Saturday, June 23, 2018

Sesamoid Problems? You Have Lots of Company

2017 Kona racer heading to the changing tent and 26.2 more miles before day's end

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

This is a reprint of a 2009 blog which has stimulated 1000s of athletes.

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 2009 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.

It's not uncommon for an exact diagnosis to be difficult to make. Stress fracture, old fracture, acute fracture, etc. Even then, the treatment can be both prolonged and frustrating. If your doc suggests the possiblity of surgery, this would be one of those instances where, in my opinion, a second opinion is mandatory.  This is your foot you're talking about and you only have one chance to get the right answer the first time.

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!

Monday, June 18, 2018

Who Cares About Sleep When You Can Do It In School?

"Who cares about sleep when you can do it in school?"                                      Corny Collins, Hairspray

Matt Fitzgerald  -  I've steered you to his writing/philosophy before but let me do it again. I've never met him, but I'd like to one day. I'm not related and we're not in any business deals that I'm aware.  But I own at least 3 of his books.  His writing style is relaxed, knowledgeable and rarely intentionally inflammatory.  But it's always well researched and accurate.

I wanted to focus on sleep this time.

Matt's opening quote in the Complete Triathlon Book: "You can do more than you might think to prevent general fatigue - a great epidemic in our society to which triathletes are especially susceptible..."

More in a minute.


Each Thanksgiving The local Turkey Trot goes right by our house.  I think there are about 3,000 runners, walkers and strollers. It's really a fun group with many in costume.  We're almost at the two mile mark of this 5K event and I make it a point to set up my own "aid station" with, well of course, what else would your body cry out for after running this distance on Thanksgiving morning, preparing as it is for the onslaught of food?  That's right, Bloody Mary's.  The competitors reactions have been quite predictable from the, "What, are you kidding me?" to "Alright, you the man!"  Most, however, just wave.  I usually run out.  Life is good - and you can quote me on that.

My in laws live in the Chicago suburbs and we spend Thanksgiving there occasionally.  A couple of years ago, the local Turkey Trot course came very near their home.  It was also a 5K race on the local streets. However, sometime later in the day, someone not connected with the event noted "an unidentified white powdery substance" on the ground!  

The authorities went ape.  The area was cordoned off, 100, not two, not twenty, but one-hundred on/off duty police and fire fighters were mobilized to protect the good citizens from what was eventually determined to be.... soccer field lime from the mornings Trot.  Ha!  What a world.

Triathletes are used to squeezing more into a day than most folks.  When given the choice between lunch with the gang or shoehorning in a 5 mile run, the run almost always gets the nod.  At the end of the day when much needed rest is in order, frequently everything's not checked off the list yet. And sleep gets short changed.  Hey, it always worked in college right?

But we're not in college anymore.  And it's not academics on the plate, it's physical effort placed on a body that oftentimes is still a tad beaten down from yesterday's work outs.  Or beaten down from that half marathon last Saturday. Repeating Fitzgerald's quote, "You can do more than you might think to prevent general fatigue - a great epidemic in our society to which triathletes are especially susceptible..."

It's pretty obvious that many younger athletes can live this way and still perform at a very high level.  We all know someone who can party till 3, get close to no sleep overnight, and still toe the line at 7:30 am for the local 5K expecting to perform at a high level. And do it.  Aging athletes just can't.  And by aging I don't just mean the Medicare crowd.  This means you Ms. Forty old.

Recovery is not a four letter word but one in which adequate rest/sleep is essential.  As one gets deeper in to the training year, and the intensity of training increases, the body simply must have regular sleep to combat the accumulating physical stress.  It's during this sleep that the body releases testosterone.  This hormone has gotten more than it's share of press recently but it's certainly important.

So, particularly as we get older, we need to be careful not to compromise sleep (yes, I know it's easy to say and harder to do. And, yes, I'm as guilty as the next athlete of occasionally cutting this corner.) It's one of the few things in triathlon that doesn't cost more money, right?  So, next time you plan turkey for supper, while contemplating that luscious taste with sleep inducing agents of it's own like L-tryptophan, take just a minute to think how today's sleep recommendation can fit into your lifestyle.  Sweet dreams. You'll be a winner if you do.

3 ways to get to bed on time.

 I hear your coaches saying it. Sleep.  That said, people in this sport get a lot done every day, including training.  But at the end of the day, when the “to do” list remains incomplete, it’s really easy to think “it’ll just take 15 minutes to finish.”  If you’re like most, it turns into 45 minutes and then there’s a recap of the Yankees game on ESPN that you missed, etc.  I know it happens to me.  Best intentions of getting to bed by 10 sharp, and then I start piddling around with little stuff.  So, if you can pick a time and stick to by powering down maybe 15 minutes before, and it gets to be habit, you’ll do it without thinking and reap the benefits at the next race.  The second way would be to simply set the alarm on your phone for perhaps 20 minutes before the desired sack time and start getting ready then.

Lastly, as a triathlete you put out all your clothes and morning workout gear before bed.  Like your own little transition area.  Instead of waiting till 10, do it right after supper and doing the dishes.  That way, at 10 pm approaches, your wind down time doesn’t get extended.

This is the lobby of the King Kamehameha Hotel, the headquarters hotel in Hawaii. No, these people have not been felled by sniper fire. They are families waiting while their athletes are running IM.  Maybe they all had turkey for breakfast.

Monday, June 11, 2018

Beware of the Emotions of Taper Week

Taper week can get you all discombobulated inside

Volunteer helps first timer at Ironman Eagleman 70.3 yesterday

Ex Scientia Tridens (Latin).  It means "From Knowledge, Seapower," and is the motto of the United States Naval Academy.  In triathlon, if you expect something to happen, have the knowledge it will, and it does, you're not at all surprised and might be able to deal with it just a little better.  Perhaps, if triathlon were a word in use when Latin was common, we would have the phrase, Tri Scientia Sit Tri Potentia (with a nod to Latin). "From Triathlon Knowledge, Triathlon Power."

I was privileged to volunteer for bike check at Ironman Eagleman 70.3 yesterday and it was terrific.  The whole range of pre-race emotions were on display by the hundreds of athletes who passed through on my shift, but two stuck out.  The large group of athletes who said thank you! to the smallest bit of assistance, and seemingly large number of first timers who were both bewildered, and at the same time thirsty for knowledge...where do the stickers go on my bike, how do I get out of transition, where does the swim come out, etc?  A terrific opportunity to be helpful and teach, it was also the perfect chance to calm nerves.  It was also noteworthy to mention the number of athletes who, with the potential for rain in the forecast, had all sorts of covers, bags and shields for their two wheeled steeds knowing that IM rules allow you to cover the seat and computer - and that's it.  Once the transition area closed, the IM people went around and removed the most egregious offenders.  Nice to see that IM keeps all athletes on the same playing field.


Taper Week

As a triathlete, as your first race of the season approaches, or any race for that matter, you've training virtually every day since Christmas and are quite familiar with being just a little tired much of the time.  You learned early on how not to let it affect your day-to-lives but to appreciate that occasional Sunday where you can sleep as late as you wish then make strawberry waffles for the kids at 8:30 or 9:00 and not have the Sword of Damocles overhead knowing it's only moments until your next workout.

No, this taper week will be a lot lighter than previous training efforts and it changes the way you think.  In fact, rather than just robotically just doing workouts, the shorter workout durations can sometimes lead to uncommon considerations, even a smidge of doubt like "where is my season going?  What is my future perormance likely to be or even future in this sport?"  Expect this.

It's also not unheard of to experience a feeling of vulnerability.  "Have I done enough?  Have I done the right things?"  Without that repeated hit of workout based endorphins, that YES feeling, the question of upcoming race success is off times entertained.  BUT, all of this goes away by the 20th stroke of the swim in your first contest.  Where am I?  Where are the others?  Boy this water feels nice.  My goggles aren't leaking, that's good, and 1000 other things that are racing through your mind at that moment.  And finally, all together now, we realize one thing.  "It's good to be a triathlete." YES!

Monday, June 4, 2018

3 Things You Can Learn From a Swim Death This Week

You never know when you can help a fellow triathlete.  I've known a local gent for a couple years, good athlete - especially swimming - very dedicated to his training.  So it surprised me a little when I got to the pool later than the group today, sat down to share a lane with him, and as I was prepping my goggles, he swam up and asked, "Is that the fog stuff?"  "Yes" I replied, "anti-fog, dilute baby

 shampoo," thinking it somewhat odd that this veteran of racing was clueless on something so basic.  "Mind if I try some?" he asked.  So I poured a smidge of the mixture in his goggles, gave them a quick swish in the pool, and "Wow. This is great.  You can actually see! Clearly."  The poor guy, and possibly a reader or two, can make the same simple discovery and enjoy the world of swimming even more.  (5-10% J&J No More Tears Baby Shampoo)


 Sunday was the USMS Long Distance National Championship, this year held in Reston, VA by the local Masters Swimmers in this bedroom community outside Washington, DC.  It's a man-made lake where one lap around makes a mile. On race day the lake front owners sit on their docks in folding aluminum chairs and smile at the swimmers.  The swimmers smile back!  Some even wave.  The mile swim is first followed shortly by the two mile.

A lot has been written about death in triathlon.  That it's frequently in the swim, often by those without a lot of experience in the sport, commonly anxious, tense or uncomfortable being in an open water start for what may be only the first or second time.

In Reston, one gent who was well know to the swim and tri communities - and quite speedy in the water - swam the mile on this picture perfect day winning his age group handily.  As many that I know, and myself on occasion, he'd planned to compete in both the mile and two mile swims.  Following the gun for the two mile (two laps of the lake) he made the turn at one mile uneventfully.  That was the last anyone saw of him until the following day when rescue teams found his body using sonar in the lake.  As was later reported, foul play was not suspected and an autopsy is pending.  As I know you're thinking this, yes, he was married with two children and well-thought of professionally as well as personally. 

Although athletes who begin races almost always finish without the need for sonar, it does happen and we need to know what can we do to avoid it in the first place?  First off you need to know you're healthy.  Heart healthy especially. 

Triathletes are generally a pretty confident crowd... "Yes I can carry all of them at one time" or "no it's not that cold outside I don't need a jacket" or "sure I can do that second workout this afternoon." Even blustery sometimes.  But when it comes to being ready race, what you don't know can kill you.  Perhaps lurking cardiac disease is what killed Kevin here.

If have any concerns whatsoever, don't blow them off.  Don't ignore them.  If you have a positive family history for heart disease, at least ASK your family physician and be doubly sure that whatever you've done to prepare is what 21st century medicine feels is appropriate for your stage in life.  It might be nothing, might be a stress test on a treadmill (take it from one who's done two; they're kind of fun.  As an in shape athlete you do way better than John or Jane Doe non-athlete and it's really reassuring to hear that from the doc.) Might even be more but have done what is considered appropriate for you.

Secondly, the race day ready athlete has already practiced the swim start in the  goggles and race wear they plan to compete in.  Although this may sound like a silly question, do you know if the race cap will be latex or silicone?  Do you know the difference?  They fit very differently and you should be at ease with donning either with the knowledge that it'll stay on since you've practiced with both many times in the pool.  Thirdly, how about that wave start?  Make you a little uneasy?  Sure.  That's a pretty normal reaction and if true, once the gun or horn goes off for your wave, just count to five before you take your first stroke giving the other rabbits in the heat a chance to vamoose.

Lastly, how much of an inconvenience is it to get the race site with a swim buddy the day before?  Or the week before?  Or both?  On race morning as you wade into the water, it will be old hat.  You have the same things on the horizon, same water, same everything.  You're just sharing it with a few friends.  And, after setting up your transition area, look to your right or left, ask the athlete "Say, have you done this before?"  Many will answer yes, five, ten or more times and like you and most in this sport, are happy to assume the role of teacher to reveal the finer points of the swim you are about to do.  When done right, this sport is a gas, not test of nervousness.

Please, I implore you, learn from the very unexpected passing of 45 year old Kevin Ruby in Reston, VA.  The life you save may be your own.


This is the letter put out by Reston Masters.                                         

Hello John,
Reston Masters Swim Team (RMST) extends our deepest condolences to the family and friends on the tragic loss of Kevin Ruby. According to the Fairfax County Police, Mr. Ruby possibly suffered a medical emergency during the United States Masters Swimming 2018 Middle Distance (2-mile) Open Water National Championship race on Sunday, May 27, 2018.  When he did not finish within his expected race time, emergency search efforts began immediately. After extensive efforts, Mr. Ruby was recovered from Lake Audubon on Monday, May 28, 2018.

Reston Masters is honored to have had Mr. Ruby compete at our Jim McDonnell Lake Swims for many years. He was a very talented top finisher. Earlier Sunday morning Mr. Ruby won his age group in the 1-mile race with a time of 23:38.

As part of all our races, Fairfax County on-water EMS staff are an integral part of our operations. We are especially grateful for the timely and extensive additional support from Fairfax County Police and Fairfax County Fire & Rescue.

Please join Reston Masters in keeping Kevin Ruby in our hearts and memories as an accomplished distance swimmer.

Any additional inquiries should be directed to
Dawson Hughes, CEO US Masters Swimming

Brian Evans / JMLS Event Director