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Case Study: Endurance athlete struggles with soft tissue injuries (Post 1)

Case Study: Endurance athlete struggles with soft tissue injuries (Post 1)

Prepare while I go full nerd: I wrote this case study after 2 seasons with this athlete, and a long struggle with injury. I love looking into this kind of thing and putting together information, so it might get a little drawn out.

Strap yourself in!

Case Study: Endurance athlete struggles with soft tissue injuries

Athlete: “John Smith” (athlete has asked not to be identified)
Age: Mid 40s
Ambition: 70.3, future 140.6
Situation: John was referred to me through a physiotherapist. As a budding endurance athlete John was having problems with soft tissue injuries, mainly in the calves.
After some digging it was found John had been attempting barefoot running, and spent a lot of time on the treadmill. Having a structured training program and correct supportive running shoes fitting, John had a great 2015/16 season.
With an increase of training load for his upcoming 70.3, John started to have some injuries. It started with a shoulder problem which restricted swimming sessions for a time, and soon after followed with reoccurrence of the lower leg pains.
Physio treatment has been ongoing, and as a coach I had an inkling that the athlete’s nutrition may not be up to scratch. Athlete filled in a food diary for a week, and the average outcome was the following table.

John Smith’s Food Diary
Before Intervention
Pre-Training Calories Protein (g) Carbs (g) Fat (g)
1 x 600mLPowerade 139 0 34.8 0
0% 100% 0%
SwisseProtein Powder 152 25 10 1.3
Milk 178 8.8 15.8 8.8
329 33.8 25.8 10.1
41% 31% 28%
1/2 Cup Oats 213 6.6 34.9 5.2
20g Cranberries 58 14.2 0.1 0.1
30g Almonds 177 5.9 1.4 16.4
448 26.7 36.4 21.7
24% 33% 44%
Morning Snack
Large Banana 117 26.7 2.3 0.1
SwisseProtein Powder 152 25 10 1.3
Milk 178 8.8 15.8 8.8
446 61 28 10
54% 25% 21%
2 slices Rye Bread 192 8.8 29.4 4.3
Salad greens (150g) 11 1.2 1.4 0.1
1/4 large avocado 82 0.9 0.2 8.6
100g smoked salmon 133 23 0 4.5
250mL orange juice 65 2.5 13.8 0
482 36 45 18
30% 37% 33%
Afternoon Snack
Large Apple 94 0.6 22.9 0
3% 97% 0%
200g meat (steak, mostly) 247 47.8 0 6.2
200g Potato 105 3.9 21.9 0.2
100g pumpkin 44 2 8.4 0.3
150g mixed veg 86 4.1 14.6 1.2
482 58 45 8
48% 37% 15%
Calories Protein (g) Carbs (g) Fat (g)
TOTAL 2421 29% 52% 20%

Table 1 – John’s average daily food consumption

Calculation Time! (Harris-Benedict Equation)

Height: 175cm
Weight: 75kg
Basal Metabolic Rate: 1790 kcal/day
Activity Multiplier: 1.2
Active Metabolic Rate: 2150 kcal/day


Quick Explanation: Your basal metabolic rate is how many calories you burn in a day, if you were in a coma. Ie you are not doing anything except laying there, breathing, beating your heart. You can calculate this with a calculator on the internet, or by using a formula. I prefer the Harris-Benedict version of calculation (I’ve found this to be most accurate).

The activity multiplier is based on your daily activity. I tend NOT to include exercise at this point, so John has a desk job which means his multiplier is 1.2. There are other multipliers based on your rough movements for the day, if you do a more active job like a labourer or nurse that moves around much more.

Your active metabolic rate is therefore the amount of calories that your body burns in a day just going about your business, with no purposeful training. Obviously with variation this is not the same each day. For example, I sit at a desk during the week, but on weekends I move a lot more (ie 2500 steps on a weekday without purposeful activity, vs 8000 steps a day). This is a GENERAL AVERAGE of what you would burn a day and gives us a good indication of a starting point.

From the above food diary, we can see that job is eating just over his active metabolic rate, 271 calories more in fact. Without activity, he would very slowly be putting on weight. The general rule is 500cal (+/-) per day = 1kg. That’s what the world tells you when you start thinking about weight loss.

But John isn’t trying to lose or gain weight. 

Taking John’s training history into account (pre injury when we had to modify his training) and the summary looks something like the table below.

Monday 200
Tuesday 946
Wednesday 882
Thursday 874
Friday 614
Saturday 1360
Sunday 964

Table 2 – John’s average calorie burn, in kcal/day

As you can see, Monday is normally John’s “rest day” he does some yoga and goes for a short walk most Mondays.

I like to take things on a weekly average, so let’s do some adding.

John currently EATS: 16947 kcal per week. That’s 2421 kcal per day by 7 days.
John currently BURNS: 20890 kcal per week. That’s AMR x 7, plus 5840 as per above table with exercise.
John currently eats 3943 kcal per week LESS than he burns, which is an average of -563kcal per day. This would be the equivalent of weight loss calories, if you want to think of it that way.

Disclaimer: this is all relative, and not an exact science. We use these numbers as an estimate of what is happening and then trial solutions with the athletes. Use the number s as indications only, as nothing is exact in the human body when we are dealing with such a complex system.

The problem is, John has been gaining weight, lacking performance and getting injured.

Stay tuned for part 2, coming soon!

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