Active Community: Message List

Re: Bruised calf

guest — Sun, 15 Aug 2010 14:26:32 GMT

Sknib,

More than likely you managed to strain the calf muscle which resulted in a little tearing of muscle fibers and bleeding.

If there isn't a significant amount of pain or swelling, then usually the conservative measures such as range of motion exercises and a little bit of ice to for 5 to 10 minutes to help with any swelling should be enough.

If there is a large amount of pain or swelling, as always, get it checked out by your doctor.

-Doc John

Re: Tips for the diabetic triathlete

guest — Tue, 20 Apr 2010 15:27:17 GMT

Kurt,

I'm guessing that you're in South Carolina based on your username. If so, check in with Jay Hewitt, a triathlete and Type 1 diabetic, who lives in Greenville, SC. He races with an insulin pump and has worked with a couple manufacturers as their endurance athlete "guinea pig" testing out some of their pumps.

Website is http://www.jayhewitt.com.

He's done a few Ironman and also competed with a team for Race Across America. I believe he was using the OmniPod insulin pump last time I saw him.

- Doc John

Re: 70.3 with a Head Cold anyone?

guest — Tue, 20 Apr 2010 15:20:14 GMT

Josh,

Congrats on the race!

One quick tip you can use in the future for deciding to train/race with an illness is what I call the "neck check". Basically, if most of your cold symptoms are above the neck (runny nose, scratchy throat, etc) then I usually give patients the green light with the comment that they should plan for slightly longer recover from hard efforts. Usually your immune system is diminshed for 2 to 24 hours after intense exercise, so its important to allow for recovery to prevent further illness.

If your symptoms are "below the neck" such as deep productive cough, wheezing, high fever or body aches, I usually tell patients to go very easy on the workouts (recovery or Zone 1 effort) or to hold off completely until their symptoms improve. Again, the goal is to allow the body to fight off the infection and to prevent secondary infections. One concern I have as a physician is the athlete's potential for developing a more severe infection such as a viral myocarditis, which is a viral infection of the heart. This infection may be the reason for some of the suprising "sudden deaths" we see in otherwise healthy athletes due to the potential of the infection to cause scarring of the heart wall.

If I recall correctly, Joe Friel of the "Triathlete Training Bible" actually had the infection once. He spent about 6 months wearing a heart rate monitor to keep his heart rate under 120 BPM until he was cleared by his doctor.

Re: ITBS

guest — Fri, 11 Sep 2009 13:56:34 GMT

Cara,

Hopefully your first triathlon went well and you're now an "official" triathlete!

Hearing your brief description, there are a few different sports injuries it could be, so like most things, if it hasn't gotten better, get it checked out by your doc and come up with a treatment plan.

Most IT band issues tend to be localized to the outside or lateral part of the knee, so if there is pain in the back of the leg or in the back itself, then you also have to consider other problems like the piriformis muscle irritating the sciatic nerve, or even a disc problem in the back.

Fortunately, these problems usually do well when properly diagnosed and the right treatment plan is applied.

-Doc John

John Martinez, MD

San Diego, CA

P.S. we have a short video and a patient handout on our website for IT band stretches as well as IT band exercises

Re: IT band issues

guest — Fri, 26 Mar 2010 03:25:10 GMT

Agree with James and Physio about looking at strength issues around the hip regarding IT band issues. In my clinic, probably 90% of the IT band cases we see have some type of core muscle or hip muscle dysfunction, which can be a combination of hip flexor tightness as well as hip extensor weakness.

We actually have a free handout of IT band exercises and stretches on our website at http://www.coastalsportsmedicine.com/itb

Hope this (and the previous) advice helps!

-Doc John

San Diego, CA

Re: Massage during taper?

guest — Wed, 29 Jul 2009 00:27:20 GMT

Mumps-

Sports massage during a taper really depends on several points:

1. Injuries leading into your taper

2. Type of race you're tapering for (short triathlon/marathon/ultradistance marathon)

3. Massage therapist's skills

Usually closer to a race, our massage therapists try to stay away from the deep tissue massage and work with a lighter, quicker touch to the muscle, with the explanation being that the lighter touch helps from a neuromuscular standpoint. Too much deep tissue work just before the race may make your legs feel heavy and less responsive.

If you already have a good massage therapist, they should be asking about your upcoming races and adapting their techniques accordingly.

Hope this helps!

-Doc John

John Martinez, M.D.

Coastal Sports and Wellness Medical Center

San Diego, CA

www.coastalsportsmedicine.com

Listen to the TriathlonDoctor.com podcast

Normann Stadler is featured guest at Triathlon Club of San Diego club meeting...

guest — Thu, 18 Sep 2008 14:33:11 GMT

Normann Stadler, the 2004 and 2006 Ironman Triathlon World Champion will be the featured guest speaker at the Triathlon Club of San Diego's September meeting on Tuesday, September 23rd. The meeting is open to non-club members and will be at Coastal Sports and Wellness Medical Center in Sorrento Valley (at the 5 and 805 merge). Food starting at 5pm, general club announcements at 6pm and Normann Stadler, interviewed by Bob Babbitt of Competitor Magazine beginning at 6:30pm

More info at the TCSD website

Directions to Coastal Sports and Wellness

Re: Shin splints/Anterior Tibialis

guest — Sat, 21 Jun 2008 06:01:38 GMT

Bella,

I'd agree with Len, that much pain is a little unusual for shin splints (medial tibial stress syndrome) and I think you need to have the proper diagnosis in order to find the right treatment.

While "shin splints" would be one of the most common causes of your pain, compartment syndrome is a good thought at least to rule out, along with other vascular issues such as entrapment of an artery in the back of the knee that can slow blood flow into the leg (popliteal artery entrapment syndrome). Other thoughts would include ruling out a stress fracture, although with only a recent return to running, that would be uncommon. And there's a long list from there...

You also need to have someone take a good look at running biomechanics - its one thing for the running store to say that you run a certain way, its another thing for a sports medicine provider to actual explain/understand WHY you run the way that you do.

At least my two cents for the night.

-John

Re: ITBS

guest — Tue, 10 Jun 2008 02:02:25 GMT

mmm08-

You may also want to make sure that you are working on strengthening your gluteus muscles. There have been several sports medicine studies looking at IT band issues and one problem found in runners with IT band issues is that they tended to have weaker gluteal muscles. The gluteal muscles help with external rotation of the hip, and if they are weak, the hip will internally rotate and increase the stress across the IT band.

Foot pronation may be another issue that is preventing your IT band from getting better, essentially for the same reasons. If there is excessive pronation of the foot, it requires more gluteal strength to prevent the hip and knee from rotating.

Keep working on the foam roller stretching as some of the other posters suggested, because that will also help eliminate any issues due to tightness and inflexibility.

You can check out one of our patient handouts for IT band issues.[IT Band article|http://coastalsportsmedicine.com/articles.htm]

Re: Foot pain - Xray and bone scan negative

guest — Mon, 16 Apr 2007 14:39:19 GMT

Ericsson,

Based on a negative bone scan four weeks after the initial onset of symptoms, its unlikely you have a stress fracture. X-rays don't usually show them, but a bone scan should show most. Other test would be an MRI which may be a little better at picking up very mild bone edema, and also better for soft tissue. If there is a radiologist or sports medicine physician skilled with musculoskeletal ultrasound, that would be another diagnostic option, but ultrasound for musculoskeletal injuries is still an evolving technology in the U.S. Much more common in Europe for sports injuries

It sounds like there is pain whenever anything comes in contact with the top of the foot - and also some numbness. So the initial thoughts would be either tendonitis (extensor hallucis, extensor digitorum longus or tibialis anterior or irritation of the retinaculum (soft tissue on the top of the foot that keeps the tendons in place).

There also may be pain or tenderness along the belly of the tibialis anterior muscle (front of shin) due to tightness since this is a main muscle that controls heel and foot strike during running. I'd expect that a 50K trail run could irritate the muscle, but the symptoms may be further down in the foot.

PT or myofascial work (ART and similar techniques such as Graston or ASTYM) may help if that's the case.

Numbness isn't typically a symptom of a stress fracture - so with that history, also have to think about nerve or vascular sources. The deep peroneal nerve splits into medial and lateral branches at the front of the ankle joint. Irritation of the extensor tendons of the foot or of the retinaculum could cause nerve irritation (something similar to carpal tunnel syndrome - but not exactly).

Depending upon exactly where the "creaking" and "grinding" is located may also consider bony cartilage.

Less likely option would be vascular - from either compression of the main artery on the top of the foot (dorsalis pedis) or a compartment syndrome in the shin causing decreased blood flow into the foot. However these problems tend to be quiescent at rest and symptomatic with exercise or activty.

As with all things medical on the internet - advice can't substitute for an exam by a trained professional, so if you're still not improving, you do always have the option of a second opinion.

Doc John

Coastal Sports and Wellness Medical Center

San Diego, CA

http://www.coastalsportsmedicine.com