Sports Physician

While I was at University I developed a keen interest in marathon running. It was a welcome distraction from my studies. In those days injured runners rested and brooded over their injuries until they recovered. It was through my injuries that I learned to swim and cycle to maintain my cardiovascular fitness while recovering. This led to me competing in few triathlons, only to realise that I should stick with running! I have put together a few tips regarding injuries and medical problems.

The basis for successful triathlon competition is optimal training. Most triathletes are basically self-trained. It is important to realise that each person is different when it comes to what training is the best. Many fall into the trap of doing too much too soon. This can lead to overuse injuries.

Some common overuse problems are:

1) Swimmer's shoulder. This refers to shoulder pain initially noticed during the pull-through phase of the freestyle stroke. The medical term is "impingement", and refers to a group of tendons called the "rotator cuff" being "caught" at the top of the shoulder. There is almost always an underlying reason (for the "impingement"), which must be treated to prevent recurrence. For example, younger athletes often have lax shoulder joints, while the over forties develop mechanical problems in the joint. General advice includes reducing swimming distance, increasing body-roll during pull-through and reducing arm height during recovery. Specific treatment depends on the underlying problem.

2) Knee pain is most likely due to kneecap pain due to biomechanical causes like tight hamstring and quadriceps muscles, and poor foot alignment. Treatment may include stretching, better running shoes, or orthotics (custom-made insoles). Ongoing pain, and especially swelling means that there may be a problem inside the joint, which will need a doctor's opinion.

3) "Shin splints" refers to pain on the inner aspects of the lower leg, associated with increased running. This term is used very broadly, and includes problems like "compartment syndrome" which refers to pressure buildup within the lower leg muscles. Most of the time the pain is from tight soleus (calf) muscles pulling on the shin bone. Treatment includes a religious stretching programme, massage, and perhaps more suitable running shoes.

It is important to have the shin pain sorted out as soon as possible, as this can develop into a stress fracture if ignored. This scenario means many weeks’ rest from running!

A common medical problem encountered in winter months is the cold. One can train and compete with a simple cold. However, one should definitely rest when there is a cough or fever.

Warning signs are:

* An elevated resting heart-rate (over 10 beats per minute)

* Muscle or joint aches

* Tender lymph nodes (glands in neck, armpits, and groin)

* Severe fatigue

Most coughs and colds are caused by viruses, for which antibiotics are no help. I recommend seeing a doctor if the infection is more than a simple cold. Vitamin C may help prevent colds, and assist with recovery during training.

There are no hard rules, but generally the longer the illness, the slower the return to training. The above signs should be absent for at least 24-48 hours before starting moderate exercise. You may not be able to resume training at the same level as before the illness; I recommend building up over a period of week or two.

Moderate training enhances immunity, but heavy training and competition has the opposite effect. It can be frustrating catching a cold just before a competition, or just after a triathlon. High distance training is known to lower one's defences to viral infections to which one is usually immune. However, when putting in the long hours of training, one's body is often pushed at the limits, and not far from illness or injury.

Those with asthma will need to be cautious as asthma usually worsens with a cough or cold. This makes it difficult to train effectively, and one may need to increase medication accordingly.

Having a log book is essential, as this is a way of keeping records of your training, injuries, response to training, resting heart rate, and whatever else you wish to record. This becomes invaluable when planning the season, and keeping track of your progress.

If you have an injury or medical problem I advise consulting your friendly doctor!