Category Archives: Bike Beginner

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?”)

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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”

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.

Triathlon Lingo 101 – Learn How to Talk Like A Triathlete

As a triathlete, you don’t want to be embarrassed by using the wrong triathlon-related words or terms when talking about your sport (including the ever-popular pronunciation of triathlon as “triath-a-lon”).

Instead, you should be able to impress your friends with your deep knowledge of triathlon lingo. So consider this post your go-to guide for learning all the important triathlon terms.

I’ve split them up into five basic categories: swimming, cycling, running, races and transitions. Without further ado, let’s dive in!

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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

www.johnpostmdsblog.blogspot.com

Knee Pain, A, B, C’s 1/1/2012