Category Archives: Periodization of Training

Prevent injuries with defensive planning

Being injured set up back on your schedule and can psychologically as well. I’ve had more than a few injuries and am in fact, being treated for two now.  If you want to avoid these set-backs, please read on. This excellent excerpt reprinted with permission from Human Kinetics of Triathlon Workout Planner by John Mora.

“The biggest key to avoiding injury is really quite simple in concept
but much, much harder in execution—high adaptability. What does it
mean? Adaptability means that at every stage of your triathlon odyssey,
from planning to training to racing, you must be receptive to your
body’s signals in order to make quick and timely adjustments.

When setting up your training plan, it’s vital to plan and execute your
training defensively. You’ve all heard the term that the safest drivers
drive defensively, with a vigilant mindset and the wherewithal to
recognize dangerous behavior. If you want to safeguard your body and
avoid injury, planning your triathlon training with the same kind of
defensive mindset is the single best thing you can do for yourself.

As you sit down to plan your schedule, listen for those instincts that
may be telling you you’re overloading yourself or stacking too many
workouts on top of each other, which may break down your body. Besides
listening to your gut, you can use the following tips for planning your
training defensively:

  • Plan your running carefully. Unless you are one of
    the few triathletes blessed with the perfect runner’s body, flawless
    form, and near-perfect technique, pounding the pavement is the activity
    (of the three disciplines) with the highest probability of injury. A
    five-year study by Staffordshire University of 116 triathletes with
    differing abilities—from elite triathlete to weekend warrior—showed
    that 58 to 64 percent of all overuse injuries stemmed from running
    (Vleck and Garbutt 1998). Be very careful when increasing distance or
    intensity abruptly, without giving your body a chance to adapt. Always
    plan an easy workout after a high-intensity or long run and never
    increase your total weekly running distance by more than 10 percent
    from week to week.
  • Lean toward safety. There may be several critical
    points in your training at which you feel a certain workout may be
    pushing it or that your body’s ability to safely finish that extra long
    run or that unusually hilly bike ride is suspect. Although some measure
    of risk is acceptable, there’s no shame in playing it safe by reducing
    the intensity or distance (or both) of these demanding workouts. If
    your gut tells you that you may be skirting that fine line between
    better performance and injury, err on the side of caution and make the
    necessary training adjustments. As you sit down to plan or review
    upcoming training, shave off some distance, notch down the intensity,
    or consider an easier course if you feel that your body may be on the
    brink of overuse.
  • Avoid the superman syndrome. Anybody who has ever
    had a sports injury can probably point to a specific workout or a
    series of efforts over a short period of time that caused it. Unless
    injury is caused by something traumatic—a fall on the bike, a dog bite
    on a run—the root cause is usually overuse that can be clearly mapped
    in a training log. So if it’s so easy to document an injury afterward,
    why is it so hard to avoid one? Part of the answer is that we become so
    attached to our training that our self-image and ego become entangled
    in it, making it hard to accept the blatantly obvious warning signs.
    This so-called superman mentality can fool you into believing one more
    track workout or one extra set of ascending laps will do no harm.
    That’s why reviewing your daily training log entries from the previous
    weeks and months on a consistent basis is so important—it keeps you in
    tune with the reality of your recent training. Examining your log can
    provide valuable evidence that an injury may be imminent, giving you an
    opportunity to dial down training and allow your body an opportunity to
    recover from any cumulative muscle tissue damage from several weeks of
    tough workouts.

During demanding peak training periods, make some time to take
a deep breath (literally), step back, and examine your training with an
objective eye. Doing so can help you to better see warning signs so
that you can adjust your training to avoid injury.”

Runners Knee Injuries

I’ve rarely talked to a runner who has not had a knee problem at some point in their running background. The following excerpt from “Healthy Runner’s Handbook” does a terrific job of explaining some of the sources.

“The knee is the largest and most complex joint in the body. Given the enormous stresses to which it is subjected during running, it is natural that knee injuries are common among runners. The potentially debilitating consequences of a knee injury reinforce the need for a focus on prevention.

Knee overuse injuries include patellofemoral pain syndrome (kneecap pain), meniscus wear and tear, tendinitis conditions both above and below the kneecap, bursitis, and loose bodies in the knee.

Overuse knee injuries are usually caused by excessive running, but can be caused by intrinsic risk factors such as poor conditioning or muscle imbalances, and anatomical abnormalities such as a difference in leg length, abnormalities in hip rotation or the position of the kneecap, bow legs, knock knees, or flat feet.

Knee function depends on the highly complex interaction among a number of the surrounding muscles. The most important actions are performed by the quadriceps (straightening) and hamstrings (bending) in the front and back of the thigh, respectively.

Imbalances in strength or flexibility between the quadriceps or hamstrings can predispose the runner to a common overuse knee injury called patellofemoral pain syndrome, which is usually caused by the kneecap tracking improperly in its groove at the front of the bottom of the thighbone. Often, this problem is caused by the excessive tightness of the hamstring muscles in back of the thigh compared to the quadriceps muscles in front of the thigh. In such circumstances, the quadriceps cannot maintain the proper straight-ahead alignment of the lower and upper leg when the person runs; as a result, the lower leg “spins out” during the running cycle, which in turn causes excessive stress to the outer side of the kneecap.

Another common imbalance within the quadriceps muscle group in the front of the thigh, between the outer quadriceps muscle (vastus lateralis) and the inner quadriceps muscle (vastus medialis), can also cause kneecap problems. These two muscles run down either side of the front of the thigh and attach to the kneecap. Part of their role is to stabilize the kneecap. When one side is stronger than the other, the kneecap can be pulled to one side when the person runs. Since runners frequently have comparatively stronger, tighter outer quadriceps muscles than inner quadriceps muscles, the kneecap can be pulled to the outer side. This mechanism is a common cause of patellofemoral pain syndrome in runners.

Tightness in the iliotibial band – a thick, wide band of muscle-tendon tissue running down the outside of the thigh from the hip to just below the knee – is the underlying cause of one of the most prevalent overuse injuries of the knee in runners, a condition known as iliotibial band friction syndrome.

Anatomical abnormalities are the second most common intrinsic risk factor. Several are closely associated with overuse knee injuries in runners:

* Flat feet, or feet that excessively turn inward (pronate) when the person runs – Inward rotation of the lower leg causes the kneecap to track improperly (see page 11).
* Knock knees – Excessive inward angling at the point where the thigh and lower leg meet (Q angle) causes the runner’s weight to be borne on the inside of the knee; an angle of greater than 10 degrees in men and 15 degrees in women is said to predispose that person to knee problems if he or she participates in a rigorous running regimen (see page 13).
* Bow legs – Greater distance over which the iliotibial band must stretch over the outside of the leg may cause tightness at the point where the iliotibial band crosses over the outside of the knee joint (iliotibial band friction syndrome; see page 13).
* Unequal leg length – In the longer leg, the greater distance over which the iliotibial band must stretch may cause inflammation in this tissue over the outside of the knee, perhaps causing iliotibial band friction syndrome (see pages 14-15).
* Turned-in thighbones – Inward-facing kneecaps characteristic of people with this abnormality may cause tracking problems in the kneecap (see page 12).
* Loose kneecaps, high-riding kneecaps (more often seen in very tall people), shallow femoral groove (the groove at the bottom of the thighbone in which the kneecap lies is too shallow) – All three of these anatomical abnormalities can cause the kneecap to track improperly, sometimes so severely that the kneecap completely slips in and out of its proper position (subluxation).
* “Miserable malalignment syndrome” – The combination of thighs that turn inward from the hip, knock knees, and flat feet can cause many problems.

Extrinsic risk factors associated with overuse knee injuries usually involve training errors, inappropriate workout structure, and improper footwear. “

Triathletes and Injury Prevention

Having spent many years training for fitness, it wasn’t until the last few years I became aware of how delicate a balancing act it can be of knowing how and when to push yourself toward greater fitness and avoiding injury.

I have had many injuries and hope I’ve learned how to approach training with the long tern goal of staying healthy and injury free. I would often push myself too hard when I did not need to or it was not the right time to push. Maybe I did not give myself enough of a rest, either between intervals, sets, or laps. It absolutely is a science and the more I read and study, the more I am able to understand when and WHY I do the things I do.

With the idea of sharing that, I posed several questions to my physical therapy group that helps heal me, Elite Physical Therapy in Charlotte, NC. Kelly Floyd started this the group and Joe and Lesley have joined in the last year. They are immensely qualified and have vast sports experience themselves as well as treating patients of all ages and ailments.

I treasure their input and advice. Here’s some advice I hope you can learn from as well.

What are the training rules of thumb and why are they important to follow?

Always break a sweat before stretching. Think of your cold muscle as a piece of bacon out of the freezer. You bend it and it breaks! Heat it up and it bends much easier!

It all starts with the core, the area of your body from your diaphragm to your groin. When running, jumping, cycling, swimming, or weight training, sitting, standing, bending, you name it, keep your spinal alignment perfect. Your spine is made to be stabilized, not twisted and bent. That’s what our other joints are for.

When increasing your mileage/running time or weight lifting, especially if you have not trained in a while, live by the 10% rule. Don’t increase your training initially by more than 10% per week. For example if you have been running for 10 minutes 1 week, don’t increase to 20 minutes the next. Try up to 5 minute increases each week. We sometimes tell our patients that if they are running every other day up to 4 days per week, try adding 1-2 minutes onto each run for the week for a total of about 5 minute increase in time per week.

As for weight training, try to only increase your resistance if your form is perfect for 2-3 repetitions in addition to your planned repetition stopping point. For example, if you had planned to do 10 repetitions with 50 lbs, if you could perform 12 repetitions with 50 lbs with perfect form, you would be able to lift the next time with 10% more weight (55 lbs) at 10 repetitions.

As to not sound redundant, most of the overuse injuries can be prevented with a gradual training program and adequate rest. But for those athletes just starting out without knowledge of their own body, it’s best to see a sports medicine specialist (physical therapist, orthopedic surgeon, athletic trainer, some well-respected personal trainers, contact local triathalon clubs for information on these specialists). These specialists can assess your muscle imbalances and functional strength, assist with appropriate shoe-wear, nutritional requirements, and make necessary training corrections in mechanics to optimize your training.

Are there any training practices specific to triathlon athletes should adhere to?

Triathletes need to understand that the specificity of their training comes from performing 3 consecutive events sustaining a relatively high intensity. Therefore program optimization would be to carry this idea into your cross training as well. For example, Pick 3 consecutive exercises, (push ups, pull ups, squats) and maximize your effort on all 3 for a certain period of time. This type of training develops anaerobic power, or the ability to work through the burn, utilizing large muscle groups. Another example would be to get on a spin bike for a mile as fast as you can, then the treadmill for ¼ mile as fast as you can, then do 1 minute of step ups onto a 8-16 in. box as fast as you can.

Your practice sees many athletes after they have injured themselves. Given your experience, what are some things triathletes can do to prevent injury?

Hydrate! Your muscles need the correct electrolyte balance for optimal contraction. If you are lacking fluids pre- or post- training, your muscles lose efficiency to contract and then you may sacrifice proper technique, cramp, or strain a muscle.

Rest and Nutrition! Sleep is a triathlete’s best, but often unappreciated friend. Plan your training to allow for maximal rest the day or night after your hard training day. Also, periodizing your programs will permit proper work to rest training days working up to the event.

Shoe-wear! A lot easier to say than do, but a proper shoe-wear assessment by a physical therapist, podiatrist, or pedorthist can be a life-saver as your mileage and intensity increases. Also, make sure you have 2 pairs of shoes to rotate at least 48 hours between because the EVA rubber in the shoe heats up and needs time to cool down to regain its properties.

Professional Movement Assessment! Along the same lines as a shoewear assessment, a physical therapist can assess the entire body from heel strike to leg swing, from pedal stroke to breast stroke to determine faulty kinetic links in your triathlete body. Many times overuse strains and sprains can be prevented before heavy training begins by a full body athletic movement assessment.

What role does technique play in athletic performance and injury prevention?

Technique can affect efficiency and spinal control. Many overuse injuries come from your muscles’ inability to slow a body part down. This is called an eccentric contraction, and this type of contraction is where muscle strains show their ugly heads…usually right when you are pushing to the next level of training. The overuse injury can often be avoided by improving your efficiency of movement, in other words optimize your muscle’s overall ability to contract, especially eccentrically.

As for spinal control, excess spinal motion leads to uneven wear on your spine’s joints. It also leads to unwanted motion that your extremities need to control. Say you use your quadriceps muscles 10% more when cycling by leaning side to side vs. keep your spine still. You are already fatiguing yourself for the run portion, and the extra 10% muscle use can affect your technique in the last leg of the race

What are the most common injuries you see in triathletes and how can they help prevent them?

Overuse injuries– The “ itis’s “(tendonitis, bursitis) Usually at the foot, ankle, knee, hip, shoulder. Usually caused when training is increased too dramatically too soon, or when the body has not rested the necessary amount.

Stress Fractures– especially of the navicular in the foot and top of tibia in the leg. In women stress fractures may be more prominent, especially in the leaner female triathlete, where the body fat percentage is low.

Joint Pains/Muscle strains– Cause by muscle imbalances, overtraining, poor knee alignment, hip abductor weakness, incorrect shoe-wear, improper postural habits while cycling.

I wholeheartedly recommend them and if you have questions feel free to contact them at:

Elite Physical Therapy
2630 E. 7th Street, Suite 206 •Charlotte, NC 28204
Office: 704.333.1052 • Fax: 704.333.1054

Here’s alittle about them:

“Kelly Floyd, president and owner, graduated with a Masters in Physical Therapy from University of North Carolina at Chapel Hill. Kelly is an active triathlete and former collegiate basketball player as well.

Joe and Lesley Tedesco graduated with their Doctorates in Physical Therapy from Duke University and are also Certified Athletic Trainers. In addition, Joe is a Certified Strength and Conditioning Specialist. As former athletic trainers for the University of Florida, Joe cared for the men’s basketball team and Lesley worked with the women’s volleyball team. Both have experience initiating functional training programs to professional, collegiate, and high school athletes.

At Elite Physical Therapy, we emphasize a hands-on-approach to treatment of orthopedic dysfunction of the spine and extremities. Our services also include movement assessment rehabilitation, injury prevention programs, therapeutic massage and/or strength and conditioning consultation for all sports and fitness levels.

We believe in community outreach and promise dedication to excellence using effective programs to keep our community’s athletes healthy now and in the future!”