Monday, December 28, 2009

Images From Kona 2009

Since many of us are on holiday and surrounded by snow, I thought I'd share a couple shots I took in Kona this year just to keep the home fires smoldering.

Wednesday, December 23, 2009

Where Are Your Sesamoid Bones?

Big Island racer on the way to the changing tent and 26.2 more miles.

"Give me three steps, gimme three steps mister..." Lynyrd Skynyrd

I was asked recently about an athlete with a foot problem and a possible sesamoid fracture. It occurred to me that most folks didn't know they had sesamoid bones, or if they did, where they were.

The simplest definition of a sesamoid bone is one that's surrounded by tendon or intratendinous. The most obvious example would be the knee cap. This blog will be devoted to the pair of sesamoid bones underneath the ball joint of the big toe. They are about the size of a lima bean, normally glide front and back with each stride and rarely give us much cause for concern. But as with any bone in the foot, they can be broken or subject to a stress fracture. A true fracture takes a pretty significant injury such as a fall from a height where we in the endurance sport world are more likely to see a stress fracture from the usual causes. (See my two recent blogs on this injury pattern.) The athlete with a true fracture is going to be immobilized between 4 and 8 weeks, will be made non-weight bearing on crutches, and like likely be doing all of his/her training in the pool for a while. Treating the stress fracture is much less aggressive, but here, too, your running shoes will see no action for longer than you'd like.

Often times, sesamoid problems present as sesamoiditis, an inflammation of the area caused by the usual culprits of too much too fast, especially speed work or hills. One starts with the gradual onset of pain under the big toe, initially present during only the hardest portion of the workout and increasing to any running, even walking. There doesn't seem to be much redness or bruising. They can be slightly swollen but frequently it's not easy to see.

So what do you do? Back off for a while. Maybe do a percentage of your weekly run volume in the pool. (It can be fun.) Then, if you can unload the area of distress by using a metatarsal pad or other device to very slightly overload the non-injured portion of the foot being certain to ice down the area once the run is over. Don't be so aggressive that you risk frostbite but 15-20 minutes ought to do it.

Lastly, trying to go through your log book examining each week, each run, for clues as to the cause and how to never have it again is always beneficial.  And if you're successful, your "three steps" will be crossing the finsh line without pain!

Saturday, December 12, 2009

Injury Rates Increasing

Growin' up, you don't see the writing on the wall. Passin' by, movin' straight ahead, you knew it all." St. Elmo's Fire

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 as they're spreading their workouts over three sports requiring "different muscles," the injury rate actually increases as the athlete has difficulty turning the desire (need?) to train off.

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 muculoskeletal 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 recently 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% 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 these 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 water as the main set is being described 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 2010,construct a sensible training plan that carefully increases the rate at which your knees 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 needed to work on your flip turns 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!

Sunday, December 6, 2009

Pick The Perfect Tri Sports Doc

Bill Vollmar, MD perfect sports doc

"Son can you play me a melody, I'm not really sure how it goes. But it's sad and it's sweet and I knew it complete when I wore a younger man's clothes." Billy Joel

So you didn't used get injured and now you might need to seek medical help? The cover of the December Triathlete Magazine has on it the title of this blog. And it gives a number of good suggestions. But it's neither written nor edited by a physician and maybe another perspective could help.

Triathletes are what's known in MBA circles as early adopters. They'll try things (anything? Compression socks...Biestmilch...dimpled aero wheels) often with minimal proof/history that the new product/technique is actually beneficial, but it might be. On the Slowtwitch site for example, when one forum poster complains of a musculoskeletal problem, invariably one of the "expert" responders notes the obvious need for ART (Active Release). Well, ART is very helpful in the right setting but the nearest practitioner to my house according to the ART website is an hour and a half away!

The two photos above are of Bill Vollmar, MD, seemingly "only" a Family Practitioner from Lancaster, PA and some would say might have trouble spelling triathlon. But he is whip-saw smart, takes care of almost exclusively athletes, and since unlike me he's not a surgeon, would likely have a non-surgical solution to almost any injury if it's feasible. Only as a last resort would he consider involving someone who might want to cut on you! And, he is so good that he could take care of me and my entire family. And lord knows I've had more than my share of musculoskeletal problems - compartment syndrome, plantar faciitis, achilles tendonitis, rotator cuff tear, I could on. The take home point is that, at least for many of us, we don't have to drive hours to the Pro from Dover with the treadmill for a good portion of our medical needs, we just need to know what's available locally. In fact, like many locations, the go to guy here for most running induced issues is the owner of the running shoe store. With 27 years of seeing runners problems he could take care of the Olympic team! And I'll bet there are examples of this in your community, say the kids swim coach who's been working on swim strokes for decades.

So, as pointed out in Triathlete, don't be embarrassed to ask around to see what's available, who's available, for your specific problem. Help could be right around the corner...and his name might be Bill Vollmar.