She was happy to tell me I could check off all the requirements.

As a thank you [...]]]> I had a patient bring me an article yesterday. It was a “checklist” on how to find a healthcare provider that was well versed in dealing with endurance athletes—even how to find a “running” or “tri-specific” practitioner.

She was happy to tell me I could check off all the requirements.

As a thank you for bringing it in, I thought I’d add my two cents.

I get the point of the article. And most of it makes sense, but in some respects the whole idea of “tri-specific” or “running specific” providers is pretty silly.

Here’s why.

No matter the activity—running, biking, computer work, housework, gardening or twiddlywinks—the only way you cause an injury to your body is by exposing it (or one specific tissue) to more activity (load/stress etc) than it can handle (it’s capacity).

This happens one of two ways:

1. Expose healthy tissues to huge loads.

2. Expose unhealthy (overloaded) tissue to normal loads (or in some cases even less than normal loads).

I know that’s getting repetitive, but only because it’s true.

I challenge anyone to come up with another mechanism for injury (please email me if you can).

Until then, that’s it. End of story.

So we only have one way to get hurt.

Now consider that when it comes to musculoskeletal care, we only have a finite number of tissues we deal with: muscle, tendon, ligament, bone, nerve, and fascia.

Each one of those tissues has it characteristic response to being overloaded.

Muscles create adhesion, tear, atrophy etc.

Tendons create adhesions, tear, inflame and degenerate.

Bones degenerate and or break.

Etc, etc, etc.

Point being, when you really think about it, there are only a few different types of tissue, with a few different types of dysfunction, and they’re all injured in the same way (by being overloaded).

That means, as much as runners, dancers, tri-athletes, gardeners, and machinist, all want to think that their problem is “different” because of what they do, it’s really not.

There are only so many choices.

The difference is only in what structures (muscle, tendon etc.) are involved, where (specific anatomic location) and what type of dysfunction (adhesion, inflammation etc).

Fill those three categories and we’re off running.

Pretty simple huh?

It also follows then, that once the type of tissue is determined, the nature of the dysfunction is found, and the location is specific, treatment would/should be largely the same for a gardener versus a runner.

What would differ? Load management factors (how they broke it in the first place).

The article suggested that tri-specific providers should be able to evaluate your bike position, swim stroke, and running gait.

I can agree with that. In most cases it’s largely unnecessary, but may be helpful in a very small percentage of cases.

But really, look at what that is; load management.

Fixing bad biking position is really just load management (and really should be done at the bike shop where they do it everyday).

Running and swimming gait, well, did you read my shoulder article? You can’t fix mechanics without fixing the tissues first.

Those are things I think any provider should be able to do, not just a “running doctor.”

Moral of the story: Physiology doesn’t change because you run a lot. It only gets magnified.

P.S. There was another interesting point made in the article that I may hash-out later about multiple treatment options for a particular injury. Hmmm…..not agreeing with that one, at least not without a bold asterisk.