Three Common Triathlon Related Injuries

Here’s a review of three common injuries in triathletes and a brief review of what to do if you experience one of these injuries: Runner’s Knee, Achilles Tendonitis and Swimmers Shoulder.

By Christian Millward MD
Member AMSSM

 

It has been a little over a month and if you are reading this hopefully you are “staying strong” with your New Year’s resolution to compete in a triathlon or improve on previous performances. Now it’s a matter of staying healthy and continuing to train properly. With that in mind the last thing you need is an injury to delay or end your training prematurely. Here’s a review of three common injuries in triathletes and a brief review of what to do if you experience one of these injuries.

Runner’s Knee (Chondromalacia Patella)
This is one of the most common injuries that occurs among runners, however it is also very common in cyclists. Normally the patella (kneecap) glides smoothly over the femur. The undersurface of the patella is covered in cartilage.

 

With runner’s knee, excessive force causes that cartilage to become roughened or softened. Thus instead of the patella gliding smoothly it rubs roughly over the femur causing pain. It is commonly caused by increased volume or too much hill work. Many times weakness of the medial quadriceps muscle is responsible.

Treatment can be very broad and the roughened kneecap may smooth out over time if offending activities are stopped. Many will respond to simple RICE (Rest, Ice, compression, Elevation) therapy and avoiding hill climbs in both running and cycling. Cyclists may try riding higher in the saddle or stand more when climbing and avoid long cranks. Strength training is used primarily to prevent injury and should be limited when injured.

Achilles Tendonitis
This is a classic overuse injury with symptoms often coming after an increase in volume, intensity, too much hill training, or poor equipment set-up. Pain is usually located in the posterior calf and may be more localized to its insertion point on the heel.
 
Worn out/improper fitting shoes or poor cleat positioning are common causes. Often it results from a new shoe or cleat, especially when leg extension is increased. Other conditions that may contribute to Achilles problems are; bike cleat positioned too far forward, soft/flexible shoes and cold/wet weather riding which gets the back of socks cold and wet.
 
Like most overuse injuries RICE therapy with training volume and intensity reduction are helpful in relieving symptoms. Avoid hilly terrain but you may continue to ride if pain free. Lowering the seat by a few millimeters may help to reduce stretch on the calf. A heel pad or lift may help if symptoms are from new shoes with a lower heel.

INJURED? Find a Sports Medicine Doctor! Just go to the American Medical Society for Sport Medicine at: www.AMSSM.org and click on 'Find-A-Doc'

Swimmers Shoulder
Although most injuries occur due to the run and bike with less impact swimming being used for rehab, swimming itself can lead to injury. Swimming, especially freestyle, causes the shoulder to undergo repetitive overhead motion which may compromise microvasculature in the rotator cuff. This repeated microtrauma can result in the development of an inflammatory response and ultimately pain. This may even progress to symptoms of impingement in the rotator cuff. It often begins due to volume and/or intensity overload while practicing poor technique. Symptoms usually are reported as pain at the shoulder during the late recovery phase and early catch phase of your stroke.

Treatment, aside from RICE therapy, includes a reduction in mileage, the use of non-steroidal anti-inflammatory drugs (NSAID), physical therapy/rehab and correcting any error in your technique to prevent future injury.

As mentioned above the treatment for these and many overuse injuries is RICE therapy. This stands for Rest, Ice, Compression, and Elevation. Although not all of the components are necessarily used in every injury it is a good pneumonic to try and remember. NSAIDS such as ibuprofen can also play a key role in healing by reducing the inflammation at the injury site. As with any injury if symptoms continue for more than 4-5 days or worsen in any way see a sports medicine physician for treatment and recommendations. If you wait for it to just “go away” you may end up developing a more chronic condition that could hamper your training and season goals.

Remember that once symptoms of injury have cleared, future prevention should begin by including regular stretching as well as strengthening exercises. Be sure to get proper fitting equipment and coaching or instructions if needed. Good Luck!

Christian Millward MD
Member AMSSM
Utah Valley Sports Medicine, Provo, Utah