Category Archives: Bike Advanced

Raynauds Syndrome, Cold Hands and Feet in Winter Training by John Post, MD

And I love to live so pleasantly,

Live this life of luxury,

Lazing on a summer afternoon.

In the summer time,….

The Kinks

Ah summertime, for many of us it’s only a memory. The arrival of winter has brought with it a host of training challenges. The cold, shorter days, more competition for pool access, the kids back in school, did I mention the cold? And how we meet these challenges tells us a lot about our seriousness in the sport. (In last weeks post, Arthritis part 3, I talked about the committment and life changes made by Farrokh Bulsara who transformed himself into Freddie Mercury . ” I guess the question is…are you willing to make the types of sacrifices Freddie made to achieve your goals?”)

Continue reading →

Road Rash, Torn Up Skin, What To Do by John Post, MD

“Ain’t no doubt about it we were doubly blessed, ’cause we were barely 17 and barely dressed.” Meat Loaf, Bat out of Hell

Possibly without intending, Meat Loaf was describing the amount of protection one gets from cycling clothing when you hit the asphalt. Barely dressed. But, you look good doing it. Right?

What would you think if this were your elbow? You crashed hard, went to the local urgent care and got sewn up…but things went down hill quickly when you started to develop a fever. Then, rather than having less pain as time passed it only increased. And then you started to sweat. Heck, you’re a veteran. You served 5 years as an instructor at the Naval Nuclear Power School, you can handle this. Why, it’s just a cut, right? Continue reading →

Elbow Pain of Swimming/Biking Origin by John Post, MD

I took a walk around the world to ease my troubled mind. I left my body lying somewhere in the sands of time.”

Kryptonite, 3 Doors Down

Your thoughts when injured?

We frequently think of overuse injuries as running related but swimming can also take it’s toll. Swim training/racing can put us at risk for a multitude of upper extremity difficulties. We frequently see problems with the rotator cuff stealing the headlines, particularly in overhead throwing sports, while less commonly the elbow is involved. Many of us have either heard about or experienced Tennis Elbow (pain over the outside of the elbow or Lateral Epicondylitis, less often from playing tennis than from an alternate source despite its moniker.) Triathletes are more prone to Medial Epicondylitis – pain over the inside of the elbow. This is known in the literature as Golfer’s Elbow. You might be able to guess why. Continue reading →

Road Rash- Limits of Home Care by John Post, MD

Road Rash – Limits of Home Care

“The road is long, with many a winding turn.” The Hollies, 1969

“You want to know what it’s like to crash on one of these bikes? Get in your car, strip down to your underwear, and jump out at 40 miles per hour!” Jonathan Vaughters

There are two groups of riders: those who have crashed and those who will crash. You look at what used to be your skin, red, raw, and painful. Frequently, if you were really lucky, this is just a scrape, a superficial abrasion – a strawberry – like you had falling on the basketball court.

Now what? First, this is why I carry a water bottle – sometimes to drink from but mostly for hygenic reasons…washing off a dog bite or road rash to try to diminsh the chance of infection or leaving a permanent mark on the skin. Once you’re back home, a mild soap and water cleansing goes a long way, cover with a light dressing and bacitracin to keep the skin from drying out, and figure out when your last tetanus shot was (normally given every ten years but if there’s been a “dirty” injury, and it’s been greater than 5 years, get a booster shot). Continue reading →

Achilles Tendon Ruptures 2012 by John Post, MD

Achilles Tendon Ruptures

“What we have here is a failure to communicate.” Cool Hand Luke

Last month I published a piece entitled “What a Triathlete Needs to Know About Antibiotics” that was well received. (Thanks) The impetus of that post was a series of confusing ST threads concerning the potential side effects of certain antibiotics, especially fluoroquinolones (Levaquin, Cipro, Avelox, etc.) It was intended to clear up misconceptions as to the relative frequency of these side effects, most noteworthy rupture of the Achilles tendon. (Note: at a Primary Care review course I taught in Florida this week to > 200 physicians, when asked, only 2 docs admitted to personally experiencing this complication in their practice.)

The Achilles tendon is the strongest, thickest tendon in the body connecting the soleus and gastrocnemius to the heel. Men in their 30’s and 40’s seem to have the highest rupture rate, particularly those who are active in sports, especially the weekend warrior who’s relatively sedentary during the work week but really goes at on Saturday . Many in medicine feel that it’s a previously abnormal tendon that ruptures. Although it can fail both at the mid calf level, the junction between the muscle and tendon, or closer to the insertion in the heel, the latter is more common. The tear itself is usually ragged and irregular and not so easy to repair. The diagnosis is made on physical exam by palpating a space where the Achilles normally resides and a positive Thompson test, squeezing of the calf of the prone patient noting whether or not the ankle flexes. In a failed tendon, the ankle will not flex. Most often, there is little or no warning that the tendon will yield.

When diagnosed acutely, options include operative or non-operative treatment, most often the younger population choosing surgery. This could be either a traditional open operation or a per cutaneous procedure. That said, there is an increased risk of complication (infection, adhesions, etc.) over those who’ve chosen the non-surgical route but a lower incidence of re-rupture. Following the operation, most patients will be placed in a cast or splint short term followed by a functional brace. Return to sport varies depending on the solidity of the repair, post-op pain, and ability to prevent re-injury.

Since our goal is to prevent injury in the first place, correction of limb length inequality, arch problems, bio mechanical issues, etc. all help in attaining this. Although there is some controversy, lightly warming up, stretching – both straight legged and bent kneed – perhaps even with a little light massage, coupled with a general fitness program seems to be our best protection in keeping the surgeon at bay.

Super Ironman Hawaii volunteer,Mike McCurdy

Quick Note: with the arrival of warmer temps and daylight savings time, many of us are out on the roads earlier, later and longer. Of the four strobe lights on biker’s butts on this Sunday’s ride, all four needed new batteries. One was so bad you could hardly see it in the pre-dawn darkness…drafting! So, before you ride again, change all those batteries and be safe.

www.johnpostmdsblog.blogspot.com

Notes From A Pregnant Athlete

DOG BITES BIKER, BOTH SURVIVE by John Post, MD

Dog Bites Man, Both Survive

The sword of time will pierce our skins, it doesn’t hurt when it begins. Johnny Mandel, Suicide is Painless

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” last year while I was cycling a few miles north of town. I stopped, went to the owner’s house and reported it. 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. I told him I’d notify animal control as soon as I got home. He was not happy and made that very clear.

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 as possible. As soon as I was back in cell phone range, I called my wife, gave her the facts and the house
address in case the headlines in the next day’s paper included “Biker shot north of town”(The dogs owner made out like it was the biker’s fault) 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 – 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. 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 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) Identify the animal and inform local animal control
2) Cleanse the wound as best you can immediately
3) Seek medical care

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!

John Post, MD

www.johnpostmdsblog.blogspot.com

“Your Medical Help at the Races”

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?

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.

STRESS FRACTURE, EH? PART TWO by John Post, MD

Stress
Fracture, Eh? Part Two

This is Ironman Week here in Kona as the sleepy fishing village and
occasional port for cruise ships turns into Triathlon Central. There are
people everywhere, fit people, running and biking up and down Alii Drive.
I hadn’t been here an hour before seeing Norman Stadler and Chrissie
Wellington. Good luck to them both on Saturday! It’s going to be a
fun week.

“Dig Me” Beach, a term I heard
credited to Scott Tinley, is seen here, soon to be clogged with
swimmers trying to get used to the change from simply following the
line on the bottom of the pool to the gentle waves and salt water of
the Pacific in Kailua Bay.

But the athlete with an injury like a stress fracture is
sitting home, an opportunity missed. I covered the basics of stress fractures
here 1/15. That these are in the category of overuse injuries where the
muscular envelope of the lower extremity becomes fatigued and the skeleton
is unable to adapt to the increased load.

The bone fractures as it is unprepared for the intensity of exercise delivered.
This might be advancing one’s training program
too quickly, changing from the relative forgiveness of the running track to
asphalt or concrete, aged or improper equipment or increasing exercise duration
as a tennis player with a substantial increase in court time.

There are 26 bones in the foot and most likely all of them have been subject
to a stress fracture at one time or another. They are frequently seen in the
other bones of the lower extremity when insufficient rest is included between
workouts. People taking Prednisone, Dilantin and other medications are at
increased risk. Women have more than men.

The predisposing symptom is pain, not so much at
rest, but brought on by exercise and it worsens. Although occasionally
visible as a crack in the bone on x-ray, frequently these films will be
negative. If the examiner finds point tenderness over a bone and a stress
fracture is suspected, an advanced study like an MRI, or more likely a bone
scan, will be order. (This is not to be confused with the DXA, the bone scan
used to measure osteoporosis, predominantly in women.)

If diagnosed, the order of the day will be rest.
This can be up to 6-8 weeks, some will be placed on crutches or given a fracture
boot, but if one returns to sport before it heals, chronic difficulties can
follow making healing a challenge. Triathletes might be shifted to pool running
and biking so as not to lose excessive fitness.

So, if you have recurring pain in the same location, and think this may
potentially describe you, get it checked out, you’ll be glad you did.

John Post, MD Kona Resident 10/1-9
www.johnpostmdsblog.blogspot.com

Cool Advanced Bike Trick: How To Install Custom Wiring on Your DI2 Electronic Shifting Group Set

This advanced bike trick is brought to you by Australian triathlon coach Graeme Turner, of Fit2Tri

Disclaimer

These modifications could void the warranty on all components in the DI2 Group Set. These modifications involve fine soldering – do not attempt unless you are confident in completing these steps.

Battery

The Shimano DI2 is rated at 7.4 volts / 500mAh. This voltage is a common voltage for items such as radio control cars and video cameras. Amperage higher than 500mAh can be safely used – it will in fact give much longer battery life between recharges than the standard battery.