Author Archives: John Post

About John Post

Othopedic Surgeon 6 Kona finishes Married, 3 children Marine Veteran Helicopter Pilot

SELF INDUCED INJURY, TIBIA FRACTURE by John Post, MD

Self Induced Injury, Tibia Fracture


I have given a name to my pain, it is Batman.” Jack Nicholson as
The Joker
And speaking of pain, I was recently asked asked about a blog I did on stress fractures a little while back and thought the following important as we set our training plans for the upcoming season. Although our weather forecast here in Virginia calls for 6 – 12″ of snow tonight, athletes everywhere are creating training plans to fit race schedules this Spring and Summer.Even the lawyers at a bicycle accident law firm would be surrounded by questions. Especially from athletes.  So many athlete’s questions involve self-induced injury!  If there are any accidents, lawyer for bike accidents can be hired! Time and again when a triathlete reports a physical issue, and then comes up with an, “I know when I did it” type of answer, I think about prevention. Any list of the most common overuse injuries in runners would include : 1) Patellofemoral pain (21%), 2) ITB friction syndrome (11%), 3) Plantar faciitis (10%), 4) Meniscal injuries (6%), 5) Shin splints (6%), 6) Patellar tendinitis (6%), 7) Achilles tendinitis (6%), 8) Gluteus medius injuries (4%), 9) Tibia stress fractures (4%), 10) Spine injuries (3%) as noted recently. People can get AED Training in case of any first aid injuries.

In one medical study, 6 young men presented with midshaft tibia stress fractures which failed to heal with the usual conservative care of rest, immobilization, etc. and 5 went on to complete fractures!! Think having a rod place down the middle of your tibia might alter your training?

We also think of the metatarsal bones in the foot as commonly seen sites of stress fractures but I was taught that they’ve actually been reported in all 26 bones in the foot and the sesamoids.

The take away lesson here is that none of us is immune. Running programs which ramp up more quickly than the athletes body can take can be hazardous to ones health, and that when weather or life get in the way of training, the better choice might be to just forget a work out or two rather than accept overload at a later date. Each of us is different as we define overload so just because a training partner can work at a certain level does not necessarily mean we can. If we just think before we make choices and listen to what our legs are telling us, we reduce the potential for self induced injury. And, we’re more likely to kick butt in that first tri. Good luck. But, if there are any injuries, personal injury lawyers based in Arkansas need to be hired.

www.johnpostmd’sblog.blogspot.com
Triathlon Swim Starts

TRAINING ADVICE FROM HEAVEN by John Post, MD

 

Training Advice From Heaven

ALII DRIVE, start and finish of the Ironman World Championship. You can bet this snowy picture wasn’t taken in Kona!

 

Dick Tomlin was a friend. A super triathlete, he podiumed twice in Kona and even won Worlds one year. He was killed on his bike in June 2005 when he was the victim of a hit and run by a motor home while training near his Kingman, AZ home.
The last time I talked to him was in February or March of that year when he was trying to help me get faster and I was trying to help him with some pain control issues he was having with arthritis in his lumbar spine.
The following is going to be a little disjointed, just like a phone call, where we talked about whatever came to mind. Even though Dick is no longer with us, you’ll see that he has a number of important training points to make: he credited his age group best bike speed to consistency, lots of winter miles indoors, abundant one-legged drills. He would decrease the resistance and do 100 revs with the right leg and then the left. Repeat this 6 times, “like wiping your feet on the floor mat.” Learn how to cycle with each of your legs.”
For short course tri preparation, he’d ride “really hard sprints.” He’d set up a one mile course near his home where he’d ride faster than race pace and, “Do a dozen with 15-20 seconds rest in between.” He didn’t do much hill work as “The races I do don’t have ’em.” Although he usually rode alone, he had one friend, a CAT 2 cyclist, who he’d been riding with for 12 years allowing, “Those guys know so much, it really pushes me up.” Weights were important as he’d follow Joe Friel’s Training Bible, “Except the max weights,” 3X’s/wk in the winter and once/wk in season. An average training week would include 110-120 miles on the bike, 25-30 miles running and 8-9,000 yds in the pool, he’d “Work up to double this for Ironman.” This would be “22 hours/week in late July and hold it to September.” He wanted 8 consecutive weeks over 250 on the bike and 50 on the run, reserving one weekend day for a 5 hour bike and a 2-2.5 hour run. Or, for variety, it would be a 2hour bike and 3 hour run. Clearly he was motivated.
But, Dick was not without pain as he’d had both knees scoped in 1998 noting, “I’d run in pain for a decade.” He took his share of Glucosamine. Plantar faciitis was a continuing issue. And I already mentioned his back. But he did not shy away from what he perceived as the work required to be tops in the age group.
And he was a nice guy.

Training a bit of a problem on your street, too?

Donating Blood, It’s Easy – Do It Today by John Post, MD

Should Triathletes Give Blood? Of Course!


“For every complex problem, there is an uncomplicated answer; neat, simple and wrong.” H.L. Menken

HuliSue’s is a terrific barbecue place in Kamuela, HI when you find yourself north of Kona some day. If you ordered a beef sandwich, you’d get plenty of iron to help make red blood cells. Ah, but then what do you do with those red cells? Keep ’em? Donate a few to someone who might really need them?

Well, I’m prejudiced. I recently donated my 100th unit of blood to Virginia Blood Services. If you realize that when a “pint” comes out of your veins, only about a third of it is blood cells, the other two thirds being plasma. The fluid portion will be replaced in your body in a couple hours but it will take the bone marrow about 3 weeks to restore the RBC’s. Each person’s reaction is different, and changes from donation to donation. One may have to reduce the intensity of work outs for a short time, and probably would cease donations a month to 6 weeks before an important race, or the racing season in general. That said, platelet need is always in season, requires no loss of red cells (or oxygen carrying capacity), and can be done virtually any time in the year.

There are lots of reasons not to give blood…a needle stick, a few days of non-maximal training, rumors from the uninformed, etc. But, there’s never an over abundance of blood, it’s needed for patients getting dialysis, heart surgery, cancer and trauma victims, etc. Heck, Lance might have even needed a transfusion following his orchiectomy and subsequent chemo.
Lastly, who among you hasn’t had a bike crash? One day, the need might be yours.

So find your local blood bank on Google, see if you need an appointment or can just drop on by – my choice; I can be out in 30 to 45 minutes – and make that mental note to give this week.  You’ll really be glad you did.

John Post, MD

Rotator Cuff Tears this week

GET A PROFESSIONAL BIKE FIT, AVOID INJURY by John Post, MD

 

What is the Value of an Experienced Bike Fit? It’s Invaluable!


John Cobb counsels a novice triathlete at Glen Ellyn, IL bike fit.
As a surgeon, I think I learned as much from doing my 1,000th, or 10,000th knee arthroscopy as I did from my 100th. When you do something over and over and over again your learning never stops. Bike fitting is no different.
I would speculate that many of you have had a professional bike fit…or two…or three…or…? Personally, I had a noted east coast coach fit me ten years ago. About 4 years later flew with my bike to the west coast to be evaluated with the IR cameras by “the pros.” These two fits were quite different from each other. Lots of computers, measurements, images, etc. during the second fit. But, I was never really comfortable, faster maybe, more aerodynamic maybe, but not more comfortable, particularly the seat. (I even had xrays taken of my pelvis.)
That is, until I met John Cobb…who just talked to me. And then we talked some more, before coming anywhere near the bike. It was very similar to the doctor patient interaction where, if the doctor actually listens to the patient, something I must admit that I don’t always do as well as I should, the patient will tell you the diagnosis.

We then spent the better part of an hour, first taking the rear end apart and putting it back together. Then the same with the bars and front end, changing bit by bit, until I was simply pedalling for 15-20 minutes talking about the old days of triathlon with John…and I realized it didn’t hurt. Hallelujah! My time was worth the 750 mile drive.

I know that we haven’t reached the end point yet but it’s nice to have a road map for the future. The take home point here is that our sport is many things to many people but foremost it should be enjoyable. We don’t all need to do the Ironman or Race Across America, but if we enjoy the time we do spend training and racing, we’ll benefit from it in ways we have yet to imagine.

HOW DO YOU MEASURE SUCCESS? by John Post, MD

How Do You Measure Success for 2012?


Some triathletes overcome greater obstacles than many.”

I’ve seen a number of criticisms directed at the print media of our sport lately. Probably pretty easy to do from the outside. The two most common seem to center around glitz, an abundance of adds loosely connected by a few articles, and second, an inability/unwillingness to be critical of say WTC or USAT in defense of the little guy. (A $650 – or more! – entry fee for a triathlon as one example.) There were even efforts afoot by H3 Publications to present a different Tri publication, seemingly more difficult than perhaps first thought. Whatever your position, as the consumer you have the right to evaluate information and apply it as seems appropriate to your sporting life.

There was a piece by Mitch Thrower in Triathlete a while back which made good reading. He made a number of excellent points regarding the well worn phrase, “We are what we eat,” and the role our current understanding of genetics plays. This relates not only to our bodies ability to process what we take in, but what we become and our control over this outcome. He goes on to show that lifestyle choices can make a significant contribution to the overall end game when combining genetic predisposition along with dietary and exercise choices. Although to some degree your athletic potential is pre-programmed, you are still Captain of the ship! (Sound like something you’ve heard from Ben more than once!)

Mitch puts you in control to some degree. I had a patient some time back that I used as an example while teaching a course in St. Louis to a group of very bright triathlon coaches. This particular young man was being prepared for a knee reconstruction and on his intake form he noted his weight at 380 lbs. When I saw him a couple weeks later for his preop physical, he mentioned erring on his weight which was really 420.  An accurate weight is essential in the operating room as, for example, medication quantity is in direct proportion to patient size…and I doubt one would like to wake up unexpectedly having been given too little of a certain drug!

Since the Day Surgery scale, like many of those at home, isn’t reliable over 330 lbs, I asked the nurses to send him down to the laundry for an accurate weight where the scale goes to 1000 lbs. And he needed it. His ultimate weight was measured at 550 lbs!  That’s right, 550!  In other words, his initially reported value of 380 was 170 lbs. less than actual, something he and I discussed at length after surgery. He admitted that he’d basically lost control of both diet and exercise and anything over 330 was simply a guess. Not a good guess but a guess none the less.

He did well post op, had a stable knee, and the last time I saw him was headed below 500. This is not easy in the rehab period but he’d defined the problem and begun to take back control of his life. I hope he’s had continued success. As triathletes, we already have the exercise part of the equation down. We now understand there’s a significant genetic component in play here, but we are also being given some bit of control knowing that our own destiny is more than putting bike miles in a training log. Can success as you define it be far off?

Happy 2012 and Best of Success in an injury free year of training and racing.
John Post, MD
Knee Pain, A, B, C’s 1/1/2012

PLANNING IS EVERYTHING by John Post,MD

Planning is Everything, Really

Plan to Stay Injury Free


This is the IM finish line in Kona the morning after. Sure it’s the stuff of dreams and many successes. History notes about a 93% completion rate. But what about those who failed, or failed at some other race, even the local sprint tri back home? Was there a lack of planning at some stage? 

“Lack of planning on your part does not constitute an emergency on mine.” What did you forget? And don’t say nothing. At one point we’ve all omitted one thing or another. In a previous post, I somewhat sheepishly admitted leaving my bike shoes home for one of my “A” races, an event in which I’d won the age group the year before. Needless to say I did not repeat!

This is the time of year that the conscientious triathlete not only begins to dream of the potential for the upcoming racing season but starts to develop a series of goals and a road map to get there. This could be something as complete as a computer generated Annual Training Plan where the entire schedule, division of swims, bikes, runs, rest days, the works, are populated. Or, it could be sitting down with the local swimming guru if this is your weakest sport, your limiter so to speak, and getting his/her hands on expertise at incorporating the best combination of workouts, drills, indoor and outdoor swims to put you at the greatest advantage come race day.

Since these posts are about minimizing injury, this time of year would also be ideal to plan ones training stress, training volume – the amount of work you plan. This is the slope of the effort line from now till the first race that not only gets you prepared, it does so in a very gradually increasing fashion, to minimize the potential for Achilles tendinitis, IT band problems, stress fractures, etc.  Determining the cause of a triathlon related injury can be a real challenge as we seldom see ourselves from the outside.  And, I don’t think that this is intentional, it’s just human nature.  I’ve talked about injuries with thousands of athletes and it takes patience and specifics to get to the root cause of an overuse injury some times.  Weakness or failure can be a hard thing to own up to in our chosen sport.  Right?

I firmly believe that much of the misery, lost training time, races missed, etc. could be avoided if each athlete took the time to plot out the whole year with this in mind. It would sure make my life easier in the office, and life happier for many athletes.  I’d like you wish you a Happy (and Injury Free) New Year!

John Post, MD

www.johnpostmdsblog.blogspot.com (Peeing on a Moving Bike)

WHOSE ADVICE DOES A TRIATHLETE FOLLOW? by John Post, MD

Whose Advice
Does a Triathlete Follow?

There are limitless sources of “good
advice” to the triathlete with a question or a problem. Pieces like this one,
clinics taught by a respected authority, various publications, the guy in
your bike or run group, triathlon forums, etc.

Each of these has a
role, a degree of timeliness and accuracy but it’s your responsibility to
carefully evaluate your “teacher” before applying the new found data to your
training.

While sitting at Dulles International last year, I struck up a
conversation with the man next to me who was wearing cowboy boots.
Eventually the talk turned to the problems of the Social Security system.
I asked him if he thought signing up for SS as soon as you were eligible was
a good idea and he thought so. Shortly after this, the man across from
“Boots” turned out to be his brother who asked, “Were you able to get on
the plane by yourself?” My neighbor turned out to be a total fruitcake and
here I was seeking his opinion on something of potential importance!

Where I’m going with this is that a questioner on one of the
tri forums recently posted a query about how he/she should spend the winter
to be his/her best come Spring, and
the answers were wildly
different. One response was to ride 300 miles/week at an easy pace.
Another respondent suggested daily intense spin classes to really push it.
What these two answerers had in common was that they were both anonymous.
They could be knowledgeable sources
like Chris Carmichael or Ben Greenfield or Joe Friel…or it could be
BOOTS!

So be careful whom you believe. Verify the
source and make sure it just makes sense.  You’ll be glad you did.

Marianne was a terrific local triathlete who
unfortunately succumbed to breast cancer about ten years ago. Sort of puts our
complaining of plantar faciitis in a different perspective.

Merry Christmas to all you Rock Stars.
John Post, MD
This week’s subject

WANNA BE FAMOUS? by John Post, MD

Wanna Be Famous?


“You want to be famous? Learn how to take blood out of car
upholstery? John Travolta as Mrs. Turnblatt in the
movie Hairspray

This is the time of year for goal setting, for planning, as
was the subject of recent weeks posts.

Consider that, according to a piece in the British Journal of Sports Medicine
a couple years ago the ten most common overuse injuries that are
seen in the running population are:

1. Patellofemoral pain (21%)
2. ITB Friction Syndrome (11%)
3. Plantar Faciitis (10%)
4. Meniscal Injuries (6%)
5. Shin Splints (6%)
6. Patellar Tendinitis (6%)
7. Achilles Tendiniitis (6%)
8. Gluteus Medius Injuries (4%)
9. Tibia Stress Fractures (4%)
10.Spine Injuries (3%)

Note that the key word here is OVERUSE. Since we are only in
December, this is a golden opportunity to set up one’s schedule for the
training and racing season. Adam Zucco, Age Group winner at IM California
70.3 and Training Bible Coach would have his coached athletes list their
planned races for the upcoming season and the importance of each. Using the
periodization model, he’d set up a 3 weeks on/1 week rest repeating game
plan to slowly build, first the mileage, then the intensity (accompanied
by a decrease in volume). In other words, he understands the principle of
gradually increased load that the body will respond to rather than acute
increases in training stress. This will give the racer the highest likelihood
of both improving the level of fitness but doing so with the lowest
potential for injury.
Ben and Kerry are hosting a webinar 12/12 that you really should watch
covering this exact process and how it relates to you.

As you prepare your plan, remember that frequently runners/triathletes will
come in to the clinic and note that a
single work out pushed themover the brink. Oftentimes this was
something foolish like racing against a friend, pushing through pain when
they knew they should stop and walk, etc., that
will cost them a part of the season, and, as they used to say in the U.S. Army
commercials, the opportunity to “Be All You Can Be.”

The time to start thinking
was yesterday.
The Female Athlete part three, The Pregnant Athlete

ARE YOUR INJURY RATES INCREASING? by John Post, MD

Injury
Rates Increasing


Growin’ up, you don’t see the writing on
the wall. Passin’ by, movin’ straight ahead, you knew it all.” St.
Elmo’s FireA recent piece in the NY Times quoted what we’ve
known for years that when single sport athletes switch to triathlon, their
overall training hours go up and that rather having a decrease in injuries as
they’re spreading their workouts over three sports requiring “different
muscles,” the injury rate actually increases as the athlete has difficulty
turning the desire (need?) to train off.

Joe Friel, author of the Triathletes Training Bible and noted
cycling author Andy Pruitt teach that the true benefit from training
comes, not during the workout itself, but during the subsequent rest period.
Upon recovery from the added stress, the muculoskeletal system is just a little
stronger than it was before.

This is the time of year, with snow on the
ground that we’re allowed to dream. We examine past racing successes and
failures and use them as a springboard to set up our next season. Hopefully this
is accomplished with more than just an ounce of common sense. Not only is the
absolute load your body sees important but the rate of change of this load is
also crucial.
As one example, I did a piece here on stress fractures in September and one
of the take home messages was that we can all do a significant amount of
training as long as the rate at which we increase the volume and intensity
of this effort is such that we can handle it. And no, I don’t mean “handle
it” as simply being able to either fit it into an already packed schedule
or that you’re tough enough to get it done. This should be interpreted as
being able to accept the increase in training load on top of what’s
currently being done and the total training increase isn’t greater than,
say 5% of the previous weeks efforts.

We all know that there are a few people, maybe the ones you
train with, who seemingly don’t need to follow these guidelines. A pair of women
I swim with are like that. They have no idea of/need for warming up. While the
rest of us complete a 1000 yard warm up set, they pop into the water as
the main set is being described and push off the wall full tilt for the
first 200. Of course I’m jealous. But my log book is fed 1000 more yards more
than theirs on a regular basis.

So as you dream about that podium spot at
the local sprint tri in 2012, construct a sensible training plan that carefully
increases the rate at which your knees are called upon to run more hills or time
trial bike efforts. And, most importantly, when that little twinge becomes full
fledged pain, take some time off of that discipline…you needed to work on your
flip turns anyway. If you can carefully mold and execute your training plan, you
stand a good chance of staying away from people like me (doctors) and having
a terrific season. Good luck!

John Post, MD

www.johnpostmdsblog.blogspot.com  This week, The Female Athlete

OVERUSE INJURIES – YOUR FAULT? by John Post, MD

 

Overuse
Injuries


Destinations probably not seen near your hometown.
Continuing the theme of self
induced problems, having discussed stress fractures and the like previously,
this weeks post will focus on potential ways to avoid ending up at the doctors
with what may be an avoidable problem.

Recently, I gave you an example of athletes who just can’t turn it
off. A local runner of some renown, while rehabing a problem
which she’d ended up in the operating room, was widely known for doing her
morning training…following doctors orders…and then seeing if she couldn’t
find someone else to go running with her (again) that
afternoon, miles that most likely will never see the light of day in her training
log. Nor will they be revealed when reporting back to the doctor if things don’t
go well.

In that this is November, and many of us have taken a break from
training or are about to do so, we get the opportunity to review 2009’s results,
both good and bad, as we prepare for 2010. We’re getting ready to create a road
map starting from today and ending up at the finish line of our “A” race(s)and
beyond. We are sort of Mapquesting the directions to our 2012 athletic goals. If
we follow the periodization model, we’re setting up a basic skeleton to control
our training volume and intensity so that we’re “all we can be” come race day.
When the training year is created with this much planning and care, the
potential for overdoing it, both in the short and long haul, is diminished. Both
training hard and resting hard are accounted for in your long term
plan.

Our bodies can perform at almost any level if we prepare them
adequately. One of the first books I read on marathon training 30 years ago was
a steady increase in long runs, each week harder than it’s predecessor, until
your chosen race. I don’t recall the author ever referring to the “R” word.
Rest. If you think about Achilles Tendon problems, plantar faciitis, runners
knee, stress fractures, etc., you grab a big group of problems that, for the
most part, are the result of training in a fashion in which the body is
unprepared. They probably didn’t need to occur much of the time.

So, I would ask you to write down
the basics of your training for the next 11 months starting backwards from the
“A” race. If you’d like a model to follow simply look at the year put together
by Ben and Kerry in this web site.  Or you might look at
trainingpeaks.com, one of the triathlete mags, etc.  But, if
you’re reading this, you have the advantage of personalization
that you don’t get out of a magazine.

But, have a plan. Oh yeah, and don’t forget the
“R” part.

John Post, MD
www.johnpostmdsblog.blogspot.com “Magic in Your First Race?”

One more photo of Ben at the Underpants Run in Kona