very large pearl of wisdom:

“I took her off the skis as she could not really handle the movements I was asking her to do. And so until she was able to do that without skis, I think, it is unfair to put her on skinny skis at 30 K an hour and ask her to do it.”

When an athlete has the physical capacity to perform the technique or movement pattern but lacks the understanding or knowledge, this is called a technical deficit. This deficit often will respond to instruction, cues, and coaching. But what if one understands what is being asked but the body won’t cooperate? This is considered a mechanical issue: when a physiological deficit like balance, stability, mobility, or coordination is preventing the appropriate execution. All the cues in the world won’t help if the athlete is physically incapable of moving as desired. 

In Katherine’s case, it sounds like she had issues with both the mobility and proprioception (awareness of your body’s position and movement) of her spine. The posture she held, without the ability to correct it on her own, put her in a compromised position which led to a loss of power through her skis and poles. With the help of a physical therapist, she was able to improve these impairments in dryland training before progressing back onto the snow. With her mechanical deficits improved, she had the best race results of her professional career.

I am not a coach or ski instructor and as a significant other I try to keep my mouth shut. I am not here to offer yet another “Hips High!” cue to overcome a technical deficit. As a physical therapist who loses sleep at night analyzing Nordic skiing biomechanics, I strive to help the readers (and my patients) overcome mechanical deficits. In what will be a series of conversions on the topic, Part 1 will be a deeper discussion about posture. Part 2 will go into more detail about the spine, when to move it, and when to keep it still. Part 3 will delve into single-limb stability for both glide and kick. Part 4 will offer advice on shoulder mechanics for powerful yet healthy poling.

Whether cycling, rollerskiing, or apparently spring skate skiing, road rash is almost inevitable. Maybe more annoying than painful, but definitely damaging to the ego, road rash is not necessarily difficult to treat. Contrary to popular belief, it acts much more like a burn than an abrasion. Also, contrary to popular belief, treatment should not attempt to dry it out.

Step 1. Cleaning

Make sure your hands are clean or gloved. Clean the area with water. If there are a lot of gravel bits, you want to remove those as best as possible. Light scrubbing with a clean brush works well but be prepared for pain and cursing. Stay away from hydrogen peroxide as it actually breaks down epithelial tissue. If there is still a bit of dirt remaining after washing with water, betadine can help prevent infection.

Step 2. Dressing

The goals of the dressing are to keep the area moist and clean. First, apply an antibacterial ointment like Neosporin or Bacitracin. Then cover the wound. Gauze and road rash don’t play well together. Unless the wound is very superficial and dry, gauze will just stick to the wound and rip it open when removed. “Non-stick” gauze is a lie. Tegaderm is what the pros use. Our medical team at the Tour of Utah gives out Tegaderm like candy on Halloween. It does a great job of meeting our goals: moist and clean. On a broad, fairly static area like the side of a hip or a butt cheek, Tegaderm will often stay in place by itself. On a knee or elbow with a lot of movement, a piece of mesh stockinette will help keep it in place. It’s also waterproof so unless you are due to change it out, leave it on while showering.

Step 3. Patience

A Tegaderm dressing can go a couple of days without changing. But if you’re exercising and getting sweaty, it won’t hold up as well and should be changed once or twice a day. Keep dressing the wound with ointment and Tegaderm until the skin is dry to the touch. Even then, it’s likely worth keeping it dressed for another couple of days. Resist the temptation to blot it with a towel, blow on it with a hairdryer, or otherwise attempt to speed up the “drying” process. The skin has to heal from the inside out. Once dry and healed, keep in mind that the new skin will be more susceptible to sunburn. If concerned about scarring, lotion or vitamin E oil can help, although you’re unlikely to escape a battle mark completely.

It should go without saying that if you see scary things like bone, bleeding that doesn’t stop, odd colored liquid, or radiating redness around the wound, stop your DIY medicine and seek professional care.

Last year at this time, I was primarily gym-ridden. After roughly five months on snow, my fitness was high but my tolerance for the impact and specific demands of running were low. Throwing better judgement to the wind, I gave in to the allure of warm days, rapidly drying trails, and beloved road loops around town, and paid the price.  

Despite running between zero and ten miles total between December and the end of February, I took off for my first run of the season: 4.5 miles. That first week totalled 20 miles in four runs. Much lower than summer totals, but far greater than the sum of the months prior.

Two weeks later, I did a 90 minute trail run with roughly 1,200 feet of climbing and descending. What started as the sensation that a tendon on the lateral side of my right knee was snagging with each leg swing quickly turned into a sharp stabbing pain. I hobbled my way home and by that afternoon, I couldn’t walk downstairs without sidestepping or even make it down the gentle slope of my front yard. Sound familiar?

This experience is not uncommon. When snow conditions deteriorate in the spring but weather is perhaps not yet conducive to cycling or rollerskiing, our options for aerobic exercise that provides the same satisfaction as the kilometers we logged all winter are limited. The best available early season option is often running, so we lace up our cobwebbed sneakers, and fight the temptation to jump back in too quickly. 

While some may tolerate a rapid transition, there are a myriad of running related injuries that could easily crop up. Last year at this time, FasterSkier featured recommendations from Dr. Ross McKinnon, DPT, to address the topic of a healthy transition to running. His advice included a slow increase in running volume, working on running mechanics, beginning with soft surfaces, and making sure your shoes are up to the task. 

To add on, we reached out to DPT candidate, Olympian, and former APU Teammate Jess Yeaton for additional information to support a healthy return to running. 

Seconding Dr. McKinnon’s first recommendation, Yeaton began with the importance of committing to a gradual return.

“I think the absolute biggest thing is taking a slow progression back and not increasing your weekly mileage too much, as well as adding in exercises that target strengthening glute med.”

The gluteus medius muscle, or glute med, is a fan shaped muscle on the outside of the hip which connects the iliac crest to the top of the femur. The glute med plays a vital role in single leg stability, in particular, in maintaining level positioning of the hips and proper alignment of the leg during each stride. After all, running is essentially a repetitive high-impact single leg motion, so stability at the hips and through the core are key.

By strengthening the glute med, runners can reduce “hip drop” and prevent the knee from caving inward with each stride. These phenomena reduce the body’s natural mechanisms for absorbing the impacts of running. They put abnormal strain on various ligaments, tendons, and joints down the chain, leading to IT Band Syndrome, knee and low back pain, and more. 

“Examples of [exercises to strengthen the glute med] would be things like donkey kicks, fire hydrants, bridging up with both legs and then holding with one leg,” Yeaton explained. “I actually had to do a community project working with a running group here in Albuquerque for school and made a video with some of these exercises, which is available on YouTube.”

In the video, Yeaton demonstrates forward and lateral walks with an exercise band looped above the knees. Maintaining tension in the band activates and strengthens the glute med, promoting better stability in single leg movements, such as running — or skiing!

Yeaton also contributed to an article on single-leg stability geared toward better balance on skis this fall, which can be found here. 

In the gym, you could try single leg deadlifts with a kettlebell or free weight to build stability. To execute this move correctly, it is important to keep the hips level to the floor and avoid the tendency to rotate away from the standing leg. While keeping a flat back, focus on hinging  from the hip and staying within the range of motion that your hamstring flexibility allows rather than reaching the weight toward the floor, which often leads to rounding at the low back. In addition to challenging your single leg balance, you should feel this in the glute and hamstring of the standing leg. 

Another option for enhanced glute med strength is to try a split squat with the rear leg elevated, also known as a Bulgarian split squat. With one foot resting on a box, stair, or bench, complete a single leg squat, creating a 90-degree bend in the knee of the standing leg. The knee of the elevated leg should drop straight down toward the ground, while the other knee stays stacked over the ankle and in line with the foot. 

By pushing your heel into the ground as you come out of the squat, you can keep the action in your glute muscle, rather than letting the quadriceps muscles on the front of the upper leg take over. Again, the positioning of the hips is important; here they should stay squared forward throughout the movement. 

Yeaton also noted that she commonly sees skiers develop calf and achilles related injuries from jumping back into running too quickly and recommended variations of calf raises and heel drops to combat these issues. 

“Another one you could add is doing calf raises with a ball between your ankles, which puts you in a supinated position (meaning the foot is rotated slightly inward), which helps target tibialis posterior. I’ve noticed this muscle is a BIG problem for a lot of skiers.”

The tibialis posterior lies underneath the gastrocnemius, more commonly known as the calf muscle. Running the full length of the lower leg, the tibialis posterior begins behind the knee and connects to the arch of the foot. It helps to flex the foot and reduce pronation, where the arch collapses and the ankle tracks inward. This is commonly seen in runners.

To perform the exercise, hold a soft ball, such as a tennis ball, between the heels of your feet. Slowly rise onto your toes while maintaining the positioning of the ball, hold briefly at the top, then return slowly to standing. 

“For achilles strength, you can do heel drop exercises on the stairs. Push up into a calf raise on both feet, then lower down slowly on one foot. The eccentric, or the slow, controlled lowering part is what’s important.”

Returning to the concept of a gradual increase in running volume, Yeaton recommends actually calculating how quickly you are ramping up. Yeaton recommends the 10% rule — meaning volume should increase by no more than 10% per week. She referenced a 2014 study titled “Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury”, which followed roughly 900 runners for one year, tracking mileage increase and injuries. The research showed that athletes who increase by 30% or more were at a higher risk for injury, whereas those who increased by 10% or less were the least likely to incur a running-related injury. 

“I think this is crazy when skiers put a number to it, because that really isn’t much of an increase… from what I’ve seen, what most athletes consider taking it slow and easing back in is really a pretty significant progression.”

Obviously, there are caveats — if you start with one three mile run, you’ll probably be okay running more than 3.3 miles total the next week. If you ran 12 miles over four runs last week, you probably shouldn’t run 13 in one go the following week. However, paying attention to frequency, distance, and intensity of your runs as you progress can play a vital role in keeping your body happy.

Anecdotally, running 5-7 miles once per week through this winter has made a big difference in my ability to progress this spring. 

So there you have it. Work on hip stability and core strength (bonus: this will help your skiing too!), incorporate calf raises and heel drops, and keep an objective eye on your progression. Have fun and stay healthy!

Lung health in Nordic Sports study!

Do you ever wonder if a bad cough or raspy voice after a ski race or biathlon race affects your lung health?

Do you ever wonder how cold is too cold to train or race or other health factors like itchy skin or food allergies affect your lung health?

Then your participation in this study will help researchers understand the full extent, type and causes of respiratory health in cross country and biathlon sports.

Eligibility:

If you are actively training and have competition goals in cross country skiing or biathlon then you are eligible for this study.

What we will ask you to do:

• Complete an online questionnaire. This will take you no more than 30 minutes.

Benefits to you:

This study has no immediate benefits to you but allows researchers to build a comprehensive profile of lung health and causes of lung health issues in Nordic sports (cross-country and biathlon).

Contact:

If you are interested in this study either click on the link found on this website or reach out to Michael Kennedy at kennedy@ualberta.ca . This study has been approved by the University of Alberta Human Research Ethics Board (Study ID Pro00096524).

Link to Respiratory Health Survey.

Regards

Michael Kennedy, PhD, Clinical Exercise Physiologist-CEP®

This article is part of a series regarding female athlete specific physiology and nutrition. To get started, you can find a primer on the menstrual cycle here and listen to this podcast on Nordic Nation discussing female athlete specific nutrition with registered dietician and professional runner Maddie Alm. The survey analyzed here is an extension of the conversation with Guro Strøm Solli on her research on female athlete specific physiology and effects that the menstrual cycle has on training and performance, which can be found here.

Over the last five years, Dr. Stacy Sims book ROAR and the work of the team behind the FitrWoman app, cited by the US Women’s National Team soccer athletes as a key to their World Cup victory, have sparked conversations on how female athletes might take their unique physiology into account to optimize their training. However, the application of this research is far from ubiquitous. Research into the implications of hormonal fluctuations across the menstrual cycle to strength, inflammation, fatigue, nutritional demands, and the myriad of other training considerations is relatively new to the exercise physiology scene, partly because women tended to be excluded from research as their cycle might cause anomalies in the data.

While this area has seen a boom in research over the last decade, the individual variation women experience coupled with the prevalent use of various forms of hormonal contraceptives makes it challenging to provide concrete generalized recommendations that will serve all female athletes. However, as the area gains more attention, trends have emerged that may help athletes who feel they could benefit from aligning their training or nutrition to their cycle.

Some examples include periodizing hard strength training and intensity sessions earlier in the cycle when the ratio of estrogen, a steroid hormone, to other sex hormones is optimal, including a greater emphasis on hydration and electrolyte supplementation in the later half when elevated levels of progesterone trigger a rise in body temperature, or consuming anti-inflammatory foods during the pre-menstrual phase to mitigate inflammation and other PMS symptoms.

For women desiring to troubleshoot or better attune their activity to their cycle, tracking is recommended as a first step to illuminate patterns in mood, fatigue, sensations during training, et cetera. Diving into the information presented in ROAR or tracking tools like the FitrWoman App that present findings on how training or nutrition might be aligned to the cycle may be a good next step to access information on existing research. Then, through self-experimentation or communication with a coach and/or registered dietician to apply these strategies, an athlete can learn which strategies might make the greatest impact in optimizing their training and overall health.

As the topic of female-specific physiology gains traction in exercise physiology research circles, we began to ask how it is being used amongst elite athletes? And, how does this apply to the FasterSkier community?

In January, FasterSkier spoke with former World Cup athlete and exercise physiologist Guro Strøm Solli regarding her recent article “Changes in Self-Reported Physical Fitness, Performance, and Side Effects Across the Phases of the Menstrual Cycle Among Competitive Endurance Athletes” published in September 2020 in the International Journal of Sports Physiology and Performance. The research presented in the article included survey data collected from 140 respondents, all of whom were elite-level cross country skiers and biathletes.

To look for parallels to this research closer to home, FasterSkier distributed a similar anonymous survey to assess the extent to which elite American skiers and biathletes track their menstrual cycle alongside their training, adjust based on cycle, experience side effects, and feel they have sufficient access to knowledge in this area. FasterSkier’s survey can be found here for reference.

And now for the takeaways: the similarities to Solli’s research and the trends in responses, including featured responses that best represent common themes or differing viewpoints, and what coaches and athletes might gain from this insight.

The Basics:

The survey saw 16 respondents, all of whom were national team members and/or trained with elite-level clubs such as Alaska Pacific University, Stratton Mountain School, Craftsbury Green Racing Project, or the Bridger Ski Foundation Pro Team. 68.8% were between the ages of 22 and 30, with 18.8% in the category of 18-22, and 12.5% between 30-35 years old. 62.5% of these athletes experienced 8-12 menstrual cycles per year, 6.3% experienced 4-7 cycles and 31.% fewer than 4.

The respondents were evenly split between hormonal contraceptive users and non-users (this question was not further broken down by type), and of athletes who used a tool like FitrWoman to track their cycle. Of the 50% who used a tracking tool, 87.5% had done so for 1-3 years, with the remainder of athletes tracking for less than one year.

Q: In your experience, what affect, if any, do the phases of your cycle have on your training adaptations and/or performance?

In line with Solli’s research, most athletes identified the week leading up to menstruation as the most common to experience detrimental symptoms, such as bloating, fatigue, lethargy, or mood changes. Some athletes also expressed positive impacts, which are featured in the next section. Three athletes expressed that due to the nature of ski racing every weekend during the winter, they either chose not to focus on the impacts of the cycle since they would need to be mentally and physically primed to race during all phases, and maybe preferred not to plant the seed that there might be factors that may hold them back on race day.

• “I have noticed that when I feel unwell due to my period, I am less inclined to train hard; however, I think if anything it is more mental than performance related (more related to just feeling unwell, tired, PMS symptoms, etc.)”
• “I don’t really change anything or adapt my training during a cycle, and haven’t noticed an impact on my performance.”
• “I use the pill and often find my best races are when I’m not taking it (I.e. when I’m on my period).”
• “Hard to really see patterns but sometimes detect a few. We have to train and race through all phases, so it’s detrimental from a mental perspective to think that any phase, in particular, is “bad” – they’re just different. I try to be extra nice to myself with training/rest/shortening workouts if I’m going through a rough phase of a cycle, which for me is usually in the lead up and when I have my period. However learning that the time on your period is when your hormones are most ideal for high performance has helped me get through it, because even though I may be feeling icky, I know that my body should be ready to go underneath it.”

Q: During which times within your cycle do you feel your performance potential and/or ability to train hard and recover well are maximized? Explain.

Most athletes indicated that the best sensations in training and racing occurred in the first half of their cycle, after their period had started. During menstruation, female sex hormones estrogen and progesterone are low, then estrogen independently rises in the second week of the cycle. Both “ROAR” and the FitrWoman app identify this as a sweet spot for high intensity training, heavy strength training, and decreased recovery time between sessions.

• “I tend to agree with the FitrWoman app predictions, of increased strength performance during my period and decreased activation beforehand. I know that I’ve had very strong races at all times of my cycle so I’m not sure it affects the very top end performance, but more affects my body’s willingness to activate and work hard. My main concern is dealing with cramps during my period. I have to take a lot of pain medication, which sometimes doesn’t seem good for racing or for general health when combined with hard efforts. Cramps also make it very hard to activate my lower abs and have stability through my torso, which makes it difficult to ski well unless I’m very motivated.”
• “I can tell that I’m more apt to lift well in the weight room while I’m on my period, after the cramps are gone. I think that also correlates to racing well. The wild mood swings before my period can occasionally be helpful in racing motivation, i.e. when I can be angry and keyed up. But moods swing both ways.”
• “Right when my period starts and the week after, I feel less bloated and I tend to feel faster in training. I don’t notice a difference in recovery time, but in overall feelings I tend to feel better.”
• “There are so many variations in a normal training cycle, and just from life, that I wouldn’t say I noticed any particularly maximized phases related to my cycle. However it is easier to embrace hard training and expect normal highs and lows when I’m not on my period, so the other 3 phases I guess.”

Q: During which times within your cycle do you feel your performance potential and/or ability to train hard and recover well are most diminished? Explain.

Thirteen of the respondents identified the week leading up and the first few days of their period as the time their training and overall feelings were most impacted, both physically and mentally. Note that registered dietitian and professional runner Maddie Alm, who is concurrently collaborating with coaches and experts on a project surrounding female physiology, offered suggestions for mitigating the effects of PMS during her interview on NordicNation.

• “I usually feel pretty drained mentally before and during my period, as well as feel effects on my body (bloating, cramps, cravings). Right after is when I feel the best since my body is back to ‘normal’.”
• “When I am on my period- I just feel very tired, irritable, bloated, and often relatively nauseous. Even with an IUD and not having normal cycles, I can feel hormonal fluctuations that make me feel unwell.This overall effect on my mental state makes me less motivated to train hard, but I am not sure if in terms of performance or recovery I actually perform worse or am less capable of adequate recovery (like in terms of race results and intervals I don’t think my performance is diminished while on my period, I just feel worse).”
• “Sometimes when I’m on my period, it feels like it affects my ability to train hard, to perform well, and to recover, as well as my mood and outlook on life. This can be in the few days leading up to the cycle starting, and the few days when it’s happening. However it doesn’t happen every month – while I get my period every month, the intensity and difficulty of it vary significantly. Unfortunately, I haven’t been able to track any patterns with this, otherwise, I would always do what makes it less severe. And as I mentioned before, hormonally the body is strong when you’re on your period, so I try to give myself extra positive thinking, pep talks, shorten workouts, and not be too hard on myself if I’m not super fast in a training session on the bad months, because that’s just what happens. Most of the time if I am gentle on myself I can still perform quite well, but there have been notable occurrences when I’ve had terrible performances that are almost directly attributable to feeling terrible from the intensity of my period.”
• “Before and during my cycle it is difficult to recover because I experience mood swings that affect the ability to recover properly. I often use ibuprofen to deal with cramps which I feel sometimes compromises how my body feels during training.”

Q: What adjustments, if any, do you make to align your training and/or nutrition with your cycle? Examples could be: postponing or increasing recovery between hard sessions, increasing volume or intensity during a specific phase, increasing/decreasing carbohydrate or fluid intake, etc.

No athlete reported strategically aligning her training or nutrition to their menstrual cycle, though several responses included the idea of listening to their body and dialing back when needed.

• “I don’t adjust because I have to race every weekend, and I want to be used to having to perform no matter what my body is feeling. That said, I always try to have good hydration and make sure I’m adequately fueling my body.”
• “I think nutritional adjustments could be made to make me feel less bloated and nauseous, but I would need education in this area (and I think there is a really big need for it). I think that much of the negative effects are from feelings of nausea, cramps, etc.- so if there are things that could be done nutritionally to help, that would be great. In terms of adjusting training, I think it’s more difficult because a race schedule won’t adjust to your cycle so it’s good to get used to pushing hard during different times of your cycle. However, if it were found that there is a training benefit associated with training a certain way during different times of your cycle (i.e. intervals at a certain time, etc.), I think it could be an awesome training tool… if only more research were done in this area!”
• “I mostly look at it mentally. I don’t make any adjustments to my training and/or nutrition, however, when I’m feeling sluggish or low-energy I reflect if this could be because of my period. Then I try to justify it and remember that it will only last a few days and that I shouldn’t be too hard on myself.”
• “I do notice that I need to eat more during PMS, so I try to follow that. I also try to let down after my period and eat less when I don’t need as much. We don’t officially change training, I guess I listen to the Fitr App about when it’s a good idea to reach a little in the weight room, but mostly I micro-adjust training to how I feel.”

Q: Do you communicate with your coach regarding how you feel during different phases of your cycle? If so, explain how you and your coach use and discuss that information.

Thirteen athletes responded that they do not communicate with their coaches about this topic, though some added that they did feel they could if they were to initiate the conversation. The remaining three athletes state that they sometimes or occasionally talked with their coaches about their cycle, usually when it pertained to feeling negative side effects that impaired their training that day.

• “I do not, but I would be comfortable doing so, since both my coaches are women. I would address if my period cramps were making me nauseous.”
• “Sometimes I’ll explain that I need space or less coaching if I’m feeling down or off because of my cycle, and my coach has always been really great at understanding and respecting that.”
• “No, I don’t communicate. I think I could if I needed to, but I also have a male coach and it is not brought up much for awkwardness level. My teammates and I communicate openly about periods and if someone has cramps, etc. and I find their support and ideas as helpful as a coach.”
• “Most phases are just normal life and training, ups and downs, but my coach and I definitely talk about it when I’m on an intensely bad cycle. Sometimes if it falls on an intensity day I’ll do fewer intervals than otherwise planned, or else use it as a wake-up workout rather than really pushing hard. More often I’ll carry on as planned, because ups and downs of feeling are just part of the training life.”

Q: What information, if any, have you received or read regarding how normal hormonal fluctuations may influence training adaptations, nutritional requirements, and performance?

Five athletes reported that they had never received information about the menstrual cycle as it pertains to female athletes. Six athletes expressed they had received some information, and five expressed that they had attended presentations put on by U.S. Ski & Snowboard or regularly used the FitrWoman app as an educational resource.

• “None! Ever! Huge need for this!!!!”
• “I have received information but chosen to ignore it.”
• “The Fitr App mentions characteristics of each phase, like when it’s good to train heavy weights for example. I generally agree with it. I’ve been to one lecture by the Fitr App creators at US Ski Team camp, which gave me the most information I’d ever gotten. Previously I’d noticed some trends myself, but didn’t understand the different phases and what hormones caused which effects.”
• “Working with Fitter Woman and using their app, I’ve learned that these fluctuations in body temperature, sleep and recovery are normal, which helps me to be less concerned by them and be able to focus on performance. It was also super helpful to learn that right before my period starts I’m most at risk for getting sick, so I try to be extra careful with my immune system that week.”
• “I have been tracking with the Fitr app the past year plus, and that has some helpful suggestions. I eat and hydrate with care and healthy habits all the time, so I can’t say that I’ve made many changes as a result of tracking or reading about it. Sometimes I do notice cravings that make sense in the context of the cycle. As I mentioned before, I prefer to believe that there are good and bad parts about each phase, and as there are ups and downs in all parts of life, it’s something I adapt to on the fly while training and don’t make too big a deal about. As we nordic racers will compete during the entire winter and just about every weekend, it’s not possible to race in the same phase of the cycle every time – we have to be adaptable and ready to handle what the body throws at us, and I find that is mostly mentally knowing that it might feel bad but I can still have a great performance if I ease into my warmup and maybe recover a little extra.”

Q: Additional comments?

• “I think effects on the body and overall experience of a cycle is not discussed enough in the ski community. I have had some ‘girl talks’ with teammates or coaches but nothing more than once or twice a year, and nothing significant to make a difference in how I train or deal with it.”
• “I would like information on nutrition/hydration/recovery and other ways I can deal with cycle side effects. Some simple tips to start and maybe more info for those interested. I also think noting birth control methods and effects for athletes would help young women make choices that they often go blindly into.”
• “This is definitely a great survey and a topic that should be discussed much more frequently!”
• “I’ve always been curious about the effects of hormonal birth control on performance. The hormonal birth control I’ve tried (Sprintec pill and NuvaRing) changed my personality somewhat, made me more compliant and non-ambitious or depressed. They also made me gain weight. None of those were good things for skiing, so I’ve been unable to find a good solution. The Fitr App lecture talked about progesterone-only options being better, but I haven’t been able to find a good one. Apparently, I’m not a good candidate for an IUD, and wish there was another very low dose progesterone-only option. I also feel that people with ‘overly healthy’ menstrual cycles are a minority at my level in this sport, so I don’t have a lot of other athletes with heavy periods to brainstorm with…”

Conclusions:

So, what can we gain from these responses?

It is noteworthy that over 80% of the responses stated that they had never spoken with a coach regarding their cycle or female physiology. As absence or irregularity of a menstrual cycle can also be thought of as a “canary in the coal mine” for the damaging condition referred to as Relative Energy Deficiency in Sport (RED-S), providing resources and initiating conversations about this topic might help female athletes not only optimize their athletic performance but also prioritize their overall health and wellbeing.

One athlete commented that it was awkward to discuss her cycle with her coach as he was male, one said she did feel comfortable because her coach was female, and another commented that their conversations about the topic were in the form of “girl talk” with teammates. This is consistent with Solli’s journal article, where athletes were quoted as citing “because he is a man” as a reason for not discussing the topic with their coaches. The respondents in this article also expressed that their coaches lacked general knowledge about the menstrual cycle and the differences between male and female athletes. “I think there may be differences due to the MC that he is not aware of,” one athlete wrote.

Female coaches are underrepresented at the elite level. In the United States, roughly 20% of Division 1 ski programs are led by a female coach, and the Craftsbury Green Racing Project stands alone as the only postgraduate elite team with a female coach, namely Pepa Miloucheva. U.S. Ski & Snowboard has recently hired a female coach to lead the D-Team, Bernie Nelson for the 2010-2020 season, who passed the baton to Kate Barton.

Though male coaches can certainly be informed in the subject matter and engage in appropriate conversations with their athletes about this topic, per the athletes’ comments, more effort may be required to normalize these conversations. (Read how Diljeet Taylor, head coach of the 2021 NCAA title winning BYU women’s cross country running team, approaches these conversations with her athletes head-on in this Runner’s World article.)

Coaches should educate themselves on these topics to help support their athletes and, if they do not feel comfortable initiating conversations with athletes directly, consider bringing in professionals to provide education to their athletes. Ensuring females are represented in a program’s coaching or support staff, or relying on female team captains to initiate these conversations may also be valuable.

As we wrap up this series (at least, for now), we remind readers that this is an evolving topic as the impacts athletes experience take place on a spectrum and research is ongoing. We hope this information has started conversations, given women tools to start their own inquiry and self-experimentation, and raised awareness for the work being done to learn more about the female athlete body.

Readers who have followed cross-country skiing for several decades may be familiar with the name Guro Strøm Solli. Now 37-years-old, Solli was a member of the Norwegian National team from 2005-2008, retiring from professional skiing in 2010. During her athletic career, Solli earned two individual sprint podiums and another in the team sprint, and finished 10th in the classic sprint during the 2005 World Championships in Oberstdorf, Germany. 

During her athletic career, Solli also earned a degree in exercise physiology, which she built upon in a master’s program after retirement. Now based at Nord University in Bodø, Norway, Solli is working on a PhD which she expects to complete this fall focusing on a variety of aspects of the training of the renowned Marit Bjørgen.

On the side, Solli has been involved in broader research on female athlete specific physiology and effects that the menstrual cycle (MC) has on training and performance. Her article, “Changes in Self-Reported Physical Fitness, Performance, and Side Effects Across the Phases of the Menstrual Cycle Among Competitive Endurance Athletes” published in September 2020 in the International Journal of Sports Physiology and Performance is part of a larger well-funded collaboration between universities investigating exercise physiology specific to female endurance athletes, which in Norway primarily includes cross country skiers.

FasterSkier connected with Solli on a call in January to discuss the findings of the research and how it might benefit female athletes.  

In reflecting on her own time as an athlete, Solli does not recall considering her own MC in training and did not experience significant side effects from it. It was not until she began working as a coach of developing athletes and an instructor at the university level that the topic crossed her radar. 

“It was not talked about at all [when I was an athlete],” Solli recalled. “It was not a topic that was discussed by the coaches, or even the athletes so much. So that was something I was kind of thinking about — it was nothing that I focused on during my career, but I received a lot of questions from my athletes when I was a coach and also teaching exercise physiology. I experienced that there are a lot of questions, and I started to think, ‘Okay, this is something we need to look into to try to answer all these questions for the athletes.’ So it’s after my career that I’ve been more aware of the topic.”

The research presented in Solli’s article summarized the results of 140 responses to a detailed survey by female Norwegian cross country skiers and biathletes 18-years and older who compete at a national or international level. The questionnaire involved 54 questions regarding age, overall training volume and high intensity training completed during the general preparation and competition periods of a training year, use of hormonal contraceptives, and the prevalence and intensity of side effects such as pain, bloating, mood swings, and appetite changes. Participants also identified when their overall feelings in training and competition were at their best, and conversely when their overall feelings in training and competition were at their worst, and when and to what extent these negative side effects required them to alter or miss training sessions.  

“I think an interesting thing that we saw was that over 50% experienced this varied physical shape or training feelings across different phases,” Solli explained. “And there were over 50% that had to actually change their training because of menstrual related side effects. But only 27% had communicated about it and only 7% had planned their training according to the menstrual cycle, so it’s kind of a mismatch between the experience of the skiers and the planning of training. So I think that was an interesting finding, and I think it’s possible to gain something by increasing communication and logging to see if you can find some patterns that work for you.”

An additional statistic that perhaps frames this series of articles is that only 8% of participants reported to have sufficient knowledge about the MC in relation to training, and, as Solli mentioned, just 27% had communicated about it with their coach.

“We asked them why [they had not discussed it], and there was a lack of knowledge, the coach was a man, it was embarrassing, and private,” said Solli. “A lot of athletes didn’t feel the need to talk about it. So it was different topics, but lack of knowledge and that the coach is a man was the most mentioned topic to why it was difficult, so I guess there is still a barrier that there are a lot of male coaches that perhaps have the knowledge but perhaps they don’t dare to talk about this or approach it or know it it’s appropriate.”

Some athlete quotes featured in Stolli’s September, 2020 article include:

• “It feels like it’s a taboo. I am afraid that the coach won’t take it seriously and thinks I’m using it as an excuse.”

• “I think I have more competence and knowledge about this topic than he.”

• “Because he is a man.” 

The September, 2020 article also summarizes the importance of this communication, both in terms of athletic development and overall well-being.

“Since menstrual dysfunctions are an important marker for relative energy deficit, a syndrome affecting many aspects of physiological functioning, health, and athletic performance, it is important that athletes feel comfortable to discuss this topic with their coach. Furthermore, because of the high inter-individual variability in performance and side effects experienced by athletes during the MC, coach-athlete communication is important to safeguard the athlete’s health as well as optimize training adaptations and performance. In response, increased attention should be paid to educating female athletes and their support teams about the MC and athletic training.”

Optimistically, Solli continued that she sees the lack of knowledge and communication as a barrier that is in the process of being broken down. 

“I have a lot of talks about this with coaches who have wanted me to talk a little bit about the topic,” explained Solli. “And they’re very curious, and they’re starting to realize — you kind of have to get over this being a topic that you don’t mention… Particularly in elite sport, when there are so many topics that are discussed, it’s kind of silly that this topic should not be mentioned as part of the whole situation of an athlete.”

She continued that both research and coach-athlete education on the subject is trending in the positive direction. However, high levels of variation are experienced by women, which makes it challenging to give generalized recommendations. 

“It’s starting to be, for the last 2-3 years, kind of a hot topic. I’ve experienced that both coaches and athletes are starting to see that and to investigate if this has an impact [on the individual]. Also, when I read up on the research and meta analysis that are published that try to sum up what we know and what do we not know, it summarizes that we don’t have evidence-based recommendations that can be done on a group level, but it seems like this topic should be approached through an individual.”

Overall, she sees increased awareness and access to information as a positive for female athletes. She noted the increased prevalence of logging apps, such as FitrWoman, that make it easier for athletes to track their cycle and observe trends in their feelings. 

In Norway, the possibility to log the MC has also been implemented into the digital training diary that has been designed by the Norwegian Olympic Federation and is used across all sports. 

“That’s a step forward, I think. It’s going quite fast in this area, so it will be interesting to see in five years, where are we? I think we will get a lot more knowledge just because athletes are starting to log and discuss this topic. Research takes time, but slowly we will be able to get more studies and more knowledge.”

Zooming out to discuss existing research on the MC and how it might influence the planning of training for elite athletes, Solli noted that a pervasive theme is that the potential for optimal performance can occur during any phase.

“In theory, we expect [hormonal fluctuations] to affect training, nutrition, and performance, but when you look at the meta analysis of how the menstrual cycle affects performance, we don’t have a clear answer on that. It seems like the studies are concluding that on average you can’t see a large difference between the performance in different phases.”

While athletes can rest assured that racing is unimpacted, Solli explained that there are considerations athletes and coaches might apply to training to optimize adaptations. 

“When it comes to training effect, there are some studies that highlight that it might be beneficial to periodize your strength training early in the menstrual cycle. This is the phase where you have an increased level of estrogen, which is a hormone with over 400 functions in the body, but two important functions is that it is an anabolic hormone, so it’s good for your ability to build muscle mass, and also important for bone health and to build bone mass and ensure bone density.”

She explained that 4-5 peer-reviewed studies indicate that you can get a higher training effect in terms of muscle strength and muscle mass by periodizing strength training sessions with higher weight and lower reps in the first half of the cycle. Solli added the caveat that, like all research in this area, the studies are often small and the overall topic is still in its infancy. 

“It will be interesting to follow the research during the next years to see if we can get stronger evidence in the case of strength training, and whether we’ll also see that we can get some endurance studies, for instance, with periodizing high intensity training in particular phases. We don’t have studies answering that conclusively yet, but it would be exciting to see.”

Diving deeper into the survey results analyzed in her study, Stolli discussed the most prevalent themes athletes reported. She also discussed how hormonal fluctuations might explain these effects.

 “As we discovered in the study, what the athletes perceive is that the phases where they feel their worst physical shape and have their worst performance was in the days right before the menstrual bleeding and during the bleeding. Right before the menstrual bleeding, we have a drop in both estrogen and progesterone, and this hormone drop is associated with PMS symptoms and different side effects, and we also saw that in our study. The negative side effects reported by the athletes were high during the periods right before and during the bleeding phase.”

This is also the time when athletes most frequently reported using pain-killers to manage symptoms and needing to alter their training by decreasing volume or intensity.

“I guess that is not only my study, but also other studies highlight that those two periods can be a risk for decreased training quality or that the athletes don’t manage to perform the training they have planned because they are experiencing these negative side effects.”

In contrast, most athletes perceived their best fitness was achieved during the middle phases of the cycle. This coincided with the window where negative side-effects were least reported.

Another noteworthy statistic Solli touched on was hormonal contraceptives (HCs), which 56% of athletes reported using. The fact that HCs were not broken into subcategories such as oral contraceptives, IUD, etc., was listed as a limitation of the study.

“A large proportion of the athletes are using hormonal contraceptives,” said Solli in the call. “And there are a lot of different types with different amounts of synthetic estrogen and progesterone that suppresses the normal hormonal fluctuations, and you get a more stable cycle. As we saw, there were positives experienced with using HC’s that athletes reported that they get reduced pain and they also get control of the bleeding phases, so they can control it according to their competitions or trainings. But there are also some negative effects with weight gain and irregular bleeding.”

Solli explained that there is little research apart from survey data pertaining to how HC’s might affect female athlete performance and, similar to experiences with a natural cycle, the side effects women experience vary considerably. Here too, Solli recommended considering each athlete and situation as unique, advising athletes to pay close attention while adjusting to new or different forms. 

“From research, when they compare using HC to having a normal menstrual cycle, most studies show that there is no effect on performance and that also performance is relatively consistent across the HC cycle,” Solli explained. “Also here, an individualized approach based on each athlete’s response is recommended from research, because you see that from some athletes they report more negative side effects, so that’s important to find a type that suits you and to log the effects when starting a new type.”

Of the athletes not using HC, a noteworthy 35% reported fewer than nine periods per year, an indicator of menstrual dysfunction possibly due to low energy availability, meaning the caloric and/or nutrient density of an athlete’s diet does not meet the demands of their training. While this may be unintentional, the condition known as Relative Energy Deficiency in Sport (RED-S) is prevalent in endurance sports, particularly those that favor leanness. It is often associated with disordered or restrictive eating behaviors. 

RED-S can cause a cascade of negative health impacts, from hormone imbalance, to low bone density, to impaired immune function, and cardiovascular problems.

“Although we did not assess energy intake or energy expenditure,” the article states, “high volumes of training and high amounts of high-intensity endurance training are associated with high energy expenditure and can prompt relative energy deficiencies. Elite endurance athletes and their coaches should therefore be aware of the risk of MC irregularities induced by high volumes of training and high amounts of high-intensity training. The prevention of MC irregularities should also be pursued, because primary and secondary amenorrhea can result in adverse health conditions, including reduced bone health.”

At the World Cup level, this phenomenon has made FasterSkier headlines in the cases of Norway’s Ingvild Flugstad Østberg and Sweden’s Frida Karlsson, who were pulled from competition last season by national team doctors after failing to meet team health metrics. Østberg resumed competition for the 2020 Tour de Ski, where she finished third, and competed through the first weekend of racing in March in Falun. Her season then ended abruptly after she sustained a stress fracture in her foot from hopping off a three foot cement step to the ground. 

The 30-year-old Østberg sustained a second stress fracture in July and has not competed on the World Cup this season. Østberg has been working with team doctors to bring her body back to health in order to compete in the 2021/2022 World Cup and Olympic season. 

Karlsson was withheld from competition from early December, 2019 to February 9th, 2020 and has remained in competition since. More recently, Finland’s Kerttu Niskanen sustained a fracture in her tibia during a race in Falun that was not caused by a crash. FasterSkier has not received further insight into her situation.

Bringing it all together with the information Solli discussed in mind, how should athletes and coaches approach this topic? Solli’s article lists a set of practical applications of the information currently available. 

Solli concluded that understanding the MC and how it might influence training and performance is just one piece of the puzzle of female athletic development. She stated that hype from media attention might make it seem essential, but for many who do not experience significant effects, this area might not be worth investing in. However, for many athletes, better understanding and communication could lead to significant improvement. For this reason, Solli recommends an individualized approach, adjusting the focus based on the extent to which an athlete is impacted.  

“It is a part of a lot of different [aspects of training],” said Solli. “So you have to look at it in the bigger picture, but that doesn’t mean that we don’t need to talk about it. You can’t ignore it, but you should not make it too big of a deal if you aren’t struggling with it and you have a natural cycle and everything is okay, I don’t think you need to change something. But I think some athletes are struggling with it and I think they should know that it’s possible to get help. 

“There is a lot of information now, a lot of good articles that are published, and information in the apps — I think it’s really good for young athletes to start there and to log [their cycle] and learn. That’s something I really would have wanted when I was a young athlete, that I could have an app and to start early to find my own pattern that I could optimize. I think that’s a really good opportunity to learn how your body works.”

This article provides an introduction to a series of interviews with professionals in sports nutrition and female physiology. Results from a survey regarding how elite US cross-country skiers and biathletes use insight into their cycles in their own training will also be analyzed and shared. 

An arguably essential component of developing as an athlete is learning how to listen to the signals one’s body sends. Am I skiing easy enough on my recovery days to absorb the interval workouts? Am I dehydrated? Bonking and in need of a quick hit of carbs? Am I feeling mentally and physically flat because I have been stressed at work or lacking sleep? 

In an ideal world, progress in skiing would be predictable. If I do X-Y-Z, my performance or technique will improve. However, the body is much more complex than a simple if-then statement. For female athletes, whose hormone levels fluctuate over approximately monthly cycles, this is especially true. 

Before we jump into the nitty gritty of hormone levels throughout the menstrual cycle and how they might be considered in optimizing training and nutrition, I’d like to insert some anec-data to highlight the importance of talking about this issue. 

Up until 2017 when my husband and I wanted to start our family, my understanding of the menstrual cycle was that it was roughly 28 days, PMS is generally unpleasant, and menstruating can be both uncomfortable and inconvenient. I thought of my cycle as two parts: bleeding and not bleeding, and I had never considered that there might be physiological changes throughout the cycle that might cause an ebb and flow (no pun intended) in my energy, moods, immune function, or nutritional requirements. In fact, had you told me that training and nutrition should be aligned with my cycle, I might have even scoffed, thinking I just needed to suck it up on the days I didn’t feel well. 

In reality, that means 15 years where, despite trying to tune in on minutia of my technique and training to improve my skiing and running, my understanding of a fundamental body process I experienced regularly was all but nonexistent. This is not an uncommon scenario. And this is from someone who has a collection of books on training and performance and loves geeking out on exercise science research.

Through learning about female physiology and tracking my cycle in preparation for pregnancy and also following the birth of my daughter in October, 2018, I’ve identified a slew of patterns that help me feel more in tune with my body than ever. I also read the book ROAR: How to Match Your Food and Fitness to Your Female Physiology for Optimum Performance, Great Health, and a Strong Lean Body for Life by Dr. Stacy Sims, which I felt provided invaluable information regarding aligning training to the menstrual cycle and empowered me to experiment in my own training and life with positive outcomes. 

Apart from training, understanding that the menstrual cycle is a window into your overall health is becoming more evident with research. The “Apple Women’s Health Study” — a partnership between Apple Inc., the Harvard T.H. Chan School of Public Health, and the National Institutes of Health (NIH) — is currently analyzing a wealth of self-reported data to “demystify and illuminate menstruation and accord it the scientific scrutiny and social acceptance it deserves.” This comes in response to the fact that hormone fluctuations were long considered an uncontrollable variable that might skew scientific data, thus women were left out of experiments. 

“In recent years, researchers have acknowledged the need to reevaluate the relationship of menstruation to overall health,” writes editor of Harvard Public Health magazine Madeline Drexler on the study. “Treating the menstrual cycle as a vital sign—comparable to blood pressure, temperature, pulse rate, and respiration rate—could lead to earlier detection of many conditions, both gynecological (such as fibroid tumors) and systemic (such as diabetes). Likewise, tracking lifestyle changes among those who menstruate—including the effects of body composition, activity levels, increased life expectancy, and postponement of childbearing—could help scientists glean factors that make an impact on menses.”

In addition to a canary in the cave for overall health, ROAR author Dr. Sims encourages women to understand that a regular period can be an “ergogenic aid”, i.e., a performance enhancer, that should not be avoided [1]. Yes, there are times when hormones might make us feel suboptimal. Wouldn’t you like to know why that is and what you might do about it so you can ameliorate your symptoms? That’s what this series is about. 

To further the point that the menstrual cycle should not be thought of as a bemoaned inconvenience limiting female athletes, there is no evidence that V02 max is affected at any phase of the cycle, indicating that top performances in endurance events cannot occur at any phase. If it’s not holding back performance, but there might be ways to adjust your training to optimize adaptations throughout the cycle, why not learn more and begin paying attention?

Here is a brief primer on the menstrual cycle and what it might mean for female athletes. This information is intended to help female athletes and coaches understand the underlying physiological changes women experience throughout their cycle so they can adjust their training and nutrition to adapt accordingly, optimizing their training outcomes and performance over the long haul of endurance sport.

Menstrual Cycle Phases and Hormones

For the purpose of this article, we’ll focus on what is considered normal menstruation in a healthy female. Lack of a period, called amenorrhea, is well discussed in this podcast and will be addressed in subsequent parts of this series. 

It is also important to note that while the fluctuations of hormones in a healthy cycle is well understood, conclusive evidence of the implications is still under research. While patterns have been seen in research, positive and negative effects of the menstrual cycle are largely individual. This information is intended to inform athletes of the body process to help kick start the process of learning their own unique patterns and responses. 

The menstrual cycle begins at the onset of menstruation and lasts on average 28 days, though 21-35 days is considered normal. At its root, the menstrual cycle prepares the uterus for pregnancy, first preparing a follicle in the ovary to release a mature egg and thickening the lining of a uterus so that the egg, if fertilized, can be implanted and develop into a tiny human. If the egg is not fertilized, the lining of the uterus begins to break down and eventually is shed during menstruation, beginning the cycle anew. Note that high performance training is not included in that basic description. 

These processes are controlled by four primary sex hormones: estradoil (or oestradiol), which is a form of estrogen, progesterone, follicle stimulating hormone (FSH), and leutinizing hormone (LH), with estradiol and progesterone being the leaders [2]. Their changes in concentration divide the menstrual cycle into two primary phases, the follicular phase, which leads up to ovulation, followed by the luteal phase. These phases can then be separated into two sub phases of early and late. 

To align with the information presented by the revolutionary FitrWoman App — which many see as the gold standard of cycle tracking for female athletes as it includes evidence-based insights from research in physiology, performance, and nutrition — I’ll refer to the progression from early to late follicular and luteal phases as Phase 1-4, which last roughly a week each [3].

As previously mentioned, phase 1 of the cycle begins when a woman’s period begins. In this phase, estrogen and progesterone are both low while testosterone (yes, women produce that too) is at an average level. This combination can help many women feel their strongest, however, because the lining of the uterus is being shed, women might experience side effects from inflammation at the beginning of this phase, like GI upset or fatigue [4]. If experiencing the latter, it could also be a good time for shorter, more intense sessions with plenty of rest in between, rather than longer threshold workouts. 

In phase 2, estrogen begins to rise while progesterone remains low. Estrogen is a steroid hormone, which is linked to increased muscle mass and strength, as well as bone health [5]. With testosterone also at its highest, this can be a sweet spot for a hard block of training. Many women experience increased pain tolerance and decreased recovery time during this phase, and positive moods and mindset are also most common. The increased levels of estrogen may also promote stability in blood sugar levels, helping athletes maintain their energy levels during training. This could be a time to ski hard and ride the endorphin high!

Phase 3 begins when ovulation occurs. After a spike in LH and FSH to initiate ovulation, estrogen drops rapidly, then begins to rise again while progesterone steadily climbs throughout. The elevated levels progesterone causes a rise in body temperature of about 0.3℃ or 0.5℉, which may influence hydration requirements and make it more challenging to regulate body temperature if training in the heat [3, 1]. Breathing rates and heart rate also increase both at rest and during exercise, making training feel a bit harder, and blood sugar levels may be less stable, placing a higher demand on carbohydrates during training and increasing the importance of balanced meals that include fiber, healthy fats, and protein to help keep energy levels and appetite predictable [2]. 

In the fourth and final phase, both estrogen and progesterone drop to their lowest levels of the cycle. This rapid drop is linked to the symptoms commonly referred to as PMS, which include GI distress, bloating, headaches, moodswings, and fatigue. These symptoms are likely due to an inflammatory response triggered by the lack of hormones, which continues into Phase 1 as mentioned previously. You read that right. When you have PMS, you’re not “hormonal” — you’re actually un-hormonal. 

From a training perspective, this inflammation may make it harder to recover from hard sessions, leaving you fatigued on top of other PMS symptoms. It may be possible to reduce these negative feelings by eating anti inflammatory foods, like berries, nuts, and fish, and avoiding processed and high sugar foods that are thought to exacerbate inflammation. 

To be clear, some women experience very mild, if any, impacts from their hormonal fluctuation. However, if this is something you’re curious about or you feel your energy levels and appetite do not always match your expectations based on your training schedule, this might be something that could help you feel better throughout the month, in and out of training. 

Conveniently, the “three weeks up, one week down” general guideline of training — meaning three weeks of building volume and/or intensity, followed by a recovery week — already aligns well with what FitrWoman recommends in terms of experimenting with aligning training to the cycle. During Phases 1 and 2, progressively build and increase loading during strength sessions. In Phase three, consolidate, meaning longer recovery between sets of intervals, or perhaps lower weight with higher reps in the gym. 

Then, in Phase 4, rather than pushing through while feeling suboptimal, back off on the intensity sessions and include additional easy or rest days to absorb the previous three weeks of training and give your body the extra recovery it might need. 

Want more? The team at FitrWoman hosted an informative free webinar in February 2019 on Facebook featuring Senior Sport Scientist and elite marathoner Dr. Georgie Bruinvels. The webinar is still available here. 

Sources:

[1] Sims, Stacy T. Roar: How to Match Your Food and Fitness to Your Unique Female Physiology for Optimum Performance, Great Health, and a Strong, Lean Body for Life. Rodale Books, 2016. 

[2] “What Athletes Need to Know about the Menstrual Cycle.” FitrWoman, www.fitrwoman.com/post/lgfa-webinar. 

[3] Beverly G Reed, MD and Bruce R Carr, MD. (August, 2018). The Normal Menstrual Cycle and the Control of Ovulation. www.endotext.org

[4] Solli, Guro & Sandbakk, Silvana & Noordhof, Dionne & Ihalainen, Johanna & Sandbakk, Oyvind. (2020). Changes in Self-Reported Physical Fitness, Performance, and Side Effects Across the Phases of the Menstrual Cycle Among Competitive Endurance Athletes. International Journal of Sports Physiology and Performance. 

[5] Chidi-Ogbolu, Nkechinyere & Barr, Keith. (January, 2019). Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Frontiers in Physiology.