Overuse Injuries or Cumulative Trauma Disorder
A study reported in The Journal of Orthopedic and Sports Physical Therapy follows 131 tri-athletes before and during their competitive season. 50% sustained an injury in the 6 months pre-season, 37% during their 10 week competition.
Out of these injuries, 68% of the pre season injuries were related to overuse compared to 78% of the injuries during competition.
Factors that play a roll include: years of experience, high running mileage, history of previous injury and inadequate warm up or cool down.
Most common overuse injuries for tri-athletes per event:
Swimming: impingement syndrome, due to multi directional instability of the shoulder (“loose shoulders”) as well as poor posture
Biking: IT-band cross friction syndrome at the knee as well as Patello-Femoral syndrome (irritation of the knee cap)
Running:Plantar Fasciitis, shin splints and stress fractures.
One of the most common causes of cumulative trauma is the inability to control pronation. Pronation is a normal movement pattern that takes place in the body as it stores or absorbs energy. It occurs at every joint in the body, but particularly in the feet. The inability to properly absorb load in the foot joints will lead to excessive forces elsewhere, usually in the joints closest to the foot: the knee and hip. “Easy” fixes such as new or better shoes, over the counter inserts or custom orthotics don’t always cure the problem: driving around with a bad shock can wear the tire on your car. Buying a new tire will not fix your shock!
A functional evaluation of your body will establish if you are pronating and are unable to control it properly. The evaluation takes about 1 hour and looks at all the joints in your body, the way they interact or not and how you compensate for this.
The most common weakness in the link of joints and muscles lies in the hips. Very few athletes will specifically train their hip muscles, especially the smaller rotators. These muscles play an important roll in stabilizing your thigh bone (Femur) and the ability for your feet, ankles and knees to absorb shock. A few simple exercises can assist you in preventing a break down in this chain.
Remember that most overuse is cumulative, not from running too much or too long, but from running consistently with an improperly balanced body. Not from swimming too many laps, but from swimming without proper stability. Not from biking too long, but from biking without the right mechanics.
As a well conditioned tri-athlete, you have the ability to continue training and racing by compensating for a very long time. But sooner or later this will lead to a break down i.e. overuse injury of which the origin can be difficult to track down, especially if it has been masked for a long time. The eventual complaint or break down may not be the actual cause of the problem.
If you experience excessive fatigue, chronic pain or soreness that does not improve with rest, you may be setting yourself up for cumulative stress disorder or overuse trauma. Listen to your body and don’t be afraid to stop training and ask questions.