Multisport: Three common Triathlon Injuries: Prevention & Treatment

By John Phillips

Introduction

As the triathlon season nears its end, you're likely finishing up the final preparations for your important last race of the season. After working hard all year, the last thing you need is an injury to end the season prematurely. The pain of the injury is at most half the suffering; having to allow your hard earned fitness erode away is far harder to manage.

One of the first ways to treat an injury is the RICE method: rest, ice, compression, and elevation. Obviously rest means to reduce or eliminate your training to reduce stress on the affected area. Icing it will help reduce any swelling that is occurring. Use an ice pack on the area for up to twenty minutes a few times per day. To further help reduce swelling you can compress it by wrapping an elastic bandage around the area. Wrap it snug, but not so tight that you eliminate blood flow. Elevate the area will also help reduce swelling. Most of the time the RICE method will take care of the problem. When the RICE method proves ineffective then you need to see a doctor for more specialized treatment and possible medication.

Swimmer's Shoulder.

Swimmer's shoulder is a basic inflammation or tendonitis of the rotator cuff muscles. It begins with too much volume and/or intensity while practicing poor swim technique. If you roll your body properly, the catch phase of your stroke will be propelled more by your powerful lats than your rotator cuff, thus reducing stress on the rotator cuff. Muscular imbalance can also contribute to such pain.

The first priority is to reduce the inflammation. Reduce your swim volume, frequency & duration. Ice the shoulder regularly. You may also use ibuprofen or other NSAID's (non steroidal anti-inflammatory drugs) to help reduce the swelling. Always use these according to the directions and only if you are not sensitive to them. Never take before or during a race.

Continued prevention of shoulder problems starts with proper swim technique. Have yourself filmed while swimming and let a skilled swim coach critique your technique. It would be even better if the coach could watch you from the pool deck so that you receive instant feedback. Out of the pool regularly perform exercises to strengthen all the muscles of your rotator cuff. A few simple exercises with elastic cords 2-3 times a week will go a long way to prevent future shoulder problems. Lastly, don't forget to stretch after each swim or strength workout. Strong & limber muscles are less prone to injury.

Runner's Knee

Chondromalacia Patella, aka Runner's Knee, is one of the most common injuries to runners and cyclists. The pain develops from excessive wearing of the cartilage beneath the Patella (kneecap). It may arise in running or cycling from too much volume or too much hill work [or more precisely, improper gearing and thus too low cadence whilst climbing]. Improper squat technique when in the weight room is also known to trigger this pain.

RICE should be the first thing you do to address the problem. Reduce your cycling & running volume. Hilly terrain should be avoided for cycling & running. Also especially avoid downhill running. If you're lifting weights, then you should avoid squats until your body is ready.

Your prevention strategy should begin with a proper bike fit and proper running shoes and/or orthotics. On the bike the number one cause of knee pain is a saddle height that is too low. Also check for excessive wear of your running shoes and orthotics. When the time comes for new shoes go to a specialty running store to try several models. Choose the shoe that gives you the best support for your biomechanics; don't choose your shoe only for its looks. Once returning to the weight room, have a knowledgeable trainer help you with your squatting technique. Don't let your knee bend to less than a 90 degree angle and don't let the knee go forward of your toes. Significantly reduce the weight to insure you learn the new proper technique.

Achilles Tendonitis

Achilles Tendonitis is another classic overuse injury. It will flare up due to too much volume or intensity, too much hill training, or a poor equipment set-up. Worn out or improperly supportive running shoes can contribute, as can improper cleat positioning on your cycling shoes.

Again RICE should be your first step. Also reduce your training volume & intensity. Avoid hilly terrain until the problem is fixed. Physical therapy can also be a good option for recovery. Ultrasound from a physical therapist is very effective in treating Achilles Tendonitis.

Once you're symptoms are cleared, your prevention plan should begin by including regular stretching as well as strengthening exercises. Simple body weight calf raises on a staircase will serve you well to strengthen the tendon & avert future problems. When doing the calf raises perform a slow controlled eccentric (lowering) movement so that your heel is below the ball of your foot, and then raise the heel slow & controlled. Examine your cycling shoes and make sure your pedal cleats are positioned so that the pedal axel is directly below the head of your third metatarsal. A cleat position that is too far forward (too close to the toes) will put excess stress on the calf & Achilles and can cause the tendonitis to flare-up. Check your running shoes for wear and replace accordingly. The maximum you should keep your running shoes should be 300 miles. As you return to normal training carefully monitor your weekly progression of volume; never increase more than 10% per week.

Conclusion

These common injuries are usually quickly solved by the RICE method. If your condition is not improving in 4 days then you need to see a sports medicine specialist such as an orthopedist or physical therapist. Don't make the rookie mistake of thinking that it will 'just go away.' Its much better to 'nip it in the bud' rather than ignore it. Once the injury becomes chronic, your recovery & rehabilitation time become much longer. The sooner you take care of the problem, the quicker you can return to normal training and top race form.

John Phillips is a senior coach with Carmichael Training Systems as well as a Pro Duathlete & Category 1 road cyclist, now focusing on middle and long distance duathlons. To learn more about John and CTS, visit www.trainright.com

Copyright 2004 Carmichael Training Systems, Inc.