Triathlon Injuries Orthopiedic Specialists
Triathlon: Triple Threat for Injuries
(Don’t Be Scared – Be Prepared)
By Bruce Wilk, PT, OCS

Training for triathlon is tough – that’s part of the challenge – but consider this: Four out of five amateur triathletes are injured while training, and three of those four are injured badly enough to affect their daily activities.
Why such a high injury rate? The complexity of the sport and broad range of knowledge needed to train and compete safely are contributing factors.  The triathlete must learn about appropriate equipment specifications, proper body mechanics, injury prevention and overall training programs that prepare the body for the stresses of triathlon.

Cross-training for three different events also increases the risk of certain overuse injuries, and an untreated injury in one part of the body can lead to problems elsewhere. For example, a knee injury from running can cause extra stress on the back, leading to lower back pain when cycling; and the cumulative effects of swimming and cycling can fatigue calf muscles, making legs more susceptible to injury during a run.

The good news is, most nontraumatic injuries are related to training errors that can be corrected – and professionals with specialized knowledge in triathlon training and injury prevention can help.

 Prevention: Training Smart

The best way to avoid a nontraumatic injury is a training program that balances strength, flexibility and endurance through appropriate weight-lifting, stretching and cross-training. But training techniques are not one-size-fits-all. Every individual has a unique combination of anatomy, strength, endurance, and flexibility – so what works well for one athlete is not always the best advice for another.

Understanding the complex interactions between musculoskeletal groups related to swimming, cycling, and running is essential in triathlon training. Only a specialist can evaluate your physical conditioning, analyze your training techniques and correct errors that can lead to future injuries, and provide a training program optimized for you as an individual.

Unfortunately, even the best training program can’t prevent all injuries. When injuries do occur, there are three things you need to know: (1) how to evaluate the severity of an injury, (2) how to self-treat an overuse injury, and (3) when to seek professional help.

Evaluating Nontraumatic Injuries

Though each triathlon event has its own types of injuries (for example, more than 20 different types of running injuries), and the number of complications from cross-training are practically limitless, they all have one thing in common: When it comes to deciding whether or not to seek professional help, the type of injury doesn’t really matter – what matters is the severity.

I use the following scale of factors to evaluate the severity of an injury. Any type of overuse injury can be staged this way:

  • Stage 1 is pain upon exertion. It starts at any time during a training session and continues as long as you are exercising, but stops when your training session ends – this is the first warning sign of an injury.
  • Stage 2 is pain at rest, immediately after exertion. The pain is there after your training session, but then it goes away – this is the time to start self management (described below).
  • Stage 3 is pain that persists during normal daily activities, like walking to the car, or walking up steps. You may be sitting at your desk and have some ache or nagging pain that bothers you. Pay attention; this should be of concern if it doesn’t improve in a few days, or worsens.
  • Stage 4 is pain that you take medication for. This is a very important factor. Medication masks the severity of an injury and allows it to get worse if you keep on training. If you are taking any kind of medication for pain, you must cease training until it is out of your system.
  • Stage 5 is pain that cripples you. It stops you from training, or maybe even walking.

Note that, even if an injury is at stage 1 pain-wise, if you take any medication for it – suddenly you’re at stage 4. This includes any pain medication from ibuprofen to a doctor’s prescription or injections. If you train on pain medication, it can mask the pain just enough to cripple you.

 Self Management: PRICE

The self management for  injuries is PRICE: Protection, Recovery, Ice, Compression, and Elevation.


  • Protect the injury and allow it to recover.
  • Identify and correct the reason for your injury.


  • Work actively to regain normal movement, strength, and function of the injured structure.
  • May include massage, rest, or modification of training.
  • Medication can be a part of recovery if one’s sleep is disturbed and medication is necessary for rest – but there must be no training or competition until the medication is out of your system.


  • Cold compresses, 360 degrees around the structure whenever possible.


  • Compress the ice pack: Put toweling around the ice pack and put pressure on the injured structure using Ace bandages or Velcro straps.


  • Raise the injured structure above the heart.
  • Ice, compression, and elevation are used together.

When to Seek Professional Help

For the triathlete, occasional pain upon exertion is inevitable. If you’re concerned, you should see a professional for evaluation and help correcting the problem, even at stage 1. 
Seek professional help immediately if you encounter any of the following warning signs:

  • If you are taking medication and continuing to train.
  • If you are being prescribed (or injected with) medication and being told you are allowed to train.
  • If you are consistently having pain at rest, or pain disturbs your sleep.
  • If you’re having pain that interferes with normal activities such as walking or climbing stairs – and it continues for more than a day a two, is not getting better, or is worsening.

Ideally, professional help means help from an experienced triathlete with licensed medical credentials. Most doctors and physical therapists aren’t trained in the specific needs of triathletes. If you are going to a doctor who prescribes medication, or injects medication, and tells you it’s okay to train or compete, that’s not professional help. Medication can never treat the cause of an injury; it only masks the pain and allows the injury to get worse if you continue to train.



Biking adds a significant fall risk to the sport of triathlon. The first thing you should do if you fall from your bike is check yourself. Many athletes will immediately rush to check their bike. Your body is more important – check it first! Assess your head, neck, chest, abdomen, and extremities. Seek advanced medical care if you experience any of the following after a fall:

Triathlon Injuries Orthopiedic Specialists

  • Cracked helmet
  • Nausea or headache
  • Change or loss of vision of any sort
  • Confusion/disorientation
  • Slurred speech
  • Blood or clear fluid draining from the ears
  • Bruising around the eyes or bloodshot eyes
  • Lacerations to the head, face, or neck
  • Neck pain
  • Numbness in any part of your body
  • Shortness of breath/difficulty breathing
  • Chest pain
  • Abdominal/chest wall bruising
  • Blood in urine or stool
  • Joint swelling and motion loss
  • Suspected fracture
  • Large laceration over bony region
  • Shoulder dislocation
  • Large area of road rash (considered a burn)
  • Bleeding that will not stop
  • Any condition that continues to worsen

Monitor yourself for 72 hours after your fall. Many signs and symptoms of serious conditions are not immediately obvious. Also, always seek care if a medical professional advises you to do so. If you think you should get help, then go!

Rehabilitation and Recovery

Following treatment for a traumatic injury, a carefully administered rehabilitation program can speed the recovery process. We take the triathlete through a progressive program to regain ability and return to the sport we love. As a bonus, my patients often learn some important lessons about training and how their body works as they recover!

There are no guarantees against injuries, even for the most cautious and well-trained triathlete. However, proper form, a balanced exercise program, and prompt attention to injuries and safety can minimize down-time and sharpen your competitive edge.

Bruce R. Wilk, P.T., O.C.S. is a board certified Physical Therapist, Director of Orthopedic Rehabilitation Specialists, President of The Runner's High, and head coach of The Miami Runner's Club. He has been an avid runner for the past 38 years, and triathlete for 18 years.