Once upon a time, a young triathlete named Goldilocks visited three sports medicine doctors. She was experiencing Achilles tendon pain and was concerned about her ability to train and compete. The first doctor told her she was training too much and simply needed complete rest; the second doctor told her she could bike and swim but could not run; the third doctor told her she could continue to train but prescribed a course of physical therapy. Goldilocks was confused and did not know what treatment was just right.

The Goldilocks Principle states that something must fall within certain margins, as opposed to reaching extremes. In the care of multisport athletes, we often apply this principle to define the appropriate balance of training volume, intensity and recovery to avoid and treat injury. This principle may work for a girl in the forest looking for a warm meal and a proper sized bed to sleep in, but anyone who has ever watched the video footage of triathlete Julie Moss stumbling, staggering and eventually crawling across the finish line in Kona at the 1982 World Championship understands that ‘extreme’ is what many multisport endurance triathletes do. The remarkable force of mental and physical will that defines many of these athletes is also the Achilles heel that exposes them to injury. Overuse injury risk has been reported to be higher during the competitive race season as opposed to preseason training,1 likely because of the strong competitive drive of these athletes. After hours and hours of training, these athletes are focused on accomplishing their competitive goals first and dealing with injury later.

It is not always the competition, however, that forces an athlete to the sideline, but sometimes their …