Applying a Holistic Injury Prevention Approach to Elite Triathletes
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Study Design
2.3. Injuries and Exposure
2.4. Intervention
2.4.1. Strength Training
- Block I (traditional-style periodization):
- Block II (ATR periodization)
2.4.2. Training Load Control
2.4.3. Session Development Control
2.4.4. Cycling Skills Training
2.4.5. Physiotherapy
2.5. Data Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- ITU Olympic Triathlon—World Triathlon. Available online: https://triathlon.org/olympics (accessed on 19 May 2024).
- Mujika, I. Olympic Preparation of a World-Class Female Triathlete. Int. J. Sports Physiol. Perform. 2014, 9, 727–731. [Google Scholar] [CrossRef]
- Cejuela, R.; Selles-Perez, S. Training Characteristics and Performance of Two Male Elite Short-Distance Triathletes: From Junior to “World-Class”. Scand. J. Med. Sci. Sports 2023, 33, 2444–2456. [Google Scholar] [CrossRef] [PubMed]
- Åman, M.; Forssblad, M.; Henriksson-Larsén, K. Incidence and Severity of Reported Acute Sports Injuries in 35 Sports Using Insurance Registry Data. Scand. J. Med. Sci. Sports 2016, 26, 451–462. [Google Scholar] [CrossRef] [PubMed]
- Vleck, V.; Caine, D.J.; Harmer, P.; Schiff, M. Epidemiology of Injury in Olympic Sports. International Olympic Committee Encyclopaedia of Sports Medicine Series Triathlon; Wiley-Blackwell: West Sussex, UK, 2009; pp. 294–320. [Google Scholar] [CrossRef]
- Vleck, V.; Hoeden, D. Epidemiological aspects of illness and injury. In Triathlon Medicine; Springer Nature: Basel, Switzerland, 2019; pp. 19–41. [Google Scholar]
- Vleck, V.; Millet, G.P.; Alves, F.B. The Impact of Triathlon Training and Racing on Athletes’ General Health. Sports Med. 2014, 44, 1659–1692. [Google Scholar] [CrossRef]
- Guevara, S.A.; Crunkhorn, M.L.; Drew, M.; Waddington, G.; Périard, J.D.; Etxebarria, N.; Toohey, L.A.; Charlton, P. Injury and Illness in Short-Course Triathletes: A Systematic Review. J. Sport Health Sci. 2024, 13, 172–185. [Google Scholar] [CrossRef]
- Vleck, V.E.; Bentley, D.J.; Millet, G.P.; Cochrane, T. Triathlon Event Distance Specialization: Training and Injury Effects. J. Strength Cond. Res. 2010, 24, 30–36. [Google Scholar] [CrossRef]
- Vleck, V.E.; Garbutt, G. Injury and Training Characteristics of Male Elite, Development Squad, and Club Triathletes. Int. J. Sports Med. 1998, 19, 38–42. [Google Scholar] [CrossRef]
- Kennedy, M.D.; Knight, C.J.; Falk Neto, J.H.; Uzzell, K.S.; Szabo, S.W. Futureproofing Triathlon: Expert Suggestions to Improve Health and Performance in Triathletes. BMC Sports Sci. Med. Rehabil. 2020, 12, 1. [Google Scholar] [CrossRef] [PubMed]
- Gosling, C.M.R.; Gabbe, B.J.; Forbes, A.B. Triathlon Related Musculoskeletal Injuries: The Status of Injury Prevention Knowledge. J. Sci. Med. Sport 2008, 11, 396–406. [Google Scholar] [CrossRef]
- Vleck, V.; Alves, F.B. Triathlon Injury Review. Br. J. Sports Med. 2011, 45, 382–383. [Google Scholar] [CrossRef]
- Edouard, P.; Ford, K.R. Great Challenges Toward Sports Injury Prevention and Rehabilitation. Front. Sports Act. Living 2020, 2, 56–63. [Google Scholar] [CrossRef]
- Vleck, V. Triathlete Training and Injury Analysis an Investigation in British National Squad and Age-Group Triathletes, 1st ed.; VDM Verlag Dr. Müller: Saarbrücken, Germany, 2010. [Google Scholar]
- Lauersen, J.B.; Andersen, T.E.; Andersen, L.B.; Lauersen, B. Strength Training as Superior, Dose-Dependent and Safe Prevention of Acute and Overuse Sports Injuries: A Systematic Review, Qualitative Analysis and Meta-Analysis. Br. J. Sports Med. 2018, 52, 1557–1563. [Google Scholar] [CrossRef] [PubMed]
- Baldwin, K.M.; Badenhorst, C.E.; Cripps, A.J.; Landers, G.J.; Merrells, R.J.; Bulsara, M.K.; Hoyne, G.F. Strength Training for Long-Distance Triathletes: Theory to Practice. Strength Cond. J. 2022, 44, 1–14. [Google Scholar] [CrossRef]
- Falk Neto, J.H.; Parent, E.C.; Vleck, V.; Kennedy, M.D. The Training Characteristics of Recreational-Level Triathletes: Influence on Fatigue and Health. Sports 2021, 9, 94. [Google Scholar] [CrossRef] [PubMed]
- Gabbett, T.J. The Training-Injury Prevention Paradox: Should Athletes Be Training Smarter and Harder? Br. J. Sports Med. 2016, 50, 273–280. [Google Scholar] [CrossRef] [PubMed]
- Gasibat, Q.; Suwehli, W. Determining the Benefits of Massage Mechanisms: A Review of Literature. J. Rehabil. Sci. 2017, 2, 58–67. [Google Scholar] [CrossRef]
- Suarez-Arrones, L.; Nakamura, F.Y.; Maldonado, R.A.; Torreno, N.; Di Salvo, V.; Mendez-Villanueva, A. Applying a Holistic Hamstring Injury Prevention Approach in Elite Football: 12 Seasons, Single Club Study. Scand. J. Med. Sci. Sports 2021, 31, 861–874. [Google Scholar] [CrossRef]
- Defi, I.R. Rehabilitation Role in Sport Injury. Orthop. J. Sports Med. 2023, 11, 2325967121S0083. [Google Scholar] [CrossRef]
- Vriend, I.; Gouttebarge, V.; Finch, C.F.; van Mechelen, W.; Verhagen, E.A.L.M. Intervention Strategies Used in Sport Injury Prevention Studies: A Systematic Review Identifying Studies Applying the Haddon Matrix. Sports Med. 2017, 47, 2027–2043. [Google Scholar] [CrossRef]
- Aicale, R.; Tarantino, D.; Maffulli, N. Overuse Injuries in Sport: A Comprehensive Overview. J. Orthop. Surg. Res. 2018, 13, 309. [Google Scholar] [CrossRef]
- Pérez-Gómez, J.; Adsuar, J.C.; Alcaraz, P.E.; Carlos-Vivas, J. Physical Exercises for Preventing Injuries among Adult Male Football Players: A Systematic Review. J. Sport Health Sci. 2022, 11, 115–122. [Google Scholar] [CrossRef] [PubMed]
- Andreoli, C.V.; Chiaramonti, B.C.; Buriel, E.; Pochini, A.D.C.; Ejnisman, B.; Cohen, M. Epidemiology of Sports Injuries in Basketball: Integrative Systematic Review. BMJ Open Sport Exerc. Med. 2018, 4, e000468. [Google Scholar] [CrossRef] [PubMed]
- Wanivenhaus, F.; Fox, A.J.S.; Chaudhury, S.; Rodeo, S.A. Epidemiology of Injuries and Prevention Strategies in Competitive Swimmers. Sports Health 2012, 4, 246. [Google Scholar] [CrossRef] [PubMed]
- Haeberle, H.S.; Navarro, S.M.; Power, E.J.; Schickendantz, M.S.; Farrow, L.D.; Ramkumar, P.N. Prevalence and Epidemiology of Injuries Among Elite Cyclists in the Tour de France. Orthop. J. Sports Med. 2018, 6, 1–5. [Google Scholar] [CrossRef] [PubMed]
- Videbæk, S.; Bueno, A.M.; Nielsen, R.O.; Rasmussen, S. Incidence of Running-Related Injuries Per 1000 h of Running in Different Types of Runners: A Systematic Review and Meta-Analysis. Sports Med. 2015, 45, 1017–1026. [Google Scholar] [CrossRef] [PubMed]
- McKay, A.K.A.; Stellingwerff, T.; Smith, E.S.; Martin, D.T.; Mujika, I.; Goosey-Tolfrey, V.L.; Sheppard, J.; Burke, L.M. Defining Training and Performance Caliber: A Participant Classification Framework. Int. J. Sports Physiol. Perform. 2022, 17, 317–331. [Google Scholar] [CrossRef] [PubMed]
- Timpka, T.; Jacobsson, J.; Bickenbach, J.; Finch, C.F.; Ekberg, J.; Nordenfelt, L. What Is a Sports Injury? Sports Med. 2014, 44, 423–428. [Google Scholar] [CrossRef]
- Issurin, V.B. Benefits and Limitations of Block Periodized Training Approaches to Athletes’ Preparation: A Review. Sports Med. 2016, 46, 329–338. [Google Scholar] [CrossRef] [PubMed]
- Llanos-Lagos, C.; Ramirez-Campillo, R.; Moran, J.; Sáez de Villarreal, E. Effect of Strength Training Programs in Middle- and Long-Distance Runners’ Economy at Different Running Speeds: A Systematic Review with Meta-Analysis. Sports Med. 2024, 54, 895–932. [Google Scholar] [CrossRef]
- Jidovtseff, B.; Harris, N.K.; Crielaard, J.M.; Cronin, J.B. Using the Load-Velocity Relationship for 1RM Prediction. J. Strength Cond. Res. 2011, 25, 267–270. [Google Scholar] [CrossRef]
- Lum, D.; Comfort, P.; Barbosa, T.M.; Balasekaran, G. Comparing the Effects of Plyometric and Isometric Strength Training on Dynamic and Isometric Force-Time Characteristics. Biol. Sport 2022, 39, 189. [Google Scholar] [CrossRef]
- Baxter, J.R.; Corrigan, P.; Hullfish, T.J.; O’Rourke, P.; Silbernagel, K.G. Exercise Progression to Incrementally Load the Achilles Tendon. Med. Sci. Sports Exerc. 2021, 53, 124–130. [Google Scholar] [CrossRef]
- Riscart-López, J.; Rendeiro-Pinho, G.; Mil-Homens, P.; Soares-Dacosta, R.; Loturco, I.; Pareja-Blanco, F.; León-Prados, J.A. Effects of Four Different Velocity-Based Training Programming Models on Strength Gains and Physical Performance. J. Strength Cond. Res. 2021, 35, 596–603. [Google Scholar] [CrossRef] [PubMed]
- Doma, K.; Deakin, G.B.; Schumann, M.; Bentley, D.J. Training Considerations for Optimising Endurance Development: An Alternate Concurrent Training Perspective. Sports Med. 2019, 49, 669–682. [Google Scholar] [CrossRef] [PubMed]
- Ji, S.; Donath, L.; Wahl, P. Effects of Alternating Unilateral vs. Bilateral Resistance Training on Sprint and Endurance Cycling Performance in Trained Endurance Athletes: A 3-Armed, Randomized, Controlled, Pilot Trial. J. Strength Cond. Res. 2022, 36, 3280–3289. [Google Scholar] [CrossRef]
- Fitzpatrick, D.A.; Cimadoro, G.; Cleather, D.J. The Magical Horizontal Force Muscle? A Preliminary Study Examining the “Force-Vector” Theory. Sports 2019, 7, 30. [Google Scholar] [CrossRef]
- Miller, A.E.J.; MacDougall, J.D.; Tarnopolsky, M.A.; Sale, D.G. Gender Differences in Strength and Muscle Fiber Characteristics. Eur. J. Appl. Physiol. Occup. Physiol. 1993, 66, 254–262. [Google Scholar] [CrossRef]
- Cardona, C.; Cejuela, R.; Esteve, J. Resistance Sports Training Manual, 1st ed.; Editorial Princesa: Madrid, Spain, 2019. [Google Scholar]
- Crunkhorn, M.L.; Toohey, L.A.; Charlton, P.; Drew, M.; Watson, K.; Etxebarria, N. Injury Incidence and Prevalence in Elite Short-Course Triathletes: A 4-Year Prospective Study. Br. J. Sports Med. 2024, 58, 470–476. [Google Scholar] [CrossRef]
- Collins, K.; Wagner, M.; Peterson, K.; Storey, M. Overuse Injuries in Triathletes. Am. J. Sports Med. 1989, 17, 675–680. [Google Scholar] [CrossRef] [PubMed]
- Lauersen, J.B.; Bertelsen, D.M.; Andersen, L.B. The Effectiveness of Exercise Interventions to Prevent Sports Injuries: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Br. J. Sports Med. 2014, 48, 871–877. [Google Scholar] [CrossRef]
- Berryman, N.; Mujika, I.; Bosquet, L. Concurrent Training for Sports Performance: The 2 Sides of the Medal. Int. J. Sports Physiol. Perform. 2019, 14, 279–285. [Google Scholar] [CrossRef]
- Pareja-Blanco, F.; Rodríguez-Rosell, D.; Sánchez-Medina, L.; Sanchis-Moysi, J.; Dorado, C.; Mora-Custodio, R.; Yáñez-García, J.M.; Morales-Alamo, D.; Pérez-Suárez, I.; Calbet, J.A.L.; et al. Effects of Velocity Loss during Resistance Training on Athletic Performance, Strength Gains and Muscle Adaptations. Scand. J. Med. Sci. Sports 2017, 27, 724–735. [Google Scholar] [CrossRef] [PubMed]
- Burns, J.; Keenan, A.M.; Redmond, A.C. Factors Associated with Triathlon-Related Overuse Injuries. J. Orthop. Sports Phys. Ther. 2003, 33, 177–184. [Google Scholar] [CrossRef]
- Bales, J.; Bales, K. Training on a Knife’s Edge: How to Balance Triathlon Training to Prevent Overuse Injuries. Sports Med. Arthrosc. Rev. 2012, 20, 214–216. [Google Scholar] [CrossRef]
- Gosling, C.M.R.; Donaldson, A.; Forbes, A.B.; Gabbe, B.J. The Perception of Injury Risk and Safety in Triathlon Competition: An Exploratory Focus Group Study. Clin. J. Sport Med. 2013, 23, 70–73. [Google Scholar] [CrossRef] [PubMed]
- Daneshfar, A.; Petersen, C.J.; Gahreman, D.E. The Effect of 4 Weeks Motor Imagery Training on Simulated BMX Race Performance. Int. J. Sport Exerc. Psychol. 2022, 20, 644–660. [Google Scholar] [CrossRef]
- Egermann, M.; Brocai, D.; Lill, C.A.; Schmitt, H. Analysis of Injuries in Long-Distance Triathletes. Int. J. Sports Med. 2003, 24, 271–276. [Google Scholar] [CrossRef] [PubMed]
- Figueiredo, P.; Marques, E.A.; Lepers, R. Changes in Contributions of Swimming, Cycling, and Running Performances on Overall Triathlon Performance Over a 26-Year Period. J. Strength Cond. Res. 2016, 30, 2406–2415. [Google Scholar] [CrossRef]
- Zech, A.; Hollander, K.; Junge, A.; Steib, S.; Groll, A.; Heiner, J.; Nowak, F.; Pfeiffer, D.; Rahlf, A.L. Sex Differences in Injury Rates in Team-Sport Athletes: A Systematic Review and Meta-Regression Analysis. J. Sport Health Sci. 2022, 11, 104–114. [Google Scholar] [CrossRef]
- Hamilton, B.; Targett, S. Ironman Triathlon: Medical Considerations. In Sports Injuries; Springer: Berlin/Heidelberg, Germany, 2015; pp. 1–7. [Google Scholar] [CrossRef]
Strength Training | Training Load Control | Session Control | Physiotherapy Treatment | Bike Skills | ||
---|---|---|---|---|---|---|
Traditional periodization | General preparatory Period | **** | *** | **** | ** | *** |
Specific Preparatory Period | *** | **** | **** | **** | **** | |
Competition Period | ** | ** | *** | *** | *** | |
Block periodization | Accumulation Block | *** | *** | *** | * | ** |
Transformation Block | ** | **** | *** | *** | *** | |
Realization Block | * | ** | ** | ** | ** |
Overall (n = 28) | Male (n = 18) | Female (n = 10) | |
---|---|---|---|
Training and Competition Exposure per season | |||
Total (mean hours (SD)) | 660 (122) | 671 (33) | 649 (89) |
Injuries during the three seasons | |||
Total (n) | 24 | 18 | 6 |
Overuse (n) | 10 | 6 | 4 |
Traumatic (n) | 14 | 12 * | 2 * |
Absenteeism (mean days (SD)) | 17.3 (54.2) | 22.6 (55.6) * | 5.83 (8.7) * |
Overall % of athletes affected by injury | |||
Among all participants (n = 28) | 53.6 | 55.6 | 30 |
In first year of following the HITP (n = 28) | 35.7 | 38.9 | 30 |
In second year of following the HITP (n = 17) | 31.6 | 30.8 | 33.3 |
In third year of following the HITP (n = 10) | 20 | 28.6 | 0 |
by OI, among all participants (n = 28) | 28.6 | 27.7 | 30 |
by TI, among all participants (n = 28) | 35.7 | 44.4 * | 20 * |
Overall Injury Severity, 2021–2023 | |||
Minimal (n) | 10 | 6 | 4 |
Mild (n) | 6 | 4 | 1 |
Moderate (n) | 6 | 6 * | 1 * |
Severe (n) | 2 | 2 | 0 |
Overuse Injury Severity 2021–2023 | |||
Minimal (n) | 4 | 1 | 3 |
Mild (n) | 2 | 1 | 0 |
Moderate (n) | 3 | 3 | 1 |
Severe (n) | 1 | 1 | 0 |
Traumatic Injury Severity, 2021–2023 | |||
Minimal (n) | 6 | 5 | 1 |
Mild (n) | 4 | 3 | 1 |
Moderate (n) | 3 | 3 | 0 |
Severe (n) | 1 | 1 | 0 |
Injury rate/1000 h of training and competition | |||
Overall | 0.65 | 0.68 | 0.61 |
Overuse | 0.27 | 0.23 | 0.41 |
Traumatic | 0.38 | 0.46 * | 0.2 * |
Anatomical location of injury | |||
Upper body (n) | 2 | 2 | 0 |
Lower body (n) | 22 | 16 | 6 |
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Arévalo-Chico, H.; Sellés-Pérez, S.; Cejuela, R. Applying a Holistic Injury Prevention Approach to Elite Triathletes. Sports 2024, 12, 225. https://doi.org/10.3390/sports12080225
Arévalo-Chico H, Sellés-Pérez S, Cejuela R. Applying a Holistic Injury Prevention Approach to Elite Triathletes. Sports. 2024; 12(8):225. https://doi.org/10.3390/sports12080225
Chicago/Turabian StyleArévalo-Chico, Héctor, Sergio Sellés-Pérez, and Roberto Cejuela. 2024. "Applying a Holistic Injury Prevention Approach to Elite Triathletes" Sports 12, no. 8: 225. https://doi.org/10.3390/sports12080225
APA StyleArévalo-Chico, H., Sellés-Pérez, S., & Cejuela, R. (2024). Applying a Holistic Injury Prevention Approach to Elite Triathletes. Sports, 12(8), 225. https://doi.org/10.3390/sports12080225