Wednesday, September 26, 2012

Cold Hands (and Feet) In Winter, Raynauds Syndrome

"You can have my gun when you pry it from my cold, dead hands."  Men in Black, Edgar (Vincent D'onofrio)

Edgar
                                     



I cover this topic every year as new readers sign on.

Although it’s not yet October, we in Virginia have had our first snow of the year. I think it’s a good time to start this year’s discussion of cold hands, Raynaud’s Syndrome in some cases.

Raynaud's is pretty common. Many will have it as an isolated phenomenon and in others, it accompanies a more global process. Those affected will have more issues in the cold conditions than warm, their fingers will have decreased sensation and turn white, almost snow white, on occasion. When placed in modestly warm water for 2 or 3 minutes, the digits re-warm and turn every shade of red and purple you can imagine before simply settling on only mildly red. Once warm, starting a car is easy.

If you want to document this, next time it occurs, start taking pictures with your cell phone, and save them for your health care provider. You will asked about a family history of certain kinds of arthritis, bowel disease and the like. You may find that your complaints are the same (or different) but it's a good starting place.

My sister and I both have this to a greater or lesser degree and I think I'm the biggest purchaser of chemical hand warmers at our local backpacking store. But, I ride outdoors all year unless there's snow or ice on the road. Cold water swimming, however, can present a certain challenge!

For those readers who may not know (or who may have it and wonder) Raynauds Syndrome is the discoloration and numbness of the fingers that many adults see in response to cold (or sometimes changes in emotion.) The finger whiteness discussed above, sensory disturbance, and even pain, make them pretty useless when trying to type or any other fine motor activity. In a few minutes, as the fingers begin to warm, they turn blue then a purple-red with a "pins and needles" feeling before they normalize. This whole process can take from just a few minutes to an hour and can be quickened by immersing ones hands in warm water as noted above. Or stick them in your pants.   Women seem to get this more than men, 2nd to 4th decade of life. There are medical answers to this, and especially medicines to avoid, which might increase the frequency of attacks.

That said, I've had it for 30 years, my Mom longer, so it's easy to follow long term. And mostly we just live with it. I use chemical hand and foot warmers biking in the winter, and when it's below freezing I have some Sidi rechargeable warming inserts for my winter biking boots (they're not cheap and don’t work all that well - read don't waste your money). It's all just a matter of preparation. So, welcome to the world of Raynauds Syndrome, it's an inconvenience but not much more.

A number of readers have had excellent posts about how to solve the cold hands problem that can accompany winter riding. Excellent suggestions have come forth about a variety of different types of gloves/mittens/socks, chemical hand warmers, etc. Some athletes have simply chosen to ride indoors until the bloom of Spring and give those Computrainers a work out. If, however, you want to stay outside all winter, depending upon your climate, some alterations may be in order to remain comfortable.



As we've noted here before, a surprising number of athletes suffer from Raynaud's Syndrome, a spasming of the small arteries in the digits, often when cold. About 5% of men and 8% of women have Raynaud's and it can affect ears, toes, and even your nose.

So, to remain comfortable we have to remain warm. All it takes is a little trial and error. Well, maybe a lot of trial and error. I'd suggest you start by putting a thermometer outside your window to get an accurate temperature before you venture out. It's better than the Weather Channel as you may live a real distance from where they get their measurements. Then, get an idea of what gloves, layering of gloves, mittens and layering/lining of mittens you need at 50 - 55 degrees, 40 - 45 degrees, etc. If your mittens are so bulky that you may lose control of the bike, figure out something else. A reader from last year noted that the important thing was not to layer each digit as you might do with shirts and coats, but to provide a “den” for the fingers. Mittens, more than a single layer, with touching digits and some type of warmer seemed best for him. One thing that many over look is a product called Bar Mitts (they also have Mountain Mitts for your mountain bike.) These are sleeve-like neoprene that fit right over your handle bars and block cold, rain and snow...not that you'll be riding outdoors on 23 mm tires in the snow. I hope. You don't even need very thick gloves to stay toasty. I'll admit that they may look a little dorky but the bike group conversation will quickly move on to something else and you keep your hands warm. I'll attach a couple pictures from a local riders bike.







Reader Darkwave added these very useful comments: I've found disposable hand warmers to be essential for winter running -- I start using them when the temperature drops below 50. For running races, I wear thin gloves, then hand warmers, and then socks over both. If I heat up too much in the race, I can toss the socks or even the hand warmers.

As always, please share your experience and comments

Cold Hands (and Feet) in Winter, Raynauds Syndrome

"You can have my gun when you pry it from my cold, dead hands."  Men in Black, Edgar (Vincent D'onofrio)


 











Edgar

 


 I cover this topic every year as new readers sign on.


Although it’s not yet October, we in Virginia have had our first snow of the year. I think it’s a good time to start this year’s discussion of cold hands, Raynaud’s Syndrome in some cases.


 Raynaud's is pretty common. Many will have it as an isolated phenomenon and in others, it accompanies a more global process. Those affected will have more issues in the cold conditions than warm, their fingers will have decreased sensation and turn white, almost snow white, on occasion. When placed in modestly warm water for 2 or 3 minutes, the digits re-warm and turn every shade of red and purple you can imagine before simply settling on only mildly red. Once warm, starting a car is easy.


 If you want to document this, next time it occurs, start taking pictures with your cell phone, and save them for your health care provider. You will asked about a family history of certain kinds of arthritis, bowel disease and the like. You may find that your complaints are the same (or different) but it's a good starting place.


 My sister and I both have this to a greater or lesser degree and I think I'm the biggest purchaser of chemical hand warmers at our local backpacking store. But, I ride outdoors all year unless there's snow or ice on the road. Cold water swimming, however, can present a certain challenge!


 For those readers who may not know (or who may have it and wonder) Raynauds Syndrome is the discoloration and numbness of the fingers that many adults see in response to cold (or sometimes changes in emotion.) The finger whiteness discussed above, sensory disturbance, and even pain, make them pretty useless when trying to type or any other fine motor activity. In a few minutes, as the fingers begin to warm, they turn blue then a purple-red with a "pins and needles" feeling before they normalize. This whole process can take from just a few minutes to an hour and can be quickened by immersing ones hands in warm water as noted above. Or stick them in your pants.   Women seem to get this more than men, 2nd to 4th decade of life. There are medical answers to this, and especially medicines to avoid, which might increase the frequency of attacks.


 That said, I've had it for 30 years, my Mom longer, so it's easy to follow long term. And mostly we just live with it. I use chemical hand and foot warmers biking in the winter, and when it's below freezing I have some Sidi rechargeable warming inserts for my winter biking boots (they're not cheap and don’t work all that well - read don't waste your money). It's all just a matter of preparation. So, welcome to the world of Raynauds Syndrome, it's an inconvenience but not much more.


 A number of readers have had excellent posts about how to solve the cold hands problem that can accompany winter riding. Excellent suggestions have come forth about a variety of different types of gloves/mittens/socks, chemical hand warmers, etc. Some athletes have simply chosen to ride indoors until the bloom of Spring and give those Computrainers a work out. If, however, you want to stay outside all winter, depending upon your climate, some alterations may be in order to remain comfortable.


 



 As we've noted here before, a surprising number of athletes suffer from Raynaud's Syndrome, a spasming of the small arteries in the digits, often when cold. About 5% of men and 8% of women have Raynaud's and it can affect ears, toes, and even your nose.


 So, to remain comfortable we have to remain warm. All it takes is a little trial and error. Well, maybe a lot of trial and error. I'd suggest you start by putting a thermometer outside your window to get an accurate temperature before you venture out. It's better than the Weather Channel as you may live a real distance from where they get their measurements. Then, get an idea of what gloves, layering of gloves, mittens and layering/lining of mittens you need at 50 - 55 degrees, 40 - 45 degrees, etc. If your mittens are so bulky that you may lose control of the bike, figure out something else. A reader from last year noted that the important thing was not to layer each digit as you might do with shirts and coats, but to provide a “den” for the fingers. Mittens, more than a single layer, with touching digits and some type of warmer seemed best for him. One thing that many over look is a product called Bar Mitts (they also have Mountain Mitts for your mountain bike.) These are sleeve-like neoprene that fit right over your handle bars and block cold, rain and snow...not that you'll be riding outdoors on 23 mm tires in the snow. I hope. You don't even need very thick gloves to stay toasty. I'll admit that they may look a little dorky but the bike group conversation will quickly move on to something else and you keep your hands warm. I'll attach a couple pictures from a local riders bike. 



 



 Reader Darkwave added these very useful comments: I've found disposable hand warmers to be essential for winter running -- I start using them when the temperature drops below 50. For running races, I wear thin gloves, then hand warmers, and then socks over both. If I heat up too much in the race, I can toss the socks or even the hand warmers.


 As always, please share your experience and comments



Sunday, September 23, 2012

What Can You Learn From This Kona Course Record Holder?

"This is a Kona course record holder!  What can you learn from him?"


 Famous tri coach Joe Friel, and Bob Scott (R) on Kona pier, race day 2011

One of these guys is the reigning Kona age group course record holder Bob Scott, and he's held two other Hawaii age group records in the past, the other is Joe Friel, the power behind Training Bible Coaching and a host of triathlon related books.  Be sure to check out his newest book, The Power Meter Handbook available on Amazon now.

I first met Bob in 2000 on the plane to Kona.  We had opposite aisle seats.  Bob was wearing white shorts and a white polo shirt.  He looked like some athlete's dad looking for a tennis match. So, stupidly, I asked him what he was going to do once the plane got to the Big Island.  (At least I didn't ask the even stupider, "Going to Hawaii?" since that was the jet's destination.) We talked for the rest of the flight and I learned a good bit on his philosophies of training.

Once we landed, I lost track of him until about a month later. There was a full page ad in Triathlete Magazine of Bob, the first and only man in the history of Ironman over 70 to go under 13 hours!  In the 12 years that have passed, Bob has continued to train, race and coach. Records have come and gone though he remains the 75-79 Kona record holder.

I think if you were summarize Bob's training success, he would agree that it comes from consistency in training, a good measure of racing, and especially watching what goes in your mouth.  A big fruit eater, but not a big eater, his e-mail handle is teamscot.  I've trained with him a number of times and when we return to his home there's always an enormous plate of freshly cut fruit courtesy of his lovely wife Wanda.  One of the major lessons taught on theNBC TV reality show The Biggest Loser is portion control, and Bob epitomizes it.  This is no more true that in Kona when we're at Lava Java where the servings are generous and the food tasty.  He possesses the ability to NOT "clean his plate" as your Mom might have wanted .  I doubt most of us, this author included, can say the same.

As for racing, in prepping for "the big dance" in Hawaii, a typical season will find at least 3 half IM's on his schedule and a smattering of other events.  He used to run Boston every year just because he liked it.  So, a qualifier marathon fit in the training schedule some place.  Meticulous care of his health is the norm. Ten years ago, a tad of chest pain led to his riding his bike to his doctors and the diagnosis of a small MI.  Told he'd need a cardiac cath, now, he was more than a little miffed that he also couldn't ride his bike to the hospital cath lab.

Before he retired, it was not uncommon for him to get up at 2:30, yep that's 2:30 am, to get one of the longer workouts in before heading to the office.  Again I would point out that I doubt most of us, the author included, can say the same.

In short, it's an unshakable commitment to training and the sport, fierce dietary control, winning the genetic lottery, health maintenance and a bit of luck that gets you to Kona.  I dare say that Bob and the other men and women who make it to the Big Island have a deep inner strength, a level of determination so to speak, in which they demand success from themselves.  And they get it.

Smiling, but always thinking of the task at hand on race day.  Always!



What You Learn From a Kona Course Record Holder













 Famous tri coach Joe Friel, and Bob Scott (R) on Kona pier, race day 2011



One of these guys is the reigning Kona age group course record holder Bob Scott, and he's held two other Hawaii age group records in the past, the other is Joe Friel, the power behind Training Bible Coaching and a host of triathlon related books.  Be sure to check out his newest book, The Power Meter Handbook available on Amazon now.


 I first met Bob in 2000 on the plane to Kona.  We had opposite aisle seats.  Bob was wearing white shorts and a white polo shirt.  He looked like some athlete's dad looking for a tennis match. So, stupidly, I asked him what he was going to do once the plane got to the Big Island.  (At least I didn't ask the even stupider, "Going to Hawaii?" since that was the jet's destination.) We talked for the rest of the flight and I learned a good bit on his philosophies of training.


 Once we landed, I lost track of him until about a month later. There was a full page ad in Triathlete Magazine of Bob, the first and only man in the history of Ironman over 70 to go under 13 hours!  In the 12 years that have passed, Bob has continued to train, race and coach. Records have come and gone though he remains the 75-79 Kona record holder.


 I think if you were summarize Bob's training success, he would agree that it comes from consistency in training, a good measure of racing, and especially watching what goes in your mouth.  A big fruit eater, but not a big eater, his e-mail handle is teamscot.  I've trained with him a number of times and when we return to his home there's always an enormous plate of freshly cut fruit courtesy of his lovely wife Wanda.  One of the major lessons taught on theNBC TV reality show The Biggest Loser is portion control, and Bob epitomizes it.  This is no more true that in Kona when we're at Lava Java where the servings are generous and the food tasty.  He possesses the ability to NOT "clean his plate" as your Mom might have wanted .  I doubt most of us, this author included, can say the same.


 As for racing, in prepping for "the big dance" in Hawaii, a typical season will find at least 3 half IM's on his schedule and a smattering of other events.  He used to run Boston every year just because he liked it.  So, a qualifier marathon fit in the training schedule some place.  Meticulous care of his health is the norm. Ten years ago, a tad of chest pain led to his riding his bike to his doctors and the diagnosis of a small MI.  Told he'd need a cardiac cath, now, he was more than a little miffed that he also couldn't ride his bike to the hospital cath lab.


 Before he retired, it was not uncommon for him to get up at 2:30, yep that's 2:30 am, to get one of the longer workouts in before heading to the office.  Again I would point out that I doubt most of us, the author included, can say the same.


 In short, it's an unshakable commitment to training and the sport, fierce dietary control, winning the genetic lottery, health maintenance and a bit of luck that gets you to Kona.  I dare say that Bob and the other men and women who make it to the Big Island have a deep inner strength, a level of determination so to speak, in which they demand success from themselves.  And they get it.


 














Smiling, but always thinking of the task at hand on race day.  Always!






Thursday, September 20, 2012

Starting to Think About Race Day


"Just once in his life, a man has his time. And my time is now, I'm coming alive!" St. Elmo's Fire


..............................Bill Bell



Race Day is October 13, 2012. Batter up!

The above photo of Bill Bell reminds us to learn from those who've walked this path before us. A number of years ago at the Thursday evening carbo dinner, they had on stage the oldest man and woman standing with the youngest man and woman in that years race. Emcee Mike Reilly asked the two elders if they had any words of wisdom for their two young counterparts in the event 36 hours hence. Never bashful, or at a loss for words, Bell strode confidently to the microphone and uttered words I've never forgotten. "Enjoy your day. You may never come back here, or do this race again, so I feel strongly that you should just enjoy your day." He was right of course. Don't forget.  Enjoy your day.  Bill said so.


In Sunday's blog, I tried to sum up many years of mistakes, my mistakes if you must know, so the first timer and support team - family and friends - could have the best Hawaiian experience possible.

This time I'll focus on race day. Actually, this will begin at noon on Friday. You've packed your blue bike bag and red run bag without distraction. You've had your bike inspected at the base of the pier under the big Banyan tree, and racked it with a volunteer. Now you hang your two bags - remember, no bag access race morning. Although the volunteer's job is to gently guide you back off the pier, this is the perfect time to see the steps being built into Kailua Bay that you'll use in the morning. Why not pretend you've just exited the water and simulate the swim-to-bike transition by following the same steps you'll do in the morning? Shower hoses, changing tent -No, not that one guys, it's the ladies changing tent. You'd get on NBC for sure...but in a pretty negative light. Understand the path you'll take out of the water, around the end of the pier, and then again in reverse when getting off the bike at the start of T2. Understand it cold.

You already have a pre-race plan including supper, sleep, what to eat and drink race morning before you get in the water. And, you've planned for months what you'll eat and drink during the event. So, the important thing here is to get started earlier than you think. There's always a line at the port-a-potties, you may have an early morning bike need, back ups have occurred at body marking, and the like. Get there early. Get everything done and then relax. Again, get in the water early, swim easily to your predetermined place in the ocean relative to your expected finishing time, thinking lines do form at water entry as well. Big ones. Plus, you can stand in knee deep water as easily as on the pier (do NOT put your foot down without looking first - sea urchins live here too.)

When the gun sounds, you're relaxed, you're experienced, you're ready. Ready for a challenging day, but a great day none the less. You will remember this day for the rest of your life. Really, you will.  Say thank you to every volunteer.  And the police.  As Bill said, "Enjoy your day!"


Bill Bell photo WTC

Starting to Think About Race Day

 



"Just once in his life, a man has his time. And my time is now, I'm coming alive!"
 
St. Elmo's Fire


 


 


..............................Bill Bell


 


 Race Day is October 13, 2012. Batter up!


 The above photo of Bill Bell reminds us to learn from those who've walked this path before us. A number of years ago at the Thursday evening carbo dinner, they had on stage the oldest man and woman standing with the youngest man and woman in that years race. Emcee Mike Reilly asked the two elders if they had any words of wisdom for their two young counterparts in the event 36 hours hence. Never bashful, or at a loss for words, Bell strode confidently to the microphone and uttered words I've never forgotten. "Enjoy your day. You may never come back here, or do this race again, so I feel strongly that you should just enjoy your day." He was right of course. Don't forget.  Enjoy your day.  Bill said so.


 In Sunday's blog, I tried to sum up many years of mistakes, my mistakes if you must know, so the first timer and support team - family and friends - could have the best Hawaiian experience possible.


 This time I'll focus on race day. Actually, this will begin at noon on Friday. You've packed your blue bike bag and red run bag without distraction. You've had your bike inspected at the base of the pier under the big Banyan tree, and racked it with a volunteer. Now you hang your two bags - remember, no bag access race morning. Although the volunteer's job is to gently guide you back off the pier, this is the perfect time to see the steps being built into Kailua Bay that you'll use in the morning. Why not pretend you've just exited the water and simulate the swim-to-bike transition by following the same steps you'll do in the morning? Shower hoses, changing tent -No, not that one guys, it's the ladies changing tent. You'd get on NBC for sure...but in a pretty negative light. Understand the path you'll take out of the water, around the end of the pier, and then again in reverse when getting off the bike at the start of T2. Understand it cold.


 You already have a pre-race plan including supper, sleep, what to eat and drink race morning before you get in the water. And, you've planned for months what you'll eat and drink during the event. So, the important thing here is to get started earlier than you think. There's always a line at the port-a-potties, you may have an early morning bike need, back ups have occurred at body marking, and the like. Get there early. Get everything done and then relax. Again, get in the water early, swim easily to your predetermined place in the ocean relative to your expected finishing time, thinking lines do form at water entry as well. Big ones. Plus, you can stand in knee deep water as easily as on the pier (do NOT put your foot down without looking first - sea urchins live here too.)


 When the gun sounds, you're relaxed, you're experienced, you're ready. Ready for a challenging day, but a great day none the less. You will remember this day for the rest of your life. Really, you will.  Say thank you to every volunteer.  And the police.  As Bill said, "Enjoy your day!"


 



Bill Bell photo WTC


 



Sunday, September 16, 2012

4 Weeks From the World Championship in Hawaii





"It's going to be a Hard Day's Night.   The Beatles


We're 26 days, and a wake up, till the cannon blast signals the start of the 2012 Ford Ironman Triathlon World Championship. The athletes who are racing this year are beginning to struggle with the upcoming need to taper opposing that intense internal drive to get every bit of training they can out of every day. It can be as much as 20, 25, even 30 or more hours per week. Age groupers too! For the first timers there are so many questions involving bike transportation, accommodations, training on the island, heat acclimation, and learning as absolutely much as possible about the race and it's conditions to ensure they're in the annually expected 93% who finish the event instead of those few who don't.



I think the biggest mistake that newcomers make is that in spite of spending 7, 8, 10 or more days on the Big Island, they don't get it. They are so focused on the event that although come race cut off time at midnight on Saturday it's "mission accomplished." They've totally missed the Hawaiian feeling of Ohana (family) or the spirit of Aloha. And, for those who've brought family and friends, they've learned little to nothing about this wonderful place as they become consumed with Ironman.



To be fair, it's this goal oriented behavior that got them here, but with actual pre-race training at a minimum now, there are frequent opportunities to learn and entertain while in Kona. Having been there 20 times, here are ten suggestions to ensure both the best race and the best experience for racer and family alike:

1. Get your bike needs taken care of early. Have it re-inspected after you assemble it by Bikeworks just because this costs less than a malfunction on race day. Drive to Hawi. Learn the route by heart and ride up Kuakini Highway to the in-town bike turn around a couple times - just because.

2. Early in the week, take a snorkel boat cruise on board the Fair Wind out of Keauhou (7 miles from the pier). Although spending time at the pier and Lava Java talking Ironman is beneficial, it has an end point. You won't get shot if you leave downtown for a little while to snorkel. Plus it's fun, relaxing and contributes to the heat acclimation.

3. Eat at some place different every day. Basil's, Splashers, Kona Inn, Jamison's, Lulu's, Lava Java, they all have something good to offer.

4. Swim a little many mornings -at 7am so you can the light and shadows - more days than you think you need to. But not a lot. It's fun, it's social, and where else can you swim out to a coffee bar? Tues - Friday.

5. When thinking about gifts for those back home, particularly kids, both Longs Drugs and the ABC stores have a wide variety for not a lot of money. You will spend more money in the Ironman store than you think. ("Well, I'll never be back here again and I do need 10 more triathlon oriented shirts in the dresser.")

6. Run the underpants run on Thursday, 8am, Pacific Vibrations...and bring a camera. It's less than 2K at about a 10min/mile pace...when you can stop laughing. Bring a special hat or mask. One guy was Elvis a couple years ago and it worked. Have your family also run the PATH safety 5K on 10/7 downtown. It's fun and supports a worthy cause.

7. Everyone who comes with you should, no MUST, be a race volunteer - sign up before you go. Do it today. I don't think I've ever heard anyone say it wasn't the highlight of their time on the Big Island.

8. On Saturday, say THANK YOU to every race volunteer you encounter. And every policeman.

9. Be kind and patient to the people of Kona - this is their home we're invading.

10. Say hello to some one you don't know every day. And, if they're having a little trouble since English isn't their first language, take a breath and see if you can work it out. It just takes a little patience to be a good ambassador. And besides, it's fun.

11. I said there'd be 10,but I forgot one. After you finish, and get your medal and something to eat, and you realize you're not going to die...when they take you to the massage tent and ask if they can help you, don't say no. Get a 5 minute foot massage. It's to die for. And besides, you earned it.

4 Weeks From the World Championship in Hawaii


"It's going to be a Hard Day's Night.   The Beatles


 We're 26 days, and a wake up, till the cannon blast signals the start of the 2012 Ford Ironman Triathlon World Championship. The athletes who are racing this year are beginning to struggle with the upcoming need to taper opposing that intense internal drive to get every bit of training they can out of every day. It can be as much as 20, 25, even 30 or more hours per week. Age groupers too! For the first timers there are so many questions involving bike transportation, accommodations, training on the island, heat acclimation, and learning as absolutely much as possible about the race and it's conditions to ensure they're in the annually expected 93% who finish the event instead of those few who don't.



 I think the biggest mistake that newcomers make is that in spite of spending 7, 8, 10 or more days on the Big Island, they don't get it. They are so focused on the event that although come race cut off time at midnight on Saturday it's "mission accomplished." They've totally missed the Hawaiian feeling of Ohana (family) or the spirit of Aloha. And, for those who've brought family and friends, they've learned little to nothing about this wonderful place as they become consumed with Ironman.


 



 To be fair, it's this goal oriented behavior that got them here, but with actual pre-race training at a minimum now, there are frequent opportunities to learn and entertain while in Kona. Having been there 20 times, here are ten suggestions to ensure both the best race and the best experience for racer and family alike:


 1. Get your bike needs taken care of early. Have it re-inspected after you assemble it by Bikeworks just because this costs less than a malfunction on race day. Drive to Hawi. Learn the route by heart and ride up Kuakini Highway to the in-town bike turn around a couple times - just because.


 2. Early in the week, take a snorkel boat cruise on board the Fair Wind out of Keauhou (7 miles from the pier). Although spending time at the pier and Lava Java talking Ironman is beneficial, it has an end point. You won't get shot if you leave downtown for a little while to snorkel. Plus it's fun, relaxing and contributes to the heat acclimation.


 3. Eat at some place different every day. Basil's, Splashers, Kona Inn, Jamison's, Lulu's, Lava Java, they all have something good to offer.


 4. Swim a little many mornings -at 7am so you can the light and shadows - more days than you think you need to. But not a lot. It's fun, it's social, and where else can you swim out to a coffee bar? Tues - Friday.


 5. When thinking about gifts for those back home, particularly kids, both Longs Drugs and the ABC stores have a wide variety for not a lot of money. You will spend more money in the Ironman store than you think. ("Well, I'll never be back here again and I do need 10 more triathlon oriented shirts in the dresser.")


 6. Run the underpants run on Thursday, 8am, Pacific Vibrations...and bring a camera. It's less than 2K at about a 10min/mile pace...when you can stop laughing. Bring a special hat or mask. One guy was Elvis a couple years ago and it worked. Have your family also run the PATH safety 5K on 10/7 downtown. It's fun and supports a worthy cause.


 7. Everyone who comes with you should, no MUST, be a race volunteer - sign up before you go. Do it today. I don't think I've ever heard anyone say it wasn't the highlight of their time on the Big Island.


 8. On Saturday, say THANK YOU to every race volunteer you encounter. And every policeman.


 9. Be kind and patient to the people of Kona - this is their home we're invading.


 10. Say hello to some one you don't know every day. And, if they're having a little trouble since English isn't their first language, take a breath and see if you can work it out. It just takes a little patience to be a good ambassador. And besides, it's fun.


 11. I said there'd be 10,but I forgot one. After you finish, and get your medal and something to eat, and you realize you're not going to die...when they take you to the massage tent and ask if they can help you, don't say no. Get a 5 minute foot massage. It's to die for. And besides, you earned it.


 




Friday, September 14, 2012

Posterior Tibial Tendon Dysfunction, Part Three

This is the final part of three on Posterior Tib tendon issues.  If this is the first blog you've seen on this subject, simply back up two issues and you'll get "the rest of the story."

In short, I hope you take away that there's a whole spectrum of both findings and treatments but none of them can start until an accurate diagnosis is made. Being an orthopedic surgeon, my obvious bias would be toward the orthopedic community, especially a Foot & Ankle Fellowship Trained Doc.  In my way of thinking,  they see these types of problems on a daily basis and are well equipped to handle your problems.

On Sunday I'll get back to single blog topics and, with Kona 4 weeks away, I'll present The World Championship.

Nonsurgical Treatment
Symptoms will be relieved in most patients with appropriate nonsurgical treatment. Pain may last longer than 3 months even with early treatment. For patients who have had pain for many months, it is not uncommon for the pain to last another 6 months after treatment starts.

Rest

Decreasing or even stopping activities that worsen the pain is the first step. Switching to low-impact exercise is helpful. Biking, elliptical machines, or swimming do not put a large impact load on the foot, and are generally tolerated by most patients.

Ice

Apply cold packs on the most painful area of the posterior tibial tendon for 20 minutes at a time, 3 or 4 times a day to keep down swelling. Do not apply ice directly to the skin. Placing ice over the tendon immediately after completing an exercise helps to decrease the inflammation around the tendon.

Nonsteroidal Anti-inflammatory Medication

Drugs, such as ibuprofen or naproxen, reduce pain and inflammation. Taking such medications about a half of an hour before an exercise activity helps to limit inflammation around the tendon. The thickening of the tendon that is present is degenerated tendon. It will not go away with medication. Talk with your primary care doctor if the medication is used for more than 1 month.

Immobilization

A short leg cast or walking boot may be used for 6 to 8 weeks. This allows the tendon to rest and the swelling to go down. However, a cast causes the other muscles of the leg to atrophy (decrease in strength) and thus is only used if no other conservative treatment works.

Orthotics

Most people can be helped with orthotics and braces. An orthotic is a shoe insert. It is the most common nonsurgical treatment for a flatfoot. An over-the-counter orthotic may be enough for patients with a mild change in the shape of the foot. A custom orthotic is required in patients who have moderate to severe changes in the shape of the foot. The custom orthotic is more costly, but it allows the doctor to better control the position the foot.

Braces

A lace-up ankle brace may help mild to moderate flatfoot. The brace would support the joints of the back of the foot and take tension off of the tendon. A custom-molded leather brace is needed in severe flatfoot that is stiff or arthritic. The brace can help some patients avoid surgery.

Physical Therapy

Physical therapy that strengthens the tendon can help patients with mild to moderate disease of the posterior tibial tendon.

Steroid Injection

Cortisone is a very powerful anti-inflammatory medicine that your doctor may consider injecting around the tendon. A cortisone injection into the posterior tibial tendon is not normally done. It carries a risk of tendon rupture. Discuss this risk with your doctor before getting an injection.
Surgical Treatment
Surgery should only be done if the pain does not get better after 6 months of appropriate treatment. The type of surgery depends on where tendonitis is located and how much the tendon is damaged. Surgical reconstruction can be extremely complex. The following is a list of the more commonly used operations. Additional procedures may also be required.

Gastrocnemius Recession or Lengthening of the Achilles Tendon

This is a surgical lengthening of the calf muscles. It is useful in patients who have limited ability to move the ankle up. This surgery can help prevent flatfoot from returning, but does create some weakness with pushing off and climbing stairs. Complication rates are low but can include nerve damage and weakness. This surgery is typically performed together with other techniques for treating flatfoot.

Tenosynovectomy (Cleaning the Tendon)

This surgery is used when there is very mild disease, the shape of the foot has not changed, and there is pain and swelling over the tendon. The surgeon will clean away and remove the inflamed tissue (synovium) surrounding the tendon. This can be performed alone or in addition to other procedures. The main risk of this surgery is that the tendon may continue to degenerate and the pain may return.

Tendon Transfer

Tendon transfer can be done in flexible flatfoot to recreate the function of the damaged posterior tibial tendon. In this procedure, the diseased posterior tibial tendon is removed and replaced with another tendon from the foot, or, if the disease is not too significant in the posterior tibial tendon, the transferred tendon is attached to the preserved (not removed) posterior tibial tendon.
One of two possible tendons are commonly used to replace the posterior tibial tendon. One tendon helps the big toe point down and the other one helps the little toes move down. After the transfer, the toes will still be able to move and most patients will not notice a change in how they walk.
Although the transferred tendon can substitute for the posterior tibial tendon, the foot still is not normal. Some people may not be able to run or return to competitive sports after surgery. Patients who need tendon transfer surgery are typically not able to participate in many sports activities before surgery because of pain and tendon disease.

Osteotomy (Cutting and Shifting Bones)

An osteotomy can change the shape of a flexible flatfoot to recreate a more "normal" arch shape. One or two bone cuts may be required, typically of the heel bone (calcaneus).
If flatfoot is severe, a bone graft may be needed. The bone graft will lengthen the outside of the foot. Other bones in the middle of the foot also may be involved. They may be cut or fused to help support the arch and prevent the flatfoot from returning. Screws or plates hold the bones in places while they heal.

X-ray of a foot as viewed from the side in a patient with a more severe deformity. This patient required fusion of the middle of the foot in addition to a tendon transfer and cut in the heel bone.

Fusion

Sometimes flatfoot is stiff or there is also arthritis in the back of the foot. In these cases, the foot will not be flexible enough to be treated successfully with bone cuts and tendon transfers. Fusion (arthrodesis) of a joint or joints in the back of the foot is used to realign the foot and make it more "normal" shaped and remove any arthritis. Fusion involves removing any remaining cartilage in the joint. Over time, this lets the body "glue" the joints together so that they become one large bone without a joint, which eliminates joint pain. Screws or plates hold the bones in places while they heal.

This x-ray shows a very stiff flatfoot deformity. A fusion of the three joints in the back of the foot is required and can successfully recreate the arch and allow restoration of function.
Side-to-side motion is lost after this operation. Patients who typically need this surgery do not have a lot of motion and will see an improvement in the way they walk. The pain they may experience on the outside of the ankle joint will be gone due to permanent realignment of the foot. The up and down motion of the ankle is not greatly affected. With any fusion, the body may fail to "glue" the bones together. This may require another operation.

Complications

The most common complication is that pain is not completely relieved. Nonunion (failure of the body to "glue" the bones together) can be a complication with both osteotomies and fusions. Wound infection is a possible complication, as well.

Surgical Outcome

Most patients have good results from surgery. The main factors that determine surgical outcome are the amount of motion possible before surgery and the severity of the flatfoot. The more severe the problem, the longer the recovery time and the less likely a patient will be able to return to sports. In many patients, it may be 12 months before there is any 

Wednesday, September 12, 2012

Posterior Tibial Tendon Dysfunction, Part Two


"I haven't had dessert in two years."
                                        2012 US Olympic Team Member  (Think what this infers as far as the motivation of this particular athlete.  Can you make a similar statement?)

Thanks for the positive comments about part one.This is part two of a three part post on Posterior Tibial Tendon issues.  It's a bit more detail than most need but it may serve as a reference for you one day.


Posterior Tibial Tendon Dysfunction
Posterior tibial tendon dysfunction is one of the most common problems of the foot and ankle. It occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be able to provide stability and support for the arch of the foot, resulting in flatfoot.
Most patients can be treated without surgery, using orthotics and braces. If orthotics and braces do not provide relief, surgery can be an effective way to help with the pain. Surgery might be as simple as removing the inflamed tissue or repairing a simple tear. However, more often than not, surgery is very involved, and many patients will notice some limitation in activity after surgery.
Anatomy
The posterior tibial tendon is one of the most important tendons of the leg. A tendon attaches muscles to bones, and the posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot. The main function of the tendon is to hold up the arch and support the foot when walking.

The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot.
Cause
An acute injury, such as from a fall, can tear the posterior tibial tendon or cause it to become inflamed. The tendon can also tear due to overuse. For example, people who do high-impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time.
Posterior tibial tendon dysfunction is more common in women and in people older than 40 years of age. Additional risk factors include obesity, diabetes, and hypertension.
Symptoms
  • Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area.
  • Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time.
  • Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot.

The most common location of pain is along the course of the posterior tibial tendon (yellow line), which travels along the back and inside of the foot and ankle.
Doctor Examination

Medical History and Physical Examination


This patient has posterior tibial tendon dysfunction with a flatfoot deformity.(Left) The front of her foot points outward. (Right) The "too many toes" sign. Even the big toe can be seen from the back of this patient's foot.
Your doctor will take a complete medical history and ask about your symptoms. During the foot and ankle examination, your doctor will check whether these signs are present.
  • Swelling along the posterior tibial tendon. This swelling is from the lower leg to the inside of the foot and ankle.
  • A change in the shape of the foot. The heel may be tilted outward and the arch will have collapsed.
  • "Too many toes" sign. When looking at the heel from the back of the patient, usually only the fifth toe and half of the fourth toe are seen. In a flatfoot deformity, more of the little toe can be seen.

This patient is able to perform a single limb heel rise on the right leg.
  • "Single limb heel rise" test. Being able to stand on one leg and come up on "tiptoes" requires a healthy posterior tibial tendon. When a patient cannot stand on one leg and raise the heel, it suggests a problem with the posterior tibial tendon.
  • Limited flexibility. The doctor may try to move the foot from side to side. The treatment plan for posterior tibial tendon tears varies depending on the flexibility of the foot. If there is no motion or if it is limited, there will need to be a different treatment than with a flexible foot.
  • The range of motion of the ankle is affected. Upward motion of the ankle (dorsiflexion) can be limited in flatfoot. The limited motion is tied to tightness of the calf muscles.
Imaging Tests
Other tests which may help your doctor confirm your diagnosis include:
X-rays. These imaging tests provide detailed pictures of dense structures, like bone. They are useful to detect arthritis. If surgery is needed, they help the doctor make measurements to determine what surgery would most helpful.

(Top) An x-ray of a normal foot. Note that the lines are parallel, indicating a normal arch.(Bottom) In this x-ray the lines diverge, which is consistent with flatfoot deformity.
Magnetic resonance imaging (MRI). These studies can create images of soft tissues like the tendons and muscles. An MRI may be ordered if the diagnosis is in doubt.
Computerized tomography scan (CT Scan). These scans are more detailed than x-rays. They create cross-section images of the foot and ankle. Because arthritis of the back of the foot has similar symptoms to posterior tibial tendon dysfunction, a CT scan may be ordered to look for arthritis.
Ultrasound. An ultrasound uses high-frequency sound waves that echo off the body. This creates a picture of the bone and tissue. Sometimes more information is needed to make a diagnosis. An ultrasound can be ordered to show the posterior tibial tendon.

Monday, September 10, 2012

Care of Posterior Tibial Tendon Issues, Part One


"Yes, there are two paths you can go by, but in the long run, there's still time to change the road you're on."


                                                        Led Zeppelin


 


 We have to take good care of our feet to do what we do. Many have learned the hard way about Plantar Faciitis, metatarsal stress fractures, interdigital neuromas and the like through unplanned interaction with the medical community. I have always felt the more knowledgeable the athlete the better. The ones with problems who end up in my office who've already asked around or researched their concerns on the net seem to be in a better place to help me help them.


 Athletes frequently complain of two types Posterior Tibial Tendon difficulties. The first is a slow, subtle deterioration process that actually tears or can even stretch the tendon leading to what's known as an acquired flat foot deformity. The tendon has slowly, over time, lengthened and can, in some cases, no longer do it's job in maintaining the longitudinal arch of the foot. In other instances, the tendon will actually rupture frequently leading to surgical repair. Those who seem to be at higher risk for this injury are the obese, diabetic, rheumatoid arthritics and those who may have had a steroid injection in the area.



I used this B andW image out of one of my old Anatomy texts as it shows only the business part of the PTT (labeled Tibialis Posterior) coursing behind the tibia and inserting on the navicular.


 So, if you have pain over the inside of the ankle, get it checked out. Your doctor will examine the ankle looking for tenderness over the course of the tendon, swelling, weakness...and those with a real problem...a gap in the tendon. The doctor will check your muscle strength by asking you to stand on your toes or determine if there's an asymmetry in the longitudinal arch while weight bearing. Although this is usually a clinical diagnosis, an MRI may be required. In my office, although tendons are not normally seen on x-ray, a plain x-ray always precedes an MRI.


 If a PTT problem is noted in the early stages, a supportive orthotic might be recommended or even a cast. I'm partial to casts. If, over time, the problem continues to worsen, then an operative procedure may be recommended to repair the tendon, occasionally using a nearby tendon as a graft. In the worst case scenario a fusion of the foot bones is done to restore the arch of the foot. As you might expect, rehab is considerable and even with appropriate treatment, one's triathlon future might be in jeopardy.


 In other words, if you have a problem in this area, don't neglect it.  Get it seen.


 The next two blogs will delve further into this problem.



Sunday, September 9, 2012

Care of Posterior Tibialis Tendon Issues, Part One


"Yes, there are two paths you can go by, but in the long run, there's still time to change the road you're on."
                                                        Led Zeppelin


We have to take good care of our feet to do what we do. Many have learned the hard way about Plantar Faciitis, metatarsal stress fractures, interdigital neuromas and the like through unplanned interaction with the medical community. I have always felt the more knowledgeable the athlete the better. The ones with problems who end up in my office who've already asked around or researched their concerns on the net seem to be in a better place to help me help them.

Athletes frequently complain of two types Posterior Tibial Tendon difficulties. The first is a slow, subtle deterioration process that actually tears or can even stretch the tendon leading to what's known as an acquired flat foot deformity. The tendon has slowly, over time, lengthened and can, in some cases, no longer do it's job in maintaining the longitudinal arch of the foot. In other instances, the tendon will actually rupture frequently leading to surgical repair. Those who seem to be at higher risk for this injury are the obese, diabetic, rheumatoid arthritics and those who may have had a steroid injection in the area.

I used this B&W image out of one of my old Anatomy texts as it shows only the business part of the PTT (labeled Tibialis Posterior) coursing behind the tibia and inserting on the navicular.

So, if you have pain over the inside of the ankle, get it checked out. Your doctor will examine the ankle looking for tenderness over the course of the tendon, swelling, weakness...and those with a real problem...a gap in the tendon. The doctor will check your muscle strength by asking you to stand on your toes or determine if there's an asymmetry in the longitudinal arch while weight bearing. Although this is usually a clinical diagnosis, an MRI may be required. In my office, although tendons are not normally seen on x-ray, a plain x-ray always precedes an MRI.

If a PTT problem is noted in the early stages, a supportive orthotic might be recommended or even a cast. I'm partial to casts. If, over time, the problem continues to worsen, then an operative procedure may be recommended to repair the tendon, occasionally using a nearby tendon as a graft. In the worst case scenario a fusion of the foot bones is done to restore the arch of the foot. As you might expect, rehab is considerable and even with appropriate treatment, one's triathlon future might be in jeopardy.

In other words, if you have a problem in this area, don't neglect it.  Get it seen.

The next two blogs will delve further into this problem.

Saddle Sores - ever had 'em?, Plus, Kona Tips 2012

"Truth hurts.  Maybe not as much as jumping on a bicycle with a seat missing, But it hurts."  Leslie Nielsen, Naked Gun 2 1/2





























If you've never had this ailment you are most fortunate.  It can really be a "pain in the butt."















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Most of the news about Lance this week is negative but, at least one source is positive.  Here's some balance for your life.  It's good!  It's Rick Reilly. http://espn.go.com/espn/story/_/id/8310275/armstrong-worth-honoring



___________________________________________________________________ 







Those of us, and there are many, who ride a good deal, not infrequently find ourselves with irritation of the buttock which, if we're not careful, can progress to full fledged saddle sores.  And if that doesn't slow you down....







Obtaining the best saddle-rider fit can be a process which takes months if not years for optimum results.  With different materials, contours, sizes, levels of firmness, etc. it wouldn't be unusual for a rider to go through five or more saddles before the best fit is obtained.  And even then, you may not be absolutely pain free. Bicycle shorts or bibs with any one of a number of chamois (butt pad) shapes and densities, chamois creams, etc. can be variables to assist in solving comfort issues.  For an excellent discussion of this, see Jim Lampley http://www.jimlangley.net/crank/bicycleseats.html .  He is open to contact and enjoys helping solve your seating requirements.







First off, Buttock deterioration is graded in three stages from simple abrasion of the skin all the way to the open, and sometimes infected, sores that can require surgical drainage when severe.  So here are a couple rules to live by to keep this problem at bay.







1.  Friction is your enemy.  Anything you can do to keep it to a minimum will benefit you.  Examine your bike shorts ensuring that there's no seam or pressure point where there are bumps or ridges.  Consider experimenting with various types of chamois cream.  I've tried many chamois creams over the years (most recently DZ Nuts, supposedly from Dave Zabriske) and always come back to Assos even though it, and everything else they sell, is so expensive.  Plus it's very water soluble and easy to wash out your cycling gear.







                                           Assos Chamois Creme -- Saddle Sore Preventer







2.  Cleanliness is next to godliness.  If you had this problem, then it's clean shorts with chamois cream every ride, removing the shorts immediately and showering.  If the skin begins to break down a  bit, a lot of folks use pimple cream, anything with 10% benzoyl peroxide available OTC (as per the directions on the box) short term.  Occasionally one of the antibiotic gels like erythromycin (Emgel) is needed.







3.  Change bike seats for a while, different brand, just to change the pressure your rear end sees. While riding, if you can move around on the saddle, stand, coast downhill putting his weight on the pedals, shifting around can be helpful.







4.  Is your saddle height correct?  This is key.  They say if it's too high, even a little, that side-to-rocking can contribute to imbalance and.......... and it's easy to fix.





Kona Tips 2012






Volunteer for the race as it could be the highlight of your vacation.





It takes about 5,000 people to put on this race and you could be one of them.  There are openings helping inspect bikes, assisting athletes rack their gear and bikes, giving out food and water at the aid stations, just about anything you could imagine.  You need to be 16 to register on line but many of the run aid stations in particular encourage family participation.  All of my kids have done it as have many of the participants of the Primary Care Sports Med Course I used to chair in Kona. Check it out at http://ironmanworldchampionship.com/volunteer/  .  Do it today.



If you're racing, a hiking/trail running style head light is a good addition to your preswim bag, along with that second set of "what if the strap breaks on my goggles when I put them on race morning" goggles.  It's still very dark in the transition area early in the am and although volunteers will have flashlights, the prepared racer can handle anything.




Image 1, Lovingthebike.com, Google images




Image 2, Mountain Flyer, 11/19/2010

Image 3, Google images



X-rays, CT's and MRI's, Understanding the Differences & Kona 2012 Tips

"How long can you stay fresh in that can?" The cowardly lion on first introduction to the tin man.


                                                                                      Bert Lahr in the Wizard of Oz



 


An old patient of mine, upon being told that an MRI was the next step in diagnosing what was thought to be a rotator cuff tear, wanted to know how long he's have to be stuffed "into that can?"


__________________________________________________


 A big arm of the American Academy of Orthopedic Surgeons, the AAOS, is education.  People don't always know the differences between these studies, what they show - and as importantly what they don't show - so I've reproduced this to eliminate that lack of understanding.


 


 


 



X-rays, CT Scans and MRIs







Diagnostic imaging techniques help narrow the causes of an injury or illness and ensure that the diagnosis is accurate. These techniques include X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI).




These imaging tools let your doctor "see" inside your body to get a "picture" of your bones, organs, muscles, tendons, nerves, and cartilage. This is a way the doctor can determine if there are any abnormalities.




X-rays




X-rays (radiographs) are the most common and widely available diagnostic imaging technique. Even if you also need more sophisticated tests, you will probably get an X-ray first.




 




The part of your body being pictured is positioned between the X-ray machine and photographic film. You have to hold still while the machine briefly sends electromagnetic waves (radiation) through your body, exposing the film to reflect your internal structure. The level of radiation exposure from X-rays is not harmful, but your doctor will take special precautions if you are pregnant.




Bones, tumors and other dense matter appear white or light because they absorb the radiation. Less dense soft tissues and breaks in bone let radiation pass through, making these parts look darker on the X-ray film. Sometimes, to make certain organs stand out in the picture, you are asked given barium sulfate or a dye.




You will probably be X-rayed from several angles. If you have a fracture in one limb, your doctor may want a comparison X-ray of your uninjured limb. Your X-ray session will probably be finished in about 10 minutes. The images are ready quickly.




X-rays may not show as much detail as an image produced using newer, more powerful techniques.




Computed Tomography (CT)




Computed tomography (CT) is a modern imaging tool that combines X-rays with computer technology to produce a more detailed, cross-sectional image of your body. A CT scan lets your doctor see the size, shape, and position of structures that are deep inside your body, such as organs, tissues, or tumors. Tell your doctor if you are pregnant before undergoing a CT scan.




You lie as motionless as possible on a table that slides into the center of the cylinder-like CT scanner. The process is painless. An X-ray tube slowly rotates around you, taking many pictures from all directions. A computer combines the images to produce a clear, two-dimensional view on a television screen.




You may need a CT scan if you have a problem with a small, bony structure or if you have severe trauma to the brain, spinal cord, chest, abdomen, or pelvis. As with a regular X-ray, sometimes you may be given barium sulfate or a dye to make certain parts of your body show up better.




A CT scan costs more and takes more time than a regular X-ray, and it is not always available in small hospitals and rural areas.




 




Magnetic Resonance Imaging (MRI)




Magnetic resonance imaging (MRI) is another modern diagnostic imaging technique that produces cross-sectional images of your body. Unlike CT scans, MRI works without radiation. The MRI tool uses magnetic fields and a sophisticated computer to take high-resolution pictures of your bones and soft tissues. Tell your doctor if you have implants, metal clips, or other metal objects in your body before you undergo an MRI scan.




You lie as motionless as possible on a table that slides into the tube-shaped MRI scanner. The MRI creates a magnetic field around you and then pulses radio waves to the area of your body to be pictured. The radio waves cause your tissues to resonate.




A computer records the rate at which your body's various parts (tendons, ligaments, nerves, etc.) give off these vibrations, and translates the data into a detailed, two-dimensional picture. You will not feel any pain while undergoing an MRI, but the machine may be noisy.




An MRI may help your doctor to diagnose your torn knee ligaments and cartilage, torn rotator cuffs, herniated disks, hip and pelvic problems, and other problems. An MRI may take 30 to 90 minutes. It is not available at all hospitals.




 Kona Tips, 42 Days




Pacific Vibrations in downtown Kona is the home to the counter culture Underpants Run, a must do "run" Thursday morning of race race week.   Well, it's more of a walk-jog-jumping jacks than anything else but most of all, it's terrific fun. Bring your camera for sure.  The proceeds benefit a local charity and I wouldn't be surprised if it were over $20,000.  The "uniform" is tighty whiteys, knee high black socks, HR monitor strap and a "bad hat," or some costume variation there of. Here's a view of 2011.




 



 



 




 Image 1, Google Images




Friday, September 7, 2012

Prevention of Shoulder Injuries In Aquatic Sports

"I take my children everywhere, but they always find their way home."        Robert Orben

Warm up swim in Kailua Bay, Kona, Hawaii


I've had, as one of the tenets of this blog, "if you don't break it, you don't have to fix it."  I truly believe that over enthusiasm, dreaming, the ground work for "too much too soon" keeps people like me in business.  This is no more true than in high school Cross Country at this time a year.  So many young people have not done enough over the summer to prepare their bodies for the rigors of the new season and they get injured.  Add to that the actual physical changes these growing bodies see and it's a set up for problems.

Translate this into triathlon and now with three sports to consider, the negative possibilities increase, especially in a population that doesn't typically find swimming as their favorite leg.  Triathletes are always looking for an edge, free speed, or as bike technology seems to be heading, not so free speed.  We are a community of what's known in Marketing circles as early adopters, one's who are willing to be first on the block to try a new technique or product, even if it hasn't been proven 100% effective (yet) but shows promise.  How else can you explain the myriad of supplements, compression devices, etc., some of which might work well, but many, how shall we say, work less well.

We have as part of our training plans, time built in for dry land exercises, weights, and cross training to both make us stronger as well as potentially diminish the chance of injury.  And make us smarter.  The video below was put together last month by FINA. It takes 15:00 minutes so if you're looking for the 90 second You Tube experience that will change your life, this isn't it.  This presentation talks about the anatomy of the swimming shoulder, how it works in the aquatic environment, and exercises that are pretty easy to incorporate into your daily routine. I'd ask that, maybe one day this WE, you put a few minutes aside to watch the video, and see if there isn't something in it for you.  I say this with a certain amount of prejudice as the triathlon swim is my favorite part.  But it wasn't when I entered this sport.  It's only been through trial and error (lots of error), and videos like this, that I've come to feel the way I do.  A knowledgeable triathlete is a faster triathlete.

http://www.youtube.com/watch?v=tP7fV_d7cDQ&feature=player_embedded