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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

Abu Dhabi Triathlon

The Abu Dhabi International Triathlon is fast becoming a must on the triathlon circuit. For professionals the large prize money and the opportunity for an early season test are very attractive.

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PICKING THE PERFECT TRIATHLON SPORTS DOC by John Post, MD

Pick Picking The Perfect Triathlon Sports Doc

Bill Vollmar, MD
example of a perfect sports doc


“Son can you play me a melody, I’m not really sure how it
goes. But it’s sad and it’s sweet and I knew it complete when I wore
a younger man’s clothes.” Billy Joel

So you didn’t used get injured and now you might need to seek
medical help? The cover of the Triathlete Magazine a couple years ago,
various internet posts, etc. and the title of this article. These sources
gave a number of good suggestions. But most are neither written nor edited
by a physician and maybe another perspective could help.

Triathletes are what’s known in MBA circles as early adopters.
They’ll try things, seemingly anything (anything? Compression
socks…Biestmilch…dimpled aero wheels) often with minimal
proof/history that the new product/technique is actually beneficial,
but it might be. On the Slowtwitch site for example, when
one forum poster complains of a musculoskeletal problem, invariably one of the
“expert” responders notes the obvious need for ART (Active Release). Well,
ART can be very helpful in the right setting but the nearest practitioner to
my house according to the ART website is an hour and a half away!

The two photos above are of Bill Vollmar, MD, seemingly “only” a Family
Practitioner from Lancaster, PA and some would say might have
trouble spelling triathlon. But he is whip-saw smart, takes care of
almost exclusively athletes, and since unlike me he’s not a surgeon, would
likely have a non-surgical solution to almost any injury if it’s feasible.
Only as a last resort would he considerinvolving someone who might want to cut
on you! And, he is so good that he could take care of me and my entire family.
And lord knows I’ve had more than my share
of musculoskeletal problems – compartment syndrome, plantar faciitis, achilles
tendonitis, rotator cuff tear, I could on. The take home point is that, at least
for many of us, we don’t have to drive hours to the Pro from Dover with the
treadmill for a good portion of our medical needs, we just need to know what’s
available locally. In fact, like many locations, the go to guy here for most
running induced issues is the owner of the running shoe store. With 27 years of
seeing runners problems he could take care of the Olympic team! And I’ll bet
there are examples of this in your community, say the kids swim coach who’s
been working on swim strokes for decades.

So, as pointed out in Triathlete, Active.com, Beginner Tri, etc.
don’t be embarrassed to ask around to see what’s available, who’s available,
for your specific problem. Help could be right around the corner…and his/her
name might be Bill Vollmar

One more thing. Many of us have had something called Microfracture as part
or a knee arthroscopy. A recent article in Arthroscopy mmagazine notes a
study in which injecting stem cells as part of this procedure shows
significant promise in improving results.

Orthopedic surgeons are early adopters too!

John Post, MD
www.johnpostmdsblog.blogspot.com

Now Available! “Top 20 Fueling Myths Exposed” by Ben Greenfield

Fueling Myths book

I wrote “Top 20 Fueling Myths Exposed”  for the recreational exerciser to the elite athlete, and it contains a collection of the most common sports nutrition and exercise fueling myths, why they’re wrong, and what you can do about it to maximize your health and performance.

When you read this book, you’ll change the way you think about fueling your body, and you’ll learn the shocking truth about popularly held sports nutritions beliefs, including:

-How everything you know about pre-workout nutrition is probably not true…

-Why you don’t need to eat within 20-60 minutes afer a workout like everybody tells you…

-How the “Glycemic Index” is a fairly useless tool for measuring carbohydrate values….

-Why whole wheat is not as healthy as you may think…

-How not drinking enough water can still lead to water intoxication.

-Why health foods and energy bars are actually making you slower…

-Why “eating too much” is rarely the cause of gas and bloating during your workout…

-And much more!

I was assigned to write this book as the resident sports nutrition expert for Endurance Planet, I am very proud of what I’ve been able to create within the pages, and I guarantee it will re-invent the way you think about fueling your body!

Click here to get the instant digital download of Ben Greenfield’s Guide To Sports Nutrition: “Top 20 Fueling Myths Exposed”  – for just $7.

PATIENCE FOR IMPROVEMENT by John Post, MD

Here’s your Fearless Leader, Ben Greenfield, as he fits right in at the Kona Underpants Run this year.  Pretty sharp outfit there Ben, we can’t wait to see what 2012 looks like.

_______________________________________________________________

Patience For Improvement


Not everyone who comes to Kailua Bay
during Ironman race week wears a Speedo!

“I’d take any risk to tie back the hands of time.” Styx

I didn’t race
at IMH this year…and likely my body’s been sending messages loud and clear
that I’m done with iron distance racing. But on Sunday morning after the event,
I went for a bike ride and was astonished to see a couple runners. Pushing it!
At first I thought they were tourista like me but as I approached, I could see
that they both had Ironman wrist bands on and a race day sunburn on their neck
and shoulders from an especially hot day yesterday for the race. (There’s almost
no shade on the Big Island bike route. Maybe one could ride in the shade of an
overflying seagull…but that would present it’s own potential
hazard!)

Running? The day after IMH? What were they thinking? Were they
thinking? Maybe getting a jump start on training for their next iron distance
race…next weekend. Or, maybe they’re just not able to turn it
off.

Racing and training at this level causes significant breakdown
of bodily systems that need recuperation time be it from training or racing.
Although there are a select few who can get by with less…and these are the
ones we hear about in the press…most of have neither a red cape nor an “S” on
our chests. And Kryptonite doesn’t bother us one bit.

Why not take the
first several days after a race to let the soreness fade, blisters, if present
resolve, and only then begin a few low effort, short workouts focusing on form
and style, not quantity. Many would suggest that it be a full 10-14 days before
getting back into full training after a 140.6 effort, assuming you already have
a race scheduled. That time would be well spent on family activities, reading
(no, not about triathlon), maybe even go see the new Michael Jackson movie for
something completely different. Or, if you’re a guy, take your spouse to a chick
flick like “The Kings Speech.” I took my wife. And I liked it. Maybe it’s time to
simply be a husband and father/mother and wife, and not an athlete. Although no
one would fault you for drifting into thoughts about HED wheels during the
credits.

John Post, MD
This week we discuss Stem Cell Transplants