Sunday, April 28, 2013

Your Top Ten Mistakes in the First Triathlon of the Season

"We are what we repeatedly do. Excellence then is not an act but a habit."        Old Chinese saying


Ten Miler and MEPS 010


 For those of us lucky enough to live in climates where Spring is in full bloom, or looking like it will get there soon, we need to remember that there are those like northern Wisconsin who "still have three and a half feet of snow on the ground and 20 inches of ice on the lake" as I was told on Weds.  Hurry Spring to you, too.


I've written many pieces on how running success and running safety go hand in hand.  It's been frequently noted that one of the "arrows in your quiver" is your local running shoe store where, when you talk to the old hands, they've seen and helped runners with just about any running related issue imaginable.  I've also been quoted as saying that they know more than many physicians in this realm.

Our local first really big (about 2500 competitors) road race, The Ten Miler, was just run and our runner's expert, Mark Lorenzoni, wrote the following.  It's so good, that I've published it in it's entirety. Even if your race isn't one of ten miles, this will benefit you for sure.  Running leads to many triathlon injuries so at least a couple of these points are talking to all of us.


Speed Bumps: The Top Ten Mistakes made by Ten Miler Racers

1. Storing too much hay in the barn the weekend prior to the race.

Most experts recommend a day/mile recovery before shifting your engine into high gear. If you want to race feeling fully recovered then run nothing further than seven miles the weekend prior to race day.

2. Not resting your piggie wiggies enough the day before the race. 

The smoking gun for "dead legs" on race day can often be directly traced to how much time you spent on your feet the day before. Especially beware of hanging out on concrete-based floors!

3. No race day navigational chart. 

One of the most dangerous pre-race phrases is "I'm simply going to run how I feel... I'm just trying to finish." Set your game plan prior to race day and visualize it. A good rule of thumb for those racing their first 10-miler is to cruise at about 20-40 sec/mile faster than what your normal long run base has been. Still would rather "race how you feel"? Well, that's exactly what's going to happen: you'll run fast at the beginning, when you're feeling great, and slow down to a crawl towards the end, when you're feeling dead tired!

4. Not enough high octane in the tank.

Improper hydration, especially if the temp or humidity is unseasonably high, can lead you down a dangerous road. Sip, not gulp, plenty of hydrating fluids the day before and morning of race. If it's warm and/or humid on race morning, make sure to take a few sips (3-5 oz) at every aid station, which are spaced 2 miles apart throughout the course. Don't wait till you're thirsty to have your 1st drink. Drink early and often!

5. Last minute cramming. 

Taking a little extra time to pick up your race packet the night before can afford you some quiet time to digest the important info included and avoid the stress of standing in long lines the morning of the race. Packet includes shirt, race #, shoe chip and important race day instructions, which are obviously useless to you if you don't pick them up until a few minutes before the start!

6. Wearing too much to the dance. 

Often the C10 lands on one of those much dreaded hot and humid early spring days and because it's often chilly at the start, many novices pile on too much clothing, forgetting the act of running warms you up. Exercise physiologists say expect to feel 15 degrees warmer than actual air temp. If you feel chilled prior to starting, layer lightweight clothes and peel it off along the course.

7. Unveiling the "new you" on race day. 

Race morning is NOT the time for experimenting... therefore no new shoes, socks, sports bras, gels, sports drinks, shirts or anything else you're tempted to add to your race experience. Any experimenting should be done during your practice long runs prior to race day!

8. Emulating the hare instead of the tortoise.

 No other rule is broken more than this mother of all mistakes and the results are always ugly! Start off your race experience on the right foot by lining up behind your predicted pace group and taking it easy for the first 2 miles. Resist the temptation and make the 1st mile your slowest, you will surely be rewarded with an excellent finish!

9. Not going for "the gold" on the downhills.Most folks moan about the uphills of the 10 Miler course, but few talk about the steep downhills along the way. There's no better way to compliment your own race performance and to make up for the tough uphills then to let yourself go by opening up your stride and leaning into the downhills. Caution: Don't practice this until race day because your knees will rebel!

10. Not knowing when to take a vacation. Most injuries associated with racing the 10 Miler occur in the weeks AFTER the race, when many folks, instead of throwing the engine into low gear, continue to pound the pavement because they're "motivated and feeling so good." Don't run more than 4 miles for a given run in the 2-3 wks after race day. This not only affords your some physical recovery, but also allows for a break in the mental intensity of training for a big race. Spend this special post-race time celebrating your accomplishments. After all, don't you deserve it?!


A corollary to number 10 involves the general category of rest. Yep, rest a four letter word as some will tell you.  Many of us who gravitate to running or triathlon are so-called type "A" personalities who'd rather please their log book than do what makes sense over the long haul. "That is so true," notes Virginia based fitness guru Jay Casey .  "I see client after client who, despite knee pain, an achy Achilles or no sleep when the baby kept her up all night, pushed through a hard work out anyway.  When I ask them if this is logical, they only answer weakly, 'Well, that's what the coach had planned for me.'"  And although this particular piece is directed toward running, I'm sure you can see where the take home lessons apply to swimming and biking, triathlon in general.

Casey goes on to encourage athletes to always think big picture, what's their goal for next month if not 6 months from now.  "Making the best decision today seems easier when placed in that context," he says.


It might not be a bad idea to print this off, put it in your log book, and maybe remind yourself from time to time of your long term goals and how well you're doing staying on track toward them.  Is it the same as doing your best to avoid injury?  Maybe.  As it says above, who knows, excellence can be habit forming.

Wishing you the best of successes in the 2013 racing season - JP

Wednesday, April 24, 2013

The Gallop Swim Stroke: Is it Faster? Should You Consider It?

You're looking to improve your swim speed and have seen the elite swimmers with a freestyle stroke different than the one you use, a galloping or loping style.  Is it worth  learning how to perform this swimming method and adding it to your armamentarium?*  


There's a nice video from a couple years ago by Gary Hall, Sr. demonstrating the hip driven freestyle, the shoulder driven freestyle and this so-called combination of both the loping style.  This is where the swimmer breathes only to one side using the hip driven technique on the breathing side and the shoulder driven technique on the non-breathing side.  A clear example of this stroke is seen by Michael Phelps in this 2009 FINA World Championship, a rare race where he does not win.

A comparison of the three types is discussed and demonstrated by Hall here .

For those of who like a more simplified explanation where they can think it through, a piece from 2008 is one than many still refer to.

Some athletes, most famously Jason Lezak, will use the loping technique for the first 50 of a 100 m event, theoretically preserving energy with a lower turnover at the start, then revert to one of the traditional strokes to bring it home.

But we haven't answered the initial question: is it for you?


I posed this to University of Virginia  swim coach Doak Finch, former holder of 5 school records.  The UVA program perennially produces the men's and women's ACC champions so I respect the opinion of team leadership.

Coach Finch said that the first requirement for this stroke was a "monster kick."  Using the supposition that we travel more quickly under water than at the surface, this kick allows a slower stroke rate  and longer glide while maintaining propulsive power.  In his mind, it seems best suited to the middle distance swimmer, 200m, 400m, etc.  He also pointed out when a true swimmer has completed his/her event, they can go talk to the coach for a while sipping water.  But the triathlete on the other hand has a date with a bike as the next order of the day.  Thus, for many who race triathlon, preserving ones legs for subsequent biking and running may be a higher priority than learning this particular swim stroke.

That said, I've always been a big believer in practicing and learning new things which may have some cross over to your current methods.  The loping stroke, as one example, forces the athlete to take a very quick breath.  This can be quite handy in open water swimming with a slight chop.  The more quickly you get the air in, the lower the chances of inhaling the next wave also.

In short, I think that racing triathlon with this technique may be wise for a small percent of triathletes but that the majority would be best served by exiting the water with fairly fresh legs having employed a two beat kick, looking to kick butt on the event's bike or run leg.

If you were to pose this question to Gary Hall, Sr. he'd tell you that it's too late to significantly strengthen that kick and a shoulder driven free style is your best bet.

 *Thanks to Coach Emily

Sunday, April 21, 2013

Triathlon Racing/Training, Are You in Pain?

Treadmill Driven Computer

We need to invent a treadmill with a laptop built into it.  If you stop walking, the Internet stops working.  You'd really have to be walking on it, not straddling the belt like some do at the gym.

Think about how much weight you could lose...although with the bouncing you'd need Spell check a whole lot more.  And, if you wanted to download anything, you'd have to run.  The faster you ran, the faster the download*.  Just make sure you're fresh if you want to download the whole Dark Knight Trilogy!


Interesting Follow Up

I took this picture in Kona a while back of an age grouper named Brian's creative helmet.  I was fairly certain (incorrectly) that following bike check in the afternoon before the race, over night the inspectors had removed the "fin" in the interest of bike safety.  Now, almost 1.5 years later, this arrived yesterday:

Dear Doctor Post - That is awesome! I was looking at pics of the Ironman and came across this. The
shark fin wasn't removed before the race! I did the entire 112 miles with it on
and man was my neck sore from the cross winds! I was raising money for the Shark
Savers Organization to get the word out about shark conservation. More than 100
million sharks are killed each year (mostly just for their fins) and it is
messing up entire ecosystems of the ocean! So tell your friends that sharks are
friends, not monsters!

Thanks to Brian Yannutz and good luck this season!


Race Limiters - Are you in pain?

Not long ago, in my capacity as Medical Director of Training Bible, I received a question from a woman who had physical pain as a limiter to improving cycling speed. She was very dedicated to triathlon, so much so that despite significant low back pain, in order to continue competing she'd undergone multiple medical evaluations and treatments over the years, even to the point of back surgery. Pain was still a problem! Below is a summary of the advice I gave her as many of us find ourselves in a similar boat, particularly as we age and just can't do what we've always done in the past:

 "You present a particularly difficult, but not uncommon situation: a strong desire to participate limited by physical constraint. A constraint that were it fixable it would have been done by now.

 As Inspector Harry Callahan (Clint Eastwood) famously stated in the movie Magnum Force, 'A man's got to know his limitations." We all have limitations. I've had many patients over the years address, define, and deal with musculoskeletal issues by doing to following:

1) honestly assess your potential given the current restrictions,

2) modify whatever it takes involving your bike, your stroke, etc.,

3) then train/race within your personal parameters.

We all know folks who used to run marathons or used to do 1/2 Ironman racing, but like you, are now physically limited. Before paying a couple hundred bucks for a bike fit, we have our patients keep a very specific log for a month or two since they know their body better than any doctor or cycling specialist. They  write down specifically what hurts, and then make a change, possibly with the local bike shop guy whom I've come to know and trust. Seat up, seat down, bars higher, etc. Keep it for a week and then after their ride, before they even go in the house or take off their cleats, write down exactly what they felt. Same? Different? Better? Worse? WHERE? Now, make another change with the bike guy and do this again.

Most notably, just because a friend has a certain aero position doesn't mean you need to. (In fact, with your back, maybe your aero bars belong in the closet.) So frequently what may feel comfortable on a trainer during a bike fit does not 30 minutes down the road. Look at Chris McCormack's aero position, somewhat higher and seemingly less aero than others at the top who you might see in a tri magazine. But, it's comfortable for him and from it he can generate his maximal sustainable power.

What works for you may be drastically different from others. Also, two ibuprofen (Aleve, NSAID of choice) before a ride has become a good friend to many (if ok with their doc.)

Lastly, it took me a long time to figure out that most days when I enter the local triathlons, I'm only racing against myself and it really doesn't matter what others in my age group, others from my town, etc. do. 

I have always appreciated this quote from Cheryl Hart:

"The goal must be based on one's personal standard of excellence (rather than a comparison with others), self-determined, specific and measurable.  If the answer is firmly fixed in your mind prior to a competition, this will serve as motivational fuel.  This should include a vivid picture of how success will look and feel, including the meaning attached."

It's what I did that's most important to me. I cherish the friends I have in the sport more than the sport itself.  So, work with you local professionals to maximize your individual skills and abilities and simply "Be all you can be!"

Hopefully, this will help you follow the path to personal success."

 Perhaps there's something here that can help us all.



 *concept from

Thursday, April 18, 2013

Got Athletes Slow Resting Pulse? Is it Dangerous?

 Athletic bradycardia, the slowed pulse and modest enlargement of the heart is frequently observed in endurance athletes.  And for most of us it's an asymptomatic state resulting from prolonged endurance sport.  But not everything that occurs to the triathletes heart is benign.














This somewhat surprising photo was taken on the Kona pier, 100' from the starting line of Ironman Triathlon World Championship in Kailua-Kona, Hawaii. What action would you take upon sighting this warning before your planned swim? I, unfortunately, saw it after my planned swim!

Issues of the Heart

My 24 year old son Chris has an occasional resting heart rate of 38. How did I learn this you might ask? Well, 3 months after receiving his Virginia drivers license, he flipped our '88 Volvo station wagon on a Saturday morning coming home from track practice. 

Eventually cleared of major injury, the interns nervously watched his heart rate monitor at 38 beats per minute, defibrillator at the ready, even though instructed by the attending physician that this is just his resting pulse, not totally unexpected in fit runner. Miguel Indurain, five time winner of the Tour de France, had a resting pulse of 38 (and a VO2 max of 88 compared to Lance Armstrong's 82.)

Some of us use heart rate monitors or take our pulse before arising to augment our training, but mostly we don't think about our hearts.

Neither did my friend Bob Scott, Ironman Hawaii course record holder for the last 10 years. Just like you and me, he's a triathlete.  Invincible, never gets sick, illness is for the other guy, the non-triathletes! That's how he thinks as I would predict do a numbers you.  This worked well for him until one day he just didn't feel right, very mild chest distress, not real pain, just a little ache.  He wonders if he should seek medical attention.

So, being the triathlete he is, he rode his bike to his doctors, and his EKG was positive for on going myocardial infarction.  A heart attack in progress.  Long story short, catheterization and stint placement followed, and Bob went on to win the age group again (yawn) and set another Kona course record. Moral, be like Bob, listen to your heart.

Listen to your body and if you have something unusual, a pain that's worsening rather than improving, stop and get it checked out. How many stress fractures could have been avoided, races missed due to an an injury, if we had only listened to our bodies instead of a demanding training log? 

Triathletes are a driven bunch, but if the Kona course record holder can listen to his body, you can too.

Thursday, April 11, 2013

Race Pace Advice for First Time IM Folks

MARATHON MAN by Marc Singer

In July, 2010, Kyle Strode, a forty-six year-old chemistry professor from Helena, Montana, ran the Missoula Marathon. Completing the 26.2-mile distance in two hours and forty-seven minutes, he placed fourth out of thirteen hundred and twenty-two finishers, and won the masters division, for entrants forty and older. Strode is among the most accomplished masters marathoners in Montana.........

This is a great piece from the New Yorker which, if you haven't had the time to read it, you've missed something.  Terribly well written.  Take a look - 


This will be a very short blog.  But I've been where you are and wish that I had gotten this advice.  It will allow you to comfortably and safely end the day smiling as you cross that finish line.

The main thing I want to say to each of you is to take it really slowly for that first part of the swim, the bike and the run.

How slow?


The swim: just start with a relaxed, easy pace, maybe draft off someone you know you can pass, just till things clear out a little, say the first 600m.  Then you'll have a feel for the day, for that specific level of difficulty.  You'll know how your body is reacting to the conditions and be better able to judge your pace.  Remember how easy it is to let that early race adrenalin take over and in two or three hundred meters you're short of breath?  Don't. "Say, this feels pretty easy (adrenaline speaking here folks)" as you mask your sense of perception on how truly difficult the course is initially.

 The bike: it's even harder to back off a little on the first couple miles of the bike.  You get passed by people who look older and slower than you, but if you race the 10- 20 miles too quickly, you will most assuredly struggle with the last 10 - 20 miles! You can always make up "the lost time" (because you rode slower for the first few miles) in the run because you'll have the energy to do so.


The run: lots of strategies for the run.  Let's just say I agree with Bob Babbitt when he preaches to stop at every aid station.  Not necessarily for water - we all know about dilutional hyponatremia don't we? - but for a pretzel, or gummy bear, or piece of fruit.  Get something a little different to break up the monotony of the last part of the day.  Frequently you'll find someone of similar running ability and you two will do most of the 26.2 miles together.  Not only does it make it easier - and harder to quit (Yeah!!) - but you make a friend by giving as much as you get.

Above all else, relax and enjoy the fruits of your labor. And, oh by the way, if it rains
don't fret as it sure beats a hot, spring day for racing fast times!


Lastly, it's not a crime to stop and rest.  You have 17 hours to finish this.  Better to sit at an aid station rehydrating, talking to a volunteer for half an hour before you resume your quest, than getting to the finish line in the sag wagon.


 And when you get to the finish, "You are an Ironman!"


Hawaii 2009 233



Wednesday, April 10, 2013

How To Care For Achilles Tendon Pain


"We run, not because we think it is doing us good, but because we enjoy it and cannot help ourselves." Sir Roger Bannister


Anybody in your running group out with achilles tendon problems? If not now, statistics would point toward the probability in the future as 8-10% of running related issues are achilles in nature. It's the strongest tendon in the body connecting the heel bone (calcaneus) to the calf musculature.



Achilles tendon pain may occur in any athlete, particularly those who may be deconditioned for the chosen activity, runners who do excessive hill work or the old "too much too soon" seen so often in my office. It starts gradually, 4-6 cm above the heel, as pain only with exercise, subsiding with rest. Jumping sports like volleyball can accelerate the process, or when making a significant change to one's training plan. You do have a training plan, right? Even normal running can cause tiny tears in the tendon which heal spontaneously unless the runner over stresses the area with insufficient rest. Rest is KEY to the triathlete! Ultimately, this can lead to a chronic tendinitis picture with nodules in the tendon and in very rare cases, rupture of the tendon. I'll bet that would change one's training.

One more thing: how do you warm up? Do you still do the old wall push ups or put your toes up on the curb?  Don't.  Research has shown that you're better off if you do a dynamic warm up before exercise.  This would include light jogging, maybe skipping, bounding, grapevine run, walking/running backwards, you get the picture, to slowly and actively engage the musculotendinous units you are preparing to stress.


So, you think you might be getting Achilles tendinitis and want to know what to do. Well, before you call the doc, you'd try twice daily cold therapy-watch out for frostbite. Have a friend inspect your legs looking for redness or maybe a cracking feeling coming from the narrowest point of the tendon. It can be pretty dramatic. A heel lift from your local running shoe store can be beneficial-both sides if you've had limb length inequality issues. While there, ask them to look at your shoes and your gait. I have great respect for the local running shoe store owners and they can be an invaluable resource.  Also, many have had success with something called a Strassburg Sock (available from your running shoe store).  This knee high sock, meant to be used while sleeping, has extra material pulling the forefoot up into neutral keeping a slight stretch on the Achilles while you rest.  The first night you may only tolerate it for an hour, second night two hours, etc.  But when worn for a couple weeks they can be of significant benefit.


In summary:

1)  back off your running volume/intensity

2)  think carefully about how you warm up and cool down from running

3)  twice a day icing

4)  think about a Strassburg Sock or similar device

5)  careful stretching after exercise

6)  short term heel lift (work shoes too)

7)  see your local "running shoe guy" then Sports Med Specialist if not getting better quickly.


Image from Google images

Sunday, April 7, 2013

Dog Bites; When Was Your Last Tetanus?

The sword of time will pierce our skins, it doesn't hurt when it begins. Johnny Mandel, Suicide is Painless, M.A.S.H.


 I'm a slower biker than I used to be.  Or maybe the dogs have gotten faster.  Either way, a dogs teeth "pierced my skin" a while back when I was cycling alone, way north of town, out in the country well out of cell phone range.  I stopped, went to the owner's house and reported it to him.  Surprisingly, he offered no apology, no help, no phone call, no nothing.  He just said,"I'll take care of it." Well, that's not good enough for 2013.  I told him I'd notify animal control as soon as I got home. The gent, shirtless in bib overalls and boots, was not happy and made that very clear.  I was actually quite uneasy to tell you the truth as this guy looked like he'd just come in from the still and I was interruptin' things!

 Actually, I pedalled out of sight of the house...and dog...stopped, cleansed the bite with everything that was in my water bottle. I tried to remove as much of the dog's saliva from the wounds as possible.  As soon as I was back in cell phone range, I called my wife, gave her the facts and the dog's house address in case the headlines in the next day's paper included "Biker Shot North of Town" (since the dog's owner made out like it was my fault) so she'd know where to start the search.

 Then it was a short ride to my doctors office where the wound was cleaned and disinfected, tetanus booster administered, and phone call made to animal control.  Although you're concerned about infection, rabies, although unlikely, is more of a concern. I had a bat land on my head once while running - I know, I know - a what?  Although I felt the sharp claws as it landed on my skull cap, the skin wasn't broken and I wasn't bitten.  They are known rabies carriers also.  The difference here is that with the dog, it can be observed for any signs of illness, it's inoculation status is known, as is it's physical location.  None are true with the bat.

 We've been vaccinating dogs in this country for over seventy years and this has reduced the documented cases of rabies to less than 5 annually. Internationally, however, upwards of 50,000 deaths occur each year, probably more. In the U.S. when we think rabies we think skunks, raccoons, foxes, and as mentioned, bats. A bat's bite can be missed, particularly by children. If one is found in the home,particularly with access to sleeping children, it should be caught for later examination.

 In short, although dogs chase us repeatedly, and there are some roads we avoid simply due to canine presence. Should you be bitten:

1) Cleanse the wound as best you can immediately

2) Seek medical evaluation that day

3) Identify the animal and inform local animal control

 As mentioned, very few die from this disease. But if you need the post-exposure rabies prophylaxis (series of shots), they are neither painless nor cheap. In other words, forget about those new aero wheels!

Saturday, April 6, 2013

Picking the Right Surgeon

Just recently I wrote about Picking the Perfect Tri Sports Doc  and it seems to have been well received.  Recently, I received a post by one of the docs from that specifically addresses this issue when looking for a surgeon.  It's short and I thought a good post for a weekend.


How To Choose A Surgeon

By , Guide

Updated January 31, 2012

Choosing the right doctor to perform your surgery is one of the most important decisions you can make. Important considerations include your surgeon's experience and skill, how you work with this doctor, how convenient he/she is located, and if you trust your surgeon.

Here's How:

  1. Are you comfortable talking to your doctor?
    No matter how well qualified your doctor may be, you will not have a good experience if you cannot effectively communicate your concerns, and he can respond adequately. Some patients need more attention, and will need a doctor willing and able to spend time discussing their concerns.


  2. Does he answer all of your questions?
    Do you feel like your doctor answers all your questions? Does he provide information in a way that you understand? Do you feel comfortable asking all of the questions you have? If you call your doctor's office, do they respond in a timely manner?


  3. Does your doctor perform this procedure regularly?
    Ask your doctor how often he performs the surgeryyou are having done. Most often you will not need to find someone who just performs your procedure, but you also don't want the surgeon who has never performed the procedure you are having. Look for a doctor who regularly performs your surgery.


  4. Is your doctor located in a place you can get to?
    It is tempting for some people to fly off to have their surgery done by the "biggest name" in the field. But often the smarter decision is to have a qualified local doctor perform your surgery. It is unusual to have to drive a long distance to find a good surgeon.

    Not only is it more convenient for you, but it can improve your rehabilitation from the surgery. You doctor will be there to guide your rehab, and he can help if you do encounter any problems after surgery.


  5. Have you asked the hard/uncomfortable questions?
    Ask direct questions, rather than hoping not to offend your doctor. It is OK to ask these questions:

    • Do you feel comfortable performing this procedure?

    • What complications have you encountered?

    • Should I see a doctor that is more specialized?

    • Can I get another opinion?

    • Are you board certified?

    If your doctor is hesitant to have you get another opinion, I think they should be avoided. If a doctor is comfortable with his recommendation, he should not worry about you seeing another doctor to confirm that recommendation.