One problem we see in many athletes with Iliotibial band pain and IT Band Syndrome is a weakness in the gluteus medius and maximus muscles (or simply an inability to fire these muscles properly). One of the first rehab exercises we try to get athletes to work on in order to rehab properly and quickly from IT Band Syndrome is to work on basic glute exercises such as Pelvic Hitches, Single Leg Bridges and Donkey Kicks. All of these exercises are aimed at firing and contracting the glutes instead of other muscles such as the hamstrings. The glutes play an important roll in stabilizing the pelvis during the stance phase of running and jogging. However, many times, athletes suffering from IT band pain don’t fire the gluteus muscles properly and as a result, they have more internal rotation at the hip or abduction of the hip while running.

One theory proposed by Fredrickson is that this inability to fire the glutes contributes to excessive internal rotation of the femur, and as a result, the knee, and increases the force and tension on the distal part of the IT band and iliotibial band’s attachment to the knee.

In the past, pronation of the foot has also been blamed for causing IT Band Syndrome, but other studies looking at high-speed videography of runners with IT band pain did not demonstrate excessive pronation of the foot when compared to runners that didn’t have IT band pain. The pronation myth may be due again to gluteus weakness. The weakness or inability to fire the glutes will cause the internal rotation of the knee and may give the impression that there is pronation of the foot during foot strike.

So we decided to take a quick look at some of the literature behind the perceived benefits of compression socks and stockings in regards to athletics. The majority of the published medical research on compression stockings looks at benefits in hospitalized patients in regards to prevention of blood clots or deep vein thrombosis, especially after surgery. Prevention of blood clots after surgery is a major concern and one of the most serious complications that can occur.

The published research regarding compression stockings and compressionwear athletic performance is mixed. Some studies such as a recent article published in the Journal Sport Science Did not show any difference in endurance performance in well trained athletes using either compression stockings or full body compression clothing.

An earlier study published in 2007 in the presternal sports medicine also did not see a performance benefit of full body compression clothing. However the researchers did see a notable benefit in a decrease in perceived muscle soreness in ahtleteswearing full-body compression clothing.

Another study published in 2010 from the School of Sport and Health Science at the University of Exeter (England) did find that the full leg compression stockings did help with recovery in women that underwent plyometric jumping drills when compared to traditional passive recovery methods.

So most of the benefits seem to be a result of improved recovery rather than performance enhancement during competition.

I’m in the unenviable position of having to inform you that Coastal Sports and Wellness Medical Center will be closing in November.

The current economic crisis has affected many in San Diego as well as throughout the country. Like many businesses, we have had continued financial difficulties that have finally reached a point where we cannot continue to operate.

This decision has been a difficult one for me to reach. The idea for Coastal Sports and Wellness came about 15 years ago at the beginning of my medical training, and I have been working toward making that idea a reality since that moment.

There has been a lot of hard work, sweat, and perseverance that went into the planning and opening of Coastal Sports and Wellness.

At this point, I don’t have an announcement about continuing my sports and family medicine practice. At this point I plan to take the month of December off from medical practice to review possible options.

In the meanwhile, to maintain a continuity of medical care, I would highly recommend the physicians at San Diego Sports and Family Medicine. Their physicians have a similar style medical practice. If you need to transfer records, please contact our office and we will assist.

San Diego Sports & Family Medicine – Carmel Valley office
3880 Valley Center Drive, Suite 201, San Diego, CA 92130
phone 858-793-7860 Web: www.sandiegosportsmed.com

Below is the current information about our partners and co-workers

- Eva Saragosa will stay on to help with the closing of the clinic and helping transfer medical records and assisting our patients.

-University City Physical Therapy and Gino Cinco will continue to see physical therapy patients at Coastal Sports and Wellness through November and also at their Governor Drive location.

-Dr. Dan Lehnberg, D.C. will continue with his sports chiropractic office in Redondo Beach. For those patients that are seeking continued chiropractic care in the area, we recommend Dr Mike Rintala at http://rintalachiro.com

-Kevin Klatt and Nikki Krause will continue to offer massage therapy through their individual practices. We will assist their current massage clients in continuing their treatments.

-Scott Richardson will be taking a 1 year position as an acupuncturist with a cruise line beginning at the end of November. He will be offering several discounts on massage and acupuncture so feel free to call us at (858) 678-0300 to find out more.

-Evan Johnson will be continuing his personal training business at a different location. We will update you on his new contact information when it becomes available.

-For those that enjoyed our Computrainer cycling classes, Urban Aire in downtown San Diego has opened a similar Computrainer Multirider center run by local cycling coach Sean Burke and should be able to meet your indoor cycling needs.

I deeply appreciate the trust and confidence that you have placed in me as your physician.

Again, this has been a decision that has been extremely difficult to make and I appreciate the support that all of you have shown Coastal Sports and Wellness.

Yours in Health,

John M. Martinez, M.D.
Medical Director
Coastal Sports and Wellness Medical Center
San Diego, CA

However, its important to understand and appreciate that there is so much more going on in life than just what exists in our own “boxes”.

I like to think as a doctor that hopefully I’ve developed a little more sense or understanding of this. Patients come into my life for a variety of reasons, some self-limiting that will get better with just a little time and rest, others with a life-changing and perspection altering disease that not only changes their view of life, but that of the people around them. However, I think I’m just as guilty as most where I don’t always realize when someone like this walks into or past my own little “box” of life. Too busy, focused on other “things” in the box, I’m sure I don’t always bother to cast my gaze outward to notice when these events occur.

Fortunately, I was paying attention for some reason this past Tuesday at the Triathlon Club of San Diego meeting with Chris Carmichael. Otherwise I would have never met the “man with the mask.”

Don’t know if other people noticed the tall bald-headed newcomer (not to be confused with the recently golden locks-shorn Buck) at the meeting wearing the surgical mask. It was the first time I had seen him at a Tri Club event. I didn’t think much about him in the hectic controlled “chaos” I feel when we host one of these events. Maybe a “Hope he doesn’t have TB or H1N1″ though crossed my mind as I returned my focus back to my own little “box”…

Chris Carmichael with Clayton Treska

Clayton is battling stage 4 testicular cancer. If you’re not familar with cancer staging, the higher the number, the further the disease has spread. Stage 4 is not where you want to start your battle against cancer. It means the testicular cancer has spread to other parts of the body and makes the job of treating the testicular cancer a lot tougher.

Its kind of like starting a baseball game in the ninth inning with two outs, two strikes and down by two runs with nobody on base. Its not impossible, but its a hard road to come back from, but with enough belief, drive, perserverance and maybe just a little bit of luck, it can be done. Just ask Lance Armstrong.

Clayton has been undergoing chemotherapy which has supressed his immune system, hence the surgical mask, and as I watched him shake hands, the reason he pulls out hand sanitizer after he shakes somebody’s hand. But as I learned later, be careful shaking his hand – he was the Armed Forces “Fleet Week” arm wrestling champion one year (oh, and he won boh left and right handed divisions, so don’t fall for the old “I’ll arm wrestle you with my bad arm” ploy…). He’s getting ready to undergo another round of chemo followed by a bone marrow transplant later this month.

I’ve dealt with a lot of people that have battled serious medical problems and its interesting to observe what drives how some people respond to the challenge with a full-hearted, 100% never-quit effort. Clayton is surprisingly upbeat when he talked about his diagnosis and the long treatment road in front of him.

How upbeat?

He’s gone ahead and registered for the Honu Ironman 70.3 Triathlon next May and has been training as much as his treatment allows. You have to like the odds of someone who thinks like this… “Gee, I have cancer and it sounds pretty bad… hmm…guess I’ll whip it and then go race an Ironman to celebrate…”

Gotta love an attitude like that, and hopefully Clayton’s attitude reminds all of us of the importance of being more aware of the people outside of our “boxes”.

Welcome to the Tri Club, Clayton.

I have full confidence after meeting you that you’ll do exactly what you plan to do. Beat cancer and cross the finishline in Hawaii.

P.S.

Oh, and thanks for reminding me to look outside my “box”

Don’t forget the the Strength Training for Triathlete workouts start this Tuesday, so make just you get registered before it fills up!

Strength Training Exercises for Triathletes – Circuit #1

One Leg Squats

How to begin

• Start standing on right foot
• Keep head and chest up at all times
• Allow right knee to bend and lower body down
• Advanced move:Reach with left hand to touch right knee, shin, or toe

Watch the video

How many to do: Start with ten on each side

Push-Up with Rotation

How to begin

• Start in push-up position
• Allow elbows to bend bringing chest down towards ground
• Contract chest muscles (pecs) to return to starting position
• Continue into the Plank Rotation
• Alternate direction of rotation with each repetition

Watch the video

How many to do: Start with twelve on each side

Lunge Jumps

How to begin

• Start in a split squat stance with right leg in front adn left leg back
• Lower body down by going into lunge by bending front knee
• Press through the front leg to jump off ground
• Advanced move: While in air switch front legs (scissor style)

Watch the video

How many to do: Start with ten on each side
Repeat the circuit three to five times with a brief rest after the the Lunge Jumps.

We’re not here as triathletes to win a power-lifting competition or try to look good while wearing a leather weight lifting belt. In fact, the only belts we have are race belts and Fuel Belts to carry our hydration and carbs with us on triathlon training rides or races.

Here’s a brief example of some of the body weight dynamic warm-up exercises that you can do – each with a link to a YouTube video to help demonstrate each exercise.

Dynamic Warm-Up Exercises for Triathletes

Squat Jumps for triathletes

• Stand with feet at shoulder width
• Squat down keeping weight back on heels
• Use arms to help propel off the ground
• Only jump about 50% of maximum height
• Upon landing, immediately begin next rep
• Try for a total of 20 reps for your warmup

Here’s the Jump Squat video on YouTube

Up-Downs

• Stand with feet at shoulder width
• Squat down placing one hand on ground behind your body
• Sit down on ground
• Lay down flat on the ground
• Sit up and then bend knees to place feet on ground
• Use one arm to come back to squat position
• Press through heels to return to full standing position
• Number of reps: 4 to 6

Plank Rotations

• Start in push up position with shoulders over hands
• Rotate torso 90 degrees
• Turn on to outside of one foot and inside of opposite foot
• Lift one arm off ground and come into “T” position
• Replace hand on ground and return to push up position
• Repeat to opposite side

Stationary Hurdle Step-Overs

• Start standing with feet at shoulder width
• Lift right knee up in front of body as high as comfortably possible
• Lift and rotate lifted leg towards side mimicking stepping over a hurdle
• Bring leg back down to ground on side
• Repeat with opposite leg

Bootstrappers

• Start in push up position
• Walk feet in 3 steps so that hips are raised well above shoulder height
• Allow knees to bend to bring butt to heels
• Extend legs to come back to starting “hip up” position

Why the concern about a change in the H1N1 influence virus?

The increased concern is due to the potential for the H1N1 virus to undergo antigenic shift, which could make it more virulent and also make the H1N1 influenza virus resistant to our current anti-viral medications and/or the upcoming H1N1 influenza vaccine die out in late October/early November.

Yes. In case you haven’t heard, several pharmaceutical companies have been steadily working on not only the annual seasonal flu vaccine, but also a second flu shot specific for the H1N1 influenza virus.

The recommendations for the regular influenza vaccine and the H1N1 influenza vaccine are slightly different.

The CDC is recommending that health care works, pregnant women and people from 6 months to age 24 years old receive the H1N1 vaccine initially. People in the 25 to 65 year old age group that have underlying health issues such as asthma or COPD should also get the H1N1 vaccine. Adults over the age of 65 are actually considered less at risk for contracting the H1N1 influenza virus due to prior exposure to prior H1N1 influenza viruses that were around in the 1960′s. However, this older age group should still get their regular influenza shots this fall since the regular influenza vaccine protects against different strains of influenza.

The FDA (Food and Drug Administration) approved the H1N1 influenza vaccine earlier this week and it is anticipated that doctor offices and pharmacies should be receiving the H1N1 vaccine by mid October. Originally, it was thought that two separate injections about a month apart were required to acquire immunity to the H1N1 virus, but the latest studies are actually showing that most healthy people are having a healthy immune response after just the first vaccination – great news, since this essentially doubles the number of vaccinations available to health officials.

Ever want to see how you’d stack up against Lance Armstrong, Levi Leipheimer and Alberto Contador climbing up Tour de France classic mountain climbs like Mount Ventoux?

Well now you can!

On San Diego’s first Computrainer MultiRider Center at Coastal Sports and Wellness, you can now climb some of the classic Tour de France climbs in our indoor door cycling classes!

Watch on our two giant screen televisions as you climb up Mount Ventoux and suffer through the ride that Lance Armstrong calls the toughest climb in the Tour de France.

Find out more about our San Diego indoor cycling center.

Hi this is Dr. John Martinez, Medical Director of Coastal Sports and Wellness Medical Center in San Diego, California.

Today, we’ll be talking about some myths and facts about both lactate testing as it applies to our endurance training—we’re talking about:

• The lactic acid myth
• The muscle burn myth and lactic acid
• The muscle pain myth
• The lactic threshold myth

Now the first myth is about “lactic acid” and that lactic acid actually appears during exercise, so it’s really the true things, it’s more of a misnomer and that lactate is actually the proper term and it’s actually a by-product of glucose utilization and a lot of coaches and athletes are taught or told that lactic acid is something that’s actually bad, when in fact that if we look at the whole breakdown of exercise metabolism, it’s that as glucose breaks down, it’s broken down to a by-product called pyruvate and eventually into a pathway that produces lactate.

There may be some true lactic acid that’s formed very briefly, but then the lactate is actually a salt by-product that’s produced and importantly, for athletes and coaches to understand is that lactate is actually used by the body specifically, the brain and the heart for fuel and this falls into a concept termed the lactate shuttle as first proposed by Dr. George Brooks up in University of California, Berkley who’s done a lot of research on this concept.

The next myth that we’re going to talk about is that muscle burn myth and this is something that I think most athletes have been told, if you’ve ever been in a spin class, ever gone out to the track and done track workout or a speed workout and told that that burn is that that lactic acid building up and again, if you go back to that first myth that we’d already talked about, the true term we should be using is lactate, but it’s actually also false that lactic acid build up causes that muscle burn that athletes experience at the high intensity exercise.

The fact is that that muscle burn is actually more of an acidosis that occurs when hydrogen ion build up and probably some other by-products in the intense exercise. Lactate itself doesn’t seem to cause that muscle burn and if you look at the research studies, we have athletes that have much different levels of blood lactate levels that have different experiences or different complaints as far as how much muscle burn and muscle discomfort there is.

So again, that lactic acid or that lactate build up doesn’t cause that muscle burn.

The third myth we’ll be talking about is muscle pain myth and that lactate or lactic acid build up causes the muscle pain most athletes experience 24 to 48 hours after a hard workout. Well, the truth is that, lactate is actually cleared from the muscles usually within an hour of most exercise, even the more high intensity exercises, and we know this because when we do a lactate testing on our athletes, we plot out the increase in the lactate levels as we increase the exercise intensity and then as we have a recovery period after exercise, we actually do a recovery lactate test to watch how quickly the athlete’s body is able to metabolize that excess lactate.

So the truth is that, a lot of that muscle damage and muscle pain that occurs 24 to 48 hours actually probably do more to micro tearing of muscle and usually, we see more muscle pain and more micro tears when there is more eccentric muscle contraction and this should be something, as far as downhill running and the eccentric lengthening of the quadriceps muscle and if you’re in the gym during a bicep curl, this would be the negative that a lot of body builders do when they slowly extend out the bicep under a heavy weight and you get more micro tearing and therefore, more inflammation and damage to the muscle and that’s what we think that delayed onset muscle soreness is that occurs, a couple of days after a hard workout.

The final myth we’ll talk about is the lactic threshold myth and that myth is that there’s a defined point where the body switches from an aerobic to anaerobic metabolism called the lactate threshold. Well, the truth is that there’s really no defined switch from aerobic to anaerobic metabolism. There’s actually more of a mixture of aerobic and anaerobic metabolism in most exercise intensities and if you think about this at a lower intensity, you do use mostly fat as your main source of energy.

But there’s always just a little bit of glucose metabolism that’s occurring and as you slowly increase your exercise intensity, there’s more of a slow transformation or slow transition to a more heavily anaerobic metabolism, but there’s no true flip of the switch where you go completely aerobic to completely anaerobic, it’s more of a transition zone that we hit.

One of the other things that we try to measure with our athletes is what we call the maximum lactate steady state, which is that steady state exercise level for either running or cycling where the athlete can maintain a constant lactate production and lactate metabolism and that’s probably the level that most athletes can race a long distance, race out over an hour.

Interested in finding out out more about blood lactate testing?

We offer blood lactate testing in San Diego at our sports medicine center and sports medical director.

Give us a call at 858-678-0300