Saturday, April 25, 2009

So You Might Have a Stress Fracture

Too many things hurt!
Triathlete Steve Smith after winning his age group and a slot in Ironman Hawaii, and turning it down!

Foot pain in the triathlete is ubiquitous and one of the more common diagnoses is a stress fracture. Classically, they're know as "march fractures" and described in the second metatarsal, but they've been noted in all the metatarsals, as well as several other bones in the foot. In runners, the most common location is in the neck of the metatarsal where ballet dancers, for another example, see them in the base of the metatarsal. They occur

due to excessive, repetitive stress applied to a bone that lacks the structural strength to withstand it.

Predisposing factors include increase in physical activity like boot camp or deciding you want to do a triathlon, previous immobilization, diabetes, etc. They're frequently found with the Female Athlete Triad of disordered eating, amenorrhea (menstrual irregularities), and osteoporosis.

If your xrays reveal a stress fracture, occasionally all that's needed is protective footwear such as hard soled shoes although some people are casted until they're pain free. Recurrence of the pain indicates the need for further rest. Once pain free, normal activities and footwear are resumed at a restricted pace allowing for a more gradual increase in stress.

Friday, April 17, 2009

Triathlon Widows

"Captain Jack will get you high tonight, and take you to your special island."Billy Joel

Endorphins, the exercise high, is there a cost involved? My wife told a friend once that she wasn't too worried about me having an affair,"HE MIGHT MISS A WORKOUT!" "Is it really that bad?" I later asked her. "YES",was her rapid response.

I saw a survey of Ironman athletes a number of years ago where the total workout hours/week were reported and I was amazed by the age groupers responses. Volumes of 20, 30 and 40 hours/week, and even more, were stated
admitted to? by many. While I'll assume that some folks include planning, workout prep and clean up in these figures, they are impressive none the less. Since then I've spoken to many athletes and more than a few spouses to fuel this piece and I've basically determined that most triathletes are blind. They are blind to the impact that their workout schedule has on those around them from family to friends and co-workers. Some even think their training is invisible to others as they:
1)while they go to the pool at 5:30am...while somebody else gets the kids up, dressed and checks for last minute school needs.
2)as they run at noon instead of going out to lunch with the gang but by the time they're showered and back at their work station sweating like two pigs somebody else has gotten those needed reports completed.
3)and, as they ride with the evening bike group, somebody else gets the kids from soccer practice, dinner and homework started...and, oh yeah, picks up the dry cleaning.

So the triathletes commitment to the sport takes an equal commitment from family and friends for which the athlete needs to say thank you, frequently, and be cognizant of on a daily basis. Each of us needs to carve out other areas of time, maybe even letting that butterfly collection or special project lie fallow for a while. His/her disposable time is already spoken for.

Tuesday, April 14, 2009

I've Ruptured My Achilles? No


If God invented marathons to keep people from doing anything more stupid, then triathlons must have taken Him completely by surprise.(P.Z.Pierce, MD)

This will be a short post but I've had two inquiries recently about ruptures of the achilles tendon. It's one of the strongest tendons in the body but failure is surprisingly common. And it doesn't always seem to require some major trauma. People seem to feel a pull or a give in the back of the lower leg some 4-6 cm above the tendon's insertion into the calcaneus (heel bone.) They realize quickly that not only are they unable to run but they have no push off power on that side. In fact, they can't even begin to stand on their toes. There's no numbness or sensory change in the foot.

After an examination by their friendly Orthopedic Surgeon, they're told that the tendon has torn leaving it shredded
to resemble mop ends. Frequently, more frequently than in the past, a repair procedure will be recommended at it seems to reduce the potential for re-rupture (about 2%) but it does carry with it all the things that that are good/and bad about surgery (infection, anesthesia, etc.)

Post operatively there will be a period of immobilization of a few weeks and then plenty of PT. Calf weakness will be a major headache as the athlete tries to resume a normal, easy running stride. This will take several months but most can get back to their sport.

Wednesday, April 8, 2009

Stupidity Plus-Bike Inspections

The "Hot Corner," Alii Drive and Hualalai Road Kona,Hawaii.

"And another year later our cameras settled, in the gathering twilight of an impossibly beautiful South Pacific afternoon, on the dwindling energy of an angular woman named Julie Moss." Jim Lampley, ABC Sports, 1982

We all owe a debt to Julie Moss. If you see her, say thanks, she's gracious to a fault. But to finish a race, you need to start it prepared to go the distance. Although I go to Kona every year, sometimes I'm a volunteer. Recently, as a Bike Inspector, it's 16 hours before the start of the Ford Ironman World Championship and I'm looking at a bike where the rear brake cable is worn all the way through with a rusted, frayed cable exposed. This may be the most important race of this person's life-what are they thinking? Are they thinking?

Bike inspections at many events are safety inspections, often done by non-bike shop employees like me. The emphasis is on a sound cycle, not a detailed inspection, and when an observation like the one above is made it seems as if the athlete is in a hurry or just doesn't care. And, when pointed out, the bike owner looks at me, a "civilian" for the fix. At the end of the bike inspection line sit the bike and tri mag reps as they count brands, wheel types, etc. for their upcoming publication of who rode what in Kona. It would be interesting to have one more person recording what was found broken by the bike inspectors.

In my mind, preparation for a triathlon begins at least a month before the race when there's no pressure, no hurry only the dream of the starting line to come. You might pick a knowledgeable friend or your local bike guy to go over every cable, tire, spoke, screw, etc. and consider replacing anything in not close to perfect condition. Can you put a price on a mid-race broken chain? A derailleur failure? If you have to ship your bike some distance why not get the local bike shop to either reassemble it, or at the very least to inspect it after you put it together. You get another pair of hands and eyes to check your trusty steed. I've had this done for me at every Ironman race, most recently by Bikeworks in Kona, and completed 6 IMH's without a whisper of a mechanical issue. Well, except saying that the bike didn't go fast enough...but I can't blame the bike shop. As Lee Trevino is fond of saying, " It's not the arrows, it's the Indian."

Thanks, Julie.

Friday, April 3, 2009

Dog Bites Biker

While riding alone on Tuesday, out in the county far from cell service, I was chased and then bitten by a dog.

NOW WHAT! Well, I think you try to get as much info about the dog as you can. I saw that the dog had a collar and where it had come from so I knocked on the door, and as I've heard happen before, the owner virtually blamed me for riding my bike near his house! Never the less, I asked about rabies shots, told him I was going to report the incident to animal control, and got his name and address. Key items. (I always have a working pen and paper in my fanny pack and in a situation like this, more than a little stressful, I wrote it down.)

Now I had to think about this wound. Dogs mouths, like those of the human, are filled with bacteria, which once the skin has been violated, have a pathway into the rider. Bites to the hand can be especially troublesome. Dogs have strong jaws and dull teeth which can crush a good deal of human tissue. And, those athletes with preexisting diabetes, steroid dependency, AIDS or those with circulation problems can be particularly at risk.

So once I had cell service, I called my doctor and was advised to immediately wash the wound-removing dog saliva-with the contents of my water bottle, then ride to their office for definitive wound care. It took 50 minutes to ride there but I was triple washed, given a tetanus shot since mine was 8 years old (no swimming for a couple days-these babies give you a sore shoulder!)and we called animal control.

In that I'm generally healthy and have not had my spleen removed, no antibiotics were necessary. Things seem to be healing nicely, the dogs rabies shots indeed turned out to be up to date and I'm back in training. If you follow these simple measures you will do well too. I think I'll ride a different route on Sunday!