Category Archives: Run Advanced

SELF INDUCED INJURY, TIBIA FRACTURE by John Post, MD

Self Induced Injury, Tibia Fracture

I have given a name to my pain, it is Batman.” Jack Nicholson as
The Joker
And speaking of pain, I was recently asked asked about a blog I did on stress fractures a little while back and thought the following important as we set our training plans for the upcoming season. Although our weather forecast here in Virginia calls for 6 – 12″ of snow tonight, athletes everywhere are creating training plans to fit race schedules this Spring and Summer.Even the lawyers at a bicycle accident law firm would be surrounded by questions. Especially from athletes. So many athlete’s questions involve self-induced injury! If there are any accidents, lawyer for bike accidents can be hired! Time and again when a triathlete reports a physical issue, and then comes up with an, “I know when I did it” type of answer, I think about prevention. Any list of the most common overuse injuries in runners would include : 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 tendinitis (6%), 8) Gluteus medius injuries (4%), 9) Tibia stress fractures (4%), 10) Spine injuries (3%) as noted recently. People can get AED Training in case of any first aid injuries.

In one medical study, 6 young men presented with midshaft tibia stress fractures which failed to heal with the usual conservative care of rest, immobilization, etc. and 5 went on to complete fractures!! Think having a rod place down the middle of your tibia might alter your training?

We also think of the metatarsal bones in the foot as commonly seen sites of stress fractures but I was taught that they’ve actually been reported in all 26 bones in the foot and the sesamoids.

The take away lesson here is that none of us is immune. Running programs which ramp up more quickly than the athletes body can take can be hazardous to ones health, and that when weather or life get in the way of training, the better choice might be to just forget a work out or two rather than accept overload at a later date. Each of us is different as we define overload so just because a training partner can work at a certain level does not necessarily mean we can. If we just think before we make choices and listen to what our legs are telling us, we reduce the potential for self induced injury. And, we’re more likely to kick butt in that first tri. Good luck. But, if there are any injuries, personal injury lawyers based in Arkansas need to be hired.

www.johnpostmd’sblog.blogspot.com

Triathlon Swim Starts

TRAINING ADVICE FROM HEAVEN by John Post, MD

Training Advice From Heaven

ALII DRIVE, start and finish of the Ironman World Championship. You can bet this snowy picture wasn’t taken in Kona!

Dick Tomlin was a friend. A super triathlete, he podiumed twice in Kona and even won Worlds one year. He was killed on his bike in June 2005 when he was the victim of a hit and run by a motor home while training near his Kingman, AZ home.
The last time I talked to him was in February or March of that year when he was trying to help me get faster and I was trying to help him with some pain control issues he was having with arthritis in his lumbar spine.

The following is going to be a little disjointed, just like a phone call, where we talked about whatever came to mind. Even though Dick is no longer with us, you’ll see that he has a number of important training points to make: he credited his age group best bike speed to consistency, lots of winter miles indoors, abundant one-legged drills. He would decrease the resistance and do 100 revs with the right leg and then the left. Repeat this 6 times, “like wiping your feet on the floor mat.” Learn how to cycle with each of your legs.”
For short course tri preparation, he’d ride “really hard sprints.” He’d set up a one mile course near his home where he’d ride faster than race pace and, “Do a dozen with 15-20 seconds rest in between.” He didn’t do much hill work as “The races I do don’t have ’em.” Although he usually rode alone, he had one friend, a CAT 2 cyclist, who he’d been riding with for 12 years allowing, “Those guys know so much, it really pushes me up.” Weights were important as he’d follow Joe Friel’s Training Bible, “Except the max weights,” 3X’s/wk in the winter and once/wk in season. An average training week would include 110-120 miles on the bike, 25-30 miles running and 8-9,000 yds in the pool, he’d “Work up to double this for Ironman.” This would be “22 hours/week in late July and hold it to September.” He wanted 8 consecutive weeks over 250 on the bike and 50 on the run, reserving one weekend day for a 5 hour bike and a 2-2.5 hour run. Or, for variety, it would be a 2hour bike and 3 hour run. Clearly he was motivated.

But, Dick was not without pain as he’d had both knees scoped in 1998 noting, “I’d run in pain for a decade.” He took his share of Glucosamine. Plantar faciitis was a continuing issue. And I already mentioned his back. But he did not shy away from what he perceived as the work required to be tops in the age group.

And he was a nice guy.

Training a bit of a problem on your street, too?

Barefoot Shoe Running Review (Minimal Shoes)

The introduction of the barefoot-style running shoe was something eagerly awaited by runners, triathletes and duathletes around the world. In the past, most athletes wanted a light-weight racing shoe to compete in but, if truth be told, a large percentage of them were looking at this for all the wrong reasons. Either the running shoe could simply not handle their body weight or their running style just did not suit the minimalist nature of the shoe, or sometimes both. What this inevitably lead to were injuries in untold proportions (and certain people rubbing their hands in glee with $ signs in their eyes.)

Word soon got out and so athletes started to return to conventional running shoes. That was until the introduction of a report in 2009 by Dr Craig Richards from the University of Newcastle in Australia. His report concluded that shoes with elevated heel pads and elaborate anti-pronation systems can’t prevent injuries in runners. This was backed up in an excerpt from Born to Run, a book by journalist Christopher McDougall. The story referenced Dr Daniel Lieberman, professor of biological anthropology at Harvard University, who offered the conclusion that “a lot of foot and knee injuries currently plaguing us are caused by people running with shoes that actually make our feet weak, cause us to overpronate (ankle rotation) and give us knee problems.” Continue reading →

POOL RUNNING CAN BE FUN by John Post, MD

Pool
Running Can Be Fun

“You got to do what you can, and let Mother Nature do the rest.”

Meat Loaf

At some time in our careers, water running, or aqua jogging,
will be recommended as a method of cross training injured athletes. Others find
it an ideal form of non-impact aerobic training. Basically, you
“run” in water that’s deeper than your limb length. This can extend from the
diving well up in to the lanes, with a flotation vest or belt to increase
buoyancy…so you don’t drown. Although most run the length of the available
area, others attach themselves, say to the ladder, and run in place. Running
with a partner provides easy conversation, or, a water proof source of music
may be of benefit. One attempts to mimic one’s form as closely as
possible to that used on land.

Mimicking run duration and intensity is also important. For
example, if you’re scheduled for 45 minutes of steady running, do 45 minutes in
the water. As you’d imagine, heart rates will be lower but many find that they
can come within about 10-15 beats/minute of their land running HR. It’s possible
to run intervals repeating levels of intensity done on land.

Athletes have shown that not only can they maintain their level of
fitness, but with dedication can actually improve. This comes into play
when one begins to return to the road. Initially, shorter workouts can
be supplemented with time in the water keeping the workout time “whole.”

Again, it’s a priority to duplicate your form on land, arm swing, head
position, elbow engagement, etc. If your pool has both vests and belts,
you may find one or the other allows you to more easily maintain this action.
Your hip flexion will likely increase in the pool giving you an artificially
lengthened “stride.”

Like many, I am currently water running at the end of my swim workout. And,
watching the others in my swim group continue to turn out the yards is all
the distraction I need to stay focused. And, I can still joke with the
lifeguards while I’m running!”

STRESS FRACTURE, EH? PART TWO by John Post, MD

Stress
Fracture, Eh? Part Two

This is Ironman Week here in Kona as the sleepy fishing village and
occasional port for cruise ships turns into Triathlon Central. There are
people everywhere, fit people, running and biking up and down Alii Drive.
I hadn’t been here an hour before seeing Norman Stadler and Chrissie
Wellington. Good luck to them both on Saturday! It’s going to be a
fun week.

“Dig Me” Beach, a term I heard
credited to Scott Tinley, is seen here, soon to be clogged with
swimmers trying to get used to the change from simply following the
line on the bottom of the pool to the gentle waves and salt water of
the Pacific in Kailua Bay.

But the athlete with an injury like a stress fracture is
sitting home, an opportunity missed. I covered the basics of stress fractures
here 1/15. That these are in the category of overuse injuries where the
muscular envelope of the lower extremity becomes fatigued and the skeleton
is unable to adapt to the increased load.

The bone fractures as it is unprepared for the intensity of exercise delivered.
This might be advancing one’s training program
too quickly, changing from the relative forgiveness of the running track to
asphalt or concrete, aged or improper equipment or increasing exercise duration
as a tennis player with a substantial increase in court time.

There are 26 bones in the foot and most likely all of them have been subject
to a stress fracture at one time or another. They are frequently seen in the
other bones of the lower extremity when insufficient rest is included between
workouts. People taking Prednisone, Dilantin and other medications are at
increased risk. Women have more than men.

The predisposing symptom is pain, not so much at
rest, but brought on by exercise and it worsens. Although occasionally
visible as a crack in the bone on x-ray, frequently these films will be
negative. If the examiner finds point tenderness over a bone and a stress
fracture is suspected, an advanced study like an MRI, or more likely a bone
scan, will be order. (This is not to be confused with the DXA, the bone scan
used to measure osteoporosis, predominantly in women.)

If diagnosed, the order of the day will be rest.
This can be up to 6-8 weeks, some will be placed on crutches or given a fracture
boot, but if one returns to sport before it heals, chronic difficulties can
follow making healing a challenge. Triathletes might be shifted to pool running
and biking so as not to lose excessive fitness.

So, if you have recurring pain in the same location, and think this may
potentially describe you, get it checked out, you’ll be glad you did.

John Post, MD Kona Resident 10/1-9
www.johnpostmdsblog.blogspot.com

THE MENISCUS; TORN YOURS? by John Post, MD

The
Meniscus – Torn Yours?

”
I don’t need a whole lots of
money, I don’t need a big, fine car. I got everything that a man could want, I
got more than I could ask for.”
Grand Funk

In other
words, my knees work just fine, thank you.

The meniscus is an
important structure in your knee. Menisci, actually as we have two in each knee,
an inside (medial) one and an outside (lateral) one. They are “C” shaped bits of
fibrocartilage also known as semi-lunar cartilages which serve many functions.
This is important as it wasn’t that many years ago that surgeons felt the
meniscus to have no purpose and excised them at will, especially in the
pre-arthroscopy days. Some of you no doubt can remember that HS athletic injury
by looking at the sizable scar on your knee from your open menisectomy
(excision).

It’s currently felt that the meniscus aids in the lubrication
of the joint, stress transfer from femur to tibia, and that it contributes to
the stability of the knee. Unless injured, the meniscus will provide a lifetime
of service to it’s owner with out complaint. That said, through injury,
arthritis or just plain bad luck, any among us may suffer a “torn knee
cartilage.” As was true for both Tom Brady and Tiger Woods, the tear can
accompany injury to one or more major ligaments. Usually bad news.

Frequently, the injured triathlete will have a physical exam, x-rays
and/or an MRI with subsequent arthroscopy to remove or repair the damaged
meniscus. (In highly selected cases, a meniscus transplant may be considered
when more traditional methods have failed.) The arthroscopy is done in the
sterile environment of the operating room under a variety of types of anesthesia
– most of my patients watched theirs on the TV at bedside! The scope is
introduced through two 1/4″ punctures which rarely even need stitches at the
end. Oftentimes the procedure is completed in under an hour, there are no
crutches, and rehab exercises begin in the recovery room.

The surgeon
who’s seen the inside of your knee is likely in the best position to determine
your return to sport, possible limitations, etc.

Take good care of your
menisci, they should last a while!

John Post, MD

www.johnpostmdsblog.blogspot.com

Image 1 from Google images

BROKEN TOES by John Post, MD

Broken Toes

St.
Peter’s Catholic Church is a tiny house of worship located at the 5 mile
turn around where the Ironman Hawaii competitors head back to town and
their journey on the Queen Ka’ahumanu Highway. If memory serves, there
have been five different run courses since the race moved to the Big
Island from Oahu in1981.

True story. A local athlete participates in the regional 70.3 race, and
seemingly coordinated in other aspects of life (yes, he can walk and chew gum at
the same time) he has broken a toe twice at this race site before really getting
his race going.

The first was his big toe having finished his warm up
swim, wading back to the starting line, when he kicked a submerged rock…and
Whammo – broken toe. Two years later, after exiting the 1.2 mile swim, running
to the transition area on a long green miniature golf-like carpet, he tripped on
a small fold in the carpet…and Whammo #2, a 4th toe broken on the other foot
and the nail pulled 1/2 way off. And bleeding!. He finished both
races!

Most broken toes are the result of trauma although I’d expect
several of you to have suffered stress fractures of the same bones. We’re
covering the former today. Usually they occur secondary to an axial load such as
a stubbed toe or some type of crush injury…such as dropping your bowling ball
on it. Most will have significant pain at the time of injury although those with
preexisting osteoporosis (thinning of the bones or loss of bone stock) may have
less. Accompanied by less trauma. The injured usually are noted to have point
tenderness at the site of the fracture although the skin is normally intact. The
toe may be pointing a different direction…always a bad sign!

Although
it’s usually not an emergency, an early x-ray can be very helpful both in
diagnosing the type and location of fracture, displacement if any, etc. A
negative x-ray is no less useful. Also, in children, an x-ray can frequently
reveal the presence or absence of a growth plate injury.

In fractures of toes 2-5, usually both the injury and treatment are less involved. Oftentimes, if the fracture is satisfactorily aligned and stable, simply taping the toe to it’s next door neighbor, avoiding activities which might tend to displace the ends of the bones and occasionally a fracture shoe are all that’s needed. However, a break in the bog toe is a horse of a different color given the importance of this structure in balance, directional control and weight bearing. If displaced or into the joint, the fracture needs to be reduced and the joint needs to be maintained. This can occasionally require a surgical procedure and prolonged post operative immobilization.

In short, if you think you may
have broken a toe, and the pain doesn’t subside in a reasonable time, why not
let you local Urgent Care or health care provider take a gander and consider an
x-ray.

John Post, MD

www.johnpostmdsblog.blogspot.com

8/17/2011

Surgery, What if I need it

“I Always Win the Transitions”

REDUCING INJURY POTENTIAL THROUGH “DATING” by John Post, MD

Know
Your Stuff

YIKES,
it’s on the inside too!

“Don’t mistake activity
for achievement.” John Wooden

It’s been
stated before that preventing an injury is usually preferable to treating one. For any kind of accidents and injuries, the lawyers from Hale Law, P.A. can help with your accident can help you!
My oldest son Chris is a superb runner…won the local 5K last week going away
in 16 and change…and it didn’t look all that hard for him. I’m not certain if
I fell off a cliff I’d go that fast. He works at Ragged Mountain Running Shoes,
a one owner shop for over 25 years. This store is a fantastic resource for the
area athletes as owner Mark Lorenzoni has seen EVERYTHING that can go wrong with
an athlete, and frequently diagnose and fix the problem on the spot. Every
community should be so lucky to have someone like Mark. If people want to check accident related information, they can click here to check a wrongful death law firm!

One important
lesson I’ve learned from Mark is to date everything. Do you know exactly when
you purchased your most recent pair of running shoes? The last chain for your
bike? Your tires? By dating/recording the purchase, you have a better idea of
the products longevity and are less likely to have an on the road failure or
injury. If uou hire injury and accident attorneys, you can read this to learn why and get to know the advantages of the same! I practice this religiously and have had six 112 mile rides on the Queen
K, all without bike related failure. (But don’t ask me how my butt feels when I
dismount.) If people have to know how to recover from the traumatic injury, they can check the lawyers’ advice from this firm. It is also advised to consult an attorney from the car accident law firm in Riverside to get compensation for the injury and damage caused.

So, why not take a Sharpie and put the date of purchase on the
sides of your new tires and the tongue of your running shoes? Add the date of a
new saddle or chain purchase to your training log and if you ride more than one
bike specify which ride got the new chain…and whether or not a new cog was
part of the deal. You’ll be ever so glad you
did.

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

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.