Category Archives: Run Advanced

Knee Arthritis, the Aging (Over 30) Triathlete by John Post, MD

Sister Madonna Buder sets the example for us all

“You’re not shy, you get around, you wanna fly, don’t want your feet on the ground. You stay up, you won’t come down…” Foreigner

Of the over 100 Rock Star pieces that I’ve done, the one that has generated the most interest was about arthritis of the knee and a procedure known as microfracture. This is an arthroscopic operation where an attempt is made to allow the damaged cartilage to heal itself. It’s usually pretty successful but the results may not last forever. In cases where microfracture is considered inappropriate, Orthopedic Surgeons have other arthroscopic tricks that can hopefully extend the life of the knee. One of these involves transplantation of bone and cartilage plugs from one part of the knee to another. Continue reading →

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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Arthritis, Part Three by John Post, MD

Supper time at the old triathletes home

Making it to Kona (written on the Big Island)

“And another one’s gone, and another one’s gone, and another one bites the dust, heh heh.” You know who sang these words. But, earlier in his career, singer Farrokh Bulsara (you now know him as Freddie Mercury) was going nowhere in a band called Sour Milk Sea. He took a look at his past, present and unpromising future, and made the changes he felt were required to reach the top. I guess the question is…are you willing to make the sacrifices Freddie made to get here? But first, answer these three questions: Continue reading →

Hematuria, Blood in Your Urine by John Post, MD

Hematuria, blood in the urine

“Oh yeah, life goes on, long after the thrill of livin’ is gone.” John Cougar Mellencamp

But Lew Hollander, yellow cap, would say you’re way wrong. At age 81, he finished his 22nd Ironman in Kona this year. He says it’s how he “tests” himself. Hard to have higher personal standards than Lew, a role model to us all. He also makes many older triathletes jealous as he’s basically able to do this with only a modicum of injuries, often the rate limiting step to continued performance, particularly as we age.

Ever stood astride the commode after your long run, and instead of the usual concentrated deep yellow urine, you see blood? Yep, it can be quite a shock. But, like most things, if you take the time to do a little research you can narrow the list of possibilities…and cancel the call to the funeral home. Continue reading →

Knee Collateral Ligament Injury 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 who is dear to you who got injured and need an attorney’s help. 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 →

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 Triathlete and Joint Replacement by John Post, MD

The Triathlete and Joint Replacement

“Some day I’ll wish upon a star, and wake up where the clouds are far behind me. Where troubles melt like lemon drops, away above the chimney tops, that’s where you’ll find me.” From, “Somewhere Over the Rainbow” (Or, it could be the unrealistic attitude of the triathlete with lower extremity arthritis when told that a joint replacement is in his/her future.)

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“When I wear these knees out, I’ll just get ‘em replaced and race another ten years.” (Joe Triathlete)

In the words of Johnnie Carson, “Wrong barn breath.”

Looks like, between me and Dr. Dan Kirschner, you’re getting your fill of medical information. Maybe better too much than too little. The first triathlete I ever met doing Iron distance racing with an artificial joint in place was a gent about 35 years old who’d taken a bullet to the knee in Vietnam – and he had no choice. Winston Allen, from Florida, had his knee replaced a couple years ago and has his eye on Kona this fall racing at 81 or 82. A tall order for anyone of that “vintage” even with two knees which came from the original manufacturer. (Too old you’re thinking? Not so. Of the four men in the 80 – 84 year old age group in Kona this year, 3 of 4 finished! Impresses me!)

A replaced weight bearing joint, be it hip or knee, is a reasonable approximation of the original equipment. But to date, we’ve not figured out how to make them last indefinitely. That said, we’re getting better. Current expectations are a product life expectancy of about 20 years depending on in whom the joint gets installed. Consider the different demand loads placed on the prostheses by your average Medicare eligible 65 year old looking for a bridge foursome versus a 50 year old triathlete with premature arthritis and stated expectation of returning to the sport. Continue reading →

Chronic Plantar Faciitis/Mumuku, the Wind That Blows Both Ways by John Post, MD

Puako is situated on the northwest coast of the Big Island of Hawaii. It is the home of one of the largest petroglyph (carvings in the lava) fields in the Hawaiian Islands. Found there are figures that are unmistakably those of the ancient Hawaiian warrior – the Alapa. Legend has it that, because of the intense heat and winds, this was an ideal training ground to harden these warriors making them Hawaii’s toughest and finest. Generally, the trade winds in the morning blow from the north, and as the volcanic soil heats up, the wind shifts around to the south.

This is especially important to would-be Ironman competitors as, after a crisp 2.4 mile swim in the Pacific with 1800 other racers with arms and legs flailing every which way in a scene more reminiscent of a washing machine than a swimming race, they mount their bikes and head north 55 miles to the coastal town of Hawi – you guessed it, into the wind. Unfortunately, by the time they reach this northern turnaround point, the land has heated sufficiently to reverse the winds, thus the bikers experience a headwind both ways – Mumuku! The locals think it’s cute.

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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.

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Notes From A Pregnant Athlete

REAP BENEFITS OF AN EFFICIENT RUNNING STRIDE by John Post, MD

A participant in the Underpants Run. A counter-culture event run in Hawaii two days before the Ironman where proceeds go to support a local charity. And yes, the shorts are bogus. Make sure you look at the rest of the runners.

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.

We tend to get complacent. To assume that because we have a great deal of experience doing something that we remain proficient at it. This is a major contributor to running injuries and a reason for people getting injured in a traffic accidents. Let’s try to reverse that. There’s already enough controversy in running equipment now…Newtons, Vibram, etc., that if we stick to what we know we’ll stay out of trouble. Let’s try to review the running stride and how to do our part to remain injury free.

Ben Greenfield preaches frequently regarding stride frequency. He feels that many of us over stride and this leads to higher loading of the lower extremity than is required for the given pace. He has his athletes take 22 strides per 15 seconds to minimize the impact seen by the limb. According to experienced defense lawyers in Rosemead, diminishing leg stress is obviously beneficial and not only might it give you a more compact running style, and help load the leg evenly decreasing injury, it might even contribute to a longer running career. If the lug injury is caused in an accident, then you can get traffic accident claims with the help of reliable lawyers. How many ex-runners do you know, out not because they’re tired of it, but because they can not stay injury free? Look at the race results of your local tri and compare the number of competitors in the 30-35 year old ager group to those of 60-65.

Mark Lorenzoni, owner of our local running shoe store, a man I’ve quoted here before, has over 25 years of caring for runners, and preaches the same thing. He wants his runners to count 30 strides per 20 seconds. He suggests they give themselves a “pop quiz” in the middle of the run after they’ve warmed up by counting the number of left foot strikes for 20 secs and checking to make sure it’s 29-30, regardless of pace. He’s convinced that the incidence of IT band problems and plantar faciitis is lower in athletes who do this.

He also is a big supporter of mid-foot strikers and tells clients to pretend they have a pebble under the heel of their shoe and they’re trying not to put too much weight on it at foot strike.

The take home point here is to have someone knowledgeable evaluate your stride at regular intervals and see if you’re as good as you think you are.

Can you identify the athlete on the left with the American Interbanc shirt just before the Underpants run start?

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