Avoiding Dreaded Injuries: My Journey to the Irish☘️Ironman | Part 1: Injury Prevention |

For the unfamiliar the ironman is a triathlon which consists of three disciplines. The swim followed by cycle and lastly the run. The distance varies, you have the half ironman 70.3miles and the full ironman 140.6 miles. The full consists of the swim 2.4 miles in open water, the cycle is 112 miles and the run is 26.2 miles (full marathon). At present I am training for the first ever full Irish ironman held in Cork in June 2019. Very exciting times ahead ☝🏼.

Why did I choose to enter into this event?

I wanted to challenge my abilities and test my stamina as I have never had this opportunity to do so in the past. I am and have always been very driven, health conscious and relatively fit all my life. I am craving the buzz, the sweat and tears, the hardship, the sacrifices, the atmosphere, the feeling of success and accomplishment. Although I have not previously been in any shape or form an established cyclist or swimmer there is no certain age requirement or time that you must start a discipline. Many folk have started training later on in life, and many previous ironman competitors have been in their 60's, 70's and 80's. Yes, it is spectacular to witness this and I admire anyone who dares to take on the challenge in general, not a mind later on in life when most peoples perception is 'I am too old for that, my body won't hack it, my joints won't hack it, I have bad knees' etc. You must ask yourself whats the reason for your body not being able to hack it and can you actually do something about it?

This particular event will be special as it will be the first full Irish Ironman ever to be held in Ireland, therefore it will attract many international and European athletes, the atmosphere will be buzzing and no better way to experience this challenge than on my own turf.

Trail running! Good views!

What motivates me?

I am lucky I have never struggled with motivation when it comes to training in general, however some days I do struggle as the training program I am following by Ben Greenfield is 10 hours per week, intense but proven to work. I have mostly been involved in team sports as a child and remember being the first on the pitch and the last to leave. Why is that? Its the love for the sport and being around people who shared the same interests. The outcome of training is very appealing to me, I know that if I follow my training program I will be in the best shape of my life, at 30 years old, I will gain a strong healthy heart and lungs on the inside as well as the perks of having a nice athletic physique on the outside.

Quad stretching pre run!

Who is my 'Trinspo' (triathlon-inspo)?

There are 3, it would have to be Lucy Charles, a British World Champion triathlete and previous professional swimmer. She is a natural beauty, humble and kind, she demonstrates hard work ethic, drive, commitment, motivation and posts many a good pun 🙌🏼. Ben Greenfield, a American Exercise Physiologist is another one, many would call him a freak of nature. He is inspirational for the efforts he has put into discovering different ways to train and eat for this type of event.

Lastly, there is the ironman-cowboy, James Lawrence. An American legend in the world of triathlons for his shocking world record break with 50 ironmans completed in 50 consecutive days across 50 different states in the USA. And you think 1 ironman is crazy?! Although sustaining a shoulder injury in day 21 he still continued the challenge (of course he had medics alongside him for the duration advising him to stop), he didn't. He achieved something beyond your imagination.

Out on a trail run last week!

A little general intro there as I am not currently blogging on a weekly basis with my training due to time constraints, juggling three jobs and trying to fit in the weekly hours of training is very time consuming and exhausting. However, I will blog on certain topics I feel will benefit other people who are either training for fitness alone, for an event or even thinking of starting back post-injury.

Why is injury prevention so important 🤔?

As your local GP or health professional will tell you, prevention is always better than treatment for any aspect in life. Getting that head start of education and awareness on the potential implications of certain training programs avoids disappointment, saves money, time and allows you to perform to your best potential and abilities. There are also long-term clinical outcomes such as osteoarthritis. Building up a general knowledge base on the sort of common injuries you can sustain from your sport or type of training to reach your goals allows you to integrate certain tips n tricks and make better decisions 🙌🏼.

Endurance training for ultra-marathons and triathlons can ultimately lead to numerous sporting injuries due to the nature of the training- repetitive loading over a long period of time can often results in either short-term or and long-term musculoskeletal pain/conditions. When we take a triathlon into consideration it is likely that the running component will cause more problems as it is a high impact exercise when we compare it to cycling and swimming which is low impact and usually advised by health professionals for rehabilitation. As a physio working in this field I often see common sports injuries over and over again. Using evidence based research I can tailor a rehabilitation program around a specific individual to target their needs. Below I am going to talk and give my own advice regarding how I aim to avoid these common sports injuries whilst I am currently in the midst of my training for an ironman. Lets start with common injuries reported in the lower limb.

6 Common Lower Limb Injuries I must Avoid:

1. Planter fasciitis (DISCOMFORT FELT UNDERNEATH THE FOOT)

Yes this is the one everyone struggles to pronounce and spell☝🏼. A disorder of the connective tissue which supports the arch of your foot. Pain will be felt underneath your foot around the midst or heal region. Pain is often felt by bending the foot upwards toward the shin. Usually a gradual onset, affecting both feet in a third of cases.

RISK FACTORS: over-use, long periods of standing, running, increase of exercise and obesity.

💡HOW DO I PREVENT THIS?

A.) I have bought appropriate training gear/equipment including appropriate running shoes (my HOKA, Asics gel and New Balance). I choose these specific trainers because they provide more shock absorption, have broader base and are designed for long distance. I have high arches in my feet and depending on your own feet requirements you may benefit from wearing a certain make suggested by a podiatrist or other specialist. I always wear special running, hockey or winter socks which go up to my knees, in cold weather it is important to keep muscles as warm as possible whilst training as this can avoid muscle tension. When we are cold our core temperature maintains heat by constricting blood flow from the extremities allowing more blood to the vital organs, a survival mechanism. I wear rugby skins or even thermal clothes underneath on very cold days.

To learn more about fitting proper running shoes for your foot type have a watch of this video:

https://youtu.be/n-8eEyZVsUk

B.) I don't run ridiculous mileage everyday (for now I am running between 6-13 miles, 2-3 times per week, no more than this as its not needed at this point in time on the training program) I integrate HITT training such as sprint intervals, hill climbing and Crossfit (Crossfit I will be explaining later is a modified approach).

An excellent video explaining what occurs to our bodies when we run long distances, if you are a runner you will relate to this:

https://youtu.be/8xELvz8GMhs

C.) I stretch my feet pre and post sessions without fail. Basic lower limb stretches are carried out most mornings before activity and during my cool down.

A video demonstration on some helpful stretches for plantar fasciitis:

https://youtu.be/XINGaYD0Zz0

D.) I avoid any forefront running whilst on my longer runs. When heel-striking, much of the impact and loading is taken by the skeletal system, through the joints. However, with a forefoot or mid foot strike the muscles and tendons are positioned to better absorb the load, in turn offloading the joints. From a bio-mechanical point of view, this works well as long as the muscles and tendons (calf muscles and achilles tendons in particular) are ready for the task. If I have a lack of strength, mobility and stability around the ankle, the muscles of the lower leg will tighten up and/or suffer an overuse injury such as a calf strain or achilles tendinopathy. In the past from experience I have integrated some fore front running and my calves were super tight the following day which caused some discomfort even when walking. It can take up to three days for the muscle to loosen and gain length again, that is with regular stretching and heat.

Luckily for me in this situation I am familiar with MSK conditions therefore if I start to feel any niggles in this area I will address it by filing a small bottle of water and freezing it, then I would rolling my bare foot over the bottle for 5 minutes (this approach is good for pain management). Carrying out specifics stretches daily & often I roll my foot over a small hard golf ball. Reflecting on the changes and progressions I have made recently which may have had an adverse effect on this body part.

2. Achilles Tendinopathy & Tears (YOUR ACHILLES IS THE BIG TENDON ON THE BACK OF YOUR HEEL RUNNING UP TO YOUR CALF MUSCLE)

Another common overuse injury caused by repetitive energy storage and release with excessive compression. Pain can be felt mid-portion or around the heel region and is usually painful when walking or running.

RISK FACTORS: overuse, poor circulation, lack of flexibility, gender, endocrine or metabolic factors and larger muscle mass in the gastrocs (calf muscle)-which can place more tension on the achilles tendon.

💡HOW DO I PREVENT THIS?

For this common pathology I do stick to this routine below as I have had problems in the past with both my achilles. I was a sprinter in my youth and sustained a partial rupture of my right achilles tendon and a few niggles on the left. I received appropriate physio and was compliant with my rehab therefore made a good recovery. However, later on in life now I often feel a 'creeking' sensation when I crouch down low on my honkers or even squatting ass to grass. I gradually come up slowly from this position for fear a rapid acceleration upwards may cause further irritation. Having a previous tear its no surprise to have lumps and bumps which are some adhesions and thickening that come with the healing process. Remember damage would more likely occur from static to an explosive movement, which is how a lot of achilles tears can occur. Tendinopathies then are more likely from over-use/loading.

A.) Always stretching out my calves pre and post training I will hold my stretches for approx 20-30 seconds, static mostly, I do not bounce.

A video demonstration of how you can stretch your achilles tendon:

https://youtu.be/vU_FVahd4HI

B.) Again I am avoiding long runs pounding the roads I do trail running as it provides the softer surface, usually a bit more bounce. Trail running subjects us to SOFTER and UNEVEN surfaces which can be a great way to strengthen all the lower limb muscles, challenge your proprioception (knowing where your limb is in space) and adds more spice to your run. Note that trail running can still subject you to ankle injuries, mostly acute due to the nature of it and road running can often lead you to chronic ankle injuries due to the repetitive nature on the same surface.

A Sports Scientist's view on trail running V's road running- this video makes you think about moving on from running/marathons alone to events like triathlons, where you have a variety of disciplines ☝🏼:

https://youtu.be/tlJO3Q__hPU

C.) Again I avoid any fore front running. I use the visualisation of landing on the rear aspect of the ball of my foot rather than on my toes to help me get a comfortable mid foot strike. Another good cue is to see how close you can get your heel to touching down simultaneously with the forefoot without actually loading the heel. This will feel like you hit the ground first with your forefoot, then almost immediately lightly kiss the ground with your heel.

Here is a video which demonstrates a female runner who is fore front running - https://youtu.be/u-8XqI-GUDI

Comparing foot positions in running

Here is a video which describes some calf pain exercises for runners and gives you an overview of some of the risk factors:

https://youtu.be/sJtlwdHtwPo

D.) When I am strength training I often incorporate weighted heel raises (usually only about 15-20kg on the bar) to build up strength in the achilles tendon itself. If I continue with weighted heel raises I am building up more resilience in my tendons, this is vital in my situation where I have sustained achilles injuries in the past.

E.) I often palpate around my achilles and mobilise them by applying gentle transverse forces. This is just a habit I do since I had the injuries and its not mandatory that I do this but I like to monitor them closely, especially around this time.

F.) After weight training I would massage out any tension in the muscles worked, so I do some self-massage on my calves- one leg up across the other and knead into them like you would do doe in cooking, approx 15 mins of this. Another really good approach to release tension is HEAT, whether you use hot water bottles, wheat packs (with the beans in them) or bath in hot water. A foam roller can be used however be prepared for another upper body workout to get in a decent amount of rolling, I personally do not use this I prefer the other approaches. Everyone differs so do what suits you best.

A video demonstration of self-massage for the calf muscles:

https://youtu.be/IDvHxir7bXM

3.) 5th Metatarsal stress fractures/Other stress fractures in the lower limb!

5th meta-tarsal stress fracture

For this I follow the above routine. Repetitive jumping and high force/high impact activities can place you at greater risk of these injuries as well as an increase in your overall activities. Luckily for me I have not sustained any stress fractures in my feet or lower legs in the past. I do avoid any training which may subject me to these forces.

A video explanation on lower limb sports related stress fractures:

https://youtu.be/Eev1LxCNepM

4.) Tibialis Posterior Tendinopathy (PAIN/DISCOMFORT FELT ON THE INSIDE OF YOUR LEG AND OR DOWN TO THE INSIDE HEEL)

Here is another common tendinopathy seen mostly in runners which we now know how to avoid from the above. Treatment varies depending on the individual.

💡HOW DO I PREVENT THIS?

We can ensure that the tendons and muscles in your lower leg are strong by carrying out a specific strengthening program. Thankfully, I have not had this condition in the past. If I continue to follow the above I will be at less risk of this condition. If I start to feel a niggling in this area I will target this area with a theraband and carry out some isometrics (if very painful), if coping well I will do eccentric strengthening. Ease back on the running which is classed as higher impact and carry on with the two other disciplines swimming and cycling which are low impact and joint friendly. Return to graded exposure as the pain starts to subside.

A video demonstration showing you how to strengthen this specific tendon if you are experiencing any symptoms:

https://youtu.be/HnUw1oHqwUA

5.) Anterior Knee Pain (PAIN ON OR AROUND THE FRONT OF THE KNEE DURING LOADING)/RUNNERS KNEE.

This is a very common complaint in both athletic and non-athletic populations for differing reasons. We have all encountered family or friends who have come to us and mentioned their currently having pains in one or both of their knees. There are approx 15 different physiological causes for this knee pain. The bone, cartilage, bursa, soft tissues can all cause knee pain.

RISK FACTORS: high BMI, lower limb biomechanics, tight and weak quadricep muscles, other muscular dysfunctions, increased loading on hard surfaces, too much too soon etc.

💡HOW DO I PREVENT THIS?

In the past I have had small niggles in my right knee and usually my knee is irritated from doing heavy weighted squats. As squats have been trending of recent with the emphasis on growing the glutes (bootay) I don't believe its worth your time and effort. If you want to grow glutes- hip thrusters, resisted hip abduction and resisted kick-backs are the way to go. Isolating the muscle group works best as your typical squat mostly activates your quads (muscle in front of your thigh) this may explain why your legs are growing bigger and bum not so much.

A.) Stretching my quads daily pre and post training for approx 20-30 second holds. Tight quads can occur if you are training hard but avoiding the tedious chore of stretching regulary and also if you are not working the muscle and it becomes weak. Weak muscles are more likely to tighten, when muscles are tight it can create tension on the proximal joint. In the knee for example, the strongest part of the quadricep is the vastus lateralis which is the part on the outer side, when tight can cause a lateral mal-tracking pulling the patella (knee-cap) out of its groove which in turn causes pain. Sooo many other factors such as inflammation of the bursa, cartilage, ligaments can cause pain.

B.) Improving and maintaining my 'neuromuscular control'. This is how well I can control my movements when I am subjected to various tasks. For example, when I stand in front of a mirror and watch myself doing a single leg squat, will I maintain a well controlled movement or will my contra-lateral hip collapse, will my knees be swaying left to right, how low can I go? I am observing the quality of the movement and also the speed. Remember movements done slowly increase the difficulty. Poor movement control is usually a result of weak gluts (glut medius), muscles around the hip joint and weak VMO (the little tear drop muscle on the inside aspect of the knee). We can easily strengthen these muscle groups and with practice enhance movement control. Often I do carry out balance, proprioceptive and neuromuscular control exercises to test my abilities and monitor my progressions.

C.) Reduce any 'over-striding' when I am running. This is thought to increase impact forces on the knees and hips.

D.) Again avoiding the long runs on hard surfaces (the roads) as the force applied on the knees is much greater than on the ankle and hip joint.

E.) Once again, appropriate foot wear is required. Many people with pronated feet or people who have problems starting at the foot can lead to problems in the knees. The lower limb biomechanics is all linked.

F.) I use heat a lot on my quads, sitting at night having my dinner, studying or watching tv I usually fill a hot water bottle and leave it sitting on my lap. I find this helps my quads relax.

*Patellar Tendinopathy is another common cause of knee pain. The pain is usually localised directly on the patellar tendon, painful to touch and on loading. Often occurs in the young and adult population who are over weight and exercise infrequently. Other causes are due to high impact activities. Isometric wall squats (3 sets of 15 reps for 5 second holds) can be a good start to strengthen the tendon , they are many other ways to mange this condition, always speak to your local physiotherapist for assessment and treatment advice.

6.) Gluteal Tendinopathy/Greater Trochanteric Pain (PAIN FELT ON LATERAL ASPECT OF THE HIP)

This condition affects both athletes and less active individuals. Females tend to be affected more than males. Due to the location of this pain it can affect quality of life, with similar symptoms to those of OA (Osteoarthritis). It interferes with sleep (side-lying) and weight bearing tasks. People often report pain when crossing their legs in sitting.

💡HOW DO I PREVENT THIS?

A.) Running in general again can cause this condition, running requires tendon stretch-shortening cycle, may include adduction during impact if control is poor. Therefore another reason why my training is a greater percentage of swimming and cycling overall.

B.) I avoid running with a narrow base of support, this exacerbates hip adduction angle leading to compressive and tensile loads. I therefore widen my base of support by keeping my ankles further apart when running.

C.) I avoid too much hill climbing and running up inclines. This movement adds hip flexion to adduction and may require more pelvic control. Doing this activity in excess can cause irritation to soft tissues around the hip joint.

D.) Again, I avoid 'over-striding' when running, as this is thought to increase impact forces in the hips. I do increase my stride lengths when I start to fatigue (to cover more ground) and this is ok because its not for long periods of time and I ensure that its more of a gliding hovering movement rather than springing to gain height (the greater height I achieve the more landing force generated, not ideal for distance running).

E.) I avoid running in the same direction around a track. The reason for this is it exacerbates hip adduction angle leading to compressive and tensile loads. For example, if you have weak ankles or previously suffered some form of ankle injury and walked for miles or gone for a run on the beach by the shore where its not flat even surface and noticed some mild or significant discomfort around your ankle joint the following day? Same principle! This is why I never advise people to constantly train the same way, mix it up to avoid problems like this arising.

F.) I avoid hip hanging in the standing position. Us girls typically are guilty of this one or mothers holding their babies on the hip. This increases tension of the ITB, compression and may lead to abductor weakness.

"A winner is a loser who was willing to fail and get up, fail and get up, fail and get up, fail and get up and win"

Peter Zafra

In summary, no matter what trick you have up your sleeve it is hard to avoid sports injuries. I can carry out the above and more however I may still easily sustain an injury, the key is knowing how to reduce the likelihood of these specific common injuries occurring. We can rely on the evidence base and research to guide us in the right direction but in the practical world we cannot expect to remain injury free when we are subjecting ourselves to greater distances and forces over time. Education has reassured me that the human body can withstand masses amounts of stress applied to it, our soft-tissues have the ability to adapt, grow, heal and strengthen. Some days when I am training I have to remind myself 'less is more', more or less! For strength gains allow your recovery day. At present in my training program I have one rest day per week, this can also be a active recovery day depending on how I am feeling. In order to continue over a long period of time rest is so important for the body and soul. I am at risk of burnout if I do not take appropriate rest periods.

Building recovery time into any training program is important because this is the time that the body adapts to the stress of exercise and the real training effect takes place. Recovery also allows the body to replenish energy stores and repair damaged tissues. Exercise or any other physical work causes changes in the body such as muscle tissue breakdown and the depletion of energy stores (muscle glycogen) as well as fluid loss.

Recovery time allows these stores to be replenished and allows tissue repair to occur. Without sufficient time to repair and replenish, the body will continue to breakdown from intensive exercise. Symptoms of over-training often occur from a lack of recovery time. Signs of overtraining include a feeling of general malaise, staleness, depression, decreased sports performance, and increased risk of injury, among others.

It is important to make your training fun and safe, it is easy to fall into unhealthy or strict eating and training routines, especially with all the hype today the fitness industry is in our face. Every few weeks I reflect on my progress and how I am feeling on an emotional and physical level. I keep a diary and jot down my achievements (times and distance) for that day. For now its tough being in the midst of the training, I hope to continue my journey enjoying every session injury free 🤞🏼.

"You can keep going and your legs might hurt for a week, or you can quit and your mind will hurt for a lifetime"

Mark Allen

To be continued.........