There has been a rise in popularity of Triathlon since its beginnings in the 1970’s . As such there has been more and more research into the field regarding optimal training programs for the sport. Part of optimal training is avoiding injuries and this requires having an in depth understanding of injuries associated with the sport. This blog will briefly lay out the key findings in this area of research and what it means for Triathletes, both amateur and professional alike.
Out of the 3 disciplines in Triathlon there seems to be consensus that running is the main culprit for causing injuries[1-4,10,11]. Korkia et al (1994) , for example, found that 65% of all reported injuries were caused during running, with cycling and swimming at 16% and 12% respectively. Overall the main injuries observed were overuse injuries [1-3, 5]. Maybe this is to be expected as it is an endurance sport, however, this fact must still be taken into account in the design of training programs in the build up to a competition. It should also be noted that correct technique to limit the stress placed on the body is important .
Swimming has the lowest risks for both acute and chronic injuries [6,7]. Of the injuries that do occur they are generally overuse injuries in the shoulders brought about by constant overhead activities (front crawl stroke mainly) [7,8]. Some 40-91% of all swimming related injuries affect the shoulder . The reason for this is multifaceted and believed to be a combination of biomechanics/technique, overuse of the shoulder girdle muscles and general laxity and shoulder instability. Despite the low risk of injury in swimming, it has been found that those who enter Triathlon with a background in swimming tend to have increased risk when running . This is thought to be due to weak glute medius and minimus; they are also more prone to increased thigh adduction and internal rotation during the mid-stance in gait which in turn predisposes the individuals to Illiotibial Band Syndrome (ITBS) . Knee injuries have also been documented in swimmers however this tends to affect those who practice the breaststroke and not the front crawl which is the commonly used stroke in Triathlon .
Cycling is seen to have the second highest incidence of injuries and is the main cause of all acute/traumatic injuries that are observed in the sport . Lower back (60%) and knee injuries (33%) are the main pathologies experienced from cycling [2,9]. What is important to note is that not all cyclists run the same risks of injuries. Mountain Bikers have a much lower incidence of both lower back pain and knee injury. Callaghan & Jarvis (1996) , found track cycling had the highest incidence with 37% of low back injuries and 32% knee injuries. Road cycling accounted for 33% and 28% respectively. This is likely due to the aggressive riding positions of the these cyclists maintaining their backs in flexed positions for extended periods of time.
As stated at the beginning of the blog, running is the main cause of all injuries in Triathlon. The majority of these injuries are overuse injuries . Lower limb injuries are by far the most prevalent, with the knee being the most common injury site of all . Clements, et al (1999) , states that as much as 72% of all knee injuries are directly related to running and that most have been found to affect the lateral aspects of the knee. Shutz, et al (2012) , further elaborates on running in a study which analysed adaptive changes in Ultra Marathon runners. They state that the main injuries associated with running are:
“anterior knee pain (for example, patella-femoral syndrome), iliotibial band friction syndrome, tibial stress syndrome (shin splint/injuries), plantar fasciitis, Achilles tendonitis and meniscal injuries of the knee”
It is noted that those from a swimming or cycling background are particularly at risk  and should therefore take care when transitioning to Triathlon.
Although there is plenty of research into the individual disciplines of Triathlon there is still research required to investigate Triathlon as a whole  . This is because during competitions all three activities are thrown together and therefore will affect one another. It has already been noted that Transition 2 (Cycle – Run) is associated with the most injuries . In the mean time what can we glean from existing research. In my opinion, the key points to take away from the evidence presented are the following:
a. Slow progression. Endurance athlete or not, if you only have experience in one of the disciplines, you must transition slowly to Triathlon.
b. Technique, technique and technique again. Its an endurance event and therefore economy of motion is vital. Coupled with this is the fact that better technique leads to less injuries. So if your participation in the sport is more than a once off sprint event, either join a reputable club or get a coach.
c. Pre-hab. Get your body looked at by qualified movement specialist (i.e. Sports Physiotherapist, Kinesiologist, Sports Rehabilitation Specialist etc). Have your weak points identified and then work on them. This way you will galvanise your body against injury in training and competition.
d. Strength and conditioning. An area often overlooked by Triathletes as they don’t see the value in lifting weights when their training schedule is already full with swimming, cycling and running. I would say make time. Even one focused 45 minute S&C session a week will make a difference. By increasing your strength in the right way, you decrease the chances of getting an overuse injury. This work should focus on exercises to increase stability and endurance during running. Triathletes tend to spend most of their training time on the bike (48%) . I would argue that at least some of this time could be spent on ensuring their running technique and running conditioning is in place to enable consistent, injury free training and competition.
Remaining injury free is the key to achieving your goals in Triathlon. The overwhelming majority of injuries are gradual onset overuse injuries, not sudden trauma. This means they are within our power to avoid and affect change through intelligent training and conditioning.
I hope you enjoyed the article and Happy Triathloning!!
1. Korkia P.J., et al. An epidemiological investigation of training and injury patterns in British triathletes. Br J Sports Med. 1994 September; 28(3): 191–196.
2. Manninen J.S.O, Kallinen M. Low back pain and other overuse injuries in a group of Japanese triathletes. Br J Sports Med. 1996 June; 30(2): 134–139.
3. Clements K., et al. The prevalence of chronic knee injury in triathletes. Br J Sports Med. 1999 June; 33(3): 214–216.
4. Gosling C.M., et al. A profile of injuries in athletes seeking treatment during a triathlon race series. Am J Sports Med. 2010 May;38(5):1007-14.
5. Anderson C.A., et al. High prevalence of overuse injury among iron-distance triathletes. Br J Sports Med 2013;47:857-861.
6. Migliorini S., Risk factors and injury mechanism in Triathlon. J. Hum. Sport Exerc. 2011; 6(2).
7. Bales J, Bales K. Swimming overuse injuries associated with triathlon training. Sports Med Arthrosc. 2012 Dec;20(4):196-9.
8. Wanivenhaus F., et al. Epidemiology of Injuries and Prevention Strategies in Competitive Swimmers.Sports Health. 2012 May; 4(3): 246–251.
10. Spiker A.M., et al. Triathlon: running injuries.Sports Med Arthrosc. 2012 Dec;20(4):206-13.
11. Gosling C.M., et al. A profile of injuries in athletes seeking treatment during a triathlon race series.Am J Sports Med. 2010 May;38(5):1007-14.
14. Marr D.S. Care of the Multisport Athlete: Lessons from Goldilocks. Br J Sports Med. 2011 November; 45(14): 1086 – 1087.