Sunday, June 18, 2017

A Dog Swimming the Kona Race Course? Seriously?/Running Keeps You Physically Younger

Kimo the dog. I wear glasses, but my eyesight's not all that bad. While treading water at the Coffees of Hawaii barge (every year during IM race week in Kona, the good folks at Coffees of Hawaii set up a large sailing craft about 700 m off shore, where anyone who swims up to it is offered a small paper cup of Kona's finest.
                                                                                  
Coffees of Hawaii barge, Kona, Hawaii
It's pretty darn cool and I'd suspect they serve over 1000 "customers" each morning. The coffee's hot, too!)
So, while sipping my excellent brew, goggled, without glasses, I noted a group of three swimmers approaching, one with a very odd mask on, but hey, it's Hawaii, home of the underpants run, who's to say what passes for odd around here?  Plus, I'm in the middle of the Pacific Ocean at a coffee barge for gosh sakes. I thought the mask had ears on it. But, once they were closer, I could see that the third swimmer was a German Shepherd.  A German Shepherd with a life vest on.! Now there's something you don't see every day back home. When the couple had had their fill of coffee, all it took was a simple, "Come Kimo," and off they went, continuing their swim.  The three swimmers.
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Triathlon Pre-race Check List. Am I really ready?  Am I safe?


USAT has the CHECK yourself program.  It's a good one.  If you take just a minute to read each of these check boxes, agree that each describes you, the potential of you ending your race in the Emergency Room is quite low.





"Twenty years from now you will be more disappointed by the things that you didn't do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover."  Mark Twain
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Running May Reverse Aging

The below written a couple years ago by Gretchen Reynolds of the NYT.  It's as true today as it was then.  Although it's pointed at running specifically, in my opinion, the cross over to triathlon is as strong if not more so than the single sport athlete.



Running (and likely triathlon) may reverse aging in certain ways while walking does not, a noteworthy new study of active older people finds. The findings raise interesting questions about whether most of us need to pick up the pace of our workouts in order to gain the greatest benefit.
Walking is excellent exercise. No one disputes that idea. Older people who walk typically have a lower incidence of obesity, arthritis, heart disease and diabetes, and longer lifespans than people who are sedentary. For many years, in fact, physicians and scientists have used how far and fast someone can walk as a marker of health as people age.
But researchers and older people themselves also have noted that walking ability tends to decline with age. Older people whose primary exercise is walking often start walking more slowly and with greater difficulty as the years pass, fatiguing more easily.
Many of us probably would assume that this physical slowing is inevitable. And in past studies of aging walkers, physiologists have found that, almost invariably, their walking economy declines over time. That is, they begin using more energy with each step, which makes moving harder and more tiring.
But researchers at the University of Colorado in Boulder and Humboldt State University in Arcata, Calif., began to wonder whether this slow decay of older people’s physical ease really is inexorable or if it might be slowed or reversed by other types of exercise and, in particular, by running.
Happily, Boulder has an unusually large population of highly active older people, so the scientists did not lack for potential research subjects. Putting the word out at gyms and among running and walking groups, they soon recruited 30 men and women in their mid- to late-60s or early 70s.
Fifteen of these volunteers walked at least three times a week for 30 minutes or more. The other 15 ran at least three times a week, again for 30 minutes or more. The runners’ pace varied, but most moved at a gentle jogging speed.
The scientists gathered all of the volunteers at the University of Colorado’s Locomotion Laboratory and had each runner and walker complete three brief sessions of walking at three different, steadily increasing speeds on specially equipped treadmills. The treadmills were designed to measure how the volunteers’ feet hit the ground, in order to assess their biomechanics.
The volunteers also wore masks that measured their oxygen intake, data that the researchers used to determine their basic walking economy.
As it turned out, the runners were better, more efficient walkers than the walkers. They required less energy to move at the same pace as the volunteers who only walked regularly.
In fact, when the researchers compared their older runners’ walking efficiency to that of young people, which had been measured in earlier experiments at the same lab, they found that 70-year-old runners had about the same walking efficiency as your typical sedentary college student. Old runners, it appeared, could walk with the pep of young people.
Older walkers, on the other hand, had about the same walking economy as people of the same age who were sedentary. In effect, walking did not prevent people from losing their ability to walk with ease.
More surprising to the researchers, the biomechanics of the runners and the walkers during walking were almost identical. Runners did not walk differently than regular walkers, in terms of how many steps they took or the length of their strides or other measures of the mechanics of their walking.
But something was different.
The researchers speculate that this difference resides deep within their volunteers’ muscle cells. Intense or prolonged aerobic exercise, such as running, is known to increase the number of mitochondria within muscle cells, said Justus Ortega, now an associate professor of kinesiology at Humboldt University, who led the study. Mitochondria help to provide energy for these cells. So more mitochondria allow people to move for longer periods of time with less effort, he said.
Runners also may have better coordination between their muscles than walkers do, Dr. Ortega said, meaning that fewer muscles need to contract during movement, resulting in less energy being used.
But whatever the reason, running definitely mitigated the otherwise substantial decline in walking economy that seems to occur with age, he said, a result that has implications beyond the physiology lab. If moving feels easier, he said, people tend to do more of it, improving their health and enhancing their lives in the process.
The good news for people who don’t currently run is that you may be able to start at any age and still benefit, Dr. Ortega said. “Quite a few of our volunteers hadn’t take up running until they were in their 60s,” he said.
And running itself may not even be needed. Any physically taxing activity likely would make you a more efficient physical machine, Dr. Ortega said. So maybe consider speeding up for a minute or so during your next walk, until your heart pounds and you pant a bit; ease off; then again pick up the pace. You will shave time from your walk and potentially decades from your body’s biological age.

Tuesday, June 13, 2017

Posterior Tib Tendon, I'd Take Any Risk to Tie Back the Hands of Time




This is an edited redo.  One of my most popular blogs of all time. Certainly the one that has generated to most "will I ever be able to exercise again?" mail came from that writing.  If you're reading this as one with the problem, why not make a pit stop by the Q&A that follows the previous post. It serves as a good library and just might answer your questions.

Previous post.  
http://www.johnpostmd.com/2009/03/posterior-tibial-tendon-problems.html

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Posterior Tibial Tendon Problems


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

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

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

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

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

The take away is that patience is key in the athlete with early symptoms and just because you may have had a scan which shows a tear, you still may not require surgery and wouldn't think about it until after 3-6 months of rest in many cases.  So as Maxwell Smart might have been thinking in the TV show of the 60's or movie from the movie from 2008, if you have a musculoskeletal issue, do your homework, read up on it and "Get Smart."


Tuesday, June 6, 2017

Why Can't You Swim Straight?

Pay Your Lifeguard With Wet Dollar Bills

On Saturdays, a sizable group of triathletes and open water swimmers meet early in the season at one of the area man-made lakes for open-water training.  It is invaluable to work on swimming in a pack, sighting, getting used to a wet suit for some, etc.  Some claimed it to be their most advantageous swims of the year.  Those seeking to improve had better swimmers and coaches literally an arm's length away.  We get one of the swimmer's kids to be our canoe-bound life guard and each swimmer pays "per mile" from money they stash in their suit and swim with.  When finished, they simply swim up to the canoe, pay cash, wet cash, to the smiling guard who's making a good living on a Saturday morning.  Even though it's wet.

We're pretty lucky.  We're able to use the same lake and course where some years the USMS Two Mile Cable Swim National Championships are held.  You see, in the late 60's, the area was home to Virginia resident and future world class distance swimmer James Kegley.  His dad wanted to help James with his swimming efforts.  In addition to building a home with a lap lane pool in the basement, Jack Kegley helped place two telephone poles into lake bottom exactly one quarter mile apart.  Mind you this was in the pre-GPS and computer days.  And it's over water.  Interestingly, using current methodology, the course has been remeasured since and found to be withing 9" of perfect.  Not bad for a "Little League Swim Dad!" James would go on to win the two-mile several times with a PR on this course of 38:32. Two miles exactly.  This guy can move!
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 At a triathlon a couple years ago, I was in a bit of hurry having forgotten to spray on sunscreen.  I grabbed the clear bottle, shut my eyes really tight, and got a good covering of my whole face.

Unfortunately I still had my glasses on!
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Swimmers exit the lake after "enduring" recent swim


Why Can't You Swim Straight?

"Swimming in open water feels different from swimming in a swimming pool.  The salt water makes you float higher and the fresh water feels good against your skin."   Lynne Cox

We had our first open water lake race of the season last weekend.  A little chilly for some at 66-68 degrees depending where you measured the lake and the wetsuited swimmers far outnumbered those simply in a suit and cap. Once in the water, although most traversed the shortest distance between every two buoys, that being a straight line, we had a fair number of Wrongway Peachfuzz navigators charting a path not unlike the zigzag setting on your Mom's Singer sewing machine.

The two main causes seem to be the refusal to learn to breathe bilaterally and the need to improve their sighting skills.  Cox points out that "swimmers in the open water who breathe only on one side are blind on one side and compensate by lifting their heads to see what's going on around them."  Two excellent sources of a step-by-step way to learn this can be found in Cox's terrific book, Open Water Swimming Manual, $12.46 on Amazon or Sara McLarty's well-written piece from Triathlete a couple years ago, Why (and How) to Bilateral Breathe, http://bit.ly/2qTelAM .  I think so highly of Cox's book that last week was a triathlete friend's birthday, and guess what her birthday present was?

Secondly, sighting is a skill easily mastered in a pool when you have your own lane to practice a few simple drills.  Here Coach Sara has explained this so even people like us can figure it out.  http://bit.ly/2rxonu2

Perhaps, if you can perfect these two techniques, then you'll have a faster, more enjoyable swim, and you won't feel the sting of being punched in the ribs by the swimmer you just tried to crawl over on your "blind side" in your next open water race.

Plea for Bike Safety

Six months ago a friend of mine had just retired.  Mayo Clinic trained, 3 lovely daughters. She was just making plans on how she was going to get to all the things she'd put off during medical training, raising the girls, etc. when she was killed on her bike.  She was following the rules but the driver of the truck was not.  Please, think before you ride, leave the tunes at home, choose your route carefully and let someone know where you're headed doing 110% of your part to be safe 100% of the time. Local triathlete Emily tries to envision any obstacles along possible bike routes doing her best to avoid construction, big yard sales, events where there are likely a fair number of automobile rubber neckers who are unlikely to see you on two wheels. If she knows of an alternative road, she takes it.  We should too.