Ironman Lake Placid : Official Thread (Page 63)

^ Well, DC, that's a nice way to get back into the thread after your little hiatus!   Glad you're back   Shhh...it was beautiful here also. 

Impressive!

Nice work tankboy!
 

5k went great.... 24:07.. 7:46 a mile. new PR by a lot. Previous was 8:17's in March.....But I missed my long bike, Sunday just got away... back to the grind this week...

awesome!! Jealous.... my first multi is in 3 weeks, duathlon, then the Triple T... cannot wait!

Thanks all for the notes.  I sat down to read them last night after the worst long run I've had in months.  As was mentioned above, back to the grind.

It probably should be said, I really value the conversation here and the support.  It is a tough, tough thing to get through the week and it helps to know there are folks out there doing the same and willing to pat each other on the back, buck each other up and generally be a pen-pal friend.

Thank you.

I did my first tri this season over the weekend, same one as klassman, although a bit slower!  I bested my prior time on this course by 23+ minutes, but bike was 1 mile shorter than last time.  It was a beautiful day and even though I've had knee pain for last 2 weeks, I couldn't make myself sit this one out, so I am dealing with more knee pain and taking the week off.

Race Report: http://www.beginnertriathlete.com/discussion/forums/thread-view.asp?tid=435353

Any thoughts on cortisone shots for knee cap (patella) pain?  pros/cons?  I've been apply RICE, aleve and stretching quite a bit to try to help it heal.  Any other tips/suggestions?  I think I'll go see a doc this week.

My fiance is a PA for a spine and wellness office. They specialize in pain management. She got me a EMPI TENS unit that I use for my knees and lower back. Also I have 2 topical gels that I use. One is Voltaren Gel, this is more for surface pain, muscles etc I use for my lats when I pulled my right one, and the second is Pensaid, this is for deeper pain, to the bone, and it works awesome. I put it on my knee area by IT band. I also take a Celebrex every morning. I am no Dr. but I know that if you use the gels you can't take an advil or other meds so check with your Dr if you want to try these out. Also taking the celebrex may be bad too but I do not use the gels a lot. only if I am hurting after some time with the EMPI TENS unit.

Injecting steroids, from what I remember her telling me, 'eats' away at muscle and tissue over time. Maybe dtoce can offer more light since he is in the medical profession and an MD from what I can tell.

Great race report, and amazing drop in time from last year, even with the slightly shorter bike. I am sure the gravel on the run MORE than made up for the short bike. Good mental game to not let the car traffic get in your head, too.

From your description I am not sure what your knee issue is? A few years ago I had a good case of patellar tendonitis and knocked it out in a few weeks using ice cups regularly (several times per day) and only running in the flats - no hills.

Great job on the race.  I know that has to feel good

Great race,  sorry about the knee pain.  I know how you feel.  I had some knee pain last year and I couldn't run on it for any length of time.  I was thinking about the cortisone shots but, I'm not a big fan of them, (I have been heard they break down the ligaments over time).  I ended up going with a knee brace.  I think my problem seemed to be when I'm pounding on the pavement and my knee cap was just bouncing up and down.  So the knee brace keeps it stable and also allows it to track smoothly through the motion.  I haven't had any pain with it since I have been using it, and at the same time I'm afraid to not use it, so I will end up racing with it for sure. 

thanks... and it does .

I have a du coming up the week after the one out in Roch. One of my teammates is doing the one out there. Have fun!

I am at the hospital all day today and will not get to write something until later tonight...and take it for what it's worth-I am a cardiologist not an orthopedist.

I work in public affairs and public policy...so I have no medical training other than experience with two knee surgeries.

I think of cortisone as a way to treat a symptom not a way to treat a problem.  If the symptom is getting in the way of treating the problem, then there are instances when it makes sense.  But if you are going to be using your joint for other activities (non-running workouts) I think you will find the downsides of tissue degeneration over time, potential for overuse because you don't hear the signals your body is sending and you'll go through your course of treatment to find that you are back where you started because the underlying problem wasn't addressed.

I'm not a fan...and I also think you have to go with what you and your own doctor will work best for your situation.

Excellent job racers!!!  Its great to hear all these positive reports! 

Along with JMoney, I too will be doing the Rochester duathlon on the 28th...Unlike JMoney, I will NOT be participating in the 1/2 mary the next day!  Best of Luck!

I think you really have to weigh the pros and cons with a cortisone shot.  I've had two done previously in my hip (had a labral tear and impingement issues which caused some bad tendonitis), and highly regret it.  

Getting one or two shots will not cause any serious degeneration, however as everyone else said they don't treat the cause and running through an injury can cause more issues.  I got one done because I wanted to finish my season (track my senior year of high school) before I took time off to get it fixed.  However, it ended up with me running through my injury for so long that I had to have a 5hr long surgery and was told I'd never be able to run again.  If I would have stopped running when it hurt, I could have lessened the damage.  Pain is your body telling you that something is wrong, and as tough as it can be, sometimes you should listen to it.  

My sensai told me it was weakness leaving the body... pain does not exit in this dojo, does it???? damn him! 

So, I had a little break and thought I would get back to this subject.

Before you consider cortisone injections, it is pretty important to know what you are treating. There are benefits for some patients in that this treatment is much more locally effective than OTC anti-inflammatory meds like ibuprofen etc. It is often something that will 'buy time' for the patient until a surgical procedure is needed-as is often the case when patients have severe degenerative arthritis. There are risks also. I'm unsure of your medical history and will always qualify what I say with -you should always see your own doctor and come up with an appropriate treatment plan.

First and foremost, you must determine why you are having pain. Causes include acute injuries/inflammation (ie from trauma on car doors), mechanical problems/issues-which can be made worse by an injury, or even degenerative injuries. Actually, there are quite a few things that can go wrong with the knee. Usually with acute injury there is pain and swelling. Typical treatment includes RICE (rest/ice/compression/elevation). Taking some OTC pain/antiinflammatory meds help somewhat. It is often critically important to not make the injury worse. REST is as important as RICE. Heat is not recommended until 48 hours after the injury to increase bloodflow and healing but will make swelling worse if the injury is not adequately iced first.

Many knee issues are caused by overuse. 'Runner's knee' is a dull ache usually at the bottom of the kneecap. Pain occurs with walking up/down stairs, kneeling, sitting, squatting. People can have malalignment of the kneecap or tightness of certain muscles/ITB which can cause tracking problems. Overuse can lead to soft tissue swelling and you can get bursitis or teninitis. Other injuries can include partial (or complete) tears of ligaments. Tears of the ACL/MCL/PCL can be quite sutble.

(I sort of convinced my wife to wait on her MRI [-although the choice was always hers]-when she hurt her knee playing tennis 2 yrs ago changing direction. She even went skiing on it as the swelling was gone and the pain was minimal. When we got back from our ski trip her MRI showed the complete tear of the ACL for which she had successful surgery. She has sinced come back to teninis and skiing. Fortunately she has forgiven me for being lax in pushing for the MRI back then.)

Many other things can happen. The meniscus can tear. Some people have a Baker's cyst that they don't know about.  Trauma can cause swelling and tracking problems of the kneecap. Muscles can cause torsion on tendons and tracking problems from being too tight...I'm not going to go into the less common causes like kneecap fracture, cellulitis etc...

So, you need a diagnosis. Then commonly RICE and REST are all that is needed. But strongly consider followup with a professional if not better after one week. Often an MRI is the best imaging modality as it will show the soft tissue and ligaments best. It is encouraging that you were able to race on it, but I'd be careful that you are not causing more damage that could impair your performance at IMLP-the bigger goal.

Good luck.

Dale

Tour of the Battenkill: or as I should probably call it how I got killed on a Saturday.

Long story short the race didn't exactly go well. Throughout the week I was feeling pretty good but race morning while I was warming up I knew I was going to have some trouble. My legs felt heavy and stiff and I knew I was in for a long race.

Honestly I didn't have high asperations for the race, I am terrible at climbing and with over 3900ft of climbing over 62 miles(my Garmin had 4700ft), and with almost all of that climbing on dirt roads I knew I wasn't going to have a high finish.

My two goals were to make it over the first dirt climb(second climb overall) on 'Juniper Swamp' road in the pack and not finish DFL.

I can say that at least I didn't finish last.

Going up the first major climb I couldn't get my legs to turn over and ended up slightly off the back going over the top with a few other guys. We tried to chase back up to the main field and almost made it by the start of the next climb on Juniper Swamp but couldn't even begin to keep up over the hill(.4 miles, 14% avg grade, 19% max(my garmin had the max at 22%)). From that point I knew my "race" was over and I made the mental switch over to long endurance training ride. 

Road the majority of the last 40 miles by myself occasionally grabbing a wheel but as soon as the road started uphill I didn't have the power to stick with them. Luckily the race draws over 3000 riders and with waves starting every 10 min I had plenty of entertainment as groups passed me.

Ended up finishing in 4:09:05, 39/41 in my field at just a bit over an hour back.

Overall I'm actually mostly pleased. Once I got a chance to recover after the race my legs felt good with no issues the next day. Also I was trying some new thing with nutrition which all worked well.

My biggest concern is that I managed to lose over 5lbs of weight from waking up in the morning to getting home after the race. This tells me that I'm still not taking in enough fluids during the race and since dehydration is what caused me to DNF LP last year something I'm highly concerned about.

Now I just need to learn how to climb.

Elevation profile from my Garmin.

Good job finishing.

I'd agree that your hydration plan needs some serious work. I've found that when racing (and this is from my running past) in the spring, my body does not do well with the initial change in weather. It takes me weeks to a month to get acclimated. I also am neurotic about hydration and know how much weight I usually lose on my runs over x distance so I can adjust my  intake the next time. I've been doing the same with the bike for nutrition/hydration and weighing myself after these long rides/runs.

You'll figure it out, but I'd consider starting by doubling that fluid intake on prolonged bike/run training or at least try to carefully document how much you are drinking and make subjective comments about feeling thirsty/having a dry mouth etc to help you the next time. You may need to figure out electrolytes too...

The time to prepare is now and you still have plenty of time.

Regarding the knee pain: I'm a physical therapist and work in an orthopedic setting. If it is patellofemoral pain, meaning the knee cap is not tracking correctly within the anatomical groove; a cortisone injection is not really the answer. I have rarely seen and ortho give a cortisone shot for patellofemoral (if that is the problem). Mainly, the knee cap has to be stabilized and allowed to track normally. Causes for pain include muscle strength and flexibility imbalances; many runners activate their ITB and hip flexors greater than their hip extensors and external rotators (glut med, glut max) so specific strengthening of these muscles is important.

In my personal experience with patellofemoral pain, because I have had it as well, proper taping or a brace can help while running. If you have time to see a good physical therapist, I would highly recommend. (look for OCS - orthopedic certified specialist, although it's not a guarantee

And again, get a firm diagnosis.