Athlete Health & Injury
Load–injury relationships, triathlon injury prevalence, illness patterns, RED-S, and the evidence for injury prevention through intelligent load management.
Source: PhD Thesis, Chapter 2 · §2.14–§2.15 · Deakin University Repository →
This page is adapted from the Literature Review of Leighton Wells' doctoral thesis: Triathlon Coaching Practices — Optimising Training Load Processes and Communication. Read the full thesis →
Injury prevalence: the cost of three-discipline training
Triathlon athletes face injury rates that reflect the demands of training across three endurance disciplines. Running injuries are the most prevalent, followed by cycling and swimming.135 The most common injuries are overuse-related, including stress fractures, tendinopathies, and iliotibial band syndrome.2
Injury risk increases with training volume, and rapid spikes in load — particularly running load — are strongly associated with overuse injury.136 This aligns with the broader literature on load–injury relationships, where sudden changes in training load are identified as a key risk factor.33
Running is the highest-risk discipline for injury in triathlon. The evidence consistently shows that rapid increases in running volume and intensity are the primary mechanism. Load spikes — not absolute load — are the danger. This is why progressive overload and monitoring adherence matter so much.
The load–injury relationship
The IOC consensus statement on load and injury33 established key principles: both too much and too little training load increase injury risk. A well-managed, progressively applied load is protective.67
Research has demonstrated that athletes with higher chronic training loads — built gradually — are more resilient to injury than those with lower chronic loads who experience sudden spikes.137 This is the 'training–injury prevention paradox': training hard, when done progressively, protects against injury.
Illness is also load-related. Upper respiratory tract infections are more common during periods of heavy training, particularly when recovery is insufficient.138 Drew and Finch139 demonstrated a clear relationship between training load and both injury and illness in their prospective cohort study.
Gabbett's paradox is one of the most important concepts in the field: well-managed high training loads are protective. The risk is in the spikes, not the volume. Coaches who build robust chronic loads through careful progression — and monitor for sudden increases — give their athletes the best chance of staying healthy.
Relative Energy Deficiency in Sport (RED-S)
Relative Energy Deficiency in Sport (RED-S) describes the syndrome resulting from insufficient caloric intake relative to energy expenditure during exercise.140 RED-S affects both male and female athletes and has wide-ranging effects on metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular function.141
Endurance athletes — particularly those in high-volume sports like triathlon — are at heightened risk.142 The IOC consensus statement on RED-S emphasises that coaches have a duty to recognise the signs and refer athletes appropriately.140
RED-S is not just about eating disorders — it's about energy availability relative to training load. Triathlon athletes training 10–20+ hours per week are at genuine risk if nutrition is not actively managed alongside load. Coaches should be aware of the signs and have referral pathways in place.
"Both too much and too little training load increase injury risk. A well-managed, progressively applied load is protective."
— Soligard et al., 2016. IOC Consensus Statement
Key takeaways
Running is the highest-risk discipline
Overuse injuries are most prevalent in running. Load spikes — not absolute volume — are the primary risk factor. Progressive build is protective.
The paradox: training hard protects
Athletes with well-built chronic loads are more resilient. The danger lies in sudden increases relative to what the athlete has been prepared for.
RED-S is a coaching responsibility
Energy availability relative to training load must be actively managed. Coaches need to recognise the signs and have referral pathways for affected athletes.
This page draws on the Literature Review of Leighton Wells' doctoral thesis and the cited researchers whose work has shaped understanding of load–injury relationships, illness prevention, and athlete health.
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