Three Common Injuries I see with Triathletes

Sharon Simpson, one of the physio's who has worked with us for a couple of years in Portugal and now resides at The Bosworth Clinic is always on hand to help with her insight and expertise. Below she explores three very common injuries she sees and likely causes to help you avoid them and stay consistent with your training. 

Sharon (right) working with athletes in Portugal under the watchful eye of Gordon Bosworth

Triathletes are particularly vulnerable to overuse injuries. This is due to the repetitive nature of the training causing stress to muscles, tendons, tissues and bones which can produce microtrauma. When the load exceeds the body’s ability to keep up the repair caused by repetitive microtrauma, pain, inflammation and weakness can result. There are many other factors that may contribute to the development of such injuries. Three common injuries are discussed below.

Swimming Technique may be a contributing factor to shoulder niggles

Shoulder Impingement

A common swimming injury caused by the impingement of tendons or bursa. The shoulder rotator cuff tendons are protected by ligaments and a bony arch called the acromion with a bursa to help with tendon gliding. When there is loss of control and stability of surrounding muscles, tendons and ligaments to hold the head of the humerus in a good position, it can rise into the sub-acromial space causing compression to the tendons and bursa, resulting in inflammation and pain. 

Due to repetitive overhead movements in swimming, there are many factors which may result in this loss of control and stability of the shoulder joint. Muscle imbalance may exist where muscles may be too tight anteriorly or overactive, whilst other muscles around the scapula (shoulder blade) may have become weak or inhibited, resulting in decreased control. Fatigue of the rotator cuff muscles may also cause loss of control in centralising the humeral head. Postural problems and stiffness of the thoracic spine may cause restriction in the movement needed. Swimming technique and training error, can also contribute to the develop of these issues. 

Illiotibial Band Syndrome (ITBS)

ITBS is a common cause of pain linked to running and cycling. The iliotibial band is a thick band of fascia running down the outside of the thigh from the pelvis to just below the outside of the knee. It is important in stabilising the knee and hip during bending and straightening of the knee. Continual friction of the band over the outside of the femur during running or cycling may cause the area to become inflamed. Training factors related to this injury include running in the same direction on the track repetitively, a sudden spike in weekly mileage, and downhill running. 

Running can be a contributing factor to ITBS, especially on a track if only gong one way!

Decreased arch support at the foot and ankle, sometimes stiff or restricted joints and inhibited muscles can cause a disruption in the timing and firing sequence of the muscles further up the chain, resulting in other structures such as the ITB compensating and becoming tight or restricted. Another cause of this happening could be fatigue or inhibition of the gluteal muscles, resulting in decreased stability of the pelvis. This could be due to a problem in the alignment of the pelvis or movement of the sacroiliac joints. 

A significant increase in training volume or intensity on the bike can be a cause of developing ITBS. Bike fit is another big factor to consider as seat height and position, cleat position, use of insoles and crank length can all influence the tension or load placed on structures of the leg and hips. 

Lower Back Pain

The lumbar spine is comprised of five vertebrae. The structure of the five vertebrae can be simplified to the body and the facets, with discs in-between. 

The repetitive nature of the movement patterns involved in this endurance sport can cause compression irritation of the structures of the lower back if control is compromised. This may be due to fatigue, soft tissue imbalances, movement dysfunctions, such as at the sacro-iliac joint or structural asymmetries such as a leg length discrepancy. 

An example of a common muscle imbalance is tightness of the flexors at the front of the hip. During running, if the hip is restricted into extension the movement needed may come from above and the pelvis rotated forwards which puts increased stress onto the lower back. 

To achieve stability in the lower back region muscles throughout the whole system need to be working well together and at the right time. As mentioned with ITBS, pelvic control is important during running gait and weak or inhibited gluteal muscles can also lead to tightness and compensation developing in the lower back.

Problems in the lower back can also occur due to prolonged flexion on the bike, especially a TT bike. Stability around the lumbar spine and pelvis is required whilst putting large forces through the legs. A sudden increase in mileage with a more aggressive position previously or an inadequate bike fit can also cause increased stress on the lumbar region.

Time hunched over a desk or bike can affect your back – sit up and take some time out every now and then! (Or get a good bike fit!)

Solutions?

It is important to remember that one area of the body does not work in isolation from another area. There may be dysfunction elsewhere in the body that may be contributing to the development of any of these problems, either from training or outside training. If experiencing pain it is always worth seeing a physiotherapist who can assess the whole picture, help to discover why problems are occurring and successful ways to combat dysfunction. Even if not injured, it is also worth having a screening to put together a plan to stop any risk factors developing into injuries.