Sports Physiotherapy : Triathlon

It’s Noosa Triathlon day!

The Noosa Triathlon Multi Sport Festival, held in picturesque Noosa (Qld), runs from October 30 to November 3 this year with several events including an open water swim and 5km run. The highlight of the weekend though is the Olympic distance Triathlon held on the Sunday. Noosa Tri is one of the most popular triathlon events in Australia, maybe even the world, and started in 1983.

Triathlon

Triathlon is a very popular and ever-growing sport in Australia. Triathlon Australia is the national body that oversees triathlon in Australia. There are currently approximately 14,000 individual members of Triathlon Australia and 180 affiliated triathlon clubs(1). The Australian triathlon season runs from August to March. Triathlon is a multi-discipline sport involving swimming, cycling and running. The Olympic (standard) distance triathlon involves a 1500m swim, 40km ride and 10km run; however triathletes can also compete in a number of different distance events (see table 1).

Table 1. Triathlon Distances

Distance	Swimming (m)	Cycling (km)	Running (km)
Sprint	750	20	5
Olympic	1500	40	10
Long	2000	80	20
Half Ironman	1900	90	21
Ironman	3900	180	42

Injury Profile

Triathletes suffer more injuries than single-discipline sports athletes (9). This may be due to the overall number of training hours or a lack of technique and expertise in one or more of the three disciplines. The incidence of injuries in triathletes varies between 37% and 91% (10). This large range is due to differences in definition of injury, competition distance, athlete ability (novice vs. elite) and time frame for reporting injury. Vleck and Bessone-Alves (2011) recommend that a consensus statement on injury definition and recording of triathlon injuries is needed. Prospective studies of the International Triathlon Union (ITU) have also been recommended (11). In larger events however it may be difficult to measure and record injuries accurately.

The majority of injuries in triathletes are related to running (58-72%) (9, 10). This high injury incidence is similar to that seen in running alone (up to 70% in one year) (12). Injuries predominantly occur due to overuse (75%) (13, 14), particularly in elite triathletes (15). Most injuries are reportedly training injuries (3); however this is difficult to quantify unless injuries are acute trauma. Several studies have found the lower limb was the most injured site of the body (3, 9, 16). Knee (14-63%) and ankle/foot injuries (9-35%) were most prevalent (14). Again these data are similar to that seen in running alone (20-40% knee injuries) (12). The lower back and shoulder have also been reported as common sites of injury (3).

Risk Management Issues

Three risk factors for injury in triathletes have been identified in the literature (3); previous history of injury, years of triathlon experience and a supinated foot type. These are addressed in the musculoskeletal screening. Findings from Shaw et al. (2004) also suggest that injury is least likely when bike and run training total between 8 to 10 hours per week (4). Revive Ashgrove triathletes train for between 13 and 20 hours per week, with between 10 to 14 hours spent cycling and running. There is currently no monitoring system for training load.

Preventative strategies to date have focussed on early diagnosis and treatment to improve prognosis, reduce prolonged injury and decrease recurrence rates (3); however this is only successful if triathletes have regular access to appropriate medical and health care services. Education is important in preventing overtraining (17). Athletes should be aware of the signs and symptoms of overtraining, how to modify training and when to seek professional advice.

Triathlon Australia is proactive in risk management for their triathlon events. Through their website the public can access the lightning safety policy (18), designed to ensure that participants and staff are not at risk of injury in bad weather. Previously open water swims have been cancelled or moved due to rough conditions to ensure swimmer safety; however these decisions are made on a case by case basis. All Australian triathlons are held outdoors from August to March – the hotter half of the year. Triathlon Australia follows the Sports Medicine Australia hot weather guidelines. The Triathlon Australia Member Protection Policy includes a code of behaviour for all people involved in triathlons including medical staff, volunteers, athletes and spectators. (19)

Results

For results of this year’s Noosa Triathlon & Multi Sport Festival click here: http://www.usmevents.com.au/Triathlon___Multi_Sport/Noosa_Triathlon_Multi_Sport_Festival/Noosa_Triathlon/Results.htm

References

. Australia T. About Triathlon Australia: Triathlon Australia; [cited 2013 7/10/2013]. Available from: http://www.triathlon.org.au/About/About_Triathlon_Australia.htm.

3. Gosling C, Gabbe B, Forbes A. Triathlon related musculoskeletal injuries: the status of injury prevention knowledge. Journal of Science and Medicine in Sport. 2008;11:396-406.

4. Shaw T, Howat P, Trainor M, Maycock B. Training Patterns and Sports Injuries in Triathletes. Journal of Science and Medicine in Sport. 2004;7(4):446-50.

9. Spiker A, Dixit S, Cosgarea A. Triathlon: Running Injuries. Sports Medicine Arthroscopy Review. 2012;20(4):206-13.

10. McHardy A, Pollard H, Fernandez M. Triathlon Injuries: A Review of the Literature and Discussion of Potential Injury Mechanisms. Clinical Chiropractic. 2006;9:129-38.

11. Vleck V, Bessonne-Alves F. Triathlon injury review. British Journal of Sports Medicine. 2011;45:310-84.

12. Hreljac A. Etiology, Prevention, and Early Intervention of Overuse Injuries in Runners: a Biomechanical Perspective. Physical Medicine and Rehabilitation Clinics of North America. 2005;16:651-67.

13. Wilk B. The incidence of musculoskeletal injuries in an amateur triathlete racing club. Journal of Orthopaedic and Sports Physical Therapy. 1995;22(3):108-12.

14. Migliorini S. Risk Factors and Injury Mechanism in Triathlon Journal of Human Sport and Exercise. 2011;6(2):309-14.