5 common triathlete injuries & how to avoid them
Accurate data on injury prevalence in triathlon is lacking; however, we know that 80-85% of injuries in triathlon are overuse injuries. Here coach Jon takes a look at 5 common injuries suffered by triathletes and gives some tips on how to avoid them.
Shoulder pain (Swimmer’s Shoulder)
We often hear of people picking up a ‘rotator cuff injury’ or having ‘swimmers shoulder’, these are often umbrella terms for a wide variety of shoulder injuries. The shoulder joint is a very complex joint; therefore, injury diagnosis is far from simple. Clearly, triathletes normally pick up shoulder injuries when swimming. A pinching sensation may be felt at the front of the shoulder during the recovery phase of the stroke. Often the pain can continue after activity and keep the athlete up at night.
Shoulder injuries can be caused by poor swim technique: a narrow recovery, straight arm catch and wide catch can all put extra strain on the shoulder. Poor posture and lack of rotation can limit the engagement of the powerful Latissimus Dorsi muscles in the swim stroke. This means the shoulders have to do more work to get the swimmer moving through the water, which can lead to overload.
As well as poor technique, muscle imbalance around the shoulder can trigger injury. The most common imbalance is found between the tight/overactive muscles at the front of the shoulder and chest and the weak/underactive muscles in the back of the shoulder and the upper back. Each individual athlete will have a slightly different degree and combination of ‘imbalance’ in the shoulder, so it is important you get your shoulder injury correctly diagnosed by a physiotherapist.
How to prevent it:
Having a swim coach assess swimming technique can be a key part of shoulder injury prevention. The majority of swimmers will also benefit from stretching and myofascial release (foam rolling) techniques on the overactive muscles at the front of the shoulder and chest. Exercises to strengthen the posterior chain, especially the upper back, muscles around the Scapula and Latissimus Dorsi, such as lateral raise, internal and external rotations, and scapula push-ups will all help. Tri Training Harder coached athletes have the benefit of access to our ‘Shoulder Robustness’ sessions with a myriad of exercises to build up your shoulders and surrounding muscles to prevent injuries in that area.
Iliotibial Band Syndrome (ITBS)
ITBS pain is usually felt on the outside of the knee; it is common amongst age group triathletes. ITBS is an overuse injury caused by repetitive friction of the iliotibial band and the underlying femoral epicondyle (the knobbly bit on the outside of the knee!). The Iliotibial band is a collection of tissue that runs from the hip, down the thigh, and to the outside of the knee, it plays a key role in stabilising the legs as we run.
Some triathletes, especially with a swimming background, tend to have weak abductor muscles on the outside of their hips (Gluteus Medius). When these muscles fatigue, they allow the knee to collapse inwards whilst running (increased valgus vector), this can increase the tension on the IT band causing it to flare up and trigger a pain response.
ITBS can also be picked up on the bike. This is common in athletes with incorrectly positioned cleats, or saddles set up too high or too far back. Getting a professional bike fit is going to be the first port of call for athletes feeling ITBS pain on the bike.
How to prevent it:
Foam rolling the quads and glutes can help release tension that can help alleviate ITBS; however, avoid foam rolling directly on the IT band. Strengthening the hips and glutes, especially glute medius with abduction exercises such as a side plank with a leg raise or banded crab walks can help to prevent ITBS flare-ups.
Runners knee (Patellofemoral Pain Syndrome)
Runner’s knee (Patellofemoral Pain Syndrome) is another common knee complaint amongst triathletes, this time, pain is usually felt around the front of the knee and the kneecap. Runner’s knee occurs when the cartilage underneath the kneecap (patella) becomes inflamed or irritated. This can be due to friction where the kneecap does not move in the correct plain due to misalignment. This can be caused by direct trauma or by muscular imbalances, tight quadriceps and hip flexors are often the culprits.
Poor running form can also be a trigger of Runner’s knee. Over-striding in the running gait, where the foot lands out in front of the centre of mass, not only decreases running efficiency but also applies stress to the front of the knee and the quads as they are left to absorb the braking force caused by the over-stride.
How to prevent it:
Myofascial release (foam rolling) of the quadriceps, hips, hamstrings and gluteal muscles can help release tight muscles and alleviate Runner’s Knee pain. Improving strength, balance and stability around the knee joint with single leg balance exercises can also help to prevent Runner's knee.
Working on running form to avoid over-striding will also help combat Runner’s knee. Gradually increasing running cadence and drills such as ‘pawbacks’ will help.
Many triathletes also pick up ‘Runner’s knee’ on the bike. A saddle that is set-up too low for the athlete can overload the quadriceps and apply stress around the front of the knee. A professional bike fit can help fix the route cause of the problem if this is the case.
Achilles tendon pain
Achilles tendon injuries can vary from mild discomfort after a hard run session, to chronic tendinopathy or even Achilles ruptures. Achilles pain normally manifests after increasing running volume or intensity too quickly. Transitioning from a heel strike to mid or forefoot running style can also cause Achilles injuries. Running in shoes that are worn out-or lack the support the athlete’s running gait needs can compound calf and Achilles problems. Achilles tendon pain can also occur on the bike with a saddle positioned too high or badly fitting bike shoes or cleat positioning.
How to prevent it:
Tight calves can lead to Achilles problems, myofascial release techniques around the calf complex can help with Achilles pain. Performing a thorough warm-up, especially before intense sessions, will help your Achilles prepare for the session.
Depending on the location of the Achilles pain (insertion or mid- Achilles), a mix of single-leg balance exercises, calf raises and heel drops can help prevent and rehabilitate Achilles injuries. TTH athletes can follow our ‘Lower Limb Robustness’ and ‘Hip Robustness’ sessions for some excellent rehabilitation and preventative exercises to avoid Achilles tendon pain, ITBS and Runner’s knee.
Stress fractures
Stress fractures are most commonly found in the hip, foot or tibia amongst triathletes. Pain may be felt in the bone itself, and mild swelling can be present. Bouts of high-intensity training with inadequate recovery can trigger stress fractures. Poor footwear, poor training load management, and muscular imbalances can all be a causal factor in stress fracture occurrence. Timely diagnosis via X-ray is essential for adequate management of this injury as recovery times can range from weeks to months.
Athletes with Vitamin D deficiency and female athletes with iron deficiency or menstrual disturbances have a higher risk of picking up stress fractures. Both female and male athletes should pay particular attention to their diet when increasing training load to avoid RED-S (Relative Energy Deficiency in Sport). Stress fractures and RED-S have a strong correlation as a calorie deficit can cause hormonal imbalances, which can reduce bone density.
How to prevent it:
Improving general biomechanical robustness with full-body strength and conditioning, especially core work, will help avoid stress fractures. Adequately fuelling workouts, prioritising rest, and recovery should be at the forefront of prevention methods. Changing footwear regularly and mixing up running terrain, rather than constantly pounding the pavement can also help.
Conclusions
With all of the injuries mentioned, it is important to take symptoms seriously, reduce your training load and apply short-term injury management techniques, such as RICE. Make sure you speak to your coach and prioritise getting booked in to see an expert.
Of course, there are many more injuries commonly picked up by triathletes, such as shin splints Plantar Fasciitis and muscle sprains. Except for the shoulder, all of the aforementioned injuries are most likely to be picked up during running, due to the extra loading on the body compared to swimming and cycling. With any triathlon related injury, the route cause can rarely be pinpointed; it is normally a combination of many factors:
Training errors account for a large proportion of overuse injuries. Doing too much too soon, at too high an intensity. ‘Spikes’ in training load in an attempt to catch-up on missed training can easily overload joints and muscles. Working with a coach to manage the training load can help the athlete avoid training errors.
Muscular imbalances can be a causal factor in all of the above examples. Working with a Personal Trainer to assess biomechanical make-up can give a structured and targeted flexibility and strength routine to re-align any imbalances, giving the best chance of remaining injury-free.
Stability, range of motion, strength and posture, can all vary from athlete to athlete and can be built upon with a well-structured strength and flexibility routine and adequate warm-up routine. A stable platform will allow the athlete to move efficiently and safely.
Injuries amongst triathletes can be quite common, but they don’t need to be. Working on all of the above elements with the help of professional coaches, physiotherapists and strength and conditioning specialists can help to build a robust body capable of tackling the rigours of a triathlon training and racing regime.
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The result is an honest, dynamic, yet simple new way of constructing an athlete’s training to allow them to reach their potential.
If you’re planning your next season, just starting out in the sport or are looking for extra guidance at the very top end of the field, we are here to help, and our coaches would be delighted to hear from you. You can contact us via the website, and one of the team will be in touch.