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Case Study: Endurance athlete struggles with soft tissue injuries (Post 2)

Case Study: Endurance athlete struggles with soft tissue injuries (Post 2)

Part 2 of the endurance athlete case study, you can view part 1 here.

What happens when someone starts an endurance sport?

Definitions before we start!

Parasympathetic nervous system: this part of your nervous system is responsible for the “fight or flight” response when stressed. Your adrenal glands send adrenaline into the system, and your body uses this hormone to divert its attention from digestion and muscle repair to providing immediate energy to your big muscle systems so you can run away or fight. This reaction can be caused by a lot of things including a fright, hard training sessions, or even a tough day at work or a fight with your spouse can cause your body to produce cortisol.

Sympathetic nervous system: as you can imagine, this is the direct opposite of the above. Cortisol and adrenaline are low, and your body is focused on digesting your food, repairing your muscles (particularly if you’re training hard) and repairing mind and body. This can happen when you are asleep, or when you are structuring good recovery sessions.

If these systems are not balanced, you can already see that there will be trouble.

John is producing a fair bit of cortisol from his training. He is working hard, he has been for a while. He had a three week break in May after his 2015/16 season, and has been slowly building up to a 70.3 training load. The problem is that his food intake didn’t change to match the load.

Lack of adequate nutrition can also be a producer of cortisol, and prevent adequate recovery. I have posted before about adequate recovery measures, and proper nutrition (enough of, and quality) and you can check that out at THIS LINK if you want.

Basically, with this deficit over a long period of time, John is struggling with soft tissue injuries.

After some consultation with a  Sports scientist we made the decision to change John’s food intake. The changes were only minor, with addition of carbohydrate gels during training, a slice of peanut butter and bread with afternoon snack, removal of a protein shake and adding some rice to dinner.

John Smith’s Food Diary
Post Intervention
Pre-Training Calories Protein (g) Carbs (g) Fat (g)
1 x 600mLPowerade 139 0 34.8 0
0% 100% 0%
During Training
2 x energy Gels 238 0 59.6 0
0% 100% 0%
Post-Training
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%
Breakfast
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
Milk 188 8.8 18.5 8.8
305 36 21 9
47% 27% 26%
Lunch
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
20g Peanut Butter 122 4.8 2.6 10.3
1 Slice Bread 96 4.4 14.7 2.2
313 9.8 40.2 12.5
13% 51% 36%
Dinner
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
100g (raw weight) rice 345 6.3 78.8 0.5
827 64 124 8
31% 60% 9%
Calories Protein (g) Carbs (g) Fat (g)
TOTAL 3082 23% 55% 22%

Table 2 – John Smith’s revised food diary

This calorie intake is much closer to John’s requirements of 2984 kcal / day. And again, this is not a perfect science, the calories might not be correct, the calorie burn might not be correct, but we know it’s a start.

Obviously, he doesn’t eat the same thing every day, and his calorie burn changes are his body adapts, along with fluctuations with his weight or hydration or wellness.

Training foods: Training foods are specifically highlighted on this table, as this part of the daily intake is adjustable based on the training session. Mondays this wouldn’t be as essential, as John only does recovery sessions. Saturdays and Sundays when he does his long rides and runs, he will be having more electrolyte and gels during these sessions. Daily targets are not important here, it’s the averages over the week that matter.

Endurance sports are tough on the body, and we need to make sure we are looking after them correctly. I direct this especially to those who start to get confused when they gain weight while training for endurance sports, and believe that this is due to changes in hormone levels for the same reason as John is getting soft tissue injuries.

Adequate calorie intake is so important for these sports, as well as adequate carb intake timed around your training sessions, and people seem to spend so much time focusing on training methodology they forget all the other aspects that they need to focus on. This includes things such as good sleep, good nutrition, and good recovery / body maintenance. A lot of “every day” people get into triathlon and use the training as a tool to change their body composition as well… and don’t realise that they are doing more harm than good when they keep pushing, much like John.

4 weeks post intervention, John’s soft tissue injuries have improved and he is training at full speed again with approval from the physiotherapists. I will post updates to this article as the “research” with this athlete is ongoing.
8 weeks post intervention, John’s half iron distance event was a complete success, and he was able to set a great benchmark time for the distance. 

If you too are struggling and wish to have a chat about your training, feel free to contact me below

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