Health & Injuries, Podcast, Strength training

Brad Beer | EP#396

 June 26, 2023

By  Bernardo Gonçalves

LISTEN TO THE EPISODE HERE:

Brad Beer - That Triathlon Show

Brad Beer is a physiotherapist with over 17 years experience and clinical expertise in running and triathlon related injuries. He is head physiotherapist of the Super League Triathlon series, consultant physiotherapist for Triathlon Australia's Olympic Podium Centre, and he has also consulted for British Triathlon, Triathlon New Zealand and Athletics New Zealand and numerous Olympic and World Champion athletes. In this interview we dive deep into triathlon related injuries, rehabilitation and prevention.

In this episode you'll learn about:

  • General advice on injury prevention, what to do if you do get injured, and the biggest mistakes athletes do that lead to injuries or after getting injured
  • Swim, bike and run related injuries
  • Symptoms and diagnosis of common triathlon injuries
  • Treatment of common triathlon injuries
  • Rehab and return to sport from common triathlon injuries
  • Deep dive into running injuries, including managing running load, strength and conditioning, and energy availability

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Shownotes

Brad's background

03:10 -

  • As an Australian-based sports and exercise physiotherapist, I currently train as a registrar for the Australian College of Physiotherapists. 
  • This two-year program specialises in sports physiotherapy. I work as a full-time practitioner.
  •  Located on the Gold Coast, Australia, I have always been passionate about triathlon and physiotherapy. It is a dream to combine both of these interests in my career.
  • Throughout the years, I have been fortunate to have some incredible opportunities in the field of sports physiotherapy. 
  • I have provided physiotherapy coverage for Super League events and served as a consultant for Triathlon Australia. 

Main reasons athletes get injured and how to prevent them

04:31 -

  • Injury in endurance sports is a complex issue with multiple contributing factors. 
  • While training errors play a significant role, it is important to recognise that they do not solely cause injuries. 
  • Other factors include an athlete's biomechanics, tissue capacity or strength, tolerance, and physiology, including energy availability and caloric intake. 
  • Psychological influences also play a role in injury susceptibility.
  • If we visualise these factors as a funnel, training errors are poured into the top and sift through the various buckets. 
  • When assessing an injury presentation, considering these main factors is crucial. 
  • It is worth noting that some individuals may have made training errors in the past without experiencing injuries, indicating that other factors may not have been in place to make them susceptible at that time. 
  • However, as strengths, biomechanics, and stress levels change, injuries can occur even with fewer training errors.
  • Preventing endurance sports injuries, including those in triathlon, is challenging. The nature of these sports often involves balancing pushing one's limits and avoiding overexertion. 
  • While there are no foolproof data sets for injury prevention, understanding an athlete's injury history can be a valuable predictor of future injuries. 
  • Past injuries can guide athletes to take precautions and adjust to reduce the reoccurrence risk.

Are all injuries preventable?

08:20 -

  • The question of injury prevention is complex and warrants careful consideration. 
  • While it may be desirable to believe that all injuries are preventable, the reality is that we live in a world where multifactorial causation plays a significant role. 
  • Renowned Australian scientist Tim and other scientific colleagues addressed this issue in a paper titled "The Unbreakable Athlete." 
  • They grappled with the idea of injury prevention and concluded that while it is technically possible to avoid injuries, the likelihood is quite low due to the numerous factors involved.
  • Athletes can face psychological pressures, financial constraints, relationship issues, physical instability, sleep deprivation, and many other challenges. 
  • It is impossible to mitigate all these factors effectively. 
  • Even athletes within well-managed ecosystems and rigorous training regimens can experience injuries, as seen in Olympic years when athletes expected to perform well often sustain injuries before major competitions. 
  • Examples include Georgia Taylor Brown and Vincent, who encountered injuries before the Tokyo Olympic Games, despite being aware of what they needed to manage.
  • While specific training details of these athletes are unknown, discussions with coaches suggest that it is uncommon for the training load to be significantly increased as the Olympics approach. 
  • In fact, in many cases, the highest training load occurs in the third year of the quadrennial cycle, with the fourth year potentially featuring a slightly decreased load but more focused on quality racing. 
  • However, regardless of training adjustments, various factors such as the stress of impending competitions, qualification periods, and the psychological impact of the Games can contribute to injuries.
  • Ultimately, mitigating all these factors is challenging, if not impossible. Acknowledging the complex nature of injury causation and striving to manage known risk factors to the best of our ability is crucial.

What to do when you get injured

11:17 -

  • When dealing with running-related injuries, it is crucial to understand the definition of such injuries clearly. 
  • Typically, a running-related injury is defined as experiencing symptoms for seven consecutive days or being unable to complete three training sessions. 
  • With this definition in mind, the question arises: what should athletes do when they find themselves in such a situation?
  • Having worked as a full-time practitioner in this field for 17 years, I have encountered numerous cases and witnessed both effective and ineffective approaches to injury management. 
  • The first and most important rule is acknowledging when something is wrong. 
  • Athletes are often aware of their bodies and can sense an issue, but we tend to deceive ourselves and think it will be fine. My advice to athletes, coaches, and anyone in a similar situation would be to seek professional advice early on. 
  • Arrange a consultation or appointment with someone who understands the specific demands of your sport, someone you trust and may have worked with before.
  • Detecting a potential bone injury, such as a bone stress injury, early on can make a significant difference. Addressing it promptly can mean the distinction between being able to compete throughout a season or losing an entire season. 
  • Therefore, seeking assistance early and collaborating with a reputable professional who can effectively manage your injury is crucial. 
  • A holistic approach to intervention is vital, ensuring that all relevant factors are considered.
  • Furthermore, I firmly believe that a well-executed rehabilitation program should help athletes recover and improve their overall condition beyond their state before the injury. 
  • Rehabilitation should strive to enhance performance and prevent future injuries.

Rehab process

13:17 -

  • Several important principles must be considered in managing and recovering from injuries in triathlon. 
  • The first principle is to ensure an accurate diagnosis of the condition. 
  • With an accurate diagnosis, athletes may avoid difficulties such as spending excessive money and time seeking different opinions and losing training availability. 
  • Identifying the specific tendon, bone, or joint-related concern is crucial to develop an appropriate treatment plan.
  • The second principle is to maintain fitness during the recovery process. 
  • Triathlon is a multidisciplinary sport, providing opportunities to focus on other disciplines while unable to perform certain activities due to injury. 
  • Athletes can use alternative training methods such as swimming, cycling, and strength and conditioning to maintain their fitness.
  • Patience is the third key principle. It is important to understand the condition and its expected timeframes for recovery and respect the body's biology. 
  • Each injury has its healing process, and attempting to rush or expedite the recovery can lead to further complications. 
  • Athletes should recognise and accept the realities of their situation, avoiding the temptation to return too early or inappropriately.
  • Returning to running, particularly after a significant period of injury, depends on various factors, including the athlete's prior injury history. 
  • If an athlete has experienced repeated bone stress injuries, a more cautious and gradual return is necessary compared to someone who has encountered their first injury. 
  • When returning from a tendon or bone injury, it is recommended to restore 80% of the athlete's normal running volume before introducing speed work or intensity. 
  • Intensity places additional stress on the tissues, so it should be reintroduced slowly and thoughtfully.
  • Walk-run returns are often preferred, especially for bone injuries, as they allow the athlete to adapt gradually to impact loading. 
  • Resting the skeleton for a sufficient period is crucial, and athletes should consider the internal loads on bones, which can reach up to 14 times body weight for certain areas like the shin. 
  • Starting slowly and gradually building up the running duration is essential to avoid excessive strain and minimise the risk of recurrence.
  • Collaboration with a therapist and coach is highly recommended throughout recovery to ensure a safe and structured return. Rushing the return to full training increases the likelihood of reinjury and further frustration, emphasising the importance of a gradual and well-managed recovery approach.
  • When guiding runners in their return from injury, the primary objective is to rebuild their endurance and avoid potential risks gradually. 
  • Typically, the aim is to have the runner back to half-hour runs within four to six weeks. 
  • However, the initial starting point may be as low as one minute of jogging interspersed with three or four minutes of walking, totalling half an hour. Over the following weeks, additional minutes of jogging are added progressively.
  • It's important to note that starting with a continuous run right away carries a higher risk. 
  • Therefore, when educating athletes or patients recovering from injury, it is crucial to emphasise the concept of tissue conditioning during the first month rather than focusing solely on fitness training. 
  • While cardiovascular benefits exist, the primary goal is to reintroduce the bones, skeleton, tendons, and muscles to the demands of running safely.
  • Although adhering to a walk-jog regimen can be challenging, it is undeniably the best approach compared to immediately attempting continuous minutes of running.

Swim related injuries

19:37 -

  • Shoulder injuries are a common concern for swimmers, including triathletes, regardless of their skill level. Most often, shoulder structures such as tendons are the ones that become irritated and painful. 
  • Tendinopathy, the contemporary term for tendon pain states, occurs when the workload exceeds tissue tolerance, leading to tendon pain due to biochemical activity rather than inflammation.
  • Shoulder pain in swimmers can occur when they return to the pool after a period of inactivity and overload the shoulder or when they increase the swimming workload, duration, or intensity leading up to a race. 
  • The term for shoulder pain related to the rotator cuff is "rotator cuff-related shoulder pain." 
  • The symptoms can manifest as pain in the front, side, or rear of the shoulder. Tendons may feel stiff and sore at the start of a swim session and may worsen as the session progresses.
  • Treating shoulder injuries requires a progressive strength and conditioning effort, as simply massaging the shoulder will not resolve the underlying issue.
  •  Strengthening and conditioning exercises are essential to restore the capacity of the affected tissues. 
  • It is common to find abnormal strength ratios between internal and external rotation in the shoulder. Stiffness in the thoracic spine can affect streamlining ability, and it's important to check other areas, such as ankles and hips, for potential swimming-related injuries.
  • Some key exercises in a shoulder strength and conditioning program for swimming athletes include basic movements like front raises, lateral raises, and upright rows using dumbbells.
  •  Isolated rotator cuff work and push-ups can be beneficial, especially for the subscapularis muscle. 
  • The push-up exercise is underrated but effective for shoulder rehabilitation.
  • More advanced exercises, such as single-arm cable rows and heavy pull-down work, can be incorporated into a gym setting.
  • It's important to note that a comprehensive shoulder rehabilitation program doesn't require many exercises. Often, prescribing three or four exercises and ensuring consistent engagement in the program can bring about positive changes in tissue qualities. The progression of exercises should continue until the athlete is no longer experiencing symptoms.

Strength Training in the Context of injury rehabilitation

24:00 -

  • During rehabilitation, the focus is on restoring capacity to the affected structures and the entire kinetic chain. 
  • It is recommended to work with heavier weights or resistance to achieve optimal results.
  • A typical prescription may involve three to four sets of six to ten reps per exercise. 
  • Athletes are advised to aim for an effort level greater than five out of ten on the RPE scale. 
  • If an exercise feels too easy and they could perform significantly more reps, it suggests that the resistance is too low. 
  • Additionally, each set should be concluded with approximately two reps remaining in reserve, indicating that the effort level was appropriately challenging.
  • One common mistake is athletes using weights that are too light, which can hinder their progress and prevent them from achieving the desired gains. 
  • Therefore, selecting a resistance level that allows for sufficient challenge and promotes strength and performance improvements is important. 

Injury risk factors

25:33 -

  • There are several factors to consider when it comes to preventing swim-related injuries. 
  • One important aspect is understanding the exceeding of tissue tolerance due to a change in workload. In addition, some anecdotal considerations can help educate injured swimmers and promote injury prevention.
  • One aspect to focus on is kickboard use. Overhead kickboard positions can place significant compression on the shoulder cuff, which may be problematic for individuals with shoulder pain. In such cases, kicking with the arms by the side is often recommended. 
  • Another consideration is addressing anterior hip or pelvic tightness, which can lead to poor body positioning in the water and increased shoulder compression. Stretching exercises targeting these areas can be beneficial.
  • Maintaining thoracic spine mobility is crucial, particularly for long-distance triathletes. A foam roller for thoracic spine mobility exercises can be simple yet effective. 
  • It is also important to be mindful of fin usage. Fins may not be suitable for individuals with lower back pain, sciatica, hip issues, foot problems, or Achilles tendon concerns.
  • While taking extended breaks from swimming may be tempting, it is advised not to rest for too long. 
  • Elite swimmers like the Australian swim team now emphasise consistent swimming even during off-season periods to minimise the risk of developing tendon issues or shoulder problems when returning to regular training. 
  • Triathletes should adopt a similar approach and be cautious about extended deloading periods.

Bike injuries

28:07 -

  • Cycling presents unique considerations compared to running and swimming due to the lower body weight experienced and the different forces exerted on the body. 
  • While acute injuries from falls are a risk in cycling, overuse injuries are more prevalent. 
  • One common overuse injury in triathletes is patellofemoral pain and kneecap pain. 
  • Factors such as cleat position, bike setup, and increased time on indoor trainers can contribute to knee pain. Training indoors with limited lateral movement can place additional strain on the knees, as seen in cases where British triathletes experienced increased kneecap pain during COVID-19 lockdowns.
  • Triathletes often experience neck stiffness and lower back soreness, typically related to exposure to load rather than specific injuries. 
  • For example, during Ironman preparations, a significant increase in cycling duration without proper tissue adaptation can lead to pain in the back. 
  • The pain may stem from various sources, such as ligament stress, soft tissue strain, and facet joint or disc irritation. 
  • Continued exposure to a consistent workload allows the body to adapt over time. 
  • Still, additional measures like strength and conditioning training can be beneficial in managing discomfort in the neck or lower back.

Triggers of kneecap pain

31:40 -

  • I can relate to experiencing knee pain, specifically kneecap soreness, for around 30 years. 
  • It's been observed that athletes who have kneecap soreness during adolescence have a 50% chance of experiencing it throughout their athletic years, and I fall into that category. 
  • I've noticed that low cadence work, such as strength endurance efforts uphill, has sometimes aggravated my knees, although there have been other instances where it hasn't caused any issues. 
  • It's important to note that the relationship between low cadence work and knee soreness can vary greatly among individuals, so it's not a definitive cause-effect correlation.
  • Proper bike fit is crucial to prevent or mitigate injuries while cycling. 
  • Bike fitting is an area of great interest for me as a sports physiotherapist working with triathletes. 
  • I collaborate with skilled bike fitters with expertise in adjusting various parameters to optimise bike positions. Factors such as the athlete's position on the bike, including how far forward they are, saddle height, saddle position, and crank length, can significantly affect comfort and injury risk. 
  • Athletes experiencing kneecap pain while cycling often benefits from using a shorter crank length.
  • In addition to bike fitting, conditioning yourself for the demands of cycling is essential. 
  • Suppose you're planning to ride for an extended duration. In that case, it's important to work on the endurance of muscles such as the neck extensors and lower back through specific strength and conditioning exercises. 
  • This preparation is more focused on building endurance rather than addressing mobility issues that may hinder attaining the desired position. 
  • Comfort plays a significant role in time trial positions nowadays, as athletes strive for stability and aerodynamics. While the positions may appear comfortable, they have been optimised to achieve exceptional speeds seen in races today.
  • Conditioning oneself to sustain the intended position on the bike is challenging. Looking back to the 90s, I recall seeing Jan Ulrich in the Tour de France riding with his bars below the bullhorns and the base plate, a position common among juniors then. 
  • However, this setup is neither aerodynamic nor comfortable by today's standards. 
  • It's fascinating to see how bike positions have evolved, and it's difficult to believe that the current positions aren't the fastest, considering the record-breaking times we witness in races. Conditioning oneself to maintain these positions is undoubtedly a demanding task.

Run injuries

35:20 -

  • Running injuries are highly prevalent among athletes, including runners and triathletes. 
  • Studies have shown that within 12 months, it is likely that around 50% of athletes will experience some form of running-related injury. 
  • A systematic review conducted in 2012 identified 28 different types of running injuries.
  • Among the most common running injuries reported in the review, medial tibial stress syndrome (shin pain) ranked highest, followed by Achilles tendinopathy and plantar fasciitis. 
  • Other frequently encountered injuries include patellofemoral pain (runner's knee) and various bone stress injuries, such as those affecting the femur, pubic area, sacrum, and foot.
  • While there are several prevalent injuries, medial tibial stress syndrome and Achilles tendinopathy are particularly notable due to their high occurrence rates among runners and triathletes. 
  • These injuries pose significant challenges and often require careful management and treatment.

Preventing run injuries

36:49 -

  • It is important to make changes in the training load slowly. 
  • While athletes can often handle volume increases, combining volume and intensity changes can stress the bones, potentially leading to injuries. 
  • Therefore, it is crucial to carefully manage the intensity and incorporate deload periods to protect the skeleton.
  • The skeleton undergoes desensitisation over a year. 
  • Athletes engaged in the year-round running are more prone to bone stress injuries in the later stages of the year, whereas team sports athletes are more likely to experience such injuries in the pre-season. 
  • Being mindful of bone health towards the end of the season is valuable. 
  • Athletes with a history of bone stress injuries might benefit from taking a complete 12th week off from running to allow their skeleton to desensitise. 
  • During this deload week, they can still engage in exercises like swimming or biking. 
  • Another approach is to incorporate skeletal deload weeks every second or third week, which may involve reducing intensity and volume.
  • Regarding whether the training load needs adjustment when resuming running after a complete break, it is generally observed that athletes can jump straight back into their normal running routine.
  •  The proposition of taking a week off every 12 weeks to prevent bone stress injuries, even though it means losing four weeks in a calendar year, outweighs the alternative of incurring a bone stress injury that could require a longer deloading period followed by reloading.
  • Relative Energy Deficiency in Sport (RED-S) is a term familiar to many athletes, as it highlights the importance of sufficient caloric intake. 
  • Low energy availability significantly increases the risk of bone stress injuries. 
  • While evidence regarding tendons is still lacking, it is known that athletes with low energy availability maybe three to four times more likely to experience another bone stress injury. 
  • Additionally, if athletes have compromised bone health, such as osteopenia, the risk factors can be amplified up to 15 times. 
  • Energy availability is a prevalent factor in injuries and often goes unrecognised by athletes who may not know their fueling needs to maintain safety.

Carbohydrate Availability and bone injuries

42:40 -

  • Athletes must understand that carbohydrates play a vital role in bone metabolism. 
  • Insufficient carbohydrate intake can impair bone health, as our skeletons are constantly undergoing remodelling. 
  • Even now, micro-cracks are present in our bones, which can develop into porous areas and sites of bone stress. 
  • When assessing athletes with bone injuries, we consider any recent dietary changes, as evidence suggests that vegans may have a higher risk of bone stress injuries, potentially related to reduced carbohydrate intake.
  • Maintaining a proper caloric balance is essential, and athletes engaged in endurance training require approximately 40 calories per kilogram of fat-free mass to support optimal bone metabolism. However, meeting these energy requirements can be challenging for triathletes, particularly due to the prolonged training duration involved. 
  • In fact, for every hour beyond four hours of training, there is an additional 5% increase in the risk of bone stress injuries. 
  • Therefore, triathletes face a particularly demanding task of consuming enough calories.
  • If I suggest one crucial action to prevent injuries or enhance injury prevention, it would be for athletes, including triathletes, to prioritise increasing their calorie intake. 
  • Providing the body with adequate fuel is essential for optimal bone health and injury prevention.

Calcium and multivitamin supplements for bone health

44:36 -

  • Nutrient availability, including vitamin D and calcium, is crucial in bone health. 
  • Athletes can experience a higher nutrient demand due to increased sweat loss during intense training sessions, leading to a potential deficiency in essential nutrients. More than merely meeting the recommended daily allowances may be required for athletes with 10 to 20 hours of training per week.
  • Calcium intake is essential for athletes recovering from bone injuries and those aiming to prevent such injuries. 
  • Given the significant calcium loss through sweat, athletes may need to triple their calcium intake compared to the recommended daily allowances. 
  • Adequate availability of all nutrients is essential for maintaining strong and healthy bones.
  • Regarding supplementation, while it is outside the scope of practice for a sports physiotherapist, supplements such as multivitamins and vitamin D are a consideration. Vitamin D, for example, is often challenging to obtain through food alone, and athletes may benefit from vitamin D sprays or other supplementation methods. 
  • Athletes should consult with a dietitian regarding appropriate supplementation, as they can provide tailored advice based on individual needs and circumstances.
  • For approximately a decade, I suffered from a vitamin D deficiency. This was primarily due to my training routine, which involved exercising in the morning with limited exposure to sunlight, followed by long hours working in a clinic, and then training again in the evening. 
  • Contrary to the common belief that being in a sunny environment ensures adequate vitamin D levels, it was evident that this was not the case.

Shin pains

47:57 -

  • Regarding shin pain, it's important to understand the two main presentations: bone stress and medial tibial stress syndrome (MTSS). 
  • Bone stress occurs when the shin bone becomes overloaded and sore, progressing from mild stress reactions to stress fractures. 
  • On the other hand, MTSS is a soft tissue condition that can be challenging to differentiate from bone stress for athletes.
  • One key distinguishing factor is the extent of soreness along the shin bone. 
  • If an athlete experiences soreness spanning more than five centimetres along the inside of the shin (medial or posterior medial), it is likely MTSS. 
  • The good news is that athletes can often continue running with MTSS and manage it effectively. 
  • Reducing volume and intensity during training is important while closely monitoring the condition. With proper care, MTSS symptoms can resolve within a few weeks.
  • If the sore region is less than five centimetres or if there are concerns about bone stress, it's advisable to consult a running-based sports practitioner for further assessment. 
  • In cases of bone stress, rest is crucial to allow proper healing.
  • Personal experience has shown that MTSS can be successfully managed by adjusting training volume and intensity. 
  • By recognising the specific characteristics of shin pain and taking appropriate steps, athletes can continue training while ensuring their well-being.

Changing running biomechanics

50:32 -

  • In biomechanics and injury prevention, there are important considerations to remember. 
  • It has been established that biomechanics alone cannot predict specific injuries. 
  • However, it can provide insights into areas of the body that may experience greater load or stress. 
  • For instance, individuals who overstride or have a low cadence may be more prone to knee or shin injuries, while forefoot strikers may be at a higher risk of Achilles tendon or calf injuries.
  • Biomechanical analysis helps identify potential risk areas for athletes but does not guarantee injury occurrence. 
  • Looking at someone's running style and predicting a particular injury is impossible. 
  • However, by using running retraining or modifying an individual's gait, it is possible to temporarily alleviate stress on sore areas and aid in their recovery.
  • It is important to note that running gait retraining is a short-term solution. 
  • It serves as a short-term intervention to unload injured or sensitive areas and facilitate the athlete's return to training or competition. 
  • While gait modifications can be beneficial in managing and preventing injuries, they are not a permanent fix and should be considered part of a larger toolbox of strategies for athletes.

Generic strength and conditioning program to prevent the most common running injuries

52:14 -

  • Focusing on specific muscle groups is crucial to improve running performance. 
  • Calf strength exercises are essential since approximately 50% of the propulsion in our running gait comes from below the knee. 
  • Unfortunately, as we age, we tend to lose strength in the plantar flexors faster than other muscle groups. 
  • By 60, we may have lost up to 30% of propulsive force while running.
  • To address this, runners should incorporate quality calf strength exercises into their training regimen. 
  • This can be done through standing and sitting exercises, with sitting exercises emphasising the deeper part of the calf known as the soleus. 
  • The soleus is particularly important as it acts as the powerhouse of our running body, generating significant force—up to eight times our body weight—regardless of our running pace.
  • In addition to calf exercises, it is essential to consider the kinetic chain and focus on other muscle groups. Quadriceps play a significant role in running and should be targeted through exercises such as single-leg extensions. 
  • Lateral hip capacity, supported by the hip abductors, can be improved with exercises like cable abductions.
  • The hamstrings are another crucial muscle group. While the soleus works continuously, the hamstrings are more phasic in their activation. 
  • During submaximal running, hamstrings may generate two and a half times our body weight, which can increase to eight times during high-intensity sprints. Single-leg hamstring curls are effective for strengthening this muscle group.
  • Including squat and lunge movements in the training, routine is also beneficial. 
  • Squats can be performed in various forms, such as front, back, Smith rack, or goblet squats. Hip hinge movements, like deadlifts using barbells, trap bars, or kettlebells, are also recommended.
  • The key is to keep the training simple and focused. Triathletes don't need lengthy gym sessions; 30 to 45 minutes can be sufficient. 
  • Single-leg exercises are often preferred to target weaknesses that may be masked in double-leg exercises, but double-leg exercises like squats and deadlifts should still be included.

Running shoes

55:22 -

  • The running shoe industry has undergone significant changes, moving away from the old motion control paradigm towards focusing on comfort and shoe geometry. 
  • The idea that specific shoe features can correct pronation has shifted, and now it's understood that shoes are simply tools or sporting equipment. 
  • Different shoes may suit individuals based on their specific conditions or injury history.
  • For example, a runner with Achilles tendon pain may benefit from a shoe with a greater drop or rocker bottom, which reduces demand on the calf and Achilles. 
  • On the other hand, a runner with kneecap pain may find a lower-drop shoe more beneficial. Personalised advice can be given based on these considerations.
  • While there is evidence that rotating shoes may help reduce the risk of injury, it can be challenging for many athletes to afford multiple pairs for regular rotation. Nonetheless, it is recommended to have at least two pairs of shoes to cycle through.
  • It's important to note that footwear is often over-attributed as a preventive measure for injuries. 
  • Despite technological advancements, the injury rate remains similar to 50 years ago. 
  • Athletes are advised to prioritise factors like caloric intake rather than obsessing solely over footwear choices.

Key Takeaways from this Interview

57:40 -

  • Working with professionals such as a sports dietitian and your coach is crucial. 
  • Collaborating with a sports dietitian will ensure that your fueling is adequate and supports your training demands. This aspect is considered highly significant in achieving your goals.
  • Incorporating strength and conditioning exercises is also beneficial, even if you cannot access a gym. 
  • Home routines, such as standing calf raises and side bridging, can contribute to your overall fitness and performance. It is recommended to establish a consistent routine, even if it is minimal, to maintain physical strength and stability.
  • Additionally, being mindful of the intensity of your workouts is essential. 
  • High-intensity running carries certain risks, so having a coach by your side can assist in monitoring and regulating your training intensity. 
  • They can help measure the appropriate level of intensity for your workouts, ensuring you strike the right balance between pushing yourself and avoiding overexertion.

Rapid-Fire Questions

58:47 -
What's your favourite book or resource related to endurance sports?
Bone Stress Injuries in Runners


What's an important habit you've benefited from athletically, professionally or personally?
A shortcut will only cut you short. So I've adopted this with my training. Sometimes you don't feel like doing the warm-up or cool down in the pool, or whatever's on the program, but when you let yourself off the hook once, you open the door to do it again.


Who's somebody that you look up to or that has inspired you?
Professionally, I've been impacted by the work of Stuart Warden and Rich Willy. They're very reputable running researchers around injuries. Any athlete pursuing their best is just an inspiration, no matter what it is. It's getting inspired by effort, not just results.

LINKS AND RESOURCES:


Bernardo Gonçalves

Bernardo is a Portuguese elite cyclist and co-founder of SpeedEdge Performance, a company focused on optimising cycling and triathlon performance. He writes the shownotes for That Triathlon Show, and also produces social media content for each new episode.

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