Identifying the ‘root cause’ of your injury…don’t blame the shoes!

May 20, 2019

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Common Causes of Injuries in Triathletes

I once heard Dr Paula Charlton (clinical Doctor of Physiotherapy at the Australian Institute of Sport) say that ‘once an athlete has sustained an injury, they will NEVER be the same again’. Scary thought huh? Now you’re probably thinking that everything heals with time, and you’re absolutely right. If you suffer from a soft tissue or skeletal injury, chances are that after a few weeks, months, or even years (hopefully not!) worth or rehab, the injury site will heal. However, despite the injury site healing, the fact is that the athlete will never be the same again.

Physically there may be residual scar tissue, or weakness at the site of the injury, but the permanent effect of the injury is more psychological. The athlete will never be able to ‘forget’ the injury and will forever be aware of that experience, it’s impact on their performance, and the inherent risk of it reoccurring. The extent of this impact will of course be influenced by the severity of the injury, which for an athlete might be measured by cost of rehabilitation, the amount of time away from training, missed competition, disappointing competition results, or even time off work.

Triathlon Injury and Training Overload

In the sport of triathlon, over 80% of injuries occur during training, and of these over 80% are in the lower limb (Andersen et al. 2016). Most commonly knee, ankle, foot, calf, Achilles, and bony stress injuries, which are most likely to be caused by running or cycling (or a combination of the two). But one of the most alarming stats around injury in the sport of triathlon, is that 90% of these injuries are caused by OVERUSE! Which is another way of saying ‘incorrect training load’ – whaaat!?

So 90% of the injured athletes kicking around in the sport of triathlon (and I know there’s a tonne of them), are in that situation because they AND their coach (assuming they have one) have failed to manage their training load. Yes, training load and physical strain is required to create performance gains, BUT for every 10% increase in training load, there is a 50% increase in the risk of muscular strain (Hellard, P. et al. 2015). And so the way an athlete / coach manages the increase in training load (which could be measured by effort and/or duration) needs to be such a delicate process, and done so within the ‘safety’ of less than 10% increases in load between any given session, day, week, cycle. Not only do we need to stay within the 10% rule (ideally more like 6%-8%), the human body was obviously not designed to simply take on an extra 10% week-in, week-out and see perpetual improvement. Which is where the reduction in training loads come into the picture. It is only during a reduced load (‘recovery’) phase, placed off the back of an adequate ‘build’ that the body will absorb, heal and adapt to the new level of fitness before getting ready for the next load increase. It is during the reduced load that the athlete is actually improving their performance – not during the building phase.

The challenge with this is that if /when an athlete starts to experience and injury, they can have such a narrow view on the possible causes of the injury. For example, you start to experience pain in your knee while out running after getting a new pair of shoes. Your first reaction is ‘it must be the shoes!’. So you throw them away (hopefully into a donation bin) and swear you’ll never use that brand of shoe again. BUT, as you can see by the above, there is so much more at play here than just the shoes, and I can guarantee you, that it isn’t the shoes in isolation. Yes, the shoes may have been the venting source for your pressure cooker, but it wasn’t the root cause.

Take a look at your training load. How rapidly was your load increasing. Did you try the new shoes during a ‘higher injury risk phase’ (ie. during a build)? And how high was that build? Was it within the ‘safe’ parameters of less than 10%, or was it higher than that? There is a good chance that if you take the time to reflect on the bigger picture, you might be able to see other contributing factors that resulted in the final trigger of the new shoes while out running.

Other Contributing Factors

Beyond training load contributions to an injury, an athlete and their coach should also reflect on their nutrition, sleep patterns, life stress levels, strength and conditioning, and mobility and movement patters. In addition to managing training load, there are so many factors that can be adding to the pressure within your ‘cooker’ that is just building up, ready for the opportunity to crack that pressure release valve.

I’ll be delving into some of these other injury contributors in future articles, but for now, my advice is – don’t blame the shoes! Look deeper into the bigger picture to see what else is contributing to that outcome.