"What you see is all there is."Daniel Kahneman It’s easy to talk to patients about exercises and training. But many running-related injuries are health problems masquerading as strength or training problems. Rehab pros must know how to screen for factors at play outside of orthopedics. And there's new research to help with just that. Where do we start? There is a growing body of evidence that metabolic factors influence bone stress injuries (and really all injuries). PTs are often the first...
14 days ago • 1 min read
“It takes a while to hear a person’s story and for that person to tell it, and like most stories it bounces all over the place before you know what the plot really is.” Lori Gottlieb When I order a coffee, I want a coffee. Preferably, a single-origin pour-over from Kenya or Ethiopia. I don't want a conversation about politics, theology, or Andy Reid's unwillingness to move away from an RPO-style running game. I want coffee. Patients don't come to us looking for caffeine, but they do come with...
21 days ago • 3 min read
It can be hard to filter the massive amount of information that we (and our patients/athletes) contend with. In today's newsletter, you've got an exclusive video where I walk you through the differential diagnosis and management of a potential femoral shaft BSI. My goal is to give you a more realistic view of how rehab unfolds, rather than the spliced-up, in-your-face version you see on social. You can check out the case by clicking below 👇. I'd love your thoughts on one thing... I'm running...
28 days ago • 1 min read
Back in the summer of 2018, my family was getting ready to head out on I-70 West for a 5-day trip to Rocky Mountain National Park. As many business owners do, I doubled my workload in the weeks before our trip, leaving me exhausted and on the verge of illness. The habit of running myself into the ground before vacation had previously left me sick on trips to San Diego, Duluth, and Machias, Maine. Working myself to the point of sickness has led to good outcomes during the beginning of my...
about 1 month ago • 2 min read
"What you pay attention to grows"-Geneen Roth There's nothing more seductive than "curing" a patient's pain. When I first started working, I just wanted my patients to like me. And if you fix a patient's symptoms in one visit, they will happily sing your praises. But as time went on, I realized symptom responses vary drastically, and sometimes the pursuit of pain resolution does a long-term disservice to patients. It's all between your ears Pain is weird, and I'm not going to pretend I...
about 1 month ago • 2 min read
“Ye can not see the wood for trees.”-John Heywood 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...
about 2 months ago • 3 min read
"Trying to weight the trade-off between what these tools are doing for us versus to us is hard to parse" -Tobias Rose-Stockwell Runners need reflection, not comparison, when dealing with an injury. Strava recently announced the ability to document "physical therapy" as a way to say "I showed up today, I did the work, and I'm still moving forward," according to their CPO, Matt Salazar. My cynical side laughs. Strava is valued as a multi-billion-dollar company with hundreds of millions of...
about 2 months ago • 3 min read
“Everything in life is writable about if you have the outgoing guts to do it, and the imagination to improvise. The worst enemy to creativity is self-doubt.” -Sylvia Plath Clinicians should think like artists, not practitioners. Too often, we speak in the same way, do the same things, and have the same message. Wouldn't it be better to express your unique perspective? But figuring out how you navigate as yourself, not as every other khaki-and-polo-wearing provider, first requires us to talk...
2 months ago • 3 min read
"High risk injuries need a more cautious treatment strategy" -Hoenig 2021 Bone stress injuries (BSIs) start well before an athlete enters at your clinic. Because bone is uniquely innervated, patients typically do not begin to feel the symptoms of a BSI until long after the injury has occurred. By the time they seek help, they are already at a disadvantage, making it crucial to manage these injuries effectively to ensure long-term success. There's no time to waste. You may think I'm being...
2 months ago • 2 min read