A triathlon incorporates three of the most popular sports disciplines – swimming, running and cycling – increasing the probability of triathletes developing overuse injuries that are commonly associated with the three sports.
There is also great variation in the distances covered in triathlon events with some races such as the ‘Ironman’ endurance event lasting for as long as 10 hours, placing significant stress on the lower limbs for an extensive period of time.
The lower extremity accounts for the most number of injuries sustained by triathletes with the knee, ankle/foot and lower back reported to be common sites of injury; the majority of these injuries are attributed to running, followed by cycling and lastly, swimming.
Considering the multidisciplinary nature of a triathlon, the aetiology of injuries incurred during the sport may also be multifactorial, requiring an extensive understanding of the risk factors that can increase the predisposition of a triathlete to lower limb injury.
The risk factors can be broadly categorised as being either intrinsic i.e. factors inherent to the athlete or extrinsic i.e. factors that are independent of the athlete; an athlete’s number of years of experience in triathlons must also be reviewed as this can increase the risk of preseason injury.
Sergio Miglorini, from the I.T.U Medical Committee Chair, outlines some of the internal factors as excessive pronation, hypermobile joints, asymmetrical lower legs, a cavus foot and varus or valgus knees.
As stated by the author in his review, “the change from concentric muscular contractions to eccentric ones, and from the unloaded cycling phase to the loaded state of running is an extremely delicate phase for the triathlon”.
This increases the triathlete’s susceptibility to low back pain or knee pain during the first kilometres of running, just after the transition from cycling to running, and so, the initial cause of the lower back pain can be found in the cycling phase.
Pre-existing injuries increase the possibility of a recurrence because of weakness in the surrounding bone or soft tissue which can consequently predispose the triathlete to a new injury; this was supported by Burns et al. in their study on factors associated with triathlon-related overuse injuries.
The authors also list inadequate warming up and cooling down as placing the triathlete at a greater risk of preseason overuse injury as warming up helps to increase joint range of motion and decreases stiffness of connective tissue which results in greater force and length of stretch to avoid musculoskeletal damage.
Cooling down, on the other hand, reduces muscle soreness and stiffness that can also produce injury during subsequent training sessions.
Apart from employing proper training techniques, biomechanical discrepancies in the athlete also need to be addressed to reduce their predisposition to overuse injuries.
This would involve a thorough gait analysis to spot any postural abnormalities that can help the clinician gain as much information about the pathology as possible and to recommend suitable treatment measures that can help in minimising loss of training time and performance.
The mechanical ‘leaf spring’ effect of the full-contact MASS4D® orthotic under the arch of the foot, applies the greatest corrective force to the plantar surface, facilitating healthy supination balanced with functional pronation; this enhances an even distribution of soft tissues, boosting proprioception capabilities and optimising joint alignment.
This is the reason for the success of MASS4D® foot orthotics in active rehabilitation programmes and for treating lower extremity biomechanical faults so the athlete is protected from the onset of a number of lower limb conditions that could potentially affect performance.
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