Cath Lab Digest

Given the rigors of training regimens for triathlons, these athletes are prone to various injuries, particularly lower extremity injuries. Accordingly, this author discusses key risk factors that contribute to running and cycling injuries, and offers salient pointers on effective treatment.

   It is clear that multi-sport endurance events such as the triathlon are growing in popularity worldwide. In North America alone, USA Triathlon sanctions over 2,500 races annually and boasts of a membership exceeding 110,000 athletes, which reflects a growth of over 100 percent in the past five years.

   Mastery of swimming, cycling and running places high physical, physiological and psychological demands on the triathlete. Whether they are recreational athletes, age class competitors or professionals, triathletes are at a high risk of suffering an injury.

   Researchers have estimated that seven out of every 10 triathletes, during the course of their triathlon career, will suffer from an overuse injury, which requires medical treatment, the modification of training habits and/or an extended period of rest.¹ Studies have shown injury rates ranging from 37 percent among British triathletes during eight weeks of training to 91 percent for ultra-endurance triathletes completing the 1986 Hawaii Ironman Triathlon.^2,3

   Korkia et al., concluded that the foot/ankle, lower leg, knee, thigh and low back were the most common areas of injury for triathletes.² Collins et al., and Cipriani similarly concluded that the lower extremity was the most vulnerable region of the body for injuries.^4,5

   Dominated by the lower extremity, overuse injuries account for up to 78 percent of injuries suffered by triathletes.⁶ During the six months leading up to a competitive season, triathletes suffer an estimated 2.5 injuries per 1,000 training hours. During a typical 10-week competitive season, triathletes suffer 4.6 injuries per 1,000 training hours.⁶ Among the three disciplines for a triathlon, run training appears to be more strongly associated with triathlon overuse injuries.^1,2,3,7

   Athlete comfort and performance have improved with advances in training systems, performance monitors, nutritional guidelines, endurance supplements/fluid replacements, cycling equipment, clothing and shoes. However, the risk of injury remains high.

   Contributing to this problem are the swelling ranks of triathletes, particularly adults who take up the sport in their 30s to 50s. Many of these adults are ex-athletes from other disciplines with hidden and long forgotten musculoskeletal injuries. While training may offer the triathlete the benefits of cross-training, the long and rigorous hours required, coupled with the demands of preparation for multiple disciplines, can place the amateur and professional alike at risk of injury.

What Are The Risk Factors For Overuse Injuries?

   Triathletes may fall victim to one or more frustrating and sometimes devastating injuries that require weeks and sometimes months for recovery. While some of these injuries can be acute, the majority of injuries are classified as overuse injuries impacting the musculoskeletal system. Advising and educating the triathlete and other medical care providers has become key for effective management and care.

   The injuries confronting triathletes are frequently progressive in nature. Overuse injuries initially present as a mild, nagging pain that slowly worsens to the point of requiring rest, medical attention or modification of training.