3
Oct
2018

Sicklines takes a closer look at Dr. Steven Noble’s Performance Lab

10/3/2018 : toni

An engineer turned doctor develops an interesting new method to improve your cycling performance…

Words and Photos: Toni Walbridge
Video: Dr. Steven Noble

Back Pains

I made a mess of my back this past winter. I spent a solid week in November surfing 4 to 5 hours a day. I quite like surfing, particularly in the fall as a bit of a break from the non-stop riding of summer. The problem is, most of the year I don’t average more than 4 or 5 hours a month in the water let alone that kind of time for 7 days straight. By the end of the week I could barely stand up straight and popping up on my board was intensely painful. I went home took a break and took to rehabbing myself as I’ve gotten so good at after a lifetime of mostly biking related injuries. I surfed a few more times over the next couple months but each session was cut short with pain. As you might have guessed, my biking suffered too. Any attempt to move quickly resulted in sharp correction as my back screamed out in pain. Back injuries have a way of f’ing up just about everything you do. After several weeks of messing around with the foam rollers, ice baths, yoga, and strength training my back wasn’t feeling any better. I’m not much for pain killers and I damn sure didn’t to talk to anyone that even owns a scalpel. So that ruled out a large percentage of my options and left me looking for someone knowledgable in Sports Medicine who would take a functional medicine approach to recovery. Without any solid recommendations, I took to Google and looked around for someone who seemed to fit the bill. And that is how I came to meet Dr. Steven Noble.

I met with Dr. Noble and received a diagnosis that I had managed to sprain my back. The good news, the damage was mostly soft tissue that would eventually heal. The bad news, it was going to take a while. As we got into his prescription for how to approach recovery, I found myself in the rare situation of talking to a health provider with direct experience in the world of mountain biking and other “extreme” sports and the sort of stress they put on the body. Historically, I have had pretty much zero luck in having an any sort of intelligent or insightful conversation around the demands of modern enduro and DH mountain biking and what a recovery plan might look like with tradition healthcare providers. This was a breath of fresh air. It turns out that Dr. Noble has built a practice around addressing the injuries of athletes using modern Chiropractic techniques but had also been hard at work at method to address both injury recovery and increasing performance that he calls the Performance Lab. The idea behind the Performance Lab as a treatment is that injuries like the one I sustained are largely attributable to a delay in muscle firing. A quick movement occurs, muscles fail to respond fast enough, bone and/or tissue is shock loaded, injury occurs. This is the heart of what the Performance Lab aims to address. Through treatment, muscles begin to fire with less delay. This improves balance, precision, strength, and power. This leaves the joint, in my case, my spine protected, stable, and less likely to be re-injured.

A look inside the Performance Lab

The Performance Lab consists of a working directly with Dr. Noble while he uses his own techniques to stimulate muscle responsiveness including a lot of time on a balance board . It turns out that the ability to balance, particularly when taken to the extreme of a balance board is rather indicative of one’s muscle firing performance. The heart of the Performance Lab is reducing delay in muscle firing. The thing about balance boards is that any delay in that muscle firing is shows up right away. Dr Noble observes and captures video of each balance challenge. In between each balance challenge, he’s busy making small adjustments, manually testing for muscle firing in various positions, and then it’s back on the balance board. Round and round you go until mastery of each challenge is achieved. To give you a better idea of what I mean, the vid illustrates the improvement I experienced in ankle stability during a single session. I responded quickly and only needed a couple adjustments to get these muscles firing but some tests might take a half a dozen attempts or more depending on your personal deficiencies.

This video highlights the core stability issues I was having and their asymmetrical nature. Note that when I lift my right leg, I’m able to remain quite stable. When I lift my left leg I really struggle to balance. Fast forward a few minutes of treatment and I’m able to stabilize much more quickly and almost equally side to side. This carried forward to the seated balance board test that we’ll look at a little later in the article. I was firing very well on once side while the other side couldn’t muster anything better than a very ugly, herky-jerky correction.

After a few months and half dozen sessions in the Peformance Lab my back recovered to the point where I surfing again and riding better than ever. My riding precision had increased to a level higher than before I was injured. For instance, approaching a near vertical rock roll with a tricky entrance blind for the first time, rather than put a foot down or stop all together, I’d find myself riding up to the top, quick pause while balancing to pick my line and go! I found myself riding all sorts of ragged lines where I felt smoother and much more in control. These experiences continued to snowball into improved confidence and started to open up new lines on the most difficult trails I ride. As time and more rides went by the anecdotal evidence continued to pile up. This is about the time that Dr Noble and I got to talking about doing an article and putting together some data a test subject. The idea was to recruit someone that I could easily observe and someone with a substantial Strava history so that we could observe correlations between the Performance Lab and riding performance. I’m a pretty lucky guy in that my wife is as addicted to mountain biking as I am and she’s a religious Strava user and has been for a few years. I suppose recruiting my wife for a critical performance analysis does sound a little dicey, but like I said, I’m pretty lucky and she’s pretty chill. More importantly, she was fairly skeptical of the whole thing so I didn’t have to worry about bias.

Misti

Misti has been riding mountain bikes for the better part of 20 years. She does not race but does ride 4 to 5 days a week on average and enjoys the sharp end of riding that the PNW and BC have to offer. A plan was hatched to take her through 6 Peformance Lab sessions over the course of a few weeks and then observe for any on-bike performance changes. The timeline that we are examining encompasses the months prior and following treatment. One hypothesis is that while muscle firing improves almost instantly, neuro pathway development continues for the days and weeks following treatment. The idea is that your mind and body need a little time to get fully into sync with your new found power and precision. As those pathways develop, power and precision in execution of motion increase which builds confidence. Once all factors for improvement are in play, the biggest gains are realized. This was the theory anyway. To be clear, Misti was not recovering from or being treated for any injury, the scope of this test was purely to improve performance on a highly trained healthy athlete. While this test was not controlled for all factors, it’s worth noting that no other changes to Misti’s diet or training regimen were altered during the course of this experiment.

Dr. Noble started off with the balance board on top of a half-round just to get the muscles around Misti’s ankle firing laterally. This is a fairly simple test but right away he observed and corrected some fairly significant delay around both ankles.
, Sicklines takes a closer look at Dr. Steven Noble’s Performance Lab

 

With lateral ankle stability achieved, the challenge was increased to placing the board on top of a 360º wobble pad. She doesn’t do too bad even before treatment but if you look closely you’ll notice how much more relaxed she is after treatment and how much less the board wobbles. Note how much less she throws her hips as her muscles start firing more quickly eliminating the need for big corrections.

 
Next up, the 360º wobble pad on the left leg. Before treatment, note how much she throws her opposite leg, shifts her shoulders, and hips to compensate. Later, her whole body really calms down and she settles in to balancing with very

 
As the performance lab moves on we start getting into more advanced work. Below, Dr. Noble tests muscle firing on Misti’s right shoulder while she has her weight was simultaneously shifted to her right leg. The idea is to look for disruptions in muscle firing when the shoulder, core, and lower body are engaged at once. Dr. Noble explains that he has found that muscles often tend to want to “turn off” when the body is in certain positions. For instance, you might be able to fire your right shoulder muscles with very little delay while sitting, but standing on one leg there might be extended delay. A big piece of the Performance Lab involves Dr. Noble looking for these hidden weaknesses and getting these muscles activated in all positions. As an application for mountain biking, think of diving into a fast turn, head up, elbows out, shoulders and core stabilizing as you look for your exit, legs absorbing imperfections in the trail. As you ride through the turn your position will change to meet the demands of the trail. If you’re not able to stabilize and react at full speed through the entire line you’re not going to be as fast as you could be. Worse, if you can’t fire fast enough in response to something like an unexpected loss of traction or obstacle that was obscured, you might end up laying on the ground.
, Sicklines takes a closer look at Dr. Steven Noble’s Performance Lab

 

Below, Misti moves into the seated on the balance board test while Dr. Noble digs in to find and activate the muscles that are not firing properly. I suspect this is probably the most difficult stage for most people and it was giving Misti fits., Sicklines takes a closer look at Dr. Steven Noble’s Performance Lab

 

After a couple sessions, we were able to put together a video of her improvement that is pretty impressive. In the first session she is able to balance only for a second or two at a time, mostly she’s just flailing. By the second session, she is able to balance for a full 30 seconds. Further, pay close attention to the roller. In the first video it’s still on the carpet which is the easiest version of this test, in the second half where she holds for 30 seconds it’s on the wood platform which is much more difficult.

Misti’s results

To the extent that we have been able to track Misti’s response to the Peformance Lab, the results have been nothing short of spectacular. We have a few years and hundreds of rides worth of Strava data to look at. Zooming out and looking at the trends across a monthy and yearly level, Misti saw a dramatic uptick in frequency of PR’s. She also advanced into the top 10 on quite a few segments and even picked up a highly contested QOM, a first for her! I want to be right up front here that we did not highly control this study nor did we use sophisticated telemetry or other advanced means of measurement. It’s also worth noting that Misti was on a different bike prior to 2018 however both bikes included in this data were similar in weight, travel, geometry, and performance. That said, I think we stayed as close to apples to apples comparison as reasonably possible without quarantining someone in a lab for 4 years. I also want to point out that while in the Performance Lab we can only correlate adjustments to balance board performance, here we have correlation to the real world. Dusty trails, slippery trails, changing conditions and results that cover a long enough time period to strongly indicate a lasting change in performance.

In the chart below, the darker colors equal more PR’s. Misti’s Performance Lab ran six sessions spanning May 21st to June 7th. Below you can see her last four years of PR data. Examining the accumulation of PR’s as one measure of relative improvement, we see 52 PRs in April, 61 PRs in May, 105 PRs in June, and whopping 142 PRs in July. Comparing those numbers to the same period in 2017, we see 37 PRs in April, 46 PRs in May, 56 Ps in June, and 44 in July. In summary, prior to starting treatment her PR frequency was up only slightly over 2017 but following her Performance Lab sessions, her PR rate was 2x to 3x as much. When we take into account that she rode approximately 33% more miles in June and July of 2018 vs 2017, the PR rate drops to 1.5 to 2x which is still a very strong correlation. More over, Misti’s treatments occurred through early June yet her measured improvement in terms of PRs did not peak until July. The best hypothesis we have is that while her muscles were immediately firing better it takes much longer for other performance influencing aspects of her physiology and psychology to realign and realize maximum performance.
, Sicklines takes a closer look at Dr. Steven Noble’s Performance Lab

Beyond the Strava data, I’ll add a few anecdotal comments of my own. Misti and I have been riding together for the better part of 20 years and we ride together several days a week. Over the past few months I have witnessed Misti riding not just faster but riding lines that she previously wouldn’t have even considered attempting. Her confidence seemed to soar and I watched as several lines that had been “in her head” were suddenly no problem. In this way, the Performance Lab seemed almost transformative for her. It appears that it didn’t just make her better at what she was already doing but opened her up to challenging lines that she would have never considered.
, Sicklines takes a closer look at Dr. Steven Noble’s Performance Lab

 

Gaining Perspective

Dr. Noble has been working with quite a few other athletes and I was able to catch up with a couple of them to find out how the Performance Lab had impacted their riding. All of them are seasoned riders and racers which I think adds an important perspective when compared to someone like Misti who is more freerider oriented and had not been chasing PRs that someone with a racing mindset might. And lets face it, while Misti’s results are very strong, more data is always better.

Steve

Steve is a mountain biker and professional road racer. Steve has been through more Performance Lab sessions than maybe anyone. Talking with Steve, I get the impression that the Performance Lab work has become something that he sees as an integral component of his ongoing training plan. He describes many of the same marked improvements that we recorded with Misti and the specific words he uses to describe the experience bear a striking similarity to my own observations. In particular, I find it fascinating that someone riding and training for about 15 years, including the past 5 years as a professional road biker, is seeing a dramatic uptick in performance. It makes sense that someone who has a more casual relationship to biking would see a big improvement but I was a little surprised to hear Steve’s take as a highly trained athlete.

Steve has a bit more history with the Performance Lab that the other athletes that we’re profiling in this article and we have some great video footage documenting his progression over the past 10 months. Steve’s progression in balance chronicled below needs to be seen.

I hit Steve up for a little Q&A to document in his own words the impact that the Peformance Lab work has had on his cycling –
Q: How many Performance Lab sessions have you been through?
A: About 20 over the last 10 months.

Q: Have you seen results in terms of PR’s or race finish times?
A: Yes, on the mountain bike I’ve been setting new downhill PR’s almost every time I ride following a performance lab session. I keep expecting to reach some sort of plateau, but that certainly hasn’t been the case yet.

Q: How would you describe your ability to balance before starting the lab and how has it improved?
A: I don’t think that my ability to balance was very good at all when compared to my strength/fitness as an athlete. That’s improved dramatically after working through even just a few sessions in the performance lab. For example I had previously only ridden the long skinny on Cedar Dust twice in the last five years. Lately I’ve been riding the skinny more often than not and feeling confident on it.

Q: Do you feel a correlation between your performance on the balance board and bike handling?
A: Absolutely. As my balance in the lab has improved I’m going faster on the bike. Yet, it doesn’t actually feel like I’m going faster down trails. I think that I just have so much more precision and control.

Q: Have you noticed any other changes around your general health and wellness or recovery?
A: I think that I have a lot more good days on the bike. Far fewer bad days and generally feel that I’m performing more consistently.

Q: Are there any other accomplishments in your riding that you directly attribute to your performance lab work?
A: The confidence that’s been added to my riding has been mind blowing. There are features that I used to look at and never even consider and now I tackle them head on with confidence.

FTP Testing with Clair and Eric

FTP (Functional Threshold Power) testing involves using a power meter and is designed to estimate a rider’s power output over one hour. With our previous subjects, Misti and Steve, the focus of the discussion was more on reducing delay and improving recruitment in muscle firing. Based on the data we have, it seems fairly evident that improving balance and precision directly improves on-bike performance. But again, we were looking at things like coordination, balance, precision in movement and the ability to ride faster and more difficult lines as a result. It had been my intention to focus solely on these aforementioned aspects for this article. But, things got interesting when I saw the data from a round of before and after FTP testing with two athletes participating in the Performance Lab. Dr. Noble had been working on the idea for a while that he could influence power output and recruited a couple local racers to test his hypothesis. Both of the test subjects are experienced Cat 1 racers so we’re not talking random untrained people off the street. Both of these riders have a few years on the bike.

Claire

Claire’s FTP test was performed over 4 weeks, 2 sessions per week, at the end of which she posted an impressive 11.4% improvement. Not only is that a pretty big gain in such a short amount of time but strongly reinforces the notion that muscle recruitment is greatly improved. More details including all of the specific numbers she posted can be found here if you want more detail. In an attempt to get a consistent picture of how these riders are feeling about their Performance Lab experience, I asked the same questions of Claire that I asked of Steve.

Q: How many Performance Lab sessions have you been through?
A: I went on average of two times a week for six weeks, and preformed three suffer-fests (FTP testing).

Q: Have you seen results in terms of PR’s or race finish times?
A: I did see a spike of PR’s (through strava segments) during my time with the Performance Lab. I also started riding/training more consistently during this time. I wasn’t able to compare race finish times as i went from sport to expert category for mtn bike races.

Q: How would you describe your ability to balance before starting the lab and how has it improved?
A: The Performance Lab highlighted my terrible balance and coordination. I was not aware of how bad I was at balancing, and i definitely saw notable improvement during my time at the lab and after. I actually think this is something i’ll work on consistently the rest of my life, because I don’t want to get old and realize i’ve lost all my coordination because i wasn’t practicing it. Use it or loose it!

Q: Do you feel a correlation between your performance on the balance board and bike handling?
A: Absolutely! I think especially with mountain biking there is so much more balance involved than most realize. Regardless if you’re catching yourself on a slippery root or finessing down through a rock garden, balance is required in order to be a dynamic rider. The better I am at balancing, the quicker I feel that I can react to a rock, root, or major change in terrain to then move my bike as desired.

Q: Have you noticed any other changes around your general health and wellness or recovery?
A: The most notable change was that I stopped getting frequent migraines after races. About thirty minutes after a race I would consistently have a terrible migraine and nothing seemed to help. Even after a 100 mile mtn bike race this summer there was no issues with headaches after-which was great because the last thing you need after riding 100 miles is a migraine.

Q: Are there any other accomplishments in your riding that you directly attribute to your performance lab work?
A: Well, i’m not a pro yet after three years of mtn biking so I guess I need more performance labs! In all seriousness, i do feel like i’ve gotten past a plateau this year and its been really fun to experience that. Yes, I am riding a lot more and followed a training plan for the first time but I do think that Dr. Noble planted the idea of how important balance/proprioception is to mountain biking so involving that into my training has been extremely helpful.

Eric

Eric is 19 year old Cat 1 mountain bike cross-country racer. In his baseline FTP test he posted a very strong 397 watts. Eric went through the Performance Lab in a more compressed timeline than Claire, completing 3 one hour sessions in a single week. 7 days after posting that 397, he put up a new PR FTP score of 406 watts, breaking through the 400 watt threshold for the first time. If you’re familiar at all with FTP testing then you’re probably aware that these are pretty high values compared to your average rider. The thing that interests me the most with Eric’s gains is that they came very quickly and on top of already being pretty dialed in terms of power output.

Again, we have some great video of Eric’s balance progression leading up to his FTP PR.

I hit Eric with the same questions previously posed to Steve and Claire. I feel like we’re seeing a common and consistent theme in how these athletes are reacting to the Performance Lab.

Q: How many Performance Lab sessions have you been through?
A: I did 3 performance lab sessions

Q: Have you seen results in terms of PR’s or race finish times?
A: Not directly, but I did get the KOM on spacewolf when I went for it right before I left for school. But Steve Fisher and I were both trying for it and the competitiveness was the main factor there haha. I also got 7th at the Mammoth CA Enduro Series race in the U21 EWS category but would have liked to have done better. The main result was in the FTP tests which I would say directly helped with a win at the first Western Conference collegiate XC race at Mt. Shasta. Enduro racing has a lot more variables so its harder to say.

Q: How would you describe your ability to balance before starting the lab and how has it improved?
A: I think the lab really highlighted ankle weakness that I needed to work on. I was impressed with the improvement in 3 sessions.

Q: Do you feel a correlation between your performance on the balance board and bike handling?
A: I think balance board carries over somewhat, but obviously sitting on the board is less of a simulation of biking as opposed to standing.

Q: Are there any other accomplishments in your riding that you directly attribute to your performance lab work?
A: I think Steve is actually on to something, I’m on the more skeptical side of things but I actually have noticed myself feeling better in certain recovery situations. I think most notably after hard efforts.
I would say that really breaking that 400W ceiling for my FTP test was the main accomplishment and with that alone, I’m pretty stoked on the results. Those small percentage improvements make such a big difference in races. Also, its fun to break into the 5+ Watts/Kg club!

Final Thoughts

The journey from my own injury to recovery through my own participation in the Performance Lab and then to writing this article has been an interesting one to say the least. While I write primary about all things mountain bike related I have a long standing obsession with human optimization. I’ve experimented with a fairly extensive list of diet and training protocols and can often be found in my garage nerding out to some of the smartest people out there like Dr. Rhonda Patrick on sulforaphane or Steven Kotler on Flow State. Normally, I’m just listening to the smart people talk though, not writing on the subject. I think this is where I want to be clear that I’m simply reporting on what I’ve observed and what I see is compelling. Very compelling. Mechanistically, how the techniques that Dr. Noble has developed in the Performance Lab work are not totally clear to me. I’m not even going to try to take a stab at how it works and thus have focused entirely on does it work. Mechanisms are interesting, real world results are more interesting. Jumping back to address my own results, I’m riding my bike better than ever, surfing well, feeling great on my moto and looking forward to slaying some winter pow. Not only is my back happy and healthy, I’ve feel like I’ve benefitted psychologically. I feel more calm in high pressure situations and find myself relaxed and precise in critical situations. For instance, I’m far more calm in the moments before attempting something at the limit of my abilities and if I do crash out, I’m far less rattled by it. I’m not saying that I don’t have bad days on my bike nor did I suddenly grow the balls of steel required for Redbull Rampage, but I’d certainly say I have far fewer bad days that I used to. Who doesn’t want to feel better, ride better, and enjoy a calmer and clearer state of mind? With that, if you find yourself in Bellingham for a few days and are looking to recover from injury or just up your game, it might be well worth taking some time to visit Dr. Noble to see what the Performance Lab can do for you.

For more information about the Performance Lab reach out to Noble Chiropractic at noblechiropractic.com


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