There are three kinds of athletes: those that have been injured, those that are injured, and those that will be injured.  To excel in competitions athletes must push themselves to their limits.  To train for competitions they must overload their physical systems in order to obtain a training adaptation.  It’s at these times that injuries can occur.
It’s been estimated that up to 17 million sport injuries occur each year in the United States.  This not only occurs among elite athletes, but among weekend warriors as well.  In the 1990s, sport-related emergency room visits increased 33% for persons between 35 and 54 years old and 54% for persons 65 years and older.

It was once thought that sports injuries were not only caused, but also cured, solely by physical processes; the mental aspects of injuries were largely ignored.  This was exemplified in the “old school” mentality when athletes were expected to fight through their pain regardless of its source and coaches treated injured athletes as worthless because they were not contributing.  These antiquated attitudes, however, began to change in the 1970s when physicians began to recognize that behavioral and psychological factors played a significant role in putting athletes at risk for injury as well as in injury rehabilitation.

Research has demonstrated that increased stress and coping difficulties increase the risk of injury.  For example, a study conducted on the University of Washington football team found that only 9% of the players with low life stress experienced injuries compared to 50% of the players with high life stress.

Stress increases the risk of injury in three ways.  First, when individuals experience stress they become physically tense.  When muscles are tense, coordination and motor speed decrease.  If you’ve ever tried to navigate through a mass sprint at the end of a race while maintaining a death grip on your handlebars, you might have first-hand knowledge of how muscle tension can affect coordination.

Secondly, when people feel tense their focus narrows.  It’s as if they are looking through a camera with a telephoto lens: They focus only on a few details, but can miss other important things happening around them.  If anxiety leads you to glue your eyes to the wheel in front of you and you don’t notice the pothole you’re about to ride into, you could be in for a bad day.

Thirdly, anxiety can cause a person to have difficulty maintaining their focus.  They can become so distracted by their anxiety that they miss something important.  All too often this leads a rider to break the first tenant of cycling:  Keep the rubber side down!

Psychological factors are also important in the injury recovery process.  A 1996 survey revealed that about half of 482 certified athletic trainers believe that every injured athlete suffers negative psychological effects.  The most common of these effects were stress and anxiety, anger, non-compliance with treatment, and problems with concentration and attention.

The good news is that this same body of research has clearly shown that athletes can use mental skills to cope with or control these psychological factors.  For example, a study with collegiate athletes who were taught relaxation training showed a 52% decrease in injury rates among swimmers and a 33% injury rate decrease among football players.  Additionally, several studies have shown that injured athletes who practiced such mental skills as a goal-setting, relaxation training and positive self-talk experienced increases in attention and decreases in stress, subjective pain and recovery time.

Okay, so what does all this data mean?  What should you do to minimize your risk of injury and to maximize your recovery after an injury?  Here are some tips to consider:

•    Learn stress management techniques.  Strategies to help you relax both physically and mentally can help you cope more effectively with life stress to avoid injury and to decrease anxiety and facilitate recovery after an injury.

•    Avoid risks when you are stressed.  When you are stressed your coordination and concentration suffer, leading you to be more vulnerable to injury.  The lesson here is this:  After your heartthrob dumps you is not a good time to practice those tricky technical descents at 50 miles an hour!

•    Know the difference between “good” and “bad” pain.  Don’t get the idea that I’m suggesting that you be so careful that you don’t train hard.  No one ever won a race with their mother running along side them screaming, “Be careful!  Don’t go so fast!  Don’t ride so close together – you’ll poke an eye out!”  What I am suggesting is that you learn to distinguish the kind of pain that comes with hard training from the pain that tells you something is wrong.  This largely comes from experience and paying attention to how your body feels.  When in doubt, consult your physician.

•    Use thought-stopping and thought-replacement.  After an injury it’s easy to catastrophize and tell yourself that your season is over or that you will never return to your previous form.  These thoughts may not be true, but they definitely will not help you recover.  To cope with this, become more aware of what you say to yourself by making a list of your negative self-talk.  Then think of a word or image that commands you to stop this type of thinking and use it every time you notice yourself having a negative thought.  Next, make a list of more positive and realistic thoughts that you can use in place of the negative ones, such as, “Yes this stinks, but if I stick to it and work hard I can make progress.”

•    Use imagery.  Imagery is a powerful tool, and can be used in two ways during injury rehabilitation.  First, you can use imagery to mentally rehearse technical skills and race strategies.  This will improve your muscle memory and strengthen your mental blueprint to keep you sharp while your body heals.  Secondly, you can use imagery to facilitate the healing process by imagining such things as diminished the swelling and increasing the blood flow to the injured area.  It helps if you have your physician show you a model or picture of your injury.  I know, this sounds hokey, but believe it or not research clearly indicates that it works.

•    Use goal-setting.  One of the worst things after an injury is the realization that you can’t do nearly as much as you used to.  This can add to your feelings of helplessness and despair.  To cope with this, it’s important to establish clear goals for your rehabilitation.  Start by thinking of your ultimate dream goal, and then make a list of the things that you need to do that can get you there (see my January, 2008 newsletter on goal-setting for more information on how to do this).  Determining realistic short-term goals and strategies to accomplish them will help you feel more confident, in more control, and assist you in complying with the treatment prescribed to you by your physician, physical therapist, or athletic trainer.

If you have a question or a topic you’d like to see covered in a future newsletter, email me at Dana@TheExtraGear.com.  I’m also available for free talks or teleconferences to groups of athletes who want to improve their mental skills, so contact me for details if you’re interested.

Until next time, Ride Smart!

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If you like what you have seen here, check out Dana’s web site:

Personal Best

But First, Doctor, What Was Your Marathon Time?

HIPPOCRATES THE OLYMPIAN Athletic patients may want to find physically fit physicians.

YOU are an athlete, or, at least, very active. Should you seek doctors who are athletes, too? After all, some obese people pass around lists of “fat friendly” doctors who treat them with respect. Women often want female doctors.

Are athletes also a special group? And, if so, do they fare any differently if they see doctors who are athletes?“Nobody knows,” said Dr. James Fries, a 20-mile-a-week runner and a professor of medicine at Stanford. “There’s no data.”

There are some hints, though, said Dr. Ronald Davis, who is the president of the American Medical Association and a specialist in preventive medicine at the Henry Ford Health System, which includes hospitals, clinics, a managed-care plan and a large physician group practice.

Dr. Davis cited a study by Dr. Erica Frank, who is now at the University of British Columbia. Her study, published a few years ago, involved a survey of about 4,000 female doctors and found that those who were at least moderately active were much more comfortable advising patients about exercise and encouraging them to exercise.

A doctor who is physically active, Dr. Davis said, “is more likely to provide advice on exercise that will be meaningful to patients.”

That stands to reason, Dr. Fries and other physicians said. Doctors who are athletes, he added, are less likely to say “untoward things like that running destroys the knees or that you need an electrocardiogram before you can exercise.”

But it is not always obvious whether a doctor is an athlete. Some tell their athletic patients about their exploits. Some have photos in their offices showing them crossing finish lines. With others, though, unless you ask, you may never know.

Of course, good doctors can be sedentary and terrible doctors can be athletic. What matters most is the doctor’s skill and training and whether you feel comfortable with the doctor. Some active people, in fact, say they had an awful experience when they sought out an athletic doctor.

But in general, doctors who are athletes tend to be more aware that active people want to stay active more than anything else, said Dr. William Kraus, 53, a cardiologist who is a professor of medicine at Duke and runs 35 miles a week and finishes 5-kilometer races in about 20 minutes. He said athletic doctors are less likely to take the easy way out and tell an active person who is injured or ill to stop exercising.

“For many of us, that’s just unacceptable,” Dr. Kraus said.

That was the reaction of Richard Hulnick, 40, a manager for business development at the New York Road Runners, when an orthopedist told him to stop running. He saw the doctor because his knee was bothering him. But the doctor, who, Mr. Hulnick said, “did not look like an athlete,” told him to take up another sport.

“I wanted to get better,” Mr. Hulnick said. “I wanted someone to work with me, but he didn’t tell me what to do.” So Mr. Hulnick walked out of the doctor’s office and resumed running. His knee recovered on its own and he never saw that doctor again, he said. Since then, he has completed six marathons and an Ironman distance triathlon.

Dr. Paul Thompson, a 60-year-old marathon runner (he finished second in his age group in the Chicago Marathon last year) and the director of cardiology at Hartford Hospital in Connecticut, said he often finds himself giving different advice to athletes than he would to more sedentary patients.

For example, he said, a woman with a malfunctioning heart valve came to him for a second opinion. Another cardiologist had told her there was no need to replace the valve because the woman had no symptoms. But she had been a competitive triathlete. So when she told Dr. Thompson that she had recently run a five-mile race in 50 minutes, he was suspicious. He asked her if that was her usual pace, and she told him that her time was actually much slower than in the past.

“To me, it was quite clear she was limited in her exercise tolerance,” Dr. Thompson said. He recommended she have the valve replaced, and she did.

Dr. William Roberts, a runner, skier and sailboat racer who is a professor of family medicine at the University of Minnesota, said active people sought him out to such an extent that his practice gradually turned into one made up mostly of athletes.

“They know I like physical activity and I am willing to try to find ways to keep them active,” said Dr. Roberts, a former president of the American College of Sports Medicine. He recently saw a patient with atrial fibrillation, a heart disorder. The man said other doctors had told him to stop exercising, so he had come to Dr. Roberts hoping to hear a different message.

He did. Dr. Roberts said he told the man that he could exercise as long as he kept his heart rate from going too high, and as long as he had no chest pain or shortness of breath.

Some athletes, like Jon Luff, a 40-year-old aerospace engineer who ran the New York City marathon in 2:39:59 said that if experience is any guide, stay away from doctors who know nothing about training. Mr. Luff’s wife is a doctor, as are three close friends, so he said he shouldn’t speak too freely. But then, just thinking about doctor problems, the floodgates opened.

“I have a story concerning heart rates,” Mr. Luff said. “I have one concerning tendinitis. I had a doctor tell me once that I had mono and had to stop everything.” Mr. Luff was 18 at the time and withdrew from two national competitions. It turned out he had only a cold.

Mr. Luff also has a good friend, Bill Burke, who was initially turned down by the Air Force because he has a resting heart rate of 33. Mr. Burke, who was the national champion in 1,500 meters in 1993, said he had to go to a cardiologist for a medical waiver, which allowed the Air Force to accept him. The cardiologist, Mr. Burke said, told him, “You’re either about to check out, or you’re going to be around for a very long time.”

Then there is the story of a Harvard professor, a surgeon. “He once told me that nobody should run marathons because it destroys knee cartilage,” said Mr. Luff, who knows, however, that most research, including a major study by Dr. Fries, has found that runners actually have a lower risk of knee arthritis.

Yet not every mistaken doctor is a nonathlete. Those who are athletes can be wrong, too.

That is what Patricia Sener, 43, an open-water swimmer who lives in Brooklyn, discovered when she had a problem and went to a doctor who specialized in treating athletes. The doctor pointed to a gray spot in an M.R.I. of her knee and told her she might need a major operation to replace her anterior cruciate ligament. But he said he would not know for sure until she was on the operating table.

“I’m training for the English Channel,” Ms. Sener said. “I’m on a time line. I can’t afford six months off.”

She went to a different doctor, a swimmer, for a second opinion.

“He pointed to the exact same spot on the M.R.I. and said: ‘See this. It’s normal.’” All she needed, she said, was physical therapy to strengthen the connecting muscle and ligaments around her knee and stabilize it. She recovered.

Athletes, though, are not the easiest patients, doctors said.

“They drive you nuts,” Dr. Thompson said. “They are very demanding. They are innately a select group, and a lot of athletes have a superior attitude. They are a little bit defensive.”

They tend, in fact, to be like one of my running partners, who told me that when it comes to a diagnosis, she regards doctors mainly as a source for a second opinion. The first opinion is her own, she said.

Perhaps the best indication of whether athletes should seek fit doctors is to ask doctors who are athletes whether they choose athletic doctors for themselves.

Dr. Roberts said there was no question: he chose a doctor who is an athlete, and so did his wife, a skier. His doctor, David Thorson, is a skier who was his partner when he was in private practice.

“I recruited him in the early 1990s after we raced against each other in sailboats,” Dr. Roberts said. He has been Dr. Thorson’s patient ever since.

A patient passed this on to me recently. New York Times January 3, 2008

A copy of the original article can be found at: http://www.nytimes.com/2008/01/03/health/nutrition/03Best.html?ex=1357102800&en=ab0c7b339e565219&ei=5124&partner=permalink&exprod=permalink

We have conventionally treated soft tissue injuries with anti-inflammatory medication (ibuprofen and naproxen).  However, we now know that inflammation is necessary to promote healing; to make the tissue stronger and faster; and stronger faster.

A method designed to promote inflammation and healing, called Prolothrapy, is gaining main stream recognition (even by the Richmond Times Dispatch , August 16, 2007).  The treatment involves a series of injections of dextrose and saline (sugar water, ie- all natural and safe).  The shot is an “irritant;” so it causes a local increase in the bodies own natural inflammation and healing factors.  This directly stimulates the growth of healthy, strong tissues. As the tendons and ligaments grow stronger and more capable of doing their tasks, the pain is alleviated. Prolotherapy starts the growth of ligaments and tendons, but an individual’s own immune system grows the tissue.

Prolotherapy is extremely safe. It is less risky than taking ibuprofen to temporarily alleviate chronic pain. Your Sports Medicine provider will review possible risks and benefits with you.

Most athletes require four or five sessions. For someone with an injury for just a few months (or less) and is in excellent shape, the number of sessions may be even less

Most Medical insurance companies cover this simple, safe procedure.

Before we jump into how to maintain fitness and train through an upper respiratory infection (URI or “cold”) lets take a look at a few other conditions that can masquerade as a “cold.”

“Mono”
Back in high school you probably heard of the “kissing disease,” Infectious Mononucleosis. While the Epstein Barr virus that causes “mono” is in fact spread by kissing, it can also be transmitted by any method of sharing saliva. So, don’t share water bottles.

Like the common cold, “mono” causes a sore throat and fatigue. However, unlike a cold, “mono” brings fever, swollen neck glands, and possibly spleen swelling. Since a swollen spleen may rupture (and it does in about 2 in 1,000 “mono” patients), workouts should be curtailed for about 3 weeks.

There is no cure for “mono.” Antibiotics will not help and may even make things worse. A Sports Medicine provider will probably recommend symptomatic treatments to help with the fever and sore throat. Adequate rest is very important.

“The Flu”
By now you should have had your influenza vaccination. If not, stop what you’re doing, and go to your doctor’s office for a shot. Influenza, “the flu,” is a common viral infection. The vaccination (ie.- “flu shot”) is 90% effective at preventing infection. Since the vaccine is made of killed virus, the chance of having an adverse reaction to the injection is even less than the possibility of dying from the flu without the shot. In summer, 2007, the CDC reiterated a previous recommendation that “all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others, should be vaccinated.”

“The flu” may act like a bad cold, causing fatigue and congestion. But the hallmarks of “the flu” are fever, severe body aches, and dry cough. You feel like you did the day after your personal best running race….without the euphoria. It is contagious- flu symptoms show up about 2 days after an exposure. The infected person is contagious to someone else from 1 day before becoming sick and for the first 6 days of illness. With enough rest, symptoms last about 7 days. Getting to a healthcare provider within 2 days of starting symptoms is critical if one is interested in getting a prescription for an anti-viral medication. When taken with in the first 2 days, these medications help speed recovery.

“A Cold”
This brings us to the common cold, upper respiratory infection, URI, or simply the crud. We all know what a URI feels like. But, what should it not feel like? Fever, difficulty breathing, and vomiting, are not part of a cold. In general, “cold” symptoms are from the neck up: headache, sore throat, and runny nose. The rule of thumb is this: If your symptoms are from the neck up, it’s OK to train if you feel like it. Some over the counter (OTC) medications might help.

OTC decongestants help “dry up” a runny nose. Decongestants also dry up your mouth, making you feel thirsty. Stay away from them before a sanctioned race. All decongestants are banned by the NCAA, USOC, and most sanctioning bodies.

An expectorant, like guaifenecin, is a medicine that “thins” secretions, making it easier to get the bad stuff out. Expectorants are legal in competition. If you try an OTC or prescription form, be sure to get plenty of fluids; don’t get to the point where you feel thirsty.

While your waiting the 5-10 days for the cold to go away, do a few more weight training workouts instead of cardio workouts. That way you can keep your strength up, and eliminate the congestion/ dehydration problem. Plenty of vitamin C (some chewable brands taste good) may help speed recovery and prevent relapse. Try to get at least 1500 mg/ day. Other alternative remedies like zinc and echinacea are also available. They won’t hurt, but well designed studies have not shown them to be very effective.

As for prevention, frequent hand washing is the way to go. The little rhinovirus doesn’t stand a chance against suds and water.

Keep training. Take a few days of rest when needed. Enjoy!

What is Hyponatremia? (hi-PO-na-tree-mee-uh)
Table salt, sodium chloride, is lost in sweat and urine and replaced by food. The sodium part (of sodium chloride) is vitally necessary for such body functions as muscle contraction and transmission of signals along nerves. The average American diet has more than enough sodium to keep these functions going… for most people.

The body has excellent adaptation mechanisms in the kidney, sweat glands, and blood vessels that maintain blood sodium levels in a very tight range of about 135-145 meq/L. Going much outside this range means trouble. So the maintaince system is very efficient. Ultra endurance events challenge this efficient survival mechanism.

Imagine your body is a glass of salt water. Poor out (sweat) some of this water. Replace it with tap water. This glass (your body) is now low in sodium compared to the original glass. This low blood sodium or hyponatremia can be tolerated for a brief period of time. But do this for 4-12 hours or more, and potentially dangerous symptoms result. In fact 30% of Hawaii IM finishers are hyponatremic.

Sweat contains 2-3.5 grams of sodium per liter. (The more trained you are, the more dilute your sweat, the better your body can conserve salt.) Triathletes can easily sweat more than 1 liter per hour during training. In a 12-hour race, that could mean 24-42 grams of salt lost. Replacing with only water causes hyponatremia.

Aspirin, ibuprofen, and other anti-inflammatory that tri racers frequently pop, interfere with kidney function and contribute to the development of hyponatremia. Under tough conditions you need your kidneys need to function at 100%.

Symptoms of Hyponatremia
Blood sodium levels below 125 produce symptoms. You’re probably familiar with the symptoms of hyponatremia: nausea, muscle cramps, and irritability. At this point many athletes think they’re dehydrated and drink more water, making the problem worse. In the past, the medical tent at races would treat these symptoms with intravenous fluids. The American College of Sports Medicine now calls such practice the “dehydration myth.” These early symptoms should be treated with salty foods and some sports drink.

More severe symptoms include seizure and coma. Of course if your training buddy has these symptoms, get him to medical attention immediately. The medical team will likely go with intravenous HYPERnatremic (high salt) solutions to rapidly elevate serum sodium level to a “safe” level of 120-130 in a few hours, followed by a gradual increase to normal over the next few days. Entirely too many athletes have died of hyponatremia.

Prevention of Hyponatremia
No clear-cut recommendations work for all. So I stress that you know your sodium needs prior to race day. Practice your hydration, eating and salt strategy during training. In general, events more than 3 hours require sodium from sports drinks. When going more than 5 hours (ultras, IMs) salty foods are necessary. Most authorities and I recommend against salt tablets (unless your very experienced with them) which may give you too much salt.

Get used to reading FDA labels. Remember training removes 2-3.5 grams of sodium per hour. Do not try to replace all of this during your workout. Rather increase sodium intake for several days prior to a long event. Then shoot to get about 1 gram of sodium an hour during training. This will keep you out of trouble. The ideal training food has both sodium and carbs. Here are a few favorites:

Serving Sodium (mg) Fat (gm) Carbs (gm)
Gatorade 8 oz 110 0 14
Exceed 8 oz 50 0 17
Salted pretzel 10 reg size 300-500 0-1 19-22
Fat free saltine 5 crackers 130 0 11

Other great choices are chicken noodle soup (a must at IM), pickles, and tomato juice. The exact amount of sodium varies among brands.

Recommendations
1. Increase sodium intake by 10-20 grams per day for a few days before the event.
2. Use a sodium containing sports drink when going for a long time.
3. Shoot to get one gram of sodium per hour during the event.
4. Weigh yourself before and after training. Drink enough sports drink to keep the numbers the same.
5. Avoid aspirin, ibuprofen, and other anti-inflammatories.
6. Discourage the practice of “drinking the maximal amount of water that can be tolerated.”

Don’t get rid of your saltshaker, know your needs, eat well, drink the right fluids, and go like hell.

Hepatitis B virus (HBV) may be spread thru sweat according to a study published this year in the British Journal of Sports medicine. The virus can survive outside the body for 1 week and can penetrate broken skin.
HBV causes a serious incurable disease that attacks the liver. This lifelong infection leads to cirrhosis (scarring) of the liver and possibly liver cancer or liver failure. HBV infection can be prevented by vaccination.
One in 20 Americans carries this virus. 75% of carriers are in their 20s and 30s. Although sexual contact is one way to “catch” the virus only 1/3 of transmissions are the results of such contact. Other ways to get HBV are:
• Needle sticks (piercing/ tattoos/ health care)
• Sharing razors or toothbrushes
• ROAD RASH
The NCAA and the American College of Sports Medicine recommend vaccination for all athletes.

10 Running all the time
Cross train and get strong. Throw in a “non-run” workout at least once a week. Lifting weights is best to help prevent injuries.

9 Overhydrating
Drinking too much water will dilute the salts in your blood, resulting in “hyponatremia” or low blood sodium. The official advice from the American Marathon Medical Directors Association is to “Drink what you’re thirsty for.”

8 Getting in the car
Many T in T workouts end with the gang hanging out in the parking lot. THIS IS YOUR TIME TO STRETCH. If you only stretch once a day, do it at the end of your workout. Don’t get in the car until you have done your stretching.

7 Throwing in “junk miles”
When you feel good, do not do more miles than your coach tells you to do. Instead use the energy to raise your funds or spend time with your family.

6 Using the same ol’ shoes
Get fresh running shoes about every 300 miles… it’s cheaper than a trip to the orthopaedist.

5 Blaming the shoe
Getting new shoes won’t fix all your running aches. If something hurts for more than 3 days, talk with a Sports Medicine provider.

4 >10%
Do not increase your long runs by more than 10-20% per week. If you get blisters, you are doing too much too soon. Blisters are an external sign of overtraining.

3 Beating the competition
The goal of your first marathon is to beat the distance; not the clock, and definitely not the competition.

2 Being unprepared for race day
Get plenty of sleep and carbohydrates the 3 days before the main event. Also, don’t try and new foods or techniques during this time. Show up early on race morning with extra pins (for your race number); old clothes that you can shed as the temperature warms; toilet paper; Vaseline for chafed skin; sunglasses, hat, gloves, sunblock….

1 Not having fun
If you heart is not in it, take a few days off from training. Then, have fun or go home!

Burrr! It is getting cold for Richmond’s athletes. Fortunately, cold weather and wet hair are not part of the current viral theory for causes of the common cold (sorry Mom!). Working out in the cold is however immunosuppressive. In other words, it decreases your ability to fight off bugs like the nasty rhinovirus, which is the most common cause of the common cold.

Before we jump into how to maintain fitness and train through an upper respiratory infection (URI or “cold”) lets take a look at a few other conditions that can masquerade as a “cold.”

“Mono”
Back in high school you probably heard of the “kissing disease,” Infectious Mononucleosis. While the Epstein Barr virus that causes “mono” is in fact spread by kissing, it can also be transmitted by any method of sharing saliva. So, don’t share water bottles.

Like the common cold, “mono” causes a sore throat and fatigue. However, unlike a cold, “mono” brings fever, swollen neck glands, and possibly spleen swelling. Since a swollen spleen may rupture (and it does in about 2 in 1,000 “mono” patients), workouts should be curtailed for about 3 weeks.

There is no cure for “mono.” Antibiotics will not help and may even make things worse. A Sports Medicine provider will probably recommend symptomatic treatments to help with the fever and sore throat. Adequate rest is very important.

“The Flu”
By now you should have had your influenza vaccination. If not, stop what you’re doing, and go to your doctor’s office for a shot. Influenza, “the flu,” is a common viral infection. The vaccination (ie.- “flu shot”) is 90% effective at preventing infection. Since the vaccine is made of killed virus, the chance of having an adverse reaction to the injection is even less than the possibility of dying from the flu without the shot. In summer, 2007, the CDC reiterated a previous recommendation that “all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others, should be vaccinated.”

“The flu” may act like a bad cold, causing fatigue and congestion. But the hallmarks of “the flu” are fever, severe body aches, and dry cough. You feel like you did the day after your personal best running race….without the euphoria and even getting to the doctors office is physically difficult at best. It is contagious- flu symptoms show up about 2 days after an exposure. The infected person is contagious to someone else from 1 day before becoming sick and for the first 6 days of illness. With enough rest, symptoms last about 7 days. Getting to a healthcare provider within 2 days of starting symptoms is critical if one is interested in getting a prescription for an anti-viral medication. When taken with in the first 2 days, these medications help speed recovery.

“A Cold”
This brings us to the common cold, upper respiratory infection, URI, or simply the crud. We all know what a URI feels like. But, what should it not feel like? Fever, difficulty breathing, and vomiting, are not part of a cold. In general, “cold” symptoms are from the neck up: headache, sore throat, and runny nose. The rule of thumb is this: If your symptoms are from the neck up, it’s OK to train if you feel like it. Some over the counter (OTC) medications might help.

OTC decongestants help “dry up” a runny nose. Decongestants also dry up your mouth, making you feel thirsty. Stay away from them before a sanctioned race. All decongestants are banned by the NCAA, USOC, and most sanctioning bodies.

An expectorant, like guaifenecin, is a medicine that “thins” secretions, making it easier to get the bad stuff out. Expectorants are legal in competition. If you try an OTC or prescription form, be sure to get plenty of fluids; don’t get to the point where you feel thirsty.

While your waiting the 5-10 days for the cold to go away, do a few more weight training workouts instead of cardio workouts. That way you can keep your strength up, and eliminate the congestion/ dehydration problem. Plenty of vitamin C (some chewable brands taste good) may help speed recovery and prevent relapse. Try to get at least 1500 mg/ day. Other alternative remedies like zinc and echinacea are also available. They won’t hurt, but well designed studies have not shown them to be very effective.

As for prevention, frequent hand washing is the way to go. The little rhinovirus doesn’t stand a chance against suds and water.

Keep training. Take a few days of rest when needed. Enjoy!
Teresa Stadler, MD, FACSM
Commonwealth Sports Medicine