17 Common Triathlon injuries (Prevention & Treatment)

All 17 common triathlon injuries, from overuse problems and knee damage to plantar fasciitis, lower back injuries and rotator cuff impingement.

Three disciplines mean three sets of risks, so cycling crashes, road rash, dehydration, heat exhaustion, sunburn and the dangers of the swim leg all get their own sections.

Keep reading to uncover the secrets of staying injury-free and on track to conquer your next triathlon challenge.

Injury Rates and Numbers

The figures below come from injury surveillance data and peer reviewed studies. Each row names the population it was measured in, because rates from elite athletes and from recreational players are not comparable.

Finding	Measured in	Source
Across 42 studies of short-course triathletes, injury incidence ranged from 15.7 to 24.3 injuries per 1,000 athlete exposures.	short-course triathletes of all sexes, ages and experience levels (systematic review of 42 studies), systematic review published 2024	Journal of Sport and Health Science, systematic review (2024)
Running is the discipline behind most triathlon injuries: across the reviewed studies, 45 to 92 percent of reported injuries occurred while running.	short-course triathletes (systematic review of 42 studies), systematic review published 2024	Journal of Sport and Health Science, systematic review (2024)
Reported injury prevalence among short-course triathletes ranged from 2 to 15 percent, while illness prevalence ranged from 6 to 84 percent.	short-course triathletes (systematic review of 42 studies), systematic review published 2024	Journal of Sport and Health Science, systematic review (2024)
In long-distance triathletes, overuse injury incidence ranged from 37 to 91 percent while acute injury incidence ranged from 24 to 27 percent, with the knee and spine most often affected.	long-distance triathletes competing at Ironman full distance or greater, mean age 35.1 years, systematic review, literature searched February 2020; published 2022	Journal of Human Kinetics, systematic review (2022)
At three editions of Ironman Italy, 3.3 percent of 10,653 race starters needed medical attention, an injury rate of 4.09 per 1,000 hours in long-distance races.	10,653 Ironman race starters (long-distance and Olympic/middle distance), three consecutive editions, 2017 to 2019; published 2022	Journal of Sports Science and Medicine (2022)

Overview

Injury	Body area	Typical time out
Overuse injuries (from repetitive motion)	Whole body	2 to 6 weeks, months if ignored
Knee injuries (ACL, meniscus)	Knee	2 to 6 weeks, 9 to 12 months post ACL
Foot injuries (plantar fasciitis, sprains)	Foot	2 to 6 weeks, heel pain often months
Lower back injuries (herniated disc, muscle strain)	Lower back	1 to 3 weeks, disc 6 weeks to 6 months
Shoulder injuries (rotator cuff, impingement)	Shoulder	4 to 12 weeks, months after surgery
Dehydration	Whole body	Hours to a few days
Heat exhaustion/heat stroke	Whole body	Days, weeks to months after heat stroke
Ankle sprains	Ankle	1 to 3 weeks, up to 12 weeks grade 3
Hip injuries (strains, impingement)	Hip	2 to 6 weeks, 3 to 6 months if chronic
Hand injuries (blisters, sprains)	Hand	Days to 2 weeks, longer if bone hurt
Wrist injuries (sprains, strains)	Hand and wrist	2 to 6 weeks, 6 to 12 weeks if fracture
Head injuries (concussions, cycling accidents)	Head	1 to 4 weeks, longer if symptoms stay
Elbow injuries (tennis elbow)	Elbow	6 weeks to 6 months
Cuts and abrasions (from falls)	Skin	Days to 2 weeks, longer if deep
Sunburn	Skin	1 to 3 days, 1 to 2 weeks if blistered
Neck injuries (muscle strain)	Neck	Days to 3 weeks, longer with nerve pain
Drowning (during the swimming stage)	Whole body	Days, weeks to months after a rescue

Overuse injuries (from repetitive motion)

Overuse injuries develop when tendon, bone or muscle tissue is loaded faster than it can adapt, so the damage accumulates without a single moment of trauma. In triathlon the running block drives most of it, because every stride sends several times body weight through the Achilles tendon, the shin and the kneecap tendon, and the swim and bike volume leave little truly unloaded time for repair.

Symptoms

• Pain that starts a few minutes into a session and eases once you are warm, then returns worse afterward
• Stiffness in the same spot for the first steps in the morning
• A tender, sometimes thickened point you can press with one finger
• Sessions that used to feel easy now need more effort at the same pace
• Pain that creeps earlier into each session from week to week

How serious it is: The mild form only hurts at the start of a session and settles during it, and training can usually continue in modified form. The severe form hurts during and after every session, hurts while walking or at rest, and forces a real break because the tissue has moved from irritation to structural damage.

Typical time out: Two to six weeks if you cut the load early and keep training in the other two disciplines, but three months or more once pain has been ignored for a whole season, because tendon and bone remodeling is slow and cannot be rushed by rest alone

See a doctor if: See a doctor if a pinpoint bone pain keeps you awake at night or hurts when you hop on that leg, because that pattern fits a bone stress injury rather than a sore tendon.

What helps

• Cut the volume of the offending discipline rather than stopping everything: swimming and cycling usually stay available when running hurts
• Load the tissue instead of resting it fully, with slow, heavy or eccentric strength work that stays inside a mild, settling pain level
• Change one training variable at a time and increase weekly load in small steps, so you can tell what the tissue tolerates
• Get a gait or bike fit review when the same side keeps flaring, since asymmetric position and cadence drive repeat episodes
• Ask for imaging when pain is localized to bone, has lasted many weeks, or has not responded to a structured loading program

Knee injuries (ACL, meniscus)

The anterior cruciate ligament sits inside the joint and stops the shin bone from sliding forward and rotating on the thigh bone, while the two menisci are wedges of cartilage that spread load between the bones. Triathletes rarely tear an ACL running in a straight line: these injuries come from a fall off the bike, a twisted landing on trail, or a foot that stays planted while the body rotates. Meniscal tissue also frays slowly with age and deep repeated flexion.

Symptoms

• A pop or tearing sensation at the moment of injury, followed by swelling within hours
• The knee gives way or feels like it will not hold you on stairs and turns
• Pain along the joint line when you squat or twist
• Catching, clicking or a knee that locks and will not straighten fully
• Swelling that returns the day after every harder session

How serious it is: Ligament injuries are graded 1 to 3: grade 1 is a stretched ligament with a stable knee, grade 2 a partial tear with mild laxity, grade 3 a complete tear with clear instability. A small stable meniscal tear at the outer rim can heal, while a large unstable flap that blocks motion usually does not.

Typical time out: Two to six weeks for a grade 1 sprain or a small stable meniscal tear, three months for a meniscal repair before running, and nine to twelve months after ACL reconstruction before racing, because the graft needs that long to mature and the leg needs that long to regain strength

See a doctor if: Get the knee looked at the same day if it swelled up within an hour of the injury, will not straighten, or cannot take your weight.

What helps

• Early rehab aimed at full extension and quadriceps activation, which protects the knee more than any brace
• Progressive strength work for quadriceps, hamstrings and hip abductors, with the injured side measured against the healthy one
• Keep swimming and, once tolerated, cycling with a slightly higher saddle and easy resistance to hold fitness
• Return to running only when you can hop and land on the leg without pain or swelling the next day
• MRI and a surgical opinion when the knee locks, gives way repeatedly, or stays unstable after several weeks of rehab

Foot injuries (plantar fasciitis, sprains)

The plantar fascia is a thick sheet of connective tissue running from the heel bone to the base of the toes that tensions the arch every time you push off. Running volume, hills and speedwork raise that tension sharply, and the tissue reacts with degeneration and pain at the heel attachment rather than classic inflammation. Foot sprains are a separate problem: a ligament between the midfoot bones is overstretched by landing on an uneven surface or by a fall in transition.

Symptoms

• Sharp heel pain with the first steps out of bed or after sitting
• Pain under the arch that eases as you warm up and returns hours later
• Tenderness when you press the inner front edge of the heel bone
• With a sprain, swelling and bruising over the top or side of the midfoot
• Difficulty pushing off the forefoot at the end of a run

How serious it is: Plantar heel pain is mild when it is limited to the first steps of the day and severe when it hurts through the whole run and while walking barefoot at home. Ligament sprains follow the usual grades 1 to 3, from a stretched ligament to a complete tear with an unstable midfoot that needs prompt assessment.

Typical time out: Two to six weeks for a mild sprain, three to twelve months for stubborn plantar heel pain, and the spread is that wide because heel pain that has already lasted months responds much more slowly than a case caught in the first weeks

See a doctor if: See a doctor if you cannot put weight through the foot after an injury, if the midfoot is bruised on the sole, or if the heel pain came on suddenly with a snap, since those point to fracture or rupture rather than overload.

What helps

• Calf and foot strength work, especially slow heel raises with the toes propped on a rolled towel, done every second day
• Cushioned shoes with a slightly higher heel drop during the painful phase, and no barefoot walking on hard floors at home
• Shift volume to swim and bike while keeping short, pain limited runs rather than stopping running entirely
• A prefabricated arch support or heel cup for symptom relief, which buys time while the loading program works
• Imaging or a clinical review if heel pain has not improved after roughly three months of consistent loading work

Lower back injuries (herniated disc, muscle strain)

The lumbar discs sit between the vertebrae and act as pressure absorbers, and their soft inner core can push through a weak point in the outer ring and press on a nerve root. Muscle and fascia strains involve the erector spinae and the deep stabilizers instead. In triathlon the aero position on the bike holds the lumbar spine in flexion for hours, and the run then loads a back that has just spent that time in one posture.

Symptoms

• A deep ache or band of tightness across the low back after long rides
• Pain shooting down the buttock and into the leg, sometimes past the knee
• Numbness, pins and needles or weakness in the leg or foot
• Pain that spikes when you cough, sneeze or bend forward to lift
• Difficulty standing straight up after getting off the bike

How serious it is: A simple muscle strain is stiff and sore, stays in the back and settles within days to a few weeks. A disc problem sends pain, numbness or weakness into the leg and takes far longer, and the small number of cases with bladder or bowel changes are emergencies.

Typical time out: One to three weeks for a muscular strain, six weeks to six months for a symptomatic disc herniation, because most herniations shrink and settle on their own but the nerve needs time to recover once it has been compressed

See a doctor if: Seek help immediately for numbness around the groin or inner thighs, loss of bladder or bowel control, or a leg that is becoming visibly weaker, and see a doctor promptly for back pain with fever or unexplained weight loss.

What helps

• Keep moving with walking and easy swimming from the first days, since staying still makes back pain last longer
• Rebuild trunk and hip strength with loaded carries, hip hinges and side planks rather than endless crunches
• Get the bike position reviewed: too long a reach, too deep a drop or too much saddle nose down all force the lumbar spine to compensate
• Change position on long rides, coming out of the aero bars regularly to unload the lumbar spine
• Physiotherapy from the start for leg symptoms, and imaging only when weakness persists or surgery is genuinely being considered

Shoulder injuries (rotator cuff, impingement)

Four muscles form the rotator cuff and their tendons hold the head of the upper arm bone centered in a shallow socket. In freestyle the arm passes overhead thousands of times per session, and the supraspinatus tendon plus the bursa above it get compressed under the bony roof of the shoulder, most of all when the pull crosses the midline or the catch drops the elbow. The result is a painful, degenerating tendon rather than a torn one in most triathletes.

Symptoms

• Pain in the outer upper arm during the recovery phase of freestyle
• Pain lying on that shoulder at night
• Weakness lifting the arm out to the side or reaching behind your back
• A painful arc as the arm passes shoulder height
• Pain that starts late in a swim session and creeps earlier week by week

How serious it is: Tendinopathy and bursitis are painful but the arm still works, and they usually respond to loading and stroke changes. A significant cuff tear leaves genuine weakness that does not improve with warm up, and full tears in older athletes may need a surgical opinion.

Typical time out: Four to twelve weeks for swimmer’s shoulder handled early with load management and strength work, four to six months or more after cuff repair surgery, since the repaired tendon has to heal to bone before overhead work resumes

See a doctor if: See a doctor if you cannot lift the arm to the side against gravity after an injury, or if pain wakes you every night for weeks despite reduced swimming.

What helps

• Reduce swim volume and cut paddles and heavy pull buoy work while the shoulder is irritable, rather than stopping swimming altogether
• Progressive strength work for the external rotators, serratus anterior and lower trapezius, three times a week
• Stroke correction: wider hand entry, high elbow catch and bilateral breathing to stop one shoulder taking every stroke
• Physiotherapy early if pain has lasted more than a few weeks, since technique and strength deficits are hard to self assess
• Treat a corticosteroid injection as an exception, not a fix: it can quiet pain short term but tendon outcomes are often worse in the long run

Dehydration

Dehydration is a fluid deficit that develops when sweat losses outrun what you drink, which reduces blood plasma volume and forces the heart to work harder to supply both muscle and skin. In triathlon it builds quietly, because the swim masks sweating, the bike is the only real chance to drink, and the run leaves little opportunity to catch up. Sodium is lost with the sweat, so water alone does not restore the balance.

Symptoms

• Thirst and a dry mouth that keeps returning
• Dark urine and much less of it than usual
• Heart rate higher than normal at your usual pace
• Headache, dizziness on standing, and unusual fatigue late in a session
• Muscle cramps in the second half of a long effort

How serious it is: Mild dehydration means thirst and a slightly harder effort at the same pace, and it corrects itself with drinking over a few hours. Severe dehydration brings confusion, fainting and a racing pulse, and it needs medical attention rather than a bottle of sports drink.

Typical time out: Hours to a day for a mild deficit corrected by drinking with meals, several days after a race that ended in collapse, because the body needs time to restore plasma volume and the kidneys need to be checked before hard training resumes

See a doctor if: Get medical help if someone becomes confused, faints, stops sweating in the heat, or cannot keep fluids down.

What helps

• Drink to thirst on the bike and take sodium with the fluid, since bike aid stations are the practical drinking window in a race
• Weigh yourself before and after long sessions to learn your own sweat rate instead of copying someone else’s plan
• Practice your exact race day drinking routine in training, including bottle handling in the aero position
• Start long hot sessions already hydrated, checking that morning urine is pale rather than drinking heavily at the last minute
• Do not overdrink plain water for hours: too much water with too little sodium causes its own dangerous problem

Heat exhaustion/heat stroke

In the heat the body sends blood to the skin to shed heat and to the working muscles at the same time, and when it cannot do both, core temperature climbs. Heat exhaustion is the stage where the circulation is struggling but the brain still works normally. Exertional heat stroke is the stage where core temperature rises high enough to disturb the brain and damage organs, and in triathlon it typically hits on the run, after the swim and bike have already loaded the system.

Symptoms

• Heavy sweating with clammy skin, weakness and nausea
• Dizziness, a pounding pulse and the feeling that your pace is suddenly impossible
• Headache and muscle cramping
• Confusion, aggression, slurred speech or stumbling, which mark heat stroke
• Collapse, with skin that may be hot and either wet or dry

How serious it is: Heat exhaustion leaves the athlete oriented and able to answer questions, and it resolves with cooling and fluids. Any change in behavior, orientation or consciousness in a hot race means heat stroke until proven otherwise, and that is a medical emergency where minutes matter.

Typical time out: One to several days after heat exhaustion once symptoms have fully cleared, several weeks to months after genuine heat stroke, with a stepwise medically supervised return because heat tolerance stays reduced for a long time afterward

See a doctor if: Call emergency services for any athlete who is confused, unresponsive or seizing in the heat, and start cooling immediately while you wait.

What helps

• Cool first and fast: cold water immersion of the whole body is the most effective field treatment for suspected heat stroke
• Stop, get into shade, remove the wetsuit or jersey and use cold water and ice on the skin at the first warning signs
• Acclimatize over ten to fourteen days of progressively longer sessions in the heat before racing somewhere hot
• Adjust pace and race goals to conditions, since the same effort produces a higher core temperature on a hot day
• Return to training only after a medical check when heat stroke is suspected, never straight back into a hard block

Ankle sprains

Most ankle sprains damage the ligaments on the outer side, above all the anterior talofibular ligament, when the foot rolls inward under a loaded leg. Triathletes usually do this on trail, on a curb during a road run, or in the crowded chaos of transition where the ground is wet and covered with equipment. A high sprain of the ligaments between shin and fibula is less common but heals far more slowly.

Symptoms

• Immediate pain on the outer ankle and swelling within an hour
• Bruising that appears over the following days and tracks toward the toes
• Difficulty putting full weight through the foot
• The ankle feels unreliable on uneven ground afterward
• Stiffness that limits how far the knee can travel over the toes

How serious it is: Grade 1 is a stretched ligament with mild swelling and walking still possible, grade 2 a partial tear with clear swelling and limping, grade 3 a complete tear with marked instability. Pain high on the shin above the ankle suggests a syndesmosis injury, which behaves differently and needs assessment.

Typical time out: One to three weeks for a grade 1 sprain, six to twelve weeks for a grade 3, and longer for a high ankle sprain because the ligaments between the two shin bones bear rotational load with every step

See a doctor if: Get an x ray if you cannot take four steps on the ankle or if the bone is tender right on the back edge of either ankle knob, since that pattern suggests a fracture.

What helps

• Start moving the ankle within the first days inside a tolerable pain range, since early controlled loading beats immobilization
• Wear a lace up brace or tape for the first weeks back in sport, which measurably reduces the chance of a repeat sprain
• Balance and hop training on one leg, continued for months, because the reflex control is what actually fails in a re-sprain
• Keep cycling and swimming with a pull buoy while the ankle is too sore to run
• See a physiotherapist if the ankle keeps giving way after several weeks, since chronic instability responds to targeted work

Hip injuries (strains, impingement)

Hip strains involve the hip flexors at the front, the adductors on the inside or the hamstring origin at the sit bone, all of which are pulled hard by the running stride and by the closed, forward rotated position on a time trial bike. Femoroacetabular impingement is different: extra bone at the head or rim of the hip joint pinches the cartilage lip when the hip is bent and rotated inward, exactly the position held for hours in the aero tuck.

Symptoms

• A deep pinch in the front of the groin when the hip is bent, often cupped with the hand in a C shape
• Groin pain that builds through a long ride and stays after you get off
• Pain at the sit bone when sitting on hard surfaces or accelerating on the run
• Clicking or catching in the hip on rotation
• Stiffness getting out of the car after a long drive or ride

How serious it is: Muscle strains follow grades 1 to 3, from a few torn fibers with full strength to a complete tear with a palpable gap and marked weakness. Impingement is graded by whether pain stays in sport or has started limiting daily life, and whether the joint cartilage has already been damaged.

Typical time out: Two to six weeks for a grade 1 or 2 strain, three to six months for a high hamstring tendinopathy or a stubborn impingement, and four to six months after hip arthroscopy, because these tendons and the joint lip load with every stride

See a doctor if: See a doctor for groin pain that came on suddenly with a pop and left the leg weak, for pain that persists at night, or for pain in the front of the hip that hurts when you hop, which can be a stress fracture of the femoral neck.

What helps

• Progressive strength work: adductor squeezes, Copenhagen planks and long lever hamstring work depending on which structure hurts
• Reduce time in the deepest aero position and raise the front end slightly when the front of the hip is the problem
• Check saddle height and setback, since a saddle too high or too far forward closes the hip angle further
• Cut hill running and speedwork first when a hamstring origin is painful, since those load it most
• Imaging and a specialist opinion for mechanical catching, night pain, or pain that persists past three months of good rehab

Hand injuries (blisters, sprains)

Blisters are fluid filled separations in the upper skin layers caused by repeated shear between the skin and a surface, and on the bike they form where the palm presses on the bar or aero pads for hours. Sprains involve the small ligaments between the finger bones or at the base of the thumb, and they usually happen in a fall when the hand takes the landing or a finger catches on the bars or on another swimmer.

Symptoms

• A raised, tender bubble or a raw patch on the palm or a finger
• Pain gripping the brake hoods or holding a bottle
• Swelling and bruising around a single joint after a fall
• A finger that will not straighten fully or is deviated to one side
• Numbness or tingling in the ring and little finger after long rides

How serious it is: A small intact blister is a nuisance, a large deroofed one on the palm is an open wound that can get infected. Finger sprains are graded 1 to 3, and any joint that looks crooked, cannot be bent, or is unstable when tested needs an x ray rather than taping.

Typical time out: A few days to two weeks for blisters and mild sprains, four to twelve weeks for a thumb ligament tear or a small fracture, and cycling often continues throughout because the legs are unaffected

See a doctor if: See a doctor for a visibly crooked finger, a thumb that feels loose when you pinch, spreading redness with fever around a blister, or numbness that does not settle after a ride.

What helps

• Cover a blister rather than removing the roof, using a hydrocolloid dressing so the skin underneath can heal
• Padded gloves and bar tape plus a hand position that changes regularly, which fixes most recurring palm problems
• Buddy tape a mildly sprained finger to its neighbor and start gentle movement within days
• Adjust aero pad width and angle if the outer hand goes numb, since the nerve is being compressed at the wrist
• X ray any injured finger or thumb that is still swollen and painful over the joint after a week

Wrist injuries (sprains, strains)

The wrist links the two forearm bones to a double row of small carpal bones held by short ligaments, and it also carries the tendons that move the fingers and thumb. In triathlon the wrist is loaded statically for hours on the aero bars, which irritates the tendon sheaths, and acutely in a fall on an outstretched hand, which sprains the ligaments or breaks the scaphoid bone. Swimming adds a rotational load at the catch when the hand enters flat and thumb first.

Symptoms

• Pain on the thumb side of the wrist when gripping or twisting a lid
• Aching along the top of the wrist after long rides in aero
• Swelling and pain in the hollow at the base of the thumb after a fall
• Weak grip and pain pushing up out of a chair
• Clicking or a sharp catch at a specific angle of rotation

How serious it is: Simple sprains and tendon irritation are graded by how much they limit grip and settle in weeks. Pain in the anatomical snuffbox at the base of the thumb after a fall is the important exception, because a scaphoid fracture can be invisible on an early x ray and heals badly if missed.

Typical time out: Two to six weeks for a sprain or tendon irritation, six to twelve weeks in a cast for a scaphoid fracture and considerably longer if it fails to unite, which is why the early assessment matters

See a doctor if: See a doctor within days of a fall if the base of the thumb is tender, even when the x ray is called normal, and go sooner for deformity or numbness in the hand.

What helps

• Lower the load first: less time in aero, no paddles, and a temporary switch to freestyle with a neutral hand entry
• A wrist splint for the painful weeks, worn for work and sleep rather than permanently
• Grip and forearm strength work once acute pain settles, progressing to loaded wrist extension and rotation
• Reposition the aero pads and bar extension angle so the wrist rests neutral rather than bent back
• Repeat imaging or a specialist review for persistent thumb side pain after a fall, since a missed scaphoid fracture is a long term problem

Head injuries (concussions, cycling accidents)

A concussion is a disturbance of brain function caused by force transmitted to the head, either by a direct blow or by rapid acceleration of the head on the neck, and it happens without any visible damage on a standard scan. In triathlon it comes almost entirely from the bike leg: a crash in a pack, a wheel touch, or a fall in a wet corner. A helmet reduces the risk of skull fracture and bleeding but does not make you immune to concussion.

Symptoms

• Headache or a pressure feeling in the head after the crash
• Dizziness, nausea, and feeling slowed down or in a fog
• Sensitivity to light and noise
• Trouble concentrating or remembering the minutes around the crash
• Irritability, poor sleep and unusual fatigue in the days afterward

How serious it is: Most concussions are self limiting and settle over one to four weeks. The dangerous minority involve bleeding inside the skull, and these announce themselves through worsening headache, repeated vomiting, growing drowsiness or one pupil larger than the other, in the hours after the impact.

Typical time out: One to four weeks in most cases, following a stepwise return where each stage is completed symptom free, and several months for a small proportion whose symptoms persist, which is why a second impact before recovery must be avoided

See a doctor if: Call emergency services for loss of consciousness, a seizure, repeated vomiting, worsening confusion, weakness on one side, or neck pain after the crash.

What helps

• Stop the session immediately: nobody returns to the bike on the same day after a suspected concussion
• Take twenty four to forty eight hours of relative rest, then start light activity below the symptom threshold rather than lying in a dark room for a week
• Follow a graded return, from walking to easy cycling on a trainer to running to open road riding, advancing only when the previous stage stayed symptom free
• Get a medical assessment and clearance before returning to group riding or racing
• Replace the helmet after any crash where it took an impact, since the foam is designed to work once

Elbow injuries (tennis elbow)

Lateral epicondylalgia, commonly called tennis elbow, is a degenerative change in the common extensor tendon where the wrist extensor muscles attach to the bony bump on the outside of the elbow. Triathletes get it from gripping the bars over rough roads and from long hours resting forearm weight on aero pads with the wrist cocked back. The tendon on the inner side can be affected in the same way, usually after heavy pulling work in the pool.

Symptoms

• Pain on the outside of the elbow when gripping or lifting a cup
• Tenderness on a small spot on the bony bump you can find with one finger
• Weakness in the grip that appears before pain does
• Pain shooting into the forearm when you extend the wrist against resistance
• Stiffness in the elbow first thing in the morning

How serious it is: The mild form hurts only with hard gripping and settles quickly after activity. The severe form hurts with everyday tasks such as opening doors and carrying a bag, has often lasted several months, and needs a structured loading program rather than rest.

Typical time out: Six weeks to six months, because tendon pain of this kind typically improves slowly and the spread depends heavily on how long it went on before treatment started, though cycling can usually continue with adjustments

See a doctor if: See a doctor for numbness or tingling in the hand, night pain, or elbow pain that followed a fall rather than building gradually.

What helps

• Progressive loading of the wrist extensors, starting isometric and moving to slow eccentric work with a light weight or band
• Widen the grip and soften it, add thicker bar tape, and reduce time gripping the brake hoods on rough surfaces
• Adjust aero pad and extension angle so the wrist rests near neutral rather than extended
• A counterforce strap can reduce pain during activity, but it is a support for the loading program, not a substitute for it
• Treat corticosteroid injection as a last resort: it eases pain for weeks but is associated with worse outcomes at one year

Cuts and abrasions (from falls)

Road rash is a friction wound where the skin is scraped away, often down to the dermis, when the body slides along tarmac. Deeper cuts go through the full skin thickness and can involve the tissue below. In triathlon these come from bike crashes, from bare feet in transition, and from contact in a mass swim start, and the wounds are usually contaminated with grit that has to come out.

Symptoms

• A raw, weeping area that stings sharply, especially in the shower
• Grit or road debris visible in the wound
• Bleeding that stops with pressure, or continued oozing from a deep cut
• Increasing redness, warmth and pain from day two onward, which suggests infection
• Stiffness where a scab crosses a joint such as the knee or elbow

How serious it is: A superficial abrasion heals in a week without a scar. A deep abrasion that exposes fat, a cut with gaping edges, or any wound with embedded grit needs proper cleaning and often closure, and untreated contamination is what turns a minor fall into weeks off.

Typical time out: A few days to two weeks for superficial road rash, three to six weeks when a wound is deep or infected, and swimming in particular must wait until the skin is fully closed to avoid infection from open water and pool water alike

See a doctor if: See a doctor for a wound you cannot get clean, one that gapes open, spreading redness with fever, or if your tetanus vaccination is not up to date.

What helps

• Irrigate the wound thoroughly with clean running water and remove all grit, since debris left in road rash both delays healing and tattoos the skin
• Keep the wound moist and covered with a non adherent or hydrocolloid dressing rather than letting it dry into a hard scab
• Change dressings as the wound weeps and watch the edges daily for spreading redness
• Stay out of pools, lakes and the sea until the skin is closed
• Keep the joint underneath moving gently so the healing skin does not tighten across it

Sunburn

Sunburn is direct ultraviolet damage to the DNA in skin cells, which triggers an inflammatory response hours after the exposure has already happened. Triathletes take a large dose because sessions are long, the sun is high in the middle of the day, and water and wet skin reflect and intensify the exposure. The back of the neck, the shoulders, the ears and the tops of the thighs are the usual sites in trisuit and helmet.

Symptoms

• Red, hot skin that appears three to six hours after exposure and peaks the next day
• Tenderness where a strap or waistband rubs
• Tight, itchy skin that later peels
• Blistering in more severe cases
• Headache, chills and nausea when a large area is burned

How serious it is: A superficial burn is red and sore and settles within a few days. A burn with blistering damages a deeper layer, takes one to two weeks and can scar, and widespread burning with fever and chills is a systemic reaction that needs medical review.

Typical time out: One to three days for mild burning, one to two weeks when blisters form, mainly because a trisuit, a wetsuit or a backpack over burned skin is not tolerable until it has healed

See a doctor if: See a doctor for widespread blistering, fever and chills after sun exposure, or for a mole that changes shape, color or size.

What helps

• Cool the skin with a cool shower and use a plain fragrance free moisturizer while it is still damp
• Apply a broad spectrum sunscreen of SPF 30 or higher, at least fifteen minutes before you start and reapplied after the swim and mid ride
• Choose a sport specific water resistant sunscreen and cover the ears, the back of the neck and the tops of the feet, which are routinely missed
• Wear sleeved trisuits, arm coolers and a cap under the run, since fabric is more reliable than reapplication during a race
• Do not burst blisters, and see a dermatologist yearly if you train outdoors year round

Neck injuries (muscle strain)

The muscles at the back of the neck, mainly the upper trapezius and the deep neck extensors, hold the weight of the head against gravity. In the aero position the trunk is nearly horizontal while the eyes must look up the road, so those muscles work continuously for hours in their shortest range. Swimming adds repeated rotation for breathing, which loads the same tissue from a different angle.

Symptoms

• A burning ache at the base of the neck that builds through a long ride
• Having to drop your head and look down for relief on the bike
• Stiffness turning the head to breathe on one side while swimming
• Headache starting at the base of the skull after long sessions
• Tender knots across the top of the shoulders

How serious it is: A simple muscular strain is stiff and sore, stays in the neck and shoulders and settles within days to a few weeks. Pain that travels down the arm with numbness, tingling or weakness points to nerve involvement and is a different problem that needs assessment.

Typical time out: A few days to three weeks for a muscular strain, six weeks or more when a nerve is irritated, and long ride volume usually has to come down before it settles even if the athlete feels fine on foot

See a doctor if: See a doctor for neck pain after a crash, for numbness or weakness in the arm or hand, or for pain that wakes you every night.

What helps

• Get the bike fit checked: too low a front end and too long a reach are the usual causes, and a small stem change often fixes it
• Build up aero time gradually rather than fitting new bars a week before a race
• Strengthen the deep neck flexors and the scapular muscles, since a neck that is only stretched keeps failing
• Change position and lift the head periodically on long rides instead of holding one posture for hours
• Bilateral breathing in the pool so one side of the neck does not take every rotation

Drowning (during the swimming stage)

Drowning is respiratory impairment from submersion or immersion, and in triathlon it develops from a chain of events rather than a single one: cold water on the face triggers a gasp and rapid breathing, the crowded start makes breathing rhythm impossible, panic follows, and the athlete can no longer keep the airway clear. Undiagnosed heart disease and swimming induced pulmonary edema account for some cases where a strong swimmer gets into trouble without warning.

Symptoms

• Sudden breathlessness that does not settle when you stop swimming
• Panic, a racing heart and the feeling of not being able to get a full breath
• Coughing, wheezing or coughing up pink frothy sputum
• Chest tightness or chest pain in the water
• A swimmer who has gone quiet, is vertical in the water and is not making progress

How serious it is: The mild end is a bad few minutes at the start that resolves once the athlete rolls onto their back and slows their breathing. The severe end is loss of consciousness in the water, which is a life threatening emergency, and anyone rescued from the water needs medical assessment even if they seem fine.

Typical time out: Days after a scare that resolved on the spot, weeks to months after an actual rescue, since the lungs need to be reviewed and any underlying cardiac or pulmonary edema cause has to be investigated before racing again

See a doctor if: Call emergency services for anyone pulled from the water who is unresponsive, not breathing normally, or coughing persistently, and never let them go home to sleep it off.

What helps

• Roll onto your back, stop swimming and breathe slowly at the first sign of panic, then wave to the nearest kayak
• Train in open water in a wetsuit before race day, including cold water face immersion so the gasp reflex is familiar
• Practice a mass start with other swimmers rather than meeting contact for the first time in a race
• Start at the side or the back of your wave if you are not confident, and use the swim course markers and support craft as rest points
• Get a cardiac check before your first event if you have chest symptoms, fainting during exercise, or a family history of sudden cardiac death

First Aid for Soft Tissue Injuries: PEACE and LOVE

Sports medicine has moved on from RICE. The current guidance, published in the British Journal of Sports Medicine in 2019, splits care into the first days after the injury and everything that follows.

PEACE, the first two to three days

• Protect: unload the area and limit movement that hurts, but only briefly.
• Elevate: keep the limb above heart level when you can.
• Avoid anti-inflammatories: they may blunt the healing you need.
• Compress: a bandage or taping limits swelling.
• Educate: your body heals this on its own; passive treatments rarely speed it up.

LOVE, from day three onward

• Load: return to movement as pain allows, early loading builds tissue.
• Optimism: expectations shape recovery more than most people assume.
• Vascularization: easy cardio that does not hurt brings blood to the area.
• Exercise: restore strength, mobility and balance before returning to play.

Ice still helps with pain in the first hours. What changed is the evidence that long icing and routine anti-inflammatory drugs slow tissue repair.

How to Lower Your Risk in Triathlon

• Increase run volume in small weekly steps and keep it separate from big bike weeks, because running is the discipline behind most triathlon injuries and it is loaded onto legs that are already fatigued from the bike.
• Get a proper bike fit before you add aero volume, and then build time in the aero position over weeks, since the neck, lower back and front of the hip all pay for a position adopted too aggressively too soon.
• Strength train twice a week all year, with calf raises, hip hinges, single leg work and rotator cuff work, so tendon and bone can carry the volume rather than only the heart and lungs being trained.
• Cap the paddle and pull buoy work and fix the catch instead, because most swimmer’s shoulder in triathletes comes from added hand surface and a dropped elbow rather than from swim volume alone.
• Practice open water skills before you need them: cold water entry, sighting, swimming in a group and rolling onto your back to recover, so a crowded start does not become the first time you meet contact.
• Rehearse hydration, sodium and pacing in heat during training and accept a slower pace on hot race days, since heat illness and dehydration in triathlon build across all three disciplines.

When to Stop and Get Medical Help

Most of the injuries on this page are treated at home. These signs are not.

• Suspected fracture: obvious deformity, bone tenderness at a single point, or a limb that will not take your weight for four steps.
• Head impact with loss of consciousness, a seizure, repeated vomiting, worsening confusion or neck pain after a crash.
• Numbness, tingling or weakness in an arm or leg, or numbness around the groin with loss of bladder or bowel control.
• A joint that locks, will not move, or gives way completely, or a swelling that balloons within an hour of the injury.
• Confusion, stumbling, aggression or collapse in the heat, which is an exertional heat stroke until proven otherwise.
• Chest pain, fainting or breathlessness out of proportion to the effort, in or out of the water.

Sources

• Journal of Sport and Health Science, systematic review (2024)
• Journal of Human Kinetics, systematic review (2022)
• Journal of Sports Science and Medicine (2022)

This article is general information, not medical advice. If you are hurt, a doctor or physiotherapist who can examine you is worth more than any web page. Last reviewed: August 2026.

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