Sunday, January 29, 2012

How to Start a Triathlon Swim

"He don't look like no high school dude!"
                   Maurice Greene, talking about Alan Webb, then a senior at South Lakes High School in Reston, VA, who, during the Prefontaine Classic in Eugene, OR, ran a 3:53.43 mile to break Jim Ryan's 36 year old national high school record (3:55.3) once thought to be untouchable. 

Your future triathlon bike? (The Cervelo display)

My last  blog, Death in Triathlon, brought a significant response.   (If you haven't had a chance to read it, please do so before you read this as the two are complimentary.)  It hit a nerve in a number of readers and I wanted to share some of those thoughts with you as I believe them to be quite pertinent.

They say that experience is the best teacher. And, we can learn from the experiences of others.  The point being made that was that if you're going to get into trouble in a race, it would most likely be in the swim and several strategies were discussed in the "forewarned is forearmed" school of thought.

1) You can't arrive at a race sit too early.  If body marking, transition set up and warm ups are complete, take the time to just sit. Sit and relax, visualize the upcoming event and the possibilities you've planned for...and maybe some you haven't.  When they call your wave, you'll be in total control.

2) Be completely comfortable in your wet suit.  I heard from one gal would said that she wore it at home, "Cooking dinner, watching TV, etc." for a little while every night for the couple weeks before the race so she was completely comfortable in it.  Like an old comfortable pair of shoes.  She also found a flaw in the zipper that if not  discovered until race day, would have ruined the event for her.  As it was, she got it easily repaired.

3) Know the course cold.  Water entry/exit, everything.  Walk through it on race morning after you have everything else set up. If you've followed #1, you'll have the time to do it in an unhurried fashion. This would seem obvious to me but potentially not to all.

4)  This 4th one came from a physician in Canada who took the time (thanks) to make an extensive blog comment (to Death in Triathlon) that applies to all of us.  I'm going to reproduce it below in it's entirety as I feel there's something here for each of us;

Thanks for adding to an important dialogue. As a triathlon physician, a triathlete, and a race director of an open water swim, I feel I can add a few points to this:

From the athletes' perspective, get in the water BEFORE the race starts if possible, to let your wetsuit fill with water and for you to warm it up. That will lessen the shock of the cool water. 
Minimize how much you eat in the hour or two before you start swimming. If you need to eat before a race, get up earlier to eat. Digestion and exercise are competing demands that have negative consequences that will stress you especially while swimming. 
Caffeine is known to enhance performance, but for those that are sensitive to it, it may cause tachycardia, and gut symptoms that may not be helpful in the swim. Ask yourself if you really need it to race.
Practice swimming in all conditions, including wind and chop and cool water. Athletes will often go home when they see these conditions while training, but you can't do that on race day. Get comfortable swimming in chop.
Practice, if you can, in a safe and friendly environment ( a pool or shallow water) with friends, "combat swims". Most swimmers don't mean to run into you, but the bigger the race, the more inevitable it becomes. 
Develop some strategies to avoid swimmers who keep running into you, without getting mad, which only increases your adrenaline further.
Seed yourself appropriately!

For race directors, organizing a race with several smaller waves, each with boat support, are clearly safer than larger ones.
Consider even starting without a loud starting gun (which also stirs up too much adrenalin), instead having everyone's race begin by crossing a timing mat (chip time, as they call it in big marathon races).
Avoid 90 or 180 turns in a swim race if possible. Tight turns cause too much congestion. Try to round the turns where possible.
Give swimmers an opportunity to warm up with some easy swimming.
Make it possible to separate good swimmers from beginners, whether by wave or cap color.

In short, with just a little pre-race planning, you can ensure both safety as well as success.

.....and take you to your special island.  (Billy Joel)

Thursday, January 26, 2012

Death in Triathlons, This is Important

"No man is entirely worthless, he can always serve as a bad example."                                    Brian Oldfield, smoking cigarettes between his shot puts.

I gave my second in a series of talks to the Annual Meeting of Training Bible Coaching this past weekend.  One of the topics was The Female Athlete which was presented here late last year as a series of 3 posts.  It was also time to review what's known about those who very unfortunately perish in races as well as what's not known in a lecture titled Death in Triathlons.

This is a serious topic that, in my opinion, coaches and athletes should include as part of their pre-season discussions.  As the musical group Kingston Trio used to sing, "This could happen to you."

While I won't review the entire lecture, suffice it to say that in the early 2000's there was explosive growth in triathlon accompanied by two unfortunate races, Ironman Utah 2002 and two weeks later the Japanese Strongman, where athlete deaths occurred in both.  One outcome of these tragedies was greater alertness of the entire triathlon community, perhaps too high initially where, without a great deal of provocation, the swim portion of several 2003 races was canceled creating duathlons.  That said, it made athletes and race directors respectful and cognizant of weather conditions, and for safer races.   This is no truer than for the novice racer.  In October 2008 Inside Triathlon had an excellent piece noting three deaths the previous July (in three separate races) and 23 deaths in the previous four years, 18 of which occurred in the swim.   Even with expert autopsies, the exact causes of these deaths were not always apparent.  This can be true on land as well.  Consider the unfortunate death of marathoner Ryan Shea in the Olympic trials in Central Park in 2008 who passed away at the 5.5 mile mark of the race.  Ryan was known to have had an "enlarged heart" (but not the so-called hypertrophic cardiomyopathy that sadly claims the lives a few young athletes each year).  This diagnosis was made many years before his demise, prior in fact to him winning 11 HS State titles, the NCAA 10,000 meter championship, etc.  According to the NY Times, the Medical Examiner felt Ryan's death was due to an irregular heartbeat.

Back to triathlon swimming.  Fast forward to a Washington Post article by David Brown 11/14/2011, "Deaths in triathlons may not be so mysterious; panic attacks may be to blame," who put forth the idea that panic attacks and anxiety may be playing a bigger role than previously credited.  In my opinion, this is very real. While experience is an excellent teacher, consider the following: how many times per year do we wear wet suits?  Are they a bit constricting and perhaps claustrophobia-inducing? Are our swimming mechanics different in a wet suit in the open water than in a Speedo in the pool?  Although many of us are pretty good pool swimmers, the difference between controlled lap lanes at 84 degrees and the mayhem of a group start in sub 70 water is substantial.  Can everyone maintain control when they are being crawled over, kicked, goggles knocked askew, etc. I think at least a part of our solution may lie here.

My recommendation is to think about all this pre-race and have options.  If you are coached, have the discussion with your coach.

  1. Try to swim at least the beginning of the course, in your wet suit, the day before the event so that at least one unknown is eliminated.  It can be a real confidence builder.
  2. If there's any doubt in your mind, when the gun goes off, wait 10 seconds for your own piece of the ocean or lake. You'll get cleaner, less turbulent water anyway and make up some of the difference.
  3. Swim a little wide around the buoys to avoid congestion.
  4. If you get at all anxious, flip over on your back, take some time and deep breaths until you feel like you're in control again.  And if you don't regain that sense of command, screw it!! Side stroke back to the start, to dry land, and save your efforts for another day.
  5. Most importantly, if the conditions look like they exceed your level of comfort, have the fortitude, as Betty Ford taught us, to "Just Say No," and save your efforts for another day.  I was in a race in Virginia Beach a few years ago which included a 1K ocean swim parallel to the shore.  The waves were pretty big that day and as my friend and I walked to the race start, we followed three (non-wet suited) young ladies obviously new to the sport.  As they approached the swim start line, they looked at the  somewhat angry ocean, at each other, and back at the ocean - and left!  They never started the race as they agreed the conditions were beyond their skill level.  It's OK for you to do the same.  It's called good head work.
Taped to the aero bars of one racer's bike in Kona - nice!

Photo #1 from Tri Madness

Sunday, January 22, 2012

Winter Running Rules

"But it's a five o'clock world when the whistle blows, no one owns a piece of my time."                                              The Vogues

Thinking about going for a run after work?  Me too.  Many of the posts on this blog are pointed toward safety.  Visible clothing and possibly a strobe in these shortened daylight hours, being especially prepared if you have Raynaud's, etc.  On 12/18/2011 I did a piece titled "Frostbite Avoidance, Dressing for Winter Training" which serves as a good base for this topic if you haven't read it yet.

  1. Prior to your run, practice dynamic not static stretching techniques like light skips, bounding, high knees, butt kicks and back pedals.  Save the static stretch for after you've completed your run.
  2. Note importance of core exercises (and sledding) in the snow.

  3. Dress properly....not too much and not too little.  Your body will warm up 10 - 15 degrees above the air temperature.  Embrace, don't fight whatever weather conditions you face. It was 20 degrees, in the dark, when we started our work out this morning with 44 folks, and shedding clothing became the rule of the day.
  4. Deliberately start with a very slow jog or fast walk for your first half mile and always make your first mile the slowest of your run.  Your last half mile should also be run at a slower pace as this helps with your post run recovery.
  5. Keep your stride length short and remember the suggested pacing of 30 Rt. foot strikes per 20 seconds (or 22/15 secs.)
  6. Maintain a "conversational pace," aerobic heart rate.  If you can hear yourself breathing, you're probably running too fast.
  7. Follow your RPE, rate of perceived exertion by maintaining the same effort, not the same pace, through out the varying terrain of your work out.  Obviously this is particularly important running up hill.
  8. You longest run of the week should not be greater than the sum of the other runs.  
  9. Take it easy on the down hills, shorter stride length is the key.
  10. Say out of the "gutter" (side of the road) by trying to maintain balanced stride lengths.
  11. Try to get something nutritional into your system within 20-30 minutes of completing your run as recommended by Triathlete Magazine author Matt Fitzgerald in his book Racing Weight.  It could be a banana, Clif-bar type product and a sports energy drink or chocolate milk.  Yes, chocolate milk.
  12. Make sure you record the stats of the run in your journal including what works and what's not working.
  13. Drink at least 60 ounces of hydrating fluids/ day....sodas don't count.
  14. Make sit ups and push ups, which work on core strength, a part of your daily routine and use Pilates and Yoga as your "cross training."
  15. Get adequate sleep - I know this is hard for most! The more you exercise the more rest you will need.
  16. Listen to your body's communication signals. Feeling fatigued?  Then back off.  Have a new ache or pain (knee, shin, hip, ankle, Achilles?) Then talk it out with your coach ASAP.  
But when you're heading out for that five o'clock run remember that upon hearing Joe Jacobi of the Washington Redskins say: "I'd run over my own mother to win the Super Bowl," Matt Millen of the Raiders said, "To win the Super Bowl, I'd run over Joe's mom, too."
Some say that winter running is the best there is.  If you follow these simple rules, I'm sure you'll agree.

Thanks to Mark Lorenzoni, author of the above, and his desire to "spread the word." 
Thanks to NIkki of SEAL Team PT for photo #2. 

Sunday, January 15, 2012

Distance Per Stroke, Decreasing Shoulder Stress, Increasing Speed

"And I'll take every moment and live it out loud...."
                                                Time of My Life, David Cook

Surf boards form a channel for the final 2.4 mile swimmer - who did NOT make the cut off!
January, a perfect time to become a better swimmer.

Although we aim to swim well, within our best skill levels, our race day abilities rest on successful training and injury avoidance.  Few triathletes label the swim as their strong suit (I am one of them) but if a tool exists that would both increase their speed in the water while diminishing their energy expended, it might be worth examining. Olympic level swimmers like Michael Phelps, Dara Torres and Natalie Coughlin ( practice techniques to decrease their stroke count per 25 yards, in other words the distance they get from each stroke. If you choose to adopt this technique, you'll see faster times, a more efficient stroke, and energy saved for the latter parts of the triathlon.  (A couple of years ago I was sitting in the stands of the University pool watching a woman do her swim work out.  For some reason, from my perspective she looked awkward, ungainly and I remember not thinking much of her abilities - until I counted her strokes. 14 strokes/25 yards and then her times, just over a minute/100 yards continuously.   Obviously, I changed my mind about her right quickly.)

Famed Swim Coach Emmet Hines, in a 1993 article put it this way, "Assume you are 6 ft. tall and have approximately a 5 ft. effective wing span measured wrist to wrist. Swimming or pulling with 100% stroke distance efficiency, you should be able to travel approximately 5 ft. with each freestyle arm stroke (10 ft. for each right-left stroke cycle). In a 25 yd. pool you push off from the wall and begin your first arm stroke at approximately the backstroke flags, leaving 20 yds. (or 60 feet) to swim. If you start counting each hand hit as you stroke down the lane at 100% efficiency you should contact the far wall after 12 strokes (or 6 stroke cycles). If you are 5 ft. tall this would work out to more like 14 strokes per length (6'6" about 11 strokes, 5'6" about 13 strokes*)." It's pretty unlikely that any of us would achieve a stroke rate of 12, but if we can use this example to decrease our current rate by 2-4 strokes, we win!

Most athletes understand the principles of increased distance per stroke, DPS, but few have the patience to actually add it to their repertoire and reap it's benefits.  It's like the NBA where Rick Barry notes his ability to increase the foul shooting percentages of players by teaching them the under handed shot but few if any take him up on the offer.  I suppose they're satisfied with shooting 60% from the charity stripe.  To adopt any new stroke change requires motivation and patience, some times in short supply with type "A" triathletes.

To start the learning process, swim 25 yards in a pool and count the number of strokes you take with your right hand.  Double it.  This is your stroke count.  I'd suggest you try this 6 or 8 times until you get what you think is an accurate assessment of your current stroke count.  Many suggest doing this at warm up pace and then again at "race pace."
    Then on the next 25, take one less stroke by working on a lowered head position, neutral body, and concentrating on just a little more efficiency with the kick.  You won't descend from 23 stokes per lap to  15 the first day but you can go to 21 or 22. You are not trying for speed here, only stroke count.

Warming up before race day, getting used to the salty water taste.

Maintaining your DPS, try a set of 6 X 50 on 2:00 or 2:15, whatever it takes to be rested, concentrating on stroke count. Be prepared to glide between strokes. It's easy to practice during warm up drills.  This is all predicated on the understanding that each of us has some happy medium, a stroke rate below which we actually slow down.   This is only January so if you can do a portion of every swim work out between now and the summer race season working on your DPS, imagine how much you might improve.  Go for it!

*USMS News, 4/1/1993

Sunday, January 8, 2012

Rotator Cuff Tears

"What about now, what about today?"  Daughtry

Not all triathletes succeed

There can be stumbling blocks in our path to success.  One of these can be a rotator cuff tear.  It's quite frequently the cause of one's shoulder pain although there's a long list of etiologies here that would include the joint, any of the muscles or tendons which surround it, the neck and nerves which emanate from it, the heart or gall bladder, infection and tumor to name a few.  Frequently we'll see someone grasp their painful shoulder noting the presence of "rheumatism." They couldn't be further from the truth.  And, we're not talking about a separated shoulder here (you can read about that in the 9/11/2011 blog).  Assuming these other potentials have been ruled out by your physician, and the diagnosis of rotator cuff disease is made, where do you go?

First, the basics - the rotator cuff is made up of of four of the smaller muscles in the shoulder and it serves many functions.  Primarily, the cuff musculature holds the humeral head in the socket so that the larger muscles like the deltoid can provide the mechanical force for work.

This diagram shows the cuff made up of supraspinatus, infraspinatus, subscapularis and teres minor muscles.  Tears usually occur where the cuff inserts into the upper humerus and although some occur acutely(motor vehicle accident, fall which possibly dislocates the shoulder too), the majority occur over time, slowly, beginning with fraying of the upper surface of the cuff.  We often divide tears in to partial or full thickness.  In a full thickness tear, there's actually a hole in it.  And, as a degenerative process, there may be a tear on the opposite side too, even if it doesn't hurt.  Symptoms classically include:
  • night time pain
  • a sense of weakness with use
  • pain with lifting or raising the arm
  • crepitus, cracking, a noisy shoulder

Initially you might only feel mild pain with a long swim or putting your bike up on a rack but over time it seems to hurt with more minor actions and at night.  When you see your physician, he/she takes a thorough history (to exclude any of the other causes of shoulder pain as listed above) and performs a careful exam, occasionally including x-rays.  If a cuff tear is suspected an MRI or ultrasound may assist making the correct diagnosis.  Please read this as not everyone needs an expensive study like an MRI.

If a tear is diagnosed,  it doesn't necessarily mean surgery.  About half of the time, non-surgical means such as rest, activity modifications, physical therapy or a home strengthening plan, even a cortisone injection or two (see blog 2/5/2011 for injection details) may be all that's needed.  This is especially true for the lower demand (read non triathlete) patient but it does little to preserve or increase the lost strength of the arm.  And, a portion of these tears that are not fixed will increase with time. (Now he's talking about what I need to know.

The Orthopedic Surgeon can recommend that you have your tear fixed if it's a large tear at initial diagnosis, the symptoms have been present for 6 - 12 months, you have weakness or function loss, etc.  The procedure is usually done as an outpatient under anesthesia, and can sometimes be completed arthroscopically with no formal incision other than the small punctures to get the scope and related equipment into the joint. A somewhat more difficult repair can be done thru a "mini-open" process where a 3 cm incision over the side of the shoulder is all that's needed. Much of the operation is still done with a scope.

Lastly, if you have a very large tear, you may still require formal open surgery to re-attach the tendon to the bone.  These procedures take approximately two hours and you'll be placed in a sling or some type of brace to support the arm post op.  The immediate goal is pain control for the first 3 - 5 days post op using narcotics, ice therapy and even anti-inflammatory drugs. Sleeping can be a real challenge for the first week or more - it's hard to lay down with the sling on - and sleeping in a recliner can be more effective. 

Your return of motion and strength will be guided by your physical therapist but plan on 4 - 6 months to fully recover, longer in overhead throwing athletes, and return to sport.  Remember, each person and each tear is individualized so it would be unwise to compare your situation to that of one of your training partners.  Good luck!

Images 2 and 3, American Academy of Orthopedic Surgeons

Sunday, January 1, 2012

Knee Pain, The A, B, C's

"As we live, a life of ease, every one of us, has all we need, sky of blue, sea of green...."      The Beatles, Yellow Submarine

It's been reported that by 2013, one in six visits to the doctor will be for knee pain.  Perhaps you've already been one of them. I suggest this because one of my most frequent questions will be from an athlete who's failed conservative care and is preparing for an operation.  Hardly a week goes without correspondence coming from someone preparing for an arthroscopy, microfracture, joint replacement, etc. and they all want to know about the probability of being able to train and race afterwards.  "When can I run?"  I submitted a piece to Inside Triathlon this week discussing the events surrounding surgery that will hopefully benefit the Tri community.

Knee Pain

So let's say you have knee pain. Without going through every possibility, what are the 10 most frequent causes of pain in the triathletes knee?

Arthritis  Realize it or not, wear and tear on the joint is one of the most common sources of pain. This can be cartilage deterioration on the back of the knee cap, so called CMP or chondromalacia patella, or in those who've had a portion of a meniscus removed in the past who are experiencing a change in load sharing in that part of the knee. The third group would be our more "Seasoned triathletes."*

Bursitis  Think of bursitis as a (hopefully) transient problem with the joint.  Directly in the front of knee, the pre-patellar bursa when inflamed is called house maid's knee and commonly seen by those who spend a good deal of time kneeling.  Pain over the upper, inner reaches of the tibia can come from the pes anserine bursa, the insertion of the hamstring tendons which flex and rotate the joint.

Cartilage Tears  The knee cartilage, or meniscus, one on the inside (medial) and one on the outside (lateral) of knee are formed of so-called fibrocartilage.  They assist in stabilization of the joint as well as the transfer of stress across the joint.  The mechanism of injury frequently involves some type of twisting or rotation of the joint, not lots of pedaling or running.  The joint can swell, crack or pop, and even buckle or give way.  Only occasionally will they heal by themselves.

Iliotibial Band Friction Syndrome  A very common problem, particularly in runners.  The athlete complains of pain on the outside of the knee, above the joint, as a wide band of tissue travels across a bony prominence. It's frequently worse with exercise and worse with those who increase their training at too rapid a rate.

Baker's Cyst  These are a sense of fullness or swelling directly over the back of the knee joint.  Some can be as large as an orange but most are less impressive.  Although they can occur spontaneously, the most common etiology is secondary to some other problem coming from inside the joint such as a meniscus tear, arthritis, etc.

Patellar Tendinitis  Just below the knee cap lies the large patellar tendon.  Another of the overuse injuries is patellar tendinitis with symptomatic pain here. A sub category is called Jumper's Knee.  Just as the Achilles is subject to micro tearing, so too can this tendon tear in this manner. Going down hill or down stairs can be quite painful as can pressing on the tendon.  I've seen some produce a cracking or creaking noise which can be very worrisome to the owner.  Only very infrequently will they rupture.

Ligament Tear  Three of the more common major ligament tears include the ACL, anterior cruciate ligament, MCL, medial collateral ligament (think Tom Brady or Adrian Peterson - they tore both) and the PCL, the posterior cruciate ligament.  These violent tears would result from a major twisting or wrenching of the knee.  Although the two examples I listed here were NFL players, the most common cause is simply the athlete who slips and twists the limb.  Really, all by him or herself!  These can be not only season-ending injuries but, in some cases, career-ending!  They're a big deal.

Dislocation of the Knee Cap  Unless there's been prior joint surgery, the patella, when it dislocates, does so laterally.  When the leg is straightened back out, the knee cap will spontaneously relocate but the probability of recurrence is considerable.  Also, it's not uncommon when the dislocated knee cap pops back in for damage to occur to the back of it.  More common than an actual dislocation is a joint in which the knee cap "subluxes" or partially dislocates.  It can be malaligned as well.

Osteochondritis Dissecans  OCD is seen usually in the adolescent population and is an incomplete fusion of a small portion of the bone.  Some can be asymptomatic.

Osgood Schlatter  Another issue seen in the growing knee which presents with pain over the front of the tibia and enlarging bony attachment of patellar tendon into the tibia.  It's usually a self limited procedure.

We've talked before many times about when to seek help from your care giver.  If the pain occurs at rest or wakes you from sleep, if it makes you limp altering your form possibly setting you up for yet another problem, calf or joint swelling, or anything that's prolonged more than a few days or worries you. 

I wish you the Happiest of 2012 and a hopefully successful and injury free season.

*Thanks to Bob Vigorito, race director of Eagleman Ironman 70.3.  This is the term he uses to describe the over 50 wave as he escorts them into the water to start the event.  Nice man.