Tri-Maine Series - Training & Preparation

2007 Maine Multisport Roundtable Announced

The 2007 Maine Multisport Roundtable is set for Saturday, November 3 from 3:30 to 5:00PM. Presented by Tri-Maine Productions in association with Personal Best Multisport Coaching and the OA Centers for Orthopaedics, the Maine Multisport Roundtable is open to the public with topics addressed specifically to the needs of endurance athletes.

The subject for this year’s fall Roundtable is “Sports Injury: Prevention, Treatment and Rehabilitation for Multisport Athletes.” OA’s Dr. Thomas Murray, Dr. Scott Marr, Dr. Eric Hoffman and Tim Davoren, Director of Physical Therapy at OAPT will each address a topic relating to common sports injuries sustained by multisport athletes. Athletes themselves, the OA team of medical professionals brings a unique perspective to Maine Multisport Athletes. A question and answer session will follow each presentation.

The Roundtable will be held at the OA Centers for Orthopaedics’ Conference Room, 33 Sewall Street in Portland. Kurt Perham of Personal Best Multisport Coaching will moderate the Tri-Maine Productions event. RSVP to: Kurt@pbmcoaching.com.

About the Maine Multisport Roundtable (MMR): the goal of the MMR is to become a twice yearly “gathering” of endurance athletes and coaches to discuss topics on all endurance subjects. The MMR is open to all Maine athletes with a focus on endurance sports (triathletes, cyclist, runners, Nordic skiers, etc). The panel and the subject will change at each “gathering”; the goal of the moderator is to keep the presenters and the audience within the scope of the subject for that given MMR.

Urban Epic Personal Safety Considerations

by Scott Marr, M.D.

The Urban Epic Triathlon presents triathletes with a number of special challenges.

First, the Urban Epic features an open water swim in Portland's Casco Bay. Current temperatures in Casco Bay are approximately 62 degrees Fahrenheit. Without a full body wet suit, even an active triathlete could expect to become hypothermic within 10 to 15 minutes. To avoid hypothermia, a full body wet suit is absolutely essential. Tri-Maine Productions will also be providing participants with race caps, which all participants are required to wear to keep the body warm.

Waves averaging 2-3 feet, crosscurrents and ocean "chop" can make the swim even more challenging. Keeping a straight line with a focused destination will minimize your time in the water and the chance of becoming hypothermic. The risk of taking in some unwanted seawater is also a risk. Triathletes exiting the water to the mini-transition area may want to have some drinking water available to rinse out the mouth and take on some fluid, as salt-water intake can hasten dehydration.

The Urban Epic is unique among triathlons in that it features a mini-transition area prior to T1. Triathletes will need to strip from their wet suits, put on a pair of running shoes and sprint 1/2 mile to T1. To avoid blood rushing to the head, triathletes are advised to sit down in the mini-transition area to put on their shoes, rather than bending over to tie up the laces. Athletes may lose a small amount of time, but this will minimize potential problems from fainting.

The early part of the bike course runs through a densely populated area of Portland. People and cars will be on the road, so triathletes will want to ride defensively during the early part of the course. The same is true for the latter part of the course as participants return to the city.

Since most triathletes will be out on the course beyond two hours, proper nutrition and hydration will also be critical to an injury-free race. Both the bike course and the run course offer little tree cover or shade. If it is a sunny, warm day, then dehydration is definitely a factor. Athletes should plan to hydrate well before the race begins, avoiding too much in the way of diuretics like coffee. Thereafter, athletes should plan to take in between 24 oz and 32 oz of fluid per hour of racing. So, an athlete expecting to complete the course in 2.5 hours, should plan to drink 60 to 80oz of fluid.

Likewise with nutrition - athletes should come to the Urban Epic well nourished with muscle glycogen stores full. Participants should then plan to consume between 250-300 calories per hour in the form of carbohydrate for the race to provide the body with adequate fuel to finish the race strong. Less than 250 calories per hour and the athlete risks bonking. More than 300 calories and the athlete risks gastrointestinal discomfort.

Being mindful of the challenges presented by the Urban Epic racecourse will enable participants to complete the course safely and quickly. In the event that you do experience problems, OA medical staff will be on site to assist triathletes. Look for OA medical staff at the transition area and along the course.

Be safe and have a great race!

Dr. Marr practices Sports Medicine at the OA Sports Medicine Center. He is a Fellow in the American College of Sports Medicine and currently serves as the Team Physician for the University of New England and Windham High School. Dr. Marr has a special interest in endurance athletics including performance physiology and injury prevention. He is the current Medical Director of the Tri-Maine triathlon race series.

Avoiding Anterior Knee Pain (Patella Femoral Syndrome)

By Tim Davoren, ATC

Anterior knee pain or Patello Femoral Syndrome (PFS) is the most common overuse injury suffered by triathletes, cyclists and runners.

Most hard working triathletes are accustomed to enduring some level of pain. A twitch here; an ache there. No big deal. Likewise with interior knee pain, which begins as generalized pain around or under the kneecap. The onset of PFS can be gradual, or sharp and severe. Most of the time athletes experience it, they brush it off and recover. Then the problem gets worse…

Technically, Patello Femoral Syndrome is the mal-tracking of the kneecap in the femoral groove –the “knuckle” of the femur. This misalignment causes stress to the soft tissue around knee, and eventually can even lead to breakdown of the boney surface of the kneecap or the groove.

The onset of anterior knee pain is generally the combination of factors starting with weakness of the inner quad muscle or Vastus Medialus Obliques (VMO). Tightness or lack of flexibility in hamstrings and the IT Band is also a contributing factor. Likewise, poor orientation of the patella resulting from God-given bone structure contributes to PFS. A greater proportion of woman suffers alignment-related PFS than do men.

Cyclists and runners both have specific issues that result in PFS.

For cyclists:
• The seat height may be too low resulting in a knee angle that is too severe at the bottom of the pedal stroke;
• Pedal/cleat position or angle/width of the cranks may result in pressure on the knee cap;
• Or the saddle position – either forward or aft – may not be set properly also resulting in stress to the knee.

For runners:
• Foot position, specifically the pronation or rolling inward of foot, results in more stress on the knee;
• Terrain is also a factor. Domed roads in particular cause the uphill leg to pronate more to compensate for the leg height differential.
• Similarly, running downhill is a significant stressor on the kneecap due to the eccentric forces on the quad.

The first course of action for triathletes experiencing anterior knee pain is to assess recent changes in training. Consult your training diary to determine which of the many training variables may have changed (volume increase, new equipment, terrain change, etc.). Once identified, discontinue or decrease the specific type of training that may have caused the injury and see if the condition improves. Icing is also an effective technique, although anti-inflammatory medications like ibuprofen are not recommended in large doses if you tend to train through the injury, (exacerbating the condition), small doses for a mild flare up may be helpful.

Of course, the best course of action is to avoid Patello Femoral Syndrome in the first place. This means purchasing the right type of running shoe, obtaining a professional bike fit, proper pre-season strength and stretching, and gradually building volume over time.

If, however, you are sore during a workout or your training is limited by pain, then it's probably time to see a professional.

Treatment for Patello Femoral Syndrome includes the following:
• Strengthening the quads and glutes to control femoral rotation (a strong butt helps control the inward roll of the foot);
• Improving both hamstring and IT Band flexibility (utilizing dynamic warm-up and foam rolling);
• Evaluating foot mechanics (what's happening at the foot and ankle level)
• Obtaining a professional bike fit;
• Assessing your gait mechanics (how you pull your leg forward and push off your foot).

Tim Davoren is the Director of OAPT and clinician at the OAPT clinic. Tim believes firmly in injury prevention has been staffing Certified Athletic Trainers at high schools throughout Southern Maine for 12+ years. Since 2000 he has been the Physical Therapy Instructor in the OA/Maine Medical Center Primary Care Sports Medicine Fellowship Training Program.

Recovery: Avoid Injury and Overtraining

Many triathletes are familiar with the principal of overload and recovery.

To improve fitness, a triathlete must progressively increase the training load over a period of time followed by a period of recovery or rest. Classic periodization theory suggests three (3) build weeks (2 weeks for older triathletes) followed by a “recovery” week. During the recovery week the volume and intensity of the training is reduced by 20-50% over the previous three-week training block. The recovery week allows the body to rest, to adapt and to prepare for the next three-week block of exercise, which builds upon the previous block. Ideally, each three-week training block applies incrementally more training stress either by increasing the volume over the previous period, increasing the intensity, or both.

As a group of overachievers, triathletes tend to excel at increasing the training load, but often fall short of taking a vital week of recovery to let the body rest and adapt. During the spring and summer months, many triathletes log between 10 and 20 hours per week of training as the days lengthen and the racing season kicks into high gear. If their bodies have not been properly conditioned for the increased load, these triathletes risk injury and overtraining. Amateur triathletes (most of us), in particular, are susceptible to overtraining. The psychology of these athletes tends to be “if I’m not training, then I must be losing fitness.”

An irregular or inconsistent training program can exacerbate the problem, as triathletes who miss a day or two of training tend to overdo it by making up for missed training sessions. Work-related or family related-stress also contributes to the problem. The body does not seem to differentiate between the stress associated with training load and the stress associated with daily living. Rest and recovery is the only effective antidote to stress – training or otherwise.

Coach Kurt Perham, the points leader of the Tri-Maine Series, advises his clients to “train smart and recover hard.” Training smart implies creating and following a training program that establishes a solid aerobic foundation, builds progressively on that foundation and applies volume and intensity gradually at a rate that assures the body is ready for the increased load. “Recover hard” means take time to rest, relax and allow the body to adapt. Triathletes are advised to be as deliberate about their recovery as they are about their active training programs.

OA would like to hear about your recovery techniques. Tell us what you do to assure your body is rested and ready to go for the next training session. In subsequent blog entries, we will share your recovery techniques, along with some suggestions of our own.

Dynamic Warm-up

Michael J. Mullin, ATC

Dynamic warm-up and flexibility
Flexibility is a key component to athletic performance enhancement and injury prevention. By being able to move more freely and efficiently, the body is always in a better position to respond to the next task. As with every aspect of your training program, you should maintain an awareness of your body position and mechanics while performing every repetition of every exercise. An increased cognizance of how your body moves during controlled activity has tremendous carry-over to athletic participation. For all exercises, repeat 10-15 repetitions for each side where appropriate.

Finger floor touches
Stand with feet a little wider than hip width apart and your back straight. Staring straight ahead, go down and try to touch the floor with your fingertips while keeping your feet flat on the floor. Exhale while you reach and inhale upon your return. Make sure to have knee travel in a straight line towards the second toe.

Palm floor touches
Stand with feet a little wider than hip width apart and feet slightly pointed outwards. Keeping back straight, go down and try to touch the floor with your palms while keeping your feet flat on the floor. Exhale while you reach and inhale upon your return. Make sure to have knee travel in a straight line towards the second toe at all times.

Leg swings
Standing on left leg with right leg suspended and your arms in running stride position, swing your right leg while counter swinging your let arm.

Knee to chest
Standing, grasp one knee with both hands and bring it towards your chest. Lower and repeat on the opposite side. Go up onto the toes of the opposite foot while grasping leg as able.

Lunging with torso twists
Starting in a standing position with arms crossed out in front at shoulder height, step forward onto your right in a large step position. Making sure to keep front foot planted, drop back knee towards the ground while rotating body to the right. Pushing off from the right foot, return to starting position and then immediately perform the same on the left side. Focus on extending through the hip. Repeat 10 times on each side.

Leg grabs
Grasp one leg at the knee and ankle and pull it towards you rotating the hip while walking, then repeat the same on the opposite side.

Resisted running
Stand facing a wall with feet about 3 feet from the wall. Lean forward into the wall so both hands are on the wall at shoulder height. Roll through one foot and then the other like you are running, driving the opposite knee towards your chest. The landing through the foot should be toe to heel and push off should be heel to toe. Perform for 2 sets of 30 seconds.

Diagonal chops
Standing with feet a little wider than hip width apart and hands clasped out in front of you. While looking at your hands and leading with your thumbs, bring your arms and your trunk up overhead to the right and then down to the left foot.

Semi-squat trunk rotations
Stand in a semi-squat position with heels planted and arms clasped out in front of you. Slowly rotate your trunk to one side while leading with the thumbs and then the other. Make sure head continues to rotate as well when performing.

Michael J. Mulln, ATC is a clinical athletic trainer at OAPT with more than 14 years of experience. Michael has co-authored a book titled “Comprehensive Approach to Sports Injury Management” and a chapter in “Knee Ligament Rehabilitation” called New Techniques in Cartilage Repair and Replacement”.

Avoiding Neck and Shoulder Pain on the Bike

By Scott Marr, M.D.
Many cyclists complain of neck and shoulder pain while on the bike. While common, these injuries can be easily avoided.

Cyclists need to make sure that the neck, shoulders and arms are conditioned to withstand long intervals in the same position. Bike riders are encouraged to avoid locking elbows, extending the neck by riding for long periods of time in the handle bar drops or aero bars (tough for a triathlete, I know), and changing positions frequently to avoid gradual, but painful injuries.

If you are experiencing discomfort in your shoulders, back, neck or anywhere else, it’s probably a good idea to have someone look at you and your bike and make sure the two of you are a good fit. Neck and shoulder pain is often caused by an extended reach, so it's a good idea to have your position on the bike evaluated and optimized.

Whether you’re riding a brand new bike or you have just made some minor adjustments to your ride over the winter, it’s important that the frame, seat position and pedals all match your individual body mechanics. Because of the repetitive nature of the sport, it’s easy for minor discomfort to escalate into something more serious.

While any good bike shop will help you find a bike that fits your riding style, budget and body size, there are also specialists in Southern Maine that make additional adjustments (for a price) that can help you maximize your cycling efficiency and overall comfort. The more miles you plan to put on your bike this season, the more these specialized services may make sense to you. At OAPT, Tim Davoren at OAPT offers a comprehensive bike fit assessment from a physical therapist's point of view.

By taking precise, often laser guided measurements and calculating ideal bike-to-body ratios, these experts can almost guarantee that you’ll get more out of your riding experience.

Dr. Marr practices Sports Medicine and Medical Orthopaedics at the OA Sports Medicine Center. He has served as a team physician for St. Joseph’s College, Windham High School and the Portland Pirates (AHL) hockey team.  Dr. Marr has a special interest in elite endurance athletics including performance physiology and injury prevention.

Stretching Before You Run

By Eric Hoffman, MD
For today's time-starved amateur triathles, one of the key challenges is to take the proper steps necessary to maintain fitness and avoid injury so that you can continue to train and compete for years to come. I recommend that you spend at least 10 minutes stretching both before and after you head out for a run. In general, you should focus on stretching hamstrings, quadriceps, Achilles and the iliotibial band (the band on the outside of the hip and knee). Proper stretching prepares your muscles and tendons for activity and reduces the risk of injury. I have found that this web article on coolrunning.com to be particularly helpful for runners.

Dr. Hoffman is a board certified orthopaedic surgeon at Orthopaedic Associates of Portland. He has a subspecialty interest in sports medicine, shoulder and knee injuries. He is the Falmouth High School team physician and a consultant for the Sunday River Ski Resort. Dr. Hoffman is an active runner and most recently has been participating in triathlons, including the Lake Placid Iron Man in July 2007.