Triathlon is a fast growing endurance sport that combines swimming, cycling and running. It’s a great way of keeping fit, but it’s also a very demanding activity and its competitive nature can lead to injury. Because of the varied formats of triathlon (sprint, Olympic and Ironman) and a lack of standardisation in injury surveillance, there is a slight variation in the published studies related to triathlon injuries.
Depending on the type of triathlon event research reports that 35%-90% of triathletes have suffered a related injury. In terms of the overall incidence of injury, 17 injuries have been reported to occur per 1000 hours of triathlon competition, compared to 5 injuries per 1000 hours of triathlon training. Despite this you are just as likely to get injured while training, because most people will spend more hours training than in competition. More triathlon injuries tend to be due to overuse, rather than trauma such as collisions during the swim or crashes on the cycling section which do occur, but not that frequently.
It’s clear that injury is the one thing that can prevent you from enjoying participation in triathlon events. This guide is intended to inform you of the common triathlon injuries and how you can best avoid these. We provide a jargon free explanation of the most common triathlon injuries together with a straightforward guide to products that can help with each injury, should you suffer one of these injuries yourself.
Blisters that prevent participation have been reported in almost half of endurance running events, including triathlon. Although blisters are not a serious injury they can seriously affect your performance and prevent you from achieving your personal best. Blisters most commonly affect the heels, toes and balls of the feet. Blisters are formed by prolonged friction that produces a shearing force between the layers of skin. The layers of skin are forced apart and the space fills with blood or fluid, producing a painful blister.
What can you do to prevent blisters?
Ensure that you have properly fitting running shoes and break these in gradually – never wear new running shoes for a long run. Moisture wicking blister socks with two layers are excellent for blister prevention. The inner layer stays with the foot; the outer layer moves with the shoe, reducing friction on the skin. In elite level triathletes who don’t wear socks, friction can also be prevented with the use of an anti blister stick. The lubricant reduces the friction that leads to blisters.
What should you do if you suffer blisters?
You have to ensure that the blister is cleaned thoroughly by a medical professional before it is lanced with a sterile implement. This can relieve the pressure and pain. Once the blister has been lanced it must be kept meticulously clean in order to prevent infection.
Blister plasters can help healing. They absorb fluids and maintain an important natural moisture balance. Skin cells are less likely to dry out and develop into a scab. This helps to form new, smooth tissue sooner.
2. IlioTibial Band (ITB) Friction Syndrome
Although iliotibial band friction syndrome is known as runner’s knee it is also prevalent in cyclists. The combination of running and cycling means that ITB syndrome is a common injury in triathlon.
Pain is located on the outer side of the knee joint, which may radiate up the thigh or down the outer-side of the shin. It is exacerbated by running and cycling. Usually, the knee pain from iliotibial band friction syndrome is only present during activity and settles during rest. However, in severe cases pain can become present at all times, especially when going up or down stairs.
What can you do to prevent ITB Syndrome?
ITB Syndrome is an overuse condition that is aggravated by excessive running and cycling training, due to the iliotibial band rubbing against the outer part of the lower thigh bone during repetitive knee bending exercises. To prevent it, make sure that you gradually increase your training load – there should be no sudden increases in workload as this can cause inflammation of the tissues.
Tightness in the iliotibial band can be a contributory factor so stretching the gluteus medius and tensor fascia latae muscles may be helpful.
Increased pronation of the foot (uncontrolled lowering of the arch) can lead to increased tension in the iliotibial band when running. Running shoes that prevent excessive pronation can be effective in reducing this iliotibial band tension. Alternatively an insole that supports the arch of the foot can help to control increased pronation.
What should you do if you suffer from ITB Syndrome?
The pain of iliotibial band friction syndrome is due to inflammation, so ice packs and non steroidal anti inflammatory medication (NSAIDs) prescribed by your doctor are effective in the early stages.
Once the inflammatory soreness has resolved a physiotherapist can assess posture and lower limb alignment in order to give specific stretching and strengthening exercises to address the underlying cause of the problem.
3. Achilles Tendinopathy
Achilles tendinopathy is commonly known as Achilles tendonitis. Achilles tendinopathy is an overuse condition that usually occurs during the running stage of the triathlon. Typically it comes on gradually, and is more common in those aged over 40. The pain is located around the back of the heel and just above. This pain is worsened by activity, and the focal areas of tendon degeneration often feels tender to touch. Often the tendon feels very stiff first thing in the morning and the affected tendon may appear thickened in comparison to the unaffected side.
What can you do to prevent Achilles tendinopathy?
The training load should be monitored carefully as Achilles tendinopathy is an overuse injury. The intensity, duration and frequency of training sessions have to be gradually progressed. Any sudden increases in these variables should be avoided in order to avoid overloading the Achilles tendon. Stick to a pre-planned training schedule and be sensible regarding the level of event you are entering. If you’re thinking about entering an Ironman event make sure that you have prepared well.
An ‘over-pronated’ foot position (where the foot rolls inwards) can put too much strain on the Achilles tendon and lead to Achilles tendinopathy. If there is an over-pronated foot position it is usually effective to insert an arch supporting insole to help to correct the problem.
What should you do if you suffer Achilles tendinopathy?
The key to recovering from Achilles tendinopathy is in trying to elicit a healing response by loading the tendon gradually without overloading it. Published research has suggested that recovery is optimised by using a programme which uses ‘eccentric muscle work’. Eccentric muscle work refers to a muscle that is lengthening while contracting – a contraction that occurs during movements such as landing and decelerating. Maximal tension is generated in the muscle during the eccentric contraction and when this is done in a gradually progressive manner, it causes the tendon to adapt and get stronger.
An ankle support can be very effective in relieving the heel pain symptoms of Achilles Tendinopathy. Ankle braces that provide compression to the heel and the arch of the foot, relieves strain on the Achilles Tendon. This can give rapid relief to those suffering with Achilles Tendinopathy and heel pain.
4. Shin Splints
Shin splints is a misleading term for any general shin pain and most sports medicine professionals try to avoid using it because shin pain and shin splints can be due to several different conditions. One of the most common shin conditions that is labelled shin splints is medial tibial stress syndrome.
Medial tibial stress syndrome is fairly common in triathletes, where there is shin pain on the inner side of the shin during running and also following load-bearing activities. The other shin problems that get labelled shin splints, such as compartment syndrome and stress fracture, must be ruled out by an experienced sports doctor or physiotherapist.
What can you do to prevent shin splints?
The stress on the shins can be minimised by supportive running shoes and adding shock absorbing insoles. As well as reducing the load on the shins, the risk of medial tibial stress syndrome could be reduced further by addressing problems such as flat feet (excessive pronation) with arch supports.
What should you do if you suffer from shin splints?
Physiotherapy treatment involves rest, strengthening and stretching exercises, and then a gradual return to running once symptoms have resolved. An assessment of body alignment, particularly of the lower limbs, is important to correct faults that may predispose the shins to excessive stress.
A common cause of medial tibial stress syndrome is excessive pronation during running. This would be identified during body alignment analysis and can be corrected with arch supporting insoles.
A shin splint compression sleeve is often helpful in alleviating mild shin pain. The elasticated fabric applies additional compression and support across the muscles and tendons of the lower leg, which reduces stress on the inside of the shin.
5. Shoulder Bursitis
Shoulder pain is the most common upper limb injury in triathletes due to the repeated stresses placed on the shoulder during the swim. Strains of any of the muscles of the shoulder can produce shoulder pain, but shoulder bursitis (inflammation of a sac of fluid called a bursa) is most common because it can develop following a small shoulder muscle strain or it can develop independently.
Frequent overuse of the rotator cuff muscles during swimming can cause the bursa to get ‘impinged’ between the muscles and the bony prominence of the shoulder, which causes the bursa to become inflamed. This causes pain during swimming and whenever the arm is raised.
What can you do to prevent shoulder bursitis?
Increases in the amount of swimming training or competition must be gradual so that the tissues of the shoulder are not overloaded. Overuse of the rotator cuff can cause a small inflammatory response and this can worsen if the tissues are not given adequate recovery time. Inflammation of the muscles in the tight space under the tip of the shoulder can cause the bursa to also become inflamed.
It’s important that triathletes address flexibility, strength and endurance of the shoulder muscles to ensure that they are prepared for the swim. Shoulder stabilisation exercises under the supervision of a chartered physiotherapist can also help prevent impingement by improving muscular control of the shoulder blade as this is important in providing increased space to prevent impingement of the bursa.
What should you do if you suffer from shoulder bursitis?
Physiotherapy treatment aims to reduce the amount of inflammation using ice therapy (never apply ice directly to the skin) and this can be helped with anti-inflammatory medication prescribed by a doctor. In some stubborn cases that have failed to respond to rest and anti-inflammatory treatment then a corticosteroid injection may be very effective in relieving the symptoms.
Once the pain and inflammation have resolved, supervised exercises to regain full shoulder movement can begin. These are followed by a gradually progressive strengthening and stabilising programme.