Monday, December 28, 2009

Images From Kona 2009

Since many of us are on holiday and surrounded by snow, I thought I'd share a couple shots I took in Kona this year just to keep the home fires smoldering.
















Wednesday, December 23, 2009

Do You Have Any Sesamoid Bones?



"Give me three steps, gimme three steps mister..." Lynyrd Skynyrd

I was asked recently about an athlete with a foot problem and a possible sesamoid fracture. It occurred to me that most folks didn't know they had sesamoid bones, or if they did, where they were.

The simplest definition of a sesamoid bone is one that's surrounded by tendon or intratendinous. The most obvious example would be the knee cap. This blog will be devoted to the pair of sesamoid bones underneath the ball joint of the big toe. They are about the size of a lima bean, normally glide front and back with each stride and rarely give us much cause for concern. But as with any bone in the foot, they can be broken or subject to a stress fracture. A true fracture takes a pretty significant injury such as a fall from a height where we in the endurance sport world are more likely to see a stress fracture from the usual causes. (See my two recent blogs on this injury pattern.) The athlete with a true fracture is going to be immobilized between 4 and 8 weeks, will be made non-weight bearing on crutches, and like likely be doing all of his/her training in the pool for a while. Treating the stress fracture is much less aggressive, but here, too, your running shoes will see no action for longer than you'd like.

Often times, sesamoid problems present as sesamoiditis, an inflammation of the area caused by the usual culprits of too much too fast, especially speed work or hills. One starts with the gradual onset of pain under the big toe, initially present during only the hardest portion of the workout and increasing to any running, even walking. There doesn't seem to be much redness or bruising. They can be slightly swollen but frequently it's not easy to see.

So what do you do? Back off for a while. Maybe do a percentage of your weekly run volume in the pool. (It can be fun.) Then, if you can unload the area of distress by using a metatarsal pad or other device to very slightly overload the non-injured portion of the foot being certain to ice down the area once the run is over. Don't be so aggressive that you risk frostbite but 15-20 minutes ought to do it.

Lastly, trying to go through your log book examining each week, each run, for clues as to the cause and how to never have it again is always beneficial.  And if you're successful, your "three steps" will be crossing the finsh line without pain!

Saturday, December 12, 2009

Injury Rates Increasing


Growin' up, you don't see the writing on the wall. Passin' by, movin' straight ahead, you knew it all." St. Elmo's Fire



A recent piece in the NY Times quoted what we've known for years that when single sport athletes switch to triathlon, their overall training hours go up and that rather having a decrease in injuries as they're spreading their workouts over three sports requiring "different muscles," the injury rate actually increases as the athlete has difficulty turning the desire (need?) to train off.

Joe Friel, author of the Triathletes Training Bible teaches that the true benefit from training comes, not during the workout itself, but during the subsequent rest period. Upon recovery from the added stress, the muculoskeletal system is just a little stronger than it was before.

This is the time of year, with snow on the ground that we're allowed to dream. We examine past racing successes and failures and use them as a springboard to set up our next season. Hopefully this is accomplished with more than just an ounce of common sense. Not only is the absolute load your body sees important but the rate of change of this load is also crucial. As one example, I did a blog on stress fractures recently and one of the take home messages is that we can all do a significant amount of training as long as the rate at which we increase the volume and intensity of this effort is such that we can handle it. And no, I don't mean "handle it" as simply being able to either fit it into an already packed schedule or that you're tough enough to get it done. This should be interpreted as being able to accept the increase in training load on top of what's currently be done and the total training increase isn't greater than, say 5% of the previous weeks efforts.

We all know that there are a few people, maybe the ones you train with, who seemingly don't need to follow these guidelines. A pair of women I swim with are like that. They have no idea of/need for warming up. While the rest of us complete a 1200 yard warm up set, they pop into the water as the main set is being described and push off the wall full tilt for the first 200. Of course I'm jealous. But my logbook is fed 1200 more yards more than theirs on a regular basis.

So as we dream about that podium spot at the local sprint tri in 2010,construct a sensible training plan that carefully increases the rate at which your knees are called upon to run more hills or time trial bike efforts. And, most importantly, when that little twinge becomes full fledged pain, take some time off of that discipline...you needed to work on your flip turns anyway. If you can carefully mold and execute your training plan, you stand a good chance of staying away from people like me (doctors) and having a terrific season. Good luck!

Sunday, December 6, 2009

Pick The Perfect Tri Sports Doc

Bill Vollmar, MD perfect sports doc











"Son can you play me a melody, I'm not really sure how it goes. But it's sad and it's sweet and I knew it complete when I wore a younger man's clothes." Billy Joel

So you didn't used get injured and now you might need to seek medical help? The cover of the December Triathlete Magazine has on it the title of this blog. And it gives a number of good suggestions. But it's neither written nor edited by a physician and maybe another perspective could help.

Triathletes are what's known in MBA circles as early adopters. They'll try things (anything? Compression socks...Biestmilch...dimpled aero wheels) often with minimal proof/history that the new product/technique is actually beneficial, but it might be. On the Slowtwitch site for example, when one forum poster complains of a musculoskeletal problem, invariably one of the "expert" responders notes the obvious need for ART (Active Release). Well, ART is very helpful in the right setting but the nearest practitioner to my house according to the ART website is an hour and a half away!

The two photos above are of Bill Vollmar, MD, seemingly "only" a Family Practitioner from Lancaster, PA and some would say might have trouble spelling triathlon. But he is whip-saw smart, takes care of almost exclusively athletes, and since unlike me he's not a surgeon, would likely have a non-surgical solution to almost any injury if it's feasible. Only as a last resort would he consider involving someone who might want to cut on you! And, he is so good that he could take care of me and my entire family. And lord knows I've had more than my share of musculoskeletal problems - compartment syndrome, plantar faciitis, achilles tendonitis, rotator cuff tear, I could on. The take home point is that, at least for many of us, we don't have to drive hours to the Pro from Dover with the treadmill for a good portion of our medical needs, we just need to know what's available locally. In fact, like many locations, the go to guy here for most running induced issues is the owner of the running shoe store. With 27 years of seeing runners problems he could take care of the Olympic team! And I'll bet there are examples of this in your community, say the kids swim coach who's been working on swim strokes for decades.

So, as pointed out in Triathlete, don't be embarrassed to ask around to see what's available, who's available, for your specific problem. Help could be right around the corner...and his name might be Bill Vollmar.

Sunday, November 29, 2009

Carpal Tunnel...Hand Numbness


If you look carefully, you can see this very inventive athlete has put clear packing tape over the holes on the front half of his helmet to convert it to a partial aero helmet yet leaving the rear half open for air and water dousing. Very clever.



WARNING: A local motorcyclist was killed this weekend when a deer ran into him! In many parts of the country hunting season is open and it may change animal behavior. A few years ago, on a pre-dawn run, one of my children actually ran into a deer. So, please be extra cautions, extra vigilant out there and don’t just go bombing down a hill without paying great attention.


CARPAL TUNNEL


Many athletes experience significant hand numbness while astride their bike. Often this involves the thumb, index and long fingers and with a change in hand location or position this feeling dissipates. The distribution of this numbness is in the median nerve as can be seen in the accompanying picture (WebMD).
This can also be accompanied by a feeling of tingling but when these feelings go away completely off the bike, it's no real cause for concern. Those who progress to weakness, occasionally dropping items, night time numbness, etc. may benefit from evaluation. The chronic case will often be accompanied by atrophy of the muscles at the base of the thumb. This condition can accompany pregnancy, diabetes, obesity,arthritis and other illnesses.

Evaluation consists of an examination of both upper extremities, neck, pulses and sensory. Although occasionally obtained, usually x-rays are not helpful in making the diagnosis. A neurologist can perform a nerve test known as an EMG to determine if there's compression of the median nerve by a ligament in the wrist thus slowing nerve function. In some cases, blood work is also helpful.

The treatment options are pretty wide, depending in the diagnosis, and whether or not the CTS is secondary to one of the causes listed above. Many benefit from simple night splints, mattress change, biking hand position change, or other mechanical alteration. But, unfortunately a release of the pressure on the nerve by releasing the ligament is in order for others. When indicated, it's a highly successful procedure but we try to avoid surgery when there are other alternatives.


Saturday, November 21, 2009

Pool Running Can Be Fun



"You got to do what you can, and let Mother Nature do the rest." Meat Loaf



At some time in our careers, water running, or aqua jogging, will be recommended as a method of cross training injured athletes. Others find it an ideal form of non-impact aerobic training. Basically, you "run" in water that's deeper than your limb length. This can extend from the diving well up in to the lanes, with a flotation vest or belt to increase buoyancy...so you don't drown. Although most run the length of the available area, others attach themselves, say to the ladder, and run in place. Running with a partner provides easy conversation, or, a water proof source of music may be of benefit. One attempts to mimic one's form as closely as possible to that used on land. Mimicking run duration and intensity is also important. For example, if you're scheduled for 45 minutes of steady running, do 45 minutes in the water. As you'd imagine, heart rates will be lower but many find that they can come within about 10 beats/minute of their land running. It's possible to run intervals repeating levels of intensity done on land.

Athletes have shown that not only can they maintain their level of fitness, but with dedication can actually improve. This comes into play when one begins to return to the road. Initially, shorter workouts can be supplemented with time in the water keeping the workout time "whole."

Again, it's a priority to duplicate your form on land, arm swing, head position, elbow engagement, etc. If your pool has both vests and belts, you may find one or the other allows you to more easily maintain this action. Your hip flexion will likely increase in the pool giving you an artificially lengthened "stride."

Like many, I am currently water running at the end of my swim workout. And, watching the others in my swim group continue to turn out the yards is all the distraction I need to stay focused. And, I can still joke with the lifeguards while I'm running!"

Saturday, November 14, 2009

Blood Thinners and Blood Clots




Testing an athlete's serum lactate levels while pedaling under a controlled load and controlled conditions is one way to determine the lactate threshold and from that one's training zones. If this athlete takes a blood thinner, would testing of this sort put him or (and possibly as important in these litigious times) the test director in jeopardy?


Blood is drawn from the athletes left ear lobe at 3 minute intervals during testing.

I fail to be surprised each time I see/hear about another athlete who's taking blood thinner medication for a recent, and some cases not so recent clot. There are frequent reports in a number of the on line Tri forums and I thought a review would be beneficial.

A pulmonary embolism or clot in the lung (sometimes air or fat, etc.) can be fatal! A person with an acute PE can complain of chest pain, often worse with deep breathing, the onset of a cough which may contain blood tinged sputum and they can breathe more rapidly. They may note both a shortness of breath and more rapid heart rate. This is obviously an emergency - go to the hospital - and treatment will be initiated to prevent new clots from forming, start oxygen, and occasionally clot busting meds will be given. A frequent source of clot can be the legs, say there's been a long airline flight (like to Kona), long car ride, etc. Other risk factors include birth control pills, positive family history, recent orthopedic surgery, cancer, etc. Prevention would obviously be the best choice as once diagnosed, there will likely be a 3 - 6 month period where blood thinners are taken on a daily basis and the blood is drawn at regular intervals to make sure the medication is working correctly. It's called Coumadin and is the active ingredient in rat poison believe it or not.

To prevent a PE, when you are on a long drive/flight get up and move around frequently, move your legs. Bed ridden patients in the hospital can be fit with devices that squeeze the foot or calf to keep the blood moving and prevent pooling.

Triathletes ask about racing and training while taking Coumadin understanding that they are at increased risk for bruising, bleeding -both external and internal - and that any cut or abrasion on the skin will bleed more. Once the Coumadin dosage has leveled off and the medical team feel the clot stabilized, then a return to training can be considered. I don't think anyone would take issue with swimming or strength training, and probably not running if the return to the roads is done slowly and carefully. Biking, where the potential for a crash (read injury) is higher, gives us the biggest worry. All of us have crashed at one point or another and in one of my previous blogs I reported being momentarily unconscious after my helmet contacted the asphalt unexpectedly. I am very glad I wasn't Coumadinized when that happened because of the risk of bleeding into my head and permanent damage. I believe I'd be inclined to ride the stationery bike watching old TdF videos for quite some time.

Lastly, the question of eating green, leafy vegetables comes up as they have plenty of vitamin K and vitamin K reverses the blood thinning action. Most people would agree that if your diet is constant, eating about the same amount of greens daily, that you should be ok and it's those patients who have a big salad one day (the day prior to their blood test could be a problem) but chili cheese dogs on the the other days. Keep it even.

In short, prevent those leg clots by moving around on long trips and, if for any reason you think you might have a PE, get to the hospital pronto, it's the best course for you.

Friday, November 6, 2009

Overuse Injuries


Destinations probably not seen near your hometown.





"Wish I didn't know now what I didn't know then." Bob Seger

Continuing the theme of self induced problems, having discussed stress fractures and the like previously, this weeks blog will focus on potential ways to avoid ending up at the doctors with what may be an avoidable problem.

Last week, I gave you an example of athletes who just can't turn it off. A local runner of some renown, while rehabing a problem for which she'd ended up in the operating room, was widely known for doing her morning training...following doctors orders...and then seeing if she couldn't find someone else to go running with her that afternoon in what most likely will never see the light of day in her training log. Nor will it be revealed when reporting back to the doctor if things don't go well.

In that this is November, and many of us have taken a break from training or are about to do so, we get the opportunity to review 2009's results, both good and bad, as we prepare for 2010. We're getting ready to create a road map starting from today and ending up at the finish line of our "A" race(s)and beyond. We are sort of Mapquesting the directions to our 2010 athletic goals. If we follow the periodization model, we're setting up a basic skeleton to control our training volume and intensity so that we're "all we can be" come race day. When the training year is created with this much planning and care, the potential for overdoing it, both in the short and long haul, is diminished. Both training hard and resting hard are accounted for in your long term plan.

Our bodies can perform at almost any level if we prepare them adequately. One of the first books I read on marathon training 30 years ago was a steady increase in long runs, each week harder than it's predecessor, until your chosen race. I don't recall the author ever referring to the "R" word. Rest. If you think about Achilles Tendon problems, plantar faciitis, runners knee, stress fractures, etc., you grab a big group of problems that, for the most part, are the result of training in a fashion in which the body is unprepared. They didn't need to occur.

So, I would ask you to write down the basics of your training for the next 11 months starting backwards from the "A" race. If you'd like a model to follow simply look at the year put together by Joe Friel in the "Triathlete's Training Bible" or go to www.trainingpeaks.com and have the computer generate one for you.

But, have a plan. Oh yeah, and don't forget the "R" part.

Monday, November 2, 2009

Patience For Improvement


Not everyone who comes to Kailua Bay during Ironman race week wears a Speedo!



"I'd take any risk to turn back the hands of time." Styx
I didn't race at IMH this year...and likely my body's been sending messages loud and clear that I'm done with iron distance racing. But on Sunday morning after the event, I went for a bike ride and was astonished to see a couple runners. Pushing it! At first I thought they were tourista like me but as I approached, I could see that they both had Ironman wrist bands on and a race day sunburn on their neck and shoulders from an especially hot day yesterday for the race. (There's almost no shade on the Big Island bike route. Maybe one could ride in the shade of an overflying seagull...but that would present it's own potential hazard!)

Running? The day after IMH? What were they thinking? Were they thinking? Maybe getting a jump start on training for their next iron distance race...next weekend. Or, maybe they're just not able to turn it off.

Racing and training at this level causes significant breakdown of bodily systems that need recuperation time be it from training or racing. Although there are a select few who can get by with less...and these are the ones we hear about in the press...most of have neither a red cape nor an "S" on our chests. And Kryptonite doesn't bother us one bit.

Why not take the first several days after a race to let the soreness fade, blisters, if present resolve, and only then begin a few low effort, short workouts focusing on form and style, not quantity. Many would suggest that it be a full 10-14 days before getting back into full training after a 140.6 effort, assuming you already have a race scheduled. That time would be well spent on family activities, reading (no, not about triathlon), maybe even go see the new Michael Jackson movie for something completely different. Or, if you're a guy, take your spouse to a chick flick like "Julie and Julia." I took my wife. And I liked it. Maybe it's time to simply be a husband and father/mother and wife, and not an athlete. Although no one would fault you for drifting into thoughts about HED wheels during the credits.

Friday, October 23, 2009

Firecrackers Thrown at Cyclist


Yes, they have Halloween, even in Kona, Hawaii.

Those of you who read my blog know that it's all about exercise safety in addition to caring for the injured athlete. One of our better local triathletes was beginning a ride near his home last week when a slow moving minivan approached with the sliding side door open. At first the biker heard explosions to his right and then very quickly they hit his shoulder and neck! As the driver sped away, the athlete took chase. But who can catch a car on their bike?

Unfortunately for this driver, he passed the athletes wife in her car at the next stop sign where a quick cell phone call from our boy allowed her to follow the van getting the license # and a description of the driver. He was apprehended that evening and a confession quickly followed. Charges have been pressed against the 11th grader from a nearby high school, and since he's under 18 and this is his first offense, he'll avoid court and go straight to the probation officer. As the athlete noted, "I make my living as a pilot and can't afford to lose my hearing or eyesight."

Our athlete was uninjured, although I suspect many of us - me included - would have crashed or run into a phone pole if the firecrackers were thrown at us. I believe I might think some one was trying to kill me. So what do we learn from this? Always carry your cell phone. Get in the habit of looking at license plates, even jot them down, which is easy to do if you keep pen and paper in your fanny pack with your emergency first aid kit. Don't confront rude drivers alone.

It's easy to think about retribution, about getting even, about finding those who run us off the road and putting a potato in their exhaust at night or flattening the tires on their car...or worse! But our goal is to live to ride another day and some of those folks on the road where I live might be just crazy enough to run me into the weeds if they thought I'd done something to them. Or worse, they'd run you into the weeds for something I did. And then we'd all lose.

Be careful.............. it's a jungle out there.

Saturday, October 17, 2009

Winter Running Tips


________When you're Norman Stadler, you get your picture on the back of the van!

We've just about run out of daylight saving time, the shorts have been put away till next summer and new rules apply to our morning run. Or any run for that matter. We need to be more vigilant than ever to protect ourselves both from those products of Detroit as well as the changing environment. Try to keep the below in mind as you make this transition.

1) Be seen. Wearing reflective, bright clothing or a reflector vest. A flashing strobe light on your belt would be a nice touch and many will don a headlight for those pre-dawn workouts.

2) No headsets. With the obvious decrease in visibility, other senses need to come into play to help you avoid the dangers your eyes might miss.

3) Stay alert. Be aware of your surroundings and weather changes. Put a thermometer outside your bedroom/bathroom window as your location may differ significantly from what the tv weather guy reports outside his door. Oncoming storms can quickly drop the temperature putting you at risk for frostbite or hypothermia if you are caught outside unprepared.

4) Don't ignore shivering. It's an important sign that the body is losing heat.

5) Carry a cell phone.

6) Carry ID. Please read my 9/7/2009 blog.

7) Write down or tell someone the direction of your run and know where shelter is if the weather gets bad.

8) Run with a partner. I it's your favorite 4 legged friend, protect his feet against the cold and ice as well as yours.

9) Run against traffic. Although we preach to equalize your time running with and against the traffic so your body sees equal crown in the road, try to eliminate or minimize this factor if possible. See approaching cars.

10) Layer your clothing to maintain body temp during warm up and cool down as well as your run. If you drive to a running trail or route, leave a change of dry clothes and a blanket in the car for emergency situations.

11) Think. If you simply use your head, you'll avoid troublesome situations and hit the Spring "running!"

Tuesday, October 6, 2009

Gotta Love This Sport


The desolate beauty afforded the biker on the NW coast of the Big Island of Hawaii. Although when one thinks of the Polynesian islands, lush tropical forests come to mind. As you can see, the harshness, almost moonscape appearance gives the feeling of being completely alone.

For many of us, triathlon training is a similar emotion, but also one that pervades all aspects of our lives. Who among you hasn't been in a social situation, out to dinner with a client or halftime at an offspring's soccer game, and when the conversation slows, your brain drifts to how to improve your T1 time in your next sprint tri? Or, maybe you should go ahead and buy that swimming video your lane mate mentioned.

Having spent the last week on the Big Island of Hawaii during Ironman race week, one gets an interesting perspective of the "top of the pyramid" in our sport and what it takes to get there. I was a volunteer on the pier helping out in transitions and part of a talented, dedicated team lead by capable David Huerta. While some of the athletes seem almost consumed by the sport, many see it as just one slice of the pie of life. Just a pretty big piece! Many have the ability, especially now that their race season is complete, to put the lifestyle inclusive of 10, 15, 20 hours/week of training behind them, spend time with family, cross train by leaving the bike behind and go hiking with the kids, etc. Sounds like a healthy approach to me.

One note. I learned just how far WTC goes to ensure a fair race and compliance with the rules. When the pros exited the swim and raced to the transition tent, they were "helped" out of their speed suits by volunteers who then labeled each suit with a number. Later, when most of the athletes were well out on their bikes, each suit was inspected to make sure that it followed race guidelines - one was not! Very interesting to observe.

Sunday, October 4, 2009

Stress Fracture, Eh? Part Two



This is Ironman Week here in Kona as the sleepy fishing village and occasional port for cruise ships turns into Triathlon Central. There are people everywhere, fit people, running and biking up and down Alii Drive. I hadn't been here an hour before seeing Norman Stadler and Chrissie Wellington. Good luck to them both on Saturday! It's going to be a fun week.

"Dig Me" Beach, a term I heard credited to Scott Tinley, is seen here, soon to be clogged with swimmers trying to get used to the change from simply following the line on the bottom of the pool to the gentle waves and salt water of the Pacific in Kailua Bay.


But the athlete with an injury like a stress fracture is sitting home, an opportunity missed. I covered the basics of stress fractures here 4/25. That these are in the category of overuse injuries where the muscular envelope of the lower extremity becomes fatigued and the skeleton is unable to bear the increased load.

The bone fractures as it is unprepared for the intensity of exercise delivered. This might be advancing one's training program too quickly, changing from the relative forgiveness of the running track to asphalt or concrete, aged or improper equipment or increasing exercise duration as a tennis player with a substantial increase in court time.

There are 26 bones in the foot and most likely all of them have been subject to a stress fracture at one time or another. They are frequently seen in the other bones of the lower extremity when insufficient rest is included between workouts. People taking Prednisone, Dilantin and other medications are at increased risk. Women have more than men.

The predisposing symptom is pain, not so much at rest, but brought on by exercise and it worsens. Although visible as a crack in the bone on x-ray, frequently these films will be negative. If the examiner finds point tenderness over a bone and a stress fracture is suspected, an advanced study like an MRI, or more likely a bone scan, will be order. (This is not to be confused with the DXA, the bone scan used to measure osteoporosis, predominantly in women.)

If diagnosed, the order of the day will be rest. This can be up to 6-8 weeks, some will be placed on crutches or given a fracture boot, but if one returns to sport before it heals, chronic difficulties can follow making healing a challenge. Triathletes might be shifted to pool running and biking so as not to lose excessive fitness.

So, if you have recurring pain in the same location, and think this may potentially describe you, get it checked out, you'll be glad you did.

Saturday, September 26, 2009

Broken Toes


St. Peter's Catholic Church is a tiny house of worship located at the 5 mile turn around where the Ironman Hawaii competitors head back to town and their journey on the Queen Ka'ahumanu Highway. If memory serves, there have been five different run courses since the race moved to the Big Island from Oahu in 1981.

True story. A local athlete participates in the regional 70.3 race, and seemingly coordinated in other aspects of life (yes, he can walk and chew gum at the same time) he has broken a toe twice at this race site before really getting his race going.

The first was his big toe having finished his warm up swim, wading back to the starting line, when he kicked a submerged rock...and Whammo - broken toe. Two years later, after exiting the 1.2 mile swim, running to the transition area on a long green miniature golf-like carpet, he tripped on a small fold in the carpet...and Whammo #2, a 4th toe broken on the other foot and the nail pulled 1/2 way off. And bleeding!. He finished both races!

Most broken toes are the result of trauma although I'd expect several of you to have suffered stress fractures of the same bones. We're covering the former today. Usually they occur secondary to an axial load such as a stubbed toe or some type of crush injury...such as dropping your bowling ball on it. Most will have significant pain at the time of injury although those with preexisting osteoporosis (thinning of the bones or loss of bone stock) may have less. Accompanied by less trauma. The injured usually are noted to have point tenderness at the site of the fracture although the skin is normally intact. The toe may be pointing a different direction...always a bad sign!

Although it's usually not an emergency, an early x-ray can be very helpful both in diagnosing the type and location of fracture, displacement if any, etc. A negative x-ray is no less useful. Also, in children, an x-ray can frequently reveal the presence or absence of a growth plate injury.

In fractures of toes 2-5, usually both the injury and treatment are less involved. Oftentimes, if the fracture is satisfactorily aligned and stable, simply taping the toe to it's next door neighbor, avoiding activities which might tend to displace the ends of the bones and occasionally a fracture shoe are all that's needed. However, a break in the bog toe is a horse of a different color given the importance of this structure in balance, directional control and weight bearing. If displaced or into the joint, the fracture needs to be reduced and the joint needs to be maintained. This can occasionally require a surgical procedure and prolonged post operative immobilization.

In short, if you think you may have broken a toe, and the pain doesn't subside in a reasonable time, why not let you local Urgent Care or health care provider take a gander and consider an x-ray.

Monday, September 21, 2009

Setting Goals - When 2nd is Better Than 1st




This is Sarah Reinertsen, the only female amputee finisher of the Hawaiian Ironman. Born with a limb deficiency known as PFFD, She had an above the knee amputation at a very early age and never really knew life without a prosthesis. Seen here from the back during the 2007 Kona Underpants Run (in a snappy home made skirt), her goal was the 2004 IMH. But, she fell short on the bike missing the cut off. Undaunted, she made some changes during the year returning in 2005. She bettered her bike split by two hours and finished the race easily with a big smile on her face. You talk about goal oriented!"


Another athlete I know is pretty competitive in his age group. In fact he can frequently win the age group at local races.

Joe Friel teaches that when you set your expectations for an upcoming race, you need to so carefully by picking an outcome that's dependent on your behavior alone. For example, a goal of winning the age group depends on the potential for a perfect race for you and the luck that nobody who can beat you shows up! Maybe, rather than an outcome of age group victory, the choice of a PR run split, or finally winning both T1 and T2 would be reasonable. A result that is both within your reach based on past performance and one that is almost totally under your control.

Our athlete has been thinking all summer that he would be getting another win at the upcoming tri (yawn - more hardware!) but what he didn't count on was that the race would be late in filling and that although he'd periodically review the list of entrants assuring himself that he was king cheese, at the last minute, someone from out of town registered who was way out of our boy's league.

Initially a little put out (and briefly considering, "Why even go if I can't win?") he eventually saw the race as an opportunity to really push it from the minute he got out of the water to the minute he exited T2 on the run. This change in attitude resulted in a terrific race, even though it was 2nd place by a wide margin. For 2009 he managed a faster swim, faster T1, faster bike, faster T2, and faster run than 2008. Overall, he cut his time for the sprint tri by SEVEN minutes over 2008.

And guess who had a huge grin getting that 2nd place trophy!

Monday, September 7, 2009

Plea For Carrying ID When You Ride


I've written before about the need to have some form of rapid ID on you when you're biking. Sadly, this article makes that point. ________



Bicyclist Killed By Car ID'd Posted 2009-08-27

Father Of JMU Frosh Was On Way To Surprise Son

By Pete DeLea and Jeremy Hunt


HARRISONBURG - Joseph V. Mirenda left Wintergreen on his bicycle Tuesday morning bound for Harrisonburg.

He was going to stop by and surprise his son, a freshman at James Madison University, but Mirenda didn't make it to the end of the 50-mile trek.

On Wednesday, police identified Mirenda, 49, of Virginia Beach, as the victim in Tuesday's fatal crash in Rockingham County.

Around 10:30 a.m. Tuesday, emergency personnel were dispatched to Port Republic Road, about a mile east of Cross Keys Road, where they found the cyclist lying in the ditch.

Mirenda was riding west on Port Republic Road when he was struck by a westbound 2000 Ford Taurus driven by Jessica Chandler, according to the Virginia State Police.

No charges were filed as of press time Wednesday, but investigators obtained a search warrant for the driver's cell phone records.

First Sgt. Bryan Hutcheson with the state police said investigators will be looking into whether Chandler, 22, of Port Republic, was talking on her cell phone or texting in the moments before the crash occurred.

"We don't want to leave any stones unturned," Hutcheson said.

Although the Daily-News Record has confirmed a search warrant was issued in the case, the document remains sealed by court order at the Rockingham County Circuit Court.

Meanwhile, investigators are still trying to piece together exactly how the crash happened.

They had spent Tuesday and most of Wednesday trying to determine the name of the cyclist, who had no identification on him.

State police caught a break in the investigation Wednesday afternoon when they received a call from the Wintergreen Police Department.

A Virginia Beach woman contacted the department and said she couldn't reach her husband, who was staying at the family's home in Wintergreen, Hutcheson explained.

The wife mentioned he may have gone on a bicycle ride.

Wintergreen officers recalled seeing a man riding a bicycle there Tuesday morning, and he matched the description of the then-unidentified cyclist killed in Tuesday's crash.

The state police and Wintergreen officers then confirmed the man's identity based on an inscription on a wedding band he was wearing.

It said "Frauke & Joe" with the date 9-24-88 on it.

Contact Pete DeLea at 574-6278 or pdelea@dnronline.com
______________________________________________________

When I put this up on one of the Tri web site forums, I received a number of clever answers where some people carry there drivers license, a business card, their cell phone, etc. One athlete has all his vitals written inside his helmet. But is seems that many simply have identifying data on a card in a plastic bag in a fanny pack, bike saddle tool kit, etc. Please make the effort. Do it today!

Sunday, September 6, 2009

The Meniscus - Torn Yours?




"
I don't need a whole lots of money, I don't need a big, fine car. I got everything that a man could want, I got more than I could ask for."
Grand Funk

In other words, my knees work just fine, thank you.

The meniscus is an important structure in your knee. Menisci, actually as we have two in each knee, an inside (medial) one and an outside (lateral) one. They are "C" shaped bits of fibrocartilage also known as semi-lunar cartilages which serve many functions. This is important as it wasn't that many years ago that surgeons felt the meniscus to have no purpose and excised them at will, especially in the pre-arthroscopy days. Some of you no doubt can remember that HS athletic injury by looking at the sizable scar on your knee from your open menisectomy (excision).

It's currently felt that the meniscus aids in the lubrication of the joint, stress transfer from femur to tibia, and that it contributes to the stability of the knee. Unless injured, the meniscus will provide a lifetime of service to it's owner with out complaint. That said, through injury, arthritis or just plain bad luck, any among us may suffer a "torn knee cartilage." As was true for both Tom Brady and Tiger Woods, the tear can accompany injury to one or more major ligaments. Usually bad news.

Frequently, the injured triathlete will have a physical exam, x-rays and/or an MRI with subsequent arthroscopy to remove or repair the damaged meniscus. (In highly selected cases, a meniscus transplant may be considered when more traditional methods have failed.) The arthroscopy is done in the sterile environment of the operating room under a variety of types of anesthesia - most of my patients watched theirs on the TV at bedside! The scope is introduced through two 1/4" punctures which rarely even need stitches at the end. Oftentimes the procedure is completed in under an hour, there are no crutches, and rehab exercises begin in the recovery room.

The surgeon who's seen the inside of your knee is likely in the best position to determine your return to sport, possible limitations, etc.

Take good care of your menisci, they should last a while!

Saturday, August 29, 2009

Tragedy on the Bike




"I'm T-N-T, I'm dynamite!"

ACDC

"Have a conversation with your bike. Before you ride, bounce it, get to know what you hear. Check it before you mount up." So teaches Scott Paisley, Uber biker, great guy, at bike repair class. Owns the local bike shop where most of us go. But despite assumptions to the contrary, Kryptonite has no effect on him. Like the rest of us, in a potential bike vs car match up, he loses. As do three others who follow.

It's been a bad day at Black Rock. This site preaches safety above almost all else and we've had a bad streak. Not long after Scott was hit by a car on a quiet country road incurring a spine fracture which required hospitalization but not surgery, another of our group had his handlebars loosen after hitting a particularly deep pothole....hip fracture with surgery and screws. Near the sight of his accident, at almost the same time, another biker crashed fracturing his neck leading to surgery and plating.

Less fortunate was a gent riding his bike from our area to visit his daughter at a nearby college when he was struck and killed by a motor vehicle. Cell phone records of the driver have been subpoenaed as authorities think this may have contributed to driver inattention. But he's still dead.

So, although the racing season has finished for many of us, significant biking challenges and work outs lay ahead. Please don't let your guard down, ride like they're out to get you - maybe they are -and take that extra minute to make sure everything...everything is 100% on the bike without taking a short cut. You could end up on this blog, and that'd be a bad thing. Have a conversation with your bike. Today and every day.

Saturday, August 22, 2009

Summer's Fading




"There was ease in Casey's manner as he stepped into his place,
There was pride in Casey's bearing and a smile lit Casey's face,
And when, responding to cheers, he lightly doffed his hat,
No stranger in the crowd could doubt t'was Casey at the bat."



While the racing season is over for some, many others are just hitting their stride, and like Casey, optimistically and confidently are looking forward to their final "A" race of the season.

We get spoiled being able to bike at 5:30 am in the summer with simply a singlet in the early dawn. But as August becomes September, the sun stays in bed another hour and retires and hour earlier. We have a tendency to get caught out after dark and the first time we hit our headlight switch...with last Spring's batteries, all too often we're headed home in the dark and not only can we not see, we cannot be seen. I think I use the strobe function on my headlight more than the simple light. So why not take some Sunday afternoon time and check all those batteries, look for your orange reflective vest and flashlight for those pre-dawn runs, and don't get caught in the dark. Take a minute to look through your bike saddle bag/fanny pack at your ability to provide first aid. I know as a physician you'd expect me to carry more (I'm always equipped with band aids, Tylenol, Benadryl, Bacitracin, Ibuprofen, cell phone, etc.) you don't want to be surprised if the ride presents a challenge. Don't the Boy Scouts promote the motto BE PREPARED?

In our county here in Virginia, school starts on Tuesday, so the buses will be back on the roads frustrating drivers. Watch that they don't take their frustration out on you as it may take some common sense route changes to ensure you stay out of harms way.

Best of luck to everyone in that final summer/fall race.

Thursday, August 6, 2009

The Guy's a Stud


"You got to do what you can, and let Mother Nature do the rest...." Meat Loaf

Jim Dicker is a stud, no two ways about it. But you'd never know it from talking to him as modesty is among his many virtues. But, he's the age group course record holder at IM Wisconsin although possibly not as speedy as his younger days he makes up for it with attention to detail, careful pre-race planning and a rigid yet flexible training plan that lets him overcome those occasional urges to over train.

Although there are a few notable age group aces like Joe Bonness, Bob Scott, Laura Sophia, etc. who year in and year out turn in startlingly fast performances, for the remainder of us the deterioration of our athletic abilities parallels that nasty little habit we've developed of having birthdays every year. It's simply a fact of life. So, we need to resist that little voice telling us to "just push a little harder" to perform like we did 10 or more years ago as we risk courting injury and the destruction of our seasonal plan.

For those of us who use the periodization model, maybe it's time to build in more frequent rest changing from the 3 hard/1 easy week template to a 2 hard/1 easy. I did this a couple years ago. Paying closer attention to that initially minor achilles ache or considering a bike re-fit if that old sore back is beginning to talk to you may be items at the front of your consciousness rather than on the back burner some where. This blog is all about exercise safety - If you don't break it you don't have to fix it - and at no time is this more important than when we look in the mirror and see some one older looking back. And besides,
Jim's qualified for Kona. Yep, he's a stud.

Know Your Stuff



YIKES, it's on the inside too!





"Don't mistake activity for achievement." John Wooden








It's been stated before that preventing an injury is usually preferable to treating one. My oldest son Chris is a superb runner...won the local 5K last week going away in 16 and change...and it didn't look all that hard for him. I'm not certain if I fell off a cliff I'd go that fast. He works at Ragged Mountain Running Shoes, a one owner shop for over 25 years. This store is a fantastic resource for the area athletes as owner Mark Lorenzoni has seen EVERYTHING that can go wrong with an athlete, and frequently diagnose and fix the problem on the spot. Every community should be so lucky to have someone like Mark.

One important lesson I've learned from Mark is to date everything. Do you know exactly when you purchased your most recent pair of running shoes? The last chain for your bike? Your tires? By dating/recording the purchase, you have a better idea of the products longevity and are less likely to have an on the road failure or injury. I practice this religiously and have had six 112 mile rides on the Queen K, all without bike related failure. (But don't ask me how my butt feels when I dismount.)

So, why not take a Sharpie and put the date of purchase on the sides of your new tires and the tongue of your running shoes? Add the date of a new saddle or chain purchase to your training log and if you ride more than one bike specify which ride got the new chain...and whether or not a new cog was part of the deal. You'll be ever so glad you did.

Saturday, August 1, 2009

Don't Believe Everything You Read


"I left a good job in the city, working for the man every night and day, and I never lost one minute of sleeping worryin' about the way things might have been." Creedence Clearwater Revival

When you're cruising through the latest literature, don't unwittingly believe all that you see. Just because it's in a magazine doesn't make it necessarily right for you. Don't change your whole training plan based on a single article in a monthly magazine or on line journal, even if it's from a source you ordinarily trust. Think, evaluate, question. You know yourself, and your limitations, best. Ask around, mentors, friends, valued sources. Then, if this new approach makes sense, incorporate it into your training or racing and watch carefully for success or failure. Change only one thing at a time. Also, you're watching for the least sign of injury.

After all, asbestos used to be the insulator of choice. And what would you say if someone asked you to make a bicycle frame from cloth...."It's got carbon fibers," they exclaim.

So, each time you read a "Get in Tour de France Shape in 3 weeks," maybe there's a role for this in your life....or maybe not.

Sunday, July 26, 2009

I Love Open Water Swimming, I Really Do



51 DEGREES, that'll do nicely!
John Shrum, MD

So started one of our early spring lake workouts before Dr. Shrum and I went to England to swim the Channel in 1998. You intentionally find the coldest water around. We stayed about an hour that day and would have gone longer but were rousted out by the park ranger.

When the swim portion of a triathlon starts with wind and waves, or cold water, or some type of challenge, I'm ready. So many in our sport would be nervous or afraid, I know this, and can't wait for the starters gun. Why? For the same reason you look forward to the run. Because you've practiced and trained for all types of weather and conditions as you've been doing it for many years. Like the NY Postal Service saying,"Neither snow nor rain not heat nor gloom of night stays these couriers from the swift completion of their appointed rounds," you've been there before. So why not make it the same with open water swimming?

If you're going to use a wetsuit, why not practice in it at the local swimming hole at least every other week. If the water temp is warm, be aware of over heating and keep the swim to a reasonable length. Many consider wetsuit swimming mandatory. They think they'll fail with out it.

I propose that it's simply a state of mind and unless you're vying for a podium spot, try the race without it. Our local swim water temp was 74 degrees, and after 100 yards in no wetsuit, it was delightful. Many folks make the should I/shouldn't I decision on wetsuit use weeks before their event when the water is still 60! Why not postpone that one?

In a previous blog, I recommended that if your race begins with an open water/ocean swim you try to get there the day before and go play in the water. In your wetsuit if you plan on using one. Practice your swim starts. And if they still make you nervous, when your wave starts on race day, wait 10-15 seconds for the mayhem to clear and then go. Practice, practice, practice. Then you'll be the confident one on race day looking forward to conditions that might slow others and give you an advantage.

Sunday, July 19, 2009

Simple Solutions For ITBS (Iliotibial Band Syndrome)



"If God invented marathons to keep people from doing anything more stupid, then triathlon must have taken him completely by surprise." P.Z. Pearce, MD

The IT Band: The band itself runs from it's insertion behind the hip down the outside of the femur and knee cap to an attachment outside the patella tendon. It is usually a tight, one inch wide tendon that can be seen on the knee when your leg is locked.
Symptoms: A sharp pain that radiates from above and outside the knee into the quadriceps and/or in the hip. It can be aggravated when running up or down hills or when going up/down stairs after a run. Frequently it hurts after the first 15 minutes or so and doesn't go away.
Causes: This can be seen in those who's bike seat is too high or there's some type of instability in the gait cycle and leg is no longer in neutral. You'll see it in those who use old or improper shoes. If the shoe is not supportive, it can lead to overpronation stretching the IT band causing a painful rubbing across the femur. Some get these symptoms from bowed legs, the crown in the road, etc.
Solutions: For runners, it is essential to match the shoe to the runner to allow proper leg alignment. Check your saddle height. Many will ask for a cessation from running/biking until the pain dissipates. Stretching the IT band, especially after runs is key. Don't forget the quads, hams and calves. Massage using a foam roller can be of benefit - but be brief and don't spend too much time on the actual point of pain. Morning runners may want to apply "Warm FX" to the IT band. It acts like Icy Hot and allows more oxygen to flow to the muscles and in turn they loosen up faster. I've also had some patients experience success with ice massage after their run.
If unsuccessful, then maybe a visit to your local runners doc may be in order. Good luck.

Monday, July 6, 2009

Runner's Trots


I'm taking my youngest kids to Sequoia National Park in California for 9 days of hiking including climbing Mt. Whitney so it'll be till 7/18 till I get a new blog up. Feel free to look at previous posts on various tri related topics.

What are runner's trots? The sometimes sudden urge to have a bowel movement while running. Some complain of this being a near explosive feeling, it spoils runs, and comes out of nowhere to runners of all levels of experience. It can be a quite frustrating problem to solve.

This problem affects 20-25% of all long distance runners at some point in their career, including the author. If you have it, you are not alone! It seems to occur with the longer or harder runs when blood may be shunted from the GI tract to the working muscles. In most of us this isn't a big deal but in others it can lead to diarrhea. As noted above, this feel can be almost explosive in nature and that if something isn't done about it quickly, well, there's going to be a problem! I've read that it's sometimes considered more common in the lactose intolerant.

Many will discuss this with their family physician, and frequently, even a colonoscopy can be recommended. Unless you are having bloody diarrhea, I think you can pass on the colonoscopy. (Had you nervous there for a minute didn't I. Actually, a colonoscopy is less of issue than you might think as I can say from personal experience as a > 50 year old male.)

So, if you happen to be suffering from this condition, here are some suggestions:

Maintain adequate hydration
Avoid caffeine as it's a colonic enhancer
Try to eat several hours before you run
Plan your route to include a rest room (I run near a golf course with lots of them)
Avoid warm fluids before a run
Limit high fiber foods in the days before a race
Consider a trial of limiting dairy foods for a couple weeks
Increase exercise intensity gradually letting you body adapt to the up/motion

And, the one you won't want to hear, a reduction in exercise. Some have the best results when they can reduce the intensity of exercise SIGNIFICANTLY for a few weeks with a gradual return to the previous high intensity workouts. On good time to do this is after your "A" race when you'd normally back off a little any way.

I can remember folding up toilet paper and putting it in my running shorts "just in case" as the Beatles might say, I had to Do It In The Road. It will go away but it may take some changes on your part, and, sorry to say, some trial and error.

Sunday, June 28, 2009

Car Vs Bike - Car Wins, Again


Natascha Badmann, 6 time winner of Ironman Hawaii, seen here exiting T1 minutes before a bike crash on the Queen "K" that would not only take her out of the race but give her training and racing problems for the next year and more."



Recently, there's been a three part article in the local paper about Matt Miller, former swimmer on the UVA team who gave it up for triathlon. While training on the Blue Ridge Parkway in November, he lost control of his bike and slammed into the front of an MG. By a stroke of incredible luck, the car behind the MG was driven by another doc from my hospital, an anesthesiolgist as chance would have it. Matt had broken his jaw in two places, along with every bone in his face, and was drowning in his own blood, until quick action by the doctor opened his airway allowing him to breathe. When taken to the trauma center, his family was told he wouldn't survive. But survive he did with multiple operations, titanium plates on his broken facial bones, a breathing tube in his neck, etc. Surprisingly, he suffered no other major injuries.

His old college coach got him back in the pool recently where he was able to crank out a "pedestrian" 59 second 100! And although he still looks forward to several more operations to put his face back together, he managed a top ten finish in a Philadelphia time trial. Go Matt!!

We take from this that it can happen to anyone...including you and me. So, when you leave home on that solo ride, tell someone where you're going and approximately what time you'll be back. If you have a cell phone, take it with you and turn it on. (I'm quite guilty of having my cell phone with me but always off.

Consider getting a Road ID. This inexpensive ankle strap yields basic identification, emergency contact phone numbers, etc. and mine has my allergy status, medications and my blood type (a good thing for the ER doc if you plant your face into the grill of a classic car. And lastly, anytime there's a close call with a car, try to figure out how you can avoid that next time. The car usually wins! Safe biking to you all and pass this along.

Friday, June 19, 2009

P's and F's of Plantar Faciitis



"Wish I didn't know now what I didn't know then." Bob Seger

They say there's no accounting for taste. This is a shot of my favorite runner in the 2007 Ironman Hawaii Underpants Run. It's done two days before the race to raise money for a local charity and it's plenty of fun. Just don't choose this outfit!

Tips to rid your life of plantar faciitis

As most of you know, many from personal experience, PF is pain on the sole of the foot, usually at the back of the arch and front of the heel. It's usually worse the first few steps you take out of bed in the morning. So, some recommend 1) tracing the alphabet in the air with the toes of your raised foot. 2) Immediately after getting out of bed, step into supportive footwear. Walk on the outside of your foot for the first ten steps. 3) Don't go barefoot or in slippers unless the slippers have arch supports. 4) In your morning shower point the nozzle at your heel and arch and let HOT water soak the injured area for at least a minute or two. 5) Wear arch supports in ALL of your shoes, especially those you wear the most when not exercising. Do not put weight on your feet unless they are properly supported! This is particularly true with your "knock around" shoes. Leave the flip flops in the closet while trying to recover from this serious injury. 6) Again, supportive shoes in the house and don't go barefooted. 7) In the evening and before you run, stretch and massage. The old wall push up, half with the leg straight and the remainder with the knee bent 30 degrees. These may hurt little so go slow and gradually stretch this area. No hurry as this is not the no pain, no gain situation.

Lastly, every evening after you've stretched, apply heat then ice (no more than 10 minutes) to the arch/heel of your sore foot. I've seen people use a frozen water bottle very effectively.

In my practice, if this isn't effective when combined with decreased running, I ask the athlete to back to his trusted shoe guy for a reevaluation of shoes and gait before getting into anything that hurts (like an injection) or costs money (like an orthotic.)

Monday, June 15, 2009

How To Beat The Heat



"...Rocky you met your match. Rocky said Doc it's only a scratch, and I'll be better, I'll be better as soon as I am able." The Beatles

Avoiding heat injury simply takes planning and common sense. Bob Vigorito, esteemed Race Director of the Eagleman Ironman 70.3 told me at the race check in on Saturday that the temperature on the road at last years race was 114 degrees!

So here are a few hot weather tips for Outdoor exercise:

Hydrate properly throughout the day. While running or walking, sip 3-5 ounces of cool water every 15-20 minutes.

On extremely hot or humid days try pouring cool water over your head, along your neck and down your spine every half hour during your exercise.

Wear light colored clothing against your skin that wicks/transfers the moisture away from your body.

Stay away from cotton, especially with shirts and socks.

Wear a light colored moisture wicking hat.

Try not to exercise outdoors after 9:00am. The safest time of day to run or walk during the summer is between 5:00 and 7:00 am.

Seek shady routes if you must exercise after 9:00am. Gravel roads are better than blacktop or tracks. Running in the woods is great.

Wear breathable shoes...mesh not leather.

Listen to your body. Feeling nauseated or light headed are distinct warning signs that you may be overheated or dehydrated. Dark yellow urine is also a sign that you're probably dehydrated.

Lastly, I saw a study that came out of Ironman Hawaii several years ago where women were weighed before and after the swim portion of thte race and they'd lost an average of 1.5 lbs...and they were in the water, not running.

Take care, it's a jungle out there.

Sunday, June 7, 2009

Will Varicose Veins Slow You Down?




I don't want to work, I want to bang on the drum all day.
Todd Rundgren


So you've got some vein concerns, eh? Well, they're pretty common. Although some folks seem more prone than others, half of all adults over 50 will have them to some degree. "Very close veins" as some of my patients call them occur as small "spider veins" or the larger "varicose veins." We know that blood in veins only goes one way, back to the heart, but when the little flaps of tissue known as valves, inside the veins, fail they can become enlarged, twisted, swollen and occasionally purple or blue. In the advanced stages they can lead to skin breakdown and infection but early on it's more of an appearance issue. Some folks might complain of an aching pain in their legs, legs becoming easily tired, swelling, darkening of the skin, and even itching or a rash.

In their most advanced stages, VV can lead to blood clots in the deep veins of the leg, always a bad thing as they'll sometimes break off, travel to the lungs, and not infrequently lead to death.

So what do we do? Things that have been shown to help include sunscreen, regular exercise (presumably not an issue in you), weight control, elimination of constricting clothing on legs, groin or waist, support stockings and elevating your legs when you sit. Some choose sclerotherapy, or injection of the veins which can significantly reduce or eliminate the smaller ones. Laser therapy is used in a similar fashion as well being placed inside the vein to shrink it. This is especially effective in the deeper veins. It's done in the doctors office under local anesthesia.

Lastly, ligation (tying off) and stripping (pulling out) in an operating room can be performed for the more involved problems. It's still performed frequently.

In short, most people don't need to do much about them...but complain...but if you need to, there are docs who specialize in vein issues who can evaluate you, define the severity of the problem and give you alternatives that are right for you.

Monday, June 1, 2009

Triathlon Friends - You got 'em


Joke heard while bike riding recently. The husband is late after a ride with his buddies and tells his wife, "You wouldn't believe what happened to me. I was on the way home when this beautiful blond abducted me, took me to her place, and had sex with me over and over." The wife replies, "Dear, you are such a liar. Can't you just tell me that you and your friends rode your bikes an extra 10 miles?"


One of the seldom recognized benefits of triathlon is the easy abundance of adult friendship. One morning last summer, we started our bike group a little early, finished at my house and my wife and I cooked breakfast for the gang. It was lots of fun...and I'm a very good waffle maker. At least my daughter thinks so. When not on bikes, we had the opportunity for extended discussion, jokes and plans for the rest of the summer. Outside of work, many adults have few friends with whom they can share the issues of the day, and I had 8 of them at my breakfast table!

On New Years Day, the group I swim with always does the main set equal to the year, or 2009 meters 1/1/2009. After busting it for 2000 m, we get out by the backstroke flags and scull backwards the last nine meters. Silly? You bet, but it's adults child's play. It's competitive in a way - the girls always win for some reason. But more than that, it provides a sense of relief and camaraderie not found in the working world.

So, if you feel like wearing a costume to the Tuesday evening bike group, or taking a camera to the Sunday long ride group and later having some fun with photo shop, I say go for it. My grandfather used to preach to me over and over again, "keep your friendships in repair." He was right. Although grandfathers usually are.

Thursday, May 28, 2009

Top Ten List to Save Your Legs (part two)

This is the second part of a piece centered around saving your legs for race day.

6) Map out your "game plan" prior to the start of the race. Knowing exactly what you're capable of racing will afford you the luxury of mapping out your splits for the crucial first two miles of the race. THE NUMBER- ONE MISTAKE MADE BY AMERICAN FOOT RACERS IS TO SURGE OUT TOO QUICKLY OVER THE FIRST PORTION OF THE COURSE. Running the first mile 30 - 45 seconds faster than your targeted pace can bring a whole world of hurt to your unsuspecting body over the latter part of the race. So, take it easy over the first part of the race, especially the first half mile. Your goal should be to negative split, to run the second half of the race faster than the first half. Sadly, most folks do the opposite.

7) Position yourself in the appropriate pace group on the starting line. The folks up front are trying to win the race and most of us have no business hanging out in their neighborhood. If it's hot (above 60-70 degrees), adjust your game plan by lining up farther back and slowing up your pace a bit.

8) Take advantage of the DOWNHILLS along the course by leaning forward and opening up your stride length. Folks like to complain about the uphills, more challenging on some courses than others, but so many of them miss the opportunity to make up loads of time taking advantage of the descents.

9) After you finish, cool down with a half mile (or so) easy jog, so as to reduce the risk of post race sore legs. During this light jog, celebrate your racing accomplishment. You have just conquered the course...and done it all before sitting down to breakfast.

10) Proper post race recovery is on of the most neglected facets of a runners road map. In the days (and week/weeks(?)) following the race, keep your running to a minimum, no more than 2-5 miles at a time, so as to avoid injury (the whole point of all of these blogs) and to allow your body and mind to feel refreshed again for your next big challenge, whatever that may be.

Thanks again to Mark Lorenzoni