As told to Chris H. Hadgis
Kristine A. Karlson rowed in the 1992 Olympics while also putting herself through medical school. Doctor Karlson has since become an avid cyclist as well as a sports medicine physician. She has worked with everyone from a WorldTour cyclist to Olympic athletes to top master’s racers. When asked for her top 10 professional medical tips and advice, here is what Dr. Karlson told us:
1. Diversify. I tell this to almost every masters age athlete. Only training in one sport is not a good idea. If you are injured, you need to have a backup activity that you either enjoy or that you are willing to do. Similarly, diversifying by season is a good idea as it helps you build strength in other ways. A sport such as cross-country skiing for example, is great winter training for cyclists, runners, and rowers. Weight training is never a bad idea for any athlete and should also be considered.
2. Cycling is a repetitive sport. When you do the same activity repeatedly and something is slightly off such as bike fit, there is inevitably going to be pain and the potential for injury. In order to avoid chronic overuse injuries, some sort of bike fit is strongly recommended for everyone.
3. If you are experiencing pain in a specific muscle or joint while cycling, this is an indication that something is wrong. You are much better off cutting a ride short, instead of pushing through and regretting later that you have a new chronic injury that will last significantly longer because you ignored the pain initially.
4. On coming back from an injury: Athletes are not able to do the same volume that they were able to tolerate prior to the injury. For example, runners who have maintained their fitness while injured cannot go back to the same training volume where they were without risking injury again. Unfortunately, you do not know during any bout of exercise whether you have crossed the threshold of what is too much: You only know that the next day. This means you need to come back slowly and do less than you thought you could tolerate. Increase the volume and intensity slowly and mix in cross-training.
5. Do not underestimate the importance of hydration. Once you get dehydrated it is likely too late to rescue that ride. If you do not have to urinate at all on a four-hour ride, you are extremely dehydrated.
6. Likewise, bonking is not fun. Eating during a ride is important to make sure you do not run out of calories: remember to eat on any ride that goes over one hour. Once you are in a calorie deficit it is virtually impossible to recover your riding speed or enjoyment.
7. Days off are important. Overtraining is another deficit that once you slip into is very difficult to get out of. Athletes who are overtrained can take a full season to recover. Do not assume that more volume and more intensity is the right way to train. Easy days and rest days are an important component of any training program; allowing both physical and mental recovery.
7a. Every ride should not be race-pace. Agree with your training partners when a ride will be social and not competitive, and stick to that plan.
8. If you are struggling with a chronic nagging injury or a painful area, seek professional help. Finding physical therapy exercises on YouTube is a poor substitute for seeing a licensed physical therapist for customized rehabilitation.
9. Do not train while sick. Specifically, the "neck check" can help you decide if you are too sick to exercise. If all of your symptoms are above the neck, such as nasal congestion only, it may be fine to try to train. However, if you do not feel well, you should cut that training session short. If there are systemic symptoms which include fever or symptoms below the neck such as cough, training should be curtailed or deferred until better.
10. If you crash, you are not the best person to judge if you are fine to get back on your bike. Your friends or riding companions may insist on taking you to the hospital: Do not argue with them. Concussed athletes make poor choices in thinking that they are fine to get back on the bike when they are not. Symptoms could significantly worsen, they may be foggy and dizzy, and risk another crash. Also, check your bike thoroughly before getting back on it after a crash. If you get back on a damaged bike, you risk further injury.
Kristine A. Karlson, MD is Section Chief of Family Medicine, Director of the Sports Concussion Program, and Associate Professor of Community and Family Medicine, of Orthopaedics, and of Pediatrics at the Geisel School of Medicine, Dartmouth.