Did you know that we have limited evidence for a lot of mainstream applications such as taping, cupping and even stretching? Sometimes evidence is conflicting. Sometimes evidence is lacking because the “thing” is still in its infancy and needs to be developed. A lot of times we have firm evidence that what is being advertised as a revolution is actually no better than a placebo. Having information readily available online is a blessing and a curse. I encounter a lot of misinformation on a daily basis as a physical therapist and as a triathlon coach. The objective of this article is to shine the light on common points of confusion when surfing the Internet without critical thinking goggles.
A PRODUCT, ILLNESS, REHABILITATION PROTOCOL OR TRAINING PROGRAM MAY OR MAY NOT APPLY TO YOU
Many products are touted as a cure or solution to a myriad of problems, or that they simply will increase performance. As an example, when choosing shoes you can go with something well cushioned like HOKAs or a minimal shoe. Both types of shoes make similar claims despite being polar opposites. So, which is the correct one? Of course the answer lies with the individual.
Picking the right footwear is critical not only for comfort but also for recovery from an injury and for injury prevention. Running on a treadmill to check the alignment and analyzing the gait is not always sufficient. If an athlete has pain and biomechanical deviations from a typical structure, an assessment needs to be performed by a trained practitioner to determine whether, in this case, the foot, can handle the shoe or an orthotic long term. Just because someone’s training partner responds well to the latest invention that does not mean that everyone will benefit from the miracle. We are all built differently.
Many triathletes experience knee pain at some point. A common diagnosis is Patellar Tendinopathy, but of course, that is not a blanket diagnosis for everyone, just as not all heel pain is Achilles Tendinosis. When in pain, get checked out. Plain and simple. Proper diagnosis is crucial to determine the right course of action. Even though pains can present with similar symptoms, they may not come from the same source. The answer to “what is the driver of the pain “ will determine the rehabilitation protocol and success of treatment.
In training, we tend to see what is working for others then incorporate it into our own training without thinking. An example is biking long on Saturday and running long on Sunday. This schedule is not for everyone for a variety of reasons. The beauty of one-on-one training is that it is custom built for the athlete’s specific needs. Once the weaknesses are established, a program is designed to make them less of a handicap. The same principle applies to strengths. An individualized program will ensure that those strengths are turned into a maximal advantage for the athlete. Comparing programs between athletes is like comparing apples to oranges. Time, experience and goals, to just name a few variables, are all determinants in creating a training schedule that will produce the best results.
LEVELS OF EVIDENCE
Someone’s personal opinion is not the best level of evidence. While clinical experience definitely counts as a pillar of evidence, it is the lowest on the pyramid of validity. Therefore it must be taken with a grain of salt. Finding a systematic review for every issue is unrealistic. However, doing some research before running off with sketchy evidence is worth the time. When reading information, such as this article for example, determine whether it is someone’s opinion. If so, ask yourself what are his or her credentials? I am a doctor of physical therapy and a triathlon coach with over ten years of experience. Having said that, most information presented in this article is an opinion and there might be practitioners who disagree with me.
When reading a study, look at the methodology and ask some critical questions. What was the sample size? Was there a control group? Who funded the study? Was there a conflict of interest? What were the confounding variables? When searching for information try to find at least three sources that have come to similar conclusions. Do not confuse opinions for a fact. And keep in mind that you are unique therefore find what fits your needs. Because that too will be unique.
Coach Martina Vidali has worked with athletes of all types and abilities. In addition to being a USA Triathlon Certified coach, she is also a Doctor of Physical Therapy and is certified by the National Association of Sports Medicine. As an athlete, she has finished two IRONMAN races, the Boston Marathon, and has been an All World Athlete.