Wednesday, January 30, 2013

Surprised? Triathletes Do Not Have Fewer Injuries Than Single Sport Athletes


What to wear when your has chores for you.
image.jpg
I've made it a little too large so you can really appreciate it.




I'll bet this athlete was dressed and out the door in a snap.

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 thinking they're spreading their workouts over three sports requiring "different muscles," the injury rate actually increases.

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 musculoskeletal 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 a while back 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%, maybe 10%, 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 the ease into the work out 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 pool as the main set is being described, adjust their goggles, 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 2013, construct a sensible training plan that carefully increases the rate at which your knees/Achilles 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...channel your efforts into a different part of triathlon....you needed to work on your transitions 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!


I'm fond of asking athletes if they think they do a great job slipping their training in between meetings, car pools, before the sun (and family) get up every day.  If they see their training as invisible.  While it's probably not, at least making the attempt to keep other's schedules and feelings in mind make for a happier triathlon family.

Below is the second fun photo, my way of "camouflaging" my indoor trainer.  You can hardly see it behind the planter.  Right?

Note clever camouflage. Plants nearly blocking view of indoor trainer

Sunday, January 27, 2013

An Ironman Age Group Winner's Take On Fluids/When to Drink

I received this very thoughtful response from a quality Ironman Athlete, 2011 Louisville Age Group Winner, Dr, Steven Maves, in 9:40, 3:08 marathon!  He is an anesthesiologist by day, used to taking care of the sickest and most complicated patients.  Here are his thoughts on race day fluid management.

Dr. Steve Maves, pre-dawn darkness Kona Pier, 2011


John,

I liked you article about drinking. Mostly. I did want to make several comments that I think get way too neglected in the discussion. First, the most quoted study on the risk of "hyponatremia" seems to be the one at the Boston Marathon a few years ago. It was a poorly designed study at very best. Several reasons: It was not hot, they did not measure baseline values on anyone, they defined hyponatremia as less that 135 (If my memory serves me, iffy at best). As you know, I see a ton of preop sodium numbers on healthy outpatients. Lots are less than 135, and these are even in people who have missed their morning coffee which should further lower Na. At the very least, researchers need to measure sodium pre exercise. Anyone starting out "hyponatremic" would need to be excluded. Personally, I would redefine hyponatremia to less than 128 or 130 mainly because you are not likely to be symptomatic until it is below these levels. Plus, the test itself has a degree of error so that running the test twice on the same sample is just as likely to give you 133 on the first run and 136 on the next. It would also depend on whether the same is analyzed at a real lab verses an iStat machine (did Apple make those?).


I think you hit the nail on the head about the pre hydration crap. Lots of people still follow this folly and I still read people recommending this.


Personally, I think the answer is to know your sweat rate and try to come close. I can never stay hydrated! There are several reasons I think this happens. We know that elite athletes do not suffer from over hydration (mostly anyway). It is primarily a problem with slower, sometimes much slower, athletes that spend way too much time at aid stations seeing how much they can drink. For these types and those close to them, thirst is the way to go. But for the athlete who pushes hard, this simple method won't work. You have to start drinking early and on a schedule. At least I do and I don't think that I'm that unusual. I limit this discussion to hot weather.

Here is my logic. Because of the physiologic effects of cold water and weightlessness on the swim, most (I believe) pee prior to leaving the water. I always have to pee immediately after swim workouts. This never occurs after a one hour ride or run (I do not hydrate during my swim workouts). Warm water swims being worse for causing dehydration I'm told. So, we get on the bike a little down. The harder I push the longer it takes for thirst to be a factor that I think about. Honestly, if I don't start hydrating until I'm thirsty, I'm in trouble.

 I've checked fluid loss during 2-5hr bike rides of all kinds from tempo to just plain endurance. Even when I drink 24oz per hour (that's my goal and about the max I can tolerate) and the temp is 85-100 (think Kona or Louisville), I will still come off the bike down 4-6 pounds. That's a lot of fluid. Trying to run hard with those deficits is challenging and dangerous. Not to mention, this is where most of my nutrition comes from. I plan,of course, to change that to a less fluid source.  If you intend on a lazy ride stopping every 8-10 miles to put down 24oz you are going to have problems. Or if it is just down right cold like the year I did Coeur d' alene IM. Then it is off on the run. Again, if you are not putting down fluids you are in trouble. I don't tend to walk water stops (unless forced to by dehydration - think Kona) or fatigue (think Kona). I think it is impossible to get more that 3-4 oz in you at these water stops. I know my running sweat rate is 8oz per mile. You simply can't keep up. I have athletes that I coach weigh in and out of run workouts to get a handle on sweat rates at various temps and efforts. Most are in the range of 6-8 oz per mile (regardless of pace). If you come off the bike down, you are in big trouble. Again, if you plan to walk the run or it is cold, things have to change.

Two final thoughts

1. I hope the people I compete against wait until they are thirsty to drink. They will be pushing hard and those of us who stayed hydrated will be eating them for lunch while they suffer their folly.

2. Bottom line is you must know your individual fluid requirements, make adjustments for effort, temp and sun.
______________________________________________
My thanks to Dr. Steve Maves for permission to print this.

An Ironman Age Group Winner's Take On Fluids/When to Drink

I received this very thoughtful response from a quality Ironman Athlete, 2011 Louisville Age Group Winner, Dr, Steven Maves, in 9:40, 3:08 marathon!  He is an anesthesiologist by day, used to taking care of the sickest and most complicated patients.  Here are his thoughts on race day fluid management.


 














Dr. Steve Maves, pre-dawn darkness Kona Pier, 2011




 John,




 I liked you article about drinking.  Mostly.  I did want to make several  comments that I think get way too neglected in the discussion.  First, the most  quoted study on the risk of "hyponatremia" seems to be the one at the Boston  Marathon a few years ago.  It was a poorly designed study at very best.  Several  reasons:  It was not hot, they did not measure baseline values on anyone, they  defined hyponatremia as less that 135 (If my memory serves me, iffy at best).  As you know, I see a ton of preop sodium numbers on healthy outpatients.  Lots  are less than 135, and these are even in people who have missed their morning  coffee which should further lower Na.  At the very least, researchers need to  measure sodium pre exercise.  Anyone starting out "hyponatremic" would need to be  excluded.  Personally, I would redefine hyponatremia to less than 128 or 130  mainly because you are not likely to be symptomatic until it is below these  levels. Plus, the test itself has a degree of error so that running the test  twice on the same sample is just as likely to give you 133 on the first run and 136 on the  next.  It would also depend on whether the same is analyzed at a real lab verses  an iStat machine (did Apple make those?).



 



 I think you hit the nail on the head about the pre hydration crap.  Lots of  people still follow this folly and I still read people recommending this.



 



 Personally, I think the answer is to know your sweat rate and try to come  close.  I can never stay hydrated!  There are several reasons I think  this happens.  We know that elite athletes do not suffer from over hydration (mostly  anyway).  It is primarily a problem with slower, sometimes much slower, athletes that spend way too  much time at aid stations seeing how much they can drink.  For these types and  those close to them, thirst is the way to go.  But for the athlete who pushes  hard, this simple method won't work.  You have to start drinking early and on a  schedule.  At least I do and I don't think that I'm that unusual.  I limit this  discussion to hot weather. 



 Here is my logic.  Because of the physiologic  effects of cold water and weightlessness on the swim, most (I believe) pee prior  to leaving the water.  I always have to pee immediately after swim workouts.  This  never occurs after a one hour ride or run (I do not hydrate during my swim  workouts).  Warm water swims being worse for causing dehydration I'm told.  So, we  get on the bike a little down.  The harder I push the longer it takes for thirst  to be a factor that I think about.  Honestly, if I don't start hydrating until  I'm thirsty, I'm in trouble.


 I've checked fluid loss during 2-5hr bike rides of  all kinds from tempo to just plain endurance.  Even when I drink 24oz per hour  (that's my goal and about the max I can tolerate) and the temp is 85-100 (think  Kona or Louisville), I will still come off the bike down 4-6 pounds.  That's a lot  of fluid.  Trying to run hard with those deficits is challenging and dangerous.  Not to mention, this is where most of my nutrition comes from.  I plan,of course, to  change that to a less fluid source.  If you intend on a lazy ride  stopping every 8-10 miles to put down 24oz you are going to have problems.  Or  if it is just down right cold like the year I did Coeur d' alene IM.  Then it is  off on the run.  Again, if you are not putting down fluids you are in trouble.  I don't tend to walk water stops (unless forced to by dehydration - think Kona)  or fatigue (think Kona).  I think it is impossible to get more that 3-4 oz in  you at these water stops.  I know my running sweat rate is 8oz per mile.  You  simply can't keep up.  I have athletes that I coach weigh in and out of run  workouts to get a handle on sweat rates at various temps and efforts.  Most are  in the range of 6-8 oz per mile (regardless of pace).  If you come off the bike  down, you are in big trouble.  Again, if you plan to walk the run or it is cold,  things have to change.


 Two final thoughts


 1.  I hope the people I compete against wait until they are thirsty to  drink.  They will be pushing hard and those of us who stayed hydrated will be eating them for lunch while they suffer their folly.


 2.  Bottom line is you must know your individual fluid requirements, make  adjustments for effort, temp and sun.



______________________________________________


My thanks to Dr. Steve Maves for permission to print this.




Teaching Triathlon Coaches; Athlete Success Factors

 














Professor Friel



 2013 TrainingBible Coaching Annual meeting.


 This weekend, the annual get together of TrainingBible Coaching took place in the Chicago suburbs with great attendance and a real give and take from all. I was invited to join the faculty including Joe Friel and Olympian Ryan Bolton. I do a fair amount of teaching each year, mostly to other doctors, but the one WE where I'm privileged to talk to triathlon coaches has become one of my favorites. I think that this group really pays attention and they make you glad you went to the time and effort to put a talk together just for them.


 I hope I'm invited back next year.


__________________________________________________________________


 Today's blog will not be a long one.  I simply wanted to present a few of the most interesting and applicable thoughts that emerged from Chicago.


 A fascinating lecture was offered by Joe Lotus, a name well known in Chicago tri circles, IM veteran and guy who seems to think problems through carefully.  He talked about the factors that contribute to an athlete's success by presenting data from a study of the 2008 Canadian Olympic Team where medal-winning athletes were questioned about which factors contributed most to their successful performance.  Below were the 5 most common responses:


 


   1) Strong athlete/coach relationship


   2) High level of athlete awareness


   3) Strong support system - Family, coach, priest, etc.


   4) Effective training environment


   5) Management of competition environment


 The study pointed out that responses 1 and 2 were overwhelming favorites.  When you think about this, I suppose it's not hard to agree with this information.  While most of us will never be Olympic caliber athletes we can still apply the above in our own lives.  If you're are a coached athlete, ensure you and your coach are on the same page and that your relationship reflects the above.  If you coach yourself, be willing ask, to change, to learn during your training cycle.  I think if you can avoid the "need" to make up work outs if you've been sick, out of town on business, victim of absolutely awful weather, etc. then you'll be less likely to suffer a training related injury.  It was 11 degrees running in Chicago this morning, -7 if you look for the wind chill.  It's easy to see that a steady diet of this might put a damper on outside training some times.


 




 One other point made this WE involved children in sports. In my mind it's also applicable to us adults.  There must be enjoyment being involved in sport.  Up to 75% of kids drop out sports by age 13....mostly because they're not having fun anymore.  Since triathlon can be an individual sport, and occasionally the work outs more drudgery than entertainment, it's up to you to keep it enjoyable over the long haul.  Mix things up, train with others, the Saturday bike group, that Tuesday evening Masters swim class, etc.  Do that and you'll be a triathlete for a long time. And a darned successful one too.



 




 



Thanks to Joe Lotus



The Ultimate, All You Need To Know, Hydration Plan

The Power of Water!














Alii Drive, Kona, Hawaii, after the tsunami from the Fukushima, Japan earthquake



 Hydration and Dehydration, All You Need to Know


 First, my bias:


      I believe the "drink all you can drink" hydration method to be both incorrect and dangerous.


      I believe the "drink to your thirst" plan misses out on an opportunity for you to excel, and at it's limits could also be dangerous.  Here's why.


 Your first day in medical school, with only a little tongue in cheek, they tell you that the answer to a question you may ask today is somebody's educated guess given knowledge available today.  If you'd asked that question 20 years ago, same question, you'd likely get a different answer.  The same may be true if you were pose this question 20 years from now.  In other words, as science moves on and we continue to learn, the following is what I believe the exercise science literature says today about your hydration and leave it up to you to ask again in two decades.


 First, let's review the above two extremes.


 I still have the CD on which a famous tri coach, at one point the official coach of Ironman so he should know something, gives the instructions to really tank up at supper the night before your race, and carry a water bottle with you around the transition area as you're prepping on race morning to start, well, saturated!  The only other really good part of that plan was to pee, probably in the body of water in which you are about to race, at the end of your warm up swim moments before race start.  You begin with an empty bladder. (Because, if you follow that strategy, it won't be empty long!)  Then, each of us has seen directives where, particularly on the run, we should never pass an aid station with out drinking at least something.  I'd agree with stopping if, at many of the stations you bypassed fluid and got a banana piece, pretzel, apple slice, gummy bear, etc.


 Option "B" would have us consume fluids normally up until race start, and then only drink when we felt thirsty, whenever that might be. As I see it, this can be problematic.  First, as we age, our ability to conserve water in our bodies diminishes and our own ability to sense thirst decreases (Mayo Clinic.)  Another getting older problem is that we respond more poorly to changes in ambient temperature.  And, although I've heard it said by some that dehydration doesn't typically effect performance, and that the winner of the race may well be "the most dehydrated one out there," that would be counterintuitive to what we know about dehydration.  In fact, a piece by noted Sports Nutritionist Asker Jeukendrup recently stated that, "Exercise performance is impaired when an individual is dehydrated by as little as 2% of body weight.  Losses in excess of 5% of body weight can decrease the capacity for work by 30% (Human Kinetics, 1/14/2013.)


 Thus it would seem that we would be best off if we constructed a hydration plan, just like we've constructed a training plan and a race plan, to keep us from over hydrating, risking Exercise Associated Hyponatremia (See my 12/17/2012 blog), and under hydrating risking a performance decrease.  Right?


 Dr. Doug Casa, head of the Korey Stringer Institute at the University of Connecticut, and author of one of the definitive books on Preventing Sudden Death in sports says that ideally we would each use a "personalized hydration plan based on our own individual sweat rate."  You can do this if you wish by referring to Track Coach 2004;167: 5321 - 5328.  It's not a  bad idea.


 OK, now how do we apply the above?


 Pre-race.  We've seen above that you don't start the night before, and maybe just a little on race morning.  You already have a mental check list including body marking, transition set-up, a visit to the port-a-pottie for that last minute poop and bladder emptying. Drink some, without going over board, so that you don't toe the start line thirsty.


 If your race is only an hour (even 1.5 hours in some of us) it's actually been shown that performance wise, you really get no benefit by drinking.  None.  You just lose the time you slowed at the aid station. But, if most of the water is poured on your face and head on a hot day, or you grab some ice that's put into your hat, I say go for it.


 In a longer race, be conscious of your thirst and drink accordingly.  Remember that although you may be "trained" to drink frequently whether or not you need it, don't.  If you are the 175 lb. athlete in Dr. Jeukendrup's model, to be 2% of your body weight down, you have to be 3.5 lbs down!  Not impossible at all but something to be aware of.


 If you carry a belt with fluids or a hand held device in training, don't race with it.  These may be beneficial in practice but most definitely not in a race.  Look around, everybody ahead of you doesn't have one.


 Lastly, remember the old adage of never doing anything new on race day?  This might include finding out the official beverage of your upcoming race.  You'll want to determine if they provide a commonly used product or possibly one that your GI track doesn't like all that much.  Or, one you don't know at all.  A simple e-mail to your race director will get you that information and from my experience, race directors are great people, interested in your success and happy to help. Now that you know, get some of this beverage, give it a go during training, and make an unknown a known.  If you don't tolerate this specific product, you can always simply rely on the old standby, water, and a gel product you've consumed in the past.


 OK?  These are the basics from which you can and should build your own hydration plan, one that fits YOU.  So, like Baby Bear in the story of Goldilocks, when she says, "Ahhh, this porridge is just right," you'll arrive at the race finish line, "Just right!"


 



 


 Images 1,2 Google Images



Faster in 2013, Plan it Today

It's January for Pete's sake!  You can be better, you can be faster, you WILL be faster in 2013!  You have months to get there. 



I'm just sure of it.







 Dinner with God

  (This is not new, but given the time of year, I thought it appropriate.)



God is eating dinner alone.

Aaron Rodgers approaches the table and God asks "What do you believe?"

Rodgers says, "I believe in hard work, and in staying true to family and friends."

God can't help but see the goodness of Rodgers and offers him a seat to his left.



Tim Tebow walks up and God says what do you believe?

Tebow says, "I believe in your total goodness, generosity, and that you have given all to mankind."

God is greatly moved by Tebow's eloquence and offers him a seat to his right.



Finally, Tom Brady comes to the table, God asks, "And Tom, what do you believe?

Brady replies, "I believe you're in my seat."

__________________________________________

I had someone tell me once that they'd think twice before hiring some one deeply involved in this sport.  Sure, the old adage about giving  something you want done to the busiest person you know is part of this, the positive part, but does the prospective hire think, plan, drown in triathlon during their work day to the point that it diminishes their effectiveness....?  I don't know, but knowing more than a few people who fit this description, what do you think?

__________________________________________

 "Lack of planning on your part does not constitute an emergency on mine."

 What did you forget? And don't say nothing. At one point we've all omitted one thing or another. In a previous blog, I somewhat sheepishly admitted leaving my bike shoes home for one of my "A" races, an event in which I'd won the age group the year before. Needless to say I did not repeat!

 This is the time of year that the conscientious triathlete not only begins to dream of the potential for the upcoming racing season but starts to develop a series of goals and a road map to get there. This could be something as complete as a computer generated Annual Training Plan where the entire schedule, division of swims, bikes, runs, rest days, the works, are populated. Or, it could be sitting down with the local swimming guru if this is your weakest sport, your limiter so to speak, and getting his/her hands on expertise at incorporating the best combination of workouts, drills, indoor and outdoor swims to put you at the greatest advantage come race day. It also wouldn't be out of the question to plan that single sport block that we've discussed before.  It's a unit of time early in the season, where an inordinate amount of training - but not so much that it leads to injury - is devoted to one of the three sports. Swimming seems to get the most attention.

 Since this blog is about minimizing injury, this time of year would also be ideal to plan ones training stress, training volume - the amount of work you plan. This is the slope of the effort line from now till the first race that not only gets you prepared, it does so in a very gradually increasing fashion, to minimize the potential for Achilles tendinitis, IT band problems, stress fractures, etc.





 I firmly believe that much of the misery, lost training time, races missed, etc. could be avoided if each athlete took the time to plot out the whole year, just as Mark Allen preaches, with this in mind. It would sure make my work load easier, and life happier for many.

 It's January for Pete's sake. If you haven't finished your Annual Training plan, do it today.


Friday, January 25, 2013

The Athlete With Bloody Urine Can be OK


As race results are posted on the back of the van.....Darn, you beat me....again!


Hematuria, blood in the urine

"Oh yeah, life goes on, long after the thrill of livin' is gone."  John Cougar Mellencamp


Ever stood astride the commode after your long run, and instead of the usual concentrated deep yellow urine, you see blood?  Yep, it can be quite a shock.  But, like most things, if you take the time to do a little research you can narrow the list of possibilities...and cancel the call to the funeral home.

In medical jargon bloody urine is known as hematuria.  Heme meaning blood and uria from urine. It can range from very slightly blood tinged all the way to frankly bloody.  It's not a diagnosis, it's a symptom.  But a symptom of what?  Let's follow a local Charlottesville runner, aged 22, runs 60 - 100 miles per week, is professionally coached and works in the local running shoe store.  He obviously has a handle on correct foot wear.  He started with a very slight pinkish tinge to his urine after his longest runs but over time has developed frank hematuria.

So, although even if you watch too much television, and are certain this is cancer, and you have mere days to live, medically speaking the first place we look is to a phenomenon called "Runner's Bladder" as it's both the most common as well as the most benign.  It's described  as bladder wall trauma, bruising, which leads to a small amount of blood in the urine.  When the runner decreases running volume or takes a couple of days off, it goes away.  For a while that is, until long runs resume.  It's said that running with a partially full bladder can eliminate this problem but it's a level of discomfort many can't stand.  Every heel strike reminds one of the urine's presence.

A visit to the Urologist by our runner reveals that although the mostly likely diagnosis is Runner's Bladder, the list of possibilities including kidney stones, tumor, infection, various kidney problems, etc., is pretty long.  So, to solidify the diagnosis, the Urologist plans to perform a cystoscopy - an in office procedure in which he will insert a small fiber optic scope through this runners penis up into the bladder. ("You're going to put a what into my where?"the runner was heard to exclaim!)  In the past, predominantly because of the larger size of the scope and the pain it would cause, this type of procedure was done in the Operating Room under anesthesia.

Good news.  During cystoscopy, our athlete's bladder wall revealed generous bruising and no other obvious source of bleeding.  So for now, he'll continue his running career, and his hematuria knowing that he's not causing irreversible long term damage.  Maybe he'll try again to learn to run with his bladder half full.  But he's 22 with a head full of steam.

Maybe.



If Crowie does it, and Macca does it, should you?

"Anything Sam Cooke did, I would do...apart from getting shot in a motel room by a hooker."


                                                                                             Rod Stewart


 






@MaccaNow 1/3/2013



 Chris McCormack ‏@MaccaNow



Double header long ride weekend. 110miles today down to the#wollongong. Perfect day for it. 120miles set for tomorrow.




 OK, his weekend is set for 230 miles on his bike....and it was 40C "down under" yesterday.  Yours?




____________________________________


I think you get the point. Triathlon  can be a big money sport.  In fact, this year on the pier in Kona, one of my fellow Transition volunteers remarked, after watching the third bike in a row equipped with electronic gear-shifting ( about $2000 over it's mechanical counterpart on your bike and my bike) that, "It looks like triathlon is becoming the sport of the 1%ers."




 Well, at that moment, wondering if one needs a $10,000 bike to make it in this sport, or looking at Chris McCormack's tweet above, the ability to ride farther than New York to Boston this  weekend, it may seem like we mortals will never have the money or ability to be great.  But I believe we don't measure ourselves by what others do, particularly professional triathletes, unless of course you're talking about your age group buddy who always seems to nip you in the last kilometer of your local sprint tri.  You never did it before, why start now?  You are your own athlete.


 Remember the  good old days?  The days if you wanted to lighten your bike and it only cost $1 a gram, and it didn't cost $375 dollars to ship your bike to the race site?   And a new pair of running shoes wasn't 90 or more dollars?  In reality, after you discount the manufacturer's bias that if you buy the...fill in the blank...that Pro Triathlete XYZ uses you'll ride like XYZ, and you have a good but not necessarily great bike, a standard power meter, etc., most of us would think you're set.


 We measure our performance against our own past, previous races and work outs, times for certain distances, etc.  We get our successes, our thrills, the first time our bike split is under 3 hours for a 70.3 event or we have the quickest transition times in the age group, something you have been focusing on for two years.  This example may be the best one as it's completely free!  It only speaks to how serious you are in the sport and how much you're willing to practice, to experiment and learn, effort (not $$) that you've put in before you actually race.


 So, do I think you need to spend cubic dollars to be a speedster, or do work outs meant for others that will surely put you in the doctor's office?  Nope.  There's room for everybody in this sport.


 





Sunday, January 20, 2013

Teaching Triathlon Coaches; Athlete Success Factors


Professor Friel


2013 TrainingBible Coaching Annual meeting.

This weekend, the annual get together of TrainingBible Coaching took place in the Chicago suburbs with great attendance and a real give and take from all. I was invited to join the faculty including Joe Friel and Olympian Ryan Bolton. I do a fair amount of teaching each year, mostly to other doctors, but the one WE where I'm privileged to talk to triathlon coaches has become one of my favorites. I think that this group really pays attention and they make you glad you went to the time and effort to put a talk together just for them.

I hope I'm invited back next year.
__________________________________________________________________

Today's blog will not be a long one.  I simply wanted to present a few of the most interesting and applicable thoughts that emerged from Chicago.

A fascinating lecture was offered by Joe Lotus, a name well known in Chicago tri circles, IM veteran and guy who seems to think problems through carefully.  He talked about the factors that contribute to an athlete's success by presenting data from a study of the 2008 Canadian Olympic Team where medal-winning athletes were questioned about which factors contributed most to their successful performance.  Below were the 5 most common responses:

   1) Strong athlete/coach relationship
   2) High level of athlete awareness
   3) Strong support system - Family, coach, priest, etc.
   4) Effective training environment
   5) Management of competition environment

The study pointed out that responses 1 and 2 were overwhelming favorites.  When you think about this, I suppose it's not hard to agree with this information.  While most of us will never be Olympic caliber athletes we can still apply the above in our own lives.  If you're are a coached athlete, ensure you and your coach are on the same page and that your relationship reflects the above.  If you coach yourself, be willing ask, to change, to learn during your training cycle.  I think if you can avoid the "need" to make up work outs if you've been sick, out of town on business, victim of absolutely awful weather, etc. then you'll be less likely to suffer a training related injury.  It was 11 degrees running in Chicago this morning, -7 if you look for the wind chill.  It's easy to see that a steady diet of this might put a damper on outside training some times.



One other point made this WE involved children in sports. In my mind it's also applicable to us adults.  There must be enjoyment being involved in sport.  Up to 75% of kids drop out sports by age 13....mostly because they're not having fun anymore.  Since triathlon can be an individual sport, and occasionally the work outs more drudgery than entertainment, it's up to you to keep it enjoyable over the long haul.  Mix things up, train with others, the Saturday bike group, that Tuesday evening Masters swim class, etc.  Do that and you'll be a triathlete for a long time. And a darned successful one too.



Thanks to Joe Lotus

Tuesday, January 15, 2013

The Ultimate, All You Need To Know, Hydration Plan

The Power of Water!
Alii Drive, Kona, Hawaii, after the tsunami from the Fukushima, Japan earthquake


Hydration and Dehydration, All You Need to Know 


First, my bias:
      I believe the "drink all you can drink" hydration method to be both incorrect and dangerous.
      I believe the "drink to your thirst" plan misses out on an opportunity for you to excel, and at it's limits could also be dangerous.  Here's why.

Your first day in medical school, with only a little tongue in cheek, they tell you that the answer to a question you may ask today is somebody's educated guess given knowledge available today.  If you'd asked that question 20 years ago, same question, you'd likely get a different answer.  The same may be true if you were pose this question 20 years from now.  In other words, as science moves on and we continue to learn, the following is what I believe the exercise science literature says today about your hydration and leave it up to you to ask again in two decades.

First, let's review the above two extremes.

I still have the CD on which a famous tri coach, at one point the official coach of Ironman so he should know something, gives the instructions to really tank up at supper the night before your race, and carry a water bottle with you around the transition area as you're prepping on race morning to start, well, saturated!  The only other really good part of that plan was to pee, probably in the body of water in which you are about to race, at the end of your warm up swim moments before race start.  You begin with an empty bladder. (Because, if you follow that strategy, it won't be empty long!)  Then, each of us has seen directives where, particularly on the run, we should never pass an aid station with out drinking at least something.  I'd agree with stopping if, at many of the stations you bypassed fluid and got a banana piece, pretzel, apple slice, gummy bear, etc.

Option "B" would have us consume fluids normally up until race start, and then only drink when we felt thirsty, whenever that might be. As I see it, this can be problematic.  First, as we age, our ability to conserve water in our bodies diminishes and our own ability to sense thirst decreases (Mayo Clinic.)  Another getting older problem is that we respond more poorly to changes in ambient temperature.  And, although I've heard it said by some that dehydration doesn't typically effect performance, and that the winner of the race may well be "the most dehydrated one out there," that would be counterintuitive to what we know about dehydration.  In fact, a piece by noted Sports Nutritionist Asker Jeukendrup recently stated that, "Exercise performance is impaired when an individual is dehydrated by as little as 2% of body weight.  Losses in excess of 5% of body weight can decrease the capacity for work by 30% (Human Kinetics, 1/14/2013.)

Thus it would seem that we would be best off if we constructed a hydration plan, just like we've constructed a training plan and a race plan, to keep us from over hydrating, risking Exercise Associated Hyponatremia (See my 12/17/2012 blog), and under hydrating risking a performance decrease.  Right?

Dr. Doug Casa, head of the Korey Stringer Institute at the University of Connecticut, and author of one of the definitive books on Preventing Sudden Death in sports says that ideally we would each use a "personalized hydration plan based on our own individual sweat rate."  You can do this if you wish by referring to Track Coach 2004;167: 5321 - 5328.  It's not a  bad idea.

OK, now how do we apply the above?

Pre-race.  We've seen above that you don't start the night before, and maybe just a little on race morning.  You already have a mental check list including body marking, transition set-up, a visit to the port-a-pottie for that last minute poop and bladder emptying. Drink some, without going over board, so that you don't toe the start line thirsty.

If your race is only an hour (even 1.5 hours in some of us) it's actually been shown that performance wise, you really get no benefit by drinking.  None.  You just lose the time you slowed at the aid station. But, if most of the water is poured on your face and head on a hot day, or you grab some ice that's put into your hat, I say go for it.

In a longer race, be conscious of your thirst and drink accordingly.  Remember that although you may be "trained" to drink frequently whether or not you need it, don't.  If you are the 175 lb. athlete in Dr. Jeukendrup's model, to be 2% of your body weight down, you have to be 3.5 lbs down!  Not impossible at all but something to be aware of.

If you carry a belt with fluids or a hand held device in training, don't race with it.  These may be beneficial in practice but most definitely not in a race.  Look around, everybody ahead of you doesn't have one.

Lastly, remember the old adage of never doing anything new on race day?  This might include finding out the official beverage of your upcoming race.  You'll want to determine if they provide a commonly used product or possibly one that your GI track doesn't like all that much.  Or, one you don't know at all.  A simple e-mail to your race director will get you that information and from my experience, race directors are great people, interested in your success and happy to help. Now that you know, get some of this beverage, give it a go during training, and make an unknown a known.  If you don't tolerate this specific product, you can always simply rely on the old standby, water, and a gel product you've consumed in the past.

OK?  These are the basics from which you can and should build your own hydration plan, one that fits YOU.  So, like Baby Bear in the story of Goldilocks, when she says, "Ahhh, this porridge is just right," you'll arrive at the race finish line, "Just right!"





Images 1,2 Google Images

Saturday, January 12, 2013

Faster in 2013, Plan it Today

It's January for Pete's sake!  You can be better, you can be faster, you WILL be faster in 2013!  You have months to get there. 

I'm just sure of it.



Dinner with God
  (This is not new, but given the time of year, I thought it appropriate.)

God is eating dinner alone.
Aaron Rodgers approaches the table and God asks "What do you believe?"
Rodgers says, "I believe in hard work, and in staying true to family and friends."
God can't help but see the goodness of Rodgers and offers him a seat to his left.

Tim Tebow walks up and God says what do you believe?
Tebow says, "I believe in your total goodness, generosity, and that you have given all to mankind."
God is greatly moved by Tebow's eloquence and offers him a seat to his right.

Finally, Tom Brady comes to the table, God asks, "And Tom, what do you believe?
Brady replies, "I believe you're in my seat."
__________________________________________

I had someone tell me once that they'd think twice before hiring some one deeply involved in this sport.  Sure, the old adage about giving  something you want done to the busiest person you know is part of this, the positive part, but does the prospective hire think, plan, drown in triathlon during their work day to the point that it diminishes their effectiveness....?  I don't know, but knowing more than a few people who fit this description, what do you think?
__________________________________________

"Lack of planning on your part does not constitute an emergency on mine."

What did you forget? And don't say nothing. At one point we've all omitted one thing or another. In a previous blog, I somewhat sheepishly admitted leaving my bike shoes home for one of my "A" races, an event in which I'd won the age group the year before. Needless to say I did not repeat!

This is the time of year that the conscientious triathlete not only begins to dream of the potential for the upcoming racing season but starts to develop a series of goals and a road map to get there. This could be something as complete as a computer generated Annual Training Plan where the entire schedule, division of swims, bikes, runs, rest days, the works, are populated. Or, it could be sitting down with the local swimming guru if this is your weakest sport, your limiter so to speak, and getting his/her hands on expertise at incorporating the best combination of workouts, drills, indoor and outdoor swims to put you at the greatest advantage come race day. It also wouldn't be out of the question to plan that single sport block that we've discussed before.  It's a unit of time early in the season, where an inordinate amount of training - but not so much that it leads to injury - is devoted to one of the three sports. Swimming seems to get the most attention.

Since this blog is about minimizing injury, this time of year would also be ideal to plan ones training stress, training volume - the amount of work you plan. This is the slope of the effort line from now till the first race that not only gets you prepared, it does so in a very gradually increasing fashion, to minimize the potential for Achilles tendinitis, IT band problems, stress fractures, etc.



I firmly believe that much of the misery, lost training time, races missed, etc. could be avoided if each athlete took the time to plot out the whole year, just as Mark Allen preaches, with this in mind. It would sure make my work load easier, and life happier for many.

It's January for Pete's sake. If you haven't finished your Annual Training plan, do it today.


Wednesday, January 9, 2013

If Crowie does it, and Macca does it, should you?


"Anything Sam Cooke did, I would do...apart from getting shot in a motel room by a hooker."
                                                                                             Rod Stewart

@MaccaNow 1/3/2013

Double header long ride weekend. 110miles today down to the. Perfect day for it. 120miles set for tomorrow.

Sunday, January 6, 2013

Running or Racing? When Not To Push It.

"I hate running!" Swimmer Magazine, January 2013
The article goes on to say, "What famous swimmer posted that at usms.org?  If you're guessing every swimmer there may be a grain of truth, because swimmers, by definition, practice a water-based sport rather than a land-based sport.  But not every swimmer hates running, and increasingly, more runners are getting into swimming thanks to the triathlon craze."*






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


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

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

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

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

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

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

Big Toe Problems

Your big toe is really important as it carries 40-60% of your body weight, twice the lesser toes!  So, anything that might affect the big toe may also alter your running gait. 

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

Lastly, let's briefly cover bunions.  Seen more frequently in females, a bunion is a lump over the inside of the big toe joint sometimes accompanied by an alignment issue.  In some, the big toe points toward the outside and the first metatarsal toward the inside.  Being a triathlete doesn't put you at risk any more than the general population.  In many instances, simply choosing bike or running shoes with enough room in the toe box is satisfactory.  Occasionally a surgical procedure may be in order. But, in contrast to the past, both the Orthopedic community and the Podiatric community have issued statements against doing surgery just to alter the appearance of the joint, or to wear fancier shoes.  No pain or dysfunction=no surgery.  I agree.

Image #1, Google images, Cha Cha.com
* Jim W. Harper

Racing or Running? Yep, it's OK Not to Push Sometimes

"I hate running!" Swimmer Magazine, January 2013


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


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


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


 Running or Racing?



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


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




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




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



 1) you're coming back from injury as noted above.



2) You had a hard race last WE, and maybe the WE before, and can treat it like a work out.




3) Fun. You just want to run for the fun of it. Maybe conversational pace with a friend.




4) A friend is looking for a PR and you've agreed to pace him/her.


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



 Big Toe Problems



 Your big toe is really important as it carries 40-60% of your body weight, twice the lesser toes!  So, anything that might affect the big toe may also alter your running gait.



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


 Lastly, let's briefly cover bunions.  Seen more frequently in females, a bunion is a lump over the inside of the big toe joint sometimes accompanied by an alignment issue.  In some, the big toe points toward the outside and the first metatarsal toward the inside.  Being a triathlete doesn't put you at risk any more than the general population.  In many instances, simply choosing bike or running shoes with enough room in the toe box is satisfactory.  Occasionally a surgical procedure may be in order. But, in contrast to the past, both the Orthopedic community and the Podiatric community have issued statements against doing surgery just to alter the appearance of the joint, or to wear fancier shoes.  No pain or dysfunction=no surgery.  I agree.




Image #1, Google images, Cha Cha.com


* Jim W. Harper




Ah, the Cleansing of January

 


 "Through early morning fog I see, visions of the things to be."*


                                                       Johnny Mandel, M*A*S*H., the movie


 






M*A*S*H last supper scene here.



* I'm betting that many of you were unaware that the TV show M*A*S*H came from the movie of the same name by Robert Altman in 1970. (If you haven't seen it, you should.  Really.)



 What a great day January First is!  We get a do over. Like in hop scotch when were 10. Those flubs and missteps from last season? Pssst, gone just like that.  "At the beginning of the year, it's good to know every race you're going to do," says 6 time Ironman World Champion Mark Allen.  And what better day to plan it than today?  I'll bet that many of you have already accomplished that task.


 We get the opportunity to review what training/racing errors, nutrition challenges and perhaps over zealous goals that were chosen for 2012.  And if Allen's comments are good for races, wouldn't they necessarily be good for work outs as well?  And, while we're at it, how about your Racing Weight plan per Matt Fitzgerald?  As has been discussed previously, about 8 weeks before your base period is to start (somewhere about now, eh?), if you can gradually reduce your caloric intake by 2-400 calories per day, remembering that crash diets seldom work, that your upcoming work load and caloric needs will dovetail nicely.


 Is this finally the year that you're going to practice open water swimming until you like it?  I said like it?  Even if there are fish and turtles in your hometown lake, and you're a tad uncomfortable sharing your Saturday swim with them, it's something that can be overcome.  Think about getting one of your friends who's pretty comfortable in that environment to accompany you, perhaps several Saturdays in a row come Spring.  And, after a few "desensitization" sessions, you'll surprise yourself at how possible this is.


 You are fully in control of your 2013.  Like fine champagne, here's hoping you use it wisely.


 Happy New Year, happy training and I wish you a successful, thoughtful and injury free season.


 


John Post, MD


 














Ironman tired, you know the feeling!




Hyponatremia (Low Sodium) in Triathlon

 


"Water, water, everywhere nor any drop to drink."


                                                                                 Rime of the Ancient Mariner


 Exertional Hyponatremia


 For the last twenty-five or so years we’ve been aware of a condition known as E.A.H., E.H., orExercise Associated Hyponatremia.  It's now generally known as Exertional Hyponatremia.  Briefly it’s a condition associated with endurance athletic racing be it triathlons, marathons and even longer events where the body's sodium level is diluted to such a degree that sufferers can seize and die.  Although it’s occurrence  is incompletely understood, the primary common factor is fluid intake before, during, and after racing be they water or sports drinks.  That's correct, sports drinks as well.  Some athletes, women more than men for some reason, can be predisposed to the development of severe, even life threatening hyponatremia. Several recent deaths in endurance sports have been attributed to EH, interestingly two in doctors


 Some athletes consume so much fluid that they actually gain weight before or even during the event. In the early days of Ironman, when the event was still held on Oahu, race inventor John Collins would actually weigh competitors at race start and at points during the competition.  Perhaps an increase in competitor weight would have been picked up in 1978-79.  Even though athletes heading toward hyponatremia perspire, compared to their fluid intake, their fluid losses cannot keep up with the intake.  Their serum sodium decreases to a dangerous, potentially fatal level, as the racer may experience fluid in their lungs, fluid on the brain, and even convulse and die.



  Symptoms seem to overlap with symptoms of dehydration to a degree: decreased urine output, nausea and/or vomiting, a bloated feeling, headache confusing race medical personnel who would encourage further oral fluids or intravenous fluids.  This would, of course, be the opposite of what's needed and the situation would worsen.




 Remember this.  Just because you feel well as you cross the finish line, the cessation of exercise can aid the sudden absorption the the water in your stomach further lowering serum sodium.  Something to remain vigilant for in the early post-race period.




 I've seen data presented where about 10% of marathoners and 18% of iron distance triathletes have this to some degree.  Yes, 18% of iron distance athletes where obviously most survive...but there are some close calls.  Our kidneys can handle about a liter an hour, over that and the sodium balance begins to shift.




 Risk factors include: excessive drinking during the event, elderly, NSAID consumption (they stimulate anti-diuretic hormone retaining water), low body weight, female, greater than 4 hour competition, and extreme temperatures.  Obviously prevention is the best solution by adequate pre-race salt in the diet, a heat acclimation period, an understanding of this illness by the athlete and medical crew, etc.




  So if next your work out or race meets the above conditions, just be aware that this could be you...or me...and that an understanding of how to both stay out of trouble and what to do if you might be headed that way are your best bet. 




  If you'd like to read a little more, Doug Casa, Phd. runs the Korey Stringer Institute at UConn where he and his staff have done a great deal to further our knowledge.  You might start off with thishttp://ksi.uconn.edu/emergency-conditions/hyponatremia/ .




Being Afraid....Being Injured...You?

 


 



"Do the conditions you encounter exceed your abilities?


 


 Although we as triathletes push pretty hard sometimes, we’re rarely outside our comfort zone in other than a physical sense.  I've previously briefly described hiking the John Muir Trail with my son Ben a couple years ago.  This was a six day journey through wooded areas, over many creeks and streams, as well as some fairly steep mountain trails culminating in standing atop Mount Whitney, the highest peak in the lower 48, with it’s seeming 100 mile view. 


 On the third day, our longest, after traversing some pretty difficult to navigate terrain (since we were so early in the season and didn’t have the benefit of hikers before us marking the correct trail), we crossed one particular river and unbeknownst to us, were off the trail.  Way off the trail. We tried to back track to a known point, but we were lost.  Lost in billions of acres of land…with no GPS…no cell service…no plan “B”, no nothing.  The only way out of this was to think our way out. And, yes, we were at least a little afraid (although maybe the bears and mountain lions were a little afraid of us too. Maybe.  Uh, maybe not.)


 It’s times like this that occasionally you don’t think terribly rationally.  Like during the run in an iron distance race.  In the former, although you have a tent and food for a week, you don’t know where you are.  And, the in latter, you’ve trained for this for an awfully long time but are rapidly running out of energy and ideas at the same time.  You may have to…oh, don’t even think it…walk!  And walk a lot.  But for us it was one of those times that, with no other option, no chance for help from any outside source, that with a little luck, you “just do it.”  You take the information you do have, think the problem through such as you might have done in a college course, and you’ll likely find your way back to the trail. With great relief I might add.


 Injuries to the triathlete can follow a similar path.  One can have a physical problem, seek help from a friend, an internet forum or local medical professional.  It's position where you're no longer in control and for some be down right scary!  But in the end, you know vastly more about your recent athletic experience than any physician.  This would include the specific training load your body has seen including any overload situations, one of the most common sources of injury in my experience.  And with just a little help from the medical community pointing you in the right direction, you and your care giver can frequently come up with the right diagnosis.  Like being lost in the woods, you think the problem through.  And from this diagnosis, like the route though the woods, the route back to your training normalcy is revealed like the yellow brick road.


 So, next time you find yourself injured, think it through.  Use your available resources, especially your own brain, and sometimes you’ll surprise yourself.  I’ve seen it happen.


 Good luck.



Friday, January 4, 2013

Will Your Training Plan Injure You?


I have given a name to my pain, it is Batman."
                                                                   Jack Nicholson as The Joker

And speaking of pain, I was recently asked asked about a blog I did on stress fractures a little while back and thought the following important as we set our training plans for the upcoming season. Although our weather forecast here in Virginia calls for snow tonight, athletes everywhere are creating training plans to fit race schedules this Spring and Summer.

So many athlete's questions involve self-induced injury! Time and again when a triathlete reports a physical issue, and then comes up with an, "I know when I did it" type of answer, I think about prevention. Any list of the most common overuse injuries in runners would include : 1) Patellofemoral pain (21%), 2) ITB friction syndrome (11%), 3) Plantar faciitis (10%), 4) Meniscal injuries (6%), 5) Shin splints (6%), 6) Patellar tendinitis (6%), 7) Achilles tendinitis (6%), 8) Gluteus medius injuries (4%), 9) Tibia stress fractures (4%), 10) Spine injuries (3%) as noted recently.

In one medical study, 6 young men presented with midshaft tibia stress fractures which failed to heal with the usual conservative care of rest, immobilization, etc. and 5 went on to complete fractures!! Think having a rod place down the middle of your tibia might alter your training?

We also think of the metatarsal bones in the foot as commonly seen sites of stress fractures but I was taught that they've actually been reported in all 26 bones in the foot and the sesamoids.

The take away lesson here is that none of us is immune. Training programs which ramp up more quickly than the athletes body can take can be hazardous to ones health. And when weather or life get in the way of training, the better choice might be to just forget a work out or two rather than accept overload at a later date. This is certainly the Training Bible philosophy.  Each of us is different as we define overload so just because a training partner can work at a certain level does not necessarily mean we can. If we just think before we make choices and listen to what our legs are telling us, we reduce the potential for self induced injury. And, we're more likely to kick butt in that first tri in the Spring. Good luck.

Hmmm, seems not everyone want to watch your warm-up swim.

Tuesday, January 1, 2013

Ah, the Cleansing of January 1!



"Through early morning fog I see, visions of the things to be."*
                                                       Johnny Mandel, M*A*S*H., the movie

M*A*S*H last supper scene here.

* I'm betting that many of you were unaware that the TV show M*A*S*H came from the movie of the same name by Robert Altman in 1970. (If you haven't seen it, you should.  Really.)

What a great day January First is!  We get a do over. Like in hop scotch when were 10. Those flubs and missteps from last season? Pssst, gone just like that.  "At the beginning of the year, it's good to know every race you're going to do," says 6 time Ironman World Champion Mark Allen.  And what better day to plan it than today?  I'll bet that many of you have already accomplished that task.

We get the opportunity to review what training/racing errors, nutrition challenges and perhaps over zealous goals that were chosen for 2012.  And if Allen's comments are good for races, wouldn't they necessarily be good for work outs as well?  And, while we're at it, how about your Racing Weight plan per Matt Fitzgerald?  As has been discussed previously, about 8 weeks before your base period is to start
(somewhere about now, eh?), if you can gradually reduce your caloric intake by 2-400 calories per day, remembering that crash diets seldom work, that your upcoming work load and caloric needs will dovetail nicely.

Is this finally the year that you're going to practice open water swimming until you like it?  I said like it?  Even if there are fish and turtles in your hometown lake, and you're a tad uncomfortable sharing your Saturday swim with them, it's something that can be overcome.  Think about getting one of your friends who's pretty comfortable in that environment to accompany you, perhaps several Saturdays in a row come Spring.  And, after a few "desensitization" sessions, you'll surprise yourself at how possible this is.

You are fully in control of your 2013.  Like fine champagne, here's hoping you use it wisely.

Happy New Year, happy training and I wish you a successful, thoughtful and injury free season.

John Post, MD

Ironman tired, you know the feeling!