How to Fix Knee Overuse Injury in Triathlon

Knee overuse injury is one of the most common problems triathletes deal with. Overuse injuries in general have been shown to affect up to 75% of triathletes during a training cycle, many of those being sustained at the knee. With such a prevalence throughout the sport, we wanted to dig into why this happens and how we can fix and prevent knee injuries in triathletes.

What is a Knee Overuse Injury?

A knee overuse injury is one that occurs due to the repetitive use of the knee joint. The structures in and around the knee are susceptible to overuse, especially in beginner triathletes, because of the loads they’re not used to bearing. Also, the general location of the knee and how vulnerable it is to twisting motions and inward/outward forces makes it vulnerable to injury in many people.

We say many people because with proper strength, conditioning, and mobility protocols, the knee joint is an absolutely remarkable part of the body that should last throughout a full, healthy, and active life, regardless of age. Unfortunately, this is not the case for many people, who end up injuring their knee in one way or another, sometimes even leading to full replacement.

Patellofemoral pain syndrome (PPS), commonly referred to as runner’s knee or cyclist’s knee, is a broad term used to describe pain in, around, above, or below the knee joint. Chronic knee pain in triathlon is commonly referring to this type of injury.

Patellofemoral pain syndrome. Notice some of the common spots of irritation highlighted in this graphic. (Image credit: Adobe Stock)

What Causes Knee Overuse Injury in Triathletes?

Of the knee injuries that occur while doing a triathlon, almost ¾ of them happen during the running portion of the event. This is telling because of the position of the run as the last discipline in a triathlon to complete, and also the prevalence of knee pain in runners in general, which is very high.

Cyclists are also known to develop a similar type of knee pain. Weak hips and excessive quadricep (front thigh) contraction to the neglect of other structures, such as the hamstrings, are common culprits. Cyclists also have a lower overall bone mineral density than many athletes (even some sedentary controls), which means a lack of overall body strength and support.

Swimmers also have this problem, because the water reduces their weight significantly. Breaststroke swimmer’s knee is another condition more specific to the knee that possibly develops due to the outward rotation of the tibia (see here). However, this is not a common stroke in triathlon, and therefore not likely a contributing factor to triathlete knee pain.

Both swimming and cycling are unique in that they both put the athlete in a semi-weightless environment. The water supports the bodyweight of the swimmer and the bike supports the bodyweight of the cyclist. This results in a lower adaptational bone density of these athletes, to the point where they aren’t recommended to treat conditions like osteoporosis. (Image credit: Adobe Stock)

That leaves running. Not only do we sustain massive amplifications in body weight every time we land while running, the event itself is taking place after we’ve already gone through tons of exhaustive, repetitive exercise. Knee overuse injuries often occur because supporting muscles get tired, and structures in the knee take the burden. Triathlon almost guarantees this scenario.

How to Prevent Knee Injuries in Triathlon

To prevent this type of injury, we have to be smarter than the sport. If you try to swim, run, and bike every workout, you’re asking for disaster. Some people think the varied activity involved in triathlon actually protects you from overuse injury, when in fact, they all have drawbacks that can actively play a part in each other’s unique, sometimes very similar, injury risks.

Focus on Strengthening the Hips

Specifically hip abduction, i.e. being able to move the hip away from the body or resist forces that want structures below the hip, such as the knee, to collapse. Improving hip abduction strength is an effective treatment for many cases of patellofemoral pain in runners and cyclists alike. A mini single-leg squat such as the one below is a great place to start.

Try doing 3 sets of 10 repetitions on each leg. This exercise strengthens the thigh and hip in concert with each other, important for maintaining relative timing of all the muscles involved in a sport like running.

Incorporate Flexibility & Mobility Training

Flexibility and mobility are often overlooked components of fitness, when they could be massive contributors to increased performance and a reduced risk of injury. Especially with endurance sports, our bodies will tighten up in certain ways from all the repetitive motion and strain. Give your body some love and learn what kind of rest and relaxation it needs between sessions.

Monitor Your Running Mileage

Be very careful about increasing your running mileage too much too soon. As we’ve mentioned earlier in the article, the forces you subject your body to, especially when compared to cycling and swimming, are massively disproportionate in the run. Also, be conscious of stacking activity before your run, which risks fatigue and heightens the chance of injury or wear while running.

(Image credit: Adobe Stock)

Heal Overuse Injuries With Dynamic Triathlete

Looking for a partner to help you train for triathlon? Not sure how to schedule or program your own workouts? Dynamic Triathlete has done it all for you, you just have to follow along! Hundreds of high-quality routines with different focuses. From strength training and injury prevention to warm ups and mobility. Become pain-free! Try us out for 7-days at no cost!

Written by Eric Lister – Certified Personal Trainer & Corrective Exercise Specialist