What I Do For "Trigger-Point" Upper Back Pain

The following plea for help was recently posted to the TCSD email list:

I'm looking for some advice/knowledge. In November, I suddenly had intense pain in my right upper back, near my shoulder blade. It made it difficult to move or turn my head. After quite a bit of trial and error, some research, and a couple visits to a doctor and masseuse, I figured out it was a "trigger point" of muscles that have a hard time relaxing, and instead stay completely contracted. It was caused by biking, as swimming and running really didn't irritate it at all. I would wait about a week for the pain to go away completely, get on the bike, and be in intense pain again within 24 hours. It eventually led to my entire right arm going numb because the muscles were hitting nerves. So I stopped biking for a little over a month. I got back on for a short trainer ride yesterday, and unfortunately the pain still came back. I'm at my wits end, and am really not sure what to do. I have gotten my bike re-fitted already and have tried muscle relaxants. Massages help immensely, but I can't afford to keep going, and it doesn't seem to be preventing it.

Does anyone have any experience with this type of injury? How can I expedite recovery and/or insure recovery at all? I'm on a budget, so cost-effective recommendations are greatly appreciated!

Please take everything that follows with a grain of salt.  It's simply the results of my own search, and what wound up working for me.  YMMV, and so on.

If you don't presently have this problem, please feel free to jump ahead to the "Cause and Prevention" section.

First, some terminology: "Trigger Point" pain is a catch-all term equivalent to a localized combination of a nerve inflammation and/or muscle spasm.  There may also be muscle damage involved, where the swollen muscle pushes against a nearby nerve.  Or a nerve may be damaged, and the local muscles are overreacting with cramping/spasming.  The central idea is that it manifests as localized point-like pain.

Let's start with finding out what's going on.  There are multiple distinct injuries (including fractures and disc problems) that can result in similar upper back pain.

Assessment #1:
Get a FREE Injury Screening from TCSD sponsors FunctionSmart or Rehab United.  Your medical insurance may cover specific forms of treatment/therapy.  Work with them to find out.  Starting with a good, focused treatment (such as ART), even if only a single session, can serve as a reset button to hasten overall recovery.

Assessment #2:
Go to the gym (or a fitness equipment store) and do a 20-30 minute high-cadence light workout on a recumbent trainer.  Push just hard enough to work up a sweat, but not so hard that you're forcing yourself against the back of the seat.  Keep your arms relaxed.  If you have a power meter available, average anywhere from 120 to no more than 250 watts.

My hope is that this recumbent spin session goes perfectly fine, with no additional upper back discomfort at all.  If so, then recumbent is your bike workout plan for a while.  If not, then stick to swim and run.

Assessment #3:
Go see your Sports MD.  I can't say it often enough: A Sports MD is an athlete's best friend and advisor in all things medical.

I'm not talking about a doctor who does sports.  "Sports MD" is a separate board-certified qualification.  Every local medical system has them.  If possible, try to select a primary physician who is also a Sports MD.

Next, let's get our toolbox together.

Recovery Equipment List:

• Tennis ball
• Foam roller
• Hot/cold pack that has a strap allowing it to be worn on the pain area while moving (like these).
• Breathable heating pad (not the sealed plastic ones)
• Epsom salts (optional)

Please notice that pain relievers are not on that list!  I use them only when I have to reduce the pain in order to sleep.  Otherwise, keep all lines of communication with your body wide open.

Another thing not on the list are motorized massagers or pressure-point devices like the "Back Buddy" or "TheraCane".  These can be useful, but it is way too easy for them to make an injury worse.  Only if you are experienced using them as part of your regular workout recovery can they also be used as part of injury recovery.  It's best to avoid them completely if there is any doubt.

Here are the two major things I do to prepare for an injury recovery session.

Preparation #1:
Always be fully hydrated.  Aim for a gallon of water per day when sedentary, especially when injured.  If your pee is yellow, you aren't drinking enough water.  It should be very close to clear.  You should be peeing fairly often, at least once every hour or two.

I can't overemphasize the importance of thorough hydration as part of both the recovery process and also of pain management.  Both the initial injury damage process and the subsequent healing process release byproducts into the blood that can cause their own irritation: Diluting and eliminating them ASAP is the way to go.  Also, pain causes the release of stress hormones such as cortisol, where again dilution and elimination really help: Pain is often a feedback loop, so cleaning things out can actually lessen the pain itself.

So stay hydrated!  (But not overhydrated: Avoid hyponatremia.)

Preparation #2:
Take a hot soaking bath, with salts if you prefer.  Showers don't count.  Or lay on the heating pad in bed and read a book or watch TV for 20 minutes.  The goal is to relax and increase blood flow to the injured area.

Thorough relaxation and increased blood flow are important to recovery, second only to thorough hydration.

Let's get ready to start fixing things.

Recovery Session Start:
What follows should not cause any pain whatsoever, nor should it make any existing pain worse.  If that happens, stop and go see a Sports MD.

1. You are hydrated.
2. The injured area (or the entire body) has been warmed.
3. Initial stretch: Pull an arm across the chest, over the collar bone.  Put the opposite forearm or hand on the elbow and pull in gently (not at all hard).  Hold the stretch for 5-10 seconds, then switch to the other arm.  Repeat 3 more times (each arm pulled twice).
4. Final stretch: Hug yourself with both arms, hands on the opposite shoulders (or as close as possible).  Exhale completely, pull in slightly, then inhale fully.  If you don't feel a stretch across your upper back, then curl forward until you do.  Hold your breath and stretch for at least 5 seconds. then slowly exhale and relax. Release the hug, letting the arms gently swing to your side.  Restart the hug so the other arm is on top.  Repeat 3 more times.

You should now feel loose and relaxed across the upper back.  Any pain you may have had should not be any worse, and is hopefully reduced.

This preparation is useful not just before injury recovery sessions, but also before going to bed, or whenever the injury is bothering you.

Let's start working the injury area.

Initial Manipulation - Tennis ball wall roll:
If you experience any pain spikes during what follows, then stop immediately and see a Sports MD.

Gently lean your upper back against a wall, with your knees slightly bent, feet placed just wider than shoulder width.  Place the tennis ball between the middle of your back and the wall, at the level of the injury but not on it. You should be leaning with only just enough pressure to keep the tennis ball from falling to the floor.  Do not press hard against the tennis ball!

Lower your arms to your side.  Relax your upper back, neck, shoulders and arms.

Using your legs, move your back so the tennis ball gently rolls all around the injury.  If the tennis ball can't gently roll over the injury itself because the shoulder blade is in the way, pull the arm on that side across the chest at the collar bone (as done in the initial stretch).  Move the tennis ball in a random motion for 1 minute.

Be sure to always keep your upper back and shoulders relaxed: Do not tense up!  The tennis ball may be uncomfortable, but it should never be painful. Pain defeats the whole intent of the manipulation, and may make the injury worse.

Repeat the same motions on the opposite side.  Be sure to always do this gently, matching what was done on the injured side.

Symmetry is important!  Whatever you do near the injury must be repeated on the other side of the body.  Why?  There are several important reasons, the most obvious of which is that your recovery will be complete when both sides feel equally good!

Take a minute break after the other side is done.  Repeat the preparation stretches if desired.

Repeat the tennis ball roll on each side with slightly increased pressure to improve muscle manipulation, but never to the point of pain or major discomfort.  Then stop: It is important to not over-do any part of an active recovery process.

This may be all you can handle for the first few times.  Stopping early is vastly better than overdoing!

You can have as many initial manipulation sessions per day as you like, so long as you rest, hydrate, heat and stretch before each one.

The tennis ball wall roll is awesome. I also use it on my lower back (QLs), glutes and hip flexor.

Time to get hard-core.

Daily Manipulation - Foam Rolling:
Daily foam rolling is the Fountain of Youth!  Well, at least for muscles.  It should be part of your daily routine, injured or not.  Training or not.  Like food and water.

Athletic injuries seldom occur in isolation.  They typically happen when the entire body is under stress, but one part is either more sensitive or is receiving extra stress (due to misuse or overuse). It is important to treat any localized injury as an injury to the entire body.  Foam rolling is the best way I know to help whole-body recovery (with hot tubs running second).

I will not cover the details of foam rolling here.  There are lots of printable instruction guides and video tutorials available online that can be found by searching for "foam roller tutorial".  Find the one you like best.  This video is pretty good, but the audio has issues.

I am more than willing to guide an informal foam rolling session for any folks wanting one.  Post a request to the TCSD email list and we'll make it happen.

Be sure to roll all of the following areas for two minutes each:

• calves
• hamstrings
• quadriceps
• ITB (outer thigh)
• adductors (inner thigh)
• glutes
• illiac crest
• lower back (QLs)
• spine (do crunch over low and mid spine, and self-hug at upper spine)
• lats (also great for swim recovery)

If you are new to the foam roller you will likely need to take frequent breaks, so plan to spend an hour getting everything rolled out.  If you are a foam rolling master, you may be able to do all the above in just over half an hour.  If you are rolling for less than 30 minutes there is no way you are doing even a minimally adequate job.

Remember what I said about no machines on the recovery equipment list?  Well, I lied.  There is one machine that has proven to be a near-miracle for me:  The HyperIce Vyper mega-vibrating roller.  It lets me get a full rolling session done in under 20 minutes.

While I highly recommend the Vyper, I do not recommend getting it until after you have become a master with the regular foam roller.  What I said about hurting yourself with machines still holds true: Using the Vyper without first mastering the regular foam roller is like riding a race motorcycle without first knowing how to ride a bicycle.  Truth!

And that's about all I do to recover from Trigger-Point upper back pain.

But what about getting along with it during the day?

Between Recovery Sessions:
That's where the wearable hot/cold packs come in.  I take them to work with me and use them as needed.  Hydrate, do a set of upper back stretches, then apply heat.  If that doesn't help enough, follow with cold.

Now lets talk about how it happened in the first place, and how we can avoid it.

Cause and Prevention:
The fundamental cause is poor riding form.

We ride in either or both of two positions: In road position, leaning on locked arms, or in aero position, leaning on our upper forearms.

Both positions transmit front wheel vibration and impacts directly to the shoulders.

Most of us ride with our shoulders relaxed, with the shoulder blades close together.

This means that shock and vibration goes from the road, up the arms, through the shoulders, and on to the shoulder blades, causing the shoulder blades to lever over, forcing their inner edges to pinch the nerves and muscles in the area against the ribs and spine.

Bingo.  Injury and pain.

Keeping this from happening requires making some changes.

Change #1 (Technique):  Ride with the shoulders neutral (front to back).

Change #2 (Technique, road):  Ride with the elbows slightly bent (never locked).

Change #3 (Equipment, road): Use cushioned bar tape and gloves with gel pads.

Change #4 (Equipment, aero): Ensure the aero bar pads are mounted on cantilevers and/or have multi-layer construction that includes gel.  Be sure to replace old pads before they lose their cushioning performance.

If, like me, you ride a road bike with clip-on aero bars, then all the above will apply.

These changes work together to accomplish two simple goals: 1) Reduce the levels of shock and vibration that reach the shoulders, and 2) keep the shoulder blades away from the spine.

A simple ride-time stretch can help reset the shoulder blade position:  Every 10 minutes or so take a moment to push the upper back as far out as it can go, hold the stretch for 5 seconds, then slowly let it go in far as it can go, and finally reset it to a mid position.  Repeat as often as needed.

Bottom-line, if you are stuck in an injury/heal/re-injury cycle, then you haven't fully addressed the cause.  Worry less about the injury and instead focus on eliminating the causes!

Update:

How can I tell if I'm OK to ride?
Elbow planks.  Be sure to always have perfect form!  Keep the knees locked.  No lifting the butt into pike, no dropped/sway back.

Breathe smoothly.  Don't struggle!  Quit before your form breaks.  The best way to exit plank is to drop the knees then push back into Child's Pose.

Once you are stable in plank, do the ride-time stretch mentioned above.  Focus on keeping your shoulders neutral.

Ready to Race!

It's the Friday before my first-ever half-marathon on Sunday, and I've learned a surprising amount during my last week of training.

Let's rewind a bit, to last summer when I finally decided to commit to some real triathlon goals, the first being to do a 70.3, and I chose O'side 70.3 on 1 April 2017.  Given my difficulties with the run, I added an interim goal of a half-marathon race, and I chose the Holiday Half on 18 December 2016.

Initially, my run training had three simple goals:

1. Become physically able to do two hours running without pain.
2. Improve my metabolic capacity.
3. Improve my speed (to spend less time running).

To accomplish these, I initially chose a two-pronged training approach:

1. Do long, easy runs to build up leg tolerance and contact time.
2. Do short, hard intervals to build speed and metabolic capacity.

This approach worked really well, permitting me to make major injury-free gains:

• I regained the 10K speed I had about 8 years ago (yeah, I had really slacked off on the run training).  
• I became able to run well over an hour with minimal mechanical discomfort (muscles and joints were OK, though I was huffing and puffing like an old horse).

Implicit in this improvement was getting my cadence up to reduce the impact and muscle recruitment associated with each stride.  My running went from "thud, thud, thud" to "tap, tap, tap".

One thing I avoided during this phase was training for a "run-walk" race style.  I freely gave myself permission to walk when needed, but never as a planned part of my race.  Typically, I'd walk for 30-60 seconds at the turn-around point in my run just to be sure I could do it well enough (many injuries occur when returning to run speed after a brief walk).

Last Sunday I finally did my first 10 mile run (two laps around Lake Miramar, 9.8 miles actual).  I intentionally started out easy, and I comfortably held a 10:00 average pace. But about 8 miles in I realized I had some extra gas in the tank, but was unable to pick up my pace!  It seemed my legs had decided they wanted to stay at the 10 minute pace, and they weren't going to change.

It seemed there was no way I could break 2 hours on my race.  A 10 minute run pace (with no walking) means a 2:11 finish.  To break 2 hours I'd need a 9:00 pace, a full minute per mile faster, and I didn't see a last-minute 10% improvement being a realistic expectation.

Since this week has been my taper week, my runs have been shorter, so I decided to see if I could make them faster, to let me do a little more work on both pacing and my metabolic capacity.  I did a 5K Thursday evening with the intent to do the first 1.5 miles as a best-effort sprint, then return at whatever pace seemed sustainable.  Despite some serious fatigue at the end of 1.5 miles, I still averaged a 9 minute average pace for the total distance!

So I'm left with two significant questions: If I start the race at a 9 minute pace, will my legs lock in to it, and will my metabolism support it all the way to the finish?

I think I'm going to go for it, and let myself briefly walk when/if needed.

The main reason for this decision is that this half-marathon and 70.3 are steps toward my goal of doing at least one full-Ironman in my life, preferably before the end of 2017.  Which means my run must enter all-new territory: The only way I'll survive 26 miles after a 120 on the bike will be to run fast and efficient, to get to the finish line before it falls apart either mechanically or metabolically.

I seriously doubt I'll be able to endure more than a 4 hour marathon after a 120 mile ride.  If it's not at least that fast, then it will likely be hours slower.

A 4-hour marathon is roughly a 9 minute pace.  If I can get close to that Sunday, then it should be an achievable marathon goal.

Run speed is my new best friend.

Update: I did 2:13:49, about what my training predicted.  But I hadn't trained on hills, and I beat myself up a bit on the first 4 miles, going way too fast downhill (6:30) and struggling too hard uphill.  By mile 8 I was power-walking up each hill.  So getting this result with all those mistakes tells me I should be able to reach sub-2:00 on a flat course.

Hoka Bondi Running Shoes

My pair of original Brooks Pure Flows died.  Not due to mileage (I only had about 250 miles on them), but due to the sole materials failing with age (not wear).  The foam broke down under the ball of each foot, and the rubber tread pieces became hard and slick.  When I slid and nearly landed on my butt during a run, I decided they had become a safety hazard and needed to be replaced right away, without delay.  (Being a Frugal Triathlete, my plan was to run in them until they wore out, no matter what. Fortunately, reason prevailed.)

The main goal for my next pair was to get shoes that would treat my feet gently enough for me to comfortably do my first half-marathon in December (Holiday Half), and my first half-IM in April (Oceanside 70.3).  The Brooks always had me hurting at the 10K distance.

I run with a forefoot strike, so I wanted a zero-drop shoe (or close to it).  And my feet are gradually getting wider with age, so I wanted a spacious toe box.  But most importantly, I needed a bit more cushioning between my feet and the road than my Pure Flows provided.

One thing I absolutely didn't want was to run directly on an EVA sole, without tread lugs.  Many running shoes have eliminated the rubber tread lugs to make the shoe lighter, but all that really does is make the sole wear out barely after they're broken in.  I refuse to buy shoes that won't last at least 350 miles.

I tried over a dozen pairs of shoes: Ten different models from seven separate brands at two local running specialty stores. My initial hopes were with Altra and Hoka, though I eagerly tried anything from anyone that looked even close.  I was a bit wary of Hoka, since I had demo'ed a pair a few years ago and found them to be unstable: I felt I was running on squishy stilts.  But I had heard they had evolved nicely, and certainly deserved a retry.

By the end of a dozen fit checks, and many treadmill and parking lot runs, the Hoka Bondi was the clear winner.  The Hoka Bondi was not perfect overall: It was just the best of what was available when I went shopping.

What's not perfect about the Hoka Bondi?  The toe-box is barely wide enough. If my foot spreads any wider, the shoe will be too narrow.  Plus, the upper isn't tongue-less (more about that below).

One feature I liked about the Hoka was pull-loops behind the heel: They will make transition a little bit faster and easier, and will also be great for hanging them to dry after getting wet.

Unfortunately, the stores that carried the Hoka Bondi didn't carry the full color range.  I refuse to buy light-colored shoes simply because they quickly look dirty, and putting them through the washer can only shorten their useful life.  I'm also tired of wacky day-glow colors that serve only as advertising. I'm paying for shoes, not for the privilege of becoming a running billboard.  I wanted a dark, solid-color shoe.  No bling, but with embedded reflectors for night runs.

Fortunately, the Hoka Bondi comes in black.  Unfortunately, none of the stores I visited carried the black version.  Since my Brooks were dead and I needed shoes ASAP, I couldn't wait for a special order to arrive.  I returned home, found the black ones online, and ordered them with rush delivery.  I also found that there are no Hoka discounts online: My final price was the same as it would have been at a local store.

Right after they arrived I went for a flat 4 mile run at an easy pace.  While the Hokas are a little unstable to walk in (the heel is squishy), they were absolutely wonderful during the run.  In the Brooks, my feet would start to feel hot after only a few miles: In the Hokas, my feet felt cool and comfortable right to the end of the run.  My legs also felt less fatigued: They could have easily done a 10K (though my lungs would have objected).

I'm looking forward to my half-marathon training!

The greatest revelation in the other shoes I tried was the awesome progress in tongue-less upper construction: Many of them felt like socks, with no pressure points at all, yet still with a very secure and comfortable fit.  But none had soles with enough cushioning to give me adequate impact isolation.  Some fit so well that I tried every accessory insole in the store, hoping I could improve the cushioning enough to do the job. Sadly, none worked well enough.

I hope Hoka has a tongue-less upper by the time my Bondis wear out. There's really no reason for a modern running shoe to have a tongue.


Woah.  A year since my last post.  Sorry 'bout that!

A Day as an APX Rep.

Today was the TCSD Swap-Meet, where club members and TCSD Sponsors try to sell off their extra gear.  The event was held in the huge parking lot behind Pulse (no longer called High Tech Bikes), with only a small sign pointing the way to it:  Everyone there knew about the swap meet, and didn't wander in off the street.

I showed up a bit early because I had offered to hand out some APX single-serving samples, since Jeff himself couldn't be there.

Jeff had sent me 30 packets and 30 APX flyers, which I attached to each other in the hope that fewer of the flyers would land on the ground to become litter.

I arrived just before the official start time of 10 AM to find that shoppers were already present and purchasing.  I started handing out APX to everyone I could.  The 30 samples were gone within 20 minutes!

I tried to keep track of who was already aware of APX, what they knew about it, and what they thought of it.  The rough breakdown was:

40% were unaware of APX.

20% were aware of APX (mainly as a TCSD Sponsor, or saw it on a retail shelf), but hadn't tried it.

15% already loved APX and wanted as many samples as they could get (I limited them to 1 each).

5% had tried it at least once (and may have bought it once), but hadn't tried other flavors.

Of those who had tried APX, none reported any problems with it.  Some remarked they didn't know where to buy it, and I told them to read the flyer and visit the APX site.  I also told them to buy from their local bike shop, and if they don't carry it, to ask them to!

Given that APX is a local company, and this was a TCSD event (though it was open to the public), I was surprised that 40% were unaware of APX.  Especially since everyone there was an athlete of one kind or another.

I have no idea how Jeff could contact that 40%, other than having a larger APX presence at future TCSD swap meets!

All in all, a fun day.

But those initial 20 minutes were very tiring!  Interacting with that many people in such a short period of time, and being sure to share whatever they wanted to know about the product, took lots of focus, attention and energy.  It was a very good thing that the T3 Cafe was open!

You may be wondering why I was handing out APX in the first place, especially since I'm not an APX rep.  Well, my prior blog post on APX gives the reasons I'm an APX fan.  And the fact that APX is a TCSD Sponsor means they help the club. Combine the two, and I felt it was a crime the Jeff wouldn't be at the Swap Meet!  So I offered to fill in as best I could.

I'm a fan of all TCSD Sponsors, but especially those who have made a meaningful and lasting difference in my own participation in, and enjoyment of, triathlon.  APX is near the top of my list.

About "Dear Fat People"

There has been great angst and consternation reverberating online in reaction to a supposedly comic YouTube video called "Dear Fat People". I was completely oblivious to the folderol until a tumblr post directed me to this video by Tessa Violet, who in turn mentioned this video by Megan Tonjes.

Please watch these two videos. Go ahead, I'll wait.

OK. Normally I don't care even a little bit about the various ephemeral memes storming across the InterWeb seas. But the above videos got me wondering what all the fuss was about, so I watched the "Dear Fat People" video for myself (which I won't link, but is easy to find if you feel you must).

I heard things I used to think (and even say out loud). Things that I stopped thinking about 7 years ago.This post is about how my views, and even my perceptions, changed. I will not describe how or why I came to hold my old views. This is just about how my views changed.

In 2005 a study was started by researchers at the University of South Carolina at Columbia to quantify the relationship between BMI (Body Mass Index) and various health outcomes for seniors (age over 60), while accounting for as many other factors as possible. To do this required a large number of participants over a significant period of time. Such studies are called "longitudinal" studies. In this case, 30,000 participants were enrolled for a study duration of 6 years.

When such studies are designed, great care is taken to set proper goals, and ensure the data gathered can be properly analyzed to assess those goals. In this case, the base assumption was simple: Extreme BMI values combined with age were thought to directly imply poor health outcomes (increased illness and injury, and shorter lifespan). As the study starts, the data analysis starts in parallel, to ensure any problems in the analysis or the study itself are identified as soon as possible.

Just 6 months into the study, the analysis indicated there was a small but significant group of high-BMI folks who had completely normal health. Initial corrections were made to weed out very muscular folks (BMI can't tell muscle from fat), and to correct for a few other known factors,

But the remaining group was still far larger than expected. The experimenters let the study continue while they took a closer look at this group. Over the following year the hundreds of folks in this group were interviewed face-to-face, and the rest of the study population was surveyed to get additional information.

Eighteen months into the study the riddle of the healthy high-BMI group was solved: Aside from a few "freaks of nature", all of the folks in this group routinely exercised at levels well above the norm. They were fat senior athletes.

The study published their findings for this small group 6 months later, in 2007. It made a splash in the press, where I remember the distinctive title of one article in particular: "Fitness Beats Fatness."

This paper was published soon after I joined TCSD (the Triathlon Club of San Diego), and it made me take a closer look at our heavier members. And for the first time, I didn't see folks I assumed were in the club to try to lose weight. I simply saw fellow triathletes.

Well, OK, that's a good step, right? No, it wasn't really much of one. Yes, I wasn't holding their fatness against them, but I realized I still wasn't seeing them in the same favorable light I saw the lean club members. I decided to try my best to truly see all my fellow club members as the athletes they are.

And you know what? It actually worked! It took a couple months, but I soon noticed how my interactions with larger club members changed, how I felt closer to, and more comfortable with, the larger club members.

But there was this damned little voice in my mind that told me I was still placing conditions on how I visually perceived people, that fat folks got a pass only if I knew they were athletes. In my mind, that clearly wasn't fair. Which led me into a more general questioning of my perceptions and assumptions. I didn't like what I learned about myself.

I was raised in multi-ethnic, multi-racial multi-generational neighborhoods, with parents who tolerated no prejudice based on age, race, ethnicity, sex, wealth or religion. My only vestiges of bigotry concerned groups I hadn't met, and those evaporated as soon as I met and got to know members of those groups (e.g., LGBT), I had taken the online "Are You A Bigot?" quizzes, and always scored as "Not A Bigot".

Yet here I was, a fatness bigot.

It took more time, but I finally pounded the simple truth all the way into my head, that a person's weight is their own concern, and had nothing to do with how I should perceive them as a person. Easy to say, easy to think, easy even to know and believe, but much, much harder to live.

Why had I been a fatness bigot? How did that bigotry survive when I was free from so many of the other bigotries that plague our society? How did I not come to recognize it earlier? Why did a scientific study finally force me to take a closer look? Why had it taken months and months to purge?

It would probably take years of therapy to dig that deep. For now, I choose not to be so smug an egalitarian, knowing there may well be other bigotries yet within me.

And today, years later, I hope you see why and how those videos affected me. I recalled my own prejudice and shame, and resolved once more to let people be who they are, and not make assumptions.

Tessa Violet's words burn in my core: "You are the first and last 'you' who will ever exist in all of human history. And you are lovable. And it's such a shame to think anything but."

Please, know this to be true for each person you see. But more importantly, know it for yourself, about yourself.

APX Chocolate Post-Workout Recovery Drink

While at the Triathlon Classic Expo a week ago (11 September 2015), I stopped by the APX display to chat with Jeff, and to let him know I still loved his product. (For those of you who did the race, APX was the course sports drink.)

But something was different.  Next to the familiar APX bags with flavors of Tangerine, Pomegranate and Ruby Red Grapefruit was a new one: Chocolate!  And it's the first flavor in an entirely new APX product line: Post-Workout Recovery Drink.  It is so new, it wasn't on the APX website when I started writing this review (it is now).

While the existing line of Carbohydrate & Electrolyte Replacement drinks is focused on what your body uses in the short term, the new Post-Workout Recovery drink focuses on what your muscles need to recover and prepare for the next workout: Protein (whey isolate) and L-Glutamine, with dextrose and flavors added.

You may recall from my prior post reviewing the APX Carbohydrate & Electrolyte Replacement drinks, it took me years to find a sports drink my stomach would tolerate under all conditions.  I've had a similar journey with protein supplements, but the result has been that I've been using no protein supplements at all.  I tried over a dozen different protein products, and they either disagreed with my stomach, or were priced well outside my budget.

Jeff assured me the APX approach is different.  The drink is tailored for post-workout recovery, a time when the body is uniquely able to rapidly absorb and use protein.  This drink is not intended as a supplement outside of exercise.

While the bag size is the same, protein is less dense, so a larger scoop is needed per serving, meaning fewer servings per bag.  Another difference is the amount of water used per serving.  Here's the comparison:

APX Product Comparison (as of 19 September 2015)

Product	Water Added Per Serving	Servings Per Bag	Cost Per Bag (MSRP)	Cost Per Serving
Carb & Electrolyte Replacement Drink	20 oz	26	$22.99	$0.88
Post-Workout Recovery Drink	8 oz	13	$25.99	$2.00

Jeff was kind enough to give me a bag to try, and I finished it just before writing this review.

My first 8 oz serving (not post-workout) was to check for taste and how well it mixes. Unlike many other chocolate protein drinks, it tastes fine when mixed with room-temperature water, though APX does suggest Almond Milk as an alternative. I've often had to use chilled water with other products, or add them to a fruit smoothie, to mask a poor flavor. And again, unlike many other protein supplements, the APX mixed completely with only moderate shaking.

My next test was a triple serving (24 oz) taken immediately after a hard run last Monday, and my stomach wasn't particularly happy with it. About 12 hours later I tried another 8 oz serving, and my stomach was fine with it. I then tried a single serving immediately after a lighter work-out, again with no issues. I wondered if using a full bottle (triple serving) was the problem, so yesterday I repeated the hard run test with a single recommended serving, and my stomach was fine with it. However, my legs weren't too happy about doing two hard runs that close together.

I don't think it would be fair for me to try to judge the effectiveness of a supplement in just one week, but with such a simple list of ingredients, I see no reason for the APX Post-Workout Recovery drink to not work every bit as well as other protein supplements on the market.

When used according to the directions, the APX Post-Workout Recovery Drink has become the only protein drink I can tolerate immediately post-workout. I'll be using it going forward.

UPDATE 19 SEP 2015: Corrected pricing.

DIY Energy Drinks and Gels

Caution: This blog post discusses the use of pure caffeine, a substance that can be hazardous if misused.  Please do not take anything I say as proven fact, or rely on the few links I have provided: Do your own research, and verify everything before proceeding on your own.

Why is it that adding caffeine to something cause its price to multiply?

A case of 12-oz sodas costs about $0.25/can, yet a case of 16-oz energy drinks costs $1.25/can.  If we allow for the fact that the energy drink is a third larger, a 16-oz soda would cost about $0.33 each.

So the extra cost for adding about 100mg of caffeine is $0.92.  Really?

Caffeine powder is available from reputable online vendors for about $3.00 for 50g (50,000mg), meaning the cost for 100mg is $0.006.  That's six tenths of a cent.

Clearly, energy drink makers don't see soda as their competition, but other caffeinated beverages, such as coffee, which is a buck at McDonald's (who has surprisingly good drip coffee).  So energy drinks are priced not by the cost of adding caffeine, but relative to the competition.

Lately I've been trying to better manage my budget, and had largely replaced energy drinks with coffee and tea (especially green tea).  But this doesn't work so well during a summer day, and my teeth aren't as white as they used to be (my whitening toothpaste isn't keeping up).

Another consideration is that energy drinks don't provide what I'm looking for in a sports beverage.  I'd like to have caffeinated versions of the electrolyte and calorie beverages I use for training and racing.

So I decided to look into making my own caffeinated drinks and gels.  Which means using raw caffeine.

First, caffeine can be nasty stuff.  It is rapidly absorbed by the body.  It can stop the heart if taken in massive doses.  It should be treated as the drug that it is, and not as "just another supplement".  I would treat raw caffeine the same as I would treat a gun or hazardous chemicals: To be locked up at all times except when actually in use.  And to be kept far, far away from children.

Assuming you are able to keep your caffeine safe from misuse, there are other things to consider before purchasing caffeine.

First, what kinds of caffeine are available?  Three kinds are most common: Anyhdrous Caffeine, Dicaffeine Malate, and Caffeine Citrate.

Anhydrous Caffeine consists of only caffeine molecules.  It the "rawest" form of caffeine, and is the type most commonly used as an additive.  But anhydrous caffeine can also be the harshest on your digestive system, especially the stomach: This form of caffeine is one of the most sour substances known. I'd call it "violently" sour.

Dicaffeine Malate binds two caffeine molecules to a malate molecule, where the malate buffers the the caffeine.  Buffering blocks absorption by the stomach, meaning it will be absorbed by the small intestine, which is a slower process.  However,  dicaffeine malate does break down a bit in the stomach, meaning its effects are felt less suddenly than anhydrous caffeine, but more quickly than caffeine citrate.

Caffeine Citrate is the most buffered form of caffeine, and may work best for folks who get mild stomach upset from other forms of caffeine.  It is important to note that due to the large size of the citrate molecule (about the same size as the caffeine molecule itself), this form of caffeine has half the caffeine per gram compared to the other two forms, though it tends to cost about the same.

For my initial tests I followed the Goldilocks Selection Method ("pick the middle one") and chose to purchase dicaffeine malate from Powder City.  I chose Powder City for several reasons: 1) They have lots of useful information on their site.  2) They provide a tiny 50 mg scoop (1/4" in diameter) with every package purchased.  3) They have a great reputation in the market, and appear to be in this for the long term.  4) They were the only reputable vendor offering all three forms of caffeine.  Other vendors tend to offer only anhydrous caffeine, though that is slowly changing.

I ordered five 50g pouches, far more than I'll ever need, because their shipping rates, while reasonable, were combined with a free shipping limit that, for a given cost, meant they essentially gave me free product in exchange for free shipping.  So I have lots extra, if anyone local is interested in a pouch of their own.

My first test was to see how dicaffeine malate affected me, and how it changed the taste of what it is added to.  So I poured two 8oz glasses of orange juice, and added half a scoop (about 25 mg) to one of them.  After stirring thoroughly, I tasted a sip of each.  The difference in sweetness was very noticeable, but not objectionable.  The caffeinated OJ still tasted plenty sweet.

I finished the caffeinated OJ over the next couple of minutes.  I felt no caffeine "rush" like I do after gulping a cup of coffee:  Over the following minutes I gradually felt more energized.  About like I would after drinking half an energy drink.  I added a half scoop to the other class of OJ and drank that as well.  As expected, I wound up feeling about the same as if I had just finished a Monster or other energy drink.

Now, when I said "scoop" above, that's a level scoop of the powder, not packed down.  A half scoop is about half of that.  A heaping scoop would be closer to 100 mg.

Some folks use a calibrated scale and careful techniques to precisely measure their caffeine.  But the cheapest "good" scale I found that was accurate to at least a milligram cost over $50, and I didn't really trust it.  Getting a feel for the "buzz per scoop" has worked well enough for me.

There are two fundamental ways of taking anything into your body: A bunch all at once, or gradually over time.  It is important to take this into account when making quantities of caffeinated beverages in advance, for future use.

I know from my own experience that it takes about 100 mg of caffeine to get me started in the morning.  On cooler mornings this is taken all at once, typically as coffee gulped to minimize the time I spend in a morning fog.  Most mornings, I typically add a heaping scoop to a large glass of OJ.

During long continuous moderate exercise (riding the bike or jogging for an hour or longer) I feel best when taking no more than 100 mg of caffeine per hour (generally less).

When I make APX per the manufacturer's recipe (one APX scoop in 20 oz water) I add one level scoop of caffeine.  This is my standard "between workouts" beverage, when I'm recovering from one workout and getting ready for another one.

But for prolonged activity, I make my APX more concentrated (2 scoops in 24 oz) and add a heaping scoop of caffeine (100 mg), and I also carry water with me.  When I feel good, I drink more water. When I'm feeling spent, I drink more APX.  For these longer activities, I generally try to stay in the zone of "slightly uncomfortable".

I next tried making caffeinated honey. I started out by putting 50 mg (a level scoop) into about 2 fluid ounces of JJ's honey (about as much as a large gel).  The honey was too thick to mix evenly, so I added a bit of water (10-15 drops).  The result was better than I expected:  I couldn't taste the caffeine at all.

There is one important thing to keep in mind when making your own caffeinated products: Labeling!  I put a rubber band around the neck of any bottle containing caffeine.  My caffeinated honey goes in either my SoftFlask or Gel-Bot. (both from Hydrapac, and bought from TCSD Sponsors).

While it may sound like making your own caffeinated beverages is easy, I want to reiterate that there are hazards that require close attention.  There are several general principles that apply to using hazardous things in general, and specifically to hazardous food additives:

1. Work from recipes.  This encourages you to plan in advance, it permits you to double-check what you are doing, and it greatly reduces the risk of silly mistakes.  A recipe helps ensure you get consistent and repeatable results every time.
2. Take notes!  I have written down everything I've tried, and recorded what went right and wrong.
3. Consistently do all work in a single place.  I use one end of my kitchen counter, the same place every time. Build good habits when using caffeine.
4. Clean the work area before and after using powdered caffeine.
5. Wash your hands both before and after using powdered caffeine.  It takes only a moment, and will make a huge difference if you happen to wipe your eye.  This stuff can be harsh!
6. Avoid using caffeine directly from the pouch it is shipped in.  It is too easy to spill, and the pouch can puff caffeine into the air when opened and closed.  Transfer some of the caffeine to a smaller wide-mouthed screw-lid container that is easier to open and close.  Powder City sells containers that are ideal for this, but I find a small baby food jar works very well.
7. Close nearby windows and turn off fans before opening the caffeine container.  You really do not want this stuff to get around.
8. Store caffeine away from where anyone (adult, child or pet) could reach it accidentally.

I know the above rules may seem overly cautious, but they are really just common sense.  I do pretty much the same for my Sriracha sauce.

UPDATE:  I've simplified my work area by using a red roll-up silicone baking sheet for my work area.  All cleanup is done at the sink, and any spilled caffeine powder shows up well on the red surface.  Much easier in all respects.  My counter is white, and I was very concerned about spills I couldn't see.  No longer an issue.

Now that I've been making my own caffeinated drinks and gels for a couple months, I must say the results are "nothing special".  That is, my homemade products have replaced the manufactured ones with no unpleasant surprises.  But the pleasant surprises of reduced cost, plus getting caffeinated versions of what I want, are well worth the minor amount of hassle.

Again, these are my own personal experiences.  You may have different reactions to caffeine, so be sure to start out slow, and take your time.

I'm not trying to change the world.  Just trying to save a buck and gain greater control over my workout and race nutrition.