Most Common Injuries in Triathlons
Triathlon is a unique sport due to its emphasis on endurance in three different areas - swimming, cycling, and running. Due to this variety, great stress is put on the body throughout a race season. And with great stress, comes great responsibility. Or something like that. We cannot totally prevent injuries, but we can set ourselves up so that when injuries do happen, we will be able to recover well and continue to perform at our highest level.
Most triathletes will suffer from an overuse injury.
What is not unique to triathlon is that it still has to respect some main guiding principles that are important in all sports. There has to be a plan. If you fail to plan, you plan to fail. Whether this looks like constructing your own workout schedule, buying something you found online, or having a coach to guide you through the season, there needs to be some form of structure and gradual progression in order to mitigate injuries. In a study conducted on triathletes, the most common cause of injuries was overuse (78%) compared to acute injuries (22%) (Burns JOSPT 2003). And that is why it is so important to adhere to a program that allows the body to build strength and tolerance to longer workouts while not overstraining to the point of injury. Life happens, you step a weird way, your dog knocks you over, you help a friend move a bunch of boxes and furniture. Injuries happen. We can only control so much in our lives. Let’s do our best to control the things we can control and let go of things we can’t.
Running is the discipline most likely to cause injury for triathletes.
In a meta-analysis looking at several studies covering injuries in triathlon, injury rates ranged from 37% up to 91%. The reason for this wide range is likely due to how each study defined or did not define what an “injury” is and how it affected the person’s training. Regardless, a high number of triathletes deal with some type of injury that may just be a soreness they can work through, or those injuries could be severe enough to end their season.
In that study, a large portion of injuries were related to running, with incident rates as low as 58% and as high as 72%. Of the three disciplines, running is certainly the most taxing on the body and arguably the easiest one to start doing due to its low entry barrier. Cycling accounts for about 15% to 20% of injuries, and swimming brings up the rear with an injury rate of about 5% to 10%.
Knowing these numbers, it makes sense that the most affected anatomical sites of injury are various places on the lower extremities, with knees being the most common area. Ankle, foot, thigh, and lower leg are the next most common sites of injury. Cycling is a major risk factor for low back pain due to being in the aero position for extended periods of time. Swimming accounts for most of upper extremity injuries, with shoulders being the primary areas affected due to the large range of motion required in order to propel through the water.
Triathletes that have competed for a longer period of time have a slightly higher risk for injury.
As mentioned earlier, most injuries that occur are related to overuse and not some type of traumatic injury i.e. falling off the bike, rolling an ankle, getting hit in the arm. Age does not appear to be directly correlated with injury prevalence, but the number of years in the sport does seem to have some impact. This could be due to the year over year load that is placed on athletes’ bodies if they do not take adequate time to rest and emphasize recovery during the off season. So if you’re a ten year veteran with several sprint, Olympic, 70.3, or 140.6 races under your belt, kudos to you! You’ve conquered the mental side of this sport, but make sure your body can handle it too. And that doesn’t necessarily mean doing more. Sometimes it means doing less. Or just doing something different.
The greatest risk for injury in triathletes is a history of a previous injury.
Higher preseason running mileage can also be associated with higher risk for an in-season injury. Again, this seems to tell the same story of training at too high a volume during a time that would be better spent allowing the body to recuperate following a big race. One of the most clear predictors of sustaining an overuse injury is having previously been injured. One study found that 50% of the participants they surveyed were already injured during preseason training, and 38% sustained at least one new injury independent of, and in addition to, those injuries experienced during the preseason. There are likely multiple factors at play here. Maybe the previous injury never healed completely or the body adapted in a way that put other body parts at risk for injury.
Triathletes should have a proper warmup routine prior to their workouts or competitions.
There is no consensus on any specific warm up being the “right” one. What has been agreed on though, is that the best warmup is a dynamic one, meaning long gone are the days of doing a calf or hamstring stretch for three sets of thirty seconds as part of your warm up routine. In fact, studies have shown that those types of stretches can actually decrease performance and increase injury if done immediately before a workout. A warm up is meant to do just that - warm you up! This could look like skips, arm circles, squats, leg swings, calf raises, hopping in place, walking lunges, the list goes on and on. This doesn’t have to take very long. A ten to fifteen minute warmup is enough to get you going.
Triathletes should seek out medical professionals if the pain is keeping them from completing their training plan.
So all this begs the question, at what point do I need to get an injury examined by a medical professional? Sometimes injuries just need some time to take care of themselves. Sometimes they need a little more specialized care in order to recover. Every single ache and pain doesn’t require a visit to the doctor. A general rule of thumb is this - if something hurts enough to where it prevents you from finishing a workout or leaves you feeling really sore for the next few days, then that’s a good sign that it may not get better on its own. If someone comes to me describing those things, one of my first pieces of advice would be to take about 2 weeks off from the aggravating activity. Just the aggravating activity. Meaning, if running really hurts your knee, but cycling and swimming feel fine, then stop running and bump up your time spent on the bike and in the pool. You don’t have to shut down everything.
A physical therapist can identify impairments in range of motion, strength, and muscle imbalances so that the discussion can then move towards fixing areas that need attention. Does a joint need to move better? Should a certain muscle group be stronger? There needs to be a holistic approach so that you can treat not just the symptoms but also the underlying issue responsible for your pain and loss of performance. Working with a specialized PT that understands the sport of triathlon is a key component in any injury recovery plan for triathletes.
