Lactate Testing is quickly becoming the preferred test for people that want to assess their aerobic capacity and determine how to make the most of their exercise program. I began to offer lactate testing to all of my patients in 2009 and I have found it effective not only for athletes but also for anyone that wants to take a more precise, deliberate approach to their exercise program.

Testing blood lactates is a relatively new practice in sport that has become popular in the last 10-20 years, especially in sports such as swimming, rowing, speed skating and endurance sports like marathons, triathalons, cycling, etc. At first, even the best trainers in the world were often confused with the use of lactate testing, but over the last 10 years, some consensus seems to have been reached on some topics and experts agree that lactate testing is a superior tool for 3 key purposes:

1 – Measurement of Endurance Performance:

Traditionally the preferred performance test for endurance activities has been the VO2 max test. A drawback to the VO2 max test is that it assesses aerobic power at a maximal intensity over a short period of time – this is not reflective of a true endurance activity which requires a longer duration of activity at a submaximal effort. Other downsides to VO2 max testing is that it can be very expensive (good equipment is very costly) and the devices used to breath in and out of can cause anxiety and discomfort in for the athlete. Aside from the minor discomfort of finger tip blood sampling, lactate testing suffers from none of these drawbacks, and is probably a better performance indicator at submaximal efforts.

2 – Assessment of changes in aerobic fitness over time:

The lactate test measures your lactate levels at many different levels of exertion. As you become more fit, your lactate levels will be lower at each of these individual exertion points; the test demonstrates that you are doing the same amount of work at lower intesities than before. This shift in lactate levels over time is a very sensitive indicator of training adaptation.

3 – A tool to opimize training intensities:

Because lactates can be used to estimate your intensity levels during exercise, it is probably the best method to determine and prescribe future training intensities or ‘training zones’. This is especially useful for fitness professionals so they can avoid overtraining or undertraining an athlete. Learning your ‘Lactate Thresholds’ can essentially make your training more specific to your goals. Whatever your goals, lactates can be used to help get reach them quicker; you can more precisely improve your endurance, your V02 max, your ability to heal and recover, or your ability to burn fat during a workout.

In his book, “The Science of Winning”, Jan Olbrecht talks about how he uses the lactate tests with elite athletes prior to big events in order to properly balance their aerobic and anaerobic systems. Although this use is less popular, it is very enticing; it is hard to argue with the 40 olympic medals that Olbrecht was part of in the Athens Olympics!

Understanding Blood Lactate

Lactate is a byproduct of glucose, or ‘sugar’ in your body. As lactate accumulates during exercise, we can assume that you are using glucose as an energy source. As the intensity of an activity increases, the percentage of energy that comes from glucose will increase, and you will produce more lactate, which can be measured in the blood. At low intensities of exercise, your body uses its aerobic energy systems (using oxygen for energy) which spares glucose and keeps lactate levels low. The more aerobically fit you are, the harder you can push yourself without accumulating lactate. Over time, as you become more aerobically fit, you will be able to achieve higher levels of intensity and keep your lactate levels the same. If we graphed this over time, your lactate curve would shift downwards, and to the right.

As you increase your intensity during exercise, you will eventually overwhelm your body’s ability to recycle or remove lactate from the blood. The highest intensity at which you can create lactate in the body and still remove it from your blood is called your lactate balance point. This is an important intensity to learn, and it has many other names; ‘anaerobic threshold’, ‘lactate threshold’, or just ‘threshold’ are the other most common names used. As you push yourself beyond this intensity, your body’s energy systems will actually become inhibited and your performance will suffer if you hope to perform much longer than 5-8 minutes. Getting to know this balance point is critical for everyone, not just athletes, exceeding your balance point in training could have negative effects to your health, your performance or even your ability to lose body fat.

How Lactate Testing is Done

So what does a blood lactate test look like? The most widely used method involves an endurance test that has incremental increases in intensity. Each stage can be anywhere from 2-5 minutes, and at the end of each stage a small blood sample is taken by a fingerprick and placed into an analyzer. The total test length can vary anywhere from 20-60 minutes, depending on the fitness of the athlete and the length or increments of the stages. Testing is usually performed on a bicycle ergometer or a treadmill.  As stated previously, the test is approximating intensity at all stages, and so it does not require the participant to go ‘all out’, but it does require the participant to go up to at least an 8 or a 9/10 on the exertion scale.

Becoming more popular is the FACT method, which involves an initial staged performance test as outlined above and then follows that up with a another staged approach that is thought to better isolate the balance point between lactate production and removal from the body. I utilize both methods, as I find the traditional method effectively demonstrates fitness adaptations over time and the FACT method is excellent for determining future training intensities or ‘training zones’.

Set Your Targets and Optimize Your Training Time

After your lactate test, you will have objective information from which you can set future targets for improvements. You will also have an outline of your individualized training zones that you can use to effectively target your weaknesses and make the most of your limited training time.

During my athletic career, I was impressed by the knowledge and understanding of the physical therapists that helped me.  Unfortunately, I almost always had to be injured before I would benefit from their expertise.  It made no sense to me to wait until I was hurt before addressing my physical weaknesses ; I wanted something more pro-active.  Prehabilitation (prehab) is the act of applying rehab principles to healthy individuals in order to prevent injury and enhance physical performance.

Rehabilitative principles are applied in a step-by-step fashion, to ensure that the body is not forced to do anything that it is not ready for.  I will outline some of these steps, and give you examples of why each could be important to you:

Reduce Pain and Inflammation

Pain or inflammation in a joint causes key muscles to be deactivated, as well leads to patterns of avoidance.  Running with a sore back for instance can train key stabilizing muscles not to work, leading to instability of the back long term, and can cause you to adopt habits that could make you a slower runner in the long term.

Ensure Proper Joint Motion and Stability

Tight ankles, especially one sided, can cause rotation through the entire body, cause unequal wear and tear of joints, overuse of other joints, and poor balance.  Weak hamstring muscles can increase your likelihood of tearing ligaments in your knee.

Efficient Movement and Posture

Your technique when you exercise determines which muscles get strong, which ones stay long and supple, which joints get stressed, and how tired you get.  Anti-inflammatory herbs or medications may help for your knee pain, but if the cause of the knee pain is the way you walk or run, then your pain will always recur.

Notice that none of the above steps have much to do with general fitness; someone can be very strong or fit, and still fail some of these steps.  Every day, people are exercising or performing simple daily tasks with limitations in the above categories, and those seemingly healthy activities can be making them unhealthy.  Don’t wait until you are unsatisfied with your physical health; learn about your physical limitations and what you can do about them right now.

Take a look at this clip which highlights some of the exercises that Mike did during his recent visit with Dr Oughtred, in Vancouver, BC.

Last weekend, Whistler hosted four world cup alpine ski races. The weather was fantastic, the snow conditions were fast, and the Canadian Alpine Ski Team athletes performed very well. I found the giant slalom race on Saturday particularly entertaining, and John Kucera’s performance down the final pitch entering the finish arena was very impressive. Our Canadian ski team is looking strong going into the 2010 Winter Olympics. 

That weekend, I also enjoyed doing some work for my friend and former teammate, Dana Williams. His company, Best of Both (www.bestofboth.ca), brings former World Cup ski racers together with ski enthusiasts of all kind. I enjoyed sharing some of my old ski racing stories and offering some helpful ski-tips to a great group of people from San Francisco. Thanks to Dana and Tim for a great experience!

During my 7 years of competition with the Canadian alpine ski team, I experienced several injuries, the most frustrating of which were the insidious injuries that seemed to appear out of nowhere. These injuries could last for months to years, and usually required multiple treatments to heal. Because one treatment alone was rarely effective, I began to think that there was more than one cause for these problems. It was for this reason that I decided to become an integrated health care professional, utilizing expertise from several different areas to help people experience better health.

Many chronic problems have more than one cause: type 2 diabetes, heart disease, autoimmune disease, asthma, headaches, overuse injuries, back and neck pain, irritable bowel, PMS, and psoriasis, are all examples of problems that have more than one cause or contributing factor. Common sense dictates that the assessment and treatment of such problems should be multifactoral. For example, an integrative assessment of the patient with chronic headaches would consider the following factors:

• Inactivity or obesity

• Overweight individuals that don’t exercise experience more health problems, including headaches

• Blood pressure

• High blood pressure or sudden changes in blood pressure can increase your likelihood of head pain

• Hormonal imbalance

• Migraines occur more in women, and they will often notice their pain fluctuates with menses

• Blood sugar imbalance

• Fluctuations in blood sugar can lead to the vascular constriction or dilation that is often associated with headaches

• Stress and cognitive influences

• Those who experience anxiety or depression, experience more headaches

• Neck problems

• The upper two vertebrae in your neck can cause an increase in head pain when they are dysfunctional

• TMJ problems or dental problems

• Food sensitivities

• Environmental sensitivities

• Poor posture and work position

• Poor vision or eye problems

• Infection or cancer

• Drug interactions

• Inflammatory disease

• Past trauma/ accidents

A multifactoral assessment allows the health provider to look at your health from a ‘bird’s eye view’, and focus treatments on the areas of your health that might contribute to your pain. Treatments could include physical therapies, supplements, therapeutic exercise, specific herbs, a special diet, or cognitive behaviour therapies. However, without an integrated assessment of your health, your treatment may be one sided, and may fail to address weaknesses in your complete health picture. It is for this reason that I recommend an integrated approach for your chronic problems, the prevention of disease, and for the pursuit of your optimum health status.

Ryan Oughtred

Injury to the lower back is one of the more common injuries incurred by the alpine skier. Waiting for back problems to happen before doing anything about them is probably a bad idea; the discs and bones of the spine generally only have nerves on their outermost portions, which means that damage to the inner portions of the vertebrae and discs can occur without experiencing any pain at all. The spine can degenerate ‘from the inside out’ for many years without any warning signals, and by the time an athlete is 26 years old-in the peak of a career-the spine can have significant amounts of permanent wear-and-tear. Here are the 5 most important preventive measures I think athletes and support staff can take to prevent back problems:

Build progressions in training schedules:

1. The risky forces for the spine are flexion, rotation, compression, and sheer; all of which are involved in skiing. Because avoidance of these risky forces is not possible, the athlete must be exposed to them gradually over time. Both on-snow and dry-land training should gradually involve progressions in both volume and intensity of activities that involve bending forward, twisting, weight lifting, and eccentric loading.

2. The adolescent spine may be especially vulnerable because the growth plates of the vertebrae are softer than in an adult, making them more prone to injury from compression and sheer forces.

Sit less, and never lift heavy after sitting:

1. Any time the spine is flexed forward for a period of time, such as with sitting, a phenomenon called ‘creep’ occurs in the tissues. The tissues are melded toward a shape that is different than normal. Heavy lifting or other compressive activity (such as ski racing) should be avoided immediately following a prolonged period of sitting or forward bending.

2. To combat the effects of creep from sitting on planes, in cars, or on chairlifts, athletes can perform extension exercises like McKenzie press-ups or other extension movements any time they have been prolonged to excess flexion.

3. When traveling – I would never allow athletes to lift heavy bags immediately after riding in a van or on a plane for hours. Stand up, walk around, and maybe bend the spine back a couple of times before lifting anything heavy.

4. When riding the chair lift – athletes should take time after every chair lift ride to stand up, bend back a little, and warm up before diving into another race run. While riding the chair, a relaxed upright posture is probably best.

Compress and twist the spine judiciously:

1. Twisting while you lift heavy weight doubles the load through the back. Athletes should be taught to never twist while they are lifting, unless it is an exercise specifically designed to prepare them for skiing.

2. Discourage athletes from packing heavy bags, and encourage them to share the work of lifting with other people.

Keep your spine neutral and stable:

We know that stability of the spine will prevent injury, but applying that to practice is not a simple task.

1. Maintain a neutral spine as much as possible when training, especially when lifting heavy weights or twisting.

2. Focus on endurance of the spinal related muscles, not just strength.

3. Integrate components of instability, unpredictability and precision into dry land training.

4. Full body exercises are probably better than isolated muscular activities. Even if the athlete feels like the exercise is too easy, it is still doing something for them.

5. Make sure athletes can breathe evenly throughout entire exercises.

6. Encouraging the athlete to lightly draw in their tummy, or ‘feel like they are stopping a pee’ while working out, might add to their spinal stability. Train everything. All the muscles of the core probably contribute to injury prevention in some way, as does the lower body and upper body. Search for balance, find weaknesses and eliminate them.

Proper biomechanics-the earlier better:

1. Taking the time to consult with someone who understands normal spinal mechanics and how to assess it could be a valuable investment.

2. If one area of the spine is not moving well, other spinal regions may be forced to work too hard, or in an unbalanced fashion. Detecting these kinds of imbalances early in a career may prevent future injury or even enhance athletic performance.

The field of low back problems is a difficult area. I have done my best to consider some of the evidence so far, and apply it to the ski racing athlete. I hope it was helpful!

Ryan Oughtred

More to read:

• Panjabi MM. The stabilizing system of the spine. Part 1. Function, dysfunction, adaptation, and enhancement. J Spinal Disord 1992; 5(4):383-9

• Richardson CA, Jull GA, Hodges PW, Hides JA. Therapeutic exercise for spinal segmental stabilization in LBP: scientific basis and clinical approach, Edinburgh: Churchill Livingstone; 1999

• McGill S. Low back disorders: evidence based prevention and rehabilitation, Champaign, IL: Human Kinetics Publishers, Inc.; 2002

• N. Bogduk, B. McGuirk. Medical Management of Acute and Chronic Low Back Pain. An Evidence Based Approach. Elsevier Science. 2002