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Prevention and Care

As a triathlete, the demands on your body will be different from other athletes, as you’re focusing efforts on three separate disciplines, each putting unique demands on your body. Chances are you’ll encounter an injury at one point or another during your triathlon career. Taking proper precautions and learning about injury prevention will help you avoid injuries and the resulting downtime.

There’s no doubt about it: Injuries are frustrating, painful—and all too common. In a five-year study from Great Britain of a small group of triathletes, 72 percent sustained injuries, and rates were the same whether they were doing Olympic- or iron-distance training. Yet doctors, physical therapists and other experts say that too often, athletes make certain mistakes that help steer them right to the sidelines.

Although a lot of triathletes will suffer some kind of injury, how the athlete handles the injury can have a significant impact on fitness, both physical and emotional, throughout the duration of the injury.

Triathlon training repetitively stresses muscles, tendons, and the tissues around joints and bones. This continuous stress produces repetitive microtrauma. The body's tissue eventually breaks down -- resulting in pain, inflammation, and weakness. Ignoring the pain and inflammation and continuing to train will lead to macrotrauma and disruption of the tendon, muscle or bone. The worst case scenario is an injury that could result in weeks or months away from your triathlon training and competition.

Injuries in triathletes are common, and can significantly hinder training and affect racing performance. It is vital that triathletes quickly recognize and treat injuries.

If you need advice or you need to manage your triathlete injury, we strongly recommend that you utilise expert advice. Poorly diagnosed and mismanaged injuries can ultimately interrupt your training and event schedules.

Leg and ankle injuries are common problems when training for a triathlon. Learn how to reduce or prevent leg and ankle injuries in this short triathalon video by Dave Campell:


Most Common Triathlon Injuries

It is not suprising that well over half of all triathletes have sustained some form of injury during training for competition. The majority of injuries involve the lower limb, probably due to the excessive impact during running, and the repetitive motion of cycling. Although no studies have been done in the area, it is thought that multisport athletes may have different injury lvels as training and racing in the run discipline is often performed on an off road surface, therefore different levels of impact are applied to the body (however injuries from accidents may be more common due to the uneven running surface).

Swimmer's Shoulder

  • Shoulder bursitis or Swimmer's Shoulder is an inflamed shoulder bursa. You have several bursa in your shoulder. Your bursa is a fluid filled sac that helps to reduce friction in your shoulder spaces. Your subacromial bursa is the most commonly inflamed of the shoulder bursa.

  • What are the Symptoms of Shoulder Bursitis?:

  • Gradual onset of your shoulder symptoms over weeks or months
  • Pain on the outside of your shoulder
  • Pain may spread down your arm towards the elbow or wrist
  • Pain made worse when lying on your affected shoulder
  • Pain made worse when using your arm above your head
  • Painful arc of movement – shoulder pain felt between 60 - 90° of arm moving up and outwards
  • When your arm is by your side there is minimal pain and above 90° relief of pain
  • Shoulder pain with activities such as washing hair, reaching up to high shelf in the cupboard

  • What causes Swimmer's Shoulder?

  • The shoulder is a very mobile joint, and being so mobile, it needs to be well controlled by the muscles and ligaments that surround the joint. Over-training, fatigue, hypermobility, poor stroke technique, weakness, tightness, previous shoulder injury or use of hand paddles can lead to your muscles and ligaments being overworked. If this goes on, injuries such as rotator cuff impingement and tendonitis, rotator cuff tears, bursitis, capsule and ligament damage, or cartilage damage can occur.

  • Suggested Treatment for Swimmers Shoulder

  • Rest
  • Ice
  • Compression
  • Elevation

  • Prevention and Care: There is no specific time frame for when to progress from each stage to the next. Your injury rehabilitation status will be determined by many factors during your physiotherapist’s clinical assessment. You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves. It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration. For more specific advice about your bursitis or rotator cuff injury, please contact your physiotherapist.


    Achilles Tendonitis (or Tendinitis)

  • Achilles Tendonitis is a term that commonly refers to an inflammation of the Achilles tendon or its covering. It is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action.

  • What are the Symptoms of Achilles Tendonitis?:

  • Achilles tendonitis usually causes pain, stiffness, and loss of strength in the affected area
  • The pain may get worse when you use your Achilles tendon
  • You may have more pain and stiffness during the night or when you get up in the morning
  • The area may be tender, red, warm, or swollen if there is inflammation
  • You may notice a crunchy sound or feeling when you use the tendon

  • What causes Achilles Tendonitis

  • Achilles tendonitis is an overuse injury caused by inflammation. This injury is not to be confused with Achilles tendon rupture, which is a much more painful and sudden injury that requires immediate medical attention. Other causes of Achilles tendonitis are poor bike fit and improper position of shoe cleats.

  • Suggested Treatment for Achilles Tendonitis

  • Rest
  • Ice
  • Compression
  • Elevation

  • Prevention and Care: The worst case scenario is a total rupture of your Achilles tendon. Treatment in this case usually requires surgery, plaster or a walking boot for at least six weeks. Most of these injuries take six months or more to adequately rehabilitate. The best advice is to seek early advice from your physiotherapist to do all you can to avoid this nasty rupture happening in the first place. Treatment in this case usually requires surgery, plaster or a walking boot for at least six weeks. Most of these injuries take six months or more to adequately rehabilitate. The best advice is to seek early advice from your physiotherapist to do all you can to avoid this nasty rupture happening in the first place.

    Lower Back Pain

  • Bike fit and long hours in an aggressive riding position are the major culprits leading to lower back pain from cycling. Excessive flexion in the lumbar region of the spine can lead to more serious conditions involving nerve entrapment and sciatica, which require medical attention.

  • What are the Symptoms of Lower Back Pain?:

  • Localised back pain, with no radiation into your buttock or leg
  • Back muscle tenderness and/or spasm
  • Protective back stiffness
  • Sudden back pain onset

  • What causes Lower Back Pain

  • Bike fit and long hours in an aggressive riding position are the major culprits leading to lower back pain from cycling. Excessive flexion in the lumbar region of the spine can lead to more serious conditions involving nerve entrapment and sciatica, which require medical attention.

  • Suggested Treatment for Lower Back Pain

  • Electrotherapy eg tens
  • Ice
  • Acupuncture
  • Taping techniques
  • Soft tissue massage
  • Back braces

  • Prevention and Care: Recurrence of low back pain can and does regularly occur. The main reason it is thought to recur is due to insufficient rehabilitation. In particular, poor deep abdominal core muscle exercises have been shown to render your back more vulnerable to instability and therefore re-injury.

    Runner's Knee

  • Everything from uneven running surfaces and poor shoe selection to weak quads and hips, as well as unaddressed biomechanical flaws, can contribute to this common injury. In most cases, runner’s knee can be traced to the inability of the tissues surrounding the knee to recover in between runs.

  • What are the Symptoms of Runner's Knee?:

  • Swelling over, above or below the kneecap
  • Limited motion of the knee
  • Redness and warmth at the site of the bursa
  • Painful movement of the knee

  • What causes Runner's Knee

  • The repetitive force of pounding on the pavement, downhill running, muscle imbalances, and weak hips can put extra stress on the kneecap, so stick to flat or uphill terrain, and opt for softer running surfaces whenever possible.

  • Suggested Treatment for Runner's Knee

  • Rest
  • Knee brace
  • Anti-inflammatory medications
  • Cutting back on mileage

  • Prevention and Care: Pacing yourself during activities which entail repeated bending or squatting is also paramount. Ensuring that you take regular rest breaks between periods of bending or kneeling and alternating them with other less aggravating activities is key. Essentially, an appropriate balance between rest and activity is recommended. Weight-management can play a role in the pressure exerted on lower limb joints, and thus should be something considered as a long-term preventative measure.

    Plantar Fasciitis

  • Plantar fasciitis, an inflammation in the bottom of the foot, is perhaps the peskiest problem that plagues the running wounded. The feeling has been described as comparable to stepping heel first onto a nail. Eventually, the pain might go away as the day or a run is carried out, only to return afterward or again the next day. It’s a vicious cycle for sure.

  • What are the Symptoms of Plantar Fasciitis?:

  • Pain under your heel
  • Pain in foot arch in the morning or after resting

  • What causes Plantar Fasciitis

  • Overtraining, overuse, and improper or worn-out footwear can cause pain in your heel, but the root of the problem lies in tight and weakened muscles in the foot. If your feet are weak, the heel takes on an excessive load and can’t handle the training you are trying to do.

  • Suggested Treatment for Plantar Fasciitis

  • Rest
  • Ice
  • Anti-inflammatory medications
  • Rolling your feet around on a golf ball
  • Stretching and strengthening the calves
  • Avoid bare feet

  • Prevention and Care: If pain is present for more than three weeks, see a sports podiatrist. Treatments such as orthotics, foot taping, cortisone injections, night splints, and anti-inflammatories decrease symptoms significantly in about 95 percent of sufferers within six weeks.

    Shin Splints

  • Shin splints, the catch-all term for lower leg pain that occurs below the knee either on the front outside part of the leg (anterior shin splints) or the inside of the leg (medial shin splints), are the bane of many triathletes. They often plague beginning runners who do not build their mileage gradually enough or seasoned runners who abruptly change their workout regimen, suddenly adding too much mileage, for example, or switching from running on flat surfaces to hills.

  • What are the Symptoms of Shin Splints?:

  • Shin splints cause dull, aching pain in the front of the lower leg
  • Depending on the exact cause, the pain may be located along either side of the shinbone or in the muscles.
  • The area may be painful to the touch

  • What causes Shin Splints

  • There can be a number of factors at work, such as overpronation (a frequent cause of medial shin splints), inadequate stretching, worn shoes, or excessive stress placed on one leg or one hip from running on cambered roads or always running in the same direction on a track. Typically, one leg is involved and it is almost always the runner's dominant one. If you're right-handed, you're usually right-footed as well, and that's the leg that's going to hurt. The most common site for shin splints is the medial area (the inside of the shin). Anterior shin splints (toward the outside of the leg) usually result from an imbalance between the calf muscles and the muscles in the front of your leg, and often afflict beginners who either have not yet adjusted to the stresses of running or are not stretching enough.

  • Suggested Treatment for Shin Splints

  • Full Rest
  • Ice
  • Anti-inflammatory medications
  • Stretching and strengthening the calves
  • Prevention and Care: It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration. The severity of your shin splints, your compliance with treatment and the workload that you need to return to will ultimately determine how long your injury takes to successfully rehabilitate.


    Triathlon Injury Prevention

    Foam Rolling for Triathletes

    Self-myofascial release, also known as “foam rolling,” has transformed from a once mysterious technique used only by professional athletes, coaches, and therapists to a familiar everyday practice for people at all levels of fitness. Recent information, technology, and affordable products have introduced an increasing array of training and recovery methods to the average person. Watch Jessica Gumkowski how to execute a Foam Rolling Technique for Triathletes:

    Swimming

    The most common injury a triathlete will encounter during swimming training is pain in the shoulder area. Shoulder aches can be an early sign of tendonitis. Underdeveloped shoulder muscles and/or poor swim technique can lead to tendonitis in the shoulder. If you are not sure if your swim technique is correct, you may want to locate a coach or find a Masters swim class to receive feedback on your stroke and get instruction on the proper swim technique. To combat underdeveloped shoulder muscles, try cross training with weights to develop muscles in the shoulder area.

  • Use good stroke technique
  • Lessen repetitive strokes that are causing the overuse injury
  • Perform core strengthening and cross-training exercises as part of pre and early season routines
  • Consider alternative training techniques rather than training through an injury
  • Use periods of rest to recover
  • Focus rehabilitation efforts on rotator cuff and scapular strengthening for most shoulder injuries and pelvic and hip strengthening exercises for hip and knee injuries

  • Cycling

    Overtraining and improper bike fit are the most common causes of aches and pains during cycling training. An improper bike fit puts your body in a bad riding position and causes aches and pains to flare up in different parts of the body, specifically the neck, lower back, waist, knees, hips, and feet. If you are not sure about your riding position, find a reputable person to fit you to your bike. Keep in mind that as you begin to ride more, your proper riding position could change, so adjustments may be needed during the season.

  • Wearing a helmet may reduce the risk for head injury by 85 percent
  • Avoid pain in the neck by doing shoulder shrugs and neck stretches that help relieve neck tension
  • Ride with your elbows slightly bent (never with their arms locked or straight).
  • Changing the tilt of the seat, or using padded cycling shorts will all help relieve pressure and prevent numbness or pain in the genital or rectal area.
  • Foot numbness and tingling are common complaints, and shoes that are too tight or narrow are often the cause.

  • Running

    Running is the highest impact of the three disciplines. There are several different injuries that can occur. You can help prevent many running injuries by following the general injury prevention guidelines and purchasing a good pair of running shoes. You should replace your running shoes often as they will wear down and lose their effectiveness. Frequency for replacing your shoes depends on the shoe construction and material and what type of runner you are. More serious runners may replace their shoes as often as every 250 miles, where as the everyday runner may replace their shoes every 600 miles. If your training volume has remained unchanged and you begin to feel new aches and pains in your foot or knee, it may be a sign that it is time to replace your running shoes.

  • Develop a running plan and strategy that is compatible with your goal
  • Set safe, achieveable goals and advance slowly and cautiously
  • Hydrate (drink water) well in advance
  • Stretch for five minutes before beginning
  • Speed up slowly
  • Running hats, head covers, and ear covers shield the sun but allow temperature regulation
  • Proper fitting and proper thickness of socks help avoid blisters and irritation
  • Proper shoes with good support arches should fit well and be comfortable

  • Suggested Reading Material


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