Neuromuscular control and exercise-related leg pain in triathletes

Injury and illness in short-course triathletes: A systematic review

BACKGROUND

Determining the incidence and prevalence of injury and illness in short-course triathletes would improve understanding of their etiologies and therefore assist in the development and implementation of prevention strategies. This study synthesizes the existing evidence on the incidence and prevalence of injury and illness and summarizes reported injury or illness etiology and risk factors affecting short-course triathletes.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting health problems (injury and illness) in triathletes (all sexes, ages, and experience levels) training and/or competing in short-course distances were included. Six electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase, APA PsychINFO, Web of Science Core Collection, and SPORTDiscus) were searched. Risk of bias was independently assessed by 2 reviewers using the Newcastle-Ottawa Quality Assessment Scale. Two authors independently completed data extraction.

RESULTS

The search yielded 7998 studies, with 42 studies eligible for inclusion. Twenty-three studies investigated injuries, 24 studies investigated illnesses, and 5 studies investigated both injuries and illnesses. The injury incidence rate ranged 15.7-24.3 per 1000 athlete exposures, and the illness incidence rate ranged 1.8-13.1 per 1000 athlete days. Injury and illness prevalence ranged between 2%-15% and 6%-84%, respectively. Most injuries reported occurred during running (45%-92%), and the most frequently reported illnesses affected the gastrointestinal (7%-70%), cardiovascular (14%-59%), and respiratory systems (5%-60%).

CONCLUSION

The most frequently reported health problems in short-course triathletes were: overuse and lower limb injuries associated with running; gastrointestinal illnesses and altered cardiac function, primarily attributable to environmental factors; and respiratory illness mostly caused by infection.

Use of planar covariation in lower limb kinematics to characterize adaptations of running after cycling in elite triathletes

Purpose

To characterize alterations of lower limb intersegmental coordination during the acute phase of running after cycling among highly trained triathletes using an analysis of planar covariation.

Methods

Nine highly trained triathletes completed a control run (CR) and a run after transitioning from cycling exercise (transition run, or TR condition) on a motorized treadmill at a self-selected pace. Sagittal plane kinematics were recorded using a 3D Vicon motion capture system. Intersegmental coordination of the thigh, shank and foot segments of the right lower limb and run loop planarity were calculated during running before cycling and at four different times after the end of cycling.

Results

PCA showed a significant within-subject phase shift of the run loop planarity (F = 6.66, P = 0.01). Post hoc analysis showed significance median differences increase for u _3t parameter between CR_SS vs. TR₃₀ (P = 0.01), TR_t1/2 (P = 0.01) and TR_MRT (P = 0.01). No difference for u _3t parameter existed between CR_SS vs. TR_SS.

Conclusion

Prior variable-cadence, moderate intensity cycling has a significant effect on run loop planarity and therefore intersegmental coordination during the acute transition phase among highly trained triathletes. However, alterations to lower limb coordination are corrected by the 3rd minute after the beginning of the post cycle run. We suggest that planar covariation can be used as a more sensitive measure of cycling-induced variations in running to characterize adaptation in elite and importantly, developing athletes.

Biomechanical and physiological implications to running after cycling and strategies to improve cycling to running transition: A systematic review

OBJECTIVES

This systematic review summarises biomechanical, physiological and performance factors affecting running after cycling and explores potential effective strategies to improve performance during running after cycling.

DESIGN

Systematic review.

METHODS

The literature search included all documents available until 14th December 2021 from Medline, CINAHL, SportDiscus, and Scopus. Studies were screened against the Appraisal tool for Cross-sectional Studies to assess methodological quality and risk of bias. After screening the initial 7495 articles identified, fulltext screening was performed on 65 studies, with 39 of these included in the systematic review.

RESULTS

The majority of studies observed detrimental effects, in terms of performance, when running after cycling compared to a control run. Unclear implications were identified from a biomechanical and physiological perspective with studies presenting conflicting evidence due to varied experimental designs. Changes in cycling intensity and cadence have been tested but conflicting evidence was observed in terms of biomechanical, physiological and performance outcomes.

CONCLUSIONS

Because methods to simulate cycle to run transition varied between studies, findings were conflicting as to whether running after cycling differed compared to a form of control run. Although most studies presented were rated high to very high quality, it is not possible to state that prior cycling does affect subsequent running, from a physiological point of view, with unclear responses in terms of biomechanical outcomes. In terms of strategies to improve running after cycling, it is unclear if manipulating pedalling cadence or intensity affects subsequent running performance.

The effect of a decrease in stretch-shortening cycle function after cycling on subsequent running

OBJECTIVES

Increased cardiorespiratory responses and changes in muscle activity and running kinematics occur in running after cycling compared with isolated running. Nevertheless, little is known about the causes of these changes. Cycling exercise decreases the stretch-shortening cycle (SSC) function, which can influence subsequent running. This study aimed to clarify whether the decrease in SSC function after cycling causes cardiorespiratory and biomechanical changes in subsequent running.

DESIGN

Cross-sectional laboratory study. Participants were divided into two groups based on SSC function: an SSC dec group (those with decreased SSC function after cycling) and an SSC non-dec group (those without decreased SSC function after cycling).

METHODS

Eighteen participants (10 triathletes and 8 runners) completed maximal aerobic tests for running and cycling. After these sessions, a submaximal run-cycle-run test was performed to compare between control run (no preceding cycle) and transition run (preceded by cycling). A jump test was administered before and after the submaximal cycling. SSC function was calculated as the ratio of the jump height to the time spent in contact with the ground (reactive strength index). Gas exchange measures, heart rate, and gait parameters were collected throughout the test.

RESULTS

Oxygen uptake and ventilation were increased by cycling in the SSC dec group but not in the SSC non-dec group. In both groups, there were no significant differences in the gait parameters between control and transition runs.

CONCLUSIONS

The decrease in SSC function after cycling would increase cardiorespiratory responses in subsequent running.

Comparison of Joint Kinematics in Transition Running and Isolated Running in Elite Triathletes in Overground Conditions

Triathletes often experience incoordination at the start of a transition run (TR); this is possibly reflected by altered joint kinematics. In this study, the first 20 steps of a run after a warm-up run (WR) and TR (following a 90 min cycling session) of 16 elite, male, long-distance triathletes (31.3 ± 5.4 years old) were compared. Measurements were executed on the competition course of the Ironman Frankfurt in Germany. Pacing and slipstream were provided by a cyclist in front of the runner. Kinematic data of the trunk and leg joints, step length, and step rate were obtained using the MVN Link inertial motion capture system by Xsens. Statistical parametric mapping was used to compare the active leg (AL) and passive leg (PL) phases of the WR and TR. In the TR, more spinal extension (~0.5–1°; p = 0.001) and rotation (~0.2–0.5°; p = 0.001–0.004), increases in hip flexion (~3°; ~65% AL−~55% PL; p = 0.001–0.004), internal hip rotation (~2.5°; AL + ~0–30% PL; p = 0.001–0.024), more knee adduction (~1°; ~80–95% AL; p = 0.001), and complex altered knee flexion patterns (~2–4°; AL + PL; p = 0.001–0.01) occurred. Complex kinematic differences between a WR and a TR were detected. This contributes to a better understanding of the incoordination in transition running.

Stretch-Shortening Cycle Function of Lower Limbs After Cycling in Triathletes

Takahashi, K, Shirai, Y, and Nabekura, Y. Stretch-shortening cycle function of lower limbs after cycling in triathletes. J Strength Cond Res XX(X): 000-000, 2020-Impaired cardiorespiratory response and changes in biomechanical variables occur when running after cycling relative to isolated running. Nevertheless, little is known about the causes of these changes or the training to prevent them. This study aimed (a) to determine whether stretch-shortening cycle (SSC) function decreases after cycling exercise and (b) to determine whether the decreases in SSC function are related to brick training. Eleven male university triathletes performed hopping tests to measure SSC function before and after cycling (30 minutes of cycling at 110% ventilatory threshold). Stretch-shortening cycle function was calculated as the ratio of the jump height to the time spent in contact with the ground (reactive strength index [RSI]). Brick training was evaluated by the total experience of brick training. The RSI significantly decreased after the cycling exercise (-10.7%; p < 0.01), but changes in RSI after cycling did not significantly correlate with the total experience of brick training, despite a large effect size (p < 0.10; r = 0.62). These results suggest that SSC function decreases after cycling and that brick training is potentially useful for inhibiting decreases in SSC function after cycling.

The Rise of Elite Short-Course Triathlon Re-Emphasises the Necessity to Transition Efficiently from Cycling to Running

Transitioning efficiently between cycling and running is considered an indication of overall performance, and as a result the cycle–run (C–R) transition is one of the most researched areas of triathlon. Previous studies have thoroughly investigated the impact of prior cycling on running performance. However, with the increasing number of short-course events and the inclusion of the mixed relay at the 2020 Tokyo Olympics, efficiently transitioning from cycle–run has been re-emphasised and with it, any potential limitations to running performance among elite triathletes. This short communication provides coaches and sports scientists a review of the literature detailing the negative effects of prior variable-cycling on running performance experienced among elite, short-course and Olympic distance triathletes; as well as discussing practical methods to minimise any negative impact of cycling on running performance. The current literature suggests that variable-cycling negatively effects running ability in at least some elite triathletes and that improving swimming performance, drafting during cycling and C–R training at race intensity could improve an athlete’s triathlon running performance. It is recommended that future research clearly define the performance level, competitive format of the experimental population and use protocols that are specific to the experimental population in order to improve the training and practical application of the research findings.

Stiffness as a Risk Factor for Achilles Tendon Injury in Running Athletes

BACKGROUND

Overuse injuries are multifactorial resulting from cumulative loading. Therefore, clear differences between normal and at-risk individuals may not be present for individual risk factors. Using a holistic measure that incorporates many of the identified risk factors, focusing on multiple joint movement patterns may give better insight into overuse injuries. Lower body stiffness may provide such a measure.

OBJECTIVE

To identify how risk factors for Achilles tendon injuries influence measures of lower body stiffness.

METHODS

SPORTDiscus, Web of Science, CINAHL and PubMed were searched for Achilles tendon injury risk factors related to vertical, leg and joint stiffness in running athletes.

RESULTS

Increased braking force and low surface stiffness, which were clearly associated with increased risk of Achilles tendon injuries, were also found to be associated with increased lower body stiffness. High arches and increased vertical and propulsive forces were protective for Achilles tendon injuries and were also associated with increased lower body stiffness. Risk factors for Achilles tendon injuries that had unclear associations were also investigated with the evidence trending towards an increase in leg stiffness and a decrease in ankle stiffness being detrimental to Achilles tendon health.

CONCLUSION

Few studies have investigated the link between lower body stiffness and Achilles injury. High stiffness is potentially associated with risk factors for Achilles tendon injuries although some of the evidence is controversial. Prospective injury studies are needed to confirm this relationship. Large amounts of high-intensity or high-speed work or running on soft surfaces such as sand may increase Achilles injury risk. Coaches and clinicians working with athletes with new or reoccurring injuries should consider training practices of the athlete and recommend reducing speed or sand running if loading is deemed to be excessive.

Triathlon transition study: quantifying differences in running movement pattern and precision after bike-run transition

Various publications discuss the discrepancies of running in triathlons and stand-alone runs. However, those methods, such as analysing step-characteristics or ground-contact time, lack the ability to quantitatively discriminate between subtle running differences. The attractor method can be applied to overcome those shortcomings. The purpose was to detect differences in athletes' running patterns (δM) and movement precision (δD) by comparing a 5,000 m run after a prior cycling session (TRun) with an isolated run over the same distance (IRun). Participants completed the conditions on a track and a stationary trainer, allowing the use of their personal bike to simulate an Olympic triathlon. During each run, three-dimensional acceleration data, using sensors attached to the ankles, were collected. Results showed that both conditions lead to elevated attractor parameters (δM and δD) over the initial five minutes before the athletes found their rhythm. This generates a new perspective because independent of running after a bike session or without preload, an athlete needs certain time to adjust to the running movement. Coaches must consider this factor as another tool to fine-tune pacing and performance. Moreover, the attractor method is a novel approach to gain deeper insight into human cyclic motions in athletic contexts.

Is Moderate Intensity Cycling Sufficient to Induce Cardiorespiratory and Biomechanical Modifications of Subsequent Running?

Walsh, JA, Dawber, JP, Lepers, R, Brown, M, and Stapley, PJ. Is moderate intensity cycling sufficient to induce cardiorespiratory and biomechanical modifications of subsequent running? J Strength Cond Res 31(4): 1078-1086, 2017-This study sought to determine whether prior moderate intensity cycling is sufficient to influence the cardiorespiratory and biomechanical responses during subsequent running. Cardiorespiratory and biomechanical variables measured after moderate intensity cycling were compared with control running at the same intensity. Eight highly trained, competitive triathletes completed 2 separate exercise tests; (a) a 10-minute control run (no prior cycling) and, (b) a 30-minute transition run (TR) (preceded by 20-minute of variable cadence cycling, i.e., run versus cycle-run). Respiratory, breathing frequency (fb), heart rate (HR), cost of running (Cr), rate constant, stride length, and stride frequency variables were recorded, normalized, and quantified at the mean response time (MRT), third minute, 10th minute (steady state), and overall for the control run (CR) and TR. Cost of running increased (p ≤ 0.05) at all respective times during the TR. The V[Combining Dot Above]E/V[Combining Dot Above]CO2 and respiratory exchange ratio (RER) were significantly (p < 0.01) elevated at the MRT and 10th minute of the TR. Furthermore, overall mean increases were recorded for Cr, V[Combining Dot Above]E, V[Combining Dot Above]E/V[Combining Dot Above]CO2, RER, fb (p < 0.01), and HR (p ≤ 0.05) during the TR. Rate constant values for oxygen uptake were significantly different between CR and TR (0.48 ± 0.04 vs. 0.89 ± 0.15; p < 0.01). Stride length decreased across all recorded points during the TR (p ≤ 0.05) and stride frequency increased at the MRT and 3 minutes (p < 0.01). The findings suggest that at moderate intensity, prior cycling influences the cardiorespiratory response during subsequent running. Furthermore, prior cycling seems to have a sustained effect on the Cr during subsequent running.