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

Upon moving to San Diego just over a year ago I was surprised at how many people were into work early so that they could be out enjoying Mother Nature in the afternoon. Being an exercise enthusiast from the North East I’ve had a blast either running 8+ miles around La Jolla cove, hopping on my bike for 40+ miles, or even the dreaded JCC Master’s swims led by full time masochists Chad, Nikee, and Rachel. The combination of any of these workouts and the preceding workday resulted in both physical and mental exhaustion, not to mention quite an appetite, which may explain why some people don’t lose as muc weight as they expect on an exercise program. And, if anyone out there has attended one of the San Diego Triathlon Club Aquathons you can attest to the caloric explosion that can occur after 30 – 50 minutes of lung burning activity followed by one of the finest post-race food spreads in the history of after-race parties.

However, a recent article in the New York Times about the timing of meals made me re-think my typical post-workout feed bag routine.

The New York Time article “Late Night Eating Linked to Weight Gain” comments on a medical study performed at Northwestern University and will be published in the peer reviewed journal Obesity next month. Researchers at the university found that mice whose feeding was restricted to daylight hours (the equivalent of our night time for our squeeky, furry, nocturnal friends) gained 28% more weight than the group that ate during their regular feeding times during the night as they instinctively do.

At first thought, you would think that the obvious reason for the weight gain in the first group of mice was because they ate more calories. Guess what? You’d be wrong! The researchers found that both groups consumed nearly equal number of calories and exercised for similar duration on each day, making the only difference between the groups the meal timing.

Now, granted this is an animal study and the results should not be immediately directed towards humans but it does give some guidance to those athletes looking to shed a few pounds.

I’m not suggesting that we all eliminate eating after our evening workouts, since re-fueling is an important part of proper recovery after a hard workout. Getting the correct amounts of protein and carbohydrates within 30 to 60 minutes after a workout (known as the glycogen window) is proven to increase muscle glycogen storage and provides a larger energy source for your next workout. However, for most of us the total calories that needs to be consumed for this effect is only around 500 calories – that maybe 2 bagels, or a turkey sandwich with a side of veggies.

I’m sure that on a semi-regular basis I approach the 1500 calorie range with my post-work meal, especially after a long workout. I have to admit, that previously I had been under the impression that in order to reduce weight, calories in had to be less than calories out. However, this new research may suggest that simply changing the time of day when these calories are consumed could help to reduce excess weight. I am even more convinced of these findings after thinking of previous research that has shown lower body weights for those individuals who ate breakfast every morning when compared to those that routinely skipped breakfast. I am sure that I’m not the only one who has over-eaten after an evening workout to the degree where breakfast isn’t even appetizing.

So once again, I’m not saying that we should stop eating when the sun goes down (we’re athletes, we need to eat). I’m saying that for the majority of us who aren’t training 30 hrs a week like the pros with a body fat percentage hovering around 6% it might be a good idea to re-distribute some of the calories. Instead of gorging yourself at the all you can eat buffet after beating yourself up with 10 x 400m with a 1 mile warm up and cool down on the track, save some of those calories for breakfast the next morning.

———————————————————————
Evan Johnson is a San Diego personal trainer with a Master’s Degree in Exercise Science. If you’d like a fitness consultation with Evan, give us a call at 858-678-0300

If you’ve been in our sports medicine clinic for a sports injury, then we’ve probably talked to you about the benefits of using a foam roller for soft tissue and myofascial work. If you haven’t had to limp across our doorway with a sports injury, even better…here’s a new sports therapy product that should keep you from meeting us too soon (and as the added bonus of being more environmentally friendly)

Trigger Point Therapy has launched  their Grid Foam Roller which far exceeds traditional foam rollers is a lot of ways. For one, the Grid Foam Roller is  made out of EVA (the same stuff used to make the soles of running shoes) and as a result, the Grid Foam Roller doesn’t break down as quickly as a traditional foam roller. The Grid Foam Roller  also has this really cool matrix shape and contour withs different texture and densities. Essentially, you’re getting three different foam rollers combined into one. The EVA is wrapped around a hard tube (which is why the Grid is hollow – all the support and firmness is from the tube.

What else makes the Grid Foam Roller unique? The Grid also has a much smaller profile – just 13 inches long compared to the typical 3 foot long foam rollers we used to use here at Coastal Sports and Wellness (yep, we’ve switched over to the Grid Foam Roller for the clinic). Plus, the final big point for me – there is a one year warranty on the Grid. IF you can wear it out, break it down, etc, Trigger Point Therapy offers a one year warranty on it. Granted it costs a little more than that typical foam roller, but if you figure that the Grid should last through at least a year of regular use, that will end up saving you money in the long run. I usually see our the foam rollers break down after about 3 to 4 months of use, so do the math…$40 for the Grid for a year, or buying a new foam roller every 4 months at $20 a pop…plus you’re not tossing the old foam roller into a landfill somewhere…

The Grid Foam Roller is a great new therapy tool for athletes suffering from a range of maladies from iliotibial band syndrome to hamstring strains and quadriceps and calf muscle injuries.

for $39.99 + shipping from the Trigger Point Therapy website.