Injuries Among Triathletes
Injuries are unfortunately relatively common among endurance athletes. However, the unique demands of triathlon place a potentially greater risk of injury on athletes competing in the sport. Prior studies have found a wide range of injury rates among triathletes, ranging from 37-91% of athletes (1). The wide range is likely due to a myriad of factors, including different lengths of studies, the training status of individuals followed, and the distance race that the athletes included were preparing for.
Nonetheless, the rate of injury among triathletes is relatively high, and so identifying the traits of characteristics associated with injury is an important first step in being able to mitigate the risk of injury among triathletes. A recent study published by Kienstra and colleagues aimed to do just this (1). Prior studies have focused a lot on identifying relationships between training-related factors (training intensity, training volume, training frequency) and injury risk. However, Kienstra and colleagues aimed to identify the relationship between training factors as well as lifestyle factors and injury risk. Let’s take a look at what they found in the next section.
Training, Injury, and Lifestyle Characteristics of Recreational Triathletes
Authors in this study administered a survey assessing training and other lifestyle characteristics (specific dietary or nutrition strategies, supplement use, medical history) to 34 recreational triathletes in the Miami, Florida area (mean age = 47.6 years; 33% female).
Authors found that 79% identified at least one current area of pain, with the lower extremity being the most common site of injury (72% of all pain and injuries reported). The leg accounted for 17% of all injuries while the hip, knee, and foot accounted for 16% of reported injuries each. Finally, the back, neck, and shoulder accounted for 6%, 7%, and 15% of reported injuries, respectively.
Training Characteristics and Injury
Athletes who trained more than 12 hours/week had an average of 3.3 injury sites while athletes training less than 12 hours/week had an average of 2.3 injury sites.
Other Training Characteristics
Only 56% of athletes reported engaging in strength training and only 15% reported engaging in some form of yoga or Pilates. Most athletes (65%) trained under the guidance of a coach. The average training volume per week across all athletes was 11.8 hours/week (range = 4 to 35 hours/week). Athletes planning to race half-distance events or longer averaged 12.6 hours/week of training whereas those planning on racing short-distance triathlons (sprint or Olympic) averaged 10.8 hours/week of training.
Nutrition and Supplement Characteristics
A total of 65% of athletes reported using some form of supplement or vitamin, with multivitamin use (47%) being the most common, followed by a specific vitamin supplement (30%), a protein supplement (26%), a calcium supplement (15%), a fish oil supplement (15%), and an iron supplement (9%). Most athletes reported no dietary restrictions; however, 15% followed a gluten-free diet, 15% reported a lactose-free diet, 9% a vegetarian diet, and 6% a vegan diet. Every single athlete following a gluten-free, vegan, and vegetarian diet reported at least one injury, whereas 80% of those following a lactose-free diet reported at least one injury.
Other Lifestyle Characteristics
Among the 34 athletes included in the study, 16 completed the survey questions regarding sleep. A total of 63% of these athletes reported sleeping 6 hours or less per night and nobody reported sleeping more than 9 hours per night.
What to Make of All This?
Despite the vast majority of triathletes reporting at least one injury, this number might be slightly biased as 9/24 participants were recruited directly from a Miami-based sports medicine clinic, potential inflating the likelihood of injuries among the total sample. Nonetheless, the rate of injury is still high among the triathletes included in this study.
The three factors that really stood out to me when sorting through the data were the following:
Those training >12 hours/week were more likely to experience injury than those training <12 hours/week. This demonstrates the positive relationship between training volume and injury risk, of which injury risk goes up as training volume goes up; this has been demonstrated among other endurance athletes as well, particularly among runners and long-distance triathletes (1).
Only 58% of all triathletes reported engaging in strength training. This is alarming and demonstrates the need for more triathletes to engage in regular strength training as strength training has been well-documented in reducing the risk of overuse and sports-related injuries (2).
Among the 16 triathletes that responded regarding their sleeping habits, 63% reported 6 hours/night or less and nobody reported sleeping 9 hours/night or more. This is HUGELY alarming as research demonstrates that nightly sleep durations of less than or equal to 7 hours/night for prolonged periods of time is associated with a 1.7x greater risk of musculoskeletal injury among athletes (3).
The important thing to note about these three characteristics above is that they are all modifiable. In other words, these characteristics and behaviors can be improved/changed. Based on the evidence we currently have, I would argue that increasing sleep quantity to >7 hours/night and increasing the proportion of athletes engaging in regular strength training would likely reduce the prevalence of injury among this small sample of recreational triathletes.
There is some research linking increased training volume with increased injury risk. For the average recreational triathlete that is usually unable to engage in extreme amounts of training like professionals/elites often engage in, however, the bigger problem is likely what happens around training and not the training volume itself. Triathletes, and endurance athletes more broadly, can lead very busy lives outside of a very demanding sport in triathlon. They quite often have families, full-time jobs, or schooling in addition to part-time jobs. The business of life outside of an already very demanding sport can lead to what is seen in the sample included within this study, chronically poor sleep habits and a lack of athletes engaging in strength training. There are other lifestyle factors contributing to risk of injury as well, including nutrition, however, I quite often see athletes sleeping too little and not engaging in regular strength training individualized for them as an endurance athlete. I would argue that these two characteristics alone account for far too many injuries among recreational triathletes that may otherwise be preventable.
It is not necessarily shocking to hear of the relatively high prevalence of injury in this small sample of recreational triathletes. I think the most important take-home message from this study for triathletes is to prioritize optimal recovery through good sleeping habits (aiming for at least 7-8 hours of sleep each night) and engaging in a safe, progressive, and individualized strength training to improve overall strength and reduce the risk of injuries. These two lifestyle habits will go a long way in keeping athletes healthy and performing at their best. If you want to learn more about sleep, click here. If you want to learn more about strength training, click here and here.
Kienstra CM, Cade WH, Best TM. Training, injury, and lifestyle characteristics of recreational triathletes. Current sports medicine reports. 2021 Feb 1;20(2):87-91.
Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British journal of sports medicine. 2014 Jun 1;48(11):871-7.
Huang K, Ihm J. Sleep and injury risk. Current sports medicine reports. 2021 Jun 1;20(6):286-90.
Happy training and racing!
-Ryan Eckert, MS, CSCS
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