Sunday, December 31, 2017

Winter Outdoor Workouts

Aging Up - "This business about aging is a sore point with me. People seem to think that because you get to a certain age, you should act in a certain manner.  I never did it when I was young, I'll be damned if I'm going to do it when I'm getting older.  If I finish the Ironman, and I'm an Ironman, then I can die happily."    Jimmy Stokes (yes, Ironman Finisher, when interviewed before his first and only iron distance attempt)

 "There are some men (and women) for whom the unattainable has a special attraction.  Usually they are not experts: their ambitions and fantasies are strong enough to brush aside doubts which more cautious men might have. Determination and faith are their strongest weapons. At best such men are regarded as eccentric, at worst, mad..." -Walt Unsworth

In my world, they call such people...Triathletes!

Happy New Year

Yes, You Can Workout Outside in January

This is the time of year when many folks, the non-believers as it were, think we're nuts.  "What, you're going outside to run in this kind of weather, why you must be ______ ."  Fill in the blank with the word you've heard most recently.

We typically spend the Christmas holidays in Chicago and on Christmas Eve, when our 25 year old son went out for a morning run, at 0 as in z-e-r-o degrees, grandma was after him like flies on flypaper. "How about this wool hat? Those gloves couldn't be thick enough.  Would you like this scarf?" Etc.  And she meant well.  But with a little trial and error, you can still run outdoors providing the footing is safe and visibility OK.  In the car vs runner arena, the car still wins.

Toe box blocked from the wind with duct tape.

It's been said that you heat up 10-15 degrees once you get going so that's in your corner and a friend tells me "There's no such thing as bad weather, only bad gear."  Many of us have other issues like Raynauds Syndrome which you can compensate for or a cold/flu which you cannot and should wait till completely healed before out of doors exercise.  I didn't mention that men can get frostbite of their private parts if they don't make allowances for it with their gear.  Take it from the voice of experience, "It hurts big time!" says one local athlete.  Avoidance is best.

Knowing the expected weather as accurately as you can before you open the door is important.  Chemical hand and toe warmers are absolutely essential for some of us and learning the number and make up of your clothing layers makes the next run even easier.  Thinking "would a turtle neck or scarf be important today?  Gloves or mittens? A running waist belt with your cell phone just in case you get in a jam and need some help will probably never be needed, but that one time......

There are those who live in the country who feel it important to give their proposed running route on very cold or snowy days and an approximate time they expect to be back home to a friend or relative.  I can't say that's a bad idea at all.  It might also be a time when you take one more step ensuring your visibility.  How about a bright yellow outer layer or strobe light on the back of your belt.  Since you're already moving, most folks I see use the light in the non-strobe mode.  (Makes me think about those little kids you see at the mall or the airport where every time they take a step there's a flash of light from their shoes.  Wish they had them when I was little.)

Biking is the same but the relative "wind chill" and lack of toe motion need to be accounted for.  Shoe covers, booties, balaclavas, mittens with hand warmers and a reminder that although your thirst drive on cold days is pretty low, you can still get dehydrated.  Water bottles can freeze so a couple bucks in that waist belt for a pit stop at 7-11 for the beverage of your choice usually works.  Lastly, being ultra careful and attendant to your road surface, black ice, and cars that may have difficulty seeing you put you on the offensive for winter.

But if you still have questions, head back to your local running shoe specialty shop.  Probably not your generic sporting goods store.  But you don't buy your running shoes at a sporting goods store anyway.  Most likely the run shoe store sales team is made up of runners - who've had their outdoor exercise for the day already - and would be only too happy to discuss cold hands and feet ,wool socks, mittens, caps and the like.  It's runners talking about running.  Doing the thing they like second best.

So, from the Post family to yours, Happy New Year, happy and successful training, and here's to a (hopefully) injury free 2018.

Wednesday, December 20, 2017

Triathletes Alcohol-Free for January. Want to Participate?

OK folks, here's round three.  Ready for this one?  In January 2015 and 2016 we went alcohol free for the entire month of January.  I wrote it up for IRONMAN last year and it was well received.  So well, in fact, that it seems logical to do it again.  On the Mayo Clinic web site then, the question was posed;

"Does drinking alcohol kill brain cells?"

This was their answer:

Alcohol is a neurotoxin that can disrupt communications of the brain. It also affects functions of brain cells directly and indirectly through different organ dysfunction from alcohol usage and vitamin deficiency. Depending on the area of the brain affected, people can have different symptoms. Abusing alcohol can lead to seizure, stroke and dementia to name just a few conditions. Additionally, alcohol is toxic to a developing brain during pregnancy and can cause birth defects, including developmental disorders with lifelong impact.

Maybe that warning should come on your post-ride Mojito.  Then again, maybe not.  So, do I drink?  Sure. I'll have a glass of wine while cooking dinner some nights, beer on the weekends or at the Tap House watching the Patriots (Aaak, not the Patriots!), a mixed drink or two at a party.   Moderation in all things though.  Some athletes feel that having a dry January is an important first step to their training year.  It gives them one more thing in sport that they have complete control over.To them it makes a statement about commitment to the triathlon lifestyle.  Not unlike a Tweet I put up recently about food which went this way:

Food - a choice. Pleasure if I eat it.  

Pleasure if I don't eat it.  I'll stay true to my core values, I'll feel strong, I'll feel proud, I'll feel I'm doing something meaningful.*

So we're talking about the whole month here, no alcohol. Birthday parties, NFL playoffs, dinner out at a nice restaurant, nada.  Abstinence.  

I know that some athletes make a point of taking 2-3 days per week where they don't imbibe.  I've read that other triathletes report that a month away from alcohol can be a life altering, life improving adventure.  

Believe it on not, I used to smoke. A lot.  I was a Marine Corps helicopter pilot overseas and a primary helicopter instructor for the Navy when I returned from Vietnam.  There's a fair amount of down time there. But I went from 2+ packs of Marlboros a day to zero the day I got accepted to medical school.  Haven't had one since.  And that was a good while ago.  It was certainly life altering for me and my family.  Oh yeah, and I discovered triathlon!

Getting back to this January challenge, I'd suspect that for some of us this won't be easy.  In fact, I'm sure it will be quite a challenge.  For example let's look at Alan, a 40 something year old tech guy who's been in triathlon going on seven years.  He drinks wine with dinner virtually every night and a cocktail or two, maybe 3, over the weekends when dining out. He is well past his college days, thus flaming shots and Jager bombs are ancient history.  So for Alan, taking this January challenge is just part of his long range plan to prepare him for the upcoming racing season. He doesn't see this as detoxing, just a desire to see if he can do it.  What he's learned is that in addition to changing his relationship with alcohol, it changed his life for the better.  And, as an unexpected side effect, he got faster.  Woowee!

So are you curious?  Me too. If it's anything like smoking cessation, the first week will be quite difficult requiring dedication and focus to get on the other side.  But by mid January, Alan says "You feel brighter, cleaner."  You're even in a better mood.  The recipe for success starts with New Years eve and not guzzling everything in sight.  It will make day one easier.  Then on your first day, give away or pour out the beverages you most commonly consume.  You're less likely to slip that way.

One author wrote that when you choose to be dry for the month, a lot of people "including your close friends" will be surprisingly nonsupportive and give you a hard time about it. I'm not sure I accept that.  Maybe it says more about his "friends" than yours or mine.  They're certainly not into triathlon!  He even went so far as recommending in some social situations that you pretend you're on antibiotics and can't drink.  Maybe that's OK for some but I doubt I'd do it.

So, are you with me?  Alan says that after January with no booze that you might just do the same with February.  It's a short month, remember?  So let's liken this to bike inspection at our first triathlon.  You were a little nervous, might have made a mistake or two during the race.  At the end, though, you were all smiles.  I'm thinking come the end of the month you'll be all smiles.  So I'm up for giving it a try.  Are you with me?

The Calorie Myth, Jonathan BailorFre

Sunday, December 10, 2017

Why T2 is the Important One, Especially in Ironman & 70.3 Racing

T2, a time to regroup, assess status and plan for the run

Fresh off the bike, a smile on her face, she's ready to run

Aren't people nice? I had a root canal done about 15 years ago and got a call from the doctor's office telling me that he was doing a study and would I possibly be available for a follow up xray.  Reluctantly, I agreed having been in that position before putting together lectures and am always grateful when patients will go out of their way to help out. When I got to the oral surgeon's office, he mentioned, "I think about you almost every day."

"Right, I believe that!" I replied.  "No, really I do. You taught me that copious irrigation, really wash
ing out surgical wounds the way you ortho guys do, would decrease my infection rate.  And you were right.  So whenever I operate on a patient, I think I'm doing the John Post wash out."

While I thanked him very much, my suggestion was hardly original.  However, if I saved any patients from an infection, then it was more than worth it.

The same thing is true in triathlon.  How often, say before a race, are you just sitting in transition waiting, and you see another athlete with different tires, or a funny transition area set up and you ask her, "say, why do you do that?"  People are very willing to share this information with you.  If fact, they consider it a true compliment that you might wish to emulate them.  So for the remainder of your tri career, every time you set your transition area up like you learned that day, you could tell that athlete, "right, I think about you almost every race."

Slow transition? SlowWhadya mean my transition is slow?
T2 - A Place to Regroup

I've always thought that T1 and T2 served different functions in longer races.  In a sprint, my goal is to have the absolute fastest transitions, both of them, in my age group.  If you've read this blog previously, you know that I preach repeatedly that giving away time in transition is just plain dumb for the serious triathlete.  I enter the race thinking, "how close to 1 minute can I make each of these discipline changes?"  And just like practicing flat tire changing, rehearsing transitions before ever race is just plain smart racing.

But, in a 70.3 (when did the half ironman get that title?  When WTC wanted to corner a larger part of the long distance market. Charlottesville, VA attorney and 2004 Kona finisher Mike Hemenway said "nobody wants to do a half anything. They should call it 70.3.") 
or 140.6 race, the transition areas take on a whole new significance.  Especially at the Iron distance.

In these longer duration contests, frequently larger races, fewer athletes may be aiming for the podium. The remainder just want to finish with a respectable performance and the ability to maintain a near normal gait pattern the next day. T1 after a 1.2 or 2.4 mile swim is the same.  Animated chatter with the volunteers, see how fast can you get into biking mode after a refreshing morning dip with 2500 of your closest friends, and get a heaping dose of sunscreen to head for your waiting 2 wheeled steed.

112 miles later, with dried salt on your bike outfit, a nutrition plan that may or may not have worked as well as planned, maybe a little less enthusiasm or brightness than upon completion of the swim, you enter T2.  For some, like T1, it's continued press. Push, push, push. But for the remainder of us, T2 can be race changing.  It can be a big contributor to race success.

On one hand, especially for first timers, Iron distance racing may now seem a whole lot harder than first imagined last winter filling out the entry on line with one of your kids in your lap.  It's supposed to be.  But with this brief interlude, like the mango sorbet you get between courses to cleanse your palate at a fancy restaurant, you can clear your brain of the past few hours and focus squarely on the upcoming run.  For some it can be almost spiritual as they blast out of T2 teasing the volunteers who are putting even more sunscreen on you pointing toward the transition exit and the first steps of the marathon.  Even those athletes who may have experienced self doubt and possibly considered turning in their chip feel this rejuvenation. Stimulation is a good thing.

This will sound odd, but for those of you who've been around for a good while, you'll remember that T1 in Kona was on the pier and T2 was at the old Kona Surf Hotel some 7 miles to the south in the golfers locker room.  What made this T2 cool was that you were encouraged to take a full shower in the golfers shower room before your run.  Soap on a rope anyone?

Then you remember why you signed up for this crazy adventure, and another athlete pulls up along side you smiling. "Care to run a little?" you're asked. "Why sure," you answer.  The finish line may be a good ways away, but a journey of a thousand miles begins with.....

Image 1, Google Images

Tuesday, December 5, 2017

Posterior Tibial Tendon Disease, A Triathlete's Cure

Posterior Tibial Tendon Induced Ankle Pain

I answer a lot of athlete's questions, many from coach referrals, some from various publications like Joe Friel's Triathlete's Training Bible.  I rarely get follow up, especially follow up that's designed to help other athletes.  But Stacy is different and if you have a PTT problem, read on and you may be able to benefit from her experience.

Dear Dr. Post:

Throughout my years of running (and injuries!), I noticed no one ever seems to come back to message boards or threads to update when things actually go well. I wanted to provide a little hope to some folks.

I originally posted back in May of this year (scroll up for the dirty details)* and I truly believe that time and keeping your calves stretched are the "magic potion" to dealing with this obnoxious injury. I did get both softer, "accommodative" orthotics and a pair of rigid ones. The softer ones fit perfectly into my Allbirds and took enough pressure off the PTT to allow me to walk around like a normal person without any pain. That alone was worth the cost, and I even popped them in my recovery shoes after my 18 and 20-mile runs...just to "protect" things. The rigid ones were just as useless this time as they were seven years ago. They're big, clunky, don't fit in any decent running shoes...and they DON'T SOLVE THE PROBLEM. This is what drives me crazy about orthotics and the prescription of them. Unless there is proof that your injury is due to mechanical issues and *absolutely nothing else*, they usually don't help and can often make things worse. For me, I figured out that running on banked sidewalks that actually made my left foot collapse were the culprit. I changed my running routes and voila! - my pain started going away. I got new shoes, but they're still neutral shoes. When I run, I don't overpronate...if anything, I wear pattern shows this.

Anyway, I just finished week 16 of Honolulu Marathon training and am proud and happy to say my PTT has been SILENT for the last five months. Not a peep, not a niggle. Starting in June I began running three days a week, and worked up to four. The deal was, I needed to get through the first three weeks of marathon training pain-free before we could buy our plane tickets to Hawaii. I'm a glass half-empty kind of girl, so I didn't have my hopes up too high. I had no pain, so we bought the tickets. I have two black toenails and a nice, cranky callous on my big toe on my left foot...but no tendonitis. I changed my running to a walk/run and I'm sure that's helped as well...I did that mostly to "ease" back into heavy training (esp during the Texas summer), but somehow it's made me faster, so there you go. I'm actually in better shape now than I have been in years...I've managed to get my hips and glutes strengthened and my core is nice and strong.

Anyway, I just wanted to share that there IS light at the end of the tunnel. This wouldn't have been much comfort to me back in February when I couldn't walk to the bathroom or the kitchen without wanting to cry from the pain, but if I knew then what I know now...and I said this back in May...I would've just sat my butt down on a couch for a month and not moved. And I would've kept foam rolling my calves. Impatience got the best of me, and that was both a huge mistake and a big lesson learned. I spent a lot of money looking for a "quick fix" and being an injury-prone runner, I should know better. Likewise, I'm glad I ignored the orthopedist who delivered the scare tactic of telling me I either had to get orthotics or I would need surgery, and the other orthopedist who told me to stop running altogether because I was "getting older". I'm only 46! Some day I will not be able to run ever again, but today is not that day. :)

Stay strong and stay positive, folks!

One last note...we're taking next year off from marathon training. Halfs are so much more fun, and I have a 4-year old PR that needs to be taken care of. Stay healthy, folks! 


One more resource that may be quite helpful comes from the Academy of Orthopedic Surgeons.  Warning: it's pretty thorough but with patience, you'll find it helpful.

*Stacy's original request.

This is probably going to sound really "out there", it possible...for pressure on the post tib tendon where it inserts into the navicular (that squishy part you can feel) to cause pain and - if done repeatedly (like, up to 35 mpw during a marathon training season, lol) to ultimately cause post tibial tendonitis? As an example, I wear "no show" socks which run right across that area and one of the first "symptoms" I had was a sore navicular, very tender to the touch.

I've been struggling with PTTD since last August, but didn't it didn't get ugly until mile 17 of the Chicago Marathon. I've gone through all of the protocols everyone else has mentioned except a boot or a brace. My PT said a boot would cause immeasurable other problems up the chain and a brace irritated my navicular just having it on so I declined.

I was off running from Dec 1 to Apr 1 (more on that below) but was able to bike pain-free during that time as long as I loosened up my shoe...keep the navicular free. Interestingly, over the last eight months my greatest "healing spurt" took place when we were in Europe in March. I walked 6-8 miles a day, but wore tights or long socks with loose-fitting boots. When we came back, I could walk around barefoot (and my affected foot is super-flat and pronates) with ZERO pain. Went for a run the next day (socks around navicular area, tight-ish shoes) and boom, back to pain in that specific area.

Saw a foot/ankle ortho who told me I needed orthotics (I'm skeptical, but he's saying it's that, stop running, or get surgery) and I have a pair of accommodative orthotics until my pedorthist can get me the rigid ones in three weeks. I've worn them twice for biking and both times was unable to bike more than ten minutes without my navicular hurting and that irritating the rest of the area. There's a really high medial post on my orthotics, and I'm wondering if that is also one of the culprits as I know my navicular is hitting it. Even more frustrating, that slight AM irritation seems to linger through the day even with icing. I didn't bike pain. Biked this AM, more pain. Once that PTT flares up...even just a takes a long time to quiet back down with me. One step forward, two steps backwards. No problems BTW, wearing the orthotics just walking around...not as much impact hitting the medial part of my shoes, I suppose.