Triathlon Injuries: Transitioning from Prevalence to Prediction and Prevention

Physicians at the University of Miami Sports Medicine Institute have closely examined the inconsistencies in recent literature between risk factor and injury occurrence in triathletes. Carolyn M. Kienstra, M.D., assistant professor of adolescent medicine at the University of Miami Miller School of Medicine, and Thomas M. Best, M.D., Ph.D., professor of orthopaedics, were contributors to an analysis published in the American College of Sports Medicine’s Current Sports Medicine Reports November/December 2017 issue. The goal of the publication is to provide recommendations for future studies and strategies for injury prevention.

Each year, more than 50,000 athletes compete in the Ironman triathlon, which consists of a 2.4-mile swim, a 112-mile bike ride, and a 26.2-mile run. As the popularity of triathlons continues to grow among recreational athletes – who may spend as much as 15 to 20 hours a week training – researchers are analyzing how athletes can improve their training while preventing injury from overuse.

While injuries suffered by triathletes can vary, most studies report that the lower extremity is the most common location for an injury, with the knee being the most common location for acute and overuse problems, followed by the lower leg, lower back and then shoulder. Cycling and running show similar injury rates, at 43 percent and 50 percent respectively, with most knee injuries attributed to running. Longer running distances in preseason training were more often associated with overuse injury.

“We are not hoping to look at triathletes and runners in our community to see how they compare to the athletes in these studies,” said Kienstra, who is also a pediatric and young adult sports medicine physician. “Eventually, we would like to find out how changes in training volume throughout a season or year affect injury patterns in triathletes, with the goal of helping them train smarter to accomplish the most gains while minimizing risk of injury.”

While triathletes must train for three different events simultaneously, studies have not found positive associations between training and injury. This could be due to variations in study designs, differing definitions of injury (a new injury versus an exacerbation of a previous injury), and athlete populations. Improvements in monitoring and assessing training load may help training recommendations for triathletes that will prevent injury.

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