Selecting medical help is a tough thing. You’d expect that all physical therapists and doctors are the same and that they can all deal with our Ironman training problems. Boy was I wrong.
Not All Practictioners Are Created Equal!!!
If any statement could summarize everything, that would be it. What I’ve discovered is that pretty much everyone can treat the symptoms. That’s what they go to school for. The study the symptoms and related treatments, take lots of hard tests, graduate, and there you go. You go to them and say you have a sore ankle and they can 9 times out of 10 get you back to a pain-free state.
However, things diverge greatly from here. There are a lot of practictioners that don’t work on pro-athletes. They concentrate on the masses, whose requirements differ greatly from pro-athletes. Pro-atheltes make their livelihood by getting up every day and going out to abuse their bodies and can’t sit on the sidelines for long. They need to be in top physical condition to do it over and over again, and to snap back from injury as soon as possible to get back in the game. You can say to the common working man to layoff jogging for 3 weeks while a knee pain heals, but you’re not doing a pro-athlete favors by saying they’re going to miss 5 games over the 3 weeks by not being able to play.
Simply not having the experience of knowing what is going to get someone back in the game in the shortest amount of time possible makes them less desirable to the athletic individual.
Then the next level is whether or not the practictioner actually participates in the sport or not. If they do not race triathlons, I have seen a marked difference in knowledge in treatment. They can still treat symptoms, but they cannot give advice on prevention and ultimate elimination of what causes the problem in the first place. So the risk increases that even though you may get a problem treated and healed, that without proper knowledge you’ll go out and just do the same activity in the same way to get you injured again.
What to Look For
Since I arrived in the Bay Area in 1987, I have had many injuries ranging from my back to knees to all over my body. I have visited many practictioners in a wide variety of areas and have thoughts about selecting the right practictioner for sports medicine. Here they are:
1. Do they work on pro-athletes? This is the first hint that the practictioner is able to understand the needs of an athlete who wants to get back in action as soon as possible, and is able to deliver. However, I would caution that this is often deceptive as Bay Area athletes often go to many facilities seeking treatment, and practictioners will often advertise this fact to get more patients. It does not singularly guarantee that the practictioner does a good job at getting athletes back in action, although it is the first clue.
2. Does the practictioner perform the sport in which you are participating? Nothing replaces intrinsic knowledge about injuries and prevention than having the practictioner actually perform the sport himself. It is like learning the theory but having no practical experience. True insight comes when the practictioner is out there physically training as well as observing athletes and treating them. Then, the practictioner can have a deeper understanding of what creates problems, knows how to treat them, and how to prevent them.
3. Do you get along with the practictioner? I have walked into offices of pompous, arrogant practictioners and never gone back. Why go to someone whom you don’t like or trust? You don’t want to dread going back to someone who is goig to be your partner in sports success.
4. Do they listen to you and try to learn from you? Back to 3, so many think they know everything and they don’t think there is any other way but what they know. They have to realize that not everyone responds to training and sports in the same way, and that treatments will vary across age, experience, fitness level, etc. They have to listen to what you tell them, be able to assimilate that information, are willing to ask more questions, and then formulate treatment for you.
5. Are they only after your money? I have also experienced practictioners who have making money on the mind. They will tell you to keep coming back even though you don’t need to come back just to get an extra bit of money from insurance companies. They treat you, but they don’t really care about you as a person. They just want to make more money off you.
6. Referrals aren’t perfect. But they are a better starting point than the phone book. Be aware that you still need to check them out, as your friends or coaches will have favorite practictioners, but they may not be right for YOU.
7. Stay away from HMOs. They attract only practictioners who are generalists and aren’t specialized enough to deal with a serious athlete’s problems.
8. Do they subscribe to the latest theories in sports medicine? Some thoughts below:
a. Do they immediately jump to “you need surgery” to cure a problem? Very bad. Everything else should be tried first. In the old days, practictioners would seek surgery as a way to cure many problems. Nowadays, therapy can take care of a huge amount of issues. Never let anyone cut you open before getting another opinion!
b. I am a big believer in ART and Graston. I would highly recommend seeking practictioners of both of those techniques, as their communities are rich in sharing the latest knowledge and treatments.
c. Does the practictioner talk about the kinetic chain and treatment based on that? A lot of practictioners will only treat the local problem. Your ankle hurts, so you treat the ankle only and hope that the problem goes away, which it probably will…for a while. Often the problem is not just local to where the pain is. It can be caused my a host of problems in muscles all along the chain of movement. For example, I had a recent ankle problem which was caused by tightness up my lower leg and into the calves. Kinetic chain treatment doesn’t just address the ankle, but worked my peroneals, my calves, the Achilles tendon, etc.
d. Does the practictioner talk about prevention? For example, running poorly will create a host of problems that will continually come back unless running form is addressed. Is the practictioner knowledgeable enough to make suggestions on the performance of activities in the sport itself to help prevent further injuries?
Get Smart, Don’t Be a Victim
Do your research as much as possible into the latest techniques. Learn as much as possible. Do not be a victim to poor and outdated treatments. Find someone who can get you back in the game as fast as possible and who will be as important a partner in your training as your coach.

This year training for Ironman Brazil has been really interesting from a recovery perspective. My high intensity climbing sessions on Old La Honda along with my jump to long rides with 3 hour interval sessions in the middle have really taxed my system more than I have experienced in the past. Chalk it up to increasing intensity, but also my age makes me recover slower.
My recovery after my long Saturdays is taking a full 3 days before I can ratchet back up to normal paces and intensities for my normal weekly workouts. Now, I am taking SportLegs supplements and jumping in an ice bath post my Saturday long sessions. Sunday is an off day, Mondays consist of short form swims of about 1500m, and then I run a form run on the treadmill lasting about 20 minutes. I can only swim/run recovery workouts as I can feel my body reaching LT very quickly during the workouts. It just isn’t worth risking overtraining or burning out by attempting to keep to normal weekly intensities. Tuesday morning I’m on my bike trainer, but either I am doing a pedaling efficiency workout for recovery or reduced wattage normal workout, as I cannot sustain normal wattages. My quads are still tight and I do not want them to seize up and wreck the rest of the week’s workouts. By Wednesday morning, however, my body seems back to normal.
Listening to my body is crucial. My fitness level, my recovery ability and my age are all factors in how I recover and I have to really accomodate that or else I could really tank my race preparation.

Aaaah….an ice bath after a hard run today works wonders. But how to get into that bathtub of freezing water? Here is Dave’s patented method of successfully performing an ice bath:
1. Prepare. No, not just mentally, but get 2 bags of 7lbs. of ice from 7-Eleven, a towel, something to drink if you want, a watch or clock to time yourself. If you can, get something warm like coffee or tea. Put the ice bags on the ground next to your bathtub. Put the watch/clock, drink, and towel within reach.
2. Get into the bathtub and sit in it empty. Mistake #1: Filling up the bathtub and dumping ice cubes in it and THEN trying to get into it is near impossible. I guarantee it. Just try it. I have never done it without screaming. Try my way; it’s better. So get into the empty bathtub and sit in it.
3. Turn on the cold water. The water will slowly fill up and your body will adapt to the cold water much easier than if you were to jump into a tub full of it instead. I would recommend not moving too much; too painful with cold water sloshing onto exposed body parts!
4. Keep filling it up until it crests over your thighs. Yes your private parts will be freezing by now. Don’t worry; it’s only for about 10 minutes or so. It will still work.
5. Turn off the water. Then carefully reach over and grab one ice bag. Rip it open and dump the ice cubes into the water. Push the ice cubes around until they are all around the tub. The coldest areas will be nearest the ice cubes.
6. When the first bag of ice nearly melts away, which is about 5-7 minutes, take the second bag of ice and dump it in.
7. You can time yourself about when the water crests your thighs. SIt in there at least 10 minutes but probably not more than 15. You don’t need to prove that you’re a real man. Just enough to get the restorative effect on your abused muscles.
8. Time’s up! Get out of the tub and run to the shower and take a nice, long hot one. The hot water blasting against your body will causing a flushing effect to remove the iced toxins and exercise by-products away from your muscles. Great job!
Now that I’m peaking for Ironman Brazil, it’s critical that I recover fast enough to get to the next workout. So I plan on using ice baths after both long run and long bike. Believe me it works great. Enjoy!