Sports Medicine for Youth Triathlon

By Michael Ross, MD, Sports Medicine Editor

Youth exiting water at triathlon

Triathlon can be a fun and rewarding pursuit for any age athlete. Getting your child into the sport has numerous health benefits, both physical and mental. Overuse injuries often detract from the positive experience of becoming an athlete. Fortunately, a majority of injuries are preventable by taking care to focus on the few problems that lead to most overuse injuries in endurance athletes.

Much like you wouldn’t let your child play in traffic or ride without a helmet, it is equally important to follow two rules of overuse injuries:
1. Overuse injuries occur when exercise demands exceed the athlete’s endurance capacity
2. Overuse injuries occur when exercise demands exceed the athlete’s core strength

What is core strength?
The core comprises a series of muscles that stabilize the chest, abdomen, and pelvis so that the arms and legs can generate power. Without the core, the spine would be unstable, and trying to turn the pedals would have the same effect as firing a cannon from a rowboat—instead of pushing down on the pedals, the leg would move the hip and pelvis off of the saddle.

In my sports medicine practice, the majority of leg overuse injuries are associated with weakness of the hip muscles and many shoulder overuse injuries are associated with weak shoulder blade stabilizers.

In swimming, if the core is not used for the body roll and the shoulder blade stabilizers are weak, then the rotator cuff is placed under undue strain, leading to injury. Similarly, if the core doesn’t support the pelvis when running or cycling, the hips and knees take on an extra load to keep everything stable, leading to injury.

Special care should be given to conditioning of the core muscles as part of training. Not only will core stability help prevent injury, a strong core will also improve speed. Core strength is not just the sit-ups that we did in high school. Core strength should provide stability while you are moving your arms and legs. In other words, strengthening relies upon machines that only add weight, rather core strength should be done on equipment that will require you to also keep your balance.

As an example, consider the push-up. You can make it harder by placing your feet on a stability ball, or you hands on a foam roller. To increase the difficulty, remove stability by placing a balance board under your hands or a basketball in each hand.

There are many options for increasing core stability with your exercises, including balance boards, standing on foam pads, stability balls, and suspension trainers.

But shouldn’t my child’s endurance be good?
There are many factors that affect how long someone can go before they start to get tired. Fatigue frequently affects the smaller and weaker muscles first, leading to a breakdown of the stabilizing muscles and altering biomechanics. Common causes of fatigue include exercise induced asthma, anemia, and poor nutrition.

Exercise induced asthma is frequently asymptomatic. Common symptoms, which occur only about half the time, include shortness of breath, coughing, or wheezing with exercise. Often, a maximal exercise test is needed to induce changes in lung function.

If your muscles don’t get an adequate amount of carbohydrate during exercise, they will also become fatigued. Having a sound nutrition plan for both exercise and recovery is important. Keep in mind, not every athlete uses energy the same. At any given pace, one runner might use all of the slow twitch fibers and some of her fast twitch fibers, while another might not even be using all of her slow twitch fibers. Since the fast twitch fibers fatigue easily, it is important to know if, and when, you are dipping into this important resource. If you do use some fast twitch fibers, then you need to be more vigilant with recovery nutrition.

Every athlete needs to replace what was lost during exercise, especially fluids, carbohydrate and protein. Consuming 1 gram of carbohydrate per kilogram of body weight and 0.3 grams of protein per kilogram of body weight will help to restore muscle glycogen. This combination should be consumed immediately after a workout and again at one hour after a workout. When the weather is hot, check weight before and after and replace the difference with water (1 pound equals 16 ounces).

Finally, its never too early to focus on recovery. Sore, tight muscles lead to altered biomechanics and can change running gait. Utilizing recovery techniques such as foam rolling, hot/cold water baths, cool down (high cadence spins at the end of the ride), and recovery nutrition can all help to decrease exercise-induced muscle soreness.

In an ideal world, athletes would not push through injuries and would give themselves the necessary time to heal. In reality, that never seems to hold true; nice weather, training schedules, and training partners tend to push us through mild aches and pains and into injury. Focusing on the elements of injuries that can be prevented through proper training and evaluation prior to undertaking a new sport will help keep you moving pain free and faster.

Michael Ross, MD Dr. Micheal Ross is a sports medicine physician who has been treating endurance athletes for over a decade. He has been a team physician for numerous professional cycling teams. He also runs the Rothman Institute Performance Lab, a medical and scientific exercise testing and training facility in Bryn Mawr, Pennsylvania. He has written two books on training and sports medicine for endurance athletes as well as multiple scientific papers. He has been an invited speaker at USA cycling and consulted for several bicycle companies to provide the optimum fit. He is an avid triathlete himself who has qualified for short course triathlon nationals several times. When he is not at work or spending time with his family he can be found on the trails and the roads around Philadelphia.


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