Blog 6: Endurance Therapeutics FAQ (Final Blog)
Part 5: Chiropractic, Osteopathy, Physiotherapy, and Massage Therapy: What Is the Difference and How Do They Work Together
Welcome to the final part of the Endurance Therapeutics FAQ. Part 4 covered exactly what happens in a treatment session. Part 5 explained the difference between chiropractic, physiotherapy, and massage therapy and how they work together. Part 6 closes the series with the question that sits at the heart of everything Endurance Therapeutics is built around, how does the way I assess and treat actually change based on the sport you play?
The short answer is significantly. And understanding why is one of the most useful things an athlete can know before they walk through any clinic door.
Why Generic Care Misses the Mark for Athletes
Most chiropractic and physiotherapy training is designed around general population presentations. Lower back pain in a desk worker. Shoulder pain from carrying bags. Knee pain from daily walking. The assessment frameworks and treatment protocols taught in most programmes are built for these presentations.
Athletes are different. Not just in the intensity of what they do but in the specific mechanical demands, the overuse patterns, the training loads, and the performance goals that shape both why their injuries develop and what recovery actually needs to look like. A runner's lower back pain develops through completely different mechanisms than a cyclist's lower back pain, even though the site of pain is identical. Treating them the same way produces inferior results.
At Endurance Therapeutics the assessment always starts with the sport. What does your training week look like? What specific demands does your sport place on the structures we are discussing? What does the injury feel like during sport specifically versus at rest? The answers to these questions change everything about where I look, what I find, and how I treat.
The Runner
Running is a single leg sport performed under fatigue, at high repetition, with significant ground impact forces. The injury patterns I see in runners are almost always overuse in nature and almost always driven by one or more of these underlying factors:
Glute inhibition, the most consistent finding in runners with knee pain, IT band syndrome, and lower back pain. My assessment of every runner includes a direct evaluation of glute medius and glute maximus activation quality, not just strength.
Hip mobility restriction, limited hip extension and internal rotation force the lumbar spine and knee to compensate with every stride. Identifying and addressing these restrictions is a priority in almost every runner I treat.
Running mechanics under fatigue, the way a runner moves fresh is often very different from how they move at kilometre 15 of a long run. Understanding where mechanics break down under fatigue helps target both treatment and exercise prescription.
The exercise prescription for a runner is built around the specific phase of the running gait where the injury occurs. A hamstring strain requires eccentric hamstring loading. An IT band presentation requires glute medius activation in single leg stance. A stress reaction requires load modification and progressive bone loading protocols. Nothing is generic.
The Triathlete
Triathlon creates a uniquely complex injury environment because three disciplines interact. The hip flexors shortened on the bike go straight into the run. The glutes inhibited during the pedal stroke are then supposed to generate propulsive force in T2. The shoulder fatigued from the swim is loading through every subsequent discipline.
My assessment of a triathlete always considers which discipline is the primary driver of the injury, even when the pain presents in a different one. A knee issue that appears on the run is often driven by what happened on the bike. A shoulder presentation needs to be understood in the context of swim volume, stroke mechanics, and upper body fatigue patterns.
Treatment sequencing for triathletes also needs to account for a training schedule that rarely has a complete rest day. The treatment approach has to be compatible with continued training in the disciplines that are not directly affected, and exercise prescription needs to fit into a programme that is already full.
The Hockey Player
Hockey places a very specific set of demands on the hip complex. The skating stride requires sustained hip flexion combined with explosive hip extension and powerful adductor loading through every push. The result is a predictable injury landscape that I see consistently across youth, junior, and adult hockey players.
Groin and adductor strains, driven by the eccentric adductor loading of the stride recovery phase. My assessment of hockey players always includes adductor strength testing and the Copenhagen plank as both an assessment and a rehabilitation tool.
Hip flexor tendinopathy, chronic hip flexion in the skating position combined with high training volumes. Addressed through progressive hip flexor loading and careful management of on-ice and off-ice total volume.
Lower back pain, the combination of sustained hip flexion, asymmetrical rotation, and board contact forces creates a predictable lumbar loading pattern. The thoracic spine mobility and glute activation work in my hockey patients directly targets the upstream and downstream drivers of this pattern.
For youth hockey players I also pay close attention to growth plate considerations, multi-team load accumulation, and the specific demands of a year-round hockey calendar that leaves very little genuine recovery time.
The Golfer
Golf is a sport that most people underestimate from a physical demand perspective. A full golf swing compresses the lumbar spine at forces up to eight times body weight and the average recreational golfer repeats this thousands of times across a season.
The injuries I see most in golfers trace almost directly to two underlying patterns:
Thoracic restriction forcing lumbar compensation, when the mid-back cannot rotate through the swing, the lumbar spine does. This is the most direct mechanical pathway to lower back pain in golfers and it is almost always addressable through thoracic mobility work and glute strengthening.
Hip mobility restriction, the lead hip needs significant internal rotation through impact. When it cannot get there the pelvis and lumbar spine compensate. Identifying and addressing hip restriction often produces immediate improvement in both pain and swing mechanics.
My treatment of golfers is heavily oriented toward movement quality. The exercise prescription connects directly to the swing, hip hikes, glute bridges, and thoracic rotation work that translate immediately to what happens on the course. I also pay close attention to golfer's elbow presentations in the trail arm and the shoulder and wrist load that comes from high swing volumes.
A Final Word on Sport Specific Care
The reason Endurance Therapeutics exists is precisely what this series has covered. Athletes deserve care that understands their sport, respects their training, and addresses the actual drivers of their injury rather than the generic presentation.
I built this practice as an athlete who has lived every one of these injury patterns personally. The hip issues that taught me what the hip actually needs to function well under endurance load. The knowledge that comes from training, competing, and treating athletes who are trying to do the same things I have spent my life doing.
That is what you get at Endurance Therapeutics. Not generic care with an athletic label. Sport specific clinical thinking that starts with your sport and builds the treatment plan around it.
If this series has given you a clearer picture of what Endurance Therapeutics is and how we work, the next step is a conversation. Book a free 15 minute phone consultation or a full assessment and let us build a plan around your sport, your body, and your goals. Reach out at Endurance Therapeutics, we would love to be part of your athletic journey.
📍 Endurance Therapeutics | Oakville, Ontario
📞 905-288-7161
Optimizing The Endurance Athlete’s Mind, Body & Performance.