Understanding Injury: Knowing when to stop may help make your season a success.

author : jsanko
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Benjamin Franklin said that only two things are certain in life: death and taxes. For those who participate in triathlon there is one more thing to add: injury. At some point in their career, all triathletes will deal with an injury of some type. The vast majority of these will be minor and require only a brief time off from training but for some, injury may be debilitating and may threaten a season or even a career.

In this article I will describe why injuries occur, what is happening on the gross and microscopic levels, and why it is so important to properly rehabilitate an injury prior to returning to activity. Finally, I will describe some successful injury prevention strategies that all new triathletes should be familiar with prior to embarking on a training regimen.

Triathlon injuries are myriad, reflecting the fact that swimming, biking and running can cause various injuries to different parts of the body. Irrespective of this, the pathway to injury and the actual anatomic structures being injured are limited.

Injuries can be grouped into three categories:

Acute injury
An example of an acute injury might be that which is sustained in a fall. Such injuries are unexpected, often difficult to prevent and may range in severity.


Chronic injury

In general, chronic injuries start at a specific time as a subacute problem but then progress and remain unchanged for long periods of time unless treatment is implemented. These are what people often think of as a nagging injury, an example of which is tendonitis.


Overuse injuries
These injuries do not begin at a specific time. Rather, they develop slowly and wax and wane in severity depending on the level of activity that the athlete maintains. Overuse injuries are common amongst triathletes and include patello-femoral syndrome, iliotibial band friction syndrome, shin splints and rotator cuff tears.

Although injuries may occur anywhere in the body, they affect the same types of tissues:

Bones
Bones may be bruised or broken (fractured). Fractures may be microscopic and involve no gross deformity, as in stress fractures, or they can be dramatic, such as in an acute fall with a resultant broken wrist.


Tendons
Tendons are the dense highly elastic structures that attach muscle to bone. All muscle activity is translated through the tendons to the bones in order to generate movement. Tendons may become inflamed, as in biceps tendonitis, or they may rupture, like is seen in Achilles tendon rupture.


Muscles
Muscles become sore with overuse but when truly injured, muscle fibers tear. Triathletes commonly tear muscles of the shoulders or legs. These tears may be small and incomplete or at the worst may involve the complete muscle. Muscles can also be bruised when struck forcefully.


Ligaments
These dense bands anchor adjacent bones and are only injured with enormous force. The ligaments of the ankles and knees are those most commonly injured by triathletes. When a ligament is partially or completely torn the injury is referred to as a sprain. Thus an ankle sprain involves a partial or complete tear of a ligament in that joint.


Cartilage
A soft tissue that lines the surface of bones in all joints, cartilage serves as both a lubricating surface and as a cushion. Cartilage may be acutely injured or can become chronically degraded. The most common site for a cartilage injury in triathletes is in the knee.

Acute injuries usually occur as a result of a violent force that damages a tissue immediately. For example, when a triathlete falls off of their bike, bones may be broken or bruised, ligaments may be sprained or torn and muscles may be bruised.

Chronic and overuse injuries are much more insidious. Having a basic understanding of what is going on at the microscopic level and how that translates to signs and symptoms may allow for improved prevention of the progression of these injuries.

All chronic and overuse injuries begin with micro-trauma to the involved tissue. Tiny tears develop that are insufficient to cause disability but enough to cause pain. At first the pain usually comes on after activity has ceased and may be short lived. However it returns shortly after beginning activity again. The tiny tears destabilize the structure locally and so further strain causes progressively more damage. Eventually, pain becomes constant.

At the cellular level a complex cascade of chemical signals is initiated whose cumulative result is termed inflammation. The inflammatory process involves the development of permeability in local blood vessels in the area of the injury. This results in the leakage of fluids and cells from the bloodstream that are needed for repairing the damage. Macroscopically, local swelling, warmth and redness are all seen. Given time and rest, most of these injuries will heal spontaneously. However, if activity is continued, the damage will progress and inflammation will worsen. Eventually, the inflammatory component begins to further exacerbate the problem rather than help repair it and the injury will progress to become more and more serious.

Understanding this process explains some of the basic tenets of injury treatment. Ice applied over an injured area reduces blood flow locally and will cause tissue swelling to improve. Anti-inflammatory medications contain the cascade of cellular signals to allow for healing without the damage that may ensue if inflammation is allowed to progress unchecked. Elevation of an injured body part makes use of gravity to drain local tissue fluid and reduce swelling. Rest and immobilization allow for healing and interrupt the cycle of injury, inflammation and re-injury.

One of the most common concerns of triathletes at the beginning of their careers is whether to cease training after sustaining an injury. Many fear that doing so places their newfound activity in jeopardy because of the misconception that the results of missing a few days of training are far worse than simply soldiering on through the pain. With a basic understanding of the principles of injury it can clearly be seen that this course of action is not in the best interest of the athlete. While it is true that detraining may occur after a prolonged period of inactivity, this is fairly short-lived and rapidly reversed once training begins anew. However, if training continues unabated after an injury, the damaging process continues to progress and may eventually result in a more serious problem. Consequently, a longer amount of time for recovery is required than would have been needed had the time for healing been taken originally. A good rule to abide by is this: if it hurts, stop the activity. Engaging in alternative training activities that do not cause pain is generally acceptable and certainly preferable. However, each injury needs to be considered individually and this should not be taken as a hard and fast rule.

Because injuries are so common and have the potential to derail even the best-laid training plans, much effort should be dedicated to injury prevention. At this time of year, when races are still months away, the emphasis of training should incorporate some important elements aimed at reducing the likelihood of injury later on when volume and intensity increase. Here are some of the things that can be done now to help ensure a lower likelihood of injury later:

Take the time to heal completely.
Athletes who finished the season with chronic or new injuries should recognize that a period of rest is critical to allow for healing prior to the resumption of training for the next season. It is completely appropriate to drastically reduce or even completely cease training in order to allow for these problems to be properly treated and permit healing. In this way the athlete may be able to return healthier and stronger than they would if they tried to somehow tough it out and train through the pain. Furthermore, the likelihood of having that chronic nagging pain evolve into something much more serious is also reduced.

Emphasize strength training.

Weight training increases muscle size and strength. By putting in time in the weight room now, triathletes may give themselves a better chance of staying out of the clinic later. Stronger muscles better resist the constant stress placed on them during long hours of swimming, riding and running. They also confer more stability to joints reducing the chance of acute injuries such as sprains.

Get the right equipment.
Almost all overuse and chronic injuries can be linked to problems with equipment. An improperly fitted bike can contribute to back and leg injuries while poorly supportive running shoes are associated with shin splints, iliotibial band friction syndrome and knee pain. The off-season is the time to get fitted either to your existing bike or to buy a new one. Have your gait analyzed and purchase the proper running shoes for you. Then, get a new pair every four to six months or three hundred miles. The investment will pay back in less pain and more training later on.

Build your training volume slowly.
Aside from equipment issues, another common cause of chronic and overuse injuries is too much too soon. Take your time building up to your maximum training volume and intensity and make use of a coach or pre-designed training program to ensure you don’t push the pace too hard too soon.

Above all else, listen to your body.
The concept of no pain, no gain is a poor one. Pain is our bodies’ way of telling us that something is wrong. Should you develop pain while training, pay attention to it. Is it persistent or does it go away? Is it reproducible with the same motion or activity or does it come on randomly? Make note of the characteristics of the pain and if it persists seek the opinion of a health professional before it progresses. Most injuries do not require a complete cessation of activity if caught early, so pay attention to what your body tells you and heed its advice!

While injury is almost unavoidable as training progresses, triathletes can take important steps to minimize the likelihood of their occurrence. Furthermore, reducing the negative effects of injury when it does occur is of utmost importance and can be abetted by many of the strategies covered in this article.

Train hard, train healthy.

Next month: Proper nutrition for health in training and racing.

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date: January 1, 2006

Author


jsanko

Began triathlon in 2001 and have now completed two IMs, (Canada, 2004 & Coeur d'Alene 2005) as well as many halfs and even more olys and sprints.
Written for first Inside Triathlon and now Triathlete Magazine since 2003. Mostly a web based column called 'Ask the Tri Doc' but also now have two print articles as well.
Member of the Canadian Alpine Ski Team Medical Group 2001-2003

Author

avatarjsanko

Began triathlon in 2001 and have now completed two IMs, (Canada, 2004 & Coeur d'Alene 2005) as well as many halfs and even more olys and sprints.
Written for first Inside Triathlon and now Triathlete Magazine since 2003. Mostly a web based column called 'Ask the Tri Doc' but also now have two print articles as well.
Member of the Canadian Alpine Ski Team Medical Group 2001-2003

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