“Ye can not see the wood for trees.”
​-John Heywood

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Maybe we should treat all running injuries the same?

In school, you learn that there are specific protocols necessary for improving VO2 max, tendon stiffness, or bone density.

Specific prescriptions lead to specific adaptations.

Zone two training builds mitochondrial density,
explosive movements strengthen bone,
and heavy slow resistance builds tendon stiffness.

Science gives us the laser focus needed to get results!

When you work with people for a while, you realize we are all complicated creatures, not simple algebra equations.

While I appreciate the microscopic considerations of working with athletes, such a small aperture misses can miss the big picture.

Should we treat all tissues the same?

When we start getting specific about tissues, things sound more alike than different.

​​Wang​ describes tendons as,

"A multi-unit hierarchical structure composed of collagen molecules, fibrils, fiber bundles, fascicles and tendon units that run parallel to the tendon's long axis…tendons are a living tissue and respond to mechanical forces by changing their metabolism as well as their structural and mechanical properties."

With ​Hart​ describing bones as,

"Hierarchically organized, where structures at macroscopic and microscopic levels co-exist at varying proportions through-out the body to manage (and adapt to) mechanical loads functionally…the skeleton is highly sensitive, responsive and adaptive to its mechanical environment."

Hmmm.
These sound similar, yes?
​
Structurally, muscles, tendons, and bones are closer to a unit than isolated tissues.
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The individual components of our body work together as a symbiotic structure, complementing each other's weaknesses 👇.

Think complementary pieces to a well put together outfit.

Is it all the same?

It's easy to understand that muscles, tendons, bones, cartilage, and fascia are different. We can see the difference!

I get really frustrated when runners get sold the idea that they need a very specific approach to a patient's painful tissues. I'm opinionated about exercise prescription, but also realize there are many ways to achieve the same goal.

The most important aspect of prescribing running or lifting is understanding the person in front of you.

Do that, then dissect whether a runner's knee pain will respond best to a front squat, split squat, or knee extension isometric.

Moving from the trees to the forest

When you meet with an athlete, you ask them to do something different than their baseline.

A new mechanical loading can be viewed as benign or a threat, depending on the circumstances.

How the body responds will vary dynamically in response to life history and oscillating biological rhythms, as highlighted by the work of ​John Kiely👇​.

"Mechanical stimuli is the primary stimulus, but not the sole driver of creating fitness adaptations...Contemporary findings thus illustrate that the long sought-after first mediator is not a biological event, but a change in emotional resonance."

Emotion calibrates our body's response to loading, highlighted in this graphic 👇.

The body first acts emotionally, then biologically.

While I'll keep having my patients lift heavy weights, jump, and execute controlled, single-leg movements, you have many options at our disposal.

People respond to the same training stress in vastly different ways, and that diversity should be celebrated.

You make exercise plans, and the body laughs

Imagine yourself 30 feet from your hypothetical injured athlete.

What do you see?

Someone who is stressed?
Or nervous?
Maybe frustrated?
Filled with rage?!

When we zoom out, people are unique, messy creatures easily affected by their surroundings. It's often more helpful to approach a patient like an engaged first-grade teacher, using the H.A.L.T. strategy to calm a student.

• Are you hungry?
• Are you angry?
• Are you lonely?
• Are you tired?

Your patient may really need a snack and a good night's sleep, before a new set of exercises.

Figure out the person in front of you before you walk them over to the dumbbells.