Female Triathlete Research Articles

Turbulences on the Road to Glory

A 30-year-old professional female triathlete has been sent to our vascular clinic for a second opinion due to exercise induced leg pain while cycling. She described a feeling of premature fatigue and cramping sensations in her left leg. These symptoms occured particularly while cycling in the aerodynamic position at maximum level of exertion and were reproducible each time after provocation of 4-5 minutes. The affected muscle groups had been identified by the patient as quadriceps, hamstrings, and calf. Similar complaints on the contralateral right side have been denied. Besides that, she suffers from an exercise-induced bronchoconstriction which is well-controlled by the application of Symbicort 400/12 Turbohaler. She is otherwise healthy. As an Olympic level triathlete she cycles around 10 000 kilometers a year. In the course of her professional career she completed approximately 80 000 kilometers on the bike (training and competitions). Finally, there is no history of premature cardiovascular disease such as myocardial infarction or strokes in under 65-year-old first-grade relatives.

Pacing and Performance Analysis of the World's Fastest Female Ultra-Triathlete in 5x and 10x Ironman.

The aim of the present case study was to analyse the performance data of the world’s best female ultra-triathlete setting a new world record in a Quintuple (5xIronman) and Deca Iron (10xIronman) ultra-triathlon, within and between race days, and between disciplines (cycling and running) and races (Quintuple and Deca Iron ultra-triathlon). The subject was an elite female triathlete (52 kg, 169 cm) born in 1983. At the time of her world record in Quintuple Iron ultra-triathlon she had an age of 35 years and at the time of the world record in Deca Iron ultra-triathlon 36 years old. The distribution of time spent in each discipline and transitions was 8.48% in swimming, 51.67% cycling, 37.91% running, and 1.94% transitions. There was no difference between the race days of the average speed neither in cycling nor running. The running pace had a within-day variation larger than the cycling pace, and also varied more between race days. In conclusion, the world’s best female ultra-triathlete adopted a steady (even) pacing strategy for both cycling and running, without substantial variations within- or between race days, for both the world record in a Quintuple and a Deca Iron ultra-triathlon.

Heart Rate Variability Biofeedback Improves Sports Performance in an Elite Female Athlete

Introduction and Purpose:Rigorous training of elite athletes can lead to nonfunctional overreaching (NFOR) and overtraining (OT), both of which decrease performance and increase the risk of injury. Heart rate variability (HRV) is a measure of autonomic nervous system balance. Reductions in HRV are associated with NFOR and OT. Breath-based biofeedback increases HRV through activation of the baroreceptor reflex.Purpose:This case study explored the impact of breath-based HRV biofeedback (HRV-BF) training on daily resting HRV values of a female triathlete and the association between daily HRV with subjective performance indicators of workout quality and amount of postworkout energy.Methods:A 24-year-old female triathlete completed an 8-week A-B repeated-measures study—A: baseline; 4 weeks and B: intervention HRV-BF training; 4 weeks. The subject recorded daily resting HRV for 120 seconds, completed regular daily training, and measured workout performance and postworkout energy levels on a 0 to 10 scale. During B, the subject added 15 minutes of HRV-BF 5 times per week.Results:With HRV-BF, median HRV level increased (A: 137; B: 191) and the interquartile band narrowed (A: 83–184; B: 142–201), suggesting higher HRV with less variability. The subject had more days at highest readiness (A: 35%; B: 62%). Median values for reports of workout performance and postworkout energy increased.Conclusions:This study found that, for this subject, 15 minutes of HRV-BF, 5 times per week, was associated with increased HRV and improved subjective workout performance. Further research exploring HRV measures and biofeedback to inform athletic performance is warranted.

Fluctuation of iron carrying capacity in an elite female triathlete while maintaining sporting performance

article: Fluctuation of iron carrying capacity in an elite female triathlete while maintaining sporting performance - Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2019 July-August;178(7-8):563-8 - Minerva Medica - Journals

Insidious Onset of Thigh Swelling After Trauma in a Triathlete

HISTORY: A 78-year-old female triathlete presented to clinic to follow-up on injuries sustained during a cycling accident. Evaluation in the ED on the day of injury showed facial bone fractures and small peripheral parenchymal hematomas in the right frontal and temporal lobes for which she had follow-up scheduled. In clinic two days later, she complained of pain and bruising over her right hip. She was diagnosed with an abrasion and contusion of the right hip and treated with ice and NSAIDs. She returned four weeks later with worsening right hip pain, described as constant, throbbing, non-radiating, and worse with weight-bearing. It was associated with swelling and a tender mass that had developed gradually over the right hip. She denied fevers or chills. PHYSICAL EXAMINATION: Vitals were normal at both visits. Initial exam of the right hip showed a large abrasion, mild ecchymosis, and tenderness. She had full range of motion without pain or edema. She also had normal balance and gait. Four weeks later, the right hip had a 15 x 17 cm, warm, tender mass over the lateral aspect of the thigh, without erythema. FABER and FADIR were negative, and muscle strength, pulses, and sensation were normal. The abrasion was well-healed. DIFFERENTIAL DIAGNOSIS: 1. Hematoma 2. Contusion 3. Bursitis 4. Abscess 5. Neoplasm TESTS AND RESULTS: CBC was normal. Radiographs of right hip were negative for fracture or soft tissue abnormalities. MRI of the right lower extremity showed a heterogeneous fluid collection measuring 22 x 4 x 6 cm (H x W x D, 528 cc) overlying the right hip with small internal foci of hemorrhage/debris, and peripheral rim enhancement without any areas of internal enhancement. FINAL WORKING DIAGNOSIS: Morel-Lavallée lesion TREATMENT AND OUTCOMES: The patient underwent aspiration, doxycycline sclerotherapy, and percutaneous drainage. Post-procedure US was negative for any significant fluid collection. Repeat MRI three weeks after the procedure showed incomplete resolution/recurrence of the lesion measuring 20 x 1.5 x 2.8 cm (84 cc). The patient had follow-up with orthopedics and elected for conservative treatment with compression dressings. She returned to triathlon training and has subsequently completed a 100-km bike race at 6 months post injury.

TOI 9. A Rare Case of Bilateral External Iliac Artery Thrombosis due to Endofibrosis in a 33-Year-Old Female Triathlete

TOI 9. A Rare Case of Bilateral External Iliac Artery Thrombosis due to Endofibrosis in a 33-Year-Old Female Triathlete

Return to Pre-Injury Level of Sport in an Elite Age-Group Triathlete after Non-Operative Treatment of Combined Complete Obturator Internus and Partial Hamstring Tendon Tears

Introduction Proximal hamstring tendon tears are uncommon injuries. Currently there is no consensus on what constitutes optimum management but the literature demonstrates a recent trend towards surgical management. Several authors have demonstrated less long-term disability and better return to sporting activity with surgical treatment when compared to non-operative treatment. However, these reports have focused on complete tears and there is a dearth of evidence to guide management of partial tears particularly in the high performance athlete. Complete tear of the obturator internus tendon has rarely been described in the literature and has not been reported in combination with proximal hamstring tendon pathology. Case description A 58-year-old female elite age-group triathlete presented with an acute on chronic exacerbation of increasing right buttock pain that had reduced her mobility such that she was unable to continue sports participation or walk unaided. Examination revealed ischial tuberosity tenderness, reduced hamstring strength and pain on hip extension. Magnetic resonance imaging revealed a 25% partial thickness tear of the conjoined hamstring tendon and complete tear of the obturator internus. In the absence of a history of trauma and no underlying osseous abnormality, the aetiology of the injury was presumed to be related to overuse and her high training load. Results and conclusions Surgical management was considered due to the considerable disability and duration of symptoms. However, repair of the partial tear would require conversion to a full tear to repair the deep fibres and surgical management of obturator internus rupture has not previously been described. Ultrasound guided steroid injection to the ischial tuberosity and physiotherapy was performed as lower risk initial options. The patient experienced immediate relief of symptoms, and this improvement is maintained at latest follow-up (12 months). There was no significant difference between the pre-injury and latest SF36 and proximal hamstring questionnaire scores and she has returned to the pre-injury level of long distance cycling but has been unable to return to running Take-home message This case report describes an injury pattern not previously described (complete rupture of obturator internus and partial tear of hamstring tendons). This case report is therefore important in demonstrating that this injury pattern can allow return to non-impact pre-injury level of sport when treated non-operatively. The case report also has broader applicability to isolated partial hamstring tendon ruptures, which occur more frequently, but have a limited evidence base to guide management. This report highlights that despite an increasing trend towards surgical management of hamstring tendon tears, patients with partial tears treated with injection and physiotherapy have the potential to return to athletic performance.

Reduction in Plantar Heel Pain and a Return to Sport After a Barefoot Running Intervention in a Female Triathlete With Plantar Fasciitis

In a 27-year-old female triathlete, magnetic resonance imaging revealed mild thickening and edema at the calcaneal insertion of the plantar fascia, in keeping with a degree of plantar fasciitis. After 6 weeks of conservative treatment failed to elicit a return to sport, the patient engaged in six sessions of barefoot running (15–30 min) on a soft grass surface, without further conservative treatment. After two sessions of barefoot running, the patient was asymptomatic before, during, and after running. This outcome was maintained at the 6-week follow-up period. This is the first case report to use barefoot running as a treatment strategy for chronic heel pain. Barefoot running has the potential to reduce the load on the plantar fascia and warrants further investigation using a case series.

Triathlete Risk of Pelvic Floor Disorders, Pelvic Girdle Pain, and Female Athlete Triad.

Our primary objective was to describe the prevalence of pelvic floor disorders (PFDs), pelvic girdle pain (PGP), and the female athlete triad (disordered eating, menstrual irregularities, and osteoporosis) in a female triathlete population. We also evaluated for an association between these conditions. We administered an online survey to women who self-identified as female triathletes. Using validated questionnaires, Epidemiology of Prolapse and Incontinence Questionnaire and Pelvic Girdle Questionnaire, along with the female athlete triad questionnaire, we identified the prevalence of PFDs, PGP, and female athlete triad in this specific population. Demographic and exercise intensity were also queried to characterize these female triathletes. Three hundred eleven female triathletes responded to the Internet survey. There was a significant prevalence of PFDs with stress urinary incontinence and anal incontinence symptoms being most common (37.4% and 28%, respectively). Urgency urinary incontinence and pelvic organ prolapse were less common (16% and 5%, respectively). Stress urinary incontinence and pelvic organ prolapse were more common in parous triathletes (P = 0.001, P = 0.05). Pelvic girdle pain was noted in 18% of these triathletes but was not disabling. Twenty-four percent of participants screened positive for at least 1 arm of the female athlete triad. No association was found between the female athlete triad and PFDs. Pelvic floor disorders are common and bothersome in female triathletes. Pelvic girdle pain, while present, does not limit these athletes from their training. These female triathletes may be at risk for the female athlete triad. Female triathletes may be at risk for both metabolic and PFDs and should be screened when identified.

The master female triathlete

The world of triathlon has expanded to include all ages and both sexes. One of the largest growing age groups is the master female athlete. It is important for the physical therapist to understand the special needs of this population in order to adequately care for master female athletes so they can participate at a high level and injury-free. Biology of aging, injury prevention and a suggested training program are presented in this Masterclass article.

Shortness Of Breath - Triathlon

HISTORY: A 50-year-old female triathlete with a history of hypertension and asthma was referred to our clinic for exercise-induced bronchoconstriction testing. She reported an 8 year history of episodes of dyspnea and cough that come on while competing in the swimming leg of the triathlon and continue through the rest of the race. Symptoms generally resolve within 24 hours. They do not occur with every race. They have never occurred during training. Onset of symptoms has never occurred during the bike or running leg. She was diagnosed with asthma 3 years prior and has been using albuterol prior to exercise as well as Advair as a controller agent since then, with no change in frequency of episodes. PHYSICAL EXAMINATION: Well-appearing, no acute distress. Neck without carotid bruits. Lungs clear bilaterally, no wheezes, rales, or rhonchi. CV normal S1 and S2, regular, with no murmurs, rubs, or gallops. No peripheral edema. Peripheral pulses 2+ DIFFERENTIAL DIAGNOSIS:Swimming-induced pulmonary edema, asthma, exercise-induced bronchoconstriction, vocal cord dysfunction, cardiogenic pulmonary edema, coronary artery disease TEST AND RESULTS: Spirometry pre- and post-exercise were performed with no evidence of obstructive lung disease and no decrease in FEV1 post-exercise. Exercise stress echo was also performed, which showed normal cardiac function and no evidence of exercise-induced ischemia. The patient had a markedly hypertensive response to exercise. Post-exercise PA systolic pressure was estimated at 65–75 mm Hg. FINAL WORKING DIAGNOSIS: Swimming-induced pulmonary edema in the setting of hypertension TREATMENT AND OUTCOMES: The patient was evaluated by cardiology. Hypertension was treated. She had not experienced any symptoms during her last few races.

Stress-induced Cardiomyopathy Precipitated by Triathlon Competition: A Case Report

Stress-induced cardiomyopathy in post-menopausal women is transient and typically precipitated by severe emotional or physical stress. We report a rare case of stressinduced cardiomyopathy mimicking acute coronary syndrome in a middle-aged female triathlete. The initial presentation included chest tightness and dyspnea; however, acute pulmonary edema and cardiogenic shock developed shortly after admission. Electrocardiography showed non-specific ST-T changes and echocardiography revealed severe left ventricular dysfunction with regional wall motion abnormalities. Coronary angiography did not reveal significant coronary artery obstruction. The patient was placed on ventilatory support and administered diuretics and an angiotensin-converting enzyme inhibitor. Follow-up echocardiography on day 3 showed nearly normal left ventricular wall motion with a 54% ejection fraction, and follow-up radiography of the chest revealed no evidence of pulmonary edema. The endotracheal tube was removed on the third day of hospitalization and the patient was discharged two days later without complications.

Sudden Cardiac Death in a Female Triathlete: Complexities of Risk Stratification

The prevention of sudden death in athletes is one the greatest challenges in sports cardiology. Early identification of athletes at high risk of sudden death can lead to difficult decisions such as restriction of competitive sports activity, but also treatment with medications and implantable cardioverter-defibrillator. We report a case of a 41-year-old female triathlete who had recurrent syncope during exercise with documented polymorphic ventricular tachycardia and nonspecific abnormalities on endomyocardial biopsy. Against medical advice, she continued to participate in athletic events and subsequently had a sudden cardiac death during a cycling event.

Olympic Preparation of a World-Class Female Triathlete

Detailed accounts of the training programs followed by today's elite triathletes are lacking in the sport-science literature. This study reports on the training program of a world-class female triathlete preparing to compete in the London 2012 Olympic Games. Over 50 wk, she performed 796 sessions (303 swim, 194 bike, 254 run, 45 strength training), ie, 16 ± 4 sessions/wk (mean ± SD). Swim, bike, and run training volumes were, respectively, 1230 km (25 ± 8 km/wk), 427 h (9 ± 3 h/wk), and 250 h (5 ± 2 h/wk). Training tasks were categorized and prescribed based on heart-rate values and/or speeds and power outputs associated with different blood lactate concentrations. Training performed at intensities below her individual lactate threshold (ILT), between the ILT and the onset of blood lactate accumulation (OBLA), and above the OBLA for swim were 74% ± 6%, 16% ± 2%, 10% ± 2%; bike 88% ± 3%, 10% ± 1%, 2.1% ± 0.2%; and run 85% ± 2%, 8.0% ± 0.3%, 6.7% ± 0.3%. Training organization was adapted to the busy competition calendar (18 events, of which 8 were Olympic-distance triathlons) and continuously responded to emerging information. Training volumes were 35-80% higher than those previously reported for elite male and female triathletes, but training intensity and tapering strategies successfully followed recommended best practice for endurance athletes. This triathlete placed 7th in London 2012, and her world ranking improved from 14th to 8th at the end of 2012.

Identifying mediators of training effects on performance-related psychobiosocial states: A single-case observational study in an elite female triathlete

ObjectivesRelationships between training load, psychobiosocial (PBS) states and performance are dynamic and individual-specific. The nature of these relationships can be investigated using a combination of dynamic linear models (DLMs) and mediating variable analysis, potentially assisting applied sports psychologists in planning and monitoring of individual elite athletes’ intervention programmes. DesignWe illustrate this approach by examining the relationships of training loads with a performance-related state (‘self-efficacy’) and the role of potential mediating PBS variables (‘fatigue/lack of energy’ and ‘being in shape’) in explaining these relationships in an elite triathlete across time. MethodSelf-reports of PBS states (twice weekly) and training data were collected over 137 days. Using DLMs and mediating variable analysis, direct (unmediated) and indirect (mediated) short-term associations of training load with ‘self-efficacy’ were examined. ResultsIn this triathlete, we found evidence for positive effects of training on ‘self-efficacy’, which were partly explained by feelings of ‘being in shape’ and suppressed by feelings of ‘fatigue/lack of energy’. Changes in the relationship between lagged training load and ‘fatigue/lack of energy’ were observed across time and were particularly pronounced in temporal proximity of an injury. ConclusionStrengths of the presented approach are its dynamic nature enabling the observation of changes occurring over time, use of statistical inference rather than visual data interpretation, and quantification of mediating effects to identify potential pathways of intervention. Additionally, the DLM method can identify complex nonlinear associations by examining correspondence between changes in levels of predictors and changes in magnitude and direction of predictor-outcome associations.

Leg Pain- Triathlete

HISTORY: A 39 year old competitive female triathlete presented with 10 months of left lower extremity pain. The pain began insidiously after a period of increased competition. There was no specific injury. At presentation, she described pain over the left anterero-lateral leg and also over the proximal posterior thigh and ischium. She noted that the discomfort was worst with running, but bothersome with biking and even with sitting. There was no numbness, tingling, weakness, or radiation of pain down the leg and no associated low back or groin pain. She tried training through the pain and also prolonged rest without relief. She presented to our clinic several months after symptom onset no longer able to compete. PHYSICAL EXAMINATION: Her PHYSICAL EXAMINATION revealed significant tenderness in the left antero-lateral calf with palpation. The pain in the left calf also worsened with weight bearing. She was tender to palpation at her left proximal hamstring near the ischial tuberosity, but her lumbar spine and sacrum were completely non-tender with full pain free range of motion in her low back. Hip range of motion was full bilaterally with no pain on either side. Neurologic examination of her lower extremities was normal, and dural tension signs were negative. DIFFERENTIAL DIAGNOSIS: 1. Radiculopathy 2. Sciatic nerve injury 3. Stress fracture 4. Medial tibial stress syndrome 5. Compartment syndrome 6. Local muscular injury 7. Neoplasm TESTS AND RESULTS Bone Scan: Negative for stress fracture MRI Leg: 5mm intramuscular, enhancing mass in the anterior extensor compartment of the leg MRI Pelvis: Edema in the obturator internus muscle consistent with a partial tear Pathology following excision of enhancing lesion in calf: Schwannoma FINAL DIAGNOSIS: Schwannoma in the peroneus longus muscle and partial tear of obturator internus TREATMENT AND OUTCOMES: 1. Surgical resection of intramuscular Schwannoma one month after initial presentation to our clinic with complete resolution of calf pain. 2. Peri-tendinous corticosteroid injection in region of obturator internus months after symptom onset and following above resection led to initial increase in pain, but pain receded over the following months. 3. Targeted physical therapy for obturator internus tear led to reduction in pain and successful return to training.

The effects of training on performance and performance-related states in individual elite athletes: A dynamic approach

There are difficulties undertaking controlled training studies with elite athletes. Thus, data from non-elite performers are often presented in scientific journals and subsequently used to guide general training principles. This information may not be transferable or specific enough to inform training practices in an individual elite athlete. However, the nature of athletic participation at elite levels provides the opportunity to collect training data, performance-related variables, and performance data of elite athletes over long periods. In this paper, we describe how dynamic linear models provide an opportunity to use these data to inform training. Data from an elite female triathlete collected over a 111-day training period were used to model the relationship between training and self-reported fatigue. The dynamic linear model analysis showed the independent effects of the three modes of triathlon training on fatigue, how these can change across time, and the possible influence of other unmeasured variables. This paper shows the potential for the use of dynamic linear models as an aid to planning training in elite athletes.

Thigh Pain In A Adoloscent Female Tri-athlete

HISTORY: An 18 year old national female tri-athlete presented with gradual discomfort in the right gluteal and proximal thigh area, which was aggrevated by sitting and climbing stairs and exercises that include squatting. Neither distal paraesthesia nor weakness of the posterior thigh and calf or lower back pain was reported. During the past 2 years several stress fractures occured at multiple sites. During this period the athlete was treated for an ongoing hamstring problem on the right side. The athlete also experienced a low body mass, amenorrhea and decreased bone density. A previous resection of colon and small bowel was performed after the diagnosis of Crohn's disease.At the time of the visit loose and unformed stools were confirmed. PHYSICAL EXAMINATION: At the affected side, tenderness over the insertion of piriformis and reduced passive internal hip rotation could be clearly demonstarted. Pain occured with resisted abduction with the hip in adduction and flexion as well as in external rotation with the hip and knee flexed. No discomfort with deep palpitation over the area of the hamstring insertion could be demonstarted. There was discomfort on deep palpitation over the muscle belly of the proximal hamstring. With biofeedback evaluation, acceptable low threshold, but weak rotational core stability was confirmed. Abnormal neuromuscular firing with hip extension, on the affected side, was positive. Examination of the back was within normal limits. Skeletal point tenderness at several sites remained negative. DIFFERENTIAL DIAGNOSIS: Chronic Piriformis Strain, Piriformis Syndrome, Apophysitis, Avulsion Fracture, Stress Fracture TEST AND RESULTS: Ultrasound Thigh:Normal. Blood:Thyroid Antibodies, Hemoglobin, Thyroid Functions and Sexual Hormones were all normal. FINAL WORKING DIAGNOSIS: Chronic Piriformis Strain TREATMENT AND OUTCOMES: PHYSICAL THERAPY: Deep tissue mobilization. Restoration of neuromuscular firing pattern. Rotational core stability STRENGTH AND CONDITIONING: Strengthening of adductors and abductors Swimming and cycling DIETARY: Increase in body mass. Energy and water intake during intensive training and races. Controll of Crohn's disease and amenorrhea. Advice on safe participation

Nutritional Intake of an Elite Female Triathlete contesting an Ironman Triathlon

Nutritional Intake of an Elite Female Triathlete contesting an Ironman Triathlon

Chest Wall Pain In A Peri-menopausal Triathlete

History A 50 year-old female triathlete and marathoner presents with constant, aching right sided chest pain of approximately two months duration. Pain worsens with prolonged exercise (biking >30 miles) but is not exacerbated by cough or deep inspiration. LMP was 3–4 months ago. Denies peri-menopausal symptoms. Past Medical History lobular carcinoma in-situ of the breast, migraine headaches, multiple stress fractures in the feet Physical Examination: General: thin white female Chest: tenderness to palpation in the 4th and 5th intercostal space along the anterior axillary line. Resisted provocation of pectoralis muscle failed to reproduce symptoms. Lungs: CTAB Breasts: mild tenderness over biopsy/lumpectomy incision, no masses. LNS: no axillary lymphadenopathy Differential Diagnosis: Intercostal muscle strain Stress fracture of rib Metastatic carcinoma of breast Tests and Results DEXA scan:L-spine T score of −3 Chest x-ray (PA, lateral and rib films): transverse fracture of 11th rib posteriorly Bone scan: three foci of increased uptake in right ribs involving anterior 6th rib and the posterior 8th and 11th ribs. FSH: 60 (23–116 is post-menopausal range) Ferritin: 51 (10–232) Pre-albumin: 30 (17–34) CMP: WNL except for ALT 60 (2–40) Final/Working Diagnosis Multiple stress fractures-right ribs, osteoporosis in a menopausal female Treatment/Outcomes Decrease training with goal to remain pain-free. Monthly follow-up with variable adherence to regimen resulted in continued symptoms suggestive of delayed healing. Fosamax 70 mg per week. Nutrition consultation was recommended but was not covered by patient's insurance and she opted not to pay out of pocket. Prempro 0.625/2.5mg dosage after discussion with breast surgeon. Patient reports that she is pain free 6 months after initial presentation.