Triathlon: medical considerations

Dr Tom CrossFACSP,MBBS,DCH

Outline of talk

Introductory concepts

Musculo-skeletal Injuries

Illness/Medical conditions

Conclusion

Introduction

Triathlon started in California in 1970’s Sport began in Australia in early 1980’s International sport: more than 120 nations Olympic sport since 2000 Sydney games 160,000 Australians compete 180 Tri clubs in Australia National and State Federations

Australian Success

Greg Welch Michellie Jones Chris McCormack Emma Moffatt Craig Alexander Emma Snowsill Miranda Carfrae

3 Disciplines

Swim-Bike-Run Competitors: recreational and elite/pro series Athletes often very successful in other sports Differing Distances

Sprint 750/20/5 Olympic 1.5/40/10 Half Iron Man 1.9/90.1/21.1 Iron Man 3.8/180.2/42.2

Medical Team Physiotherapist Soft tissue therapist Chiropractor/Osteopath Doctor Nurse Dietician Podiatrist Bike Mechanic Biomechanist St John’s Ambulance

Injuries and Illness

Musculoskeletal (MSK) injuries Acute Overuse

Illness Dehydration/Heat Illness Hypothermia Water Intoxication Cardiovascular Female athlete triad Overtraining Syndrome/Fatigue Infectious Disease

Injuries

Sport specific injuries

Discipline specific

Swimming Cycling Running: causes most injuries

Paucity of Evidence Based Medicine regarding Injuries!

Injuries

Injuries

Injuries

Injuries

Running overuse injuries Causes

Training Error (volume, frequency, intensity, surfaces) Biomechanics (alignment, running efficiency) New coach/club/training group Footwear Poor Bone health Inadequate warm up/cool down, stretching, massage

Prevention Scientific approach to training Podiatry Optimize running technique Optimize Bone health Recovery strategies

Illness

1. Thermal stress1. Heat illness/dehydration

2. Hypothermia

2. Water Intoxication

3. Cardiovascular

4. Female athlete triad

5. Overtraining syndrome

6. Infection

Illness

Illness

Hypothermia

Swim: most at risk! Cycling

Prevention

Wetsuit choice Clothing on bike

Illness

Water Intoxication

Fluid and electrolyte disturbance Drinking yourself to death

Exercise associated Hyponatraemia Serum sodium <135 mmol/litre

Risk Factors longer endurance events > 4 hours Female Slower runners (more time to drink)

Occurred secondary to perception Drinking caused performance enhancement Drinking reduces risk of Dehydration/heat illness

Symptoms Nausea/vomiting, shortness of breath, confusion, coma and death

Illness

Illness

Cardiovascular

Recreational

Sudden cardiac death <35 Congenital heart disease >35 Coronary artery disease

Elite/Pro Triathletes

Pathological variant of Athlete’s heart: Cardiomyopathy: conduction disorders/arrhythmias

Greg Welch: “ventricular tachycardia” requiring an implantable defibrillator

Illness The Female Athlete Triad

Disordered eating (much more common in elite athletic women than normal population) EDNOS, Anorexia,Bulimia

Menstrual disturbance (Caloric restriction + Intensive exercise) Amenorrhea, Oligomenorrhoea, luteal phase defects

Poor Bone heath (inadequate estrogen) Osteopenia, Osteoporosis: Increased risk of STRESS FRACTURES and OSTEOPOROSIS in later life!

At risk sports Endurance (running, triathlon) Aesthetic (gymnastics, diving, figure skating, synchronized swimming) Weight divisions (Martial arts)

Bone health

Accrual occurs in teenage/early 20’s Peak Bone mass by 25-30 Can assess with BMD testing (Anthropometric assessment) Bone mineral density deficit only partially reversible

Illness

Illness

Overtraining syndrome/Fatigue

Definition: continued fatigue after 2 weeks of rest. Causes

Excessive exercise TRAINING ERROR Over-crowded lifestyle/Time poor individual (Psycho-social stressors) Poor nutrition: “running on empty” ! Inadequate recovery from viral illness Sympathetic nervous system exhaustion !

Symptoms Training and performance decrement Increased perceived level of exertion Increased muscle soreness

Exclude other causes of fatigue

Iron deficiency Other Nutritional deficiencies (COH, Dehydration etc) Depression Disordered eating Other medical causes (Cardiac, respiratory, endocrine etc)

Illness

OTS/Fatigue

Treatment Relative rest Simplify lifestyle/minimize stressors Optimize diet/recovery strategies/meditation

Prevention Periodize training (micro/macro cycles) Monitor symptoms (energy, mood, muscle soreness, sleep quality etc) Optimize diet/recovery strategies

Illness

Illness

Illness

Infection

Prevention

Immunization (Routine + Hep A/B, Influenza, meningococcal ) Periodize training Optimize diet/recovery strategies Universal precautions while traveling (e.g. sharing drink bottles etc.) Increased risk with adverse environmental conditions (cold and heat stress) Avoid/isolate sick athletes Supplements: Lactobacillus Yogurt, Echinacea, Multivitamins

Concluding remarks

1. Beware “Drugs in sport”

1. If concerned check WADA website

2. Seek medical screening (Doctor/Physiotherapist) if concerned about past medical history &/or injury history

3. Report injury/illness early!

4. Educate yourself about Periodization of training and practice other PREVENTATIVE strategies to prevent both injury and illness!!

Thank you