Running Injuries in Triathlon

author : AMSSM

comments : 2

Three sports medicine Doctors discuss the results of our user injury poll

Earlier this year we asked our members about their injuries for the 2010 season.  Armed with the results, we asked three doctors from the American Medical Society for Sports Medicine to discuss the results so that triathletes can minimize being injured from this sport. 

Question #1

Does is surprise you that over 50% of people that train did receive training-related injuries?

Christopher Aaron Gee MD - Yes it does.  I feel like we see lots of people in the clinic who get injured, but always felt like this was a distortion of what really was out there.  I feel this just goes to show how important it is to educate our patients and communities about how to train appropriately.

Masaru Furukawa M.D. M.S - This does not surprise me at all.  Out of the three components of triathlon, running is the only weight bearing, high impact activity, and the majority of triathlon injuries are running related.  Higher impact forces on joints and tendons leads to higher injury rates.

Benjamin A. Hasan, MD - I am not surprised. Serious athletes train seriously. Overuse injuries come with the territory.  The great majority of these injuries can be addressed successfully.

Question #2

Does it seem appropriate that there are so many running-related injuries? Do you see this in your practice as the predominate injury?

Christopher Aaron Gee MD - Yes, I do see the majority of injuries as being running related.  This is because the repetitive shock absorbed at each foot strike can cause injury itself, and can even wear down and tire out an athlete’s stride to the point where they begin to run incorrectly and introduce injurious running patterns.

Masaru Furukawa M.D. M.S - I would like to first point out that the triathlon athlete group has fewer injuries overall than the pure running group. Running related injures are in fact the most common complaint in my triathlete patients, however management of these injuries is much easier in triathletes as they can maintain their fitness level by focusing on the other two, non weight bearing sports while they recover.

Benjamin A. Hasan, MD - As a runner myself I see a large number of running athletes in my practice. Soccer players, basketball players, track athletes, and long distance runners are commonly injured. Overuse injuries do actually dominate in my practice.

Question #3

What are the main factors that you notice would explain the preponderance of run training injuries? (ex, too much volume too soon, etc.)

Christopher Aaron Gee MD - The top factors that I see are increasing mileage counts too fast for unrealistic goals, or attempting to restart at a previously attained mileage level after an injury or time off.  It takes time to build back up to those levels and often athletes try to push too hard to get back to where they were. 

Masaru Furukawa M.D. M.S  - Injuries are due to the inherent high impact nature and physics of running.  Another common reason for injuries is a sudden increase in training density (volume and intensity).  The most problematic cases are when athletes come into the clinic after running through their injury for several weeks without appropriate home care. These injuries can be prevented by improved athlete education about early detection, using basic injury care such as decreasing training density, icing, appropriate use of over the counter pain and anti-inflammatory medications and home physical therapy exercises.

Benjamin A. Hasan, MD  - The high school and college running seasons are really quite short. Athletes learn to push the pace too quickly from these school experiences. My healthiest long distance runners are the older masters runners who have mastered training year-round over many years. Those that get their rest and participate in cross-training seem to be almost always injury-free.

Those that are pushing the pace and amplifying their training intensity because of a race schedule on the immediate horizon can quickly get into trouble with soft tissue break-down.

Question #4

In your opinion, from a 'balanced body' approach, is run training over-emphasized? After the Olympic triathlon 6.2 mile running distance, does the body really benefit from running longer? Is there a point of diminishing returns for run training distance as far as health? 

Christopher Aaron Gee MD -  I love running, and I feel that done properly, there are enormous health benefits.  However, it is not the end-all be-all of training.  There are many other ways to train and oftentimes running is over emphasized.

Masaru Furukawa M.D. M.S - Depending on the individual training plans the run certainly could be over emphasized by some people.  As long course athletes gradually increase their long runs over several weeks, 6.2 miles is not a distance that is too long.  A more important factor is how many miles a week an athlete is investing to complete an Olympic distance triathlon.  Running injury rates increase with increased weekly mileage, especially greater than 30 miles a week.  Beginner to intermediate triathletes training for the Olympic distance triathlon should not be running more than 30 miles a week.

Benjamin A. Hasan, MD - The body trains itself to use free fatty acids as an energy source by running long. There are diminishing returns if the trauma of too many long runs or runs that are just too long come too often.

Question #5

From the poll, and assuming that most people, at least beginners, probably undertrain for the swim, do you think the swim distance for most triathlons is too short and is essentially 'tokenism'? 

Christopher Aaron Gee MD - In my experience, many people feel they can easily make the swim, but worry more about the run and therefore spend more time run training.  Triathletes need to maintain balance and sometimes the swim length doesn’t reflect the balance that the athletes should shoot for.

Masaru Furukawa M.D. M.S  - Yes, it is true that in most triathlons the swim is proportionally the smallest part of the race. This is true from sprint to iron distance races.  In an iron distance races the swim may be only 10% of the total race time.  Perhaps the swim is too short, but I believe many people would agree that they would rather have the swim be the shortest part of the race. If you are a competitive triathlete, although the swim is proportionally short, it remains a very important aspect of the race where time gaps that determine whether you get on the podium or not can occur.

I do not think people undertrain because it is the shortest part of the race.  Most people are not from a competitive swimming background and of the three sports swimming is usually the most inconvenient sport to train for (requiring membership to a pool, odd pool hours, parking, changing, showering, waiting for lanes, etc).  If you do not come from a swimming background, the mass start swim can be very intimidating and inherently the scariest part of the race.   

Benjamin A. Hasan, MD - I do not believe it is too short. The swim is long enough to be a significant challenge for most participants.

Question #6

From an 'injury reduction' and 'healthy body' point of view, should a triathlon swim be longer and the runs made shorter - especially for the half Iron and Full Ironman distance? 

Christopher Aaron Gee MD - Yes, this would definitely maintain healthy body standards, but also decrease the impact of the over-training injuries we often see. 

Masaru Furukawa M.D. M.S  - From an injury reduction standpoint I think it would be a reasonable recommendation to make the swim longer and the run shorter.  From a practical standpoint there will be many people who would resist these changes for various reasons. One reason there will be resistance from triathletes is tradition; many of the race distances are well established.  One argument that race directors would have is that most deaths, though rare, occur during the swim and increasing the swim length will only increase that risk.  Subjectively, most people who compete in triathlons are not from a swimming background so inherently do not like the swim portion as much as running or cycling.

Benjamin A. Hasan, MD  - Preparing for the half and full iron distances takes a significant toll on the body during training. Shorter races would pose less injury risk, but they would be just that-shorter races. The shorter races are different events. There are different training challenges for each event.

Question #7

Do you believe that swimming greater distances can pay off more in terms of bodyweight reduction, injury prevention and a full upper body workout - since it is almost without impact as compared to running?

Christopher Aaron Gee MD - I feel that done properly, running can have equal benefits with swimming, but all too often it is approached with a cavalier attitude regarding impact induced injury. 

Masaru Furukawa M.D. M.S - I do not think there is a significant pay-off by increasing the swim distances.  Swimming improves overall full body fitness but as in any sport, as you increase the training density you will increase your risk of chronic use injuries.

Benjamin A. Hasan, MD - Swimming is wonderful exercise. The cool temperature of the water has been identified as a reason that weight reduction is achieved less efficiently while swimming compared with other aerobic activities outside of the pool. The body tends to try to conserve heat during cold activities. Thus, losing weight in the pool may not be as simple as in the gym, on the bike, or on the roads.

Low impact is an advantage. Even with aggressive swimming, weight training is needed for full upper body fitness. Even swimming does not challenge all of our muscle groups.

Question #8

What are the top 3 things you would like to make people aware of when ramping up triathlon training to prevent running injuries? 

Christopher Aaron Gee MD - First, start slow- overtraining will not only lead to injury, but often causes burn out.  Second, listen to your body- small aches and pains are often early indications of potential injuries.  Third, invest in your running- good equipment can make the run more enjoyable.  Consider having a running analysis done, it may pay off in avoiding serious injuries.

Masaru Furukawa M.D. M.S
1. If you recognize that you are developing a running related injury, be flexible with your training plan and shift your focus to swimming or cycling.  You will continue to maintain fitness by cycling or swimming only.

2. Cycling is an excellent way to build base fitness.  Consider building up the mileage through cycling before starting your run training.  Building base by cycling helps develop stronger lower extremity muscles, increases general cardiovascular fitness, and supports weight reduction. All of these factors are helpful before starting running where you are more prone to injury.  

3. I do not know how much evidence there is behind this statement, but I find that six weeks of consistent weight training before starting a running program can prevent running associated injuries.  Not only does weight-training strengthen the muscles that act as shock absorbers but it also builds the muscles used for lower extremity stabilization and helps with flexibility. 

Benjamin A. Hasan, MD
1. The "ten percent rule" is really a good, effective, and simple rule in distance training. Limit your increases in distance, speed, surface hardness, and time to no more than 10% per week. This slow rise is certainly frustrating for athletes passionate for success, but the 10% adds up rather quickly.

2. Sleep is needed for tissue recovery. A tired athlete may soon become an injured athlete.

3. It is important to adjust a race schedule in order to deal with injury rehabilitation, not the other way around.

Question #9

Knowing that most of the BeginnerTriathlete.com population are Age-Groupers with a job and family, from a health professional's point of view, what do you think is the 'perfect' triathlon distance with a good tradeoff in health, injury prevention and time management? (sprint, olympic, half iron, full iron)...why?

Christopher Aaron Gee MD
Personally, I prefer the sprint.  I understand the distances are smaller, however, considering the time involved in training at each of the disciplines, the individual gains three times the health benefits of doing just one of them.  In addition, this limits the time demands on busy schedules and avoids burn out from heavy training schedules.

Masaru Furukawa M.D. M.S
Having trained for sprint through iron distances races through medical school and residency, I would say the optimal triathlon distance is the Olympic distance triathlon.  The swim, bike and run are well balanced; the volume of training is enough to have excellent health benefits yet should be small enough to avoid training injuries.  If you choose to train for an Olympic distance triathlon, you can participate in several sprint and Olympic distance races in a season without worrying about the prolong recovery period after distances such as the half iron and iron distance races.  As athletes accumulate experience and training, they are able to complete longer distances with less training.  For this reason, I would recommend targeting the half iron and iron distances races after a few years of triathlon experience at shorter distances.

Benjamin A. Hasan, MD 
This is different for each participant. Training for half marathons, marathons, and half or full iron distances takes serious time on the roads. Not all successful professionals and parents can or should commit huge hours every year. As children grow, professional routines become more stable, and life decisions are made in favor of training, the longer distances can be tackled. Those shorter races are there for all who spend time outside of sports. AND, for those who have the blistering speed to benefit from the shorter distances.

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date: December 22, 2011