James T. Barker

816-835-9007

NYTimes

Protective Tick Saliva. A protein found in the saliva of ticks helps protect mice from developing Lyme disease, researchers report. The findings could lead to a new vaccine against infection from Lyme disease, which is spread through tick bites. Researchers say it is the first time that antibodies against a protein in the saliva of a pathogen's transmitting agent has been shown to confer immunity when administered protectively as a vaccine. A live tick is pictured here.

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James T. Barker

816-835-9007

NYTimes

December 3, 2009

Fitness

Becoming Your Own Massage Therapist

By DIMITY McDOWELL

AS a former cross-country runner for the University of Wisconsin-Madison, where a free massage was part of an athlete’s weekly schedule, Briana Boehmer remembers the benefits of having qualified hands work her sore muscles.

Now that she is 30 and starting a corporate wellness business with her husband, Mrs. Boehmer no longer enjoys such a perk, so she massages her muscles herself. She works out about seven hours a week, training for triathlons and duathlons, and begins and ends each session by kneading her back and legs on a foam roller, which she calls her “best friend.”

“It’s like getting a massage without having to pay $85 an hour,” she said. “I can’t afford the real thing right now.”

Devices for self-massage have become more common as more people compete in endurance sports and, more recently, as the recession has made professional rubdowns look prohibitively expensive. Trainers usually recommend a massage every week or every other week for people who are training for a marathon or triathlon, but the costs do add up: according to the American Massage Therapy Association, the average price of a massage is $63 an hour.

Though a massage may sound like a luxury, it can become a necessity as part of a training regimen. When the same muscles are forced to do the same motions over and over, they become tight and injury-prone.

For instance, “riding on aerobars on the bike sets up a huge muscle imbalance in the upper back and shoulders,” said Tim Crowley, a triathlon coach in Marlboro, Mass. “Hip flexors, hamstrings and glutes become extremely tight and immobile from running.”

While it’s hard to say how many people do self-massage, many athletes swear by it, and a growing range of products and how-to videos is available in stores and online. A foam roller, which costs about $25, is just one of a family of products, manufactured or improvised, that can relieve tight muscles.

“In the late ’90s, you could only find foam rollers through physical therapy catalogs,” said Keats Snideman, a massage therapist and conditioning coach in Tempe, Ariz., who produced a DVD about self-massage. “Now you can buy them anywhere, and exercises with them are all over YouTube.”

In addition to the many name-brand products that are sold specifically as massage aids, old-fashioned household objects will do, too. Most small balls, including golf, tennis, baseball and lacrosse balls, can unkink sore muscles.

Rich Poley, author of the book “Self-Massage for Athletes,” favors using your own hands. But he is also a fan of the Knobble II, a mushroom-shaped device that can be used to press on muscles at specific trigger points to try to break up knots, and the Thera Cane, a hook that can be used to reach points on the back.

For all its advantages, self-massage has its limitations. Cassidy Phillips, founder of Trigger Point Performance Therapy, considers it the equivalent of oral hygiene. “You brush away some plaque yourself,” he said, “but you still go to the dentist for a thorough cleaning.” His company, based in Austin, Tex., sells self-massage tools for athletes.

Clearly, a massage from a trained therapist can be more effective — and relaxing — than a self-administered massage. A therapist also has a comprehensive knowledge of anatomy and can help with injuries, like muscle strains, that may not respond to self-massage.

“A foam roller can’t alleviate deep trigger points the way an experienced thumb or knuckle can,” said Collette Glass, a sports massage therapist in Atlanta.

Yet Mrs. Glass, whose livelihood depends on athletes who need her care, is a proponent of self-massage. She and her husband, Dr. Josh Glass, a sports chiropractor, hold self-care seminars in the Atlanta area several times a year. “The message we stress through the whole demonstration,” she said, “is that self-massage keeps you out of our offices.”

Any kind of massage —the professional type and the D.I.Y. — can stimulate blood flow and break up scar tissue, thus reducing an athlete’s risk of injury, Mrs. Glass said. “In massage, shortened, overworked muscles get flushed out and return to a normal length, which helps them properly recover,” she said. When she was training for Ironman triathlons in 2006 and 2008, she said, she used a roller every day to soothe her iliotibial bands (tendons that run along the outside of the upper leg).

Jenni Gaertner, a physical therapist and competitive cyclist in Coeur d’Alene, Idaho, also advocates a combination approach. “I go to a massage therapist only during racing season, because it can be so expensive,” she said. “But I use a foam roller year-round and prescribe it to patients and teammates.”

ABBY RUBY, an athlete and coach from Manitou Springs, Colo., massaged her muscles daily while training for a 100-mile trail run in Leadville, Colo., this year. She doesn’t leave home without her tools: half of a foam roller and a small ball from Trigger Point Performance Therapy. “I sit on the ball on flights to release my piriformis,” she said, referring to a muscle deep within the hip and buttock region.

Convenience and affordability are the selling points for Ms. Ruby. “When I need a massage, I need it now, not next Wednesday at 3 p.m.,” she said.

James T. Barker

816-835-9007

NYTimes

December 1, 2009

Really?

The Claim: Exercise More During the Day, and You Will Sleep Better at Night

By ANAHAD O’CONNOR

THE FACTS It has long been said that regular physical activity and better sleep go hand in hand. Burn more energy during the day, the thinking goes, and you will be more tired at night.

But only recently have scientists sought to find out precisely to what extent. One extensive study published this year looked for answers by having healthy children wear actigraphs — devices that measure movement — and then seeing whether more movement and activity during the day meant improved sleep at night. The results should be particularly enlightening to parents.

The study found that sleep onset latency — the time it takes to fall asleep once in bed — ranged from as little as roughly 10 minutes for some children to more than 40 minutes for others. But physical activity during the day and sleep onset at night were closely linked: every hour of sedentary activity during the day resulted in an additional three minutes in the time it took to fall asleep at night. And the children who fell asleep faster ultimately slept longer, getting an extra hour of sleep for every 10-minute reduction in the time it took them to drift off.

Studies on adults have reached generally similar results, showing that an increase in physical activity improves sleep onset and increases sleep duration, particularly in people who have trouble sleeping.

THE BOTTOM LINE Studies suggest that being more physically active can lead to better sleep.

ANAHAD O’CONNOR scitimes@...

James T. Barker

816-835-9007

NYTimes

December 1, 2009, 11:59 pm

Phys Ed: How to Prevent Stress Fractures

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Stress fractures are one of the more pernicious injuries in sports, afflicting the experienced and the aspiring, with no regard for competitive timing. Last year, Tiger Woods managed to win the U.S. Open despite suffering from stress fractures in his left leg (as well as other leg and knee injuries), while the great British marathoner Paula Radcliffe struggled through the Beijing Olympics Marathon on a leg barely recovered from a stress fracture, one of several she’s suffered. The International Association of Athletics Federations, the world governing body for track and field, recently described stress fractures, with a kind of grim resignation, as “the curse of athletes.”

But studies published in this month’s issue of the journal Medicine & Science in Sports & Exercise offer hope that, at least for runners, simple alterations in their stride or in the strength of their legs might reduce their risk for the most common type of stress fracture.

In one of the studies, undertaken at the University of Minnesota, researchers recruited 39 competitive women runners, ages 18 to 35, and started measuring them. In particular, the scientists wanted to examine the size and shape of their shinbones, or tibias. About half of all stress fractures occur in the tibia, studies show. When you run or jump, that bone is pulled and bent. Sometimes, microscopic fissures form. In most cases, these tiny cracks heal quickly. But, sometimes, continued activity overwhelms the bone’s capacity to recover. The cracks grow and combine into a fracture.

The Minnesota researchers wanted to see whether the shinbones of the runners with a history of stress fractures were weaker than those without. Earlier studies suggested that this would be the case. But few studies have examined the size of the runners’ calf muscles. Bones tend to adapt to the muscles around them; puny muscles can mean puny bones. The Minnesota scientists, using a new machine that examines bone in three dimensions and measuring the runners’ leg muscles, found that, surprisingly, the injured runners’ bones were as strong, in relation to their muscle size as the bones in the uninjured runners. But the injured runners had significantly smaller calf muscles and therefore also slighter bones. The primary difference, the researchers concluded, between the women who suffered stress fractures and those who hadn’t was the size (and presumably strength) of their calf muscles.

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This finding should be encouraging to anyone who has had a tibial stress fracture or would prefer not to. “It does seem as if strengthening the calf muscles may be a very easy way” to reduce fracture risk, says Moira Petit, an associate professor of kinesiology at the University of Minnesota and an author of the study. In addition, she said, “our data suggest that you don’t have to strengthen the muscle by much.” A small increase of bulk, achievable by, for instance, rising up on to your toes and sinking back to the floor 10 or 12 times every day, might be enough. Adding even a small amount of calf muscle “serves two purposes,” Ms. Petit says. First, “the strength of the bone will usually increase” in response to the added muscle. And, as a bonus, the new muscle “can absorb more” of the forces generated when you run. So even as the tibia strengthens in response to the new muscle, it also is subjected to less shock. “Really, there’s no downside to this,” Ms. Petit says.

Her results, though, may apply primarily to women; she’s studying male runners, but so far, she says, isn’t seeing the same relationship between their calf-muscle size and bone strength. The other study in the current Medicine & Science in Sports & Exercise, however, did focus on men and their stress fractures, although, in this case, the lead researcher suggests that the findings would be true in women as well. In the work, from Iowa State University in Ames, computer modeling was used to predict what would happen to stress fracture risk if runners changed their strides. The researchers attached reflective markers to the bodies of 10 former or current collegiate-level cross-country runners and had them run repeatedly down a runway nearly 30 meters long, making sure to step onto a force plate that measured how hard they were striking the ground. During successive runs, the men were asked to shorten their natural strides, while maintaining their pace. The scientists entered the data into computer programs that calculated just how much force was being applied to the shinbone under different striding conditions. The researchers determined that reducing stride length by about 10 percent seemed to reduce the stress on the tibia enough to lower the risk of a stress fracture.

Why, though, should shortening your stride affect your tibia at all? “Think of it this way,” says Brent Edwards, lead author of the study and now a post-doctoral research fellow in the Department of Kinesiology and Nutrition at the University of Illinois, in Chicago. “If you spend less time in the flight phase of running” — meaning in the air — “you’ll hit the ground with less force.” On the other hand, you’ll hit the ground more often. But in Mr. Edwards’s models, the reduction in pounding from an abbreviated stride outweighed the shock from a few additional strides per mile.

Even for those of us without a biomechanical expert in the house, gauging a 10 percent reduction in stride is not difficult, Mr. Edwards says. “Ten percent is about as much as you can shorten your stride without it beginning to feel quite uncomfortable,” he says. And absolute precision isn’t necessary. “Seven or eight or nine percent is fine,” he says.

Neither Ms. Petit nor Mr. Edwards suggests, of course, that any, single prevention approach will end all tibial stress fractures. “There are so many elements involved,” Ms. Petit says. Training, hormones, genetics, diet and shoe choice probably all play a role. “But if there’s something easy and benign that you can do to lessen the risk,” she asks, “why not?”

James T. Barker

816-835-9007

NYTimes

November 26, 2009

Fitness

Triathletes, on Your Mark ...Whoa!

By SEAN D. HAMILL

RICK MOTTER remembers the first twinge.

He was about to finish first in his age group at the Reeds Lake Triathlon in East Grand Rapids, Mich., when, after swimming a half-mile and biking 17.2 miles, a younger competitor began to surge by him at the end of the 4.9-mile running portion of the race.

“I thought, ‘Well, that’s not going to happen,’ and I sprinted really hard — that’s when I felt it,” said Mr. Motter, 61, a manufacturing plant manager from Plainwell, Mich., who began competing in triathlons three years ago when his doctor told him he needed to reduce his cholesterol.

Soon the twinge in his right ankle evolved into severe pain, severe enough that he wound up in physical therapy with Achilles tendinitis. “A lot of my triathletes end up here because they do way too much too soon,” said Scott Miller, Mr. Motter’s physical therapist.

As more casual athletes like Mr. Motter sign up for triathlons, the sport has seen a corresponding rise in injuries. The newcomers are particularly injury-prone, doctors say, because of the rigors of training simultaneously for swimming, bicycling and running.

Paradoxically, many people move from a single sport to triathlons because of the oft-heard promise that adding variety to their exercise regimen will reduce injuries. The theory is that the three sports work different muscles, ideally minimizing the strain on any single muscle set. For runners in particular, adding biking and swimming to their repertory means less pounding against pavement.

But in practice, people who take up triathlons tend to train harder, adding rigors to their workouts without necessarily subtracting anything. Thus, the idea that people can reduce their chance of injury by competing in triathlons may be a fallacy.

“That’s been a throwaway line for quite a long time,” said Dr. Joshua Burns, a researcher and podiatrist at the University of Sydney in Australia, who has studied the nature of triathletes’ injuries. “As humans, we try to do as much as we can to be the best we can,” he said. “So if we’re just running and doing 10 hours of workouts a week and we switch to triathlons, now we’ll try to work out 20 hours a week. It’s like a bottomless cup. You can’t do enough, and people end up breaking down.”

His study of 131 triathletes in Sydney found the same basic result that other studies have over the years: that triathletes suffer as many injuries, if not more, than people who just run — and certainly more injuries than people who just swim or bike.

“What we have to compare it to other sports is the injury rate, and triathletes have one of the highest incidence rates of any sport,” Dr. Burns said. “So there is a compound effect” of doing all three activities in triathlons.

Despite, or perhaps because of, their punishing nature, triathlons are becoming more popular. The two main organizing bodies in the United States, USA Triathlon and the World Triathlon Corporation, which puts on the famed Ironman contests, both report that the number of events they sponsor has nearly doubled over the last five years, as has the number of people who sign up. (The World Triathlon Corporation has 40 events next year, up from 17 in 2006.)

Those numbers have continued to increase despite news coverage of at least 26 people dying during triathlons from 2004 to 2008, with 21 of those deaths occurring during the swimming segment of the races. The death of a contestant in the 2008 Nautica New York City Triathlon did not seem to weaken interest: registration for the 2009 event lasted 22 minutes before all the slots were sold. For the 2010 race, the nearly 5,000 spots were spoken for in just six minutes.

The health news for triathletes isn’t all bad. Most of the dozen doctors, physical therapists, coaches and athletes interviewed for this article said they had seen fewer triathlon-related injuries than injuries related to other sports. But they also said that newer triathletes suffered more injuries than more experienced ones.

Mike Walther, 32, a computer engineer in Pittsburgh who has competed in triathlons for two years, had an accident during bicycle training and is recovering from a broken collarbone. (It’s an injury that one physical therapist called “a triathlete’s rite of passage” because of how common it is among newcomers.)

Mr. Walther had been a competitive swimmer and a recreational cyclist before a friend persuaded him to begin running, which led him to triathlons. “I don’t look at my shoulder injury as related to my triathlon training,” he said. “It could have happened on a Saturday recreational bike ride. My friends with more experience in triathlons tell me I’m lucky to have suffered the injury so early in my career, because I’m just starting out and haven’t been set back much.”

Even the most experienced triathletes are not immune to injury. Paula Newby-Fraser, 47, who has won the Ironman World Championships in Hawaii eight times, was at her peak in 1993 when, she said, she decided to increase her training. It was then she sustained a stress fracture in a foot.

“I thought, ‘If this much gets me through, then that much more will get this,’ ” she said, “If riding 100 miles a week was good, then 200 miles a week will make me that much faster.”

Ms. Newby-Fraser has a name for this mind-set. “I call it athletic greediness, and that’s what a lot of new athletes coming in to it do and get injured,” she said.

Doctors, therapists and coaches say the most common injuries among triathletes come from overtraining, usually in the legs from running and cycling. Typical problems are stress fractures, injuries to the Achilles tendons and knees, and iliotibial band syndrome, which causes pain in the thigh or knee region. But doctors also see plenty of swimming-related injuries: many a new triathlete has overtrained in the pool and hurt a shoulder’s rotator cuff.

Triathletes are prone to “everything that a swimmer, runner or cyclist gets,” said Dr. Andrew Hunt, medical director for USA Triathlon.

Doctors and coaches point out that the sport is still new, and there is still time for it to live up to its cross-training purpose. The first modern triathlon was held in 1974, and the Ironman competition began in 1978. The recent surge in popularity has put the sports medicine community on a fast learning curve as it tries to address the injury problem.

One lesson — that less is more — has come through loud and clear. At the coaching certification clinics run by USA Triathlon, instructors drive home the point that while there are benefits to doing 10 to 12 workouts a week, maybe triathletes don’t need to run as far some days, that a day off is more than good for the soul, and that putting more time on the bike and in the pool can make up for one day fewer spent running.

“You don’t build your fitness while in a workout, you build while in rest mode,” said Mary Delaney, a physical therapist, triathlete and certified coach. “As your whole self and cardiac system need to recover, you’ve also got to let your muscles and tendons recover, too.”

Mr. Motter, the triathlete in Michigan, said his Achilles tendinitis was a result of overtraining and not stretching properly, according to his doctors. He said that working with a physical therapist, modifying his workouts and stretching more over the last year have helped.

Yet, in typical triathlete fashion, he has never really stopped exercising to recover. “I have a hard time taking off,” he said. “I just enjoy the effort and activity so much, and right now the pain has been bearable.”