A Top PT Answers Your Injury Questions – Triathlete

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This past week in the Team Triathlete community, physical therapist and athletic trainer Shefali Christopher answered injury & PT-related questions in the #training channel. As the physical therapist for the US Paratriathlon Team (a position she’s held since 2018) and a longtime triathlete, Dr. Shefali brought a perfect blend of academic and in-the-field experience.

RELATED:What It Takes to Keep Paratriathletes in Top Shape

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Here’s a roundup of the best questions from Dr. Christopher’s AMA, from dealing with nagging injuries to coming back stronger than ever, plus the question everyone’s asking: Do massage guns actually do anything?

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Dr. Shefali Christopher Answers Your Tri Injury Questions

Do you have any advice for managing an injury that only seems to bother me when I’m not training? After taking an extended off-season with lots of rest, I found that it crept back up right away. But the strange part is that it doesn’t cause me any pain while I’m actually training. I do some stretches and warm up, get started running and biking and don’t have any issues. The pain comes when I’m done and just working and living life. Sometimes it’s so tender that it causes me to limp around the house. — Joshua I.

Christopher: Tendons love movement and loading, so this injury might be related to a tendon. I would make sure to get it evaluated by a physician to rule out a bone injury as those injuries can also at first feel better with movement. If it is a tendon it’s not surprising that this seems to be fine when training and painful when not (stiff, cold, etc). Tendon rehab actually involves a few stages:

  1. Isometrics (where you don’t move through a range but hold for 30-40 seconds against a weight (so seated calf raise). Then, once you have less pain, you can move into:
  2. A slightly bigger range of movement, doing slow heavy resistance (3 count up, 3 count down for 8 reps, with weight enough to fatigue you). You can eventually graduate to:
  3. Full range of motion with heavy resistance.

Tendons can take a while to heal, so if you have a physical therapist, this might be something worth seeing them for once or twice a month to get stronger. The PT can also help you see if there are other things, like flexibility or joint stiffness, that may be contributing to this. My first step however is to make sure you have a diagnosis so you can target the treatment appropriately.

One thing I’ve been wondering as I gear up for the season: How should my strength training change as I shift from the off-season to race prep? I want to do enough so I don’t get injured, but not too much that I get tired for tri-specific training. But what is that “sweet spot”? — Susan L.

Christopher: Just like your training follows phases, I would cycle your strength as well. Heavier weights for in-season, lighter weights and higher reps for pre-race, then move into a taper. I would also use the off-season to get strong! I love a well-periodized program that matches your triathlon training!

RELATED: The Key to Strength Training for Triathletes

I sprained my ankle back in December. I didn’t have an issue with any pain until my Ironman training started ramping up. Now I deal with a bit of pain in my ankle, bottom of my foot, calf and hamstring; all on the same side. Aside from straight up rest (which isn’t a possibility with a month left until my Ironman), what can I do to try and heal or relieve the pain? -Julie P.

Christopher: Depending on the injury we are learning that sometimes rest might not be as beneficial as we thought so I don’t believe in total rest, because sometimes motion is a lotion! (unless something is broken—then please do rest!) Usually, Ironman training is a lot of repetitive miles, so try some regular stretching/mobility and see if that makes any difference. Muscles contract to produce a force, and repetitive contraction may need some stretching to return to its regular length. Any injury that last more than 14 days and is not getting better (or getting worse) needs to be evaluated.

If the problem is a tendon, know that tendons like load and strength, so you can try some specific strength movements and keep a log to see what feels better and you might be able to answer the question.

I have seen people get too flexible from ankle sprains, and in this case, they need some balance exercises and single leg strength exercises. I have also seen people get too tight (usually when they have rested and maybe had a cast/boot/brace) and they need more mobility exercises.

Lastly, you can try a lace up ankle brace (over the counter) and see if the extra stability helps. If it does, keep using it but also add some balance and strength exercises, so eventually your muscles are supporting you, not just the brace.

The human body is amazing, magnificent and can respond differently to an injury than anyone else you know. I would highly encourage you to get the injury evaluated to make sure it is accurately diagnosed so the treatment can make it better not worse.

I have a tightness behind one knee on the outside. It feels like it’s where that tendon or ligament is that you can feel there. There’s no pain when running or biking, but I noticed after a workout (especially if it was a harder one) that I’m a lot stiffer and it’s mildly uncomfortable to straighten my leg. It feels like one of those aches I might blame on getting old, except it’s only on one side which makes it more obvious and makes me think there is something I could be doing to improve the situation. It seems like there must be something I could do to help (maybe in my hamstrings?) Any suggestions? — Alex H.

Christopher: You could try to foam roll the muscle and surrounding area (not the bone) and see if that reduces the symptoms. You could also try some specific hamstring exercises to see if it makes it feel better and not worse. I would be more concerned about the cause, as the stretching and rolling may be a Band-Aid but not a long term solution.

Are the outside of your shoes worn down too? I always look at the wear pattern on shoes because that can tell me if the athlete has any specific running mechanical issues that are leading to the problem. I’m specifically looking to see if there is a pattern (too much heel, too much on the outside, too much on the inside, etc.) that might give me some more ideas as to why the athlete is having pain. The human body is fascinating and when there is tightness, pain or weakness will use other strategies to help you move forward and compensate as needed!

RELATED: Injury Guide for Triathletes

Do massage guns do anything? I use mine a lot, but it definitely doesn’t feel like a substitute for rolling, so it’s more just a comforting feeling. Also it looks like there’s not a ton of evidence in the literature of their value. Any thoughts? — Teddy S.

Christopher: I’m a strong believer in if it makes you feel better or more flexible, use it. There isn’t much evidence on the gun but the power of placebo is amazing. I personally use one because it helps me feel more mobile after a bike and run. I also can’t convince my husband or kids to work on me, and there is only so much I can do before my hands are tired! I do have a massage therapist who does the hard work and I supplement that work with a gun and foam rolling between visits.

RELATED: Which Percussive Massager is Right For You?

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