Triathlon: Triple Threat for Injuries

Wed, 7 Sept. 2011 - 3:27 p.m. MT
Credit: ARA Staff - American Running Association

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, and overall training programs that prepare the body for triathlon’s unique stresses. Crosstraining for three different events increases the risk of certain overuse injuries, and an untreated injury in one part of the body can lead to problems elsewhere. 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.


Prevention: Training Smart

The best way to avoid a nontraumatic injury is a training program that balances strength, flexibility, and endurance through appropriate weightlifting, stretching, and crosstraining. But training techniques are not one-size-fits-all. 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. 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 severity; 2.) how to self-treat; and 3.) when to seek professional help. 

Evaluating Nontraumatic Injuries

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 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 up steps. You may be sitting at your desk and have 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 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 you’re suddenly 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

It’s worth reviewing the self-management for injuries, PRICE: Protection, Recovery, Ice, Compression, and Elevation (ice, compression, and elevation are used together). Protection: Protect the injury and allow it to recover. Identify and correct the reason for your injury. Recovery: Work actively to regain normal movement, strength, and function of the injured structure. This phase may include massage, rest, or modification of training. Medication can be a part of recovery if your sleep is disturbed, but there must be no training or competition until the medication is out of your system. Ice: Use cold compresses, 360 degrees around the structure whenever possible. Compression: Put toweling around the ice pack and put pressure on the injured structure using Ace bandages or Velcro straps. Elevation: Raise the injured structure above the heart.


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 and s/he 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. 


Bruce R. Wilk, PT, OCS, is a board certified physical therapist and director of Orthopedic Rehabilitation Specialists in Miami, FL. He has been an avid runner for the past 38 years, and a triathlete for 18 years.


Eggplant: Superfood?


It turns out that the zucchini-like, slightly spongy vegetable in your crisper, the eggplant, is not just an odd looking vessel for holding water. Eggplant is packed with nutrients, and the properties of those specific nutrients, some nearly exclusive to eggplant, make it one of the healthiest foods around. More and more studies are revealing eggplant’s unusual ability to repair free radical damage and lower cholesterol. There is even reason to believe it can help stave off rheumatoid arthritis. At 2.48 grams per cup (cubed), it provides an excellent source of dietary fiber, and is considered a very good source of potassium, manganese, copper, and vitamin B1 (thiamin); it is considered a good source of vitamin B6 (pyridoxine), folate, magnesium, and vitamin B3 (niacin). Inexpensive, readily available, and only 27 calories per cup (cubed), eggplant is right up there with broccoli as quite possibly one of nature’s superfoods. 


Eggplant is Phytonutrient-rich

In addition to the vitamins and minerals mentioned above, eggplant also contains important phytonutrients, many of which have antioxidant activity. Phytonutrients contained in eggplant include phenolic compounds, such caffeic and chlorogenic acid, and flavonoids, such as nasunin.


Much of the research on eggplant has focused on this anthocyanin phytonutrient. Nasunin is a potent antioxidant and free radical scavenger that has been shown to protect cell membranes from damage. In animal studies, nasunin has been found to protect the lipids in brain cell membranes. Cell membranes are almost entirely composed of lipids and are responsible for protecting the cell from free radicals, letting nutrients in and waste out, and receiving instructions from messenger molecules that tell the cell which activities it should perform.


Nasunin is not only a potent free-radical scavenger, but is also an iron chelator. A chelator is a chemical that removes free metal ions from the bloodstream. Chelating agents are sometimes used to treat people suffering from lead, mercury, or other heavy metal poisoning. Although iron is an essential nutrient and is necessary for oxygen transport, immune function, and collagen synthesis, excess iron increases free radical production and is associated with an increased risk of heart disease and cancer. 


In postmenopausal women and in men, iron, which is not easily excreted, can accumulate. By chelating iron, nasunin lessens free radical formation with numerous beneficial results, including protecting blood cholesterol from peroxidation. It also helps prevent cancer-promoting cell damage, and lessens free radical damage in joints, a primary factor in rheumatoid arthritis. 


Even More Good News

More good news concerning eggplant is that the predominant phenolic compound found in all varieties tested is chlorogenic acid, which is one of the most effective free-radical scavengers found in plant tissues. Benefits attributed to chlorogenic acid include antimutagenic (anti-cancer), antimicrobial, anti-LDL (bad cholesterol) and antiviral activities.


Somewhat astonishingly, when laboratory animals with high cholesterol were given eggplant juice, their blood cholesterol, the cholesterol in their artery walls, and the cholesterol in their aortas were all significantly reduced, while the walls of their blood vessels relaxed, improving blood flow. These positive effects were likely due not only to nasunin but also to several other terpene phytonutrients in eggplant. 


Oxalate Concerns?

Eggplant is also among a small number of foods that contain measurable amounts of oxalates, naturally-occurring substances found in plants and animals. When oxalates become too concentrated in body fluids, they can crystallize and cause health problems. For this reason, individuals with already existing and untreated kidney or gallbladder problems may want to avoid eating eggplant. Laboratory studies have shown that oxalates may also interfere with absorption of calcium from the body. 


Yet, the peer-reviewed research evidence showing the ability of oxalates to lower calcium absorption is scant and the effects relatively small. It does not outweigh the ability of oxalate-containing foods to contribute calcium to the meal plan. If your digestive tract is healthy, and you do a good job of chewing and relaxing while you enjoy your meals, you will get significant benefits—including absorption of calcium—from calcium-rich plant foods that also contain oxalic acid. Most doctors would not discourage a person concerned about meeting their calcium requirements from eating these nutrient-rich foods because of their oxalate content.


Getting the Most Out of Eggplant

Eggplants belong to the nightshade family of vegetables, which also includes tomatoes, sweet peppers, and potatoes. They are at their very best from August through October when they are in season. Choose eggplants that are firm and heavy for their size. To test for the ripeness of an eggplant, gently press the skin with the pad of your thumb. If it springs back, the eggplant is ripe, while if an indentation remains, it is not.


Although they look hardy, eggplants are actually very perishable and care should be taken in their storage. Eggplants are sensitive to both heat and cold and should ideally be stored at around 50 degrees Fahrenheit. Do not cut eggplant before you store it as it perishes quickly once its skin has been punctured or its inner flesh exposed. Place uncut and unwashed eggplant in a plastic bag and store in the refrigerator crisper where it will keep for only a few days before it starts losing its nutrients. 


To tenderize the flesh's texture and reduce some of its naturally occurring bitter taste, you can sweat the eggplant by salting it. After cutting the eggplant into the desired size and shape, sprinkle it with salt and allow it to rest for about 30 minutes. This process pulls out some of its water content and so will also make it less permeable to absorbing any oil used in cooking. Rinsing the eggplant after sweating it will remove most of the salt. 


Exotic in taste and texture, eggplant can be prepared in a variety of ways. Consider baking, roasting, grilling, or steaming eggplant. Due to its high water content, frying the porous eggplant over-saturates it with oil, particularly if you don’t sweat it first. 


If baking it whole, pierce the eggplant several times with a fork to make small holes for the steam to escape. Bake at 350 degrees Fahrenheit for 15 to 25 minutes, depending upon size. Eggplant’s unique flavor and ability to absorb other flavors makes it great as a spread. For homemade baba ganoush, purée roasted eggplant, garlic, tahini, lemon juice, and olive oil. Use it as a dip for vegetables or as a sandwich filling.




Grilled Eggplant Sandwich 


Makes 2 sandwiches


4 teaspoons olive oil
1 clove garlic, finely chopped
1 1/2 teaspoons chopped, fresh basil
salt, to taste
fresh ground black pepper
2 large eggplant slices


1/2 cup low-fat, whipped cream cheese or goat cheese
4 pieces focaccia sliced in half, lengthwise
2/3 cup spinach, washed and dried
4 slices tomato



Preheat grill to medium heat.

Add olive oil, garlic, salt, and fresh ground pepper and ½ teaspoon fresh chopped basil to small bowl. Stir to combine.

Brush both sides of eggplant slices with olive oil mixture.

Grill eggplant over direct heat, 3 minutes per side.


Mix cream cheese, 1 tablespoon fresh chopped basil, salt, and fresh ground pepper in small bowl.

Spread 4 halves of focaccia bread with cheese mixture.

Add eggplant slices.

Top with spinach, slice of tomato and focaccia bread slice.


USDA Nutrient Data Laboratory,


Eggplant Recipes,


The World’s Healthiest Foods,


(RUNNING & FITNEWS®  May / June 2010 • Volume 28, Number 3)


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