*Please not this is not medical advice and you should see a registered medical practitioner for full assessment of your injury
What is an overuse injury?
Triathlon is the sport we all know and love, but managing three different disciplines can often cause overuse injuries, with over 50% of triathletes experiencing some form of injury in a season with 75% of them being due to overuse, most prevalent in the lower body (Ankle, knee, hip) and often associated with running (Mchardy et al., 2006; Bertola et al., 2014).
But could you just be sore? Well this is common amongst triathletes juggling high workloads. A good indicator to differentiate fatigue from an injury is that soreness usually dissipated in 72 hours post session, known as delayed onset muscle soreness (DOMS). Pain usually lingers >3 days and is localized to a specific area or joint and is accompanied with an onset of pain.
Could you prevent overuse injuries?
Well, yes and no. Injuries can occur at any point in the season, due to a number of imbalances or in proper form. Think of it like threshold sessions, they become easier as you progressively overload your body causing a super compensation effect or fitness, then new zones are tested and you restart the cycle. Tendons and ligaments follow the same protocol, as you begin to train them under load or increased time under tension, their capacity or ‘ceiling’ becomes higher and therefore their ability to deal with the repeated movements of swim, bike, run becomes higher.
Strength Training - Current research has suggested that Strength training can reduce your injury risk by 66% as stronger athletes can tolerate high workloads (Lauersen et al., 2018). Common tests we use include - Overhead squat test, single leg balance, shoulder mobility test, push ups, pull-ups, Lateral stability bunkie & Posterior stability bunkie.
What kind of exercises should I be doing? - Movement and strength testing is your first step. The most common movement patterns that should be trained weekly are: Squat, Hinge, Push, Pull, Step and Lunge with core exercises trained through flexion, rotation, anti-extension and anti lateral flexion.
Do I have to go to a Gym? - How you train these is up to you and your coach, that can be through weights, plyometrics (see previous blog), static holds all of which can be done in or outside of the gym.
Do I need to change my weekly routine? - Its important to have a plan and outline of your sessions and week. By knowing this or communicating with your coach you’re able to mange your weekly load and reduce the likelihood of overuse injury.
How to I progress my Strength rehab? - When considering your progressions of your exercises, your coach and physiotherapist will often follow a multistage process to progressing exercises such as:
- Isometric (i.e static movements) loading of the tendon or ligament.
- Eccentric loading to lengthen and re-introduce force absorption.
- Concentric > Eccentric movements.
- Heavy Loading of movements
- Plyometics / Speed work
Treatment Plan
Step 1- Seek medical assessment for diagnoses of the injury, to be discussed with your coach.
Step 2 - Work around your injury, whilst continuing the rehab exercises we don't want to give up and sit of the sofa. Come up with a plan with your coach on exercises you can do to maintain your fitness, whilst strengthening the muscles around your injury.
Step 3- Have an exit criteria before re-introducing the painful movements, e.g, passing the physiotherapy assessment or retesting previous movement patterns compared to your ‘un-injuried self’
Step 4 - Re-introducing your painful movement slowly e.g, run / walk (see previous blog) or following the 10% rule.
Final thoughts?
Top Tips:
- Get medical advice for what is the root cause of the injury.
- Don’t just stop, work around your injury but don't do more of the movement that causes pain.
- Maintain your cardiovascular fitness other ways, so when you come back to increasing you volume your ceiling won’t be too far lowered.
- DELOAD > RELOAD slowly
- Tendons and ligament respond to load, time under tension and eccentric loading.
- Have a plan and exit criteria to get you back to what you love... Triathlon.
Coach Sam, Optimal Endurance.
References
- Lauersen JB, Andersen TE, Andersen LB. Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. British Journal of Sports Medicine 2018;52:1557-1563.
- Mchardy, Andrew & Pollard, Henry & Fernandez, Matt. (2006). Triathlon Injuries: A review of the literature and discussion of potential injury mechanisms. Clinical Chiropractic. 9. 10.1016/j.clch.2006.04.001.
- Bertola IP, Sartori RP, Corrêa DG, Zotz TG, Gomes AR. Profile of injures prevalence in athletes who participated in SESC Triathlon Caiobá-2011. Acta Ortop Bras. 2014;22(4):191-6.