Lane 07 — Sports & performance.

Lake Walk, 06:18 — the easy block before the long block.

Minute 03 — The geography decides the work

Most of this lane's volume traces back to a handful of regional events: Grandma's Marathon (Two Harbors → Duluth, third weekend in June), the American Birkebeiner (Cable, WI → Hayward, WI, last weekend in February), the Superior Spring Trail Race series on the Superior Hiking Trail, the USA Hockey youth and high-school seasons that run from October to April, and a quietly serious group of master swimmers training out of the Duluth Area YMCA on West Superior. The training calendars of those events drive most of what we do: a Grandma's-cycle member is doing different work in February than in June; a Birkie skier at the Pre-Birkie has different lab values than at the start of October.

Block 01 — The training panel

Three times a year — late September (winter base), late January (winter race), and late April (summer build) — we offer endurance members a "training panel" that runs:

• Iron studies: ferritin, transferrin saturation, total iron-binding capacity. Iron deficiency without anemia is the single most common reversible performance ceiling we encounter; the British Journal of Sports Medicine has published extensively on the female-athlete iron literature¹, and we screen by ferritin not just hemoglobin.
• 25-OH vitamin D: this is Duluth, the sun is gone for six months, and the data on stress-fracture risk and immune-function ties to vitamin D in athletes is taken seriously here. The Endocrine Society's 2024 vitamin D guideline retreated from broad supplementation in the general population²; we still measure in this athlete subgroup.
• TSH and free T4: a quiet thyroid is a quiet ceiling.
• Comp metabolic and lipid panel: athletes are not exempt from the same cardiometabolic curves as anyone else, and their lipid math is sometimes counterintuitive (LDL-C in a low-body-fat endurance athlete on a relatively low-carb training diet often looks worse than expected; we don't reflexively start a statin).
• HbA1c if anything in the metabolic panel suggests a screen is warranted.
• Sex-steroid panel in selected female athletes with cycle disturbance per the REDs framework (see below).

Block 02 — Lactate testing, once a season

We offer a finger-stick lactate-threshold test in office, at the start of a training block, for members who want to anchor their training zones to a measured threshold rather than to a percentage of estimated max heart rate. The test takes 45 minutes, costs $32 (which is the cost of the test strips), and produces a one-page report with their LT1 and LT2 power and pace. This is not a research-grade VO2 max test. It is a working tool, in the way a torque wrench is a working tool. We do not run it more than once or twice a season; the marginal information of a third test in a single calendar year is small.

Per event — Concussion follow-up

We follow the 2023 Concussion in Sport Group consensus statement³. The stepwise return-to-school and return-to-play progression is non-negotiable; we resist pressure to short-circuit it. We use the SCAT6 acutely and the SCOAT6 in the office at follow-up. We work closely with athletic trainers at Duluth Public Schools and at St. Scholastica for the high-school and college populations; the trainers are not in our employ but they are part of the team.

Year 01 — Bone-stress injuries

Tibial, metatarsal, navicular, sacral, femoral-neck. The high-risk sites get an MRI without delay; the low-risk sites get conservative management with serial exam and pain-on-loading scoring. We are particular about navicular and femoral-neck stress fractures because the failure case (complete fracture, surgical fixation, season lost) is nasty enough that the cost of a precautionary MRI is dwarfed. We use the AMSSM position statement on bone-stress injury⁴ as the framework.

Per visit — Relative Energy Deficiency in Sport (REDs)

The 2023 IOC consensus update on Relative Energy Deficiency in Sport⁵ — a re-framing of the older Female Athlete Triad as a population-wide energy-availability problem — is taken seriously in this lane. We screen with a structured energy-availability conversation at the spring training-panel visit, with the LEAF-Q in female athletes, and with menstrual-cycle history in any female athlete training over six hours per week. Where REDs is identified, the management is not a referral; it is a multi-month coordinated plan with the member, their coach, a sports dietitian (we work most often with Helena Sanders, RD, CSSD on Lake Avenue), and us.

Phase 03 — Return-to-play

Return-to-play decisions in this practice are not a stamp at the bottom of a form. They are a conversation between the member, the clinician, and — when the athlete is a minor — the parent and athletic trainer. We document the decision in the chart, we copy the athletic trainer, and we put a date on it. If the answer is "not yet," we say "not yet" and we say what specifically would change the answer. Members and parents have the right to disagree. We have the right to write our note honestly.

Cross-references: 02 · Musculoskeletal shares its lead clinician and most of its imaging tools; 01 · Cardiometabolic for the endurance-athlete lipid conversation; 06 · Perimenopause for masters-class female athletes navigating performance changes during the transition. The transcript "The March cold-snap debrief" walks through a Birkie-cycle planning session.