Tara Lazarski is the Physiotherapist and Team Manager for the Rocky Mountain Race Face Enduro team’s Jesse Melamed, Remi Gauvin, and Andreane Lanthier-Nadeau, as well as the Physiotherapist for the Canadian National Mountain Bike team, and she spends most of the year on the road between the two programs. Curious as to how she helps professional athletes prepare for major races, deal with injuries, and what average mountain bikers suffering from injuries could learn from her expertise, I sat down with her at Whistler during Crankworx.
How did you become a physio?Tara Lazarski:
As a high school kid and in elementary school, I was a runner. It was one of my main sports. But I was always injured so I was always in physio clinics. I thought my physio was cool and it looked like a fun place to work. Everyone had a great time at the physio clinic. I also had a high school co-op in a physio clinic and nothing really ever pulled me in any other direction. I did my undergrad in kinesiology and then went to grad school to become a physio. It's what I always aspired to do.
Once you became a physio, did you go straight into working with cyclists or did you work in the traditional clinic first?Tara Lazarski:
I started working in cycling as a kinesiology student. I've actually been working in cycling for longer than I've been a registered physio. When I was a first-year kinesiology student, I was working in the gym with a strength coach (Neil Ross) who also happened to be a physio and the coach for the Ontario Cycling Team. He needed somebody to help him with a road stage race that he was working. So he taught me everything you need to know to work at bike races - massage, driving, feed bottles and food, and organizing. It all started there.
All through my undergrad and through physio school, I worked with him and the Ontario road team. Then, slowly, I started working with the National Road Program as I became a registered physio and shifted it into mountain biking naturally over time. I've always worked in a clinic as well. From the day I graduated, I would spend most of the year in the clinic and then just leave for a race here and there. It's progressed and now I'm basically with the team(s) from March/April all the way through until October and I just go into the clinic in the winter.
My work has always been sport-focused. I've always put my time and learning into being better at working in that environment.
What races have you gone to this year?Tara Lazarski:
This year, the season started with the Commonwealth Games in Brisbane, Australia. I worked track, road and mountain biking there. I've also been to most of the cross-country World Cups and then the remainder of the EWS races.
Walk me through a weekend at an event where you're working with athletes ahead of a race weekndTara Lazarski:
If I'm working with the cross-country mountain bike program with Cycling Canada, we generally arrive Tuesday or Wednesday if the race is on Saturday or Sunday.
Depending on the race, we usually travel as a national team with about 8 athletes. I'm also there to support any of our Olympic targeted athletes that have professional teams. Some of those teams don't necessarily have physios, so if they need extra help beyond what their team can support then that's what I'm there for. So, at any given XC World Cup, I'm technically there supporting close to 20 athletes.
So in a typical week, Wednesday or Thursday, the athletes start training on the course. I'll be out there for a couple hours every day while they're training in case anything was to happen. Then we go back to our accommodation and I do treatments from 3 pm until bedtime, more or less.
Then on race day for XC mountain biking, we have a feed zone, so every half lap the riders are passing bottles. So I organize that and work with the mechanic to make sure that goes smoothly.
Race days are busy, but with mountain bike racing logistics and support, not physio stuff.
Then if I'm working an Enduro World Series race, we have three riders on our factory team (some races we have 4) and we usually get in the week before race week. The first couple of days is just getting over jet lag and some riding. Then, I do treatments with the athletes when they're done with riding every day.
Are you the one who would go on hospital visits if needed? Tara Lazarski:
Generally I would be the one doing the hospital trips, with either program. In some cases if I have a busy day of treatments, then I may send someone else, so that the other athletes don’t miss their sessions.
Could you take me through the day before the Whistler EWS, when Jesse Melamed got injured? What was your immediate response?Tara Lazarski:
On one of the stages in the morning, while I was prepping lunch, we got the call that Jesse had injured his hand and he was walking out of the stage. So I sent one of our mechanics to pick him up and drop him off at the clinic.
His X-rays showed a fracture in his hand, in his third metacarpal - stable and minor. The doctor gave us off the record clearance that if he was able to hold on and if he didn't have pain, then he could race. So we did a bunch of treatment that included some acupuncture and other treatments to address the swelling to see if could possibly get him ready. Is it possible in under 24 hours to calm this down enough so he can get on his bike?
The next morning we did some taping and he tried to ride up and down the road on the side of our house. There was pain, and there was swelling, but the strength was the bigger issue. He wasn't able to hold on or pull up so we just made the call that it wasn't safe. It wasn't worth it. These are big, heavy tracks. You need both your hands to be functioning really well.
So he became a super fan and ran around and we continued on as usual with the other athletes that we had racing.
That was his second injury of the year. Five weeks after the first injury, he came fourth at an EWS. How is that possible?Tara Lazarski:
He had a collarbone fracture while we were in France and the doctors at the hospital in France didn't want to do surgery there. They said, "Go home, deal with it at home." So we got him into surgery pretty quickly when he returned home. He had surgery within the week, I believe. He just had a great surgeon and his body responded really well. Within a couple of days, he didn't have any pain. He had full range of motion. He was lucky in that sense that we weren't battling inflammation. We weren't working on pain. We just needed it to heal.
He did have a follow-up X-ray before the next race and the plates and the hardware were stable so there were signs that it was healing. It wasn't fully healed, but there were signs that it was. Basically, the surgeon said, “you just can't crash on it”. So you do take a risk. He didn't crash. He had a great ride just keeping it smooth and keeping it safe. He responded amazingly well to the surgery.
What is the risk of breaking a bone and coming back too soon and breaking it again? Is it a worse break?Tara Lazarski:
So, in the case of Jesse and his collarbone, if he was to have crashed on his collarbone in a certain direction, the force could potentially break the plate. So the plate could break or pull out of the repair site and then it's another surgery and it's harder to recover from a second surgery so soon and dealing with a broken plate. Then you're just looking at more problems down the road.
There are some athletes out there that have had a heck of a journey with crashing, not on a freshly broken collarbone but even two years later. Falling on the plate can still cause problems if the hardware breaks or if the bone is weaker. The second injury anywhere, you're always injuring tissue that's not as healthy as it was pre-injury so it just compounds on top of it and it won't heal as well.
Earlier this year, you had another success story. Remi Gauvin returned from injury in record time as well.Tara Lazarski:
Remi had a scaphoid fracture six weeks out from the first race of the season. We got him into a surgeon quickly and the surgeon said, "If it was you or me, they wouldn't be putting a pin in, in this case. Because of the nature of his fracture, they'd give it the six weeks and see if it heals and then if it's not healing then possibly go in and do the surgery." But we had an awesome surgeon and he's like, "No, you're a pro athlete, if we put the pin in, you can move it right away."
So they pinned it and got him moving right away. We were controlling the inflammation. We were respecting the timelines, but putting some force through it early. Doing lots of acupuncture. Then we had a plan that we were going to go to South America. The flight was on Friday, and we had a surgeon appointment on the Thursday. We had a whole bunch of "if this, then that." We had a full list of options. It was "Okay, it's 50% healed", or "it's not healing," or all these various scenarios of what he could possibly say and what we were going to do.
If it was healing, but not fully healed, we planned to go to South America, and not race the first race, but race the second (one example of a scenario we have talked through). Then we went to the surgeon and he says, "It’s fully healed, good to go." Nothing, no restrictions, just "you can ride”. That was not one of our scenarios when we were going through what the surgeon was potentially going to say and we were so fresh post-op that it was unheard of for somebody to heal so quickly. We were excited for sure! Remi got on a plane. He hadn't been riding so there's some fitness that you lose being off your bike for the better part of two months. Then he didn't have great range of motion because we weren't pushing that. Those first two races were harder for him. He wasn't up to race speed but he was able to get out there.
We've already talked about one difference from being a pro athlete to not - right away the surgeon said: "We'll pin it." What did the next 6 weeks look like that he was able to recover so fast? What specifically are the different treatments?Tara Lazarski:
I can't specifically say, "Oh, this is why he recovered faster." There isn't necessarily literature to say that athletes heal faster or that doing acupuncture makes a post-op scaphoid heal faster. I think it's the nature of being a professional athlete and it's your job to get better. You and I still have to go to work if something like that happens. If you have kids, you're taking care of them. Healing is your only job if you're a professional athlete. You allow yourself to have lots of sleep. He was still getting some workouts in that he could, so still stimulating the body that way. The treatment we were doing was very light because we couldn't push it. It needed to heal. We were probably doing 4-6 days a week of acupuncture and just light range of motion and some other techniques to address the inflammation. Checking in frequently and talking about it and making a plan of what's happening the next day. Eating healthy to heal the injured bone.
We weren't necessarily doing anything special. I think just that - that was the focus and athletes are fortunate enough that they can focus entirely on healing.
How important do you think that having that plan is for the psychology of going through an injury?Tara Lazarski:
I've done some extra coursework in pain science and one of the major pieces when you're experiencing pain or an injury, whether it's acute or chronic, is having a plan and moving forward with how you're dealing with your injury and your rehab. It's a huge part. Knowing it's a couple of days on the road bike before we get on the trail bike, and then trail bike on the road and trail bike on easy trails, and trail bike on harder trails and then trail bike on downhill trails. There is that progression. Maybe we don't necessarily write it down, but it's talked about, it's discussed, it's re-evaluated, and it's changed depending on the circumstances. It's flexible, but it's there. Everyone knows what they should be doing.
We haven't talked about Andreane Lanthier-Nadeau yet. Her recovery wasn't as fast so I imagine the treatment and psychology for that was more difficult.Tara Lazarski:
Yes, for her, she was off the bike for the better part of 9 months. She had her last surgery in February. That one was different. It was somewhat of an experimental surgery. We didn't know if she was going to be healed and cleared to ride just three months post-op.
There are different layers to rehabbing Remi's scaphoid fracture than ALN's. She hadn't been on the bike and her story was more complicated. The surgery, the history of surgeries, the history of fractures. It takes more time to get your fitness back when you’ve been off for more extended periods. It's easy enough for me to sit back and say, "Yes, this is our first race back. We're just riding. We're just rolling it. The second race, we just roll it a little bit more. Then we get some fitness back. Then race."
It's easy enough for me to sit and say that, but for the athlete, it's harder for them to see that that's the plan and to believe in that. I think that she can probably look back now that she's closer to that race speed and she has some of her fitness back and see that it was all part of the process.
The psychology is huge and one of the big things with pain science is that your brain remembers environment. Pain is a descending message from the brain and your brain takes various inputs to decide what message it's going to send out. So if you had a major injury that's affected your life while you're bike riding, then while you're out riding your bike, your brain may send a message to your body that "Hey, last time you were riding a bike we had a really big injury so I'm going to make your wrist hurt so you stop riding because we don't want that to happen again."
This is where people say “oh the pain is in your head”. It is in your head, but it's hard-wired. It's how the nervous system works. Even though it comes from your brain, you're not making it up. It is a wiring. So, we try to break some of those cycles and there are various techniques you can use to get through that. But yes, there is a huge component of just telling your body it's okay and there's a line because maybe it's not okay and you battle with that. Is it okay to push past this pain? Is it not okay? I think you have to trust yourself with that.
I think that's really hard recovering from injury - is this pain okay, am I still getting better despite it? Or is this pain hindering my recovery?Tara Lazarski:
Exactly, and no one can answer... For a lot of injuries, those questions can be answered because we have imaging or various outcome measures that we can use and say, "Hey, yes, you have a fracture and it's not healing, so yes, riding can make it worse." Or we do an X-ray and it's not getting better. Or you can stress the tissue to see if it's healing or whatnot but in her case, it was a lot more gray. There was no surgeon who could say, "Re-image, it's getting better or it's not getting better." I really pushed to put the imaging outside of the puzzle and just look at how she felt and how the body was performing as the outcome measure. As opposed to "what is the CT scan and MRI showing?" because even with that we weren't getting hard answers.
I think that's paid off. Taking that approach. There are still some really bad days for her but more good days than bad days and that's over the course of a year or so. That's what we want to see.
You've talked about getting up to speed after an injury. How do you work with the coaches, the strength trainers, together with the athletes?Tara Lazarski:
Oh yes that's a huge part of it. We're pretty lucky that we have a fabulous community of coaches that our athletes are working with. So it's really easy. I just call them. I call the coach and the coaches are really good and they've all had experience with that sort of thing. We generally work together on what the best progression would be given the time of season and what the return to riding plan should look like. That's the easy part.
What's your first line of defense when an athlete's injured at a World Cup?Tara Lazarski:
I wish there was a magic wand! But, whenever I'm at a race I have a backpack full of supplies and gear and generally our first line of defense (if trail side) is stabilizing the injury and getting ice on it. At Cross-Country World Cups there are event medics that respond if somebody crashes. Same with enduro, you can't be everywhere on the course, So we rely heavily on venue or event medical in the case of a crash that needs to be responded to immediately. Then by the time they get to me hopefully they would be splinted or in a sling or whatever they need to be transported off the trail in.
We've talked about different bone breaks, what about people who have ligament damage? How does the treatment differ between those two?Tara Lazarski:
I would say with bone healing, we do have the luxury of X-rays to confirm whether healing is occurring. With bones, we're looking at whether something is stable or unstable and do we need to immobilize it or can we put some weight through it. Every bone and every fracture in itself is different that way and the literature is changing on early mobilization. It's rare to cast something for three months like we used to. But with ligament injuries, I would say we're definitely going more off the presentation of symptoms and how the person is feeling. The textbook tells us it's 6-12 weeks for an ankle sprain, but we don't necessarily stick to those timelines. We're re-evaluating and re-assessing a collection of assessment pieces and always re-evaluating and progressing based on the presentation.
We're not going to wait until week 4 to give you single leg squatting if you can do it on week 1. There are lots of pieces that go into that decision-making so I would say in some cases ligament sprains can be quicker than a fracture. But in other cases, the injuries are bigger and they take longer but it's dependant on the person and the joint. Talking about mountain biking here - a ligament sprain to a shoulder or a wrist is going to have a lot more impact on riding than say a ligament injury in an ankle or something that doesn't get tossed around as much while riding.
How vital do you think physio is for helping athletes throughout the year?Tara Lazarski:
Of course I'm biased. I think it's important in a situation with the team. Something I think is super valuable is being able to respond within those first 24 hours with doing the right things. Starting the correct treatment right away and getting the injury on track can mean getting back to riding and racing.
I can't say for sure that makes healing faster but again people have a plan, and there are fewer unknowns. It's here are the five things you have to do every day for the first 3 days as opposed to sitting at home wondering if you're supposed to be walking on it, or putting your leg up. We eliminate unknowns, which is huge. We know just in general that fear of the unknown creates stress. We can eliminate that by working on it right away. If we can fix something straight out of the gates it's going to be easier long-term than waiting.
So what would you say are your main tips for riders right now, either they've just been injured, or they've been battling an injury for a while?Tara Lazarski:
As a blanket statement, I always suggest having a professional assessment. So, physio isn't the only profession that is good at assessing these things. We have chiros and massage therapists and osteopaths. Whoever your choice practitioner is, having that assessment to address the underlying issue or to help you create a plan and put the treatment plan into play.
I hesitate to say, "Oh if you've crashed, do these 5 things." Because it can be different. I would say in most cases, light compression and ice isn't going to hurt anything. If it hurts to bear weight or to put force through it, until you can be assessed, limit the amount of pain you're recreating that way. Decreasing the aggravator for whatever the injury is and trying to stabilize it. For sure getting it assessed. In mountain biking, it's crazy how many times we say, "Oh I think it's fine, I don't think it's broken." Then we go for X-rays and there are lots of fractures.
But mountain biking is high speed. You're hitting hard objects. I'm often shocked at the things that are fractured. I send athletes for X-rays because I have experience knowing that my assessments aren't always accurate. We send them anyways but I'll think, "I didn't think that was fractured” and then it is. Thankfully, a lot of times it's not fractured and we wasted our time with an X-ray, but I wasn't going to work on a shoulder for example, if there was a fracture in there. Now that we know there isn't, we can do more aggressive treatment to move it along.
What are the main things that you've learned as a physio in your years working with different cyclists?Tara Lazarski:
I've learned a ton. I learn every single day that I'm working with these athletes. I can't really make a list but I would say working in this industry, “expect the unexpected” You'll never have seen everything. Be open to being adaptable. More those type things than specific injury things. I've learned how to be that way and how important that is and how valuable that is.