Physio Advice for Triathlon and Iron Man events

This guide will provide you with advice on posture, prehabilitation and common injuries associated with running, swimming and cycling.

Benefits of Multisport Training:

Multi sport maybe demanding, but doing more than one event can actually spread the exercise load, thereby reducing the incidence of overuse injuries.

Multi sport also enables you to keep exercising even if you are injured, e.g. you maybe able to swim, even if you are dealing with patella-femoral joint pain.

Multi sport enables you to keep exercising at a high level without accumulating fatigue, like you would with just one repetitive activity.

Multi sport enables you to develop muscle strength and control through all three planes of motion and through the full available range of motion, thereby reducing muscle imbalance and promoting joint health.

Benefits of Physiotherapy:

Physiotherapy can benefit a multisport athlete in a number of ways:

a) Expert advice from a profession that understand biomechanics, pathology and a range of interventions.

b) Screening to prevent injuries before they happen.

c) Hands on manual therapy to fix problems quickly and keep you in the game.

d) Expertise in movement to help you gain efficiencies and improve performance.

Introduction to Posture:

Our posture is the response of our body to gravity. Gravity is constant pulling us into the ground, so we need to minimise the leverage that we give gravity.

We spend much of our time sat down in the office/home and create lots of tension in our shoulder and back muscles that are spending hours fighting gravity.

So first thing manage your posture in the workplace.

But when you get out running, cycling and swimming - posture is also super important.

Running:

Posture

Front to back plane [saggital] plane

Keep:

Ears

Shoulders

Hips

…in line.

Not head forward.

Leaning forwards will create tension in the muscles on the back of your body and tension is the enemy of efficiency, and running is an efficiency sport.

Your spinal discs, ligaments and muscles from your feet to your head provide elastic recoil, and this will be greatest when your joints are in the mid range.

Angel/Zombie posture:

Extend your arms in front of you [like a zombie] and walk - you will notice that because your centre of gravity moves forwards, you need to fling your feet out in front of you to stop falling over, this increases heel strike, which is less efficient.

Extend your arms behind you [like an angel] and walk - you will notice that because your centre of gravity moves forwards, you find your feet striking the ground in the mid foot and importantly under the hip, which is much more efficient.

You want to run with the mid forearms in the mid line of your body.

For most of us, that will shift our weight backwards, improving efficiency. You will notice the biggest difference when you are fatigued.

Prehabilitation

Thoracic extension stretch:

a) prone kneeling with elbows on box/bed

b) Supine lying over a foam roller

Gluteal activation and strengthening:

a) Single leg half squat whilst activating gluts

b) Thigh band walking with resistance band

Hamstring activation and strengthening:

a) Eccentric loading with resistance band or hamstring curl machine in gym.

b) Nordic curls

Injuries

a) Tendinopathies

Common sites: achilles, hams, peroneal, patella

Symptoms: pain on loading, morning stiffness, unpredictable pain

Causes: step change in loading, weak muscles, unsuitable footwear

b) Bone stress fracture

Common sites: shin, foot, lumbar spine

Symptoms: Localised bone pain, aches after activity/night

Causes: inc in training volume, change of surface, previous history

More common in women because of hormonal changes

c) Shin splints

Site: front of shin

Symptoms: pain on loading, localised swelling

Causes: step change in loading, footwear, incline of surface

d) Runners Knee (patella-femoral joint pain)

Site: under the knee cap

Symptoms: pain with ascending/descending stairs, squats, pain after running, sitting with knees flexed.

Causes: tight IT Band, short quads, weak hams, lateral pelvic instability caused by poor recruitment of glutes.

e) Iliotibial band (ITB) syndrome

Site: outside of the knee

Symptoms: sharp pain/ache spreading up/down outside of thigh, usually only when running or cycling, may linger afterwards.

Causes: Lateral pelvic instability caused by poor recruitment of glutes, tightening/drying out of the fascia in the ITB.

Swimming:

Posture

Aiming for a streamlined position in the water.

a) Good thoracic extension and lumbar rotation.

b) Good lat dorsi length to give shoulders full range of motion.

c) Good gluteal recruitment to prevent flexion at the hips.

Prehabilitation

Thoracic extension stretch:

a) prone kneeling with elbows on box/bed or,

b) Supine lying over a foam roller

Lumbar rotation stretch:

a) Prone 3 point kneeling, rotate trunk and horizontally flex free shoulder across chest, reverse into full horizontal rotation of the shoulder.

Gluteal activation exercises:

a) Single leg half squat whilst activating gluts

b) Thigh band walking with resistance band

c) Lying prone, engaging gluts and extending hips

Injuries

Common issues:

a) Tendinopathy or tears, bursitis and impingement, occasional labral tears

Common site: Shoulder

Symptoms: pain, instability, clicking, locking, muscle weakness

Causes: Scapula mechanics, stiff thoracic spine, tight lat dorsi

b) Nerve root impingement, spinal disc bulges (herniation)

Common site: cervical spine

Symptoms: pain, pins/needles, numbness in arms and hands

Causes: head and neck mechanics, poor breathing techniques,

reduced extension of the thoracic spine.

c) Nerve root impingement, spinal disc bulges (herniation), facet joint inflammation

Common site: lumbar spine

Symptoms: low back pain; pain, pins/needles, numbness in legs

Causes: weak core (TrA, multifidus, pelvic floor muscles), under active glutes.

Cycling:

Posture

a) Get a bike fit to sort geometry out (Bike Science, BW Cycling)

b) Relax shoulders, bend elbows, neutral wrists.

c) Rotate pelvis forwards to reduce C shaped spine, engage core

d) Keep your knee tracking over the ball of your foot.

Prehabilitation

Quads strengthening exercises:

a) Single leg squats whilst activating gluts

b) Split squats

Core strengthening exercises:

a) Plank

b) Bird dog

c) Bicycle crunch

d) Reverse crunch

Calf strengthening exercises:

a) Heel raises (two/one leg) with/without dumbbells

b) Calf step ups

Injuries

a) Muscle strain

Common site: lumbar spine, pelvis

Symptoms: low back pain, sciatica

Causes: Sustained trunk flexion, poor bike fit, weak core (TrA, multifidus, pelvic floor muscles).

b) Iliotibial band (ITB) syndrome

Site: outside of the knee

Symptoms: sharp pain/ache spreading up/down outside of thigh, usually only when running or cycling, may linger afterwards.

Causes: Lateral pelvic instability caused by poor recruitment of glutes, tightening/drying out of the fascia in the ITB.

c) Joint compression at end of range

Site: under the knee cap

Symptoms: pain with ascending/descending stairs, squats, pain after running, sitting with knees flexed.

Causes: tight IT Band, short quads, weak hams, lateral pelvic instability caused by poor recruitment of glutes.

d) Joint compression at end of range

Site: wrists and hands

Symptoms: pain, pins/needles, numbness

Causes: >40% body weight through hands on handlebars, poor bike fit, weak core (TrA, multifidus, pelvic floor muscles)

e) Nerve compression (hot foot)

Site: ball of the foot

Symptoms: Pain, pins/needles, numbness, temperature changes

Causes: poorly fitted shoes, cleat alignment/stiffness, thickness of socks

f) Plantar Fasciitis

Site: underside of the foot in the arch

Symptoms: searing pain normally with cycling, walking

Causes: tightening/drying out of the fascia, weak calf muscles