"I can't just get out of bed, make my coffee and go for a run. I have to make my coffee, do some mobility activations, and then I can start. Which is so much more time on top of an already demanding sport. But there's a higher risk of injury if you don't."

Caitlin Alexander grew up dancing. Eighteen years of it — the kind of training that demands extreme flexibility in the feet and hips, that rewires how your soft tissues work and what your joints expect. It also left her with labral tears in both hips. Usually asymptomatic. Until training load spikes, or recovery slips, and then things flare.

When she transitioned to running and triathlon, the body she'd built for dance kept getting in the way. Too much mobility. Not enough stiffness in the right places. Injury after injury through high school and college — and no one telling her what to do about it. She became a Doctor of Physical Therapy partly because of that gap. Now she trains 18 to 22 hours a week as a pro triathlete, runs a full clinical practice treating endurance athletes, and sees the same patterns in her patients that she lived through herself.

One pattern above all others: 95% of the athletes who walk into her clinic have a repetitive stress injury related to running. Almost all of them could have prevented it.

Honestly — I see more injuries with triathletes than I do with elite or semi-elite pure runners. And it's because of the demands across three disciplines, not despite them. You're spending five or six hours on the bike in a race, in a lot of hip flexion, a lot of spinal flexion — and then you're expected to get off and run with full hip extension and spinal rotation. Those are opposite ends of the spectrum. The transition is where a lot of injury comes from.

And then the run is just the most stressful of the three. The impact is stressful for all your soft tissues and joints. Running alongside the swim and bike volume makes that impact exponentially worse. There's also very little time left for the recovery piece — especially if you have a full-time job, a family, if you're in school. That definitely influences your ability to adapt to the training load.

People think cross-training means lower injury risk. Sometimes it means you're accumulating load across more systems with less time to recover between them.

Dance requires a totally different demand on your joints and soft tissues than running. As a dancer you need a lot of flexibility — especially in the feet and hips. But for running, you don't want that kind of flexibility. You want stiffness. Tendons need a certain amount of stiffness to store and release energy efficiently. I had hypermobility, and I kept trying to run on it. So I always had a lot of injuries growing up.

I treated an Olympian once — one of the tests I always do is have patients bend down and touch their toes. As a runner, you don't want to be able to put your hands flat on the floor. That means you've got hypermobility. This Olympian came in and could barely get her hands down to her knees. Always been that way. And she runs a 4:20 mile. You don't need to be super flexible as a runner. You need just enough mobility for the demands of the sport — and enough stiffness to transfer force.

The labral tears in both hips are from dance. They're usually asymptomatic — I don't typically have pain. But if my training load spikes abnormally, or I'm poor with my recovery, things flare up. So I'm always managing the balance between load and stability. That's shaped how I think about every patient I treat: what is this person's body history, and what does it actually demand of them right now?

Carbon shoes are a performance enhancer — especially at the highest level, they're pretty much non-negotiable for racing. But the plate adds a rocker effect to the shoe, which moves the work done by the body from the ankle upward — up to the knee and up to the hip. Those shoes basically take a lot of the work away from the muscles in your feet and ankles, specifically the Achilles tendon.

We know these shoes change your biomechanics — there's solid research showing we land differently in highly cushioned shoes than in minimal ones or barefoot. On an unstable surface, we stiffen our joints. On a stable one, we soften them. Counterintuitive, but that's how the body works. So with a highly cushioned shoe, we actually tend to land stiffer — and I've had runners come in with more impact-related, joint-related pain in these shoes.

We don't have enough longitudinal research yet to know the long-term effects. But we do know how they change load distribution. If you're going to race in carbon shoes — and you probably should — then it's even more important that you're training the foot and ankle specifically outside of running. The AxisBoard is built for exactly this. You can target the rearfoot or the forefoot, and train in different planes of motion — which is how the foot actually works. We've got different segments of the foot that move in different ways, and strengthening them in those specific orientations improves resilience and gives you the control the rocker shoe is quietly taking away. Before Sidekick I was using a foam pad or a standard balance board. The foam pad, as I know now from clinical practice, is not appropriate — it adds too much extraneous movement and doesn't replicate what the foot experiences in running. The AxisBoard is specific in a way those tools aren't.

It has to be short. That's the reality. Post-training, two things always happen: stiff calves, which activates the Achilles and is very uncomfortable — and tight hips. So before any session, making sure the hip flexors are loose. That's non-negotiable. You are much better off doing a couple of minutes every day to keep yourself healthy than rehabbing an injury once it has flared up. That's not an opinion — that's what I see clinically, and what I live personally.

For the strength work, I was using plyo boxes and benches that just took up enormous space — trying to get different heights for step ups, eccentric calf raises, different exercises meant either buying multiple pieces or compromising the movement. The LadderPod replaced all of that. 12 adjustable heights, one tool. I can drop it low for eccentric calf raises to load the Achilles, bring it up for step ups and step downs for glute and quad strength, go higher for explosive work. And I combine it with the Heel Hero for the push-off phase of gait — a reverse lunge onto the LadderPod with the Heel Hero under the back foot trains the toe flexors in a lengthened position, which is crucial for runners. That's something you can't replicate with a standard box or a flat floor.

The other thing is just the consistency piece. Running and cycling and swimming do not inherently make your muscles strong. You can get really good at moving in one direction and really weak at moving in others. That's how repetitive stress injuries happen. Strength work challenges those weaknesses. It doesn't have to be a long session. It has to happen every day.