Injury Warning Signs

Triathletes and runners alike, everyone has their own motivations for training. Whether it be for stress relief, for fitness and health, for performance, or for personal sanity, there are countless physical and psychological benefits to participating in regular physical activity, and pushing your body to the limits through hard training. The sense of euphoria you experience with exercise is great for the soul, and it can definitely become addictive.

Whilst staying active has countless benefits, exercise addiction can also cloud your judgement if you're not careful. Too much exercise can lead to overtraining and overload on the body. Ignoring the warning signs and pushing through fatigue often leads to increased injury risk. .

Overtraining and Overload Training load can be quantified in many ways, and significant changes and increases to load outside standard periodised training will create huge increases in stress to the body. For triathletes it’s also important to consider the variable stress placed on the body through each of the three disciplines. Volume, frequency and intensity are key variables that need to be manipulated and balanced with relation to load, whilst other considerations like training specificity and variation, and changes to footwear or running terrain can also change load, even if nothing seems out of the ordinary on paper.

Perhaps the most important and overlooked of all, is the impact of other lifestyle factors and their contribution to overload and stress on the body. Even though not physical training, stress and fatigue from life, school, work, family and relationships all contribute to overload. The body can not distinguish the cause of stress/overload, but merely that the load is too high to sustain. Whether from overtraining or otherwise, when the body is overloaded, something has to give. Unfortunately for athletes, often the outcome is injury.

Overtraining is one of the biggest risk factors for injury, especially overuse injuries. But, once you're injured it's too late. There are warning signs that you should be wary of in the first instance to reduce your risk of overload and injury. These include:

  1. Feeling flat, tired and stressed

  2. Lingering pain after sessions

  3. Niggling injuries

  4. Bone related injuries

  5. Muscle tears and strains

Feeling Flat, Tired and Stressed This may seem obvious, but it’s important not to overlook constant feelings of tiredness and stress, especially when these feelings are more elevated than normal or last for more than a few consecutive days. The following are all warning signs from your body: - feeling flat during training - struggling with motivation or fatigue - feeling more stressed - struggling to maintain your normal sleep pattern To prevent excessive tiredness and fatigue while making changes to your training load, you need to manage load and stress from other areas of your life. Here are some tips: - Listen to your body, and be willing to adjust your training plans if you’re feeling off - Check your resting Heart Rate: an elevated resting heart rate is a good indicator of tiredness, stress, fatigue or sickness

- Improve your sleep patterns

- Maintain a healthy diet, and really focus on getting your essential macro-nutrients at the right times (ie. refuelling ASAP after exercise, carbohydrates for fuel, protein for recovery)

- Stay well hydrated

Lingering Pain after Training Some fatigue and soreness is normal after exercise, particularly longer and more intense sessions. DOMS (delayed onset muscle soreness) is common. However, if your pain doesn't fit the DOMS profile targeted to the key muscles you've used during the session rather than whole-body fatigue and aching.

If pain lingers and worsens, or doesn’t ease off or dissipate during the first 10-15min of your next session despite normal post-training recovery and sleep, this could mean that your body is compromised and suffering from overload.

Niggling Injuries It can be difficult to differentiate between a niggle and an injury. When can you push through and when do you need to ease off? It's not always a simple answer. Often there is a risk element involved too - depending on upcoming plans and the location of pain as well.

However, the following guidelines may help you to determine whether or not you should see a health practitioner for an assessment: - Pain >2/10 and present for three consecutive training sessions - Pain that worsens during or after training rather than easing off - Pain at rest - Pain that compromises your ability to train and complete standard sessions

Bone Stress and Stress Fracture Bone stress is a sure sign of overtraining. It occurs when the body’s natural bone remodelling process is unable to keep up with the level of training and consequent breakdown of bone tissue. Bone stress will typically present 4-6 weeks after a sudden change to training load, with the tibia (shine bone) and smaller bones of the feet being the most commonly injured amongst runners. Bone injuries usually display recognisable symptoms: - Sharp/intense pain, which worsens with increased training - Focal pain with pressure/touch - General aching pain at rest (more severe bone stress)

Immediate rest is essential to address bone injuries, and offloading is vital. Delays in diagnosis and/or continued training through pain caused by bone stress or stress reactions can result in stress fractures and more time without running.

Muscle Injury There are various different presentations of muscle injuries, with strains and tears being most commonly linked to fatigue. Fatigue can contribute to muscle injuries in a number of ways:

  1. Muscle contraction (movement) requires neural innervation (messages from the brain). With fatigue at play, there is often mis-timing between these messages and the muscle movement, and consequently the normal muscle contraction can become strained and unnatural.

  2. Tight, shortened muscles are compromised, and more likely to become injured if pushed too hard during training. Knots or adhesions in the muscle, caused by high training load, races and speed, and lack of recovery, compromise elasticity and function and therefore often predispose to injury.

  3. Fatigue during running often leads to form faults such as poor posture (eg. collapse through the hips) and over-striding. As a result, muscles like the calves and hamstrings are over- worked and functioning outside their normal range, and thus more susceptible to injury.

Typical symptoms of acute muscle injuries include: - Sudden, sharp, stabbing pain - Partial or full loss of power and function - Ongoing pain and tightness - Tightness worse after rest, but tends to warm up somewhat with gentle movement

Struggling with Fatigue or Injury... What Should You Do?

Don't ignore these warning signs. Prevention is better than a cure. Learn to recognise potential overload, and increased injury risk. With overload, your body will struggle to cope - your ability to function, train effectively and recover will be compromised. If you're feeling flat and tired, constantly sore and not recovering from training, or worried about a niggling injury, it's possible that overload is the underlying cause. You need to also be willing to adapt and implement changes to your training and lifestyle to overcome these feelings before they lead to injury, or more serious health concerns.

If you’re worried about a potential niggle or injury - seek advise from a health professional immediately. Remember that Podiatrists specialise in lower limb and foot injuries - anything from the hips down.

At Running Fix, I enjoy working with athletes and active individuals to address their injury concerns. I take a comprehensive approach to injury assessment, and provide short-term pain relief strategies in addition to long-term management to reduce future injury risk.

Resources: Kozinc Z & Sarabon N, (2017) “Common Running Overuse Injuries and Prevention”, Monten J Sports Sci Med 6:2. pg 67-74 Wright AA (2015) “Risk Factors Associated with Lower Extremity Stress Fractures in Runners: A Systematic Review with Meta-analysis”, British Journal of Sports Medicine. 49:23. Pg 1517-1523 Tenforde AS, Kraus E & Fredericson M (2016) Phys Med Rehabil Clin N Am. 27:1. Pg139-149.

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