Sports Medicine: Just the Facts

respectively. Acute injuries caused by trauma make

up the difference.

• Injury incidence: A range of 2.5—5.4 injuries per
  1000 h of triathlon training and 4.6—17.4 injuries per
  1000 h of triathlon competition have been reported.
  These rates are higher than the reported incidences of
  3.9 and 2.5 injuries per 1000 h of training for track
  and field or marathon running respectively (Burns,
  Keenan, and Redmond, 2003).
  
  
  1. Running causes 65–78%, cycling causes 16–37%,
     and swimming causes 11–21% of the injuries that
     triathletes experience (Korkia, Tunstall-Pedoe, and
     Maffulli, 1994).
     a. Iliotibial band syndrome, patellofemoral pain
     syndrome, patellar and Achilles tendinitis are
     common injuries encountered during running
     b.Aeroneck: Neck pain and stiffness caused by
     prolonged sitting with the shoulders hunched
     and the arms tucked tightly in underneath and
     the neck hyperextended. This is a complaint that
     many triathletes have after or during the cycling
     portion of the race.
     c. Patellofemoral pain, quadriceps and calf strains
     are common cycling injuries (Thompson and
     Rivara, 2001).
     d.Corneal abrasions: Frequently result from
     having the goggles kicked off the face at the
     congested start of the swim phase (Hellemans).
  
  
  2. Despite differences in training mileage, duration,
     and number of workouts per week there has been
     no reported difference in the injury prevalence, dis-
     tribution, or severity amongst triathletes who
     varied in skill from elite to recreational.
  
  
  3. Predictors of injury: Is there any one-factor or
     group of factors that predispose triathletes to an
     increase rate of injury?
     a. Total weekly training distance, weekly cycling
     distance, swimming distance, total number of
     workouts (swimming, cycling, and running) per
     week but surprisingly not running distance per
     week are all associated with an increased inci-
     dence of running injuries (Williams et al,
     1988).
     b.Total amount of time spent running and cycling
     but not total distance played a role in the inci-
     dence of cycling injuries.
     c. The most significant predictor of injury in the
     preseason is number of years of experience in
     triathlons, with more experienced triathletes
     having a higher injury rate (Korkia, Tunstall-
     Pedoe, and Maffulli, 1994).
     d. The most significant predictor of injury during
     the season was a history of previous injury and
     high preseason running mileage.
  
  
  
  

e. Training errors, most specifically form and

style, have been frequently associated with

injuries related to cycling and swimming.

4. Running is by far the most injury producing aspect
   of a triathlon. The amount of time and distance cov-
   ered while conducting cycling and swim training
   are directly associated with higher rates of running
   injury, not increased running mileage as one might
   expect.
   a. It is believed that the extra training put in for the
   swimming and cycling phases delays muscle
   recovery enough that the stress for running is
   magnified and leads to more injuries.

• Specific injury rates

1. Cardiovascular: Cardiac muscle fatigues and is
   damaged while performing endurance events simi-
   larly to skeletal muscle. Troponin T levels are ele-
   vated in 27% of Ironman Triathlon finishers and
   echocardiograms have demonstrated a 24% reduc-
   tion in postrace ejection fractions compared to pre-
   race values. There is no published data concerning
   the rate of fatal cardiac complications in triathletes.
   We do know from the marathon literature that it is
   a very rare, one in 50,000 complications (Mayers
   and Noakes, 2000).


2. Gastrointestinal bleeding: About 8 to 30% of
   marathoners have evidence of intra- or postrace
   gastrointestinal bleeding. The etiology is believed
   to be relative intestinal ischemia as a result of
   blood shunting to exercising muscles.


3. Abdominal cramping: Associated with competitors
   who consume a diet high in fiber before the race. It
   may also be seen with the excess consumption of
   carbohydrates before or during the race.


4. Diarrhea (Runners Trots): Abdominal pain and
   diarrhea associated with prolonged running or
   biking. This condition is caused by ischemic
   changes in the bowel as a result of the shunting of
   blood to exercising muscles. This may occur
   during or shortly after the completion of the race.


5. Nausea and vomiting: Eating 30 min before a
   triathlon is highly associated with vomiting during
   the swim. A diet high in fat or protein and the con-
   sumption of hypertonic beverages results in a high
   rate of nausea and vomiting amongst competitors.


6. Hematology: About 30% of triathletes demon-
   strate microscopic hematuria and 95% have a
   decrease in haptoglobin after an event. These
   numbers demonstrate that foot strike hemolysis,
   renal ischemia, and bladder contusions are fre-
   quent occurrences.


7. Infectious diseases: Fresh water swimming in
   high-risk areas has resulted in triathletes develop-
   ing leptospirosis. Lyme disease in endemic areas

540 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS