Pain management during ultra rides

[jonesy792]

So I haven't seen much about this topic on the forum so far but I find it hard to believe that I am the only one.  During the 300 I almost dropped out several times due to lower back pain, hand and foot pain and saddle sores.  It took the better part of 100 ibuprofens and several thermacare wraps to keep the pain managable.    How do you guys deal with this?

[Marshal]

So I haven't seen much about this topic on the forum so far but I find it hard to believe that I am the only one.  During the 300 I almost dropped out several times due to lower back pain, hand and foot pain and saddle sores.  It took the better part of 100 ibuprofens and several thermacare wraps to keep the pain managable.    How do you guys deal with this?

Hand pain—use ergonomic style grips or lots of padding wrap

Hand and Back Pain – move your handlebars up and back to take weight off the hands/forearms and lower back.  This upright position can be a balancing compromise with steep climb handling, at some point the front wheel lifts to easy.  Bottom line is pain mitigation trumps handling on long multi days.  Core work also helps with the back but upright position is the larger factor.

Foot- find a shoe that is very very stiff in the sole so as to spread out the pedal pressure over the whole fore-front of the foot vs a softer sole which concentrates the pedal pressure in a smaller area and causes hot spots.  Also find a pedal with more surface contact area at the shoe/pedal interface, this also helps to distribute the pressure over a bigger area.  What not to use--eggbeaters are the best/worst at putting all the foot pressure in a tiny area—combined with a soft sole = hot spots after say 15+ hours
There are a few shoes with stiff soles that work fine for hike-a-bike, just have to look around and do some trial/testing.  I recommend Mavic Pulse’s if they fit your foot—stiff with excellent grip/traction!

Saddle sores- I am still working on this one—see my blog for what I am trying
http://desertmountaindivide.blogspot.com/2010/03/experimentation-in-pressure-point.html

Bty, 100 ibuprofens is asking for serious damage.  You need to find a comfortable ‘all-day’ position that eliminates the need for pain pills.  Use the ibuprofen at night at regular dosage for inflammation, neosporin topical ointment type stuff for the pain on the lower end

[AZTtripper]

Weed!

And I do take vitamin-I but never more then 4 at a time and never more then 4 every 6-8 hours.

[sean salach]

I didn't ingest anything other than food and water/tang/emergenC/soda during this year's ITI350. No painkillers, no sleep aides, no electrolyte pills or pill vitamins. My hands were the only part of me that experienced any real soreness, and I just made sure to keep varying hand position as much as possible. I think adequate training before and adequate warm up and rest during the race go a long way toward preventing the need for painkillers. As for saddle sores, when I use NuButte shammy cream, I don't get any. It lasts a really long time. I reapplied twice over the 4 1/2 days of the race. I haven't used any others, so I really can't compare, but I can say without reservation that NuButte works really well. I also used a suspension seatpost this year, and I think that may have gone a long way toward keeping my lower back pain free on the ss.

[ScottM]

Pretty sure he's exaggerating with the 100 I's.

I'd echo most of what Marshal said -- it sounds like adjusting bike position might alleviate some of your issues. 

For hands -- bar ends!  Required equipment, IMO, for any multiday ride.  No matter what kind you go with, just something so you can completely change the pressure points.

I usually end up taking one form or another of painkillers before any multiday race is done.  I try (want) to avoid them, as it's a sign that 'things' are going well if you don't need to take them.  But if you're pushing the envelope something's gotta give at some point...

[Marshal]

Mind Tricks with common, over the counter, pain pills…….and caffeine

For me pain pills are a necessary multi-day ‘tool’. But-best used sparingly. 

So far (fingers crossed) I have been able to limit my use of pain pills to a max of 4, taken during the actual ride.  It was a bad day………..

Normally I try to play a little psychological mind trick with pain pills—use 1 normal dose, only if needed, as a sort of reward waiting at the tail end of a long hard day.  Personally I like to think pain pills have a stronger effect the less often they are used (this is probably not really true but I like to think so, and who knows, maybe the body ‘does’ develop a slight ‘tolerance’ to over the counter pain pills) Anyway by delaying/limiting use till the end of the day, say the last 4-5 hours, I get the real or imagined effect when I need it most. 

Also I sometimes take a normal dose as soon as I stop, but this is more of a ‘recovery/sleep’ issue rather than a pure pain issue.  See, I also have a personal believe that a pain pill right before beddy-by helps me relax and hence fall to sleep a bit easier, sort of like a sleep pill but with no side effects, (again probably not really true but hey, it works for me and they can/do help with inflammation)

In terms of ‘artificial aids’ to help one on down the trail, the best for me is a caffeinated energy drink – and with them I use the same approach- limit/save it till you really need it, say ½ way up Mt Lemmon on day 3 etc etc.  The less you use caffeine the more effect it has—this I know to be both scientifically and personally true, the body does build up a strong tolerance to caffeine.  So if you deliberately limit your intake, then when you do use it, you get more bang for the buck with a lower dose


(Ha, I strongly suspect however that I will be living off caffeinated drinks for days on end during the TDR so I guess I will just have to drink ever more of them….)

[AZTtripper]

This is something I was told by a friend of mine who is an ER doc.

"When it comes to over the counter I's to get the full anti-inflammatory benefit you need to take 4 at once. This is equal to one 800mg prescription strength pill, and then never more then one dose every 6-8 hours. I usually start out the day with one dose and then not again until the end of the day for recovery.

I also like "Sport Legs" brand electrolyte pills they seem to help a lot at least I thinks so, and doc says placebo's do work so it may just be a mind trick but if it works it works.     

[jonesy792]

thanks for the input guys.  I'm definitely looking into bar ends for the hands, bag balm pretty much took care of the saddle sore and the feet weren't too bad.  My main problem was the lower back, I'm thinking that core workouts will help that out.  Only one way to find out I guess...

[jonesy792]

and tim, that weed comment made my day.  Unfortunately I think that the side effects of me sitting around not wanting to do anything might outweigh any pain relief benefits

[DaveC]

I've seen the dank stuff act as a performance enhancer.  Some people are just f%$$@&* crazy like that.

For me stiff shoes, Ergons with bar ends, chamois butter, and standing up plenty (especially climbing) have taken care of most point soreness issues.  I only have back soreness when I'm soft.  As for the more generalized misery, I'm still working on that one.

[Bral]

I am a firm believer that regular core and upper body workouts help with back, neck and shoulder problems.

[bartspedden]

I second Bral's advice. I've had back pain in my life from a car accident, and regular core exercises went a long way for me. I hate working out in the gym, but do it so that those parts of my body that don't get a good workout while skiing/riding are still strong.

 I personally don't like bar end's, but I fell in love with my wife's ergo grips while "test" riding her new bike last year.  I bought myself a pair with some x-mas cash for this season. 

As for the feet, I like a mid-stiff shoe with a little flex in it so that I'm not hobbling on the hike-a-bike sections.  i find my left foot goes a little numb with a totally stiff shoe.

Something else to experiment with is hydration. I've fixed all sorts of personal "ailments" by more hydration.

good luck!

[DaveH]

A roomy toe box in whatever shoe you use does wonders to keep the feet happy.  Of course this has to be balanced with keeping the shoe snug enough for the hike a bikes, but minimizing pressure is the goal.

MP3s can do wonders to relieve pain if you chosen your music well.  No lie!

As(s) for the back end, mine used to hurt like hell after 18 hours or so until I started riding SS.  The constant in/out of the saddle riding style of the SS does amazing things for core strength and keeping the butt happy.  Chammy butter has even been shelved!

[jonesy792]

Thanks for the advice guys, I'm going to start core workouts right away and hopefully there will be a pair of barends in the near future...