Wednesday, November 25, 2015

How Do You Deal With an Injury Psychologically?


     The personality issues associated with an injury can be quite depressing.  “It’s a stress fracture, I don’t want you to run for 6 weeks,” said b the doc but interpreted as the death sentence by the athlete.  Often times, when hearing this, the athlete’s initial reaction is a flood of tears!  Or patent denial.  The athlete informs the care giver that he/she is terribly close to qualifying for Boston and has the perfect race scheduled shortly.  They can’t possibly put their sport on hold.

    When injured and told to decrease or eliminate that activity which gives them joy and a sense of purpose, the triathlete sees a piece of themselves being taken away.  Some even believe that the restriction will last forever, like an image in facing mirrors at the barber shop, and they are losing personal control.  It can be complicated dealing with the emotional ups and downs that accompany athletic trauma.  Friendships through the sport are temporarily put on hold and the daily enjoyment/refreshment of the work out is lost.  One’s sense of achievement or identity is removed and it can be a bitter pill to swallow.  In many cases, understanding the emotional impact is as crucial as understanding the physical nature of the problem.  When the damaged body part requires a prolonged rehab and recovery, at least a light at the end of the tunnel can be seen.  But occasionally, when surgery is required or a season ending problem is diagnosed, down right depression can be the result.

    If an athlete is part of triathlon long enough, it’s virtually guaranteed that something will be injured at one time or another.  Some, unfortunately, many times as they bring previous medical and physical baggage with them with their desire to achieve.  So, if some type of pre-injury preparedness is undertaken the emotional blow can be lessened.  An effort is made to fill the daily time block allotted for training in some fulfilling way as this will soften the blow.  LifeSport coach Lance Watson compares this grief reaction to that of researcher Elisabeth Kubler-Ross who defines five stages of loss from her pioneering work with the terminally ill.  These are denial, anger, bargaining, depression and acceptance as seen in her classic text On Death and Dying.  If you think about this for a minute you’ll see that it’s quite applicable in this instance.  Indeed the injured party has lost the ability to race and train, possibly through no fault of their own.  Watson tells us to “reframe the injury.”  View it as an opportunity to work on our triathlon limiters in other areas.  He states, “Do as much as you can to solve the problem each day even if it’s only stretching and icing.”  Do your part so to speak. We’re told to “stay involved with what you love.”  Can you help out at local races, assist in set up, body marking, be a volunteer? It can also be a time to take care of things you’ve put off like chronic bike discrepancies and maintenance, repairing your rain gear or reading up on nutritional or recovery advances.  Finally, “look for the silver lining.” If you’ve been diagnosed with an issue that prevents you from running, perhaps you can make a short term “single sport block” as taught by Chicago based tri coach Ryan Riell.

View this as an opportunity to ramp up a very select part of your training to accomplish something that’s been holding you back in the past.  This will also force you to take ownership of the injury and increase your knowledge base as to the source of this type of damage.  It follows that it becomes your responsibility to ensure that the potential for recurrence is minimized.  In most all cases, the issue will be resolved and you’ll be back on the street in racing form.  And, you’ll also be a wiser triathlete.  

Monday, November 23, 2015

Knee Injections, A Look From the Inside

Hyalgan, Synvisc, Orthovisc, Quaker State, Knee Injections

With accumulated wear and tear, or even after trauma, the bone covering articular cartilage of the knee joint can erode.  You know it as arthritis. In addition to the various types of cortisone which can be injected, a class of agents focused on one of the building blocks of cartilage, hyaluronic acid, is also available for injection.  They are known as hyaluronate preparations and can be effective diminishing both joint pain and swelling.

These agents (Euflexxa, Hyalgan, Synvisc, Orthovisc, etc.) can be costly and are usually not considered until the patient is a failure to other conservative measures like limb strengthening exercises, Tylenol, possibly a non-steroidal anti-inflammatory drug like ibuprofen (Advil) or naproxen (Aleve.)  Frequently, injection of a corticosteroid (cortisone, steroid) would be tried given it's proven success rate and much lower cost.  These can be repeated over time.

Easily done as an office procedure, after sterilely prepping the skin at the intended point of injection, and aspirating any effusion (excess joint fluid) which may be present, the physician takes great care to ensure exact placement into the joint.  Depending on the product, there can be 1-3 injections and, other than the sting of the needle stick, seem to cause very little in the way of pain.  Post injection the patient is asked to refrain  from vigorous exercise (like triathlon!) for 48 hours.

The success rate in lowering pain and swelling while increasing patient activity levels can be impressive. Upwards of 80% patient satisfaction has been reported.  One company advertises “Over 1.8 million knees treated….and still going strong.”  It can be repeated if/when necessary.  And, if it’s included in a overall program to maintain/preserve knee health as well as forestall a larger procedure like joint replacement, it’s role is clear.

So, if you have osteoarthritis of the knee, and a hyaluronate is being considered by your care giver, it may be “just what the doctor ordered.” 

Our first two Ironman Champions 

Thursday, November 19, 2015

33 Year Old Kona Memories Kept Alive/ Two Steve Smiths

33 Later, I Still Send a Kona Race Program

My first trip to Hawaii and my first try at this newly created Ironman thingy was in 1982, its 2nd year on the Big Island only 3 years after the first ever race on Oahu.  I was a hospital resident in Orthopedic Surgery at the time and my training buddy Ed and I were going to give this event a try.  Neither of us had ever done a triathlon but then neither had many of the others in the field. And heck, entry was only $100, so what did we have to lose? 

The headquarters hotel for that years race was the Kona Surf, now known as the Sheraton Keauhou Bay Resort and Spa located in Keauhou near the birthplace of King Kamehameha III.  Never having been to Hawaii, I made my reservations there and met a fellow Virginian named Ben with his family on my second day.  He mentioned they had an unused bed and that I should check out of my solo room and split one with them for the duration saving me a bundle of money.  I only had to be asked once.  We did a number of activities together during race week, finished our first Ironmans, and returned home to the Olde Dominion.  I visited his home 2 hours away once decades ago but otherwise have never seen him again. But I've been back to Kona over twenty times and make a point of mailing Ben Kendrick a race program every single time just to remind him that his act of random kindness has never been forgotten.

One time he contacted me, said we should do the race again.  We talked about what a different kind of beast it is this many years later and agreed that doing one is much better than doing none.

So, Thanks Ben, be sure to look in your mailbox in October for you-know-what. 

Ben Kendrick, Alii Drive 1982
How has the Hawaiian race changed since then?

Well, if you can imagine, in 1982 there were NO
Markers of any kind on the swim course
Energy lab
Time limits for anything; you finished when you finished
No qualification 
You just sent in an application

Second Kona story:

As you may know, I've written a number of pieces for over the years and this year, purely coincidentally I selected Steve Smith of New Hampshire for one of the many athlete profiles I was asked to contribute.  But those of you who been in triathlon for any length of time know that name.  Steve Smith #2 was from Indiana, had a string of triathlon wins, Iron distance victories, Kona age group wins, etc. as long as your arm.  Plus, he was a nice guy.  Sadly, Steve-O as his friends called him, passed away in 2014 following a three battle with cancer. If you'd like to see more check out .

Our Steve Smith points out regularly that he's "the other one" downplaying his athletic virtues.  Pretty hard to do if you're on the podium after the 2015 Kona race.  "The last time I saw Steve-O," he says, "was in Hawaii in 2011 in the Energy Lab. He didn't look good, but then who does after 9-10 hours on the Hawaiian course?" 

This year, Steve was 3rd in the age group as he was leaving the Energy Lab "when my hamstrings struck!"  He'd been prone to hamstring cramps for years and it took 133 miles of racing for them to rear their ugly heads this time.  But, he was still on the stage at the awards ceremony the day following the race!  You just know that Steve-O would be right proud of the effort!

Steve Smith of New Hampshire, Kona awards ceremony, 2015

What do you say we meet at the Kona Post Office next October to mail next years program to Ben?

Thursday, November 12, 2015

Do You Know Your Triathlon History?

 "Through early morning fog I see, visions of the things to be,
the pains that are withheld for me, I realize and I can see..."
                        Suicide is Painless, Johnny Mandel  (Theme to MASH)

Did any of this well known cast come from the original movie?
It's important to understand our triathlon history.  By history, I'm not only referring to the contributions of John Collins, Scott Tinley, Dan Empfield, Bob Babbitt and Joe Friel, but of the more recent experiences of everyday Joe Athlete who's walked the road you're on before you.  USAT thinks that this is important enough that it's the very first thing taught in the Coaching Certification Course for would-be coaches. In the words of George Santayana, "Those who cannot remember the past are condemned to repeat it."

I met a young woman recently who had no clue that the TV show MASH had come from a very successful movie by the same name, and the movie from a book by Richard Hooker (actually a pseudonym for a surgeon named H. Richard Hornberger.) 

One of the reasons this truth hits home in the triathlon world is the very common tri forum post, "I just was looking at buying some of those new xyz carbon wheels and wondered if anyone had any experience with them?"  Or you noticed that in your last sprint tri, the athlete next you in the transition area finished the swim well behind you but managed to exit T1 well before you and you figure that cutting time off your transitioning is needed..  All you have to do is go to You Tube for videos like and after a few practice sessions in the driveway - yes, the neighbors will stare at a woman in her wet suit standing next to her garbage can in suburbia but this is one of the small costs of excellence in triathlon - you'll be the queen/king of T1 and T2.

A terrific place to learn new things is the transition area before the race. Triathletes are proud folks and many like to talk.  I do pretty well in my age group and I can't tell you hoe many times a complete stranger will approach me and ask something like, "How come you have so few items in your transition set up?"  I then go right back to the video above, experience and the particulars of this specific race and we have a good give and take.  Just as often, I'll learn something from them like, "Well if you were to place your bike over there for this particular race you'll avoid much of the foot traffic."  This is also very true at races end before the finishers party when everyone is full of themselves, their accomplishments, and relaxed.

In short, take the time to read, to talk, to quiz others, understand the "history" of your sport and it's intricacies and you'll be faster,  For sure.

Monday, November 9, 2015

You Know You're a Masters Triathlete/Ironman

"There's something happening here.  What it is ain't exactly clear."  Buffalo Springfield.

Masters Athlete...older than his baby face would appear.

Some of us, er, some of you have been around this sport for a long time.  As such you've seen fads (skid lids, long sleeved tri suits) come and go but now approach the sport with a little more casual eye.  If there's something you learn that can save you a few seconds in transition, but maybe it itches, you think "maybe tomorrow."  Here are a few other ways you know you're a masters triathlete.

Aging up - being the youngest in your age group used to be a good thing, but the older age groups are often more fierce - and in some cases faster.

Masters prerogative - at swim team or in your Sunday bike group, you may at times employ MP in changing the work out or negotiating sets with the coach or fellow athletes, something you could never do as a youngster.

It's a Fine Line - you no longer have 14 or more workouts/week.  Hell, you're lucky if you get 7!  So when it's time to race, you're not sure if tapering will get you out of shape or the warm up gets you in shape.  It's a fine line.

Bodies - Many have taken their ailing shoulders, backs and knees to that place where the cutting is done.  In other words, butterfly is no longer an option, hill repeats (?) forget 'em.  At least your Ortho doc says so.  And so do you when you want to try the second one.

Adult beverages - relaxing with a glass of wine, or three, the night before a race was never an option.  But it is now!  In fact, it wouldn't be  uncommon to find a bottle of that great cabernet from the recent wine tasting mixed in with your race number and helmet in your suitcase.

Laughing out loud - everybody shows up at bike group, not because their parents or coach are making them, just because it's what you do..  I don't remember smiling or laughing this much during training as a younger age grouper. 

Doesn't Matter - Some have extended masters credentials.  They can't see, can't pee, can't hear but it just doesn't matter.  "Consider the alternative" is often heard finding it remarkable that you're still out here.

Morning math -  Having to think twice, maybe three times while swimming a complex set as you try to compute the interval (I screw this up all the time.)

Remembering when morning stiffness was a good thing.

Many thanks to Kirsten Read

Thursday, November 5, 2015

Goal Setting 2016, Thanks to You the Readers!

When I buy cookies, I eat just 4 and then throw the rest away.  But first I spray them with Raid so I won't dig them out of the garbage later. Be careful though because Raid really doesn't taste all that bad.        Janette Barber

The most advanced SAFETY FEATURE this car has is THE DRIVER standing next to it. 

Thanks to you, the readers, from this author.

First, I want to thank all of you who:
A) Sent me positive feedback on my pieces on during Ironman Championship week in Kona,The Athlete Profiles like or were fun to do and even though not competing, it makes you a part of the race. I very much agree that it captures the feeling, the wonder, the absolute joy you experience at this terrific event.

B) Commented on the piece I was privileged to write for LAVA Magazine recently, :

Kona From the Perspective of a Snowed Under Bike Mechanic


C) followed me on Twitter as I'm over 1400 now.

D) took the time out of your busy lives to read this blog.  I'm at 6-10,000 hits per month and growing steadily thanks to you.  Who says a blog can't be fun?

Ironman support from your kids.  Can anything be better? Nope.

Below is a piece by motivational speaker Jim Rohn.  It's particularly well suited to the triathlete as he/she is reflecting on 2015 and planning the upcoming year.

What goals did you set at the start of this year? Have you accomplished them? Personal development legend Jim Rohn says it's ok if you haven't yet achieved your goals. The more important question to ask is if you've started.

“The real value in setting goals is not in their achievement. The acquisition of the things you want is strictly secondary. The major reason for setting goals is to compel you to become the person it takes to achieve them,” Rohn says. Say you want to be a millionaire. The greatest value to becoming one is actually not the million dollars. (Seriously!) “The greatest value is in the skills, knowledge, discipline and leadership qualities you’ll develop in reaching that elevated status,” Rohn says.

"Answer this question: What kind of person will you have to become to get all you want?

Write down the kinds of skills you’ll need to develop and the knowledge you’ll need to gain. Your answers might give you some new goals for your personal development. Work on your goals. Your ability will grow to match your dreams. This is the magic of goal setting. The more you work on your goals, the more new opportunities will present themselves to you,” Rohn says.

You can make big changes in your life. “You can make startling changes you can’t even conceive of right now, if you just give yourself half a chance.”

Sounds good doesn't it?


I think as triathletes, this is what we do as we prepare for the upcoming season.

Here's wishing you racing and training success, hopefully smart and injury free, in 2016.

Hope you never see the inside of this tent in 2013

Friday, October 30, 2015

When Is It OK To Just Do the Race as a Workout?

Great Opportunity - have a close look at your stroke!

"I hate running!" Swimmer Magazine, January 2013

The article goes on to say, "What famous swimmer posted that at  If you're guessing every swimmer there may be a grain of truth, because swimmers, by definition, practice a water-based sport rather than a land-based sport.  But not every swimmer hates running, and increasingly, more runners are getting into swimming thanks to the triathlon craze."*

Triathlon and some of the personality types that gravitate to the sport can, in some cases make us our own worst enemies.

I had someone tell me once that they'd think twice before hiring some one deeply involved in this sport.  Sure, the old adage about giving something you want done to the busiest person you know is part of this, the positive part.   But does the distance triathlete think, plan, drown in triathlon during their work day to the point that it sometimes diminishes their effectiveness?  From a personal perspective, when I was still racing iron distance events, the answer approached, dare I admit it but on occasion the answer might be yes.

 Running or Racing?

We've all been in this setting.  You are just about completely recovered from your first/latest(?) major running injury, gradually increasing your mileage as ordered. Then you remember that your very favorite race is coming up next week.  What do you do? Enter anyway?

 This question is asked repeatedly and the answer is hard to come by.  If you run it do you race it, seek that PR, look for the podium?  Is there a reason not to?

Race?  Don't race?  Just run it?  It all depends, in my mind, on how your rehab is coming and your physical condition.  There will be 100's more races down the road and from a physicians perspective, just like shutting down Stephen Strasburg of the Washington Nationals after his Tommy John elbow surgery, in my opinion, you always think long term.  Always.  Is there a level of effort, after which I risk worsening my injury and delaying my being at 100% healed?  Only you can answer this.

But there are several reasons why running a race, but not racing it, makes good sense:

1) you're coming back from injury as noted above.
2) You had a hard race last WE, and maybe the WE before, and can treat it like a work out.
3) Fun. You just want to run for the fun of it. Maybe conversational pace with a friend.
4) A friend is looking for a PR and you've agreed to pace him/her.

 So just because you're not at full steam, you don't necessarily have to drop race participation. Just think before you do, make a game plan, and stick to it.  That may be the hardest part.

 Big Toe Problems

 We covered bunions a couple weeks ago with some pretty good pictures if you missed it. Your big toe is really important as it carries 40-60% of your body weight, twice the lesser toes!  So, anything that might affect the big toe may also alter your running gait.

Some athletes will suffer an injury with subsequent loss of motion of the big toe.  This stiffness of the joint can be known as "turf toe" from it's initial frequency on artificial turf.  Imagine you pause to tie your shoe in a race with lots of runners around you - and one trips - landing on the heel of your back foot driving your forefoot into the pavement.  If this becomes sufficiently symptomatic, one fairly drastic treatment includes fusion of the first metatarsophalangeal joint.  Obviously this leaves bone where a joint used to be, not acceptable in some.   Other options called interpositional arthroplasties can maintain some of the motion and diminish pain. Basically, avoidance is your best option.  That said, after surgery, almost all noted improvement and there was a 75% patient satisfaction rate.  I doubt many were triathletes. 

* Jim W. Harper