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Injury avoidance for athletes
The focus of this section is to provide you with knowledge to prevent injury and to reduce the consequences of injury. Injury in triathletes is common (about 30-40% per year) and strangely enough, your risk of injury actually increases with experience. This is probably because experienced athletes are more likely to be pushing the performance envelope!
Knee pain
Persistent pain and especially swelling when or after running always indicates a need for medical attention. If you have an internal knee injury, continuing to run may let the injured part further injure or destroy the remaining normal interior cartilage structures in your knee leading to early arthritis and the end of your running career.
Bike fit ( or misfit )
There is a small core of science looking at the interaction of the rider and bike that has been published in the last 30 years. One fact is that as the bike racing community transitioned from toe clips and straps to clipless pedal-shoe combinations, we began to see more hip and knee problems. This was simply because the fixation of the foot to the pedal sometimes does not allow the knee to move in the directions that it needs to during the pedal stroke. This additional stress may also be transmitted to the hip.
For instance, if you wear the outside edge of your running shoe toward the mid and forefoot, then your foot wants to be tilted slightly outward with your little toe toward the ground or everted. On the bike, it is then quite likely that fixing your foot flat will generate unnatural forces in your knees and or hips which may eventually produce pain and injury. The solution is to place a wedge, actually quite a thin one usually, with the thicker side towards your big toe, between your cleat and bike shoe.
Another common problem occurs if you are bow legged. That is when you stand with your feet together, your ankles touch before your knees do. The name for this is varus at the knee. If you have knee varus, then your foot may want to rotate during the pedal stroke. Some pedals strictly limit foot rotation during the pedal stroke, thereby generating potentially damaging forces in the knee and hip during cycling. The solution is often a pedal with more rotational freedom.
If you have plantar fasciitis, then moving the cleat toward your heel will reduce the stress in the sole of your foot during your pedal stroke. The same thing applies to the tension in your Achilles tendon. This may be important if you have injured your Achilles, have Achilles tendonitis, or are having heel pain.
Have you had a previous medial meniscus injury (torn the cartilage) in your knee or do you have arthritis on the medial ( inside ) side of your knee? Well, you may need to add pedal extensions to reduce the compressive forces on the inside of your knee to help preserve the remaining cartilage.
All the above illustrates that expert service in the area of bike fit that takes details of your anatomy and past injury history into account can reduce the health risks of cycling, and if you are more comfortable, then you will almost always be faster!
Periodization of training.
Tudor Bompa, as an Eastern European coach before the fall of the Iron Curtain, developed and promoted the concept of periodization in exercise training programs. This development was a major factor in the success of Eastern European and USSR athletes during the late 1970s and 1980s. His work was published in English in 1983.
There is simply no question that in endurance athletics, age appropriate periodization of training, when coupled with appropriate nutrition and hydration commonly results in substantial improvements in performance. As one ages, the initial principles and practice developed by Dr Bompa need to be modified progressively to allow the mature athlete the complete training progressions in microcycles without injury. We have spent the last 6 years refining elements of the age related changes required to modify Dr Bompa's ideas. By way of example, commonly periodization involves one month cycles with three weeks of progressive exercise stress, followed by one week of reduced exercise at about 50% of peak week hours. Most, if not all 55-59 yr old athletes simply cannot complete a series of three week progressive stress periods that approach their limits.
Recovery from injury.
Injury recovery time is related to the type of tissue injured, age, site of injury, nutrition, and genetics in approximately that order. Whereas a broken collarbone in a 27 yr old cyclist may heal with surgical repair in 3-4 weeks, the same process in a 65 yr athlete may take 6 weeks or more. Non-operative of that injury will approximately double the healing time. Healing of certain types of injury, such as a broken bone requires immobility of the injury site, whereas other injuries such as a muscle strain with an associated hematoma in the muscle benefit from progressive therapy. Early icing to reduce bleeding and swelling, then progresses to motion to maintain muscle length and recover mobility. Physical therapy modalities including massage and mobilization can improve the rate of restoration of function. Continued use of some injured parts may encourage progression of the acute problem to a chronic one that is much more difficult to resolve. In the worst case, running or "pushing" through an injury may turn a simple problem into one requiring a surgical solution.
Professional expert evaluation of athletic injuries is essential to prevent mis-diagnosis and further injury. Early recovery may require medical help. Unfortunately the arrival of managed care on the health care scene often means that rehabilitation is curtained to the point that your insured rehab stops before you are able to return to your former activity level.
Power to weight ratio.
There is simply no question that in running and cycling, especially in the hills, that your power to weight ratio is strongly related to your speed. As you become heavier, more energy and oxygen consumption is needed to achieve any given speed. More work must be done against gravity to climb a hill. The unspoken element here is that being overweight or at the upper end of your weight range dramatically increases your risk of injury. If you consider that the impact force at footfall while running may be more that 4 times your weight for a heel strike runner, you can understand our recommendation that little running should be done by the nascent athlete more than 30 lbs overweight. Power to weight ratio can by reduced on the bicycle by getting a lighter bicycle, but that is very expensive at about $25+ per ounce once you get below about 18 lbs. Appropriate weight loss is much cheaper and reduces your risk of injury substantially.
Weight loss is only beneficial when carried out properly, and excessive weight loss eventually leads to very significant health problems with loss of muscle and bone mass, resultant osteoporosis, and loss of power and speed. A balanced diet is essential, and weight loss is best achieved during your off season or base training.
How to avoid foot and knee injury?
It takes years of training to toughen your ligaments and tendons to do hard intervals without significant risk of injury. Avoid hard interval training until you have been training for at least two years unless you have an extensive, recent athletic background. Always warm up/down when doing intervals. Please see also the comments about running shoe longevity. Analysis of your running gait by an expert with the aid of a treadmill can identify subtle gait, footfall, and leg motion issues that, when corrected, will reduce the risk of injury.
Hydration and race nutrition.
You can use an accurate home electronic scale to determine your fluid balance before and after longer workouts. Weigh just before starting in the buff. Weigh the same way after undressing on the way to the shower as soon as possible after your workout. Sweat weighs about two pounds per quart. A weight loss of ½ pound may be due to other variables, but if it's more than that, then you didn't consume enough salt containing fluids during your workout. ( Note that for workouts longer than 2 hrs, the allowable wt loss increases about 1/4 lb per hour...e.g. in a 4 hour workout , you can lose up to 1 lb )If you want to improve your performance, then for the conditions and energy output of the workout you just finished, your fluid intake must increase. For instance, if you lost 2 pounds, then you should take in at least an additional one to two 20 oz water bottles of salt containing fluid next time. That fluid should be an electrolyte drink, not water. As little as 1-2% dehydration can make the difference between winning and losing. Dehydration also increases your risks of heat related injury in hot weather.
Racing and training in hot weather.
Folks sweat various amounts of salt. Testing is possible, but impractical. So, some of us will need to add common table salt to our drink of choice or use salt tablets to supplement our salt intake. The amount of salt you need will in general rise with the temperature. We add 1/8 tsp per bottle in moderate temperatures and ¼ - ½ tsp as the temp passes 80° F. Experiment with this during training to figure out what to use when racing. Very high salt sweaters may need even more salt. You must train yourself to tolerate elevated temperatures carefully. You should read up on the signs and symptoms of heat related injury to avoid becoming an emergency room statistic. Certainly, when training/racing in hot weather, you should stop and seek help if you stop sweating, feel chilled, or get at all dizzy or faint. Also, wear light colored clothes and a light colored hat. Wetting your hat and clothing will help, but avoid enough water to make your shoes wet and soggy as that is a recipe for blisters.
Should I drink water or something else when I train and race?
First of all, we were correct when in the 1970s we established as principle that as you become progressively dehydrated, your performance significantly deteriorates. As little as 1-2% dehydration can make the difference between winning and losing. Second, by encouraging athletes to drink fluids, particularly water as much as possible, we actually contributed to the problem. I guess the law of unintended consequences applies here as well. Athletes in endurance events forcing hydration with water alone then became subject to developing symptomatic hyponatremia or water overload.
Beginning about 7 years ago race medical directors began to look at strategies to reduce the incidence of symptomatic hyponatremia. The first real publicized success came as Ironman New Zealand where by limiting competitors access to water at aide stations and only offering electrolyte containing drinks, a dramatic reduction in admits to the medical tent was achieved from one year to the next... So now those of us in sports medicine are faced with re-educating athletes. In general, drink water only about every third or forth aid station at most, and otherwise drink an electrolyte solution which is best matched to the salt content of your sweat. Water is much more useful to cool your body during hot weather racing and training.
Running & Running shoes – dos and don’ts.
Common injuries from too much of an increase in running volume/speed and inadequate rest include plantar fasciitis, shin splints, compartment syndromes, stress fractures, torn achilles or plantaris tendons. Your shoes are a part of that equation.
Running shoes lose most of their shock absorbing ability after about 90 days use or 200-300 mi. Label each pair with a magic marker when you buy them( the edge of the midsole is a good place ). ONLY Run with your running shoes, Don't wear them to play, go to the mall or movies. If you run a lot ( more than 20 mi/week ) get two pair and alternate them, they'll protect your knees and feet a lot longer. When your running shoes reach their limit, make them into play shoes, but stop running in them. Buy the best shock absorbing insoles you can afford, and lose the stock insoles.
So you have a cartilage injury in your knee.
CContributing factors to running injury include age of the athlete, weight, total mileage on the athlete, gait, running surface, specific muscle/tendon imbalances, prior knee injury/operations, shoes, and genetics. You can strengthen your leg muscles and cardiovascular system much faster than your bones and tendons, so rapid progression of training increases your injury risk, especially when the increase in yearly training hours exceeds 10% in a beginner or 5% in a veteran athlete.
Prior knee meniscectomy dramatically increases the risks of early arthritis and cartilage damage associated with running activity, so you need the knowledge necessary to prolong the remaining life in your knee. Impact forces can be up to 4 times your weight. changing from a heel strike to a mid-forefoot strike stride can dramatically reduce impact forces by way of example. Another example is detecting knee instability due to a weak vastus medialis, that untreated would lead to rapidly progressive arthritis and a rather short running career.
Racing tips.
Appropriately periodized training, coupled with a well timed taper should leave you feeling anxious to race by the day before race day. Other essentials include an off-season to let you recover from racing season, and good nutrition and hydration. Important points include the following items:
- Use a formal printed race checklist. Forgetting essential items is a stressful experience you won't forget, and a rather expensive error if you can't race.
- NEVER make a change in your bike setup, shoes, race nutrition, or hydration fluids just before a race. These important things deserve to be tried during your harder workouts before you use them in a race.
- Remember that the sequence of events during a race don't always go the way you had planned. You can only control yourself, and how you react to events and people around you. Changes in weather for better or worse; flat tires; loss of your special needs bag at 60 mi into an Ironman bike leg, bad water conditions beyond your capabilities are all reasons to change your racing plans on the spot to accommodate the reality of the moment.
- Rehearse and visualize - Drive the bike course at least once. Consider riding any technically challenging portions of the bike course. Walk through and review transition entry and departure both for T1 and T2. Review the water exit. What are the landmarks? Carefully review the run course, especially if you will be near the front of the pack.
- BE PRESENT. Paula Newby Fraser by her own admission once lost Ironman Hawaii because she was so sure she had won, she began planning her dress for the awards dinner and stopped listening to her body and abandoned her nutrition/hydration needs late in the marathon. So listen to your body carefully. Once the race is longer than a sprint, it is often the determined smarter competitor that wins, not the faster one.
- The only old experienced folks in triathlon race smart if they are successful. We personally have been on the podium in over 80 races by racing hard and smart, beating others that by the numbers should have won by a mile.
- Match your expectations about the race to reality. Unrealistic expectations almost surely will just serve to leave you with a bad taste in your mouth. Incomplete, preparation will cost you in progressively worse ways as the race course lengthens. Among those of us with a decade or more experience, one saying is that you can get by slacking the prep for an Olympic distance or shorter race, but will pay a progressively higher price as the race gets longer.
- You would rather be 5-10% undertrained than 1% overtrained.
- Consider getting a coach at least for a year or two. Also couple this with educating your self about modern training concepts.
How to go faster on the bike?
Bike speed ultimately is determined by air resistance, which when balanced against your maximum sustainable power output will determine your speed. Thus, aero bars when used properly can make a real difference. Your air resistance is so much greater though when you sit, that your aero bar set-up needs adjustment if you cannot remain in them 95% of every hour, except on significant hills. Next in importance is an aero helmet and good aero wheels.
Most cyclists that utilize a lower cadence will show speed improvement by increasing their cadence to the 90-100 range. If you only practice at slow speeds, you may develop a good aerobic base, but probably never will be truly fast on the bicycle. After your first year of training, at least 5% of your training should be at or above your aerobic limit.
Remember the adage that cycling improves your running, but not necessarily vice versa. So an increase in cycling hours, especially during base period training is an important element of increased racing speed. Also, if you are over 40, you need to lift cycling specific weights, especially in the off-season.
Open water swimming and wetsuits.
There are wetsuits made specifically for open water swimming, they are quite different from wetsuits made for scuba diving. The two types of suits are similar in being designed to protect the wearer from hypothermia. The primary difference is that swimming wetsuits are dramatically more flexible than their diving cousins.
These suits have thin, very flexible neoprene around the knees, elbows, and shoulders. Wetsuits offer substantial protection against hypothermia as water temperatures approach and fall below 72°. Also you should wear a wetsuit when it is allowed as they make you 5-7% faster through the water. Above 80°, wetsuits actually impose a risk of hyperthermia and should not be used except when required by race directors for safety reasons in rough water.
Race checklist.
Making a laminated checklist of everything you may need at a race and checking it twice as you pack and load your car is the best way not to arrive at the race site without running shoes or suntan lotion. Things to list include bug dope( some sites have mosquitoes and horseflies ), dry clothes to put on after the race, money, your USAT card, race entry info, driver's license, insurance card, emergency contact info, spare contacts, or glasses if needed, and etc.
Weight lifting for the older athlete.
After the age of 40, everyone loses muscle mass without resistance activity/training. So regular resistance activity for all muscle groups is a necessity. Strength training and stretching should be focused on weaknesses, core strength and flexibility.
Lack of hip flexibility - tightness in both flexors and extensors coupled with core weakness is a major contributor to back pain, difficulty being effective on the bike in the aero position, poor climbing, poor sprinting performance on the bike, and multiple knee problems. Weight lifting then also must include stretching to maintain flexibility. There is a large body of mis-interpreted evidence, and some poorly done studies that have led many "so called" experts to advise against stretching at all. Almost all physical therapists stretch personally and use stretching as an essential part of therapy to treat patients on a regular basis.
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