NJ State Olympic tri- coming soon. July 24.

So, I'm excited to compete in my first olympic distance triathlon. The training for a longer distance triathlon obviously requires different demands on your system, which I'm currently experiencing. Official "oly" triathlon distances for each even (in miles) are as following:


SWIM: 0.93 mi (1.5k)


BIKE: 24.86 mi (40k)


RUN: 6.2 mi (10k)

Training distances are a bit longer for each of the events, recovery times are a bit different, and of course, the overall strategy is going to be different as well. This is not a race where one can just go all out for each event...well, at least not for me.

My goal time is under 2:20 minutes, which would place me in the top 20 for the race overall (based on 2010 rankings). The goal is lofty, since it's my first oly, but hey, I'll be happy if I can get my time under 2:35.

My goal splits: 24 min swim (1:36/100 m), 1:05 bike (23.3 mph), 46 min (7:30 mi).

I have two concerns before me:
1) After my Wyckoff run catastrophe (read previous blog), my infamous cramps on the run haunt me (yes, I am always well-hydrated and electrolyte-balanced). I'm hoping Wyckoff will always be my one fluke race, so that I can get all the cramps out of the way.

2) My next concern is the swim. Most likely, no wetsuit for the race based on the high water temperature...though, in a way, I'm looking forward to swimming without the suit, because I'll be able to see how I really fare as an open water swimmer.

I'll be incorporating a lot of CFE (CrossFit Endurance) principles and generally higher intensity, lower volume of training strategies . More on training for the race coming soon...

Wyckoff Triathlon 2011. The good, the bad, and the ugly...

Summary:
In 10 years, I've never cramped in my quads/hams during a race or training...save both of my
tries at Wyckoff. I was debilitated during the swim transition to T1, T1 to the bike, and to cap it off, during the entire run. The race was an utter disappointment as a result, as my expectation of a 1:45 was high and well within the realm of achievable.

Ok, ok, all was not lost, however, as there were some notable high notes. :)

Stats:
Overall time: 2:02 (I did beat my Wyckoff 2009 time by 1 minute!).
Overall Place: 250/650 (better than the 406/750 2 years ago).
Age group males: 42/85 (ok, pretty good, all things considered).

Swim-
Swim went very well. My best open water 1/2 mile swim to date- I clocked out of the water at 14 min, but as soon as I reached the shore, the thigh cramps started, so by the time I completed my gimp to the sensor into T1, I added 4 minutes to my swim time...then I gimped some more during the 1/4 mile T1 to my bike. Bad, bad start and a hauntingly possible
deja vu of Wyckoff 2009.

Bike-
Sam's bike strategy helped me INCREDIBLY- average of 20.3 during the 17 miler with hills.
My best bike race pace to date! Thanks Sam! Not sure why I didn't cramp at all during the ride...and, I was so hopeful for a strong run...however....

Run-
I literally had to walk-jog the entire 5 mile run. Bam! Deja vu. I uttered a hysterical giggle at multiple times during the ordeal. My ABSOLUTE worst run to date...ever....even worse than my run time of Wyckoff 2009, which I also had to gimp through. 10:05 pace. I was miserable with hammie/quad cramps, but somehow mustered up a limping jog across the finish line for the fans, and, of course, for the photographers. I think people thought I had some sort of disability by the running "strategy" I chose to employ (if you could imagine a constipated countenance on a bow-legged, galloping, hunchbacked quasimodo, you might get a hint of what I mean).

Coolest part of the run- several people offered their gels, electrolytes, words of encouragement, and a pat on the back.

Ok, off to the next race. NEW JERSEY STATE OLYMPIC TRIATHLON. JULY 24TH!!

happy training!

Isn't swimming the safest kind of cardio? Not as safe as you may think...

I get this question often. As a triathlete, I can tell you from experience that any kind of repetitive physical activity produces wear-and-tear on the joint involved...and for swimming, there are a lot of joints involved and lots of potential for wear-and-tear.

Susceptible joints:

Shoulder- swimmers with poor technique (crossing arms midline during the pull, e.g.) can acquire shoulder problems like impingment syndrome, rotator cuff tears, and labral tears. Keeping one's hands/arms in line with the shoulder can prevent these types of problems as well as dry-land strengthening and conditioning aimed at improving muscular endurance.

Knee- meniscus tears are potentially high for the breastroke- that whipping frog kick can wreak havoc on the menisci, which are susceptible to twisting-type injuries.

Back- I've treated a number of swimmers in the past with back problems. Disc herniations, bakc strain and spasms are among the few. In fact, there are some types of back disorders where specific strokes should be avoided. For example- spinal stenosis (which usually occurs in the >50 crowd) sufferers should limit or avoid butterfly, freestyle or breastroke because lumbar extension is what worsens their symptoms in the first place. When I get a patient who tells me that their physician recommend swimming, I'm very careful about what exactly they'll be doing in the pool.

So, while swimming is an awesome calorie burning and cardiovascular activity, it is not as safe as people may think of it to be!

Do I need a prescription to start physical therapy? What's Direct Access?

"Oh, I want to start physical therapy, but don't I need to get a prescription first?" This is a common question that we receive from patients. The quick answer is....mostly no.

In nearly 40 states, Direct Access legislation has been passed, allowing doctors of physical therapy varying degrees of autonomy. For example, in the state of New Jersey, physical therapists are permitted to evaluate and treat patients without an MD prescription for most commercial insurance plans (BC/BS, United Healthcare, etc). However, Medicare, workers' compensation, and no-fault patients do require a prescription.

The advantage to you as the consumer is that your musculoskeletal pain (neck, back, shoulder, knee, etc) can be addressed far more quickly instead of the weeks of waiting that can occur when trying to see a physician. Also, while family/primary care physicians, and internists are adept in utilizing their knowledge of medicine and systemic diseases, physical therapists are trained in evaluating and treating musculoskeletal injuries and can usually arrive at a movement impairment diagnosis without the use of diagnostic studies such as MRI, X-ray. Physical therapists are also educated on medical screening and will send patients to the appropriate physician when a medical yellow or red flag may be present.

Don't I need to get an MRI or xray before I see a physical therapist?

Seeing is not always believing-

I will venture out and say that 95% of the cases I've treated- whether it be neck, low back, shoulder, knee, or ankle pain have not required a diagnostic study (MRI, X-ray) for a patient to be treated successfully. Any orthopedist, neurologist, or physical therapist will tell you that most of the time, musculoskeletal and neurological pain follow specific pain patterns and with a good history taken and thorough clinical neuromusculoskeletal examination, a diagnosis can be determined without a diagnostic study.

Case in point- We have had a number of patients who have had a "torn meniscus" show up on their MRI study only to have surgeons go into the knee arthroscopically and finding no tear.

Another case in point- MRIs demonstrate a 30% FALSE positive in determining the presence of a disc herniation. What does that mean? 30% of the time the MRI study will read that a disc herniation is present when in fact, a herniation is not even there. AND, even if a disc herniation is present, unless the patient reports very specific kinds of pain patterns (worse with sitting or bending forward, and sciatic pain down the back of the thigh, e.g), the disc herniation is probably NOT the cause of the patient's back pain.

When pain does not follow the typical pain patterns or if pain is constant, if there's night pain, or if conservative care does not bring about significant change in a few weeks, then a diagnostic study may be ordered by your physician.

I strained my quads yesterday after squatting. Should I stretch them out?

The intuitive answer for most people facing this question would be, yes. Perhaps, you figured
that you injured your quads in the first place because you haven't stretched them out enough in the past, so you should start stretching now. Bad idea. what?! but, why?

If you've strained your quads (or any muscle for that matter), then at the micro-level,
you've torn some of your muscle fibers; essentially, a strain is equated to damage to a muscle because it was either overloaded or overstretched during activity. Stretching the muscle right after an injury can actually worsen the strained muscle.

WWJD (What Would Jerry Do)? From a nutritional standpoint- Focus on getting the injured muscle healthier by drinking plenty of water, upping your protein intake (I would focus on whey and egg whites due to their high absorption rate into muscle), and
active rest. What's active rest? Avoiding activities that caused the injury in the first place.

Seeing a physical therapist can accelerate your recovery with a combination of modalities,
taping techniques to calm the muscle, and professional guidance. Stretching can be implemented after 10 days (past the acute stage of an injury) in a slow and gradual manner. After the acute stage, I recommend holding your stretches for at least 1 minute and perform the stretch for 3-5 times, several times a day because lengthening is best achieved with longer duration stretches performed throughout the day. There should be no pain when you stretch.
At the same time, if you're doing a pre-game warm-up, then shorter duration (10-30 seconds) is the way to go, because you don't want your muscles to lose their game-ready tone!

Is Surgery Needed to Treat a Rotator Cuff Tear?

Is rotator cuff surgery always necessary to treat a tear? The quick answer is no. One must distinguish a full-thickness tear from a partial-thickness tear before arriving at a more accurate decision. Full-thickness tears typically result in a patient unable to lift his/her arm and is associated with significant weakness during muscle testing; partial-thickness tears, on the other hand, vary in their presentation and may require an MRI study (see below).

Clinical evaluation is necessary in ruling in or ruling out a tear and more importantly, as to whether or not surgery is absolutely indicated. A thorough review of the patient's history is necessary to begin shedding some light on the prognosis. The examination performed by a physician (usually, orthopedist or sports medicine) or physical therapist provides valuable information about the patient's movement restrictions and limitations via range of motion testing, special clinical tests, and muscle/joint testing.

Is an MRI necessary? In some cases, yes. Partial-thickness tears, determined by clinical examination, may warrant the need for an MRI study, especially if the patient's signs and symptoms do not improve after a few weeks of physical therapy. Again, a good clinical examination will usually reveal the severity of a tear based on the functional limitations and impairments noted. If I see a patient for a diagnosis of "rotator cuff tear", and the patient is able to perform movements and tests without restriction, I usually tell the patient to rehab (or "prehab") the shoulder, and if the symptoms don't dramatically improve in 2-3 weeks, then I'll go ahead and refer the patient to the appropriate physician for further testing.

Can a rotator cuff tear "heal" on its own? Again, it depends on the size the tear. Full-thickness tears will not heal on their own. Partial thickness tears may scar down with time.
Gender, age, activity level, lifestyle, occupation, and diet are all factors that can influence general tissue healing and post-surgery recovery.