We place about 4 times our bodyweight across our joints with running, and our lower extremity joints are placed through approximately 5,400 revolutions per minute in 60 minutes of cycling. Here are my top 7 tips for triathletes that I have been communicating to my patients for decades in my orthopedic practice.
1. Strengthen your quads. The quadriceps are made up of three muscles. An imbalance between your quadriceps musculature can cause your patella (kneecap) to maltrack in its groove on your femur (thighbone). The vastus medialis on the inside of your thigh , the rectus femoris in the middle and the vastus lateralis on the outside. The vastus lateralis is a bigger, stronger muscle than the vastus medialis and as such tends to pull our patella laterally (toward the outside of our leg). A super simple exercise called a quad set in which you lie with your legs extended and contract your quadriceps by driving the back of your leg into the surface below will strengthen the vastus medialis.
2. Don’t just focus on your quads though. Think strong glutes and hamstrings, in addition to your quads. All three can cause issues with your knees as well. Focus on exercises that incorporate all the leg muscles at once such as squats, hack squats, leg presses, and deadlifts. These exercises all have one important theme in that your legs are firmly planted on the ground or another surface, such as with the leg press. These are called closed chain exercises. Avoid leg exercises in which your feet are not planted on a surface, such as knee extension machines and hamstring curl machines. These are called open chain exercises.
3. With every exercise you do, make sure you are able to see your toes throughout the full range of motion. For example, if you are doing a squat, and when you squat down do your knees block you from seeing your toes? If so, then you are putting too much stress on your knees. This is a big No, No. Re-adjust so you can see your toes at all times.
4. Avoid kneeling. Just don’t. Like an eye doctor tells their patients never to rub their eyes. In orthopedics we tell our patients never to kneel. There are plenty of other exercises to do that can easily replace any exercises that requires you to kneel.
5. Keep your knees warm. Avoid running or cycling with your knees exposed. Keep those tights on if the temperature is below 65-68 degrees.
6. Avoid big gear intervals with low cadence until you build up your durability to tolerate this type of work.
7. When it comes to running, include hill training. Running solely on flat surfaces and declining surfaces puts more strain on your knees. In the same light, when on the treadmill make sure to keep a slight incline of 0.5 - 1%. The treadmill works on momentum and when completely flat mimics running downhill outside. A slight incline will take that strain off your knees.
Other considerations:
Overuse injuries and chronic conditions don’t occur from a one time flaw. They occur from repetitive use done over a course of days, weeks, months, and even years. In the same light, prevention occurs from repeating well - intentioned habits over the course of weeks, months and years.