Endurance-sports athletes like triathletes conduct a high volume of physical activity on a daily basis, making injuries more than likely to occur. With consistent, repetitive use, the body takes a beating.
“Endurance athletes of all types must be careful of overuse injuries to a specific body part,” says Scott Hudson, a performance rehabilitation specialist at St. Vincent Sports Performance in Indiana. “Swimmers have to be mindful of their shoulders, while runners should be paying attention to everything from waist down, including the hips, knees, ankles and feet. Biking carries with it more ‘saddle-sore issues’ from sitting too long, along with wrist and elbow problems, if the athlete is not properly fitted on the bike.” So, what can be done about it?
These eight physical therapists discuss common injuries among endurance-sport athletes and how you can take proactive steps to avoid them.
1. ACHILLES TENDINITIS
Scott McGeary, DPT, CSCS, and a clinical director at Drayer Physical Therapy Institute, in Hershey, Pennsylvania, notes this is a repetitive-use issue that can stem from a pre-existing tightness or joint restriction.
Causes: Repetitive motion and improper training — like going too fast, too quickly or ramping up training volume (i.e., running 10 miles one week and then pushing yourself to run 50 miles the next week) — can inflame the end of the Achilles tendon.
Prevention: Run an appropriate amount of mileage for your fitness level and progress your mileage and speed work carefully. Be sure to stretch your calves (especially if you sit for long periods, like at a desk job) and strengthen your legs and core and work on your balance. You can even do many of these exercises while you brush your teeth, such as calf raises, squats and single-leg balances.
2. SHIN SPLINTS
Eric Edelman, PT, owner of Peak Physical Therapy & Sports Performance in Massachusetts describes shin splits as “debilitating pain.”
Causes: When tissue gets irritated from a pounding activity like running, it gets inflamed.
Prevention: Have an expert examine your biomechanics, which includes observing your running form and gait. Depending on the results of this examination, you should find a proper shoe for your form and, if necessary, purchase either over-the-counter or custom orthotics. Also, pay attention to the terrain you run on — hard surfaces like concrete can have an affect on your lower legs.
3. HIP BURSITIS
Brian Dombal, PT, DPT, of ProClinix Sports Physical Therapy & Chiropractic, in Armonk, New York, explains that repetitive use can inflame the bursa — a fluid-filled sac that functions as a cushion to reduce friction between tissues of the body.
Causes: Repetitive biking and changing position in the saddle can cause your muscles to get tight and compress on the bursa, leading to pain.
Prevention: Spend a considerable amount of time stretching the hips, quads and TFL (tensor fascia latae, a muscle of the thigh) and foam roll your quads. To keep your knees in line when you ride, strengthen your glutes, core and hip stabilizers.
4. IT BAND SYNDROME
Stephen Chao, PT, DPT, CSCS, and a clinical professor at SUNY Stony Brook, says this is a primary injury among long-distance runners and cyclists.
Causes: Repetitive motion.
Prevention: Get your running mechanics down so you’re not running bowlegged or knock-kneed — your knee should remain over the foot. Stretch and strengthen your hip rotator. Keep your glutes strong. Use self-myofascial release and foam roller or employ a lacrosse ball — it’s a nice size to help with a deep massage.
5. SHOULDER PAIN
Matt Likins, PT, MPT, OCS, of 1st Choice Physical Therapy, in Sterling Heights, Michigan, notes that this is the most common orthopedic complaint of high-level swimmers.
Causes: The swimming stroke forces parts of the rotator cuff tendons come in contact with the bony surface of the shoulder, which is not automatically a problem, but when it happens repeatedly, it causes both inflammation (tendinitis) and eventually changes within the tendon (tendinosis).
Prevention: Use a foam roller by lying on it perpendicular to your spine and rolling up and down, sort of like you would do to loosen your muscles. You’ll also want to strengthen your shoulder muscles. This can be done with weights or rubber bands, using a lifting bench or an exercise ball. Just remember that to build muscle strength you must exercise until you fatigue the muscle. Appropriate shoulder exercises include: Upright rows, lateral flies and bent-over flies. Finally, you’ll want to stretch the shoulder muscles with pectoralis doorway stretches. To do this, stand at a doorway, bend your arms like you are making a goal-post shape and then press them into the wall at the sides of the doorway. Hold the stretch.
6. KNEE PAIN
Jonathan Zaid, PT, DPT, of BetterPT and the Drayer Physical Therapy Institute, in Parsippany, New Jersey, says, “Long-distance runners typically have weak hips and core stability in the frontal plane because their sport is very sagittal plane in nature.”
Causes: Weak core, glutes and ankle instability.
Prevention: Perform monster walks with a band and maintain good knee alignment, also do squats with a band around your knees for glute and ankle recruitment. It is also beneficial to add side planks to your workouts.
7. TORN ROTATOR CUFF
Vasili Gatsinaris, DC, QME, of Next Level Wellness Center, in Irvine, California, says, “When it comes to competing in a triathlon competition, most athletes spend the weekends training for the triathlon and spend days sitting at a desk at work.”
Causes: Repetitive motion.
Prevention Make sure to train consistently so you don’t overwork your muscles during training.
Stretch as much as possible before and after workouts. You should also foam roll, get massages and use a lacrosse ball to self-massage. “Lacrosse balls are your best friend,” he says.
8. ALL INJURIES
Shaun Logan, DPT, founder of Logan Kinei, in Philadelphia, Pennsylvania, affirms that all injuries can benefit from range-of-motion movements.
Prevention: Regardless of injury, one of the greatest proactive practices an endurance athlete (and all humans) can do are Controlled Articular Rotations (CARs) from Functional Range Conditioning (FRC). These are basically joint circles for all joints of the body, working on improving control and range of motion through active movement of the joint.