IronMan race reflection: a physio perspective

Having completed my first IronMan event in Port Elizabeth two weeks ago, I thought it may be a good idea to reflect about the experience from a physiotherapy and injury perspective. Obviously, the joy and pride one gets from crossing the finish line is just amazing; it really is a great achievement. Exercising non-stop for more than twelve hours gives some perspective of what the body and mind goes through on the day. Another achievement was that I ran my first marathon on the day as well…so a double winner for me.

In preparation for the race I followed a well-structured six-month progressive training program. There are three key learning points I would like to discuss in this blog:

  1. at around 23km into the run of the race, I really started fatiguing at a rapid rate
  2. a few hours after the race I noticed I had a reactive achilles tendon on my right side
  3. during the training process, I hit a tough spot around six weeks before the race where I was showing signs of overtraining

Point 1: the mid-run explosion

My training plan was sound and based on solid principles of progression. My peak volume week was planned for four weeks before race day, allowing adequate time to recover and arrive at race day as fresh as possible. I didn’t manage to hit the volumes I had planned for, and so my longest run before the race was only 30km. This left me with the risk of blowing up at some stage, and it happened at 23km into the run. The bike went as planned as I did hit my numbers during the training process. It is just amazing and a great learning experience to realise that the body needs that stimulus in training to handle the race day loading. For the run, I would do things differently next time by doing a few more longer slow runs, of around 30-35km. This will allow the body to get that longevity/endurance adaption required. In terms of physiology, what happened to me at 23km in the race is called cardiovascular drift. I will leave the details of this normal body phenomenon to the exercise physiologists, but I will try summarise it briefly:

[With each heart beat, the heart pumps a certain amount of blood through the body (a.k.a. cardiac output). Cardiac output is a function of heart contraction strength (stroke volume) and heart contraction rate (heart rate)……[cardiac output = stroke volume x heart rate]……Higher exercise performance occurs with high stroke volumes and low heart rates. When the body starts overheating (which can be the result of a number of factors), the heart begins to beat faster rather than harder, and so a drift occurs towards high heart rates to maintain exercise performance.]

So my heart rate was exponentially going up to keep me running at the same speed, instead of maintaining a strong beat-to-beat contraction. Maintaining a high heart rate for another 18km would have been very difficult, and so I had to slow down to get back some form of homeostasis. It is really the body trying to find another way to keep you going when the body is fatiguing or overheating i.e. my cardiovascular fitness for the run was not where it should have been.

Point 2: the post-race injury

I have a history of right ankle injury (osteochondral lesion for the medical readers), sustained from my rugby days, which needs to be fixed at some stage. Also, I had an operation last year to repair my lower abdominal/groin area (also an old rugby injury) on the right side. I have been doing extensive rehab on the right side particularly to fix some imbalances. My isokinetic testing results show some strong deficits on the right side. Although I have improved a lot in terms of strength and stability, there is still some unresolved issues. The most notable of these is a dorsiflexion ROM deficit and a general neuromuscular control deficit. This resulted in an abnormally high achilles tendon load during the run leg of the race, and subsequently the achilles tendon reaction (on a side note, this has recovered nicely). The learning from this post-race reactive tendinopathy…preventative rehab is essential for reducing the risk of injuries, but it may not remove the risk all together! I do believe I would have been worse off if I had not managed to reduce some deficits through my rehab program. It also highlights the need to monitor loading programs for injuries during training and races…clearly the marathon was a load that the achilles tendon could not handle yet.  

Point 3: overtraining

Exercising places the body under stress, and with time it learns to handle this stress via adaption of metabolic, neural, muscular, and various other systems. In exercise physiology we term this functional overreaching:

[Overreaching is an essential part of training. This is where the body systems adapt to the stress demands from exercise. If this overreaching becomes too much for the body to handle, the athlete enters a state of dysfunctional-overreaching or overtraining, which is where I was heading. If this is not handled properly, the athlete can suffer from burnout, and this requires extended rest and recovery.] 

About six weeks before the race, I really started to feel overtrained. I had a few symptoms, this included an inability to recover, constant fatigue/lethargy, disrupted sleep patterns, and a general lack of interest in training anymore.  The biggest sign for me was when I tried to go for a short 8km run, I stopped at 2km in and sat down, feeling as if I was about to pass out on the spot. I know from working on this topic for my master’s thesis that these are known risk factors for injuries, and so I pulled back for about two weeks. I did nothing for one week (apart from two gym strength sessions), and the second week I did only three hours of training. I recovered nicely and got my excitement back for training, although I think this was largely due to the race looming down at me in four weeks’ time. There are a few major learning opportunities here from this overtraining experience: 1) I listened to body when it was telling me to slow down, 2) I rested and did something different (and which was exciting for me) in the form of gym strength sessions, 3) the biggest issue I had was a complete emotional and mental block; my enthusiasm and ambition to train was lost, and I could feel a form of “depressive” state hanging over me. Again, I listened to my body.

Final comments:

  • Keep an eye out for signs and symptoms of overtraining. These may include a drop in performance, constant fatigue, inability to recover, change in mood, irritability, loss of appetite, or loss of sleep.
  • We know that overtraining may be associated with increased risk for illness and injuries, so these are also signs to watch out for.
  • The body needs functional over-reaching to get fitness, but a well structured program will ensure you avoid injuries, illness, and overtraining. Exposure to an inadequate training load may lead to an injury just as exposure to a load that is too high. 
  • Listen to your body- it’s the best alarm system you have. It will tell you when to push a bit more or when to pull back slightly.
  • Overuse injuries occur suddenly from a change in load or exposure to a load that the body cannot handle adequately. Ultra-endurance athletes may be particularly prone to these injuries, and so take necessary preventative steps to minimise the risks of getting injured.
  • Monitor your training load using internal measures (heart rate, rate of perceived exertion, etc.) and external measures (hours, speed, etc.). Acute and chronic training loads should be considered in developing your training plans.

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