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Triathlon : medical considerations. Dr Tom Cross FACSP,MBBS,DCH. Outline of talk . Introductory concepts Musculo-skeletal Injuries Illness/Medical conditions Conclusion. Introduction. Triathlon started in California in 1970’s Sport began in Australia in early 1980’s

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triathlon medical considerations

Triathlon: medical considerations

Dr Tom Cross

FACSP,MBBS,DCH

outline of talk
Outline of talk
  • Introductory concepts
  • Musculo-skeletal Injuries
  • Illness/Medical conditions
  • Conclusion
introduction
Introduction
  • Triathlon started in California in 1970’s
  • Sport began in Australia in early 1980’s
  • International sport: more than 120 nations
  • Olympic sport since 2000 Sydney games
  • 160,000 Australians compete
  • 180 Tri clubs in Australia
  • National and State Federations
australian success
Australian Success
  • Greg Welch
  • Michellie Jones
  • Chris McCormack
  • Emma Moffatt
  • Craig Alexander
  • Emma Snowsill
  • Miranda Carfrae
3 disciplines
3 Disciplines
  • Swim-Bike-Run
  • Competitors: recreational and elite/pro series
  • Athletes often very successful in other sports
  • Differing Distances
      • Sprint 750/20/5
      • Olympic 1.5/40/10
      • Half Iron Man 1.9/90.1/21.1
      • Iron Man 3.8/180.2/42.2
medical team
Medical Team
  • Physiotherapist
  • Soft tissue therapist
  • Chiropractor/Osteopath
  • Doctor
  • Nurse
  • Dietician
  • Podiatrist
  • Bike Mechanic
  • Biomechanist
  • St John’s Ambulance
injuries and illness
Injuries and Illness
  • Musculoskeletal (MSK) injuries
      • Acute
      • Overuse
  • Illness
      • Dehydration/Heat Illness
      • Hypothermia
      • Water Intoxication
      • Cardiovascular
      • Female athlete triad
      • Overtraining Syndrome/Fatigue
      • Infectious Disease
injuries
Injuries
  • Sport specific injuries
      • Discipline specific
          • Swimming
          • Cycling
          • Running: causes most injuries

Paucity of Evidence Based Medicine regarding Injuries!

injuries1
Injuries
  • Swimming
      • Shoulder
          • Rotator cuff tendinopathy
      • Common causes
          • Training error
          • Technique flaw
            • Dropping the elbow
            • Insufficient body roll
            • Unidirectional breathing
            • Pull through phase
            • Using paddles and pool buoys
      • Prevention
            • Correct technique flaws
            • Periodize training
            • Theraband exercises/gym training/stretching programme
            • Scientific approach to training
injuries2
Injuries
  • Cycling
      • Acute
          • Falls
            • Head and Spine
            • Shoulder girdle (fractures/dislocations)
            • Abrasions/lacerations
            • Prevention
              • Familiarize self with course
              • Helmet
              • Exercise caution
      • Overuse
            • Spine (neck, thoracic, low back)
            • Knee –patellofemoralpain,ITB friction syndrome
            • Pressure neuropathies (wrist ,perineum)
            • Prevention
              • Bike set up
              • Core Stability on Bike
              • Scientific approach to training
injuries3
Injuries
  • Running
          • Acute
              • Muscle strain injury
              • Muscle cramping
              • Joint sprains (ankle,knee etc)
          • Overuse
              • Tendinopathy (achilles,patellar etc)
              • Stress Fractures (foot, tibia, femur etc)
              • Myofascial pain e.g. Plantar fasciitis
injuries4
Injuries
  • Running overuse injuries
      • Causes
          • Training Error (volume, frequency, intensity, surfaces)
          • Biomechanics (alignment, running efficiency)
          • New coach/club/training group
          • Footwear
          • Poor Bone health
          • Inadequate warm up/cool down, stretching, massage
      • Prevention
          • Scientific approach to training
          • Podiatry
          • Optimize running technique
          • Optimize Bone health
          • Recovery strategies
illness
Illness
  • Thermal stress
      • Heat illness/dehydration
      • Hypothermia
  • Water Intoxication
  • Cardiovascular
  • Female athlete triad
  • Overtraining syndrome
  • Infection
illness1
Illness
  • Heat Illness/Dehydration
      • Wet bulb globe temperature: measure of thermal stress
      • Risk factors
          • Individual susceptibility
          • Recent illness
          • Inadequate fluid intake
          • Sleep deprivation/jet lag
          • Failure to acclimatize
          • Clothing
          • Medications (amphetamines, alcohol)
          • Prevention
            • Hydration
            • Acclimatize
            • Clothing choice (high “wicking” factor)
            • Modify other risk factors
illness2
Illness
  • Hypothermia
      • Swim: most at risk!
      • Cycling
      • Prevention
        • Wetsuit choice
        • Clothing on bike
illness3
Illness
  • Water Intoxication
      • Fluid and electrolyte disturbance
      • Drinking yourself to death
      • Exercise associated Hyponatraemia
        • Serum sodium <135 mmol/litre
      • Risk Factors
        • longer endurance events > 4 hours
        • Female
        • Slower runners (more time to drink)
      • Occurred secondary to perception
          • Drinking caused performance enhancement
          • Drinking reduces risk of Dehydration/heat illness
      • Symptoms
        • Nausea/vomiting, shortness of breath, confusion, coma and death
illness4
Illness
  • Water Intoxication
          • Prevention
            • Fewer drinking stations
            • Education: dangers of over-drinking
            • Aim to drink 400-800 mls per hour
            • No difference if water or sports drinks or take salt tablets
            • Medications: avoid Anti-inflammatories
illness5
Illness
  • Cardiovascular
  • Recreational
      • Sudden cardiac death
          • <35 Congenital heart disease
          • >35 Coronary artery disease
  • Elite/Pro Triathletes
        • Pathological variant of Athlete’s heart: Cardiomyopathy: conduction disorders/arrhythmias
          • Greg Welch: “ventricular tachycardia” requiring an implantable defibrillator
illness6
Illness
  • The Female Athlete Triad
      • Disordered eating (much more common in elite athletic women than normal population)
          • EDNOS, Anorexia,Bulimia
      • Menstrual disturbance (Caloric restriction + Intensive exercise)
          • Amenorrhea, Oligomenorrhoea, luteal phase defects
      • Poor Bone heath (inadequate estrogen)
          • Osteopenia, Osteoporosis: Increased risk of STRESS FRACTURES and OSTEOPOROSIS in later life!
  • At risk sports
      • Endurance (running, triathlon)
      • Aesthetic (gymnastics, diving, figure skating, synchronized swimming)
      • Weight divisions (Martial arts)
  • Bone health
    • Accrual occurs in teenage/early 20’s
    • Peak Bone mass by 25-30
    • Can assess with BMD testing (Anthropometric assessment)
    • Bone mineral density deficit only partially reversible
illness7
Illness
  • Female Athlete Triad
  • Treatment
      • Multi-disciplinary
      • Treat the disordered eating and compulsive exercise
      • Aim to restore menstrual cycle, if not use OCP
      • Use of Calcium and Vit D supplementation
  • Prevention
      • Educate female athletes
      • Screening of athletes: identify at risk athletic women
illness8
Illness
  • Overtraining syndrome/Fatigue
      • Definition: continued fatigue after 2 weeks of rest.
      • Causes
          • Excessive exercise TRAINING ERROR
          • Over-crowded lifestyle/Time poor individual (Psycho-social stressors)
          • Poor nutrition: “running on empty” !
          • Inadequate recovery from viral illness
          • Sympathetic nervous system exhaustion !
      • Symptoms
        • Training and performance decrement
        • Increased perceived level of exertion
        • Increased muscle soreness
  • Exclude other causes of fatigue
        • Iron deficiency
        • Other Nutritional deficiencies (COH, Dehydration etc)
        • Depression
        • Disordered eating
        • Other medical causes (Cardiac, respiratory, endocrine etc)
illness9
Illness
  • OTS/Fatigue
  • Treatment
      • Relative rest
      • Simplify lifestyle/minimize stressors
      • Optimize diet/recovery strategies/meditation
  • Prevention
      • Periodize training (micro/macro cycles)
      • Monitor symptoms (energy, mood, muscle soreness, sleep quality etc)
      • Optimize diet/recovery strategies
illness10
Illness
  • Infection
  • Exercise and Immunity
      • Inverted “U curve”
          • Moderate exercise improves immune function (<60% of VO2 max)
          • Excessive/intensive exercise (>80% VO2 max) causes a transient depression of immunity: The “open window” theory
              • Decrease in mucosal immunity
              • Decrease in cellular function
              • Micro-organisms get the “upper hand” !
illness11
Illness
  • Infection
  • Can I train when I am sick?
      • Do a “neck check”!
        • Symptoms above the neck? (sore throat/running nose)
            • Either train at 50% of usual intensity/duration
            • Wait until symptoms resolve and recommence usual training
        • Symptoms above and below neck (fever, cough, muscle soreness, nausea etc)
            • Wait until symptoms resolve and then wait a further 2 days and then slowly recommence training
illness12
Illness
  • Infection
  • Prevention
      • Immunization (Routine + Hep A/B, Influenza, meningococcal )
      • Periodize training
      • Optimize diet/recovery strategies
      • Universal precautions while traveling (e.g. sharing drink bottles etc.)
      • Increased risk with adverse environmental conditions (cold and heat stress)
      • Avoid/isolate sick athletes
      • Supplements: Lactobacillus Yogurt, Echinacea, Multivitamins
concluding remarks
Concluding remarks
  • Beware “Drugs in sport”
      • If concerned check WADA website
  • Seek medical screening (Doctor/Physiotherapist) if concerned about past medical history &/or injury history
  • Report injury/illness early!
  • Educate yourself about Periodization of training and practice other PREVENTATIVE strategies to prevent both injury and illness!!