I’ve been meaning to write about this topic for over ten years because nearly every week I get the: ‘Coach, I’m getting sick, what do I do?”
Practicing what I preach, “Always seek the help of a medical professional” I reached out to Dr. Kevin Sprouse who is the Head of Medicine for the World Tour Professional Cycling Team EF Education First – Drapac p/b Cannondale. When Kevin is not on the road with the EF Teams he’s at home as the Medical Director of Podium Sports Medicine in Knoxville, TN
Right off the bat, Dr. Sprouse dispelled a myth that I had about brown/green mucus being an indicator of a bacterial infection (because that is what I used to ask athletes first):
Do You Have a Fever?
The color of mucus doesn’t correlate with the presence of bacterial infection. My first question? “Do you have a fever?” And that’s not “do you think you have a fever”. Get out the thermometer and take your temperature. Anyone with a fever should absolutely avoid exercise, as there is a risk of the infection leading to damage of the heart muscle. Asking about mucous production, thickness, color, and sinus pain can be helpful, but it doesn’t indicate a bacterial infection. It can, however, be a good indicator that they need to see their doctor.
The Logistics of Seeing a Doctor Soon
There is a new service Dr. Sprouse recommends: www.SteadyMD.com
“It can be hard to get in to see a doctor, and going to Urgent Care always gets you a nebulous diagnosis and a Z-pack. If this is your reality, I’d recommend finding a new doctor. See a Sports Medicine Physician who understands your training and goals. They will be able to give you solid guidance which can help ensure you have minimal downtime. In my practice, we always get sick athletes in for an appointment within a day or two, and I’d hope you could find a similar practice near you. Along these lines, there is a new service called SteadyMD (www.steadymd.com) that pairs athletes with doctors online who understand their sport and strive to help them stay active and healthy. (Note: While I truly think this is a great service, there is the conflict of shameless promotion, in that I’m about to help them launch their cycling practice.)”
As a coach I want my athletes to see the doctor right away as soon as the symptoms begin because the sooner they see the doctor the sooner they can get back to meaningful training.
You’re Sick, Now What?
- Do what your doc says (be sure to tell them you are an athlete and directly ask, “when can I ride again?”.
- Tell your coach
- Be patient
- Let your body be the boss until you feel better.
Dr. Sprouse agrees, “If you’ve had to stop exercise entirely, I always suggest waiting until you’ve felt “good” for 24 hours before restarting your training. Too often (and I’ve been guilty too!), we start to feel pretty good, so we hop on the bike and go a bit too hard. Voila! We’ve just set ourselves back two or three days. I’d rather an athlete wish they’d started training again sooner, as opposed to wishing they’d just waited one more day. And when you do get back to it, Frank’s easy Zone 2 progression is perfect!”
Beginning to Ride Again
When an athlete is sick the first thing I do is completely clear their training calendar (yes, leave it blank) for a whole week. This is where the athlete should take training on a day by day basis depending how they feel. Your training is to not train! During this time try to stay on top of your fluids and caloric intake because when you do resume riding you’ll need your energy.
I have the athlete send me morning updates reporting symptoms and noting improvement in how they feel. I like to see a 2-day trend before we think about riding again.
When you do feel better wait one more day (be patient) and then do a “tester ride” which is 30 minutes in zone 2, no more. Often times the trainer is great for this because if after 5 minutes you simply don’t have it, you haven’t spent 30 minutes getting dressed.
The “Tester Ride” and Zone 2 Progression
Your goal for the 30-minute tester ride is to move your legs and maybe sweat a little. What you want to find out and report back to your coach is a) how you felt and how your energy was. Power and heart rate data is often useful. Did your zone 2 feel like zone 2 when you are well or did your zone 2 feel like threshold and your legs felt weak? The best thing for you to do is to share your ride data and how you felt in your post activity comments with your coach and let them interpret the results.
If the initial 30-minute tester ride goes well try 60 minutes of zone 2 the next day. If the 30-minute tester ride doesn’t go well either keep resting or do another 30 minutes in zone 2. Do not add additional time until you feel better. When you do feel better add 30 minutes of zone 2 per day until you are feeling back to 100%. Then at that point, I revise the training plan downstream a second time gradually ramping back up. For example:
The worst thing you can do is jump back into hard interval training. Never jump back on the previously designed training plan. You have to let your body be the boss for awhile and it will tell you when you are GTG (good to go)!
Again Dr. Sprouse provided some additional wisdom, “ “All athletes get sick at some point. It just happens. And often, it’s an inopportune moment in the training calendar. But you know what? It’s usually not as big of an obstacle as it initially seems. The key is to respect the illness and adjust accordingly. The goal of training is to get fitter and faster. Training while ill will make you sicker and slower. When sick, taking some time off is your training plan! Let your body heal so that you can get back to enjoying your sport.”
What If You Don’t Have a Fever?
Dr. Sprouse: Fever is an initial barrier to training, but the absence of fever doesn’t mean you are free to train hard. You must listen to your body! Body aches, joint pain, fatigue…these are all signs that the illness is taking effect on your entire body. In the vast majority of scenarios, you should rest and recover*. If you are racing worlds that day, you might have an argument for pressing on. I’m also a fan of gathering some objective data on a daily basis which can help add clarity to these pictures. Recovery scores based on tools like WHOOP, HRV4Training, RestWise, and similar can help athletes and coaches make informed decisions as to when and how hard to train. They are not flawless! But they add another layer of information that can be considered in context when addressing these issues.
*then do a Zone 2 Tester Ride and Progression
Additional Considerations: to take or not take antibiotics
If you were prescribed antibiotics here is a great blog post from Dr. Sprouse with additional considerations. The main point is to seek treatment from a sports medicine physician and take antibiotics with caution. Do not self-diagnose! This is a must-read for getting back to training as soon as possible.
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