Saturday, April 24, 2010

A participant in the Underpants Run. A counter-culture event run in Hawaii two days before the Ironman where proceeds go to support a local charity. And yes, the shorts are bogus. Make sure you look at the rest of the runners.

Quick Note: with the arrival of warmer temps and daylight savings time. many of us are out on the roads earlier, later and longer. Of the four strobe lights on biker's butts on this Sunday's ride, all four needed new batteries. One was so bad you could hardly see it in the pre-dawn darkness...drafting! So, before you ride again, change all those batteries and be safe.

We tend to get complacent. To assume that because we have a great deal of experience doing something that we remain proficient at it. This is a major contributor to running injuries. Let's try to reverse that. There's already enough controversy in running equipment now...Newtons, Vibram, etc., that if we stick to what we know we'll stay out of trouble. Let's try to review the running stride and how to do our part to remain injury free.

USAT Certified coach Jim Dicker of Training Bible preaches frequently regarding stride frequency. He feels that many of us over stride and this leads to higher loading of the lower extremity than is required for the given pace. He has his athletes take 22 strides per 15 seconds to minimize the impact seen by the limb. Diminishing leg stress is obviously beneficial and not only might it give you a more compact running style, and help load the leg evenly decreasing injury, it might even contribute to a longer running career. How many ex-runners do you know, out not because they're tired of it, but because they can not stay injury free? Look at the race results of your local tri and compare the number of competitors in the 30-35 year old ager group to those of 60-65.

Mark Lorenzoni, owner of our local running shoe store, a man I've quoted here before, has over 25 years of caring for runners, and preaches the same thing. He wants his runners to count 30 strides per 20 seconds. He suggests they give themselves a "pop quiz" in the middle of the run after they've warmed up by counting the number of left foot strikes for 20 secs and checking to make sure it's 29-30, regardless of pace. He's convinced that the incidence of IT band problems and plantar faciitis is lower in athletes who do this.

He also is a big supporter of mid-foot strikers and tells clients to pretend they have a pebble under the heel of their shoe and they're trying not to put too much weight on it at foot strike.

The take home point here is to have someone knowledgeable evaluate your stride at regular intervals and see if you're as good as you think you are.

Can you identify the athlete on the left with the American Interbanc shirt just before the Underpants run start?

Wednesday, April 14, 2010

Achilles Tendon Ruptures 2010

"What we have here is a failure to communicate." Cool Hand Luke

Last month I published a piece entitled “What a Triathlete Needs to Know About Antibiotics” that was well received. (Thanks) The impetus of that post was a series of confusing ST threads concerning the potential side effects of certain antibiotics, especially fluoroquinolones (Levaquin, Cipro, Avelox, etc.) It was intended to clear up misconceptions as to the relative frequency of these side effects, most noteworthy rupture of the Achilles tendon. (Note: at a Primary Care review course I taught in Florida this week to > 200 physicians, when asked, only 2 docs admitted to personally experiencing this complication in their practice.)

The Achilles tendon is the strongest, thickest tendon in the body connecting the soleus and gastrocnemius to the heel. Men in their 30’s and 40’s seem to have the highest rupture rate, particularly those who are active in sports, especially the weekend warrior who’s relatively sedentary during the work week but really goes at on Saturday . Many in medicine feel that it’s a previously abnormal tendon that ruptures. Although it can fail both at the mid calf level, the junction between the muscle and tendon, or closer to the insertion in the heel, the latter is more common. The tear itself is usually ragged and irregular and not so easy to repair. The diagnosis is made on physical exam by palpating a space where the Achilles normally resides and a positive Thompson test, squeezing of the calf of the prone patient noting whether or not the ankle flexes. In a failed tendon, the ankle will not flex. Most often, there is little or no warning that the tendon will yield.

When diagnosed acutely, options include operative or non-operative treatment, most often the younger population choosing surgery. This could be either a traditional open operation or a per cutaneous procedure. That said, there is an increased risk of complication (infection, adhesions, etc.) over those who’ve chosen the non-surgical route but a lower incidence of re-rupture. Following the operation, most patients will be placed in a cast or splint short term followed by a functional brace. Return to sport varies depending on the solidity of the repair, post-op pain, and ability to prevent re-injury.

Since our goal is to prevent injury in the first place, correction of limb length inequality, arch problems, bio mechanical issues, etc. all help in attaining this. Although there is some controversy, lightly warming up, stretching – both straight legged and bent kneed – perhaps even with a little light massage, coupled with a general fitness program seems to be our best protection in keeping the surgeon at bay.

Super Ironman Hawaii volunteer,Mike McCurdy

Quick Note: with the arrival of warmer temps and daylight savings time, many of us are out on the roads earlier, later and longer. Of the four strobe lights on biker's butts on this Sunday's ride, all four needed new batteries. One was so bad you could hardly see it in the pre-dawn darkness...drafting! So, before you ride again, change all those batteries and be safe.

Wednesday, April 7, 2010

Confidence in Triathlon Swimming

Through early morning fog I see,
visions of the things to be...
Johnnie Mandel, Suicide is Painless

This week, as we prepare for the 2010 racing season , I’ll bypass the injury pipeline and pass on a little experience. After making many mistakes over the years, I can reveal the secrets to not only your fastest safe swim but how to be equipped for those unexpected problems that can throw a wrench into your whole day.

In other words, this is why I keep a spare pair of goggles in my suit. You must think of things that can go wrong, and have a solution in mind, well in advance of the race. Let’s divide these into:
Equipment issues – cap, goggles, suit
Personal issues – need to warm up. need to pee, sunscreen, body prepped for wetsuit removal
Nerves – fear of the immediate future, possible panic attacks
Event issues – being hit or kicked, choking on the water, swimming off course

We’ll assume for this piece an athlete in a sprint tri, wet suit legal, with at least one race experience. I’m pretty sure that almost everybody practices transitions now. If not, 30 minutes on Youtube choosing what seems to work best for you, is invaluable. You’ve planned an early arrival at the race for body marking, transition set up, and generally getting the lay of the land. You’ve thought about swim conditions, goggle selection (newer rather than older but not new ones) and have brought 2-3 pair – including one that’s shaded for a bright sunny day. Although many recommend goggle straps under cap, that’s never worked for me. I just make sure that as I’m donning my wetsuit…after the bathroom break of course…that I’ve lubed my ankles, neck and shoulders, wiping off my hands before I touch my goggles. I keep a second set in my suit and a tiny bottle of anti-fog in my hand which I discard jus before the gun. I don’t zip up my suit until 2 minutes before my warm up swim asking whomever is standing next to me for assistance. Once in the water, I know I’ll need to pee again and just let it fly knowing that it will be rinsed out shortly.

At this point, right before the gun, if I had to credit one thing for being relaxed, it’s pre-race preparation. Viewing the swim course the day before and maybe even going for a short swim, accompanied of course, can pay innumerable dividends on race morning. Practice is a real confidence builder. That, and not being in any hurry at all make for one relaxed triathlete!

Once my wave starts, I try to stay a little off to the side of the main group to get my own little piece of the water even if it means I add a few yards to avoid being hit or kicked…or both. If I inadvertently inhale some water and start to choke, I tread water until it clears. There’s no harm, or penalty, for grabbing a surfboard or boat till you’re stable, that’s what they’re for. It’s safety first, remember? And then, it’s back to sighting the swim course. The old philosophy of just following who’s in front of me doesn’t work all that well in open water swimming. I highly recommend that you practice sighting the other end of your lane at the pool daily, even if it’s just one 25 yard lap of your warm up, and you’ll be surprised at how skilled you become.

Lastly, I’m surprised how easy it is to get “pissed off” at a fellow triathlete who happens to interfere with your swim somehow. My advice is to just shrug it off, stay loose, and think about the finish line. That gives you the advantage and keeps the race fun. Ready for a swim PR?