Being able to perform a thorough orthopedic evaluation is a cornerstone of a managing a running related injury. Not only can it determine if someone needs more advanced testing (blood work, imaging, etc.), it can provide a window into what is the best place to start managing an athlete with the ultimate goal of getting them back to consistent training.
In school, we learn a plethora of tests. When you have a patient that comes in with hip pain I need to determine the exact weak muscle that is causing their problem. Is their weakness with hip ER more do to their inferior glemmus or obturator internus?
Since my focus is on injuries related to running and triathlon, this means I spent a lot of my time developing my skills assessing lower extremity injuries. It was very reassuring to know that all I needed to do was have enough tests in my arsenal I would be able to get 100% of my patients better guaranteed. Not only would it tell me exactly how to manage an injury, it would tell me exactly how a runner ran and what muscles were too weak or inflexible. Imagining that this is how running related injuries work really makes the role of the clinician very easy. I was simply using algebra to solve an equation.
The problem is that every injury has a person behind it. I was lucky enough to spend the weekend hosting Chris Johnson and Joel Sattgast, as well as 18 outstanding clinicians from across the country, to @KCEndurance this weekend. We spent the weekend talking about all things related to injuries and endurance athletes.
Over and over again we talked about how so much of one's ability to recover from an injury, and perform well on race day, comes down to that individual. There is no exact recipe that everyone must follow. No assessment piece that overrides all others. You have to connect and understand the person in front of you. Not only must we consider training volume, running mechanics, and various other assessments, we have to consider the person that we are assessing.
Growing up I loved Chris Farley. While I’m sure my parents didn’t appreciate his movies the way I did, I thought he was hilarious. In Tommy Boy, he accurately described how a guarantee on brake pads is very similar to using one orthopedic test to determine a runner’s plan of care.
Tommy: Here's the way I see it, Ted. Guy puts a fancy guarantee on a box 'cause he wants you to feel all warm and toasty inside.
Ted Nelson: Yeah, makes a man feel good.
Tommy: 'Course it does. Why shouldn't it? Ya figure you put that little box under your pillow at night, the Guarantee Fairy might come by and leave a quarter, am I right, Ted?
Ted Nelson: What's your point?
Tommy: The point is, how do you know the fairy isn't a crazy glue sniffer? "Building model airplanes" says the little fairy, well, we're not buying it. He sneaks into your house once, that's all it takes. The next thing you know, there's money missing off the dresser and your daughter's knocked up, I seen it a hundred times.
Ted Nelson: But why do they put a guarantee on the box?
Tommy: Because they know all they sold ya was a guaranteed piece of…
Well you know the rest.
I write this today for two reasons. First, for athletes out there that have been told that because they have tight, weak, or inhibited whatever, they are destined to a career of injuries and poor performances. A majority of my patients have seen another provider before seeing me. When they come to my office, they often have many inaccurate beliefs they have been told by another well intentioned health care provider. One test is NEVER a guarantee that you are destined for trouble.
Secondly, to frustrated clinicians that put too much emphasis on what an orthopedic test might say. People, and injuries, are complex. Trying to boil them down to a specific test is a recipe for failure. Get to know the person in front of you.