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The healthcare systems in America have been front and center in the media over the past few months, and for good reason. While Americans spend more per capita on healthcare by a wide margin than citizens of any other country in the world, by almost every objective measure, our system is failing to make us healthier than people in countries who spend far less.
Triathletes, however, frequently have different complaints about their interactions with the healthcare system, regardless of where they live. Often, athletes feel they are misunderstood by their primary care physicians, who then make inappropriate treatment recommendations that can undermine an endurance athlete’s ability to train and perform.
Consider this example: A well-trained triathlete visits their family doctor for a minor injury. After ensuring there is no fracture, the doctor recommends splinting and rest – full rest, as in no training for two weeks. Furthermore, the doctor is alarmed by the triathlete’s “low heart rate” during the physical exam, so an electrocardiogram and additional testing are ordered to rule out any undiagnosed endocrine or underlying cardiac issues.
Sound familiar? It happens quite frequently with endurance athletes. It’s not an example of poor medical care; rather, it reflects how most physicians do not take care of many healthy, well-trained endurance athletes. When your reference is sedentary individuals at risk for (or already afflicted by) a variety of chronic ailments, it can be challenging to adjust your perspective to allow for outliers, like the triathlete who comes in very infrequently and who has adapted multiple organ systems to the physiologic stress of their training program. Consequently, diagnostic approaches and treatment regimens – while appropriate for most of that physician’s patients – may not be suitable for the triathlete.
So does that mean well-trained endurance athletes get a free pass to skip the doctor’s office forever? Not quite. It’s just a matter of finding the right expert for your needs. Getting the correct physician or allied health provider in your corner can help you obtain an accurate diagnosis and get the best treatment plan.
When triathletes should see their doctor
The best option is to have a primary care provider who is familiar with managing athletes. Generally, this will mean seeking a provider who has undertaken specific training in sports medicine. Unfortunately, these types of providers are difficult to find because most who obtain that additional certification choose to focus on musculoskeletal care and not primary care. Still, many exist, and the single best way to find them is by asking Dr. Google. Search for “sports medicine and primary care” and see what turns up. You will want to be sure that you choose a physician who provides primary care and is certified in sports medicine, not a family physician who only does sports medicine.
When to seek out a different expert
Perhaps a doctor with this skill set does not exist in your community, or your health insurance does not cover them. You might also have questions that someone with a particular area of expertise would be better at answering. At this point, consider whether or not other health practitioners can help you.
Physical therapists, registered dietitians, exercise physiologists, massage therapists, and sports psychologists can also play an important role in managing the health of athletes.
Here are some general guidelines to help determine when to call upon a different healthcare professional (understanding that not every possible situation can be covered below).
| SEE THE M.D. | SEEK ANOTHER EXPERT |
| Acute injury with concern about a broken bone or torn ligament | Acute injury without concern of broken bone or torn ligament |
| Chest pain | Chronic overuse injury |
| Abdominal pain | Muscular pain upon movement without an obvious cause |
| Bleeding | Nutrition advice and planning |
| Concern of serious infection | Mental health* |
*In some instances mental health may be serious enough to require medical management. If you are experiencing physical symptoms related to your mental health or any thoughts of self-harm, seek medical help immediately.
If you have sustained an acute injury and there is any concern for a broken bone, you will need to see a physician to get X-rays and to determine if there are any other underlying injuries.
If your issue is unrelated to your training (for example, you have chest pain, abdominal pain, a bleeding issue, or a concern for a serious infection) then a visit to a medical doctor is critical.
However, if your problem is related to an acute injury without concern for a broken bone, a chronic overuse injury, or muscular pain upon movement without an obvious cause, starting with an allied professional makes a lot of sense. If the issue is limited to the feet or ankles, then a podiatrist can be helpful. Otherwise, a physical therapist can help. In both cases, they will do what they can to diagnose and manage your problem considering who you are as an athlete because you will look much more like the kinds of patients that they usually see.
If either is unable to manage the problem, or if they feel that what you presented with is out of their scope, they will gladly refer you to a physician for additional work-up and management.
Instead of a primary care physician, see…
Physical therapists
Best for:
- Sprains
- Strains
- Overuse conditions
- Rehabilitating
- Preventing injuries
A physical therapist (or physiotherapist) is a healthcare professional trained in diagnosing, treating, and preventing movement-related disorders and injuries. For athletes, physiotherapists can assess the extent of injuries such as sprains, strains, or overuse conditions. They develop personalized treatment plans, including therapies like manual manipulation, strength training, and rehabilitation exercises, to expedite recovery and prevent future injuries. The goal of a physical therapist is to ensure the athlete can return to peak performance safely.
Podiatrists
Best for:
- Foot pain
- Ankle problems
- Lower limb conditions
- Gait analysis
A podiatrist specializes in diagnosing and treating conditions affecting the feet, ankles, and lower limbs. Podiatrists can optimize an athlete’s alignment and movement by conducting gait analysis and prescribing custom orthotics or footwear. They also provide treatment plans, rehabilitation exercises, and preventive care to reduce the risk of future injuries and keep athletes performing at their best.
Registered dietitians
Best for:
- Body weight and composition
- Fueling and nutrition planning
Registered dietitians, or RDs, are professionals with the education and credentials to provide medical nutrition therapy. In other words, they can prescribe diets to patients like doctors prescribe medication. This shouldn’t be confused with nutritionists or nutrition coaches, who are not held to the same rigorous standards as RDs. Some RDs are also certified in sports dietetics – look for those with “CSSD” in their title, which is designated for RDs who have completed specialized training on top of their RD requirements.
An athlete may seek out an RD for nutrition advice, particularly if they are trying to lose (or gain) weight or train with a medical condition such as diabetes or anemia. RDs can also help athletes optimize their diet for performance
Exercise physiologists
Best for:
- Chronic disability
- Mental health issues
Exercise physiologists are specialists in developing exercise programs that can help patients manage mental health issues and find the best means of incorporating movement and physical function in the physical disability setting. Exercise physiologists also work to help patients manage chronic diseases through the development of personalized exercise programs.
Massage therapists
Best for:
- Muscle aches and strains related to regular exercise
Although the clinical evidence to support massage as a recovery modality is inconsistent there is no doubt that the psychological benefits of massage are very real. In addition, massage is a good ancillary tool in managing strains and muscle soreness related to regular intense exercise.
Sports psychologists
Best for:
- Mental health and performance
Sport psychologists have specialized training in managing the common mental health issues that athletes frequently encounter. These include anything from performance anxiety, imposter syndrome, and fear of failure to exercise addiction and disordered eating. A good psychologist can help athletes elevate their physical performance with tools to deal with the mental and emotional obstacles we frequently encounter.
Building your best healthcare team
By expanding your team of providers in this way you can ensure that you see someone who understands you as an athlete, gets to the crux of the matter as soon as possible, and finds a way to keep you moving towards your individual performance and health goals.