Sunday, December 25, 2016

Triathlon Speed 2.0, Eat a full Jar of Peanut Butter?

11%  The percentage of people asked who reported having eaten an entire jar of peanut butter in a single sitting, according to a survey conducted by Peter Pan Simply Ground.  Of 1000 plus subjects, 12% claimed they had hidden while eating peanut butter or lied about how much the ate.  Whether you opt to eat chunky or smooth, eat with abandon on National Peanut Butter Day (January 24)*. 

I'm thinking, and this is just a guess now, that these people were not triathletes trying to cut even a little off their 40 K bike time.
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We start out alcohol free January in one week. My three kids were home for a short time during the holidays but put a huge dent in our beer, wine and bourbon supplies.  That will help me come Sunday January 1 as without booze in the house, my temptations will go down.


Transition area just waiting for your bike.


You're a triathlete, you're serious about this stuff.  

What a great day January First is!  It's almost upon us. We get a do over. Like in hop scotch when we were 10. Those flubs and missteps from last season?  Pffft, gone just like that.

Use January 1 as a time to fix just one thing.  If you just choose one thing, it's a lot easier to be successful. New Years resolutions are not about the grand or fantastic, they're about picking a goal that is worthwhile, viable and obtainable.  It's important to be realistic.  Maybe you'd like to lose 50 lbs but a realistic goal would be 20 lbs. Or perhaps you'd like to reduce or eliminate alcohol,  finally sign up for masters swim lessons/stroke eval even though you  know it will embarrass the living daylights out of you. Pick something very personal and selfish.  It's all about you for today.  You can work on world peace some other time.

"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 have already accomplished that task.  I have.

 We get the opportunity to review what training/racing errors, nutrition challenges and perhaps over zealous goals that were chosen for 2016.  If Allen's comments are good for races, wouldn't they necessarily be good for key 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, depending on your particular schedule?), if you can gradually reduce your caloric intake by 2-400 calories per day, remembering that crash diets seldom work, your upcoming work load and caloric needs will dovetail nicely.  Regardless of what dietary regimen you select, if energy expenditure exceeds energy intake, your weight will drop.

 Is this finally the year that you're going to practice open water swimming until you like it?  (Like it?  Is that even possible?)  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 2017.  Like fine wine, here's hoping you use it wisely.

Promises to self: 1) I will ride my race wheels more than just occasionally so when there's a problem during the race I've already solved it in training.

                            2) I will use my wet suit frequently so that it's just second nature come race day. Especially getting it off.

                            3) I will say thank you to all the volunteers who are there just to help you do your best.
                            4) If something starts to hurt, unlike my past, I will back off until it resolves or if it doesn't will get it checked out.

                            5) I will help people new to the sport, just like I was helped way back when.

                            6) And possibly most important for the long run, a quote from my boss Jen Barber at Ironman, "Race day didn’t feel monumental, but like a slightly more complicated Saturday long ride. Sure, I got a tiny bit stressed at gear drop-off (“S*** I forgot my gels … we can access these bags in the morning, right?!”) and battled the usual fitful sleep on race eve. But aside from those few expected blips, it was business as usual. I think this is a significant point to get to as an athlete—when [racing] becomes  comfortable . Not ordinary, exactly, but the sort of thing that makes you shrug and say “this is just what I do.

This is just what you do!  Right?
                            
Happy New Year, happy training and I wish you a successful, thoughtful and most of all, injury free season.  I will leave you with one quote from Colin Powell that has meant a lot to many:  

"A dream doesn't become reality through magic; it takes sweat, determination, and hard work."

Here's a toast to all your dreams for 2017 and wishing you plenty of sweat, determination and hard work.

Thanks for reading, 

John H. Post, III, MD

* Realsimple.com, January 2017

Tuesday, December 20, 2016

Holiday Fall Prevention, Alcohol-Free January


 My 12/16/2016 blog, Alcohol-Free January, Are You Up to the
Challenge, http://buff.ly/2huu730 , introduced the 2017 edition of same.  A group of us did this in January 2016 and it worked. I got feedback from a number of athletes and I'll share the one I liked best with you.


Dear Doctor Post,
As an alcoholic in recovery-and Ironman triathlete-I am in total agreement with you as to how thirty-one days away from alcohol can be life-changing. Of course, it will be relatively easy for me, as I have been doing this for eight and a half years now, but, the truth of the matter is that if I decide to have a beer, that is tantamount to saying I am done with the sport of triathlon. And I just refuse to say that.

Ghent Lummis, University of South Florida, 2016

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IRONMAN med tent in the making. Do your best not to be a visitor later in the day
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Fall Prevention
 
Many common holiday activities can cause injuries that can make any festive season anything but jolly.  
For example, approximately 39,700 people were treated in emergency departments for fall-related injuries during the 2010 holiday season, according to the US Centers for Disease Control and Prevention (CDC). In addition, more than 12,100 visits to emergency departments resulted from activities related to decorating for the holiday season. Sure each of these suggestions don't apply to everyone but for me the "use a step stool instead of furniture to stand on" hits home for sure.  I guess I'm in too much of a hurry to get the proper gear and will stand on whatever is close by.  I'll try to do better.


Fall Prevention

  • Do not drink and decorate. Save your celebratory drink for after the lights are up and illuminated.
  • Select the right ladder for the job. When working at low and medium heights, choose step stools or utility ladders. Extension ladders are ideal for use outdoors to reach high places, as when hanging items from the rooftop. The weight the ladder is supporting should never exceed its maximum load capacity.
  • Inspect ladders for loose screws, hinges, or rungs that may not have been fixed from last use. Clean off any mud or liquids that have accumulated on the ladder.
  • Properly set up the ladder on a firm, level surface. Watch for soft, muddy spots or uneven flooring, and never place a ladder on ground that is uneven. Remember the 1-to-4 rule: the bottom of the ladder should be 1 foot away from the wall for every 4 feet that the ladder rises.
  • Be careful when putting up holiday decorations, including lights and trees. Move materials with caution when on the ladder, and always position the ladder close to the work area, so you do not lose your balance and fall. Wear proper footwear with securely tied shoelaces.
  • Use a step stool instead of furniture to stand on when you need a few more inches to hang a wreath or picture.
  • Be mindful of any rearranged furniture and new decorations and make sure others in the house are familiar with the changes as well. Serious falls can happen when people trip over furniture placed in what used to be open space.
  • Ask for help when moving heavy or awkward items.
  • Minimize clutter and keep pathways clear of decorations, gift boxes, and other items that can trip you up.

Saturday, December 17, 2016

Alcohol Free January, Are You Up to the Challenge?


OK folks, here's round two.  Ready for this one?  In January 2016, I wrote a similar article for IRONMAN http://bit.ly/2humN7m and it was well received.  So well, in fact, that it seems logical to do it again.  On the Mayo Clinic web site then, the question was posed;

"Does drinking alcohol kill brain cells?"





This was their answer:

Alcohol is a neurotoxin that can disrupt communications of the brain. It also affects functions of brain cells directly and indirectly through different organ dysfunction from alcohol usage and vitamin deficiency. Depending on the area of the brain affected, people can have different symptoms. Abusing alcohol can lead to seizure, stroke and dementia to name just a few conditions. Additionally, alcohol is toxic to a developing brain during pregnancy and can cause birth defects, including developmental disorders with lifelong impact.
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Maybe that warning should come on your post-ride Mojito.  Then again, maybe not.  So, do I drink?  Sure. I'll have a glass of wine while cooking dinner some nights, beer on the weekends or at the Tap House watching the Patriots (Aaak, not the Patriots!), a mixed drink or two at a party.   Moderation in all things though.  Some athletes feel that having a dry January is an important first step to their training year.  It gives them one more thing in sport that they have complete control over.To them it makes a statement about commitment to the triathlon lifestyle.  Not unlike a Tweet I put up recently about food which went this way:

Food - a choice. Pleasure if I eat it.  

Pleasure if I don't eat it.  I'll stay true to my core values, I'll feel strong, I'll feel proud, I'll feel I'm doing something meaningful.*
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So we're talking about the whole month here, no alcohol. Birthday parties, NFL playoffs, dinner out at a nice restaurant, nada.  Abstinence.  

I know that some athletes make a point of taking 2-3 days per week where they don't imbibe.  I've read that other triathletes report that a month away from alcohol can be a life altering, life improving adventure.  

Believe it on not, I used to smoke. A lot.  I was a Marine Corps helicopter pilot overseas and a primary helicopter instructor for the Navy when I returned from Vietnam.  There's a fair amount of down time there. But I went from 2+ packs of Marlboros a day to zero the day I got accepted to medical school.  Haven't had one since.  And that was a good while ago.  It was certainly life altering for me and my family.  Oh yeah, and I discovered triathlon!

Getting back to this January challenge, I'd suspect that for some of us this won't be easy.  In fact, I'm sure it will be quite a challenge.  For example let's look at Alan, a 40 something year old tech guy who's been in triathlon going on seven years.  He drinks wine with dinner virtually every night and a cocktail or two, maybe 3, over the weekends when dining out. He is well past his college days, thus flaming shots and Jager bombs are ancient history.  So for Alan, taking this January challenge is just part of his long range plan to prepare him for the upcoming racing season. He doesn't see this as detoxing, just a desire to see if he can do it.  What he's learned is that in addition to changing his relationship with alcohol, it changed his life for the better.  And, as an unexpected side effect, he got faster.  Woowee!

So are you curious?  Me too. If it's anything like smoking cessation, the first week will be quite difficult requiring dedication and focus to get on the other side.  But by mid January, Alan says "You feel brighter, cleaner."  You're even in a better mood.  The recipe for success starts with New Years eve and not guzzling everything in sight.  It will make day one easier.  Then on your first day, give away or pour out the beverages you most commonly consume.  You're less likely to slip that way.

One author wrote that when you choose to be dry for the month, a lot of people "including your close friends" will be surprisingly nonsupportive and give you a hard time about it. I'm not sure I accept that.  Maybe it says more about his "friends" than yours or mine.  They're certainly not into triathlon!  He even went so far as recommending in some social situations that you pretend you're on antibiotics and can't drink.  Maybe that's OK for some but I doubt I'd do it.

So, are you with me?  Alan says that after January with no booze that you might just do the same with February.  It's a short month, remember?  So let's liken this to bike inspection at our first triathlon.  You were a little nervous, might have made a mistake or two during the race.  At the end, though, you were all smiles.  I'm thinking come the end of the month you'll be all smiles.  So I'm up for giving it a try.  Are you with me?


The Calorie Myth, Jonathan Bailor

Wednesday, December 14, 2016

Athlete With Plantar Faciitis, Question and Response

Supplements Part of Your Day? A Different Tri Product May Be Better Use of Your $$

"Dietary supplements encompass a wide variety of products from vitamins , minerals, and botanicals to probiotics, protein powders, and fish oils. During the past 2 decades, a steady stream of high-quality studies evaluating dietary supplements has yielded predominantly disappointing results about potential health benefits, whereas evidence of harm has continued to accumulate."  

                       Journal of the American Medical Association, October 11, 2016

Swimmers line for the mile lake swim
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The question

Hi Dr. Post,

My name is Thuy Nguyen.  I used to walk 4 miles, twice a day.  The only problem I have was the irritation at the ball of my feet.  I am over weight and it is hard to lose weight with walking, so I was jogging in place barefoot on the trampoline last June.  Jogging in place on the trampoline, I sweated, which I liked it.  However, I got my L heel and arch pain.  

I saw one podiatrist in July.  His diagnosis was that I have Planta Fasciitis.  Since I got heel pain, I insisted with Xray.  Xray showed I have a heel spur.  He recommended calf stretch, and a custom orthotic.  My arch is normal, and it is hard to make appointment with him, so I saw another Podiatrist.

I saw the second Podiatris every two weeks since October.  He prescribed all kind of stuffs for my L foot: night splint, night boot, cortisone shots (twice), fiberglass casting (sawed it the next day because my foot was too loose in the cast, that my skin at the ball of my foot was irritated), and walking boot. Nothing has helped, I am back to the usual pain the next day after he took the cast out.    

Since I noticed the pain kind of better after one day of casting, and the pain returned as soon as I stay on my foot with daily activities.  I decided 1) not to put weight on my L foot as much as I can, 2) stopped going to the gym for exercise (back rest stationary bike (30'), and rowing (30'), and 3) use crutches around the house.  I cancelled my appointment with the Podiatrist this week, because it seems to me that he just sells me stuffs.

1.  Do I need to see an orthopedist?
2.  Do I need a custom orthotics since my arch is normal?, or just by good orthotics from Aetrex Lynco 
2.  Please advice of what I need to do to be able to walk for exercise again? 

Thank you very much for your help.

Thuy Nguyen
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The response

Thuy – heel pain can be an athlete’s dread.  Your mechanism, jogging on the trampoline, is a bit unusual, as most of the athletes I come in contact with get heel pain from running.  And they hate it when you tell them they have plantar faciitis.  Many runners will get this, some only once, a small few repeatedly.  They describe their pain located at the bottom inside of the heel, worst for the first steps out of bed in the morning.  Push off yields pain, but no so much at heel strike, going down stairs, that type of thing.  The doctor also considers problems like stress fracture or tumor in the calcaneus, or heel bone.

The painful spot is located at the insertion point of the plantar fascia, the tissue that makes the arch of the foot, into the heel bone.  It’s an area of fairly low blood flow so that healing can be quite slow in some.  Rest, yep that 4 letter word, is the order of the day along with stretching.  The runner’s stretch that everyone knows followed by the same with bent knee.  Tight calf muscles are often a contributing factor in PF.  People benefit from icing in one of several ways.  Many will freeze a water bottle then roll the arch and foot over it.  Some prefer an ice pack or Dixie cup where they peel off the upper half of the paper using the bottom as a handle.  Judicious use of ibuprofen or other anti-inflammatory drug can help with the pain.  Foot massage with a lacrosse ball helps in some cases.  I’ve had good luck with night splints and so-called Strassburg socks. Pool running, while not in the great outdoors, helps.  I wrote this for Ironman a while back but it's useful today.  http://bit.ly/2h2ie1b

If all of the above fail, there may be a role for a cortisone injection or maybe even PRP, platelet-rich plasma.  This is blood taken from your arm, spun in a centrifuge, and a small portion injected into the heel.  The last result is surgery.  Although this can be done a number of ways including open or arthroscopic, knowing that I favor arthroscopy for knee and shoulders, with this diagnosis, in my mind, the open incision gives a more precise result.

Thuy, in your case, since you’ve failed most of the above, you would at least wonder if a second opinion or further x-ray studies would be of benefit.  My bias would obviously be a an orthopedic foot and ankle surgeon but that’s your call.  Best of luck to you.

John

John H. Post, MD
Medical Director
TRAININGBIBLE TRIATHLON COACHING
You bring the passion. We apply the science.

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Sunday, December 11, 2016

How Does Alcohol Affect Your Recovery? (Hint, It's Not Good)


"Dietary supplements encompass a wide variety of products from vitamins, minerals, and botanicals to probiotics, protein powders, and fish oils. During the past 2 decades, a steady stream of high-quality studies evaluating dietary supplements has yielded predominantly disappointing results about potential health benefits, whereas evidence of harm has continued to accumulate."  

                       Journal of the American Medical Association, October 11, 2016
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This is the first of two parts.  Each year we try to encourage athletes to take a 31 day holiday from alcohol in January.  Yep, not a drop.  We were pretty successful in 2016.  I think that it's pretty important and encourage the reader to join us in this effort.  Triathlon is a sport that requires discipline.  It's all about discipline in fact.  Next week's blog will be the request for an Alcohol Free January.

Until then, this from Asker Jeukendrup at MySportScience.  See how it's information relates to your alcohol consumption and if some modification is in order for you to realize your maximum athletic potential.  Sorry about the slight margin mismatch below.


Alcohol and recovery

February 3, 2016
|
Asker Jeukendrup

Recovery starts immediately after exercise. It is well established that the first hours after exercise are particularly important for recovery as well as longer term adaptations. Nutrition plays an important role in this process: it helps to restore muscle glycogen, hydration and may enhance protein synthesis. Protein synthesis is important for repair and adaptation. The ingestion of ∼20–25 g of high quality protein soon after exercise, repeated every 3-4 h has been shown to maximise the anabolic response in skeletal muscle.

In many sports there is a culture of consuming alcohol after training and competition, sometimes in large amounts. “binge drinking” practices are not uncommon in certain sports (especially team sports). In fact, studies suggest that athletes are more likely than the general population to drink alcohol to excess! This alcohol consumption may have an impact on the recovery process. First it may directly affect the processes of recovery in the hours after exercise. Secondly there may be indirect effects because drinking often replaces eating and resting adequately as a result of intoxication.

Alcohol and muscle glycogen synthesis
Alcohol intake has been shown to impair the rates of muscle glycogen synthesis after exercise. These effect were mostly because of the indirect effects of alcohol consumption; because athletes were drinking they were not taking in carbohydrate as recommended for optimal recovery. The direct effects of alcohol on the process of glycogen synthesis were less clear (1).

Alcohol and protein synthesis
More recently the effects of alcohol consumption on protein synthesis were investigated (2). In this study, alcohol consumption reduced muscle protein synthesis following a bout of concurrent exercise. This occurred even though protein was ingested with the alcohol. It was therefore concluded that alcohol ingestion suppresses the anabolic response in muscle and may therefore impair recovery and adaptation to training. Ultimately this may have a negative effect on performance.

Other effects
In addition to effects of muscle glycogen and protein synthesis, alcohol consumption has been linked to reduced sleep quality. Heavy episodic alcohol use, and associated reduced sleep hours, results in a reduction in lower body power output the morning after a drinking session (3). Other studies showed effects on cognitive function the morning after and suggested increased risk of injury.

Critical note
It must be noted that most of these studies were designed to mimic binge drinking and thus alcohol intake was high. In many studies an intake of 1 gram of alcohol per kg body weight was used. That is 80 grams for an 80 kg person (176 lbs). This equals 10 units or 3.5 pints of beer or 4 (medium, 275ml) glasses of wine. 3.5 pints may be a lot for some, but is only a "warm-up" for others after a game! 

Of course, it remains to be seen what the effects are of modest alcohol consumption (for example one pint or one glass of wine). Those effects are likely smaller and perhaps even negligible. Studies need to be performed to confirm. Until that time, the general advice is clear: if you are serious about performance, avoid binge drinking. 

References



3. Prentice C, Stannard SR, Barnes MJ. Effects of heavy episodic drinking on physical performance in club level rugby union players. J Sci Med Sport. 18(3):268-71, 2015.

4. Murphy AP, Snape AE, Minett GM, Skein M, Duffield R. The effect of post-match alcohol ingestion on recovery from competitive rugby league matches. J Strength Cond Res. 27(5):1304-12, 2013

Sunday, December 4, 2016

Masters Triathlete with Asthma/ Ironman Athlete With Knee Pain


Ice Baths, Should You Use Them?

The answer, like so many seemingly simple questions in this sport, is not a yes or no. It depends on what your goals are.  If you have one competition and want to be ready for another as soon as the next day, as I understand the literature, an ice bath may help.  But if your goal is somewhere in the future, an ice bath today may ultimately be detrimental for you say 2-3 months down the road.  Therefore, it seems to me that in general, ice baths have a limited role in triathlon.
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Athlete leaves now frozen bathing suit in car overnight in sub freezing weather. I 'm sure that more than one reader knows what it's like to don an ice cold suit like this.  Right?______________________________________________________________

Two recent athlete letters and responses:

The first, a letter to Joe Friel passed on to me. Masters Athlete with asthma


 Joe - I am a 74 year old Ironman triathlete. Awhile back was top 10 in world 70.3.  In the last 2 years have come down with asthma.  In your research have you found any information regarding building aerobic capacity as it relates to lung capacity in asthmatics?   I have your book "Fast After 50", and am following your training methods. I use an inhaler and try to warm up before starting my work out.   
Thanks for your help.
Best Regards,    Wayne

Wayne - HI, I'm John Post, MD the Medical Director of TrainingBible Coaching and Joe has sent your note to me.  Sorry to hear of your difficulties.  Of the the three of us, you and Father Time are the best of friends.  That's one of your problems.  As you likely already know, after our peak racing years, say our 20's, our aerobic capacity, expressed as VO2 max, begins to decrease.  In some this can be as much as a percent per year.  This is primarily due to a lowering of our max heart rate with age and diminished lung function, both the total capacity of the lungs as well as the rate at which you can exhale the air.
Given that, now add asthma on top of it, and it can be a real pickle.  Maximizing your lung function and the influences of the asthma medically is done between you and your physician.  Your part is to not smoke, avoid areas of air pollution, get your flu shot (as well as Pneumovax and Prevnar - both vaccines recommended for all three of us since we're over 65.  I've had all three.) and doing your best not to get some kind of infection.  Got grandkids??  Good oral hygeine and frequent hand washing?
Lastly, your interest in endurance athletics will be the best antidote to this decline. Keep training!
Hope that helps.
John
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The second, an athlete with a long history of knee pain:

Hi Dr. Post- 

I'll make this brief, and if you would please take a moment to help me, I would truly and dearly appreciate an objective criticism of the condition that I have gotten myself into. 

Demographics: 
40 y/o male. 
Frequent Ultra runner. 
IM Finisher 
Registered Nurse (humbly before you) 

History: 
Because of a clogged sweat gland on the bottom of my foot (took 3 yrs for me to see the right person to get it fixed), I altered my walking and running form and also my cleat position on my cycling shoes. 

Changing my active forms of movement caused me to develop hip pain that was unexplainable, undiagnosable, and was found negative after 2 standard MRIs and 1 MRI Arthrogram (a 1cm x 2cm cyst was found and that's why the arthrogram). 

Lumbar MRI was unremarkable and interpreted as not causative of my hip pain, nor the knee pain that sometimes flares-up. 

After the arthrogram and Lumbar MRIs were negative, I went back to my most natural feeling movement patterns and relocated my cleats---AND THEN after about 3 months the hip pain stopped. 

I have one remaining residual issue that I need to ask about to better understand what I need to discuss with my orthopedist. I get a tight/pinching feeling (probably inflammation) at the distal head of one of my medial hamstring tendons. 
I rarely take NSAIDS, but it does improve with 800mg Ibuprofen BID. However, without medication the medial hamstring tendon bothers me while sitting, squatting (to play with my children), and also if I sleep with my knee in flexion. 

The orthopedist said it wouldn't hurt to check my knee with imaging and the knee MRI says that I have a popliteal cyst and some horizontal signal intensity on the posterior horn of my medial meniscus that, in the presence of the cyst, might be indicative of a meniscal tear. 

I am at a loss about how to approach this. My sports medicine doctor says that orthopedist might want to take out the cyst, but that a meniscus repair is probably not warranted. 

Should I just chill out and check back with the orthopedist in another 4-8 weeks, or should I press on and have the cyst removed? It seems like it will resolve itself, but the sports medicine doctor is wanting to use ultrasound to inject the cyst with cortisone, but then tells me about how that the cortisone is caustic and that it might damage me and then require surgery. 

Financially I'm running on fumes, and I really need to concentrate on my family and my work, but I desperately want to return to the sports that I love for both my physical and mental health (which also help me to concentrate on my family and my work). 

Thank you Sir.


You didn't give me your name so I'll call you Steve. After reading your note, I have a few observations that may help. In no particular order, any doc with an active knee practice likely gives a couple thousand knee injections each year. If there were a significant downside, that number would likely be lower. Popliteal cysts themselves are rarely primary and rarely the source of the patient's symptoms. I'm surprised between the radiologist and the ortho guy they can't be more certain of the presence/absence of torn meniscus. That said, the situation where a meniscus is repairable occurs much less frequently than that where the torn piece is simply removed, something done every day in the operating room by many docs. Is there a mild degree of early arthritis present in this medial side of the joint on would wonder as well. 

Your doc, after your knee exam, must have some opinion as to which of these two is more likely the source of distress. My money would be on a torn meniscus. If the decision to scope the knee is made, doing something to the cyst would be unusual. The norm is arthroscopically address the problems inside the joint and leave the cyst alone. If indeed you have a medial meniscus tear, removing the torn portion is quite easy and you'll back on the roads quickly. 

Steve - it sounds like you have a Sports doc and an ortho guy. If so, two opinions may benefit you more than one! 

Good luck, John 

John H. Post, III, MD 
Medical Director, Training Bible Coaching 
Contributor, Ironman.com 
john@johnpostmd.com 

Below is the full text of our followup e-mail traffic if you might be interested.

Thanks Dr. Post. I'm Mark. 

I agree that the cyst is probably not primary. 

An analogous situation occurred with my hip MRI and the presence of a cyst there, but then the arthrogram showed no tear. For whatever reason, I seem to be forming cysts due to minor injuries and overuse (or poor ergonomics) because I also had a ganglion cyst on my wrist this year. 

I'm very apprehensive about general anesthesia especially because the cyst might spontaneously resolve. 

I'm further distressed about the fact that neither radiology, ortho, nor sports Med has a conclusive opinion. 

Isn't it possible that the popliteal cyst is from an injury to my distal hamstring tendon? 

Dear Mark (maybe Steve in a former life? Ha!) 

Re: I'm very apprehensive about general anesthesia especially because the cyst might spontaneously resolve. 

Nobody is pushing you so take your time. And if you don't want general anes, don't have it. I've had a couple procedures on my legs had either local or spinal. No GA.

Re:  
I'm further distressed about the fact that neither radiology, ortho, nor sports Med has a conclusive opinion. That may be good. No one is forcing your hand...."well sir, your only way out is an operation.." You got over the hip pain without a trip to the OR. Here in VA there's a resource the athletes love. It's called the speed clinic. They examine you, look at your studies, put you on a treadmill and try to heal you with exercise. One of my group had butt pain for a year, two injections, but since going to the SC, is planing IM Chatannooga in the fall. I wrote it up for LAVA - yet to be published - but if you promise not to share it and send me an email add I'll send it to you. john@johnpostmd.com 

Maybe there's one near you wherever you live. Google UVA Speed Clinic. 
Re: Isn't it possible that the popliteal cyst is from an injury to my distal hamstring tendon? 

I doubt it 

JP 

Mark has since read the Speed Clinic piece and offered:

Thx for allowing me to talk this through. I cannot tell you (succinctly) how much that this dialogue has helped me. 

I appreciate your email. I will consider the concepts of speed clinic and whether it might help me. 

Merry Christmas, and all the best in the new year. 
Mark 

Thanks Mark, Happy Holidays to you and your family.