Got a lump on the back of your knee? Somebody mention Baker’s Cyst or popliteal cyst? Although it may be news to you, these are more common than many people suspect. While not normally an isolated finding, there are two bursae (bursas) in the back of the knee joint which can fill with fluid. Even though it feels like a mass, and when we think mass we think cancer and these have nothing to do with cancer. Most commonly these are a secondary process in reaction to something going on in the knee joint itself. They are neither life nor limb threatening but can be quite bothersome. They are not the result of an infection. People who have them will report that some days they’re large, some small, and while intermittently painful, the patient can actually be symptom free for much of the time. Continue reading
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Athlete Case Study
Case Study
Male Athlete’s Statistics:
Height: 6’1
Weight: 200 lbs
Race: 70.3 Galveston, TX
Report:
The athlete hydrated every 10-15 minutes averaging 30 oz of fluid an hour totaling 75 oz on the bike portion.
Took in about 480 calories an hour (288 from liquid, 192 from gels).
Total sodium intake per hour was 1160 mg (1080 mg from liquid and 80 mg from gels).
Lower average watts for bike portion and felt like some energy was needed to be saved in order to finish the run.
Athlete reported to have brown urine color with a bad odor at the end of the race – meaning he was severely dehydrated.
Initial first step is to determine what the athlete’s sweat rate is. The athlete did this in race like weather conditions with a 120 minute run. A nude body weight was taken prior to exercise and again after exercise (and after being wiped down dry with a towel). Convert the weight lost into ounces (1 lb = 16 oz). The athlete drank 80 oz of water during exercise and consumed 2 bags of chews totaling 120 g. Then add back the amount of liquid consumed with the total lost. Divide this number by the hours he exercised and notice his sweat rate is 96 fl oz/hour (~6 lbs an hour) or ~2.8 L/hr.
During the sweat test you can tell he was 5% dehydrated when he finished which is not good. Your performance decreases significantly at 2% dehydration (~4 lbs an hour for this athlete). Another problem noticed in this sweat test was that there was not enough electrolytes or carbohydrates consumed during exercise. The electrolytes will help maintain your fluid balance, increase your thirst mechanism to encourage hydration, and will help you optimally perform. The carbohydrates will help fuel you through the work out, also allow you to attain better training adaptations. Another aspect to keep in mind is that recovery can improve with proper hydration and fueling.
Recommendation:
Sports drinks (ideally 3-6% carbohydrate beverage with 2:1 ratio blend of sugars, no protein) will need to be consumed since this subject has such a high sweat rate and energy needs. Plus they will help provide electrolytes to aid in maintaining hydration. Since the athlete is a heavy sweater, extra electrolyte supplementation may be needed. Typically when losing 2 Liters plus per hour you are losing a lot of salt as well (~1500-1700 mg).
This athlete should focus on about 320-350 calories an hour for a half ironman or full ironman distance race. This needs to be trialed in brick workouts. If he were to add gels, he would need to make sure that he doesn’t add too many carbohydrates because that can lead to stomach distress (caused by slow gastric emptying).
The target for fuel should be 75-80 g of carbohydrates an hour. Typically endurance athletes will oxidize or utilize that much per hour with the highest being recorded over 90 g per hour (rare to oxidize at the highest amounts).
This wasn’t a pure scientific test, but a good quick and dirty method to fine tune nutrition and hydration plans to help this athlete race at his best in the future. These are merely suggestions to start at, and tweaks may be needed.
Another reminder: the days leading up to your race that your nutrition and hydration is just as important and can play a role on your race day performance. As this could have played a role in this case. Never start a workout or race dehydrated.
~Analysis conducted by Nick Suffredin, formerly a scientist at the Gatorade Sports Science Institute where he worked on testing elite professional athletes to enhance their hydration practices and nutrition intake to improve their performance. He has been part of human performance and sports nutrition advisory boards. Currently provides endurance and nutrition coaching as well as consulting. He enjoys spending time with his wife Melanie and daughter Makayla. For coaching and nutrition inquiries Nick can be contacted at: [email protected]
Arthroscopy for Arthritis, When is it Appropriate? by John Post,MD
“I’ll take any risk to tie back the hands of time.” Styx
Triathlon covers all walks of life and all age groups. It’s addictive, and it’s cumulative training, plus getting older, can have deleterious effects on the body. Why do we see fewer and fewer folks in the older age groups? It’s not ’cause they’re busy playing Mahjong at the Senior Center. As we begin to “wear out” arthritis can become part of the picture and we reach for the cure so we can continue training and racing.
When the knees start to go (and we’re not talking about the patient with some type of inflammatory arthritis here), many remedies can be recommended and be helpful including rest, or decreased training load anyway. Some variety of braces or sleeves are often of benefit. Therapy of one form or another with oral meds and injections have been known to be helpful in specific cases. And what about surgery? Continue reading
How To Have A Perfect Workout
Sometimes coaches and athletes have different ideas about what makes for a great workout. As a coach, the easiest part of my job is posting a workout. As an athlete, the easiest part of your job should be doing them. Sure, some workouts are really, really tough and some intervals might make you want to puke. But the easy part I’m talking about is completing them according to a plan.
Here’s the recipe for completing the perfect workout.
Work Out Guilt, of Course You Have It by John Post, MD
“It’s not having what you want, it’s wanting what you’ve got” Sheryl Crow
Triathlon training takes a long time. (“Duh”, many of you say.) This is especially true when preparing for the longer distance events. There’s only so much you can do squeezing training in and around your schedule before you have to do the same to their schedule whether “they” is wife, husband, kids, co-workers, etc. Frequently we find ourselves battling that inner demon who tells us that we need 30 more minutes on this run but our soul tells us to go home and relieve the baby sitter.
I was rereading John L. Parker, Jr.’s “Once a Runner” this week and thought a page spoke directly to this. I’m sure you’ve all read this wonderful text – if not go to Amazon.com and order a copy right now – but wanted to refresh your thought processes reminding us that endurance athletes have had to vault this hurdle for ages. Continue reading
The Importance Of Warming Up
Recently along the Front Range we had our first outdoor Triathlon of the season. Temperatures had been in the 80’s earlier in the week but Friday night the mercury plummeted and the wind started to blow hard from the North. This particular race is held in Longmont at Union Reservoir in open country. There is not much stopping the wind from the North to the South except the open prairie. Air Temperature was just above 50 degrees, and the wind chill, was in the low 40’s. The water temperature was a balmy 65 degrees. Continue reading
Knee Collateral Ligament Injuries by John Post MD
“…fate comes at you cat-footed, unavoidable, and bloodthirsty.” Pat Conroy, South of Broad
We hear a lot about knee ligament injuries, especially when they happen to someone else. But when it’s our knee that’s out of commission from falling off the bike while still clipped in, or twisted water skiing at the lake, it’s a different matter. The ACL or anterior cruciate ligament gets a lot of press. Bode Miller, Tom Brady, Tiger Woods. But the collateral ligaments (Tom Brady again) seem to take a back seat here. One reason could be that they usually heal without a lot of fuss so maybe less notoriety as well. Continue reading
Climbing Mountains Part Two, Being Afraid by John Post, MD
“Do the conditions you encounter exceed your abilities?
Although we as triathletes push pretty hard sometimes, we’re rarely outside our comfort zone in other than a physical sense. In last week’s blog, I briefly described hiking the John Muir Trail with my son Ben a couple years ago. This was a six day journey through wooded areas, over many creeks and streams, as well as some fairly steep mountain trails culminating in standing atop Mount Whitney, the highest peak in the lower 48, with it’s seeming 100 mile view. On the third day, our longest, after traversing some pretty difficult to navigate terrain (since we were so early in the season and didn’t have the benefit of hikers before us marking the correct trail), we crossed one particular river and unbeknownst to us, were off the trail. Way off the trail. We tried to back track to a known point, but we were lost. Lost in billions of acres of land…with no GPS…no cell service…no plan “B”, no nothing. The only way out of this was to think our way out. And, yes, we were at least a little afraid (although maybe the bears and mountain lions were a little afraid of us too. Maybe.)
It’s times like this that occasionally you don’t think terribly rationally. Like during the run in an iron distance race. In the former, although you have a tent and food for a week, you don’t know where you are. And, the in latter, you’ve trained for this for an awfully long time but are rapidly running out of energy and ideas at the same time. You may have to…oh, don’t even think it…walk! And walk a lot. Continue reading
What To Do When Your’e A Sick Triathlete
Sickness seems to be hitting plenty of athletes right now with the very changeable weather this spring. Training hard in the final weeks before the main races of the season start, your chances of catching an illness are high.
If you’re unlucky enough to pick something up, what should be the protocol with training?
Firstly, maintaining your level of training as normal when you’re sick is not wise and can do a lot of damage to your body. It can also prolong, or increase the intensity of, the illness. As soon as you start to display any sign of illness, you need to move away from your planned training and into recovery mode.
Training Doldrums, or 14,496.811 feet by John Post, MD
Training Doldrums, or 14,496.811 feet
Mt. Whitney, California, 14,496 feet, 7/17/2010
“Nothing happens by accident. I learned this the hard way, long before I knew that the hard way was the only path to true, certain knowledge.” Pat Conroy, South of Broad
I’ve been told that many of us train all winter with a subconscious goal, not of the season of races, but primarily with the season opener in mind. How were my transitions last year in race #1, am I prepared to exceed my swim time from last year now that I truly understand the course? That sort of thing. So, that regardless of this years performance (hopefully good), once the race is over some of us lose our way. We have difficulty finding that intensity, that focus, that drive. I don’t think that this is uncommon. Continue reading