Damage Limitation Exercise

When your chosen sport involves three disciplines the range of possible injuries is impressive, but you can take steps to limit or, with luck, avoid them


Posted: 23 November 2009
by Nick Grantham

Triathlon has certainly come a long way since its low-key beginning in the 1970s. It has evolved from a daunting activity that was seen as the preserve of the elite and super-fit into a sport that welcomes all levels of competition. The variety of race formats and the inherent attraction of three disciplines have helped triathlon become a hugely popular sport, attracting people of all ages and fitness levels. It's still one of the fastest-growing sports in the UK.

Increased participation has of course led to an increase in the number of triathletes picking up injuries. The problems that most often trouble triathletes can be broadly described as 'overuse' injuries. But triathlon does not necessarily have to result in recurring injuries. Many of the problems that can stop your training in its tracks can be controlled or even prevented, if you take action early. 

It helps to have some knowledge of the injuries common to each discipline, how and how easily they occur and the effect they can have on performance. Prevention is, of course, better than cure - there are simple exercises you can do that may help prevent these injuries from developing in the first place, or assist your recovery if they are already present.

The nature of triathlon means that you are likely to suffer an injury at some point and each discipline can present specific injury problems. Many of the injuries picked up while training for one discipline can often have a knock-on effect in another area and if you develop a problem you can use the exercises overleaf to help you recover and return to training. Even better, a well-balanced training programme that includes some or all of these exercises will go a long way to preventing many common overuse injuries.

Swim

Researchers have found that swimming is the least likely of the three triathlon disciplines to cause injury. That isn't to say that it is without its problems, especially for newcomers. Swimming is a technical sport that tends to cause more problems for novices than running or cycling. The back and shoulders are the areas that come in for the most punishment. 

Swimmer's shoulder

Poor technique, unilateral breathing and the repetitive overhead action of the freestyle stroke can bring on what is commonly called swimmer's shoulder. This is a complex condition and while debate continues as to exactly why the injury develops, it's clear that maintaining a stable scapula (shoulder blade) is a vital component in the prevention and rehabilitation of this injury. 

To ensure a stable scapula you need to develop strength mainly in two muscles, the supraspinatus, a small shoulder muscle that is part of the rotator cuff, and the serratus anterior (or boxer's muscle), which can be seen on the upper ribs on the side of the chest. When these muscles become fatigued, faults in your technique set in. You can develop strength in these muscles by performing the following exercises. 

Dumbbell Scaption (this works the  Supraspinatus muscle)

1 Hold a light dumbbell in each hand at arm's length, with palms facing forward and thumbs pointing out. Your hands should be just in front of your body so that the weights will travel about 30 degree in front of your body (this is known as the scapula plane).

2 Lift the dumbbells until they are level with your shoulders. Your thumbs will be pointing up to the ceiling at the top of the movement.

3 Lower your hands to the start position, making sure the weights travel in the same plane.

4 Complete 1-3 sets of 8-15 repetitions with a slow and controlled tempo.

Push-up Plus (this works the Serratus Anterior muscle)

1 Begin at the top of a push-up, with your weight on your arms. 

2 Keeping your arms straight, raise the torso away from the floor.

3 Lower your torso back toward the floor between your arms, without bending your arms. 

4 Complete 1-3 sets of 8-15 repetitions with a slow and controlled tempo.

5 You can raise the difficulty of this exercise by performing a normal push-up, at the end of which you really emphasise pushing away from the floor to fully activate the serratus anterior.

Bike 

Cycling and running can cause several injuries. Iliotibial Band Syndrome (ITBS), resulting in lateral knee pain, can be the bane of a triathlete's life. You need a strong ITB to prevent or at least limit injury to the area. Another frequent complaint is stiffness in the upper back. Spending hours on the bike can lead to fatigue and it becomes increasingly difficult to maintain good posture, resulting in an excessively hunched bike position. 

upper-back stiffness 

If stiffness is left unchecked, you won't be able to adopt or maintain an aerodynamic position. A tight upper back can also cause problems in the pool, worsening conditions such as swimmer's shoulder. 

Four-Point Rotation Extension

1 Kneel on all fours, then place your left hand on the back of your head.

2 Rotate your trunk by taking the left elbow to the right knee.

3 Change direction and rotate and extend the trunk; the head and elbow should be pointing up.

4 The movement should come from the trunk and scapula, rather than leading with the elbow.

5 Repeat the exercise 10 times on each side.

Iliotibial Band Syndrome

The two muscles associated with the ITB are the tensor fascia lata (TFL) and gluteus maximus. This exercise concentrates on the TFL, which runs down the outside of the thigh from just below the hip and attaches to the outside of the tibia, just below the knee. Its primary role is hip flexion (which happens a lot during cycling). When the TFL and ITB, to which it's attached, become fatigued and overloaded, they can't stabilise the leg, placing stress on the knee. 

 ITB Stretch

1 Stand on an aerobic step or bench using your injured leg. Hold on to a rail or the wall with the opposite hand. 

2 Keeping both knees straight, lower the opposite foot and hip toward the floor.

3 Shift your weight to the inside of the foot of the injured leg, keeping most of your weight on your heel.

4 Bend your knee slightly (10-20 degrees), making sure to keep the other foot off the ground.

5 Move the hip on the problem side forward about 10-15cm, keeping the heel in contact with the step and your weight on the inside of the foot. Your upper body should move backward.

6 After you've moved your hip forward, move it straight backward (10-15cm past the starting point). As your hip moves backward, your upper body will tend to bend forward.

7 Start with 10 reps per day on each leg, and gradually build up to a set of 20 to 30 reps, carried out twice a day.

Run

Running tends to cause more problems than cycling and swimming. Most injuries occur in the lower limb, with the knee and ankle/foot the most susceptible areas. 

PatelloFemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is a term used to describe nonspecific pain around the patella (kneecap). There are many potential causes but one of the most popular theories links PFPS to faulty tracking of the patella. Weakness in the quadricep muscles holding the patella in position can create unwanted sideways movement of the patella, resulting in pain and inflammation. Exercises to strengthen the Vastus Medialis Oblique muscles, on the inside of the leg just above the knee are recommended to prevent this movement and reduce the pain associated with PFPS. 

The Vastus Medialis Oblique Squat

1 Place a stability ball against a wall and gently lean against it, positioning the top of the ball at the small of your back. Your feet should be positioned 15-30cm in front of your body, hip-width apart and facing forward or turned out slightly.

2 Place a ball between your knees and squeeze your thighs tight against it throughout the exercise.

3 Lower your body, rolling the ball down the wall simultaneously. Keep your lower and mid-back in contact with the ball. Focus on dropping your hips under the ball and pushing your hips back. Keep your knees aligned over your second and third toes.

4 Continue to lower yourself until the tops of your thighs are parallel to the floor. 

5 Return to the starting position, focusing on extending your hips to bring them back underneath your body. Continue pushing up until your hips and knees are fully extended. 

6 Complete 1-3 sets of 8-15 repetitions of the exercise.

Achilles Tendinitis

This is an overuse injury that can result from the constant repetitive loading experienced during running. Increased pronation (inward movement of the foot during ground contact), along with weak and/or tight calf muscles can contribute to the problem, resulting in the Achilles tendon becoming unable to cope with the forces being applied to it. 

Eccentric Lower

1 Stand on a step and perform a calf raise with both legs.

2 Once high on your toes, lift one leg off the step and lower yourself slowly down using the other leg until your heel has dropped below the level of the step.

3 The drop should be done slowly, lasting about four seconds.

4 Perform 1-3 sets of 10-15 reps of the exercise, on each side. 

5 Once you can comfortably perform three sets, drop more quickly, but maintain control (this will place a greater load through the Achilles tendon).


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