Hey Reader!

Despite how much we try to mitigate injuries, at some point, they just happen. Sadly, this is the boat I am in right now.

After a mid-week run, my leg started aching. Then, after my long run, I couldn't walk. In all my running, my worst injuries are foot extensor inflammation and an acute glute strain; I've had a good run!

However, there have been some very serious injuries in skiing, so I have a good feel for what's minor and more major, or at least could be. After some challenges, as we will talk about today, I got an MRI and have a Femoral Shaft stress fracture. I will be out for 10-12 weeks. It's a weird place for a runner to get a stress injury.

Why am I telling you all this? It's not for sympathy. The diagnosis and treatment process has been tricky, and I am very lucky to have very good connections to help me through it. Others are not so fortunate.

I had two different practitioners, whom I am sure are very good at what they do, misdiagnosing this as a muscle/nerve problem: I was cleared to run. In reality, I was a couple of runs away from completely cracking my femur - turning a stress injury into a fully broken leg.

Why did they miss it? At the root of it, I think it's because we runners are tricky people to work with, and our injuries can present as other things. Now, in my case, I was pretty sure this was a stress response due to the presentation. Then I spoke to Luke, a Sports Chiropractor you will hear from later, on one of our coaching catchups (two coaches chatting coaching, it's great fun!). Within a couple of minutes, he sent me straight for an MRI with the same suspicion as me.

Luke works with runners and has seen this before, so he knows what to look for. This immediately made me want to put this article together to equip you all with a better understanding of who to see, when to see them, and how to choose who to see.

I wish it were simpler, but my experience is specialities matter greatly, especially regarding runners with our high-loading event, and the practioner is more important than their field.

If you have a local practitioner who understands treating runners, please let me know! I am always trying to build a deeper Rolodex of running-specific practitioners.

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Who, Why, and How of Sports Practitioners

I am very fortunate to know some excellent practitioners who specialise in sports or have extensive experience working with athletes. So, I asked a few questions and sought clarification for each of them. Here are the results!

Sports Dietitian

Vic Johnson. Mountain Sports Nutrition.

What does a sports dietitian do?

A sports dietitian can help active people understand when, what, and how much to eat to improve their health and performance in sports. It would be beneficial to get the help of a sports dietitian if you are curious about how to fuel your sport or are at a point where you want to improve but don't know how.

How do they compare to a sports nutritionist?

Dietitians are different from nutritionists, mostly in terms of licensing. In the US, a dietitian has to have a master's degree (a recent change) and go through a very rigorous dietetics educational program. They are licensed through the Academy of Nutrition and Dietetics.
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Nutritionists do not have to have any special education or licensing to call themselves nutritionists. Anyone can call themselves a nutritionist. That being said, there are still nutritionists who do have nutrition degrees; they just aren't accredited by the AND academy.

What to consider when looking for someone to work with?

When choosing a sports dietitian, choosing one that specialises in your sport is ideal. It's even better if they have experience competing in the sport themselves. Find someone who understands the concepts (well-educated) but is also able to explain them in a way that is applicable to you (a good teacher). It's also important to find someone who is empathetic, kind, a good communicator, and within your price range.
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Before you choose a sports dietitian, try to understand what the coaching relationship will look like. How often will you meet? Are meetings online or in person? How long will the coaching relationship last? How much will it cost?

Why could it be worth a runner to work with a sports dietitian?

Especially for runners, dietitians can be a huge help. They can help runners know how to eat in their day-to-day nutrition and also for training and racing. Dietitians can help runners understand how to solve gastrointestinal issues, fuel adequately during training and racing, collect important data like sweat rate, and understand hydration, electrolytes, ergogenic aids like caffeine, and recovery nutrition.

Osteopath

When should you see an Osteo?

It depends on the practitioner, but patients should see an Osteo when they want various techniques, such as manipulation, dry needling, deep tissue massage and other complementary treatments like Shockwave.

How does an Osteo compare to other manual therapists?

With an Osteo, you will get more hands-on treatment than with a physiotherapist. Physio's are more commonly engaged for post-surgical treatment and rehabilitation, using exercise prescriptions more frequently. An Osteo looks at you more structurally, taking a wider holistic view of the body to treat the root cause.

Compared to other manual therapies, such as myotherapy, the clear distinction is in our education, which requires a Master's degree in Australia, usually meaning a greater understanding of the body.

What advice do you have to look for when working with an Osteopath?

I advise that every practitioner you see should perform thorough orthopaedic testing, giving you a clear diagnosis, maybe a hypothesis as to why that’s happened and definitely a plan on how to treat and manage it. For runners, that treatment plan should always align with your goals (such as races, cross-training, etc) and work alongside your training plan.

Chiropractor

Luke Nelson. Health + High Performance, Melbourne.

When to see a Sports Chiropractor?

A common question I hear is: What’s the difference between a chiropractor, physiotherapist, and osteopath? The answer isn’t as clear-cut as it once was.

Traditionally, chiropractors focused on spinal conditions—such as neck pain, back pain, and headaches—often using spinal manipulation as a primary treatment. However, the distinctions between these professions have become less rigid over time, ultimately benefiting you as the patient.

How do you make an informed choice for who to see?

Today, the most important factor when choosing a healthcare professional isn’t their title but their skillset and approach to care. If you’re looking for a chiropractor (or any healthcare provider), here’s what to consider:

• They take the time to listen to your concerns and goals.
• They conduct a thorough assessment to determine a diagnosis (or tentative diagnosis).
• They recommend medical imaging only when necessary.
• They integrate passive treatments (such as adjustments, mobilizations, massage, and dry needling) with active care strategies (rehabilitation exercises and self-management techniques).
• They provide a treatment schedule tailored to your specific needs.
• They don’t simply advise you to stop running and rest unless necessary. Instead, they explore ways to modify your activity, such as adjusting your running technique, cross-training, or incorporating strength training.

Ultimately, the right practitioner will empower you to take an active role in your recovery and long-term health.

Podiatrist

Tim Pargeter. Foot & Ankle, Albury​

What a sports Podiatrist does, and why/when to engage with one?

Podiatrists improve foot and ankle pain, function and performance. As a profession, we focus on all things lower limb (some Pod’s work around the knee also), and others work from the shin down. We are trained in pain and injury, neural and vascular issues with the lower legs, as well as having the ability to use injection therapies.

It’s important to engage with a Podiatrist when symptoms begin to move from a niggle to pain. This is usually when symptoms last >24 hours post-session and are not fully cleared.

Things we see:

• Heel pain
• Achilles tendon pain
• shin pain
• Calf injuries
• Forefoot pain, including big toe pain.

How do you make an informed choice for who to see?

Every practitioner and clinic is different, and different clinics have different specialties. Word of mouth is really helpful for this—speak to your coach and other health professionals to gauge what clinic might best suit your needs. For example, our clinic focuses on load management, strength prescription, and manual therapies, while another clinic may focus on orthotic prescriptions. You do you!

Why would you see a Sports Podiatrist over another type of practitioner?

Podiatrists spend all week treating foot and ankle pain. This allows us to (hopefully) improve our skills in the niche to quickly diagnose and plan treatment. But every profession has different skills to add. Finding someone you get along with and trust trumps all.

Myotherapist

Matt McNeill. Peak Body Hub, Wodonga.

What a Myotherapist does, and why/when to engage with one?

Myotherapists provide a wide array of services. We predominantly look at things from a Soft tissue perspective, so we are often a lot more hands-on, as we do come from a massage background. In saying this, an experienced Myotherapist will have a wide array of skill sets that allow them to treat the nervous, skeletal, vascular, and lymphatic systems depending on further education and the presenting condition.

Myotherapy often approaches the issue from a zoomed-out perspective, considering that different fascial lines and muscle imbalances can have a ripple effect up or down the chain. As we treat all areas of the body, we are particularly good at returning optimal full-body function.

Other forms of therapy are often specialised in one region, which is great for specific conditions, but it can also make patients blind by not looking away from the local region of pain or injury.

A common misconception is that remedial massage and Myotherapy are the same. Generally speaking, Remedial Massage only treats the muscular system and does not often have the wide array of skill sets needed to treat other body systems.

Common skill sets for myotherapists include Dry Needling, Scraping/ Gusha, Joint mobilisation, Muscle energy techniques, electrotherapies, and Soft tissue techniques.

How do you make an informed choice for who to see?

Look for a therapist with 6+ years of experience and a broad skill set. If the bookings are full, then be patient; it will be worth it. This is a sign of a great practitioner.

The education period is now quite short, given that we treat the whole body. If your therapist does not have years of experience, then be aware of it and be happy with the fact that it will most likely be a good targeted rub and may not treat specific issues.

Most importantly, for all therapists, find someone you genuinely feel has your best interests at heart. If the practitioner is not retesting occasionally, you get stale/ repetitive treatments. You must feel trust and get along with your practitioner.

Your therapist should always have the end goal of pushing appointments out for general maintenance. Do not fall into the trap of going 2-3 times a week for 12 months or more. In the beginning, this may be needed for up to a month, but It should not continue.

Read Google reviews and ask around in your community, especially runners.

Why would you see a Myo over another type of practitioner?

Myotherapy/Advanced remedial Massage is best for General maintenance, injury prevention, and post-soft tissue and common injuries.

If you are feeling generally off and have ongoing niggles then this is a great place to gain your function and return to your full biomechanical self.

Bang for your buck, this is possibly your best option for general maintenance.

Past Newsletter Editions

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Closing Thoughts

Hopefully, you have found this helpful. As you can tell, some consistent themes are rapport, experience, and knowledge working with runners. What stands out to me is if you have an issue that could be treated by a number of different practitioners, choose the person you trust, not the type of practitioner that may be slightly "better". They are all well trained and so will likely be able to treat you/refer you if not, as long as they meet these criteria!

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