Triathlon Tips For Newbies!

The triathlon bug has now taken over at the FAANT office. Janet and I have been training for the Inaugural Texas Ironman on May 21st for the last 6 months and Janet has done a great job of blogging about our adventures. (click here to read her blog) The women in our office have now been inspired to “tri” their first triathlon. Grapevine recreation is having a sprint triathlon on June 4th right here in town, so many of the ladies have signed up! Even more are taking the role of Sherpa or cheerleaders to encourage their co-workers. I am so excited to see the enthusiasm for the sport. So here are a few tips for getting ready for your first tri!

Have a Plan. It’s not like you just wake up one morning and decide you want to do a triathlon. Or maybe you did and then realized you have no idea how to get ready for one! There are lots of on-line plans and relatively inexpensive coaching available. Having a plan is like having a recipe for success. Make a plan and stick to it!

Be Consistent. If you have ever jumped into a race very undertrained, the experience is not pleasant. You want your first triathlon to be an uplifting experience, not a painful blur. Stick to your training plan and be consistent with your workouts. After the first three weeks it gets a lot easier!

Review the Course. Knowing the course is very helpful in getting through rough spots in the race. You can anticipate the harder spots and know that the finish in near. Also, occasionally the course is not well marked and you can go awry. Knowing the course ahead of time is always a bonus if the going gets rough.

Watch Your Nutrition. Training for your first race is not the time to try a new diet or new foods. Consistent and normal good eating habits will ensure a stable stomach during the race. You don’t want to spend half the day in the porta-potty!

Sleep is Important. Training is taxing on the body and the mind. Getting plenty of rest will help your body recharge and be ready for the race. The sleep you get two nights before is more important than the night before, so if you have pre-race jitters and don’t sleep well….no fear if you have adequate rest in the weeks before.

Pack the Night Before. And use a List! I always set out my transition and all my gear the night before. The morning of the race is always full of chaos and usually starts a 5am, so packing your bag the night before using a checklist will ensure you have necessary tools like goggles and sunglasses!

Visualize Success. Get a mental image of yourself not only crossing the finish line, but being happy with your finish. Your body tends to follow your mind.

Pace Yourself. Many newbies go out way too fast on the swim or start to hammer the bike, only to find themselves walking the run. Pace yourself. The first one is about finishing standing up!

Don’t Freak Out! Janet can tell stories about panicking on the swim. I can tell stories about crashing on the bike. Neither one of us has ever had a flat tire in a race, but we’ve seen enough of them! Relax. Things happen. Your goggles can fall off, you can crash your bike, and you can forget to put sock on with your running shoes.

Relax and Execute Your Race. We have all had stuff happen that didn’t fall into our “perfect race” plan. Go to plan “B”!

Have Fun. Don’t be so serious about the challenge that you don’t enjoy the day. I remember finishing my first sprint triathlon after years of marathon running and feeling. “Wow! That was fun!” Let’s face it, most of us won’t win our first time out, so our reward is the sense of accomplishment (and the beer at the finish!)

Hopefully these tips will help any newbies and all the staff in my office who are training for their first tri! You will get addicted! Triathlon gets in your blood and you will be hooked!

Step into Minimalism Slowly at the Boston Marathon

Wow! What a great panel discussion put on by Saucony in Boston last Thursday night. I love going to Boston during marathon week. It's like Marathon Mecca! The whole city seems to buzz with running excitement. Boston will always be my favorite marathon.

I had the privilege to be part of the discussion of the evolution of minimalist running and how to transition from stability or motion control shoes to a more minimalist shoe.

The panel consisted of Michael Sandler, who wrote a fabulously crazy but poignant book on Barefoot Running and how it saved him after a severe accident; myself discussing how to strengthen your feet in order to even attempt transition from minimalist shoe gear or barefoot running as well as reminding runners to proceed with caution; Spencer White, head of the Saucony human performance lab, discussing in depth the biomechanical basis for the development of minimalist shoes and how they actually strengthen your feet over time; the legendary coach Dr Jack Daniels, doing coach chalk talk on a white board in order to discuss how to integrate minimalist running as a training tool; and last but not least, Collin Dibble, the owner of Marathon Sports in Boston discussing how to fit runners into the correct minimalist shoe and how retailers have a responsibility to caution and educate consumers on how to slowly integrate these shoes. Whew! What a panel! A fabulous educational experience for all present. I could listen to Dr Jack Daniels telling stories for hours.

After the panel spoke individually for 10-15 minutes each, then it was time for Q&A. Great questions from the audience showed they were actually paying attention. Even Amby Burfoot from Runners World asked a biomechanics question!

Then it was time to separate into small groups and talk with the runners’ one on one. I was happy to see that I drew a small crowd that wanted to discuss everything from how can I strengthen this muscle or that area to how can I transition safely or can I even think about doing this? Great discussion with a local pedorthist who will probably send me hate mail because I told him he was crazy to be running in a graphite orthotics. A few local podiatrists were also in attendance and I was surprised but delighted that they actually agreed with me that everyone does not need to be in orthotics permanently if their biomechanics can be rehabbed instead of permanently braced. We had a lively discussion about this highly controversial subject in our industry.

Let's briefly discuss this alternative thinking. A runners does too much, too soon, too fast and ends up with let's say plantar fasciitis. Traditional thinking is PF is most likely caused by abnormal pronation. Treatment is to put him in a more stable shoe with orthotics to brace his foot, start stretching, anti-inflammatories, rest and lots of ice. Now what? He's better in 6-8 weeks. Now he wants to start running again. Traditional thought is that his underlying biomechanics predisposed him to have the injury so we should leave him in the stiffer shoes with orthotics. What if he really doesn't have a significantly jacked up foot? Maybe just a slightly over pronating foot? Do we have an alternative to offer him? Yes! Now the hard work starts. Lots of strengthening exercises for the medial and plantar foot and lower leg musculature coupled with balance and proprioceptive training followed by lots and lots of stretching. Then slowly wean him off his orthotics and stability shoes over a period of 3-4 months and transition to a more minimalist shoe gear.

Easy? No! Worth it? Yes, if he wants to find his inner gazelle. No, if he really doesn't care about changing the way he runs to be lighter, faster, and in the long run, less pounding. Can everyone do this? No way! Only about 15% of runners will work that hard to change their running style after an injury, so I don't worry about the orthotics labs going out of business.

That's just the tip of the discussion going on in sports medicine today about the trend of minimalism that is sweeping the running world. Hmmm. Sounds like more blogs to come.

Six Simple Exercise For Stronger Strides!

Are you thinking about embracing minimlaism or barefoot running? These can be good adjunctive training exercises to make you stronger, fitter and faster! All in is not the way to go. I feel a better approach to minimalism is to realize that your feet are weak in their current state and you need to add a foot and leg strengthening program to your current regimen. A strong core is imperative for good, efficient running form. The stronger the core, the longer you can hold good posture as you run down the road in search of your zen.

Here are six simple exercises to stronger strides

Here are six simple exercises you can do daily to improve your intrinsic foot strength. I recommend you walk around your house barefoot for five minutes to warm up your feet. Then really warm up your foot muscles by pretending your big toe is a marker and writing the alphabet with your foot. Do this twice. Now you are ready to begin strengthening your feet.

1. Towel crunches. Your foot has tiny intrinsic muscles that stabilize your toes called the interossei and lumbricals. A great way to strengthen them is to put your foot on a towel and crunch your toes. Do this ten times, then take a 30 second break and repeat to complete three sets of ten. When you get good at this, replace the towel with a pen or marker and grab it with your toes.

2. Heel walking. Heel striking is what we are avoiding, but heel walking is a great way to strengthen your anterior lower leg muscles (muscles in your shin). Roll back on your heels and walk forward balancing yourself on your heels for about 30 seconds, then take a 30 second break and repeat two more times.

3. Deep squats on your forefoot. Roll up onto your forefoot then squat down into an almost sitting position, trying to keep your balance and avoid shifting back onto your heels. Hold this pose for 30 seconds then stand up for 10 seconds and repeat 5 more times. When you get good at this, try holding a weighted bar at you shoulder level and then squat.

4. Inner foot strengthening with a resistance band. (This targets the medial muscles; the posterior tibial muscle and abductor hallucis) Tie the resistance band on a chair leg then use your medial muscles to pull the band toward the center of your body. Other option is to hook the band around your foot, then use the other foot to stabilize it. Pull your foot toward the midline of your body. Hold for 10 seconds then relax for 10 seconds. Repeat 10 times. (An alternative is to balance on the inside of your foot and walk for 30 seconds, following the pattern of heel walking)

5. Outer foot strengthening with a resistance band. (This targets the lateral muscles; the peroneals) Tie the resistance band on a chair leg then use your lateral muscles to pull the band toward the outside of your body. Other option is to hook the band around your foot, then use the other foot to stabilize. Then move your foot towards the outside of your body. Hold for 10 seconds then relax for 10 seconds. Repeat 10 times. (An alternative is to balance on the outside of your foot and walk for 30 seconds, following the pattern of heel walking)

6. Proprioceptive/Balance Training. Balance on one foot with other leg bent. Hold for 30 seconds. Repeat 5 times. When you get good, then roll up onto your forefoot. If you are a pro, then put a 5 pound weight in the opposite hand and touch your toes while balancing on your forefoot. (An alternative progression is to go from one leg on forefoot on level ground, to a foam mat then a Bosu ball or wobble board)

These six simple exercises can help you strengthen the intrinsic muscles of your feet and lower legs to help you transition to a minimalist running style. Remember to also stretch your quads, hip flexors, hamstrings, and calf (gastrocnemius and soleus) as well as your plantar fascia after these exercises to warm down. Small incremental increases in stress make us stronger. Large incremental increases in stress lead to overuse injuries! Achieve your natural stride slowly and carefully to stay injury free.

Watch the video for help with these exercises! Click here

What's Up With Minimalist Shoes?

Stronger Feet Can Lead To Running Zen

Why embrace minimalism? Minimalist shoes can help you achieve a more natural running stride. Why is this important? Many biomechanics gurus are finding that a more natural running stride can decrease your impact by over one third and therefore, in theory, decrease running injuries. What I have found is that it can help you find a faster, more balanced, stream lined version of you or what can be described as your running zen.

Running zen is a total state of focus that is a fusion of body and mind while running. Your goal is to develop your natural stride, which in most experienced runners, leads to being fitter, faster and staying injury free.

Your most efficient foot strike is one that lands exactly below your center of gravity, which is usually right below your hips in a mid-to-forefoot fashion, slightly towards your fifth toe. As you land, your foot rolls slightly inwards and propulses off your big toe. This slight roll is NORMAL pronation and is meant to cushion the running stride. Excessive pronation is the effect of weak foot intrinsics and lower leg muscles and is the main cause of many overuse injuries common to runners. This abnormal pronation is often mitigated by stability running shoes and orthotics, but a better long-term approach in healthy athletes should be to strengthen the underlying muscular weakness. Stronger lower leg and intrinsic foot muscles coupled with a stronger core, flexibility and better proprioception can diminish many of these abnormal forces and reduce injury recurrance.

A motion control shoe works to alleviate abnormal pronation and does a great job stabilizing your foot, especially after an injury; but it does little to strengthen the key muscles and ligaments of your feet.

A highly cushioned shoe may overprotect your foot from the stress of the road, preventing natural strengthening while you build mileage.

So, should we all go back to the ballerina flat looking shoes we wore in the seventies? Unfortunately I remember them well and the tibial stress fractures that occurred while I was in high school. No, old school is not the answer; but perhaps a happy medium.

A minimalist shoe guides your foot into a more natural stride by providing cushioning and flexibility, but does not elevate the heel to increase pronatory forces. It allows a shorter stride and softer landing, while encouraging mid-to-forefoot striking to help you manage your impact. It also allows for intrinsic strengthening while you build your mileage and hopefully puts you on the road to finding your sweet spot in your stride.

Who shouldn’t try a minimalist approach? Those runners with severe foot deformities or significant arthritis. As well as people with nerve issues like diabetic neuropathy. As for the rest of the running world, a caution sign should go up here.

A side note of caution to anyone trying to go “less is more.” When you begin to run with less shoe than you have been in years, it is important to realize that your stride is now very different and you have to relearn the fundamentals of running. Please avoid the “too much, too soon, too fast” syndrome that can sideline even the most cautious of runners.

A better approach to minimalism is to realize that your feet are weak in their current state and you need to add a foot and leg strengthening program to your current regimen. A strong core is imperative for good, efficient running form. The stronger the core, the longer you can hold good posture as you run down the road in search of your zen.

Watch for my next post: Simple Six to Stronger Strides: exercises to strengthen your feet and find the sweet spot of your stride!

11 Reasons Why Pool Running Doesn't Suck!

As a sports medicine podiatrist, I often encourage injured athletes to cross train and keep up their cardio fitness during their “rest period”. Pool running can be very helpful, but is frowned on as extremely boring and down right tedious by most runners and triathletes alike.

I also had to enter the conversation in our series “The Journey to Texas Ironman” with a shout out to everyone who has a little ache or pain in their foot or ,God forbid, a stress fracture, but still wants to join us at the starting line of the Texas Ironman in May. This was taken and liberally adapted from an article in the December 2010 issue of Triathlete magazine:

11 Reasons Pool Running Doesn't Suck
Completely stolen and altered from Holly Bennett, please forgive me….

1. It gives the barefoot movement a whole new angle -- and spares the wear and tear on your running kicks. Better than a pair of Vibrams!
2. You earn sympathetic looks from the cute boy-toy lifeguards. And at 40+, let’s face it – we like to look and dream, but would have a heart attack if they were serious!
3. Until now you thought breastroke was the slowest way you could possibly travel from one end of the pool to the other. Or my pathetic looking side stroke!
4. Hello, six-pack! Water running recruits those pesky, oft-neglected core muscles. Even your arms will exhibit extra buffness, strengthening with the resistance of the water. Let’s face it; most of us girls would be happy with a two pack after 4 pregnancies’!
5. If ever you long for a surrogate granny, there are plenty of gentle, smiling faces in the therapeutic lap lane. And most of them are my patients!
6. From your vertical vantage point, you can observe, admire and critique the swim strokes of the nearby lap swimmers. Maybe you'll learn something. And often times, you will realize your stroke is not so bad!
7. There are no rocks, stumps, curbs or other obstacles in the pool. In the water, you're no longer a danger to yourself. You can try running with your eyes closed. (Note: Resist the urge to fall asleep.)
8. One rarely encounters rattlesnakes while pool running. Or any kind of creature commonly seen while we practice open-water swimming on Lake Grapevine. And it’s not 60 degrees!
9. If you hop in immediately following a bike session, you get to call it a "P-run."
10. If you can mentally endure two hours of water running, your next Ironman marathon will feel short. I highly encourage a swim man IPod…..I could never even train for the Ironman swim without it.
11. And of course, the most important reason pool running doesn’t suck: Dr Crane won’t completely bust you when she or Janet passes you on the trail when you are still supposed to be in the walking cast!

Bottom line, pool running really doesn’t suck if you have the right attitude and tunes! Embrace the change and come out of the “rest period” that much stronger so none of us will be carried off by the ambulance come May!

Chronic Heel Pain Responds to Night Splint

Plantar Fasciitis a.k.a. Plantar Fasciosis (PF) is an extremely common foot injury usually described as heel pain. The pain is usually first thing in the morning and after rest. PF is by far the most common injury I see in my North Texas sports medicine clinic. PF is seen in most athletes, and is one of the most common running injuries. One study described PF as affecting 8% of habitual runners. 8%! When you calculate that approximately 2% of the US population runs on a regular basis (based on a survey of how many people ran a marathon in their lifetime). That is a lot of people. Actually the rough estimate is 6.2 million runners in the US alone with about a half a million suffering from heel pain. Wow! Oh my aching heel!

Why is there so much heel pain in runners? Too much, too soon, too fast syndrome. In other words, we want to be in shape way before our bodies are ready. The rule of adaptation states that our bodies become stronger with small incremental increases inn stress, but we break down with large incremental increases in stress. This is why PF is described as an overuse injury.

So how do we treat is? A protocol approach that starts with simple, stupid and follows a stepwise pattern that ends with 85% of runners having complete resolution with conservative therapy and 15% going on to move invasive surgical procedures.

Mainstays of treatment: orthotics, better and/or different shoes (that is an entire article in and of itself), lots and lots of stretching, night splint, anti-inflammatories, physical therapy, extracorporeal pulse activated treatment (EPAT), and in some cases, injection therapy (always a debate in athletes).

Simply reducing pain and inflammation alone is unlikely to result in long term recovery. Rest is usually not enough. The minute the runners gets back to activity, their pain is back! I find that most runners, especially over the age of 40, desperately need to stretch their Achilles tendon and plantar fascia. The plantar fascia tightens up making the origin at the heel more susceptible to stress. The best way to do this is a combination of dynamic stretching throughout the day (see my video on Youtube) and a night splint. A plantar fascial night splint is an excellent product which is worn overnight and gently stretches the calf muscles and plantar fascia preventing it from tightening up overnight.

Why does a night splint work, especially in athletes?

The plantar fascia is the ligament that holds up your arch. It is a thick band of fibers that go from the heel of the foot across the bottom of the foot to the toes. Plantar fasciitis is considered to be an inflammatory process following micro tears in the fascia. Plantar fasciosis is a degenerative process that occurs after several months of chronic plantar fasciitis. The reason PF causes so much pain in the morning, is that during the night the foot is relaxed and drops so the toes are pointed downwards. In this position the plantar fascia is relaxed, healing of the micro tears occurs overnight, but when the foot is put to the floor in the morning the fascia has to stretch to a longer position and this tears the new healing. Think of ripping a scab off every morning! Ouch! The idea of a night splint is that the foot is held overnight with the toes pulled upwards and thus the healing occurs with the fascia in its stretched position.

Many research studies have looked at night splints and the treatment of plantar fasciitis. There have been some mixed results due to the construct of the studies, but overwhelmingly the whole body of evidence suggests that night splints can help ease pain and assist healing, and this is especially true for people who have been suffering from plantar fasciitis for several months or more (truly plantar fasciosis).

Night splints do generally have to be used consistently for at least one month or more before significant improvement is seen. If you are a light sleeper, just make sure your wear it at least 4 hours a night.

A number of good night splints are available, and the fit and comfort is important given you will be wearing it for at least 6 weeks AFTER your symptoms resolve. A dorsal night splint will allow you to walk to the bathroom in the middle of the night without taking it off. A posterior night splint usually is better tolerated long term.

Got an aching heel, seek out a running podiatrist to get you back on the roads in better shape than you left them!

EPAT Treats Chronic Heel Pain

EPAT is the most advanced non-invasive treatment for musculoskeletal pain. Extracorporeal Pulse Activation Treatment is a new way to conquer chronic heel pain. Pressure waves stimulate the metabolism, enhance circulation and accelerate the healing process without surgery. Dmaged tissue of the plantar fascia or Achilles tendon gradually regenerates and eventually heals. Here are the top 16 frequently asked questions about EPAT.

The Top 16 FAQ’s About EPAT Therapy for Heel Pain:

1. What Is EPAT?

EPAT is an acronym for Extracorporeal Pulse Activation Technology. It is a highly effective non-invasive office based treatment method that accelerates healing of injured tissues.

2. How Does EPAT Work?

The treatment utilizes a unique set of acoustic pressure waves that are delivered through the body and focused on the site of pain/injury with a special applicator. These pressure waves stimulate the metabolism, enhance blood circulation and accelerate the healing process.

3. How is the Treatment Performed?

Ultrasound gel is applied over the skin of the treatment area to enhance the transmission of the pressure waves. The pressure waves are applied using a special applicator tip. The tip is moved over the injured tissue using circular motions.

4. How Long Does the Treatment Take and How Many Treatments are Required?

Treatment sessions take approximately 15 minutes per site and vary slightly depending on the site to be treated. Generally 3 treatment sessions are necessary and are performed on a weekly interval. If you are improving, but not completely better; up to 5 treatments can be performed.

5. What Conditions Can Be Treated With EPAT?

EPAT can be used to treat many painful soft tissue injuries. Including: plantar fasciitis, Achilles tendonitis, tendon insertional pain, acute and chronic muscle pain, and myofascial trigger points.

6. Is EPAT Safe?

EPAT is a safe treatment with virtually no side effects. It was originally developed in Europe and is currently used around the world.

7. Is EPAT Safe for Pregnant Patients?

EPAT is a safe treatment, but has never been tested on pregnant patients. Patients are advised to wait at least 3 months post partum before treatment, as many foot pains subside after weight loss and hormonal equilibrium is reached.

8. Is EPAT FDA Approved?

Yes, the machine is FDA cleared for usage.

9. What are the Expected Results?

Most people will experience pain relief after 3 treatments. Some patients report immediate pain relief after the first treatment, but maximum relief can take up to four weeks after the last treatment to begin. Over 80% of patients treated report to be pain free or have significant pain reduction.

10. Are There Any Special Aftercare Instructions?

All patients receiving EPAT therapy should be off all anti-inflammatory medication for a minimum of 2 weeks prior to the procedure and 4 weeks after. This includes common over the counter medication such as, ibuprofen (Motrin, Advil), naproxen (Aleve) and aspirin. Your doctor will provide you with detailed after care instructions.

11. What are the Possible Side-Effects or Complications?

EPAT is a non-invasive treatment and has virtually no risks or side effects. In some cases patients may experience some minor discomfort which may continue for a few days. On rare occasion, the skin may become bruised or red after the treatment.

12. Who Should not Have EPAT?

EPAT should not be used in people who have deep venous thrombosis or malignancy. It is also best to avoid the procedure if you are taking blood thinners.

13. Why Consider EPAT?

EPAT has a proven success rate equal to or better than traditional treatment methods (including surgery) without the risks or lengthy recovery time. It is performed in your physician's office without the need for anesthesia.

14. Does My Insurance Pay For EPAT?

No, unfortunately insurance companies do not pay for EPAT, though the cost of EPAT can often be reimbursed from a qualified health savings account. Non-covered services and/or procedures without billable terminology are paid to the office by the patient at the time of service; a claim will not be submitted to the insurance, though our office can provide receipts for reimbursement accounts to consider.

15. How Much Does it Cost?

EPAT is an affordable alternative to invasive surgery, lengthy physical therapy and other costly treatments. The first 3 treatments are bundled at a cost of $500 for the procedure, but you are still responsible for any co-pays or costs associated with the initial and/or any follow up office visit. If a 4th or 5th treatments are deemed necessary, these cost $150 per treatment.

16. How Can I Get More Information About EPAT?

The physicians at FAANT all have experience in providing EPAT treatment and are the best people to speak with if you have additional questions regarding the procedure. Call or contact our office for a consultation.

There is also much more extensive information available at http://www.curamedix.com/