Monday, March 5, 2018

The Triathlete's Physical Therapist: Stephanie Shew

There's a famous poem you may have heard about a triathlete named Humpty:

Humpty Dumpty ran on a wall,
Humpty Dumpty had a great fall;
All the king's horses and all the king's men
Couldn't put Humpty together again.

But Stephanie Shew could, salvaging Humpty's race season.

Before we get to the interview, please allow me as Utah Tri Buzz editor to offer my witness regarding the truthfulness of this poem!

After trying to manage an injury for several weeks, I finally got smart and sought out Stephanie's expertise. In addition to the hands on work she does, the strength/flexibility stuff she prescribes, etc, it's been awesome to be able to ask specific things triathlete to triathlete... "so, St. George is 2 months away... do you think I can still give it a go or would that be stupid?"  "I was gonna do a 60 min tempo run today... what would you do, should I just swim instead?" etc, etc. 
She can relate, and will help get you back on track while mitigating loss of fitness.

5 stars!

What’s your professional background as a PT as well as your athletic background? How did you first get started with triathlon?

I received my Doctorate in Physical Therapy from the University of Utah in 2013, following receiving my Bachelor's in Exercise Physiology, with minors in Chemistry and Nutrition in 2009. I was lucky enough to jump directly into Outpatient Orthopedics following PT school, and have been working with the same company since graduation. I am currently a Clinical Director with Registered Physical Therapists, Inc at the Life Centre.

Stephanie at her triathlon debut, Ice Breaker 2015

I was a competitive gymnast growing up, and commuted 45 min each way to practice 5-6 days/wk. So, I have been used to a fairly hectic and regimented schedule from a very young age. I competed throughout my grade school years and then decided to not pursue gymnastics further in college. My body had dealt with its fair amount of nagging injuries and challenges, as well as I wanted to focus on academics. I also dabbled in short distance track events throughout high school, but gymnastics always took priority. I actually really enjoyed sprinting, but didn't have the time I would have liked to commit to it.

I first got into triathlon because of a good friend from grad school. We had gotten into some 1/2 marathons and marathons, but nothing crazy. It wasn't until after PT school that I got into triathlons. My friend asked if I wanted to do an Ironman, I said "Someday. It is on my bucket list." Her reply, "Ok, good. Because I just signed up for the St. George half." We only had a couple of months to train, and neither of us could swim more than a length of the pool. We figured we should do at least one tri before St. George, so we signed up for Ice Breaker. We muddled our way through together, but survived. Luckily, we were able to attend tri camp with SLTC a couple weeks before St. George. Everyone was great at guiding us and answering all of our pestering questions! Race day was not ideal for me, ended up with significant nutrition problems, and DNF'd during the run. I told myself that I wouldn't listen to my friend EVER again, but 5 70.3's and one full Ironman later, I am still at it, ha!


What are your favorite races you’ve done, and plans for the upcoming season?

Ironman Santa Rosa will always be near the top of my list, mainly because it was my first full...but it was a great venue and I really enjoyed the course! I always enjoy St. George 70.3 because of how many local racers there are. No matter where you are on the course, you always see familiar faces. Coeur d'Alene 70.3 last year was gorgeous and a lot of fun, so I'm hoping to race that again this year. As always, all of the local races are always a blast!

After a crazy race season last year, my first 140.6, and keeping athletes healthy with work, I am taking this year a little easier. I have Oceanside 70.3, St. George 70.3, and hopefully CDA 70.3 on my list this season thus far. I'm hoping to get a couple of local sprint/olympic races in this year as well.

What are the stupidest things triathletes can do, i.e. common recipes for getting injured?

Ha, triathletes in general do a lot of stupid things...I mean who really wants to participate in a constant activity for up to 17 hours at a time??

That being said, the most common thing I see is overuse injuries and people not listening to their body. Triathletes are notorious for overtraining and "pushing through" a nagging injury. A lot of people panic if they miss a workout or when a race is approaching faster than they expected.

a little PT mid-ride.... here, bite on this cracker for the pain

On a scale from 1-10, from your perspective how important are each of the following:

Stretching 1 2 3 4 5 6 7 8 9 10

Comments: This has been a great debate for years! Stretching and strengthening are both things that tend to be overlooked. We like to get our workouts done, shower, and get back to life. Research has shown that stretching prior to exercise has not proven to prevent injuries any more than an active warm up. Stretching muscles that are not warmed up (either passively or actively) can do more harm than good. I like to tell patients to always try to do an active warm up. This can be muscle activation drills/exercises, light spinning, brisk walk/jog, dynamic stretching, and then progress into your workout. 

Stretching post workout is ideal. Your muscles are warm and have been used, so take advantage of that! It is a great way to recover and let your HR slow down.

top of the world with Mary Day and Perry Hacker

Icing stuff 1 2 3 4 5 6 7 8 9 10

Comments: This one is hard to put a frequency to, since it is so dependent on the person and injury/recovery. Ice is typically used to facilitate a decrease in swelling and manage pain. When using ice for these purposes, I would recommend icing 10-15 min, up to 3-4 times/day. Just make sure there is a layer between you and the ice (you would be amazed at how many people give themselves frostbite). There is also a fair amount of research out there about contrast baths (hot/cold) for muscle recovery. But, I won't go into that rabbit hole right now.

Kona 2017 with Perry Hacker and Rory Duckworth

Strength work 1 2 3 4 5 6 7 8 9 10

Comments: Strengthening should go hand in hand with stretching. You want to be strong/stable within the range of motion that you have. There are people that are Gumby-like, and there are people that are bricks. You want to be in between that. Like stretching, strengthening tends to get overlooked. I think it is important for athletes to be "functionally strong." We need our bodies to hold up for hours and hours at a time. A lot of injuries surface because of compensations over a prolonged period of time. Our bodies are great at compensating and getting what needs to be done, done. But, they can only hold up for so long. This is where strength work comes into play.

My general rule that I tell patients is to do light strengthening exercises to "wake-up" your muscles that you will be using for a particular discipline. This can include bandwork, dynamic stretching, etc. It is also important not to push strength work to fatigue prior to a long/hard workout. Those muscles will already be tired and performing hours of activity will only exacerbate poor biomechanics, which can lead to further injury. A Physical Therapist can give you some good ideas on key exercises to address your specific deficits.

volunteering at Kona 2017

Scenario for you: Jane Triathlete starts a run and notices a new pain in her knee. She hadn’t felt anything prior, but that brick the other day must have caused some inflammation. What’s the best course of action in that moment? Stop and go home? Continue cautiously? Rub some dirt on it and go faster? Other?

It would depend on what type of pain it is. If it is sharp and debilitating, definitely stop, go home, and contact a PT or orthopedist. If it is a dull ache/discomfort, sometimes this is a sign of imbalances and overtraining. In this case, proceed cautiously. The discomfort may calm down after warming up. If it does not, stop. Missing a workout because you are too cautious is not the end of the world. Listening to your body is always important. As a general statement, pushing through an injury is not the best advice...

How about over the next few days… what’s the best way to nip something minor in the bud? Is it best to shut things down for a bit (or just swim, etc.) or is it generally ok to start workouts and see how you feel?

I wouldn't completely shut things down. "Motion is lotion". Light, painfree, activity is always good. You can always adjust a workout based on how you feel. I have had a fair number of patients think that they "have to get a workout done", and end up injuring themselves further. I like to tell patients that pain is their guide. If activities flare-up your injury and pain levels, you need to back off a little. If you are able to make it through a workout with minimal increase in pain, and it doesn't linger, you are right on track. Gradually increase activity/intensity as your body allows and WITHOUT increases in pain levels. If a pain is consistent for a week, does not improve with rest, and you aren't able to participate in activities, contact a PT. PT's are trained to screen injuries and refer out if they think it is something that needs additional evaluation.

CDA 70.3

From a scientific standpoint, what causes typical “overuse” injuries… as in, what happens to ligaments, tendons, muscles, etc. to sometimes push them over the edge into injury land?

Overuse injuries are usually caused by a sudden increase in training or training with bad biomechanics. Like I mentioned earlier, your body is great at compensating and allowing you to perform desired movements. However, if there is an underlying abnormality/imbalance in regards to flexibility/strength/stability, something will give at some point in time. Your body can only compensate for so long. Most overuse injuries are tendon related...where muscles attach to bone.

I'll try not to sound really nerdy..."Tendinitis" is an acute tendon injury due to repetitive loading. As it becomes more chronic, it technically is a "tendinosus" or "tendinopathy". In tendinopathies, there is a degeneration of the tendon, microtears, disorientation of fibers, vascular trauma, and localized swelling. There are several stages in pathology, and if not addressed appropriately, injury can progress on the continuum.

Climbing around in her "free" time. No tendinitis here.

Let’s say you have a particular area that gives you trouble over time… (flares up, you deal with it, heals, flares up the next year, etc). What’s the best way to stop an injury from reoccurring after you’re back in your training groove?

The best way to manage an injury is to find out what the underlying cause is. Many things are just "band-aids" and mask the problem. Having someone with a trained eye look up/down the chain will help prevent further injury. It is also important that once an injury is managed, to stay on top of it. This may mean continuing to perform certain exercises/stretches that were prescribed to you during your time of injury. I often see patients return with a flare-up of the same injury, however they had also stopped doing the things that had helped them manage those symptoms beforehand.

When should someone see you vs. powering through on their own? How do you help people get back to what they love, and how can they get started with you?

With having direct access to PT's now, I would err on the side of caution and get an injury checked out as soon as you can. PT's are trained to screen injuries, direct care, and get you back to activities faster. If we suspect that there is something more involved, typically a PT can get you in to see an Orthopedist faster than you can on your own. It is especially important to have an injury evaluated if you have taken some time off to rest, but has not been improving over the last couple of weeks. It is always easier to rehab an injury when it is acute vs chronic.

Ironman Santa Rosa

At RPT, we offer free consultations and can typically get people in that same day. A PT will meet with you, do a quick screen, and determine what would be best for you. That could be therapy, referring to another Physician, or kindly telling you that you are a hypochondriac. If I think that you would benefit from therapy, we get you started by managing your symptoms. A more comprehensive evaluation takes place and exercises can be personalized to you and your injury. As you improve over time, changes to your specific plan will be made so that you can get back to what you love!

RPT has 9 locations around the Salt Lake Valley, so it makes access and scheduling availability more convenient. I am located at the Life Centre building in Sandy. At the Sandy/Life Centre clinic, we offer some unique services like dry needling, IASTM, running analyses, and aquatic therapy. You can find all of our locations and information on our website. Any of our clinics should be able to get you in that day or the next, so you do not have to delay your training too long!

I am always available to reach by email and office phone. It's always great to get athletic, motivated people in the clinic! If you have an injury, come in and we can get you the care that is needed!


I am also at RPT Recharge Sports Performance. I am there doing injury evaluations and work closely with them and their members. Make sure you check their facility out, as it is a great relaxing recovery tool!

CDA 70.3

Anything else you’d like to share?

Hopefully, I am not the only one that really enjoys their job. But, I can honestly say I do enjoy what I do. It is one of the most rewarding things to see someone get back to what they love, and know that I helped them accomplish that. I am definitely never bored with my job. There is always research on new techniques to keep up to date on, and no 2 injuries are ever the same. Everyone's goals are different, and everyone responds differently. I am definitely the nerdy one that reads journal articles for fun and listens to podcasts at 1 1/2 speed. But it keeps me on my toes and I am able to get you back to what you love!

Food for thought...I was asked this during my PT school interview. Why are manhole covers round? Not square, triangular, hexagonal, dodecahedral, etc.??

I hope to see all of you out on the course this year!

Humpty doing his happy dance in a sick new race kit

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1 comment:

  1. Thanks for your information and also a comparison between physical therapy and personal training on iinn