The Ironman/long distance triathlon blog series

Part 3 : Injury Prevention; numero uno in endurance training

If you’re not in, you can’t win.  One Ironman survey participant put it bluntly with his/her piece of advice, “No. 1 rule, don’t get injured”.
This blog is going to try to lay out the top tips to stay off the physio’s patient list!  You might have noticed I didn’t use the old cliché to stay off the physio table.  That’s because I happen to have a little bug bear around that.  When it comes to overuse injuries (stress fracture, shin splints, achilles tendon, calf strain, frontal knee pain, runners knee, IT band, tendinopathies etc.) and you attend your physio, there needs to be an in-depth discussion about your training volume/speed/recovery leading up to the injury.  This chat should happen before you throw yourself up on the table.  The interview, if carried out properly, will steer the diagnosis hugely.  At that point, the table can be used, but only to carry out a series of objective tests in order to confirm or disprove the diagnosis.  Then, and only then, should a finger be pressed against the area looking for the “ow” from the patient.  This logical work up of questions and tests will allow for a non-biased approach and better patient care.  
Let’s move on with the blog now that I’ve got that out of the way!  I plan to stay regimented and straight to the point with this week’s post using bullet points to keep me right.  If you make these part of your endurance training plan, you will have a significantly lower risk of overuse injury.

• Keep your easy sessions easy and your hard sessions hard.  You may have heard this been thrown around your training circles and to be fair, it’s a solid piece of advice. It really follows on from last week’s blog, here where we spoke about the importance of zone 2 training.  If you are dedicating a block of training to zone 2 intensities, then keep these sessions easy.  You may be tempted into working harder because you may believe it will lead to greater fitness gains.  After reading the 2nd blog, I’m hoping those beliefs are now banished.  This tip is simply asking for discipline, so that if you enter a block of training containing tempo sessions (Zone 3) and threshold efforts (Zone 4), then work hard for these sessions and hit the target heart rate/power zones. 

 
NB: It is so important to not interpret the zone 2 recommendations as a blanket recommendation that everyone should do.  Zone 2 training is not useful for someone who already has impressive metabolic efficiency at low intensity training.  They already have high capillary content and mitochondria density, so they are better working in the zones where they are not as efficient.   Gas analysis fitness testing finds out where the client is inefficient, their physiological limitations and the intensities where they do not train.  The advice is to start training where the client doesn’t usually train.  This is called training variability and it is vital to any well-rounded training plan.
 
The Running Shoe
This one may cause a stir amongst my readers!! I'm gonna conserve my bullet points and go in all guns blazin' here! There is no scientific evidence to show that changing running shoes after a certain number of kilometres have any bearing on injury risk.  We know the manufacturer of the shoe sets out a number of kilometres where they recommend changing the shoe like you would the tyre on a car.  There is no research showing this to be the case.  There is also no conclusive research showing the need for a stability shoe to help control over-pronation, or likewise the need for a neutral shoe for those who don’t have fallen arches or otherwise known as over-pronation.  There is a study however with a large sample size where they followed runners for 1 year.  The participants of the study were graded in terms of their foot position from one of supination (high arch) all the way to pronation (flat foot).  The results were interesting in that injury rates were lowest in the group where the foot position was between 7-10 degrees pronation.  This group had injury rates significantly less than all the other groups.  This tells us that a flat foot can be seen as an advantage with respect to running injuries!  To second that statement, there are no studies showing a relationship between over-pronation and increased risk of injuries.  To stay with the science here, the reason why general wear of the cushion in the shoe after so many kilometres is not a reason to go to the shops or online to buy another pair is because there is no research connecting cushioning properties to injury risk.  What may entice you to the shops is when you feel your shoe is no longer as comfortable after however many miles.  That’s the right time to change them.  Comfort is now the new paradigm in the world of running shoes instead of cushioning and pronation.  Comfort is a vague term, it’s difficult to define and to quantify and it’s very subjective, I know.  More research is needed, but for now, the comfort filter is backed by science.  In summary, is that the research does not support the requirement for neutral shoes, stability shoes or hoka shoes in order to reduce injury risk.  In practical terms, you should try on lots of shoes and go with the ones that feel the most comfortable.  If they still feel comfortable after 6 years including the 2015 Dublin marathon under their belt, then that’s absolutely fine and will not put me at increased risk of injury!  I say this because it’s true.  Myself and Aisling ran the 2015 Dublin marathon together, and stayed together for the entire thing.  We still run in the same runners! 

A show and tell video with the famous shoes and a little piece on barefoot runners.

Allow adequate recovery.  This is a huge topic to cover so I’ll keep it to the following points

• Zone 2 sessions require much less rest and recovery between them.  There is no issue with training consecutive days in zone 2.  The same could be said for zone 3 (tempo).  Once the athlete is experienced and has years of training under their belt, then tempo training sessions can be carried out over consecutive days, but nutrition and sleep quality would need to be paramount during such a training block. 
• Follow a structured progressive plan that includes a recovery week every 4th week.  Be kind to your body and allow it to recover by not continuously applying a progressive training stimulus to it.  Overtraining and overreaching are one sure way of getting yourself injured.  The research backs this up as well, showing stagnation and even reversal of fitness with overtraining.  One well known metric called Training Stress Score (TSS) allows you to monitor your training load.  The algorithm will denote a score to your training session and you can tot these up at the end of the week, making it easy to plot your plan and make room for the recovery weeks when they come round.  If you don’t use a fitness tracking platform and don’t use TSS, then think about your rate of perceived exertion.  This is your very own internal measure of how hard you are training.  You could simply score your session on the scale of 0-10 and then multiply that by the number of minutes to give you an overall score for the day.  Add up your numbers at the end of the week to give you a total RPE value.  You could even go one better and copy one of my clients who keeps an excel account of his training and in it he splits the session into training zones. Zone two through to zone five.  His Garmin (with heart rate strap) tells him the time spent in each zone and then he rates the RPE for each zone and then multiplies this rating by the length of the training within each zone, then adds them together to give him a total number at the end of that day.  Here is a little sneak peek of this man’s work.

• Sleep: This is when the magic happens.  We need between 7-9 hours of it per night.  Sleep is when the body and brain get to work in making the necessary changes to our physiology, and that’s just one of many other fascinating things that happen when we sleep.  The importance of sufficient sleep has finally made it to the front and centre of our minds thanks to the great research in the area over the years.  I won’t go into it any further here, but can highly recommend a very interesting read “Why We Sleep” by Mathew Walker.  It will seriously shock you how sleep affects so many parts of our physiology and behaviour.  And it is linked to injury risk.  The risk of injury in teenagers doubles if they get less than 8 hours per night! Poor sleep hygiene is strongly linked to over-training injuries because both our muscles and tendons undergo adaptation and remodeling overnight in order to be able to adapt to the new training stimulus that we are putting our bodies through.  Most over-training injuries involve tendons and are categorised as ‘tendinopathies’.  These include the usual suspects such as achilles tendon issues, patellar tendon at the front of the knee, hamstring tendon at the back of the knee and also don’t forget the hamstring tendon at the other end of the hamstring muscle, on the sitting bone.  These tendon problems are all hugely common in running and triathlon and are usually linked with a sudden change in the client’s training (maybe an addition of sprints to the weekly plan), a failure to allow adequate recovery in the plan, or poor sleep.  It is a known fact that the lockdowns have resulted in a significant rise in tendon complaints around the world. Basically, this is due to people falling into the trap of thinking they could up their training volume suddenly with all the spare time available to them and get away scot-free!  You have been warned!  To avoid falling down the tendinopathy trap, just monitor your training as mentioned above and get in your strength and conditioning during the week.  More on that in a dedicated blog.
• Zone 4 sessions are not to be taken lightly.  These are tough sessions which typically include spending time at threshold intensity with recovery bouts between these zone 4 intervals.  The length of these Z4 intervals can vary, from 2 – 8 minutes.  A session could instead be 30-40mins continuous effort holding this high pace, but is more often a better idea to break the session down into intervals.  It is not recommended to be doing more than 2 of these sessions in one week.

• Zone 5 anaerobic intervals. Or otherwise known as a VO2Max workout.  A typical session would involve intervals of 3-6mins at intensity of 10-15 beats per minute below max heart rate with 3-4mins easy recovery between intervals.  Start with 2-3 of these intense intervals and progress up to 2 sets of 3.  This type of session is often abused and used to much, once per week is the ideal amount.  Another variation of anaerobic training is to spend 90secs at high intensity followed by 3 minute recovery and start with a few and work up to 2 sets of 4.  This will improve your body’s ability to combust lactate or use lactate as a fuel so that it doesn’t accumulate as easy.  We all know what happens when lactate accumulates, we need to slow down.  All of these sessions will of course include a warm up and cool down phase.  Finally, sprint training is done at a supra-maximal intensity, typically 5-20 sec with a long 2-5 min recovery, starting with 3 and building up to 10 reps.

 
Lastly but very importantly, keep tabs on your mood.  Psychological symptoms will usually occur before physiological symptoms.  If you sense a change, this should alarm you to check your training volume/intensity to see if you can detect any overtraining.

This is a good place to point you towards a running performance and injury prevention short video series I made for the Run Killarney event back when the world had not yet met Covid.  I don't know why I let my hair grow that much!  I didn't have the excuse of level 5 restrictions either.

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The above Runfit service has progressed from the time when the videos were recorded.  I now use Leomo technology to capture running metrics such as cadence, vertical oscillation, foot strike, recoil angular range, leg swing speed and more.  The best thing about this technology is that it allows for a gait analysis assessment to take place outdoors.
For more information on this service, click here 

Thanks again to all of you for following the blog series. 

John Phelan
MSc Physio, BSc Nutrition
www.thebikefitphysio.com & www.lifefitphysio.ie