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Rock Star Triathlete Articles

IT BAND FRICTION SYNDROME by JOHN POST, MD

Simple
Solutions For ITBS (Iliotibial Band Syndrome)

“If
God invented marathons to keep people from doing anything more stupid, then
triathlon must have taken him completely by surprise.” P.Z. Pearce,
MD

The IT Band: The band itself runs from it’s insertion
behind the hip down the outside of the femur and knee cap to an attachment
outside the patella tendon. It is usually a tight, one inch wide tendon that can
be seen on the knee when your leg is locked.
Symptoms: A
sharp pain that radiates from above and outside the knee into the quadriceps
and/or in the hip. It can be aggravated when running up or down hills or when
going up/down stairs after a run. Frequently it hurts after the first 15 minutes
or so and doesn’t go away.
Causes: This can be seen in
those who’s bike seat is too high or there’s some type of instability in the
gait cycle and leg is no longer in neutral. You’ll see it in those who use old
or improper shoes. If the shoe is not supportive, it can lead to overpronation
stretching the IT band causing a painful rubbing across the femur. Some get
these symptoms from bowed legs, the crown in the road,
etc. In Andy Pruitt’s Complete Medical Guide For Cyclists, he notes that “too
much riding too soon can cause this problem. IT problems rarely happen after
a period of base mileage.”
Solutions: For runners, it is essential to match the
shoe to the runner to allow proper leg alignment. Check your saddle height. Many
will ask for a cessation from running/biking until the pain dissipates.
Check that your feet aren’t too close together while riding.
Stretching the IT band, especially after runs is key. Don’t forget the quads,
hams and calves. Massage using a foam roller can be of benefit – but be brief
and don’t spend too much time on the actual point of pain. Morning runners/bikers may
want to apply “Warm FX” to the IT band. It acts like Icy Hot and allows more
oxygen to flow to the muscles and in turn they loosen up faster. I’ve also had
some patients experience excellent success with ice massage after their run/ride.

If unsuccessful, then maybe a visit to your local runners doc may be in order. Good
luck.

John Post, MD

There Are Two Ideal Stroke Styles

Most people assume that the Smooth Swim Type is the ideal stroke style. Very tall swimmers like Grant Hackett, Ian Thorpe and Rebecca Addlington epitomise this style – their long strokes setting world records and winning multiple Olympic gold medals.

But, unfortunately, it’s not quite that simple. There is another stroke style that can be just as fast: the refined version of The Swinger. This shorter, punchier style of stroke can be incredibly quick, especially when combined with a two beat kick. Laure Manadou, Kate Ziegler, David Davies and Janet Evans used this style of stroke to win gold medals and set world records in the pool. In fact, at the 2007 World Championships, the women’s 200m, 400m, 800m and 1500m freestyle were all won by Swingers – proof that they can dominate in the pool.

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RUNNER’S TROTS by JOHN POST, MD

Runner’s Trots

I’m
taking my two boys to Sequoia National Park in California for 9 days of
hiking including climbing Mt. Whitney so it’ll be till 7/20 till I get a new
post up. Feel free to look at previous posts on various tri related
topics.What are runner’s trots? The sometimes sudden urge to have a
bowel movement while running. Some complain of this being a near explosive
feeling, it spoils runs, and comes out of nowhere to runners of all levels of
experience. It can be a quite frustrating problem to solve.This problem
affects 20-25% of all long distance runners at some point in their career,
including the author. If you have it, you are not alone! It seems to occur with
the longer or harder runs when blood may be shunted from the GI tract to the
working muscles. In most of us this isn’t a big deal but in others it can lead
to diarrhea. As noted above, this feel can be almost explosive in nature and
that if something isn’t done about it quickly, well, there’s going to be a
problem! I’ve read that it’s sometimes considered more common in the lactose
intolerant.

Many will discuss this with their family physician, and
frequently, even a colonoscopy can be recommended. Unless you are having bloody
diarrhea, I think you can pass on the colonoscopy. (Had you nervous there for a
minute didn’t I. Actually, a colonoscopy is less of issue than you might think
as I can say from personal experience as an over 50 year old male.)

So, if
you happen to be suffering from this condition, here are some
suggestions:

Maintain adequate hydration
Avoid caffeine as it’s a
colonic enhancer
Try to eat several hours before you run
Plan your route
to include a rest room (I run near a golf course with lots of them)
Avoid
warm fluids before a run
Limit high fiber foods in the days before a
race
Consider a trial of limiting dairy foods for a couple weeks
Increase
exercise intensity gradually letting you body adapt to the up/motion

And, the one you won’t want to hear, a reduction in exercise. Some have
the best results when they can reduce the intensity of exercise SIGNIFICANTLY
for a few weeks with a gradual return to the previous high intensity workouts.
On good time to do this is after your “A” race when you’d normally back off a
little any way.

I can remember folding up toilet paper and putting it in
my running shorts “just in case” as the Beatles might say, I had to Do
It In The Road. It will go away but it may take some changes on your
part, and, sorry to say, some trial and error.

Swim Sighting

Sighting – lifting your eyes out of the water to see where you are going – is a very important skill in open water and triathlon swimming. The mistake most swimmers make is to crane their head high out of the water to try and sight and breathe at the same time. This sinks your legs, adding lots of drag (even in a wetsuit) and ruins your stroke rhythm.

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P’s and F’s of Plantar Faciitis by John Post, MD

“Wish I didn’t know now what I didn’t know then.” Bob Seger

They say there’s no accounting for taste. This is a shot of my favorite runner in
the Ironman Hawaii Underpants Run. It’s done two days before the race
to raise money for a local charity and it’s plenty of fun. Just don’t choose this
outfit!

Tips to rid your life of plantar faciitis

As most of you know, many from personal experience, PF
is pain on the sole of the foot, usually at the back of the arch and front of
the heel. It’s usually worse the first few steps you take out of bed in the
morning. So, some recommend 1) tracing the alphabet in the air with the toes of
your raised foot. 2) Immediately after getting out of bed, step into supportive
footwear. Walk on the outside of your foot for the first ten steps. 3) Don’t go
barefoot or in slippers unless the slippers have arch supports. 4) In your
morning shower point the nozzle at your heel and arch and let HOT water soak
the injured area for at least a minute or two. 5) Wear arch supports in ALL of
your shoes, especially those you wear the most when not exercising. Do not
put weight on your feet unless they are properly supported! This is particularly
true with your “knock around” shoes. Leave the flip flops in the closet while
trying to recover from this serious injury. 6) Again, supportive shoes in the house
and don’t go barefooted. 7) In the evening and before you run, stretch and
massage.The old wall push up, half with the leg straight and the remainder with
the knee bent 30 degrees. These may hurt little so go slow and gradually stretch
this area. No hurry as this is not the no pain, no gain situation.

Lastly, every evening after you’ve stretched, apply heat then ice (no more than
10 minutes) to the arch/heel of your sore foot. I’ve seen people use a frozen
water bottle very effectively.

I’ve had good success having athletes sleep with a plastic brace on their ankle
in a plastic brace, an AFO, to keep the ankle in neutral. The running shoe
stores have something called the Strassburg sock which seems to offer the
same night time support but I have no experience with it.

In my practice, if this isn’t effective when combined with decreased running,
I ask the athlete to head back to his trusted shoe guy for a reevaluation of
shoes and gait before getting into anything that hurts (like an injection) or
costs money (like an orthotic.)

How and Why to Train Through Races, Instead of Tapering

As we head full on into race season, tapering is the topic on everyone’s mind. Should we taper for every race, how do we recover from the race, and how do we get back to productive training as soon as possible. The process of tapering I have talked about in previous articles. What I want to talk about here is the process of training through smaller, less important races that we use as stepping stones to our BIG races.

We can only really go through a full taper process 2 or 3 times per season without losing fitness—these tapers should ideally be a month or more apart.

For smaller races we do not maintain our full training schedule right up to the race either. Instead we have a mini refresh before the race and train as normal immediately following the race, essentially treating the event as an important training session.

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From Good to Excellent: Training to Win

This article is about the training strategy that took ironguides athlete Leonardo Moreira to an age group win at Ironman Brazil 2011. It explains the strategies we used to win the M40-44 age group and finish in 9hr 03, a 19-minute PB for Leonardo.

When a coach is working with an improving Ironman athlete who over the years managed to go from 10hr 56 to an age group (M40-44) win with 9hr 22 at the age of 40, both coach and athlete are faced with a new challenge.

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Car vs Bike – Car Wins Again by John Post, MD

Natascha Badmann, 6 time winner of Ironman Hawaii, seen here

exiting T1 minutes before a bike crash on the Queen “K” that

would not only take her out of the race but give her training and

racing problems for the next year and more, potentially a career

ending injury.”

Recently, there’s been a three part article in the
local paper about Matt Miller, former swimmer on the UVA team who gave

it up for triathlon. While training on the Blue Ridge Parkway in November ’09, he

lost control of his bike and slammed into the front of an MG. By a stroke of

incredible luck, the car behind the MG was driven by another doc from my

hospital, an anesthesiolgist as chance would have it. Matt had broken his jaw

in two places, along with every bone in his face, and was drowning in his

own blood, until quick action by the doctor opened his airway allowing him to

breathe. When taken to the trauma center, his family was told he wouldn’t

survive. But survive he did with multiple operations, titanium plates on his

broken facial bones, a breathing tube in his neck, etc. Surprisingly, he suffered

no other major injuries.

His old college coach got him back in the pool recently where
he was able to crank out a “pedestrian” 59 second 100! And although he still
looks forward to several more operations to put his face back together, he
managed a top ten finish in a Philadelphia time trial. Go Matt!!

We take from this that it can happen to anyone…including you and me.

So, when you leave home on that solo ride, tell someone where you’re going,

approximately what time you’ll be back and if you have a cell phone, take it with

you and turn it on. (I’m quite guilty of having my cell phone with me but always
off.

Consider getting a Road ID. This inexpensive ankle strap yields
basic identification, emergency contact phone numbers, etc. and mine has my
allergy status, medications and my blood type (a good thing for the ER doc if
you plant your face into the grill of a classic car. And lastly, anytime there’s
a close call with a car, try to figure out how you can avoid that next time.
The car usually wins! Safe biking to you all and pass this
along.

John Post, MD

Get A Black Belt in Running

In some ways I am in a unique position. A fourth degree Black Belt/Instructor AND an endurance athlete. In studying both sports there are a lot of similarities both from a physical and psychology perspective.

So what are those parallels and what would someone have to do to earn a Black Belt in running?

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Will Varicose Veins Slow You Down? by John Post, MD

Will Varicose Veins Slow You Down?

I don’t want to work, I want to bang on the drum all day.
Todd
Rundgren

So you’ve got some vein concerns, eh? Well, they’re pretty
common. Although some folks seem more prone than others, half
of all adults over 50 will have them to some degree. “Very close veins” as some
of my patients call them occur as small “spider veins” or the larger “varicose
veins.” We know that blood in veins only goes one way, back to the heart, but
when the little flaps of tissue known as valves, inside the veins, fail they can
become enlarged, twisted, swollen and occasionally purple or blue. In the
advanced stages they can lead to skin breakdown and infection but early on it’s
more of an appearance issue. Some folks might complain of an aching pain in
their legs, legs becoming easily tired, swelling, darkening of the skin, and
even itching or a rash.

In their most advanced stages, VV can lead to
blood clots in the deep veins of the leg, always a bad thing as they’ll
sometimes break off, travel to the lungs, and not infrequently lead to
death.

So what do we do? Things that have been shown to help include
sunscreen, regular exercise (presumably not an issue in you), weight control,
elimination of constricting clothing on legs, groin or waist, support stockings
and elevating your legs when you sit. Some choose sclerotherapy, or injection of
the veins which can significantly reduce or eliminate the smaller ones. Laser
therapy is used in a similar fashion as well being placed inside the vein to
shrink it. This is especially effective in the deeper veins. It’s done in the
doctors office under local anesthesia.

Lastly, ligation (tying off) and
stripping (pulling out) in an operating room can be performed for the more
involved problems. It’s still performed frequently.

In short, most
people don’t need to do much about them…but complain…but if you need to,
there are docs who specialize in vein issues who can evaluate you, define the
severity of the problem and give you alternatives that are right for you

Simple Solutions For ITBS (Iliotibial Band Syndrome)

Runner’s Trots

Simple
Solutions For ITBS (Iliotibial Band Syndrome)