Injury Prevention for Triathletes
Spring is finally in the air! For triathletes that means finally getting off of the bike trainers and treadmills and getting out on the concrete for the first time in months while dreaming of the upcoming race season. While preparing for your race season, here are some tips to prevent and rehab injuries while training and help you achieve success throughout the season.
With swimming being an overhead sport, swimmers are highly susceptible to shoulder injuries, which have been reported to account for nearly 90% of all swimming related pain complaints and injuries (1). This susceptibility is the result of a myriad of anatomical and biomechanical factors. The shoulder has the greatest amount of movement of any other area in the body. While this range of motion allows us to do everyday tasks, including swimming, it also requires greater stability from the muscles of the shoulder, back, chest and core. Injuries tend to stem from the repetitive nature of swimming, continuous force and load, poor shoulder stability or muscle imbalances, a weak base of support, and poor or inefficient technique. A common issue seen in swimmers is tightening of the shoulder structures that alter the shoulder’s movement pattern, reduce the shoulder’s movement into internal rotation and increase risk of shoulder injury. This range of motion is particularly important for the pull and final push phases of freestyle stoke when the arm is underwater to just before it leaves the water.
Here are some tips to prevent swimming injuries:
· Strengthen rotator cuff muscles
· Work on scapular stability and endurance
· Address any muscular imbalances
· Maintain shoulder range of motion, especially internal rotation. Studies reveal that performing the Sleeper Stretch daily will aid in increasing shoulder mobility and function in overhead athletes (1). The Sleeper Stretch is demonstrated in this video: https://www.youtube.com/watch?v=VC__RjKLBHc)
· Always be thinking of the kinetic chain. Incorporate global mobility and strengthening with particular focus on the core, upper and lower back, and hips.
· Work on swimming technique and stroke efficiency. When training in the pool, abide by the mantra “slow is smooth and smooth is fast”. Always favour technique over speed in the pool. If your technique is efficient and smooth, the speed will follow. Forcing speed with sloppy technique comes with a higher risk of shoulder injuries.
· If you are new to swimming or unsure of your technique, join a swim team or consider consulting a swim coach to ensure you are using proper technique
· At the first signs of pain or injury, seek a healthcare professional right away to minimize time away from training and optimize your rehab period
Since about half of your time racing and training in triathlon will be on the bike, the most crucial component to preventing injury is ensuring you have a comfortable and efficient bike setup. It probably comes as no surprise that the most commonly injured area in Ironman distance triathletes is the lumbo-sacral region, or the low back and hips. Olympic distance triathletes, however, most commonly have overuse injuries around the area of the knee (2). The knee joint is under stress while cycling, particularly due to the repetitive knee movement and primary muscle activation occurring around this joint. Common mistakes that can contribute to knee injuries while cycling include improper bike setup (typically riding with the saddle too low), and biking in too high of a gear.
To prevent bike related injuries:
· Ensure your bike frame is the right size for you and that all of the components are set up properly. If you are unsure, get a professional bike fitting done.
· An efficient bike cadence is between 80-100 RPM. If you are struggling to hit above 80 RPM on a flat stretch, change your gears or consider teaming up with a coach to assess your cycling form
· While the key muscles that activate while pedaling include your quads, hamstrings, glutes, calf, and shin muscles, don’t overlook strengthening up the kinetic chain. Ensure you are also working on the mobility and strength of your neck, entire back, shoulders, and your core.
Training errors, including ramping up running intensity, frequency and volume too quickly, account for approximately 75-80% of all running-related overuse injuries. Since running can increase the force put through your body by up to 3x your body weight, it is crucial to have a strong foundation to minimize impact and overuse injuries. Add strength training, focusing on the glutes, hips, knees, back and core, to your training program. How you run can also play a large role in succumbing to overuse injuries. Inefficient gaits, or running patterns where you strike the ground at the heel of your foot ahead of your center of gravity, has been linked to an increased risk of shin splints, stress fractures, runner’s knee, and other overuse injuries. An efficient gait is considered one where the runner contacts the ground with their mid-foot, directly under their center of gravity, and has a cadence of 170-190 foot strikes per minute. These components of efficiency decrease the amount of time your feet are in contact with the ground, useless muscle contractions, and vertical displacement of your body. This ensures proper stability, alignment and weight distribution resulting in a lower risk of injury.
To prevent common running injuries:
· Abide by the 10-15% rule in increasing weekly running mileage
· Don’t make sudden drastic changes in footwear (ie. if switching to a more minimalist shoe from a stability running shoe, do so very gradually)
· Address muscle imbalances. Common imbalances in runners include: weak inner quads, weak glute med/hip abductors, and weak hamstrings. Runners are also prone to tightness in the outer quads, IT band, and calf muscles.
· Ensure your runs are full of variety. Mix up running surfaces (trails, sidewalk, track, road, treadmill, etc.), elevation (hill days and flat days), distance, pace, and speed training.
· Get your gait assessed to ensure efficiency and prevent future injury
IMPLEMENT A BALANCED & INDIVIDUALIZED TRAINING PLAN
A study that examined the correlation between injury and training patterns in non-elite triathletes revealed that hours of training could predict rate of injury. Triathletes that trained at too low or too high of a volume were more likely to sustain an injury when preparing for racing season. The group with the lowest risk of injury trained an average of 8-10 hours per week, comprised of 5-6 hours of cycling and 3-4 hours of running, for a standard triathlon. The amount of time spent swimming was found to have no significant correlation to risk of injury (3).
Compared to runners, triathletes have a reduced rate of overuse injuries as the result of being able to spread training over 3 disciplines. Despite this, overuse injuries are still very prevalent with 80-85% of all triathlon injuries being contributed to overuse (2). The most common sites of overuse injuries in triathletes are the knee, lower leg, lower back, and shoulder (4). Overuse injuries occur as a result of repetitive microtraumas to the musculoskeletal system. This happens when the same stress is applied repetitively and continuously to the same muscles, connective tissue and bone structures without enough time for these structures to heal or to adapt to this stress. If the same microtrauma-inducing stress is continually applied, this may result in a full-blown injury, such as a stress fracture (5). This is why ensuring you have variability, alternating high and low intensity days, and having reduced mileage/recovery weeks interspersed within your training plan are so crucial for injury prevention.
Tips on how to implement variability into your training plan:
· Add varying running surfaces (track, sidewalk, trails, treadmill, pool running, etc.)
· Add in hill days and speed work on runs or on the bike
· Warm up and/or cool down with some running/biking/swimming drills focusing on technique and efficiency
· Mix up distances, intensity/pace, interval training often (avoid doing the same bike/running course every time; mix it up!)
· Cross-training and strengthening
· Incorporate transitions into your training plan. Add brick workouts, or go for an easy run after a bike workout.
If you are forced to take time off due to injury or illness, don’t just jump ahead to what you should be doing training-wise when you get back into training. Here is a good rule of thumb for how to return to training depending on how long you are forced to rest:
· 1-2 days off: this will have minimal to no impact on your fitness and training physiologically. You should be able to jump right back into your training program.
· 3-6 days off: you will encounter minimal physiological setbacks in this time frame. If you are able to get in some easy physical activity (ie. if you have a nagging running injury, but are able to swim or bike pain-free) during this time, do so. If you need complete rest, focus on healing up. Start a gradual return to training after by training easy for the first 3-4 days and then start back into your training program starting with the previous weeks training plan.
· 7-10 days off: with this amount of time off you will have lost some of the physiological gains in fitness that you have made with training so far. As above, if you are able to continue doing other activities during this time (or have other recommendations for how to continue training despite an injury or illness as per a healthcare profession), do so. If not, you should exercise a gradual return back to training. Start with a week of easy workouts and then get back into your training plan starting over at the last week you completed and continue from there.
· 11+ days off: expect about 3-5% loss in the physiological gains you have made in training so far. You may need to adjust your goal finishing time and/or change your race schedule to accommodate the training absence. Exercise a more gradual return to training (6).
If you are new to the sport, or don’t know where to start in developing and executing a training plan that is appropriate for you, you may want to consider consulting a trained personal trainer or coach with triathlon experience to get you started.
RECOVERY AND POST-RACE NUTRITION
After a race, make sure you are recovering properly with an active recovery before getting back into high intensity and high volume training. Active recovery is low to moderate intensity exercise that occurs while recovering from a high-intensity physical activity. Studies have shown that an active recovery increases the removal of skeletal muscle breakdown components (lactate and H+) which allows muscles to return to their baseline levels faster than passive recovery (complete rest) (7).
Also crucial to recovery is nutrition. Ensure that your body has what it needs to repair tissue and replenish lost energy stores prior to training again. Carbohydrates are an important component of post-race (and post-training) nutrition as they are your primary fuel source while training and race. Failing to have adequate post-race nutrition that involves carbohydrates can impair muscle glycogen re-synthesis, result in poor muscle recovery and increase your risk of injury (7). It may be a wise investment to see a registered dietician/nutritionist that specializes in working with endurance athletes/triathletes to ensure you are fueling your body appropriately and consuming what your body needs to reach your training and racing potential. At Active Physio Works, we have a Registered Dietitian, Jenny Wilson-Gibbons who is able to assist with your nutrition needs, to book an appointment with her, email firstname.lastname@example.org
If you do succumb to an injury at any point in the season, get it checked out by a healthcare professional as soon as possible. While most athletes fear having to take time off, training through an injury may have more severe consequences for your racing season. A physical therapist that works with endurance athletes and triathletes will make sure you are able to optimize your rehabilitation while maintaining your cardiovascular fitness to get you back to doing what you love. To book an appointment with myself or one of our qualified Physiotherapists, give us a call 780-458-8505.
Good luck to all triathletes in the upcoming race season!
(1) Chepeha, J. Shoulder Injury Prevention for the Overhead Athlete. University of Alberta, Edmonton. 19 June 2015. Lecture.
(2) Migliorini, S. (2000). The Triathlon: Acute and Overuse Injuries. Journal of Sports Traumatology and Related Research, 22(4): 186-195.
(3) Shaw, T. et al. (2004). Training patterns and sports injuries in triathletes. Journal of Science and Medicine in Sport, 7(4):446-450.
(4) Andersen, C. A., et al. (2013). High prevalence of overuse injury among iron-distance triathletes. British Journal of Sports, 47:856-860.
(5) Dufek, J. S. (2002) Exercise Variability: A Prescription for Overuse Injury Prevention. American College of Sports Medicine: Health & Fitness Journal, 6(4): 18-23.
(6) Humphrey, L. (2016) Hanson’s Marathon Method, 2nd Ed. Boulder, CO: VeloPress.
(7) Fairchild, T. J., et al. (2003) Glycogen Synthesis in Muscle Fibers during Active Recovery from Intense Exercise. American College of Sports Medicine: Medicine & Science in Sports & Exercise, 35(4): 595-602.