I had the good fortune this year to be on hand for the 29th Ironman Hawaii World Championships in Kona this past weekend. Once again, we were given an amazing race with some amazing human performances. Every time I've been to Kona I have been reminded of how special this event really is.

I want to reflect upon a number of surprising (and perhaps not-so-surprising) observations that I made during this year's race. Let's start with the obvious ones - those that seem to occur on a fairly consistent basis from year to year ...

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The best option with regards to running injuries is to simply not get one in the first place. Unfortunately, if you take the data compiled by Runner's World magazine, 60% of runners will sustain an injury within a given year that will cause them to alter their training. I can only imagine the statistics for any given marathon training program.

I would always go back to a simple caveat - if you're training, you're getting more "fit" (faster, stronger, etc) ... and if you're not, you're not. If you're injured, you're not training. If you're not training, you're not getting "fit". Simple.

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I would suspect that if you read Part 1 of this series, you've probably been left with many questions. Perhaps there are some points that are counter to what you believe to be true - or what you've been told to be true. What I would offer at this point is that "evidence-based medicine" starts with evidence - which is science-based and not belief- or anecdote-based. In the process of finding better ways to look at injuries and their optimal and effective rehabilitation we will almost certainly be uncomfortable with what we discover along the way. It is the ability of the clinician in dealing with this objectively that sets them apart and frees them to find the best options.

If there is a discrepancy of viewpoints regarding the assessment of running injuries, then it snowballs immensely when we discuss treatment options.

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It's that time of year again. Fall will soon be here (hard as that is to imagine when it's 100 degrees outside) and training programs for the AT&T Marathon and Half Marathon in Austin will be starting. There will be hordes of runners on Town Lake on the weekends. From the perspective of "health", it's great to see people out exercising. Unfortunately, this time of year also brings with it a plethora of running injuries.

Since that's the case, this is the first of a three part series on running injuries.

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It seems like everyone is talking about "it" - performance enhancement - these days. Whether it's Barry Bonds breaking the 755 home run record - or the multiple positive doping tests in this year's Tour de France - or even going back to Ben Johnson's 100m performance in the 1988 Summer Olympics - the topic of "performance enhancement" swirls about our culture.

When sport performance equates to dollars and cents, then there are always the questions of "how to do it - and if it's not legal, how to do it without getting caught". It is pervasive in our culture - and it's not just the athletes and coaches in whom this exists.

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I recently found myself on the "client" side of the health care equation. I was on vacation - Canada to be exact - visiting my family and looking forward to some rest and relaxation. It would be a nice change of pace from the summer in Austin, that's for sure. Within hours of my arrival, I was stepping out onto my father's front porch ... placed my foot in an awkward position ... and suddenly, I felt an ouch. I sat down - and within moments, found myself trying to problem-solve my way out of it. That's the physical therapist in me - collecting data, assessing my active and passive ranges of motion, trying to make sense of my apparent clumsiness doing something I've done routinely for 40-odd years!

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In today's world, the paradigm of health care is based around "going to see a provider for care". Yes, there are certainly instances and circumstances in which this is a necessary scenario. The question I pose today is this - how many health-related issues do we experience that can be readily dealt with on the basis of self-care strategies - if we simply knew how to use them?

Many of the chronic health issues facing our society today - for example, heart disease and diabetes - are integrally related to self-care. "Lifestyle changes" are critical to success with many (if not all) long-term chronic conditions. Along with these chronic conditions, we have another set of conditions that are self-limiting and have their own natural history. Consider the common cold as but one example. How many people get it? Lots. But it has it's own self-limiting course that it takes, and with time (and an environment in which the immune system can respond as it is designed), the condition goes away.

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