Ruminations on sports, training, health, and wellness

Posts tagged “education

A Massage Therapist’s Notes on an Imperfect Art

Nearly 2 years ago, when I was just starting to post on this blog, I was thrilled to attend a talk given by one of my childhood heroes, Robert Ballard, who answered my questions about how to get kids excited about science. He told me to meet their passions with matched enthusiasm, and to keep asking questions of my own.

Two years later, and I’m happily in the position of doing just that — getting young people excited about science as I continue to delve into the beginnings of what I hope will be a career as a science educator. Yesterday I took my students on a tour of active biomechanics labs at a high research activity institution, and this morning we talked about physics in the context of football pads and baseball bats. It’s been a pretty awesome week already, and it’s only Tuesday night.

temp-complications-cover-203x300The highlight of my week was outside the classroom, however — I had the great good fortune to attend another Bryan Series talk given by Dr. Atul Gawande: surgeon, MacArthur fellow, and author of four highly acclaimed books. I read Dr. Gawande’s Complications: A Surgeon’s Notes on an Imperfect Science in 2010 while I was recovering from a cholecystectomy (which made me really glad I waited until after the surgery to read it when I got to the chapter about how often cholecystectomies go terribly wrong). The book made me examine my own approach to science and knowledge; one of my great frustrations with massage school was hearing teachers parrot outdated assertions because that was the way it’s always been done, even though advances in science give us new perspective on our practices. Dr. Gawande’s approach to medicine by asking why we do what we do, whether it’s working, and how we can do it better was the first in a series of “eureka” moments that ultimately led to my decision to go to graduate school and pursue a better rounded education in STEM topics.

I’m batting 1.000 at questions I submit to Bryan Series speakers actually getting asked in the Q&A portion of the lecture; I posed to Dr. Gawande how allied complimentary healthcare practitioners, such as massage therapists and acupuncturists, can communicate better with physicians to become a more effective part of the healthcare team. Dr. Gawande described his sister in law, a massage therapist and “holistic healer” in Asheville, NC as an “artisan” whose vocabulary and rhetoric regarding medicine failed to mesh with his own and resulted in communication breakdown even when probably talking about very similar things. But, he said he recognized that his patients seek out practitioners like her for their services, so it’s important for physicians to be aware that these people are meeting some kind of particular need. And he added that his wife much more frequently seeks advice from her sister than she does from him.

Albinius-217x300Atul Gawande’s tacit acknowledgement of complimentary alternative practitioners as a bit of a fringe entity to the medical mainstream speaks to a lot of my frustrations with massage education and science education as a whole. I had a huge epiphany when I took a continuing education class on structural myofascial therapy last winter and I caught myself tuning out as soon as the instructor mentioned “energetic connection.” My woowoo-ometer is on a pretty fine hair-trigger these days. But as I willed myself to appreciate the spirit of the instructor’s message, I realized that when he talked about the implicit energetic connection between the feet (energetic grounding) and the hip (energetic centering), he was using different words to describe the principles of biomechanics that I know and embrace — kinetic energy manifested in the form of mechanical work is dispersed from the feet (ground reaction force) to the hip (joint reaction force) by the same network of musculoskeletal and connective tissues he was describing as a “myofascial meridian.” Holy crap. Mind blown. We’re talking, gray matter spattered on the walls, here.

We massage therapists devote a lot of hand-wringing to being taken seriously as medical professionals. Indeed, we have come leaps and bounds thanks to leaders in the field who are producing some very fine scholarship and advocacy for better education and standards for licensure. We’re enjoying a very exciting time for our profession as cutting-edge evidence-based practice collides with millennia of tradition to snowball into a paradigm shift. I’ve only recently come to recognize that great groups of thinkers and doers don’t become great without extremely hard, intentional work. I want to be there — out on the front lines, surging ahead at the prow as we enter a new era in integrative medicine.

I also recognize I can’t do it alone; this has to be a group effort. The old adage goes, “dress for the job you want.” We, as a profession, need to become fluent in the language of progress. We need to make a concerted effort to learn not only the common tongue of medicine, but of professional scientific practice. Let us abandon the days of “we do it because that’s the way we always have” and open wide the floodgates of the relentless, “why.” We need to be critical consumers of information and implacable questioners of the provisional. When our best understanding of our practice evolves, we have to evolve with it.

I take my fair share of barbs for voicing my criticisms, but I assure you I hold no one to a higher standard than to which I hold myself. I make no asservations of touchy-feeliness. I am utterly fascinated at the phenomenon of how different people, presented with the exact same availability of information, can arrive at diametrically opposite conclusions on any matter (science or otherwise), and I am recognizing that my convictions I hold to be self-evident are just as true to me as their mirror images are to my peers who fall on the opposite side of the fence. What I mean is that I am becoming more aware, as a practitioner and an educator, that all truths should be subjected to equal scrutiny to separate the staunch edifices from the crumbling sand foundations. When we ask the tough questions, we have to be prepared to accept tough answers.

Keep digging, friends.

Digging


A Change of Scenery

Hi friends!

It’s time again to set aside lofty expectations of mind-expanding academic inquiry in blog post form, and present instead a newsy update of life and times in massage therapy and bodywork.

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In the beginning of November, I joined Dr. Damien Rodulfo’s sports chiropractic practice, Healing Hands Chiropractic. Just around the corner from my old digs, this office houses two chiropractors with advanced specialized training — Dr. Rodulfo and Dr. Herman — a physical therapy assistant, an acupuncturist specializing in dry needling and neuromuscular therapy, and me — sports massage therapist and science nerd extraordinaire. It is truly a dream team of allied practitioners and I am tremendously excited to be settling in and finding my niche in the practice.

download (1)This past week was my first week of class back at the Body Therapy Institute, where I attended massage school in 2009, this time taking the Advanced Myofascial Massage Certification course. This approach to bodywork more closely resembles Structural Integration or Rolfing while applying the principles of deep tissue massage to treat fascial restrictions. The concept is based on Tom Myers’ groundbreaking theory, presented in Anatomy Trains, wherein the connective tissue web that encapsulates every bone, muscle fiber, bundle of muscle tissue, and organ in the body is treated as a single unit — thus, a restriction in one extremity can affect movement and postural patterns in a completely different part of the body through the kinetic chain. The first week of class was an eye-opening and invigorating shift that turned my approach to massage on its ear (sometimes literally!), and it has really gotten me excited about the possibilities for applying this work in a sports and physical activity capacity.

As such, a unapologetic plug for my business: To complete the certification requirements, I must log several sessions of massage using these techniques between now and February, including a case study. This is your chance to get some awesome bodywork at a substantial discount. Myofascial structural massage is most effective if performed in a series with one session every week. If you book a 3-week massage series between now and February, you will receive 3 90-minute massages for just $50 each — a $120 savings. Payment in full is due at the time of the first appointment. These sessions are non-refundable for cancellation and non-transferable (re-scheduling accommodations within reason can be made). To book your myofascial structural massage series, you can call me at 336.253.4263 or book online at www.saraclawson.com (put “myofascial series” in the notes section to receive the discount). Myofascial massage is perfect for anyone — you will be able to remain clothed, move around, and notice immediate changes to posture and movement patterns. I really believe my existing and new clients alike will be impressed with the effectiveness of this approach!

2015 is shaping up to be a year of education for me: not only will I be completing my Advanced Myofascial Massage certification, but I am stepping over to the other side of the classroom as a science educator in several different venues.

post-greensboro-college-304I’m excited to be joining Greensboro College’s kinesiology department as an adjunct professor of biomechanics in January, offering a course and lab both spring and fall semesters. This is my first foray into higher education as a professor teaching a complete course, so I’m really nervous about doing a good job and getting my class excited about physics, math, and the elegantly intricate body in motion. Do you have any memories of great professors (or terrible ones) whose teaching methods have impacted your life? Let me know in the comments — I need all the help I can get!

I am also joining the faculty of Kneaded Energy School of Massage in January as the anatomy, physiology, and pathology teacher for the night program. We’ll be starting out with musculoskeletal anatomy until April, at which point I get to dive into physiology, chemistry, and pathology. This is a great step for me to bridge the gap between education and massage therapy, and I can’t wait to see the next generation of massage therapists in action as they enter the career at a time of wonderful growth and development. If you’ve ever been interested in pursuing massage as a career, KESM is a great place to start.

Also on the massage front, I am extremely excited to be offering a continuing education class of my own at the Body Therapy Institute in April: Sports and Performance Massage. If you are a massage therapist, physical therapist, or athletic trainer, this course is for you! We will be drawing from biomechanics, sports medicine, and evidence-based practice methods for therapeutic manual bodywork in an athletic setting. This is going to be a major on-your-feet, get-up-and-move class, and in the course of 3 days we’ll cover the body in motion, practical approaches to sports injuries, and coaching rehabilitative exercise to maximize performance (and save your hands). It’s a 21-hour course, which (combined with 3 hours of mandatory ethics training) satisfies the North Carolina requirement for massage therapy license renewal. We are going to have so much fun!

That’s all for now — gosh, I’m tired already just from proofreading this list, and it’s not even January! I hope the coming weeks and months hold winter wonderment for you and your family, and a special thank-you goes out to all the friends, family, clients, and mentors who have supported me on what has been a wild and amazing journey in sports medicine this year. Here’s wishing holiday cheer to all you happy runners, determined triathletes, crazy cyclists, and everyone else this year and 2015!


Relentless Curiousity

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It’s autumn in North Carolina, which can only mean three things: spectacular sunlit leaf color, a distinct uptick in latte consumption, and NCAA college sports in full swing.

I get the privilege of working with several Division I college sports programs, most notably my graduate school alma mater: the University of North Carolina at Greensboro. I’ve been feeling the Spartan love this week with lots of outcall sports massages in the athletic training room, and working with these talented young people never fails to keep me on my toes.

The Internet Age has given athletic people vast resources to learn more about sports, nutrition, physiology, training, and therapies. On the whole, I am impressed that the availability of knowledge seems to help my massage clients to be well-informed and discriminating consumers of information. People who participate in sports at a high level view their bodies as tools — their vehicles for recreation and competition. This insight frequently leads them to constantly seek and evaluate information that will improve their performance, health, and experience. It also means they ask practitioners a lot of questions.

It’s easy to view “why?” as a challenge: a threat to authority and credibility. But forcing myself to dig deep into the body of knowledge through the incredibly effective (and sometimes incredibly annoying) Socratic method makes me a better practitioner and helps me build a reputation among my clients that I am a trustworthy source of information. The college students I work with ask questions that often catch me off guard, and the exercise of thinking analytically and critically to construct a thoughtful answer is often a missing ingredient in massage education.

Let’s apply it to a common instruction massage therapists give to clients following a bodywork session: “Be sure to drink plenty of water after your massage.”

But why?

The pat answer many of us learn in massage school is “to help flush out metabolic waste.” But what does that mean, and most importantly, is it a rigorous and factual response to the physiologic processes at work?

To be thorough and deductive in crafting an answer, consider all the pertinent facts. Massage therapy has a demonstrable effect on blood and lymphatic circulation, because the mechanical manipulation of soft tissues introduces heat and pressure, which creates a mild inflammatory response. The body’s response to topical heat is rapid dispersal by dilating capillaries in the tissue, which decreases blood pressure because of decreased vascular resistance. To maintain homeostasis, the body responds to the drop in blood pressure by adjusting fluid uptake in the blood stream and changing heart rate to stabilize blood pressure. One important role the circulatory system performs is transportation of the surplus substances of metabolism and energy production and expenditure to the kidneys to be excreted from the body. An example is the process of converting protein into energy: the leftover substances include ammonia, urea, and uric acid, which are toxic if they remain in the body. Massage is not directly shown to release metabolic waste from soft tissues under study conditions, but in consideration of the peripheral responses to massage, appropriate hydration supports homeostatic processes to promote optimal muscle function and recovery. Most importantly: with the exception of a few conditions such as hyponatremia (abnormally low electrolyte dilution), drinking water is an appropriate recommendation for overall health an wellness; the risks are vanishingly small, and the potential benefits are great.

For many clients, this explanation goes in to way too much physiology detail. However, I think as a therapist, it is important to understand the complete picture and to be able to articulate it accessibly and intelligently. It establishes credibility and develops the ability to think critically and scientifically about the therapeutic intention of our work. It also helps me to be better able to talk about the effects and benefits of massage to other medical providers, which has made a huge impact on building my client base and becoming regarded as a skilled practitioner, able to get into a variety of unique opportunities as a massage therapist. For me, it’s simply not enough to regurgitate pat answers; I am voraciously curious and keeping current on research helps me to continuously refine my methods and understanding.

If you are a consumer of massage therapy, I encourage you to ask your therapist questions about what he or she is doing and effects on the body. I think most therapists are like me — we get really excited when clients show an interest in our specialty and we want to share with you information that can positively impact your health, wellness, and understanding of your body. Learning about physiology and anatomy in school was like getting an owner’s manual to my body and I love sharing that feeling of empowerment through knowledge with my clients. I don’t think it’s appropriate to try to test therapists’ knowledge with “trap” questions, but to approach your therapist as a resource to broaden your understanding of health, wellness, and activity. Additionally, most massage therapists maintain an extensive referral network of other allied healthcare professionals, so even if we can’t directly answer your questions, we can almost certainly direct you to another expert who can.

Do you have a burning question about massage therapy, or are you a practitioner who has encountered great questions from your clients? Shout out below!


Striving for a Beginner’s Mind

First, a disclaimer: this post is going to be a self-congratulatory/self-flagellating exercise in navel gazing, although I hope not entirely devoid of insights. If that’s not your thing (and it’s totally cool if it isn’t!), it’s probably best to skip over this one. I promise to get back to bicycle racing soon. Without further delay, I present my latest Soigneur’s Diary entry.

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This is a really flippant, privileged, entitled-white-girl-from-the-suburbs thing to say, but rings true: I’m not used to not being good at things.

I’m a little bit on the type-A side in that respect. I tend to pick up new things pretty easily — new sports (with the notable exception of inline skating), artistic pursuits, academic skills, clinical skills, using technology, and so forth. I try to embrace the “see one, do one, teach one” approach to learning and it generally serves me well. I take pride in mastery of processes and making meaningful contributions through my work. I learn best when I can take a methodical approach and clearly see how all the moving pieces fit together.

So it’s absolutely driving me crazy that I’m not a great soigneur already. I feel like I have about 1 out of every 10 days of total competence versus completely screwing up and getting in the way. There are a few things I’m doing very well, like therapeutic massage and first aid management, but it seems like such a small percentage of the job. It’s the part that the director rarely sees, which really shouldn’t matter — performing my job expertly is its own reward and if I’m doing it right, my part should be relatively invisible as athletes recover from racing and heal from injury easily and rapidly. I would never presume to take credit for their achievements, but I am keenly aware that poor clinical reasoning on my part will inevitably impact them negatively.

But that’s the tip of the iceberg; the other 90% of unseen lurking mass is the part that consistently trips me up and makes me feel foolish at best and incompetently negligent at worst. Part of the challenge is the rest of the job should be more or less invisible too: the best soigneurs get noticed by going unnoticed. Everything is immaculately prepared and arranged when it needs to happen without question or hesitation. All the details are managed to make a perfectly smooth big picture. All this is done without the expectation of thanks; at the end of the day, the things that matter are that the riders are cared for, and the rest of the staff is happy and never inconvenienced by a task left incomplete.

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I am working so hard to get to that point. I had a long phone conversation with my mentor yesterday, who likened my situation to being thrown into battle on the front lines without basic training. (I have a hard enough time justifying a career in something as “trivial” as sports to my Quaker Meeting; the military metaphor might be enough to get my Friend card revoked!) It does feel a bit like that sometimes, but I think of it more like a counter-terrorism squad: people only notice the superb work they do when they let that one-in-a-million slip through the cracks and horrors ensue. (I’ve been watching Homeland in my spare time before bed; ugh, my Quaker card is definitely in serious jeopardy now). Obviously, forgetting a chair or mislabeling a supply box doesn’t have quite as serious repercussions, but it shows that I’m not performing at the high standards to which I hold myself. I feel like 5 months of doing this job should be enough time to achieve proficiency; I mean, seriously, sure there’s the sports medicine bit, but mostly I wash vans and fill bottles and make sandwiches. How hard can it be?

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I’m not a dumb person. I’m comfortable solving calculus-based biomechanics problems, I know all the bones in the human hand and nerves in the brachial plexus, I play half a dozen musical instruments, I got a perfect score on a section of the GRE, I can still recite the first canto of Dante’s Inferno in Italian that I memorized in college (which is probably why I have trouble remembering phone numbers). I’m a serial enthusiast and when I get really excited and into a particular topic, I read everything I can get my hands on to amass a near-encyclopedic knowledge about it (my mom sometimes calls me Cliff Clavin and I don’t think it’s a compliment). Emotional and social intelligence…maybe not so much. I have a hard time fitting in and perceiving social cues. I get so excited about successfully navigating a social interaction when I meet a new person that I invariably immediately forget their name. I don’t have a strong personality, and I think that causes me to come off as aloof, shy, and boring. In reality, I usually just have no idea what to say. I don’t think of myself as particularly cute, funny, or interesting, so I tend to discount and discredit the qualities and contributions I bring to the table. I am less shy than just painfully introverted, and I recharge with alone time and spending one-on-one time with close friends. I expend so much energy trying to be liked that I make myself wholly unlikeable. I’ve come to grips with the realization that I’m kind of weird and have weird interests, but I lack the confidence to fully own my weirdness and instead fall firmly into the awkward zone. I haven’t really found my people, so I make up for my difficulty forming friendships by throwing myself into work and dramatically overthinking everything. It’s pretty exhausting, actually.

Brain

I’m a worrier. I was in therapy specifically for aviophobia last year, and I realized that air travel was hardly the only time I experienced overwhelming anxiety. The psychologist I worked with appealed to my academic tendencies and gave me an array of articles and chapters to read about how the brain processes threat. Fear is hardwired into the prefrontal cortex “lizard brain” as an important survival tactic. When we receive a sensory stimulus like a sabertooth tiger crouching in the grass, an ancient programmed circuitry fires into action, engaging the sympathetic nervous system to divert all energy to escaping the danger. It is an evolutionary advantage for the brain to perceive a threat where none exists — if we assume that every rustle in the grass is a tiger, we are more likely to survive rather than if we incorrectly identify the rustle in the grass as just the wind when a tiger is ready to pounce. This tendency toward hypervigilance is the reason our species has been able to survive, proliferate, and evolve. It also causes an awful lot of problems in the modern world. When the amygdala receives signals that a threat is present, it floods the blood stream with stress hormones that activate the sympathetic nervous system, stopping metabolic processes and heightening sensory input to prepare the body to face or flee from danger. When a specific, discernable threat is present in the environment (the tiger, to continue the example), the system functions as designed. When there is not a threat readily identifiable, the amygdala looks for other environmental cues that could signal danger, and even cues within the body such as elevated heart rate and respiration. A panic attack is, in essence, crippling fear of fear itself. We then spin “what if” stories that have no actual basis in reality, taking us out of the moment to exist in an imaginary realm of fear and dread. Even though the conscious mind knows it isn’t real, the prefrontal cortex has no way of differentiating and responds to the imagined fear stimulus just as if it were a tangible threat.

My biggest fear is shame, and I am tremendously good at inducing it in a variety of situations. I think this is true for most people, and definitely for me: if I’m given a list of a hundred things I do well and one area in need of improvement, I obsess about the shortcoming and discount all the proficiencies. I dwell on my goof-ups and allow them to overshadow my talents. I walk around like a puppy that’s just been beaten with a newspaper, afraid that my coworkers are going to yell at me the way I am mentally berating myself (usually they don’t, but I live in terror of their disapproval). I parked a van in the wrong place yesterday and I spent the rest of the day in a funk when one of the other staff pointed out my error in an effort to help. It’s an attractive quality, no?

It’s also absurdly unproductive, and I know it is. My guilt and fear that I will never measure up is probably my biggest obstacle to competence. How do I possibly ask others to put their confidence in me, when I lack confidence in my own abilities?

While I was bemoaning my plight to my endlessly indulgent mentor, my mother sent me a TED talk that spoke to the heart of the matter.

In the video, researcher-storyteller Brené Brown explores the link between vulnerability, authenticity, shame, and courage — spoiler alert: she finds that the ability to embrace imperfection and celebrate shortfalls with successes alike is at the core of successfully finding fulfillment in all our relationships and endeavors. Yikes. The very idea makes my throat tight with the first inklings of panic. Wouldn’t putting my vulnerability on display counteract all the effort and energy I put into appearing like a pillar of confidence and strength?

Writing this post to go in the public sphere is my first step toward a healthier exploration of vulnerability. I don’t have to turn into a scared child to accept the fact that I will fail in life, sometimes often, hopefully not too spectacularly, and that’s ok.

My mentor had some great advice that is already helping me to feel more secure about my abilities. His first piece was to stop assuming logical leaps and to be more pedantic about questioning each procedural step. I love this approach; I learn best when I read the directions completely before assembling an appliance, so I have a thorough understanding of the process timeline from start to finish, and a discernable checklist of items that assure the task has been completed correctly. He told me to let go of my concern that people will judge me for insisting on a detailed explanation of mundane things, because an excellent end product at the expense of taking a little more time with the process is better than struggling as I go without a clear vision. The same concept applies to the challenge of dealing with cultural differences that I face with working in Europe — it is always preferable to spend more time hammering out details ahead of time than to assume we’re all on the same page because I don’t want to take up anybody’s time.

He implored me to do one thing at a time. Multitasking is the enemy of process. In science, the most important part of experimentation is the ability to repeat the exact conditions that will achieve a specific end result. Adding too many variables invites error. Accomplish each task completely before moving on to the next, and focus on the task at hand instead of allowing my attention to wander to the next one. Keeping a physical checklist is helpful for me in this area, because it’s one fewer thing to juggle in my mind as I learn a new skill. A slightly slower, more deliberate process is always preferable to hurried neglect.

As I establish processes that achieve satisfactory results, he encouraged me to allow those to become as instinctive as my sports medicine practice has become. He is the only director I have worked with who has actually seen me in action doing sports massage and first aid, and he commented that I am so comfortable in my element that a complex maneuver looks as intuitive and natural as getting out of a chair and walking across a room. I find it a little ironic that I am struggling to make setting out chairs and mixing sports drink as easy a task as performing a physical evaluation for knee pathologies. On the other hand, it’s good to remember that the hard medical part that many soigneurs spend years mastering is already more or less second nature for me.

One piece of advice that struck me at first as a little counter-intuitive was to apologize less. I have always tended to show profuse contrition over even relatively minor offenses, or those that are not even really my fault but I appeared in the wrong place at the wrong time. He told me to quit taking ownership and responsibility for things that are out of my control — not to be an excuse-maker, but also not to saddle myself with the burden of every mishap. Sincerity comes less from expression guilt and more from the actions taken to not let the same mistake happen again, and that’s what’s really meaningful to other people.

He instructed me to let mistakes go immediately. Every time I allow some part of my mind to linger in the past and obsess about a mistake, I am diverting attention from the task at hand and making another mistake more likely. It is always more productive, and often safer, to take a lesson and whisk away the rest. Mistakes in and of themselves have no value — the value comes from learning to approach the situation differently next time for a successful outcome.

Finally, he cautioned me against comparing myself to others. This is a pretty tall order, as I tend to evaluate the world around me through judgment rather than perception. There was a beautiful blonde Australian soigneur here this spring who was also a first-timer, and I was in awe of her skill. She was such a natural at every part of the job, and her extroverted effervescence and gregarious personality endeared her to the rest of the staff quickly in a way I admired and even envied. I have come to realize that she made just as many mistakes as me, but the biggest difference in her approach was her ability to laugh it off and hop right back on the horse. She seemed a lot less stressed than I feel most of the time, and I think her resilience was a huge part of that. I have been racking my brain for ways to develop the same resilience myself; it hadn’t occurred to me that perhaps it already exists within me and was waiting to be tapped.

I cash in another night feeling just a little better about my work today than I did yesterday. I gave a director a bad driving direction today, and I forgot that I had promised a rider to change his wound dressing when another director asked me to make a gas station run for diesel in the van. I didn’t let go quite soon enough on a water bottle feed and the rider knocked it out of my hand. But nobody died. We even won our race. And I am coming to realize that today was a job well done, even if it wasn’t a job done perfectly. And that’s ok.


USAC Redux, part 1

It’s a pleasantly steamy early summer evening in North Carolina and I’m enjoying a glass of wine on my porch and watching the fireflies dance in my yard. The relaxation and leisure of my life in this moment makes my life in Europe the last couple months seem like a dream. But I loved the thinly veiled chaos of my work in Europe as much or more than the luxurious Sunday afternoon nap earlier today.

To bring this blog back up to speed, we have to go all the way back to the Koga Ronde Zuid-Oost Friesland in the middle of May, a one-day interclub road race in the beautiful verdant farmland and pristinely groomed villages near Appelscha, Netherlands. We had all gotten a few days to recover from the Peace Race and legs were primed, injuries nearly healed. This was a new race on the calendar, and a dream-race for staff — spectacularly comfortable nearby accommodations (with an equally spectacular breakfast buffet), a non-UCI race with no caravan and no designated feed zones on the course, minimal gear, food, and prep necessary. Our seven-man team lined up with the directive of racing forward, getting at least one rider in every breakaway move, communicating with one another, and staying out of trouble. Easy enough.

Once the riders were off, the director, mechanic, and I made our way back to the team car and proceeded to the first point in the race for open feeding, a picturesque tree-lined lane just after a section of pavé. These were not the helter-skelter cobblestones of Paris-Roubaix, but had enough of a crest in the middle to scrape against the undercarriage plate on the team car (which had been installed before Paris-Roubaix for that very reason). Coming off the first stretch of pavé, our smallest, lightest rider who was crushing cobbles for his first time ever streaked off the front of the peloton like a rocket. We knew already that we were in for a show.

We wended our way through the course circuitously and managed to feed the riders at 4 different places before feeding was closed. By the 3rd time we passed out bottles, a dozen or so riders had broken off the front, including 4 of our team. They were doing exactly as their director had instructed: racing forward, being conservative but appropriately aggressive, taking the race in exactly the direction they desired. After the last open feeding, we proceeded back to the finish line. Our director reported that the Dutch race organizer had actually expressed that he wanted the Americans to win, that it would be good for the sport. This attitude is wholly unprecedented in European racing; American riders have almost always been viewed as relatively unwelcome outsiders.

We waited at the finish line, getting bits and pieces of race reporting in Dutch that bode well for our team. I left my cooler bag of water and soda at the end of the barricades, strapped a podium bag with a fresh kit, wet wipes, and recovery mix to my back, and staked out a good position to get some photo ops. Soon we heard that a single rider had broken away off the front, and it was indeed our incredible time trial master who performed so spectacularly at the Peace Race. Minutes later, the race radio reported that two more riders had broken away while the fourth remaining USA rider blocked to let them ride. We realized we were about to see something incredibly special: a 1-2-3 podium sweep team victory.

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It was breathtaking to see, made even more special from the Dutch race organizers and fans who said things like “magnificent!” The riders had truly raced forward, communicated with one another, and put on one heck of a race. Even at relatively small races like this, outstanding performances are widely recognized and not quickly forgotten — every other race I attended with the juniors team, someone mentioned the 1-2-3 podium sweep in Friesland.

After that, the team was on cloud nine. I had made a nice selection of sandwiches and race food goodies the night before, and had stopped at a roadside stand in Germany to buy several cartons of field-fresh strawberries as a special treat. Their excitement and satisfaction was as palpable as it was infectious; being part of the staff behind a big team win is almost as exciting as being out there on the road.

The next day we headed back out to the small Dutch village Lieshout, home to the Bavaria brewery, for an inter-club circuit race — something of a cross between a Belgian-style kermesse and an American-style criterium. The course was surprisingly challenging: hot and sunny with paver brick road surface, lots of turns and chicanes, and several raised roundabouts in corners. The juniors completed 65 kilometers, which is too short to permit or necessitate feeding, giving the staff a break and me a chance to indulge one of my other passions: race photography.

It was a heated race with an early two-man break by one of our riders and his trade team teammate from Hot Tubes Development, which the pack brought back until a bigger bunch got away and stayed away. It ended with a bunch sprint in which another of our riders gave it his all for a hard-fought 2nd, and our 4th podium in 2 days!

The team had such an outstanding, intense weekend that I got permission from their director to take them on a field trip to the nearby city of Maastricht, capital of Limburg with ancient roots dating back to Roman times. Today Maastricht is known for its vibrant city center shopping and dining district, with several beautiful churches and medieval structures still intact. Most of the riders had already visited on other trips, but it was the first trip for several of them, as it was for me. It was a great opportunity to have a nice lunch away from home base or racing with the guys, and to turn them loose while I did a little shopping and sightseeing.

The next day I had to fetch two more riders from the airport in Brussels, one of whom would join us for the upcoming Three Days of Axel race and the other who would ride Axel for his trade team, Hot Tubes Development, and join the USA team later in the season. After a nasty taste of Brussels traffic (some of the worst in the world; I got charlie horses in my legs in my sleep for days after riding the clutch for so long!) we packed up a truck and took the group to Zeeland, on the Dutch coast, to get a first taste of cobblestones and to deliver a couple riders to Hot Tubes.

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It was really neat to see such a large group of the best juniors in the United States in the same place at once. (If the one in the middle looks a little old to be a junior, that’s because he is our intrepid program director, William Innes). Cobblestones, sometimes called pavé, are a classic hallmark of northern European racing and riders who handle them with speed and agility forever have their careers defined by their excellence in “cobble crushing.” Nearly all of the famous spring classics feature sections of cobblestones, which range in difficulty from patio pavers to mud and moss-slick rock gardens more appropriate for mountain biking than road biking. Axel is known for its rough field cobbles with soft, grassy, muddy shoulders; they are as difficult to ride at high speed as they are dangerous, especially for riders without experience or proper equipment.

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With the team prepped and ready, it was up to me and our mechanic to get the bikes and remaining equipment shipshape. The courses of Axel are notoriously hard on wheels, so all the bikes were equipped with our special “Roubaix” wheels: aluminum Easton tubulars with heavy-duty puncture-resistant, wider tires. The wheels were an abnormally heavy setup for racing, but would give our riders the best possible chance at avoiding flat tires or crashes due to poor traction.

Unlike the Peace Race, the race organizers at Axel provide somewhat more edible food options, so I didn’t need to cook. From that standpoint it made the race logistics a bit easier on me, although I packed double of everything in the medical kit in hopes that it would be like carrying an umbrella when rain is in the forecast: preparedness would stave off necessity.

Prepping for Axel also gave me time to reflect on the weeks I had spent traveling to races in Europe, and I was truly sad that this would be my last race with the team. I knew they would get excellent care from other soigneurs as they continued their racing season, but the infectious excitement of racing had done its work and I was hooked. Had it been any other kind of hard work, I would have been looking forward to a respite, but I found soigneur work inspired an ethic and passion in me that I had never experienced to that extent.

The hour has grown late, my candle has begun to flicker, my laptop battery is waning and (most upsetting of all) my glass of wine is empty; we’ll pick this up next week with the pavé pandemonium of Three Days of Axel!


Fanning the Spark

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When I was in 1st grade, I thought dinosaurs were the best. The greatest of course was Triceratops, because of the beast’s striking, instantly recognizable features, and because it had “Sara” in its name (say it out loud). My mom showed me a book with beautiful pictures called Digging Up Tyrannosaurus Rex about the most complete T-Rex fossil ever found (incidentally, by my uncle’s sister in Montana) written by paleontologist Jack Horner. She told me that Dr. Horner had trouble in school because of a reading disability but he became a great scientist anyway. That was it; I wanted to be a paleontologist just like Dr. Horner.

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In 2nd grade, I did a book report on the American astronaut Sally Ride. I learned that she was the first American woman to go to space, and I was captivated by the pictures of her with her long hair floating weightlessly like a mermaid underwater. She used the robot arm on the spacecraft to retrieve a satellite, which I thought would be very handy to remotely play with my friends on the playground while I was still in class. That was it; I wanted to be an astronaut just like Sally Ride.

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Another book report in the 3rd grade brought to life Robert Ballard’s discovery of the German warship Bismarck. Dr. Ballard is best known for his discovery of the RMS Titanic, although he says that the lack of historical record and the nature of the shipwreck made the Bismarck much more difficult to locate. I read that Dr. Ballard’s tiny submarine, Alvin, fit 3 people in the space of a walk-in closet (I made two of my friends squeeze into a bathroom stall with me to experience this claustrophobia firsthand). I read that the pressure at 15,719 feet below sea level, where the Bismarck was found, was so immense that a styrofoam head would be crushed to the size of a shooter marble (I crushed a lot of styrofoam cups to see how much force it took). I read about how Dr. Ballard gathered evidence about the ship to recreate the battle that led to her sinking, and his observations supported the theory that the German crew had “scuttled” the ship, (a delightful word for an 8-year-old audience) intentionally sabotaging her inner compartments to sink the disabled ship faster and prevent her from being captured by the British navy. Most compellingly, Dr. Ballard had kept the Bismarck’s location a secret so that less scrupulous explorers couldn’t rob artifacts, preserving the shipwreck as a historical site. That sealed the deal: I was absolutely, positively going to be an oceanographer, just like Robert Ballard.

I actually stuck with my marine science enthusiasm for quite a long time, as these things go in the elementary-age demographic. Having to wait until age 12 to get SCUBA certified made my ambitions more difficult to maintain, and my interests drifted to a range of topics — music and the arts, then large animal veterinary medicine, then political speechwriting (that one is a little harder to explain, but I was really into it).

When I was in high school, my mom got really into running. I went to see her run the Women’s Only 5k on a beautiful, crisp October morning, and I was so impressed — there was my mom, lithe and powerful, with an awesome kick finish at the end! Something inspired me to requisition her steel hybrid bike that afternoon and I went out on my first real bike ride, a 4-mile loop near my house with a couple pretty good hills in it. When I got back, I had to lay on the living room floor with the ceiling fan blasting full-force for half an hour before I felt like I could walk. I was not a fit kid.

But the next day, darn it if I didn’t go ride that loop again. Twenty-five minutes to recover this time. Two weeks later, I had ridden every day and had gotten up to 20 miles in one shot! A month later, not knowing any better, I showed up at Paceline Bicycles on Saturday morning, 34-pound steel hybrid in hand, and rode 45 miles with some incredibly indulgent, sweet, helpful cyclists who took it upon themselves to make sure this strange kid on her wholly inappropriate bike didn’t become road kill out there.

My parents made what was, in retrospect, a slightly absurd leap of purchasing a $1200 Cannondale road bike for me for Christmas that year, and the shop let me ride it on the Saturday rides. Three months into cycling, and I was getting inexplicably fast. Chubby 16-year-olds typically do not keep up on 19-mph hilly shop rides, let alone start contesting sprints. This was a big deal for me — I had finally found my “why,” and at the same time a community of people who thought I was pretty cool for doing it.

I am not exaggerating when I say that cycling has changed my life in ways I never thought anything would. It led me to a career I love, deep and fulfilling friendships, a recreational outlet that feeds my soul and fuels my body, and a competitive activity that motivates me. My first date with my long-time boyfriend? A bike ride. It has become one of the most enriching parts of my life.

Earlier this week, I got to go back in time to visit 3rd-grader Sara when I attended a lecture by one of my aforementioned heroes, Dr. Robert Ballard. He is an extraordinary speaker, full of infectious vitality and passion. His vast knowledge from his prestigious career is almost overshadowed by his palpable sense of wonder and reverence for the thrill of discovery and the beauty of the world. Here he is in 2008 giving a talk at a TED conference:

Tell me that watching that didn’t make you want to drop everything and go be an oceanographer too!

After his talk, Dr. Ballard answered questions submitted from the audience beforehand. I really hope someone filmed this and it goes up on YouTube soon, but for now I’m going to try to remember it as best as I can. The moderator spoke, “This question comes from a Guilford alumna, Sara, who did a book report on your discovery of the Bismarck in 3rd grade. Presumably that went well for her and she finished her M.S. in a STEM field earlier this year.” Dr. Ballard gave a thumbs up. Swoon! “Sara asks what advice you have for young minds interested in science, and for the adults who want to encourage them.” Just when it couldn’t get any better, Dr. Ballard gave a beautiful, honest, heartfelt answer. An article in the Greensboro News & Record quoted him as saying, “Work with your kid. Don’t laugh at their passion. No passion is a bad passion. You just need to modify it sometimes.” He spoke of hard work and perseverance, what graduate students know all too well: you really have to want it; if it were easy, everybody would have a PhD. Most importantly, Dr. Ballard spoke about the importance of being supportive of children’s dreams — don’t dismiss them as unrealistic or unimportant or just plain weird, but share in their excitement and provide the support they need to chase their passion. Fan the spark just enough for the flame to ignite and come to life.

Whether or not we are parents, educators in the classroom or a less formal environment, or involved in the sciences and humanities, each of us has a real responsibility to usher in the next great generation of thinkers. We like to berate the kids of today for their “plugged in” attitudes, but the prevalence of technology and fluency in its use that “digital native” kids develop from an incredibly early age will be responsible for the next wave of innovation and advances. This is a big part of why I like working with youth and collegiate sports so much — committed, enthusiastic, hard-working young people engage with challenges in a very different, creative way. It is our responsibility to be open to those ideas and willing to entertain fresh thinking, rather than dismissing it as naive and supplanting it with the same kind of thinking that caused our problems in the first place. We live in a world that paradoxically judges the people who are “too into” their specific enthusiasm, but turns around and praise the Steve Jobs and Bill Gates people whose obsessive determination leads to outrageous wealth and advancement. We need to start redefining success; the first step, for me, is to embrace my passion.

Today, I’m about to get passionate about yard work. Go find your passion, and let me know how it goes!


Why We All Need Evidenced-Based Practice

evidenceYou may have heard the term “evidence-based practice” bandied about in relation to a broad range of disciplines, from medical practice to education to social psychology. Although the term was coined in 1992, the idea has been around for much longer, emphasizing a synthesis of rigorous peer-reviewed research, clinical observation and expertise, and interpretation of anecdotal and intuitive information through the scientific method. Evidenced-based practice has quickly gained traction among the medical community and has helped to improve patient care and practitioner credibility through establishing standards of practice and reliable sources of information.

Evidence-based practice (EBP) was a new concept to me when I started graduate school, which in retrospect is actually a little alarming. I immediately saw the potential to apply EBP to my massage therapy, and found it a little hard to believe that this wasn’t being already routinely taught and reinforced in massage schools. The school I attended has an excellent reputation and I believe that I got a high-quality foundation in massage therapy. However, the two days of class (out of an entire year) that we spent on reading and evaluating peer-reviewed journal articles were sorely inadequate (and the information on how to evaluate the impact of studies was cursory at best). I don’t think everyone needs to have taken graduate-level research methods and statistical analysis to be a great massage practitioner and consumer of information, but the disconnect I see between empiricism and practice in my profession troubles me.

I feel like massage therapy, as a discipline, is at the same crossroads that chiropractic medicine was 15 or 20 years ago. Chiropractors faced a conflict between highly educated, skilled practitioners whose methods were informed by keeping up with current research and their own expertise built upon observation over years of practice, and practitioners with dubious credentials who peddled quackery and “cures” on par with the snake oil salesmen of yesteryear. Chiropractors managed to change and improve standards of practice and the educational gateways to certification and licensure, bringing the profession as a whole into a more credible light in the medical community.The key to this paradigm shift was attention to the existing body of empirical evidence and constantly questioning tradition, asking “is there a more effective way to do this” than simply accepting that the current methodology is best because it’s the way it has always been done.

I routinely hear massage therapists insist that massage helps to flush lactic acid from the body to reduce the onset of muscle soreness. While this was an accepted explanation of mechanism 30 years ago, advances in muscle physiology now suggest that lactic acid uptake occurs rapidly following intense efforts and physiologists agree that lactate buildup is not responsible for delayed onset muscle soreness (although the exact mechanism remains unclear). The research has progressed to offer new answers and better understanding because we continue to question why and how. Keeping up with current empirical evidence and developments is an essential part of EBP – otherwise, our practices stagnate and we end up reinventing the wheel with each iteration from teacher to student. (On a side note, a slightly devious confession: I actually like using the lactic acid uptake question as a litmus test for massage therapists to see if they are keeping up with the literature or just parroting what they learned in school. It’s surprisingly revealing.)

Perhaps EBP’s greatest strength is the emphasis on blending old with new, looking to history and tradition as well as the latest empirical research and clinical evidence to offer the best possible clinical reasoning. I often einsteinhear things like “massage wouldn’t have been around for thousands of years if it didn’t work,” and I think there is merit to this argument. At the same time, it is essential to use all the modern tools at our disposal to question tradition; otherwise, people might still be saying the same thing about antiquated practices like bloodletting that have been discontinued, having been disproved by scientific inquiry. By testing traditional wisdom through carefully designed experimentation, we can confirm methods that promote beneficial effect and eliminate those that may be ineffectual or even harmful.

What I hope for you to take away is an appreciation for the rigorous questioning of information. Assess the reliability of your sources and note where they agree or diverge. Seek a multitude of resources and opinions, and ask meaningful questions about why we do what we do. Be confident in your convictions but always ready to entertain questions and defend them honestly and with awareness of all factors, even when they are in conflict. Don’t settle for “this is the way we do things,” but challenge the norms – at the very worst, you will confirm the veracity of your claims, and at best you will be armed with new knowledge to improve upon your methods and reach toward excellence. This is the very basis for growth in everything we do, and it is an absolute win-win. My charge to you is to challenge something small every day, and keep digging tenaciously until your curiosity is satisfied.