Why do some collarbone breaks heal quickly while others are far more serious?

Jonathan P. Braman, M.D - TRIA Orthopaedic Center

Broken collarbones, or “clavicles” are a frequent result of falls, especially involving cycling. Most breaks can be managed without needing surgery, by placing the arm in a sling for a period of time then gradually getting the strength and motion back over time.

Sometimes, however, they do not heal in a sling. This can be especially troubling for cyclists as the collarbone absorbs much of the stress during long rides.

One reason why some breaks don’t heal is if during the first part of healing, too much motion occurs. This can cause the broken bone to fail to grow back together.

Also, new studies looking at how people do after breaking their collarbones has shown that some broken collarbones should be operated on at the start. As a result, it is best to see a shoulder surgeon with any broken collarbone.

Fluid, hydration, and sodium balance

By Susan M. Parks M.S., R.D.,C.S.S.D.,L.D., C.P.T. Sports Nutritionist

Is cutting back on sodium appropriate for the healthy athlete?

NO--- Athletes who lose a large volume of sweat during activity should not restrict their sodium intake!

That does not mean to OVER consume sodium on a continuous basis! Even though the general public health message is to decrease habitual high salt intake for hypertension is correct, a short term high intake of sodium causes a short term rise in blood pressure in healthy individuals, but for the healthy athlete sodium may be needed to maintain proper fluid and electrolyte balance during strenuous workouts. It restores plasma volume after strenuous exercise. Both dehydration AND hyponatremia (low sodium plasma) can have serious consequences for the endurance athlete, running or biking. Under-and over-drinking water during activity and ignoring mineral balance besides hydration can be the main cause of most medical problems seen in athletes.


CAN THIS BE AVOIDED? WHAT CAN YOU DO?
Hydration (fluid balance) is a very individual situation. Sweat, sodium and volume shifts and rates are highly variable, depending on individual responses to exercise intensity, duration, and environmental conditions (heat, humidity, heat index, and altitude). Athletes SHOULD learn their OWN fluid requirements.


WEIGH BEFORE AND AFTER a STRENUOUS and/or LONG WORKOUT.
This will provide you with a personal guide to your sweat loss, in order to create a fluid plan for your future workouts or training.


AS A RULE: Drink 3 cups (24 fluid ounces) per pound lost to replace the lost water weight as well as to account for urine production. Dehydration usually causes thirst, but for athletes drinking plain water without ingesting adequate sodium suppresses thirst BEFORE fluid balance can be restored. Therefore, consuming a sport drink with at least 100 mg. OF SODIUM for each 8 ounce serving can help counteract dehydration and avoid hyponatremia. Rebalancing both thirst and mineral needs for a heavy sweater can prevent severe muscle cramping and even death for some individuals.

Please let me know your thoughts and comments by posting questions/comments on this blog.

Larry’s Top Three Aches and Pains: Part 1

By Larry Foss, US National Team, owner The Fix Active Body Massage, specializing in sports massage, bike fitting and FaCT lactate testing.

After 20 years of being a cyclist and 11 seasons as the massage therapist for the US Cycling Team I have learned a few things about making cycling a more pleasurable experience.

This is intended to let the novice in on a few tricks of the trade.

Every cyclist I have worked with seems to have similar aches and pains associated with either the beginning of the season or just starting out as a cyclist and the number one complaint is my butt hurts!!!

Most beginners are too often riding a bike that isn’t adjusted to the rider. If the seat is too high or low it is going to put undo strain of your behind.

Another problem is that they are riding a saddle that doesn’t fit their “sit bones.” Everyone’s pelvis is unique and when you have the proper seat set up i.e. proper saddle width, saddle height, and saddle tilt. Your sit bones will be positioned on the wider portion of the saddle taking the strain off any of the soft tissue.

OFF-SEASON TRAINING FOR THE CYCLIST

By Dan Carey, Phd., Univ. of St. Thomas

Like most cyclists, you are anxious to see the temperature rise and the winds subside so you can get outside on the bike. Maybe you have gained a few pounds over the winter because it is just too hard to burn calories sitting on your indoor trainer/stationary ergometer. You are also wondering how your fitness for cycling has changed. Maybe you have elected to do some cross-training in the winter and have done virtually no cycling.

The concept of specificity says that if you want to be “bike fit”, you better spend most of your time cycling. However, from a sport physiology perspective, there are 2 components of endurance fitness 1)central factors, including the heart and lungs, and 2)peripheral factors, or the specific muscles used in a given activity.

If you have maintained some training intensity over the winter, you have maintained your “central” fitness. The heart and lungs do not know where they are sending that oxygenated blood. They just know that they must pump blood(heart) and breathe air(lungs) if the muscle is to be supplied with adequate oxygen. An excellent supplementary activity for cycling is cross-country skiing. Cross country skiers are generally reported to have the greatest VO2 max(maximal oxygen consumption) of any endurance athlete. It has been one of the better winters in recent memory for this activity.

Running is another outdoor activity that can be used in the winter to maintain fitness. While many cyclists will say it is too cold to run outdoors, I contend that the only smart thing to be doing outside in cold weather is generating heat.

Other winter endurance activities are elliptical training and the treadmill. Research on the elliptical cross-trainer support its value in improving/maintaining endurance fitness and burning calories. Many consider walking on a treadmill as an inadequate stimulus for endurance fitness. Anyone who has set the speed at a brisk walk(4-4.5 mph) and put the incline at 10-15% will quickly realize the intensity of this activity. Studies which have examined which piece of aerobic equipment in the health club results in the expending of the most calories and produces the highest heart have shown the treadmill as the winner of this distinction.

Finally, the winter is a great time to improve your muscle strength and endurance. Research has supported the fact that a once- per- week weight training program is adequate to maintain muscle strength/endurance. What you develop in the winter can be maintained in the spring and summer relatively easily, especially when you want to spend most of your time on the bike.

Injury Prevention 101 - Strength Training

Dr. Josh Sandell
Spine and Sports Institute

The risk of injury is an ever-present aspect of cycling, but almost every great performance follows a long period of relatively uninterrupted training. Though many athletes believe either that an injury is just a normal part of training or an unfortunate random event, the frequency of injuries may be dramatically reduced by an injury prevention program that develops strength, flexibility, and elasticity in tissues that are at high risk for injuries. Use this program to prepare your body fully for the high-volume, high-intensity training that will come later in the season.

Strength Training

Strength training is a critical aspect of injury prevention, affecting the connective tissues and the muscles. Since cycling actions occur primarily in a single plane, the tissues that act in that plane become disproportionately strong while those that act side-to-side atrophy. Programs developed only for performance enhancement usually neglect tissues that act laterally, therefore increasing the risk of injury. Several muscles that are neglected in strength training programs are the hip abductors, hip adductors, and the ankle dorsiflexors. When performing the weight training exercises, use relatively heavy weights and slow movements. Keep the duration of each set between 40 and 60 seconds. Strength training can be accomplished by simply using your own body weight with the use of physio balls and balance trainers. These exercises should be performed slow and controlled with the use of rotational movement and frontal plane movements.

Next Week we will come back and talk about flexibility.

STRETCHING YES, STRETCHING NO…

Fernando A Pena, MD – TRIA Orthopaedic Center

In spite of scientists’ best efforts, we are still missing the scientific evidence that regular stretching prevents injuries. At the most, there is some suggestion that it may help to recover from an injury, like a muscle strain or pulled groin, but still it is a very soft correlation.

The benefit from stretching comes from preparing a muscle group for an athletic activity and sending the proper “signals” to get ready. The benefit is believed to be related to the increased blood flow to the muscle fibers as well as the connective tissue surrounding the muscle. Excessive stretching may be counterproductive, as it may create some degree of instability to a specific joint and therefore make it more susceptible to injuries.

The human body has to get ready to exercise. Similarly, it has also to get ready for something apparently as trivial as stretching. Something as simple as a brisk walk or a light vertical jumping for a few minutes would help to get the blood flow going and therefore it will facilitate the stretching program.

The golden rule for stretching is to avoid pain. To stretch until the rider feels pain it is considered to be excessive and definitely not beneficial. It is recommended to feel tension and a “stretch” but not necessarily pain. A good stretch should be held under tension for 10 to 30 seconds. Beyond that point it does not seem to be of an extra benefit either.

It is very important to avoid any “bouncing” of the muscle group while stretching. The “bouncing” will generate neurological signals at the level of the spinal cord which will be transmitted to the muscle and prevent further stretching, making the rest of the session useless and in some cases even injury prone.

In the case of a cyclist, the muscle groups, to benefit from stretching will include the lumbosacral spine (lower back) and lower extremities. The cervical spine (neck) and upper extremities will be positioned almost completely static during a ride. Regular stretching of those areas while riding will be of benefit to avoid overload injuries to tendons and ligaments of the neck and upper extremities.

Regarding the lower extremities, special attention has to be paid to the iliotibial band also known as the IT band (a ligament that stretches from the hip to the knee along the outside of your thigh). Both at the level of the hip and the knee joint, the IT band is prone to irritation. When the pain is felt at the hip level, it is also called the “snapping hip” as the IT band “jumps” over the bony prominence of the hip area with every flexion-extension of the hip joint. At the knee level, it is very unlikely to feel any snapping, but still it may be of significant discomfort after long rides in the presence of a tight IT band. Proper stretching of the IT band is the best initial remedy to avoid those conditions as well as a very diligent program of icing to the affected area.

Group riding etiquette 101: Stick with the plan.

Have you had this experience?

Your group ride started out at an easy pace. Pretty soon, someone riders to the front and picks the pace up. Your little ego demon says “he’s not faster than me!”, so you follow suit. So does everyone else. Then someone else ups the ante. Pretty soon, everyone’s heart rate is pegged out, white knuckles threatening to bend your handlebars and you’re coughing up little bits of your lungs.

What did you everyone say in the parking lot before the ride starts?

“Easy ride today.”

And this group delusion was followed by “I’m toast from yesterday’s hundred miler”, “I haven’t been on by bike in a week”, “my program calls for a recovery ride today” or “I’m tapering for a big ride/race this weekend”. All the pre-torture fest excuses that signals that everyone knows that no one is going to stick to the “easy ride” plan.

What would have happened if one person (just ONE) had said “hey, dude, dial it back. This is an easy day.” when that first knucklehead had picked up the pace? Everyone would have given a deep sigh of relief, because they really DID want an easy day. They just knew the group would have no self discipline. That egos would have gotten involved and the response to someone amping it up would be to amp it further. A response of “Take THAT” is a lot easier on the ego than “Slow DOWN”.

But easy rides are an essential part of training. You can only ride really hard on hard days if you’re rested. If you ride hard on days that are supposed to be easy, all you’ll manage on the hard days is to ride a little (but not much) harder.

If you want to be fast, keep your easy days really easy so that you can make your hard days really hard.

And what do you do if the dude that amps it up DOESN’T slow down when asked? Before the ride starts, agree that anyone who amps it up will be ignored. Then, when Mr. Macho picks up the pace, tell everyone “let him go”.

And the fool will ride up the road on his own.

David Laporte