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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I am fortunate to have lived a rather eclectic existence thus far - with no signs of that changing any time soon. My days go from left brain, problem-solving-oriented activities, to right brain, creative activities. This variety has added perspective to my world in many ways - and as my thinking skills continue to evolve, so do my creative skills - and vice versa.

I mention this today because I have been thinking about a concept that I apply on a daily basis in my professional world - and how it applies to my everyday life. It is that of "Specific Adaptations To Imposed Demands". From a cellular perspective, this simply means that the tissues of the body adapt to the demands imposed upon them. For example, weight bearing activities foster an in crease in bone density, and strength training fosters muscular strength and power development. Both are examples of very specific adaptations that the human body makes in order to adapt to the demands placed on the system. Within this concept, we traditionally think of the primary tissues of the human body - muscle, bone, cartilage, tendon, and ligament being the main examples.

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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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