Balancing act: incidence and prevalence of triathlon injuries

When assessing the risk factors in triathlon, the accumulative stress of high-volume training increases the injury risk, and athletes commonly attribute the high load to their injuries⁽²⁾. Therefore, coaches and practitioners must consider the interplay and accumulation of load when designing training, rehabilitation, and competition schedules.

Researchers at the School of Health Jean Piaget Algarve in Portugal conducted a study to identify the prevalence of injuries during training or competition in triathletes. The results showed a prevalence of 2.39 injuries per 1000 hours of training, with the primary mechanism of injury being overtraining. The researchers noted that 14 injuries occurred during swimming, 23 during cycling, and 93 during running⁽³⁾. Soft tissue muscle injuries (31.5%) were the most common injury, followed by inflammatory injuries (19.2%), tendinopathy (16.2%), then ligament injuries (15.4%) (see figure 2). The results show that running conditioning and technique could play a more significant role in injury prevention strategies and needs to be considered when planning training programs.

Due to the different intensities between competition and training, competition has a 6-fold increase in all injuries amongst long-distance triathletes, with an increased acute injury incidence per 1000 hours of competition⁽⁴⁾.

There is a clear positive correlation between time spent training and the incidence of injury. Still, the fact that elite athletes have lower injury rates suggests that the quality of training influences injury rates⁽¹⁾. This further emphasizes the importance of having triathlon-specific coaching and health professionals that understand the sport. 

The most common extrinsic cause of injuries in triathlon is inadequate equipment⁽³⁾. Although extrinsic factors are often uncontrollable, in the case of the athlete’s equipment, coaches and practitioners need to be involved and advise the athlete on what equipment should be renewed or set up differently. The most common extrinsic factor that could prevent injuries on the cycle would be bicycle setup and, on the run, would be the mileage on the shoes⁽³⁾. 

Training and strength program periodization is currently the generalized approach to help prevent injuries for triathletes and other cardiovascular sports⁽⁶⁾. However, specific research on triathletes is lacking. With a better understanding of how they differ from other sporting codes, coaches and practitioners will move one step closer to creating effective injury prevention protocols specific to the demands. However, there is ample evidence to suggest that strength training effectively prevents athletes from getting injured.

Conclusion

When assessing the injury risk in triathlons, running is where most injuries occur, especially overuse injuries. Prevention programs need to target the run phase and create the capacity transition from low-impact cycling to high-impact running after the second transition. Strength training is often neglected in the world of endurance sports and could also be an effective answer to decreasing running injuries. Optimal loading and program adherence by the athlete also become vital in preventing injury. 

References

1.    J Hum Kinet, 2022, 81(1), pp.123–134
2.    J Strength Cond Res. 2010;24(1):30–36
3.    Rev. Assoc. Med Bras, 2020, 66(11), pp.1536–1541
4.    Acta Ortop Bras. 2014;22(4):191-6
5.    Br J Sports Med. 2013;47(13):857–861