Written by: By Nathan Koch and Matt Kraemer
You don’t cut any corners on your training to perform at your best. You have every minute of every day scheduled to make sure your training is complete. You account for every single calorie. Your equipment is state-of-the-art and tuned to precision. Even your work vacation days have already been allocated in advance in preparation for your race. But there was an unforeseen bump in the road: an injury. How could this happen? Everything was planned to the most minute detail. Now what? What caused it and how do you fix it?
You search for keywords such as “knee pain” and “running” on the Internet in an attempt to self-diagnose and even self-treat. A lot of good information on injuries and injury recovery is available, but this can only provide ideas. This information should come with a warning, such as “relieves injury-induced insanity only temporarily” or “may be hazardous to your health (if you are the worst-case scenario type).” Gathering information is a logical and natural first step. However, the decisions you make next are time-sensitive and critical to achieving top form for race day.
Finding the right practitioner to treat your injury is the key to resolving your injury and figuring out why it happened in the first place. The person you choose to treat your injury should be knowledgeable in your sport and the demands it places on you. She will be able to talk you down off the wall and calmly explain the cause of the injury and how to fix it, suggest a timeline for return to normal training and—most importantly—say what you can do for exercise while injured. A triathlete without the ability to increase his heart rate is like a caffeine addict without coffee.
Unfortunately, the stereotypical triathlete is addicted to both exercise and caffeine. Abort mission if your medical practitioner tells you to rest and take meds and wonders why you spend so much of your weekend training. Be conscious of the amount of time he spends with you. Is he interested in the details, or just in getting to the next patient? Make sure that the plan of care that you develop with your practitioner is specific to your injury and goals, and not just a common prescription to a diagnosis. Keep in mind that you alone determine the members of your performance training team.
A general practioner, sports medicine physician, orthopedic surgeon or physical therapist with advanced knowledge in triathlon can be an integral part of your training team. Team-sport athletes at all levels are surrounded by health and performance staff to address all their needs. It should be no different for triathletes.
The biomechanics of swimming, biking and running are each very different and equally important. These mechanics impose special demands that are different from those of everyday activities performed by the general population, and your practioner should realize this. Regardless of which practitioner is treating you, she should have an in-depth background in all three disciplines and a firm grasp of the physiological requirements to compete in them as well. If she is not familiar with the activity, equipment, nutrition, training schedule or demands on race day, how can she effectively evaluate, diagnose and then provide a solution to the injury?
To accurately determine the source of your injury, it may be necessary to observe any possible faulty mechanics. Observing your swim stroke, cycling position and/or running gait can provide the crucial technical information necessary to fix the cause of the breakdown. Typical scenario: A triathlete complains of Achilles tendon pain first noticed while running after the bike during a group brick session. It progresses to hurting during all running and cycling. Diagnosis is Achilles tendinosis.
There is a wide range of acceptable treatments for this condition. Let’s say this triathlete was treated with physical therapy and rest. He improved and was running and cycling pain-free in three or four weeks. Another couple of months go by and the pain returns. Obviously, frustration sets in. The triathlete seeks the advice of a triathlon-specific physical therapist. After the initial discussion and examination, the therapist puts the bike on a trainer to check the rider’s position. This analysis reveals that the cleats are too far forward and the seat is too high. Once the bike position is adjusted and tendinosis treated, the triathlete is once again pain-free and able to train with greater confidence and less fear of a recurrence. If a practitioner doesn’t have a bike trainer or a decent treadmill in the office, it’s a good indication that working with triathletes is not his forte.
Video analysis software is also a nice bonus that can provide instant feedback to the practitioner and the athlete. Yes, in some cases the pain is too severe to have you perform the affected activity, but after a period of healing has taken place, movement assessment is crucial for a full recovery.
A great way to find members of your medical performance team is by talking with other triathletes you train or race with, as well as the staff at the shoe or bike store you frequent. Some triathlon clubs and teams have already made alliances with various practitioners and will even offer special rates and times for priority scheduling. Many doctors, surgeons and therapists advertise themselves as specializing in triathlon, and they may even train and compete in triathlon as well.
Do your homework by visiting the facility, looking at the company website and interviewing the practitioner prior to making your choice. Do not be afraid to get specific and ask questions about the doctor’s experience in this sport, if he’s treated you type of injury before, his overall success in treating patients, and how many triathletes does he treat on a regular basis.
Remember that what works for one person does not always work for another. Maintain good communication with whichever practioner you choose, be candid with your goals and provide ongoing feedback. As in any well-functioning relationship, trust and honesty are important. You play a major role in determining the success of your injury recovery. While triathlon is not a team sport, it does require a team approach to achieve maximal potential in a healthful manner.
Nathan Koch, PT, ATC, is based in Scottsdale, Ariz., and Matt Kraemer, PT, ATC, Is based in Phoenix. You can find them at Endurancerehab.com.