In early 2021, pro triathlete Caroline Livesey and her husband Mark headed to Costa Rica in search of a gravel cycling adventure. They embarked on a challenge to ride across the country from the Caribbean Sea to the Pacific Ocean in two days. Over 270 km of mixed riding through the incredible landscape of Costa Rica with 6500+ m of ascent ensued with lots of drama thrown in.
This adventure (which can be watched on YouTube https://www.youtube.com/watch?v=bsqW5KJtjXc) was only possible because their osteopath Helen How was able to accelerate the healing of Caroline’s stubborn and slow-healing hamstring injury in advance through intensive treatment with ESWT and EMTT. We spoke to Caroline, Mark and Helen about the successful treatment and their future adventures.
Caroline, Mark, and Helen, can you please say a few words about your professional background before we get started with the detailed questions about your fantastic coast-to-coast trip and Helen’s treatment?
Caroline: Yes, of course! I am a professional triathlete, triathlon coach, endurance adventurer, financial analyst, engineer, sports journalist, and life coach. I spent 10 years in the British Army as a civil engineer and was only able to do sport full-time after leaving the army. Now I live in Mallorca and continue to compete in triathlons, although the races tend to be more extreme these days.
Mark: I am a film producer, podcaster (The Brick Session), co-founder of the Xhale software platform, triathlon coach and dedicated athlete. After leaving the British Army, where I worked as a physical training instructor, I started to develop my filming and editing skills. Me and Caroline seek races and adventures all over the world and I provide the footage to inspire others to do the same.
Helen: I did my training at the European School of Osteopathy and spent over 35 years combining my hands-on skills as an osteopath with exercise and rehabilitation. I have been working with radial shock waves for 7 years and for some time now also with focused shock waves and Extracorporeal Magnetotransduction Therapy (EMTT). I incorporate evidence-based exercise and loading protocols, concurrently with shock wave therapy for optimal results. I regularly update my clinical practice over the years with attending many courses on current concepts in multi-modal management of musculoskeletal pathologies.
Caroline and Mark, what sporting activities do you do?
Mark: Swim, Bike, Run. In all forms! For example, Caroline swam an 18 km point-to-point ocean channel crossing from Cabrera to Mallorca last summer. In early 2021, the two of you rode from coast-to-coast across Costa Rica in two days on gravel bikes through jungles, banana, sugar, and coffee plantations. But due to injuries, it was not clear for a long time whether you would be able to do this tour at all, right?
Caroline: During the COVID lockdown in 2020 in our home of Mallorca, we were not allowed to exercise outside for 9 weeks. For avid athletes like us, this was incredibly tough. While we had a treadmill and turbo to use during this time, there was a lot of pent-up energy to spend when the lockdown ended. Running in the mountains of Mallorca shortly after, I got acute tendonitis with a likely tear on the hamstring insertion on the right-hand side. Your osteopath Helen treated the injury… Caroline: Over the summer months while in the UK, I visited Helen first in July/August, and had an intense course of treatment with ESWT and EMTT. The follow-up treatment took place in October.
Mark: Helen’s great. I first visited her for treatment on a long-standing (3 or 4 years) Achilles injury. The treatment hastened the healing of the injury. I am also having treatment for my hands and an old ankle injury.
Helen, how did you treat Caroline’s injury with ESWT and EMTT?
Helen: I used focused shock waves with DUOLITH and EMTT as Caroline had a multi-site challenging tendinopathies of Proximal Hamstring and Gluteal Tendinopathies. The focused ESWT dose was according to Caroline’s tolerance. We started at 0.07 mJ/mm2, with no stand-off due to the large muscle mass. The stimulation was done with 3000 pulses. What was the treatment result?
Caroline: Hamstring injuries are notorious for being really stubborn and slow to heal. For the first month or two it felt as if there was no progress and it was really frustrating. However, over time and with the repeated course of treatment in October, it began to heal. Rehab was essential to the process as well as a very conservative return to running. I was so happy to be fit again in time for our Costa Rica trip.
Caroline and Mark, what are your plans for the near future? What adventures can your followers look forward to?
We like to compete in the XTRI World Tour series. These extreme races consist of a 3.8 to 4 km swim, 180+ km on a road bike usually with a lot of ascent, and then a 42+ km mountain marathon. We will start with the “HimalayanXtri” in May. This incredible race will take in over 8000 m of ascent in total between the bike and run and will be our biggest challenge to date. There is sure to be some amazing footage. We also hope to do another big gravel riding adventure in the Himalayas. Then we will take part in one of Scotland’s most iconic races, the “Celtman”, where we will be tested by extreme cold water, doubtful weather and a mountain run like no other. Shortly after this Caroline will compete in the XTRI World Championships in Norway at the “Norseman”. Amongst all this, we will also compete in various other more “normal” races.
That sounds fantastic! We wish you all the best!
