Triathlon: Triple Threat for Injuries
By Bruce Wilk, PT, OCS
Training for triathlon is tough—that's part of the challenge—but consider this: Four out of five amateur triathletes are injured while training, and three of those four are injured badly enough to affect their daily activities.
Why such a high injury rate? The complexity of the sport and broad range of knowledge needed to train and compete safely are contributing factors. The triathlete must learn about appropriate equipment specifications, proper body mechanics, and overall training programs that prepare the body for triathlon's unique stresses. Crosstraining for three different events increases the risk of certain overuse injuries, and an untreated injury in one part of the body can lead to problems elsewhere. A knee injury from running can cause extra stress on the back, leading to lower back pain when cycling; and the cumulative effects of swimming and cycling can fatigue calf muscles, making legs more susceptible to injury during a run. The good news is, most nontraumatic injuries are related to training errors that can be corrected.
Prevention: Training Smart
The best way to avoid a nontraumatic injury is a training program that balances strength, flexibility, and endurance through appropriate weightlifting, stretching, and crosstraining. But training techniques are not one-size-fits-all. What works well for one athlete is not always the best advice for another. Understanding the complex interactions between musculoskeletal groups related to swimming, cycling, and running is essential in triathlon training. Only a specialist can evaluate your physical conditioning, analyze your training techniques, and correct errors that can lead to future injuries. Unfortunately, even the best training program can't prevent all injuries. When injuries do occur, there are three things you need to know: 1.) how to evaluate severity; 2.) how to self-treat; and 3.) when to seek professional help.
Evaluating Nontraumatic Injuries
When it comes to deciding whether or not to seek professional help, the type of injury doesn't really matter; what matters is the severity. I use the following scale to evaluate the severity of an injury. Any type of overuse injury can be staged this way:
Stage 1 is pain upon exertion. It starts at any time during a training session and continues as long as you are exercising, but stops when your training session ends. This is the first warning sign of an injury.
Stage 2 is pain at rest, immediately after exertion. The pain is there after your training session, but then it goes away. This is the time to start self-management (described below).
Stage 3 is pain that persists during normal daily activities, like walking to the car or up steps. You may be sitting at your desk and have nagging pain that bothers you. Pay attention; this should be of concern if it doesn't improve in a few days, or worsens.
Stage 4 is pain that you take medication for. This is a very important factor. Medication masks the severity of an injury and allows it to get worse if you keep training. If you are taking any kind of medication for pain, you must cease training until it is out of your system.
Stage 5 is pain that cripples you. It stops you from training, or maybe even walking.
Note that, even if an injury is at Stage 1 pain-wise, if you take any medication for it you're suddenly at stage 4. This includes any pain medication from ibuprofen to a doctor's prescription or injections. If you train on pain medication, it can mask the pain just enough to cripple you.
Self-Management: PRICE
It's worth reviewing the self-management for injuries, PRICE: Protection, Recovery, Ice, Compression, and Elevation (ice, compression, and elevation are used together). Protection: Protect the injury and allow it to recover. Identify and correct the reason for your injury. Recovery: Work actively to regain normal movement, strength, and function of the injured structure. This phase may include massage, rest, or modification of training. Medication can be a part of recovery if your sleep is disturbed, but there must be no training or competition until the medication is out of your system. Ice: Use cold compresses, 360 degrees around the structure whenever possible. Compression: Put toweling around the ice pack and put pressure on the injured structure using Ace bandages or Velcro straps. Elevation: Raise the injured structure above the heart.
When to Seek Professional Help
For the triathlete, occasional pain upon exertion is inevitable. If you're concerned, you should see a professional for evaluation and help correcting the problem, even at stage 1. Seek professional help immediately if you encounter any of the following warning signs:
- If you are taking medication and continuing to train;
- If you are being prescribed (or injected with) medication and being told you are allowed to train;
- If you are consistently having pain at rest, or pain disturbs your sleep;
- If you're having pain that interferes with normal activities such as walking or climbing stairs, and it continues for more than a day a two, is not getting better, or is worsening.
Ideally, professional help means help from an experienced triathlete with licensed medical credentials. Most doctors and physical therapists aren't trained in the specific needs of triathletes. If you are going to a doctor who prescribes medication and s/he tells you it's okay to train or compete, that's not professional help. Medication can never treat the cause of an injury; it only masks the pain and allows the injury to get worse if you continue to train.
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