Sunday, July 8, 2007

Goals


As many know, I have Ironman Canada as my “A” race for the year. Shortly after deciding to do this race, I set out to determine a worthy race goal. Since then, many people have inquired about that goal. My goals are usually lofty and take a fair time to accomplish, so this created a bit of a self-inflicted dilemma. This was complicated further by my expectation that my sabbatical opportunity removed many of my prior obstacles to train and raised the bar further.

Fortunately, Erin cares enough to take my incessant triathlon ranting seriously and has been patient enough to remind me of my long term goal of continual improvement while the sport remains challenging and fun.

So my goal…run faster than I have in the past. I feel that I likely can run 3:15 off the bike and so my plan is to do what it takes to get there. One may expect a faster swim or bike considering the training I’ve been able to do, but my goal is to do the swim and bike that allows me to run 3:15. It is possible that it may only be same or slower than swim/bikes that I’ve done in the past, but I’m confident that running faster is the next step for me to continue to improve.

So with that, I will leave you with some thoughts about achieving goals.

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Over the past 8 years, a large portion of my practice has been caring for children with cerebral palsy. There is a large spectrum of intellectual and motor impairment in these children, ranging from children who are completely cognitively impaired to those who have normal intellectual capacity but an ability to walk limited by tightness in their legs.

Treatment of this latter group of children has perplexed me. Many of these children have seemingly similar potential based upon their intelligence and physical handicap, yet there is huge difference in their functional abilities. As a surgeon, it is frustrating that I can do the same operation in 2 different children who have a similar apparent handicap, yet end up with dramatically different results.

As I have scrutinized my surgical outcomes in these patients, I’ve realized that the perfect surgery isn’t all it takes to get these patients walking. Instead, I define three factors that determine their ability to gain ambulatory function. These are: ability, social support, desire. I can improve “ability” by surgically correcting biomechanical imperfections, but without adequate social support and an appropriate desire, the patients will not achieve the ability to walk.

Over time, I’ve realized these factors predict success in any endeavor. Each of them performs a different role and importance that is unique to each undertaking and person. The interplay of these factors is what makes undertaking challenges exciting.

If triathlon victories relied purely upon genetic ability, then the guy with the highest VO2 max would win. Although this may occur, it isn’t the only factor. That individual still must have adequate desire to train himself sufficiently to utilize his genetic gifts. That said, those with less ability can have tremendous desire to overcome their lack of ability. Although I don’t know Obree’s physiologic numbers, the tremendous desire to break the hour cycling world record allowed him the ability to train sufficiently to overcome any talent deficit he might have had.

As far as I was concerned, I had two arms and two legs, and that put me on a par with Moser, and any other shortfall would be made up by my ability to push myself harder than any other human being who had ever lived. Graeme Obree

In helping young children with a disability to learn to walk, social support is imperative to provide an environment that is conducive to this goal. This support can come in a variety of forms…encouragement, driving to the physical therapist, helping them stretch, and financial assistance are all different examples.

In sport, surrounding oneself with adequate support is critical as well. Creating the necessary infrastructure facilitates your goals significantly. That can come in many forms as well. It can be as simple as having a partner who encourages and believes in your goal. It can be someone who provides the financial support that allows you the opportunity to train without this added stress. It can be your training partner’s motivation, your coach’s inspiration, finding the job that is conducive to training.
I believe that one has the opportunity to improve each one of these factors…that is the beauty. My thoughts on that I will save for another day.

4 comments:

mat steinmetz said...

Great article Dr. J. As hard as you've been training, you will have a great shot at your 3:15. You have been one of the most consistent runners on the squad and are always grinding away, looking "as relaxed as can be".

Mat

Jeff Shilt, M.D. said...

Thanks, Mat. Fortunately I've got quite a few great training partners, ALL who motivate me in some way.

BRFOOT said...

Very interesting article. Desire is is a tough thing to pin down. In the case of your pts. What do they truely desire??? We assume in the big picture they want to walk,stand or whatever is resonable for them. But maybe they just desire to not feel the pain that comes with and post pt. Or maybe they don't have confidnce in their Therapist and don't buy into the plan. The same way a diabetic desires to be disease free but won't monitor his sugars or control his diet or exercise. Human nature, much like water, seeks the path of least resistance. As triathletes I think we forget that. In medicine I know we do.
Bryan

Jeff Shilt, M.D. said...

Very insightful, Bryan. There is good literature to support that many kids with disabilities don't attain treatment goals unless they are interested in them. Often times, we are guilty as care providers/parents of subjecting our goals on to our patients. Thanks for the comment