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 Beating the Band  The Strength to Swim Properly
Nutrition: The Fourth Discipline Top athletes have coaches. Why do you need one?



Top athletes have coaches.  Why do you need one?

What is similar between Ironman World Champions, Tour De France winners, and Olympic gold medalists?  The simple answer is they all have a coach.  What about if you don’t necessarily have aspirations to be a world champion or gold medalist?  What if you just want to complete your first Ironman, win your local criterium race, or set a PR in an upcoming half marathon?  Coaches provide the input and flexibility to maximize your time.  The goal is to always do the minimum amount necessary to maximize your adaptation and benefit to training time.

Coach vs. Online Training Plan:

A lot of people fall into the trap of downloading that 18 week “Couch to 5k” set-in-stone training plan.  I am not saying that these training plans are horrible.  If someone has a lot of experience and knows how to properly modify the training to fit the stresses of daily life then these plans provide a decent footprint.  Let’s look at a trusty pro/con list to see what a training plan is all about.



         Typically budget friendly

         Long term planning possible (but not necessarily a good thing)

         Provides footprint for an experienced athlete


         Inflexible to daily life

         Good possibility of over or under training

         No feedback on training could lead to injury

IREP athletics does have these set-in-stone training plans for triathlon, running, cycling, and swimming.  Partnering one of these training plans with a one or two consultations would provide a budget friendly alternative to monthly coaching.

Online/local Coaching:

The stigma around hiring a coach is that it is always too expensive.  But can you put a value on your overall health and performance goals?  Hiring a coach provides the flexibility and experience to maximize an athlete’s potential through maximizing the time available to train.  A coach will listen to the athlete and modify the daily training plan in order to work around those life events and stresses that you can’t control.  A coach will know when to back off and perform some serious body maintenance when that niggle pops up.  Take a look at the following pro/con list for hiring a coach:



         Best bang for the dollar

         Personalized training programmed with high frequency

         Adaptable to daily life events and stresses

         Adaptable to injuries and niggles

         Form/gait coaching

         Maximize training daily training time


         Can be expensive (discounts are available and all IREP coaches are willing to discuss budget limitations)

All of the coaches at IREP Athletics believe in implementing the most up to date training theories to set our athletes up for success.  We believe in connecting with our clients and building a relationship where sharing information is not looked down upon.  I recommend connecting with one of our coaches to find out some more information about what we can provide.  This initial communication is completely free so there is really no reason not to talk.  Don't put off until tomorrow what you can do today.

Nutrition: The Fourth Discipline

Imagine if you were in a big city traveling with a large group of people.  You got to the subway station and realized only a small amount of you would fit on the subway car.  You are left with two options: wait for the next subway car and continue to move your group over a longer period of time or use the bus that runs at street level and move some of your group to your destination at the same time on the bus.  Even though the bus takes longer the synergistic effect of being able to trickle some of your group members to your destination via two transport systems is most efficient.

Race day nutrition functions in a similar manner.  An average size male athlete has absorptions rates between 30-90grams/hr during exercise.  The upper end of this scale 90g can only be achieved with utilizing multiple delivery methods our bodies can utilize.  We transport glucose and fructose via different transport systems.  Knowing what is in your nutritional product is key and what you tolerate well is vital to your performance.

There are many triathlon fuel options available and an entire industry devoted to it.  Glucose, fructose and maltodextrin are the primary ingredients that contain the calories of these fuel sources.  The delivery methods come in powders that are mixed into liquids solutions, gel packets, bars, chewy candies etc…  The delivery method to use is very individual.  As intensity increases blood is shunted from the core of the body and shifted out to the working skeletal muscles.  This slows the digestion process down significantly and may wreak havoc on a normally iron stomached person.

With under-fueling the dreaded “bonk” or “hitting the wall” technically called hypoglycemia may show up stopping an athlete in their tracks whereas on the polar opposite end of the spectrum over fueling in a short duration may lock up the stomach and shutdown all forward progress and leave you lying on the side of the course in the fetal position contemplating jumping in front of traffic to end the misery.

As the distance of your triathlon increases nutrition inevitably becomes more and more important.  As any motor vehicle is limited by it’s efficiency and size of it’s gas tank the human body functions in a similar manner.  We can store around 1hr-1.5 hrs worth of calories on board in the form of glycogen which we store in our skeletal muscles and liver.

In half Ironman and Ironman distance events developing and practicing a nutritional strategy is vital and should be implemented in to the specificity of the workouts during the build- up.  The old clich� “Nothing new on Race day” is very fitting in regards to nutritional strategies, therefore rehearsal and fine tuning is imperative.

Individuals usually tolerate liquids fairly well.  If you can find out what you’re “A” race will have available on course it is a good idea to start utilizing that on your  longer workouts, or have  a strategy and set up that allows you to carry all you will need on board your bike of a liquid of you’re choice.  A host of bike hydration options are available, often a simple behind the seat and between the aerobars set up is a good safe option.  Practice with that bottle location to assure you can that it can be safely and effectively reached during the ride.  On the run there are options to carry your own liquids as well through the use of fuel belts.  Maltodextrin products such as CarboPro are tasteless and easily dissolvable in most liquids. There are also flavored options available such as INFINIT (IREPINFINIT for 10% off at check off)  Practice adding these at different amounts to deliver more calories during exercise to replace the calories burned and increase performance. 


Gels would be our next easiest product to process during an event.  Some gels are mixed with sources of fuel that come from fructose and glucose.  Also pay attention to your electrolyte needs, a “salty” sweater may benefit from a gel that contains more sodium in hot/humid conditions.  You may also get some benefit from gels that contain caffeine as it is a proven performance enhancer.

As food sources start to get more solid the processing time increases as some more complex digestion is required.  Some may choose to experiment with more semi solid/solid food sources. While some do very well with these types of fuel, be cognizant of how easily these are eaten at race pace.  The unwrapping and chewing process can be more difficult than one may think and leave people unsteady on a bike or choking on the run.

A quick and easy starting point is to assign 2 calories per hour per pound of lean body weight.


200lb @ 20% Bodyfat

200lbs x .20 = 40 lbs of fat

200lbs – 40lbs = 160 lbs of lean body mass

160lbs  x 2 cals per lb per hour = 320 calories/hour

In summary, KISS (Keep, It, Simple, Stupid).  The less moving parts the better and the simpler your nutrition strategy the more likely you are to execute it perfectly.  Sometimes Less is More and Nothing New on Race Day!!

Best in Health,

Scott Proscia, BS ATC M.Ed
Head Performance coach IREP Athletics


The Strength to Swim Properly

The early vertical forearm in swimming is an elusive skill for most adult onset swimmers. It is the ability to latch on to the water soon after the hand enters the water and pull the body past an anchored hand in an efficient manner. The swimmer does this by internally rotating the shoulder allowing the hand and forearm to drop below the elbow before initiating the pull while the arm stays abducted out to the side. The swimmer should feel some resistance from the water medium in the palmar aspect of the hand and on the forearm. This feeling can be illustrated by imagining a driver in a car rolling down their window and placing their hand on the side view mirror. If they were to externally rotate their shoulder and lift their hand straight up (as if they were signaling a Right turn on a bicycle) they would feel a similar resistance on their hand and forearm.

A common problem for some swimmers is dropping the elbow below the forearm and hand and pulling with a straight arm. People simply do not have the strength to hold elbow in a high position close to the surface as the forearm and hand drops down during the catch and pull.

We can address the strength deficit with the exercises below:

Prone Scaption Series

All of the following exercises can be done on a Treatment table, flat weight bench, incline weight bench or on a stability ball:

“I”/ “i’s” – the arms remain close to the trunk and are raised with the palms facing each other. The shoulder can flex and the arms extend past the head or the shoulders can flex bring the hands near the hips

Prone Scaption Series I Arm Abductions

“T” the arms are abducted with a straight arm. Weight may be added to the hand. This exercise can be done with thumb up and thumb down

“W” the arms are abducted out to the side with a flexed elbow creating “W’ shape. The palms should face the ground
 ?W? the arms are abducted

“Y” the arms are extended out in front of the head. This exercise can be done with the thumb up and thumb down.

swimming arm exercises 

Weight/Band Bent Over 90 degree Shoulder Abduction


Weights or bands are placed in the hands with shoulder and elbow both abducted to 90 degrees the weight is lifted straight up linearly. The hands should remain on plan and not deviate towards or away from the body.

Standing Shoulder Flexion with External Rotation Isometric using band

Shoulders are flexed overhead and arms are slightly internally rotated as if initiating the catch phase of the freestyle stroke. This isometric contraction should be held static for time.

Prone resisted abduction and external rotation isometric


Resistance for abduction can be placed around the elbow joint using a band or weight cuff.  The use of a distal weight in the hand stressing the isometric external rotation can be utilized to emphasize keeping the shoulder high when initiating the catch phase of the swim stroke

Beating the band

I have been either studying or working in Sports Medicine since I entered Undergrad in 2001.  I had no major injuries even though I was an athlete from the age of 3 through college.  I always thought that my patients with overuse injuries had a bit of a soft side to them and were looking for an easy out as all of my injuries I was able to play through or missed very little time of practice or competition.  From 2005-2010 I was very sporadic in my exercise regimen.  I neglected my body and when I started off in endurance sports I met my first overuse injury.  I was running some stairs (never again by the way) and it felt like someone stuck a hot knife in the side of my knee.  I ran back the 2 miles to my starting location with this grinding and clicking that reminded me the time the transmission blew in my Camaro and I had to limp home in 1st gear.  Thinking I was just having a bad day I went out the next day for the next run was and BOOM! Less than a mile in and I am officially injured.  I immediately went past ITBS and thought this must be a Lateral Meniscus Tear or I avulsed something off because it hurt so bad.

Decades of runners and cyclists have been plagued with the infamous Iliotibial Band (ITB) pain.  Iliotibial band syndrome (ITBS) usually presents as sharp or burning lateral knee pain.  The pain is often reproducible and rears itself early in a workout often at a specific time or distance stopping the runner in their tracks.  This debilitating pain usually subsides rather quickly with only lingering symptoms occurring with ascending and descending stairs.  This article will review condition and provide rehabilitation strategies for managing ITBS.

Anatomy Review

The ITB is a thick band of fibrous connective tissue that originates on the iliac crest sharing fascia with the gluteal muscles and Tensor Fasciae Lata (TFL) proximally and continues down the lateral aspect of the leg tying in with the Biceps Femoris and Vastus lateralis where it crosses the knee joint over the lateral epicondyle inserting on to the Tibia.

When a person runs their hip and thigh muscles help to stabilize the thigh and pelvis.  The range of motion of moving your lower extremity at the hip away from the midline of the body is called abduction.  During the running gait at the initiation of the swing phase of one limb the opposing leg is in full contact with the ground at mid stance and the pelvis should remain stabilized by the active muscles of the TFL and Gluteus Medius to prevent “crashing” or a Trendelenburg’s gait pattern by abducting the hip.


The ITB is a thick tendinous extension of the TFL.  Tensile strength of the ITB has been reported at 7800 psi or the same as soft metal.  The ITB shares some attachment with the lateral patella as it crosses the knee joint before inserting onto the lateral tibia.  As the knee flexes around 30 degrees an area of friction or compression occurs at the lateral knee.  Irritation occurs at this location (impingement zone) causing inflammation of the underlying tissues of the posterior side of the ITB, Bursa and fatty tissue.  Chronic ITBS suffers may even develop thickening of the ITB in this area further exacerbating the condition.   Some studies have even shown bony erosion occurring at the lateral epicondyle in the most severe cases.

So why do some athletes get this injury and others do not?

Am I just tight?  The Ober test is a standard clinical laxity stress to to evaluate tightness of the ITB. (insert picture)  Tightness of the ITB will present with the leg not falling into adduction past neutral.  A fair assumption is that if we are qualifying compression or friction as a mechanism of injury that a tighter structure would cause more of this to occur further increasing the problem.

What causes this tightness?  It was mentioned in the anatomy section that the ITB is a biarticular structure that shares fascia connections throughout the hip and thigh which makes this a complex question.  The common belief is that the ITB is tight when rather it is a holistic problem affecting several muscles of the hip and thigh.  A trigger point is an area of restricted tissue.  All trigger points are not created equal and restoring these tissues often requires movement patterns and manipulations that differ from traditional techniques.  Kelley Starrett, DPT of the Mobility WOD and author Supple Leopard is an expert that has developed various movement techniques which do a tremendous job of addressing these tissue conditions.  With ITBS we often see restrictions proximally in the entire hip region, restrictions can be found in the flexor component of the TFL (which also is in charge of abduction), the Gluteal muscles and the hip rotators.  So what is not affected?  Not much!  We are plagued as a society that most of us sit entirely too long.  We develop contractures, tightness and a laminating effect of our tissues through lack of movement and spending most of our time in a far from ideal position.  As we move distally we see restrictions in muscles that connect directly to the ITB which include the Vastus Lateralis and the Biceps Femoris.  Getting “slack” and allowing these muscles to slide on each other normally again is the mission and one that often requires habitual attention.  There have been some contradictory research that shows a correlation between excessively mobile ITB and ITBS but far more has been published on the other end of the spectrum.

Am I just weak?

I mentioned tightness first because I feel that there is a connection between tightness and weakness and it is often similar to the chicken and the egg question; which came first?  I think the answer to this varies but they may be interconnected or one may have caused or exacerbated the other.  We can see a phenomenon called reciprocal inhibition occur in the muscles that affect ITBS suffers.  Our muscles work in opposing pairs called agonist (primary mover) and antagonist (the muscle that goes on stretch or opposes this muscle) the simplest example is the Biceps and Triceps of the upper arm.  When the Biceps muscle is contracted the Triceps muscle goes on stretch.  Now imagine if we transplanted someone’s triceps muscle with a wooden dowel that was 2 inches shorter than the maximum length the muscle normally stretches too.  We would see a major restriction in the amount of elbow flexion that would occur creating a deficit.

 Now weakness may be the chief cause of the tightness which starts this cascade of events.   Using our same example of the biceps and triceps, if the person developed a major biceps tear which caused significant weakness in the range of elbow flexion.  The lack of exposure the triceps will receive in a stretching capacity will increase.  The response from lack of stress being applied to them is that they like to stay in that position more.  The sliding surfaces get sticky and matted down and the muscles adapt to the new stress level that is placed upon them.  SAID specific adaptations to imposed demands.

We classically see hip abductor weakness in ITBS patients.  The Gluteus Medius is in charge of abduction in midstance and is in charge of preventing the pelvis crashing down on the opposing side which creates a huge amount of biomechanical compromise creating large amounts of tension in the ITB system when the foot is in contact with the ground in the running gait.  We will address strategies and exercises that target this musculature in later sections.

So the answer to what cause ITBS is complex and often has many contributing factors that we will need to manage over time to resolve symptoms.

 So what can we do to resolve ITB pain?

A regiment of mobilization, stretching and strengthening is a recipe for success.  Let’s start by exploring stretching.  There is something to be said about getting tissues in a good position prior to performing strengthening.

Let’s dive into mobility first

Distal Quad mobility with lax ball

In a prone position place Lax ball just above the patella (knee cap) shift weight to side of lax ball pinning down tissues,  flex and extend knee repeatedly until  any crepitation or tightness resolves or up to 3 mins.  Note you may find an area of “Gristle” on the lateral border of the patella with connections to the ITB, do not be afraid to spend some time here and clear that area.  You can also move this lax ball against the entire length of the ITB peeling the vastus lateralis off of it ungluing the tissues and gaining extensibilitiy.

Foam Roller

In a prone position start foam rolling quadriceps rotating to a sidelying position and mobilizing vastus lateralis , pay additional time mobilizing tissue connection points of vastus lateralis ( outside part of thighs) to the ITB.  If you find a trigger point or tender spot do not roll past it but oscillate and rotate on that area until that tissue releases.  (Yes! if you are doing this for the first time you will want to die….no eye water please) 

MWOD inspired Hip Opener


Start in quadraped (on all fours) position.  Cross affected side across the body and locking it in front of opposite knee.  Shift weight to the side with the leg that is being crossed.  Shift hips laterally in the frontal plane (like your sticking your hip out to that side) and scour and oscillate on that side you should feel like the head of your femur is being stripped of its tightness releasing as time goes on.  See for additional variations including banded distraction (super awesome)

Lax ball hip smash

In a seated position with leg crossed sit on lax ball on affected side.   Roll smash and oscillate on the ball around the head of the femur stripping connection points as you roll.  Control weight with pressure on your hands as you move into muscular structures including all of the glute musculature working all the way up into your lower back.  If you come across a tender spot attempt to apply additional pressure until released and oscillate through it.  You may need to swing your knee in various directions to get to deep nastiness.  If you are lucky you will find a nice little tender area just superior to your femur on the lateral side that sends an electric sensation down to your lateral knee lean into it and enjoy.

Sidelying Hip Flexor Knee Extensor smash

In sidelying position get lax ball in the ara between the top of the iliac crest (hip bone) and the head of the femur.  You will find some tendons that need some attention. As you roll try to separate these tissues releasing the entire area. (do you hate your lax ball yet?)

Moving to stretching

SUPER QUAD or (KStarr’s Couch Stretch)

In a kneeling position place knee into corner of wall and floor.  Working from a quadraped position move to an upright position attempting to fire glute and press hip forward.  You may use Proprioceptive Neuromuscular facilitation (PNF ) or periods of pressing forward followed by relaxation to gain further Range of Motion opening the hip angle.   You may add hands overhead or rotation away from the knee that is down for additional problem areas of tenderness and restriction

Standing Hip Flexor/ Knee Extensor hang

Place knee on back of chair, couch or table.  Drop knee toward floor hanging toward foot support.  Oscillate and maneuver knee so that you get a pulling or stretching occurring at the lateral knee cap.  Goal here is to open hip, stretch anterior thigh and distal fascia at knee.

Cross Over ITB

In a standing position cross the affected leg behind the other.  Drive hip laterally out to the side utilize reach across and reach overhead to add additional tension to the stretch. (Research has shown overhead reach to add most increase in length to length with stretching)

Partner Y stretch

Have your patient lie supine bend knee and place foot of non-affected side across the affected side.  Place affected leg on your hip and block knee movement with hands at other sides.  You will shift your weight to the opposite side manually stretching the ITB of the patient.

Mobilization/ Stretching Summary – Hold all positions and movements 1-3 minutes spending up to 5-8 minutes on problematic areas. Note – there really is no right or wrong here you will develop a feel for when you have cleared the area.  You may not be able to get all of the problems resolved in your first attempt.  Spending 10-30 minutes a day either before or after your activity will get you on the road to preventing or fighting ITBS.  For ITBS I do like a mobilizing and stretching tissues prior to running.  I want as much length in the complex as possible prior to running.


3 point Lunge


Multidirectional Lunge – step forward bending back knee to 90 degrees.  Step straight forward, Step on a 45 degree angle, step to the side, repeat 6-10 times each leg in each direction for multiple (sets 2-4)

Straight leg raise

Lie supine with one knee bent and foot flat on floor.  Lock knee into terminal knee extension and lift leg to the level of the bent knee.  Repeat this with hip external rotation (rotate foot toward the outside) this will target the VMO and hip adductors 3-4 sets of 10-12 reps

Hip abduction

Side lying with effected leg up perform straight leg lift, add internal and external hip rotation (pointing toes toward the ground or ceiling for progression.  Perform 3-4 sets of 10-12 reps

Hip Hikes

On a step or box start with pelvis in neutral position controlling drop of leg until foot comes close to touching ground with straight leg.  Actively fire hip abductors moving past neutral hiking hip up perform 4 sets of 12-15 reps

Cross Over Step up

Stand parallel to stairs or step up box.  Cross outside leg up onto step pushing through flat foot control hip motion moving to a hike position.  Control slow eccentric movement ad you return crossing back in front of leg. 3-4 sets of 8-12 reps

Weight shift step ups

Place foot flat on step or step up box.  Shift weight loading hip and glute on the side you are stepping with.  Driving through heel  step up and repeat. 3-4 reps of 10-12 each side.

Lateral Band Walks

Place band at Knees or ankles.  Shuffle without clicking heels in a controlled manner 10-20 steps in each direction. Repeat 3-4 times with legs straight and knees bent

Quaraped Hip circles

On all fours lift knee off of ground perform small and large circles with knee.  20 small circles clockwise 20 counterclockwise 20 large clockwise 20 large counter clockwise


Side lying with surgical tubing around knee place heels together and abduct hip opening knees apart 3-4 sets of 10-15 each side

Wall twists

Standing in line with wall approximately 6-10 inches away rotate trunk away from wall while rotating hips toward wall until tapping wall with hip in a controlled manner.  3-4 sets of 15-20 touches

When am I ready to return to running?

This is a tough one and one that I cannot answer precisely and even struggled with management of answering this in my own recovery.  This is very subjective and may lead to a few setbacks or disappointments along the way.  Research has shown that the area of friction/compression is reduced during faster running so actually starting back with something faster paced in an interval manner may be of better choice in return to play decisions.  Some articles contribute downhill running to ITBS albeit scant anecdotal information we might as well keep the course flat and why not softer surface, track or firm grass early on. There is no measurement or guide as to return to play protocol but there are some things to look for.  We want to make sure that the ITB is flat meaning that any acute swelling or inflammation to the problem area has resolved.  Pain with ascending and descending stairs should be resolved prior to any progression into a running program.  Any clicking or popping should be non-existent.  I would like to see patient’s symptom free for 7-10 days at minimum.  Aggressive mobility and strengthening can alleviate symptoms very fast but an aggressive return to running may lead to a restart in the recovery process.   Triathletes must also be cognizant of non-running aggravating activities such as pushing off the wall swimming and cycling.  Note some can tolerate these activities very well but others this flares their symptoms.  As you can see there are so many tissues that may be involved that the determination of the recovery timeline can only vary from individual to individual.  Working with a local Athletic Trainer or Physical Therapist should help guide your recovery and return to play decision making plan.  They will also have access to specialized equipment such as Alter G and aquatic treadmills which may be beneficial in a return to running protocol.  Work hard listen to your body and BEAT THE BAND.

Best in Health,

 Scott Proscia, ATC M.Ed