Winter’s finally over – bring on the triathlon season

Well the season is upon us. We’ve had some (slightly) warmer weather and the majority of you Tri enthusiasts will have been venturing outside to clock up some training miles on the bike and in the running shoes. Some of you brave souls may also been down to your local Lido training in well below average temperatures to get the swimming fitness up to scratch. But now comes the push, the first few races are close on the horizon and whether you’re training for sprint distance or Olympic, you’re going to be increasing you’re training schedule to prepare.

The sobering info

According to several studies, overuse injuries account for between 70-80% of all injuries sustained during preseason and season training. Running is the worst culprit for these injuries and is especially linked with those athletes who are increasing their running distance. Cycling and swimming are linked with fewer injuries, but are by no means blameless. One study suggests that you’re likely to pick up at least 1 injury for every 500 hours of training you do.

Below are 5 of the most common overuse injuries associated with triathlon training and competing. Look out for them, catch them early and DON’T’ assume they will go away on their own or it could be ‘season over’. If you feel like you have any of these symptoms get down to see one of our specialist physiotherapists as soon as possible to help you overcome the problem.

Shoulder pain, Rotator cuff tendinopathy, Subacromial Bursitis

What will I feel? Anything from a dull ache or a sharp catching pain in the shoulder area. During training you may feel this especially when swimming during the recovery phase of the freestyle stroke (arm exiting the water). It may also be painful to sleep on and can quite often wake you at night.

How has this happened? As with all overuse injuries, the underlying mechanics of the injury would have been present for a while. In short it is mainly due to an ‘imbalance’ between the muscles at the front of the shoulder being tight and over active and those at the back being long and weak. Each individual athlete will have a slightly different degree and combination of ‘imbalance’ in the shoulder. It is vital to get the right advice for your problem so you can work on the remedy.

Self management? Firstly the best advice is…..STOP. Even if the pain is mild, it will only get worse. Rest is the key to the initial phase of healing. Stretching the tight pectoral muscles and strengthening the posterior cuff muscles and scapula (shoulder blade) muscles is essential whilst the shoulder settles. Getting some coaching on your technique may also be highly advisable.

ITB friction syndrome or Runners knee

What will I feel? Classically this is a sharp pain in the side of the knee. It may start as a tightness or ache, but soon it will be a full-on pain. This can get so bad as to force a return home via public transport halfway through your run or bike ride.

How has this happened? Weak hips combined with or without poor foot biomechanics, depending on which research you read. The ITB is a long strip of connective tissue which travels down the side of thigh from your gluts to your knee and is a key stabiliser of the hip and knee. Weakness in the hips leads to excessive rubbing of this structure over the bony side of the knee and results in inflammation and pain.

Self management? Foam Rollers and side planks. The foam roller is a great way to get rid of all those knots in the muscles in the side of your thigh. Side planks ranging from ½ to full side planks for lateral hip and trunk stability are a good place to start on preventative and rehab-based exercises.

Anterior knee pain and patella tendinopathy

What will I feel? Pain in the centre or behind the knee cap or just below the knee cap. Repetitive movements like running or cycling will generally aggravate the pain especially on long hill climbs or runs. Sitting still with your knee bent may also cause significant stiffness and pain.

How has this happened? There are many different causes for this problem to occur; weak quadriceps, tight lower limb muscles i.e. hamstrings or hip flexors  or a combination of both. Another important factor to take into account is a proper bike fit (we recommend a Balfe’s bike fit).

Self management? General strength training and stretching for the lower limb and the use of a foam roller to take out the knots in the quads are good places to start. A concise and thorough assessment from a physiotherapist will help you figure out the best course of action to take depending on how your injury presents and how long you’ve had it for.

Tendon Achilles tendinopathy

What will I feel? A pain in the long tendon between your calf and above your heel. You may also see a bump or swelling in the normally smooth Achilles tendon, or feel tightness and see redness in the tendon. The pain may not be very bad at first, but don’t ignore it—it can quickly change into a chronic issue if you don’t deal with it.

How has this happened? Overuse of the tendon through running extra distances or increased speeds results in a degenerative process. Continual use of the tendon in this way causes small amounts of damage and over time, without the correct management, this can become a chronically damaged structure leading to long term dysfunction and pain.

Self management? Once again, the foam roller on the calf is a good way to reduce the tightness in the calf muscle along with stretching. Specific eccentric muscle strength training may be indicated, but again you should consult advice from a physiotherapist as to when you should start these.

Stress fractures

What will I feel? This is definitely one injury not to ignore. Any pain in the groin, long shin bone (tibia) or foot which really feels like it is in the bone should be taken seriously. Stress fractures in triathletes occur mainly in the hip, foot, or tibia. You’ll feel pain in the bone during exercise which can range from mild to severe and you may see some swelling in the area of pain.

How has this happened? Again it’s normally the result of a combination of poor lower limb biomechanics, muscle imbalance, over enthusiastic training regime and excessive impact.

Self management? If you are suspicious in any way then consult your G.P. or a physiotherapist and they can start the process to get some imaging of the area to assess the degree of injury. If this is confirmed then a level of immobilisation and rest will be needed for 6-8 weeks to allow the injury to heal. To avoid this type of problem you need to be realistic about the amount of running you do. A screening assessment by a physiotherapist will pick up any risk factors that could result in this injury. A general strengthening and flexibility program will normally be what is needed to avoid the problem.

The good news

All of these injuries are avoidable or at least very treatable if they are not left too long. Quite often rest is the answer in the short term. The problem however is when you return to your training regime and you still have the underlying problems that led to injury in the first place. So the advice is: be sensible, be proactive and if you’re in any doubt always get advice from a professional.

All of our physiotherapists are highly skilled in assessing the risk of injuries for preventative measures. We also specialise in treating any of these injuries you may have sustained in your pursuit of triathlon glory.

So if you want to prevent injury blighting your season:

Get in touch now

References:

Factors associated with triathlon-related overuse injuries – Burns J, Keenan AM, Redmond AC.J Orthop Sports Phys Ther. 2003 Apr;33(4):177-84.

Injury and Training Characteristics of Male Elite, Development Squad, and Club Triathletes – V. E. Vleck, G. GarbuttInt J Sports Med 1998; 19(1): 38-42