physiotherapy and injury prevention tips for triathletes

Physiotherapy stands as the foundational pillar of musculoskeletal health and performance optimization for the modern endurance athlete, particularly within the multi-disciplinary rigors of triathlon. As participation in triathlon events across the United Kingdom surges—ranging from local sprint distances to the grueling demands of Ironman competitions—clinical practitioners are increasingly confronted with a complex array of overuse injuries that necessitate a sophisticated, evidence-based approach to management and prevention.¹ This report serves as an exhaustive resource for sports medicine professionals, coaches, and athletes, synthesizing contemporary research, clinical guidelines, and advanced therapeutic modalities to define the gold standard in triathlon care.

The unique "brick" nature of triathlon—stacking the disparate biomechanical loads of hydrodynamic swimming, closed-chain cycling, and high-impact running—creates a cumulative fatigue profile that is distinct from single-sport endurance events. Consequently, physiotherapy treatment must evolve beyond reactive symptom management to embrace a holistic model of "prehabilitation," structural resilience, and metabolic recovery. In the UK context, where environmental factors such as cold-water swimming conditions and hard-surface winter running prevail, the role of the physiotherapist becomes even more critical in mitigating injury risk.³

This analysis will rigorously examine the epidemiology of triathlon injuries, dissect the pathophysiology of common conditions, and evaluate the efficacy of advanced interventions including shockwave therapy and electro therapy. By integrating data from the Chartered Society of Physiotherapy (CSP), British Triathlon guidelines, and peer-reviewed clinical studies, we aim to provide a nuanced understanding of how targeted physiotherapy can not only restore function but elevate athletic performance to new heights.

The Physiology of the Triathlete and Biomechanical Demands

To effectively treat and prevent injuries, one must first understand the physiological and biomechanical crucible of the triathlon. The sport requires the athlete to master three distinct movement patterns, each placing unique stresses on the kinetic chain.

Hydrodynamic Stress: The Swim

The swim leg, while non-weight-bearing, demands immense repetitive capability from the upper body. The shoulder complex acts as the primary engine, generating propulsion through a massive range of motion.

• Biomechanics: A proper freestyle stroke requires significant thoracic extension and scapular stability. The "catch" phase places the shoulder in internal rotation and abduction, a position that can impinge the rotator cuff tendons if scapular mechanics are flawed.⁵
• Kinetic Chain: Although upper-body dominant, the swim requires a taut core to minimize drag. A disconnect in the core leads to "snaking" in the water, increasing the load on the lumbar spine and shoulders.¹
• Physiological Load: In UK waters, cold shock response can lead to involuntary muscle tension, elevating the risk of acute neck spasms (torticollis) and cramping.⁴

Closed-Chain Constraint: The Bike

Cycling locks the pelvis onto the saddle and the feet onto the pedals, creating a closed kinetic chain where force must be transferred efficiently without energy leaks.

• Lumbar Flexion: The aerodynamic position ("aero tuck") requires sustained lumbar flexion. If the athlete lacks hamstring flexibility or core endurance, this position places excessive shear force on the lumbar discs and strain on the posterior ligamentous system.³
• Hip Flexor Shortening: Prolonged hip flexion in the aero position functionally shortens the iliopsoas and rectus femoris. This adaptive shortening is a critical precursor to running injuries, as it inhibits hip extension in the subsequent run leg.⁶
• Knee Tracking: The knee must track directly over the pedal spindle. Deviations caused by weak gluteal muscles or improper cleat setup result in repetitive micro-trauma to the patellofemoral joint.⁷

Impact Loading: The Run

Running is the most injurious discipline, responsible for the majority of time-loss injuries in triathlon.

• Ground Reaction Forces: Each heel strike generates forces 2.5 to 3 times body weight. Over the course of a 10km or marathon run, this accumulates to tons of load transmitted through the tibia, talus, and calcaneus.⁸
• Neuromuscular Fatigue: Running off the bike (T2) occurs in a state of glycogen depletion and neuromuscular fatigue. The altered muscle recruitment patterns—often termed "jelly legs"—compromise form, leading to increased adduction and internal rotation at the hip, which correlates with iliotibial band syndrome (ITBS) and medial tibial stress syndrome (MTSS).⁹

Epidemiology of Triathlon Injuries in the UK

A granular analysis of injury data reveals clear patterns that should inform physiotherapy screening and treatment protocols.

Prevalence and Distribution

Research consistently identifies the lower limb as the primary site of pathology, with overuse injuries significantly outnumbering acute trauma.

Data synthesized from.¹

The "Weekend Warrior" Phenomenon and Age Demographics

The demographic profile of UK triathletes is skewing older, with the 30-49 age bracket seeing the most growth.² This has significant implications for physiotherapy:

• Tendon Stiffness: Aging tendons lose water content and elasticity, making them more susceptible to tendinopathy (e.g., Achilles, Patellar) under high eccentric loads.²
• Recovery Rates: Older athletes require longer recovery periods between high-intensity sessions to allow for collagen synthesis and structural repair.
• Weekend Loading: Many amateurs concentrate training volume on weekends due to work commitments. This "spike" in acute workload is a classic violation of the Acute:Chronic Workload Ratio (ACWR), significantly elevating injury risk.¹¹

Environmental Contributors

The UK environment plays a distinct role in injury etiology.

• Surface Hardness: During winter, athletes often shift from softer trails to tarmac or treadmills to avoid mud, increasing the impact shock and the prevalence of shin splints.³
• Cold Exposure: Swimming in cold open water (often <15°C) can induce shivering and muscle tensing, altering stroke biomechanics and predisposing athletes to supraspinatus impingement and neck strain.⁴

Advanced Therapeutic Modalities in Physiotherapy Treatment

Contemporary physiotherapy treatment has moved beyond simple rest and ice. High-performance clinics now employ a suite of advanced modalities designed to accelerate tissue healing and manage pain. Specifically, shockwave therapy and electro therapy have become integral to the management of recalcitrant triathlon injuries.

Shockwave Therapy (ESWT): Mechanisms and Efficacy

Shockwave therapy, or Extracorporeal Shockwave Therapy (ESWT), represents a paradigm shift in the treatment of chronic tendinopathies. It is a non-invasive modality that utilizes high-energy acoustic waves to stimulate healing in degenerated tissue.

Biological Mechanisms

The efficacy of shockwave therapy lies in the principle of mechanotransduction—the conversion of mechanical force into biochemical signals.

• Neovascularization: The acoustic pulses create micro-ruptures in capillaries, stimulating the release of vascular endothelial growth factors (VEGF). This leads to the formation of new blood vessels, improving oxygenation and nutrient delivery to poorly vascularized tendons like the Achilles and supraspinatus.¹¹
• Pain Modulation: Shockwaves hyper-stimulate nociceptors (pain receptors), leading to a depletion of Substance P, a key neurotransmitter for pain. This provides a significant analgesic effect, allowing athletes to continue rehabilitation exercises with reduced discomfort.¹³
• Calcific Reabsorption: In conditions like calcific tendinitis of the shoulder, focused shockwaves can mechanically disintegrate calcium deposits, which are then reabsorbed by the lymphatic system.³

Radial vs. Focused Shockwave Therapy

It is crucial for clinicians and patients to distinguish between the two types of ESWT:

1. Radial Shockwave Therapy (rESWT): The wave spreads outwards, losing energy as it penetrates deeper. It is ideal for superficial treatments like plantar fasciitis and extensive muscular tightness.¹²
2. Focused Shockwave Therapy (fESWT): The energy is concentrated at a specific depth within the tissue. This is the superior choice for deep-seated pathologies such as insertional Achilles tendinopathy, proximal hamstring tendinopathy, or deep calcifications. Clinics like CK Physio emphasize the use of focused ESWT for its precision in targeting deep tissue layers.¹¹

Evidence in Triathlon Context

• Achilles Tendinopathy: A condition plaguing many runners. Research indicates that ESWT, when combined with eccentric loading protocols, significantly outperforms exercise alone in reducing pain and improving function in chronic Achilles tendinopathy.¹⁶ It is particularly effective for insertional tendinopathy, where traditional heel-drop exercises might be too aggressive.¹⁸
• Plantar Fasciitis: Multiple studies confirm ESWT as a highly effective intervention for chronic plantar heel pain, often resolving symptoms where corticosteroid injections have failed.¹⁶
• Bone Stress Injuries: Emerging evidence suggests ESWT can accelerate bone healing in medial tibial stress syndrome (shin splints) and stress fractures by stimulating osteoblastic activity.²⁰

Electro Therapy: Spectrum of Applications

Electro therapy encompasses a range of modalities that use electrical energy to produce therapeutic effects. In the context of triathlon injuries, these are used for pain management, inflammation control, and muscle re-education.

Therapeutic Ultrasound

Ultrasound utilizes sound waves (typically 1MHz or 3MHz) to transfer energy to tissues.

• Thermal Effects: Continuous mode ultrasound generates heat deep within tissues, increasing collagen extensibility. This is beneficial for treating chronic scar tissue or preparing tight structures (like the calf complex) for stretching.¹³
• Non-Thermal Effects: Pulsed ultrasound produces acoustic streaming and cavitation, which can alter cell membrane permeability. This is used in the acute inflammatory phase of ligament sprains (e.g., ankle inversion) to accelerate the resolution of edema and promote tissue repair.²²

Transcutaneous Electrical Nerve Stimulation (TENS)

TENS is a widely recognized modality for symptomatic pain relief.

Mechanism: It operates on the Gate Control Theory of pain. By stimulating large-diameter sensory nerves (A-beta fibers), it blocks the transmission of pain signals from smaller C-fibers to the brain. Additionally, low-frequency TENS can stimulate the release of endogenous opioids (endorphins).²⁴

Application: For a triathlete managing acute lower back pain after a long ride, TENS offers a drug-free method to reduce pain perception, facilitating better sleep and mobility without masking injury severity during training.²⁵

Neuromuscular Electrical Stimulation (NMES)

Unlike TENS, which targets sensory nerves, NMES targets motor nerves to induce muscle contraction.

Rehabilitation Utility: NMES is critical in the early post-operative or post-injury phase when voluntary muscle activation is inhibited by pain (arthrogenic muscle inhibition). For example, following a knee injury, the VMO (vastus medialis) often shuts down. NMES can force this muscle to contract, preventing atrophy and maintaining neural pathways during the rehabilitation process.²⁶

Manual Therapy and Soft Tissue Mobilization

While technology is powerful, the hands-on skills of a physiotherapist remain irreplaceable.

Joint Mobilization: Techniques such as Maitland mobilizations are used to restore physiological range of motion in stiff joints. For triathletes, mobilizing the ankle joint (talocrural joint) is often necessary to achieve the dorsiflexion required for efficient running and cycling mechanics.²⁸

Myofascial Release: Deep tissue techniques address fascial restrictions that limit movement. Releasing the iliotibial band (ITB) and tensor fasciae latae (TFL) can alleviate the lateral knee pain common in cyclists and runners.²⁹

Acupuncture and Dry Needling: Dry needling targets myofascial trigger points—hyper-irritable spots in skeletal muscle. By inserting a fine needle, the physio can induce a "local twitch response," which releases the knot and restores normal muscle function. This is particularly effective for tight calves and glutes in endurance athletes.³⁰

Pathophysiology and Management of Common Triathlon Injuries

A deeper dive into specific injuries reveals the necessity of a tailored approach.

Achilles Tendinopathy

Pathology: Often mislabeled as "tendinitis," this is rarely an inflammatory condition. It is a degenerative process (tendinosis) where the collagen matrix breaks down due to failed healing responses to repetitive load.

Triathlon Context: The transition from bike to run places the Achilles under immediate high load while the calf muscles may be fatigued. Low-drop racing shoes further increase tensile strain on the tendon.

Management Protocol:

• Load Management: Cessation of aggravating activities (hills, speed work).
• Shockwave Therapy: A course of focused ESWT to stimulate regeneration.¹⁶
• Alfredson Protocol: A structured eccentric loading program (heel drops) performed twice daily for 12 weeks. This remodels the tendon structure, aligning collagen fibers to withstand tensile loads.³²

Swimmer's Shoulder (Subacromial Impingement)

Pathology: Compression of the rotator cuff tendons (supraspinatus) and subacromial bursa between the humeral head and the acromion process.

Triathlon Context: Often caused by a "crossover" hand entry in swimming or excessive use of hand paddles which overload the shoulder stabilizers.

Management Protocol:

• Electro Therapy: Ultrasound to manage bursitis inflammation.²²
• Kinetic Chain Rehab: Strengthening the serratus anterior and lower trapezius to ensure proper scapular upward rotation (clearing the subacromial space).
• Technique Correction: widening the entry point of the hand in the water to neutral alignment.⁵

Medial Tibial Stress Syndrome (Shin Splints)

Pathology: Traction periostitis of the soleus or tibialis posterior attachment on the tibia, or early bone stress reaction.

Triathlon Context: Running on concrete pavements in the UK, old footwear with compressed EVA foam, and over-striding.

Management Protocol:

Biomechanical Screening and Injury Prevention

The most effective injury management is prevention. Physiotherapy screening identifies "silent" dysfunctions before they become symptomatic injuries.

Functional Movement Screening (FMS)

A comprehensive screen for triathletes must assess mobility and stability in sport-specific patterns.

Thoracic Extension: Essential for the aero position on the bike and overhead reach in swimming. Restriction here forces the lumbar spine into hyperextension or rotation, leading to injury.¹

Hip Extension: Critical for running drive. Tight hip flexors (from cycling) inhibit the gluteus maximus. If the glutes don't fire, the hamstrings and lower back overwork to extend the hip, leading to strains.⁶

Ankle Dorsiflexion: Limited ankle range compromises the bottom of the pedal stroke and forces compensatory pronation during running, stressing the Achilles and plantar fascia.³⁵

Strength and Conditioning (S&C): The "Fourth Discipline"

There is a pervasive myth in endurance sports that resistance training builds unwanted bulk. However, research confirms that heavy, slow resistance training improves tendon stiffness and neuromuscular efficiency without significant hypertrophy.³⁶

Tendon Stiffness: A stiffer tendon acts like a stronger spring, storing and returning energy more efficiently. This improves running economy—the oxygen cost of running at a given speed.

Protocol: Exercises such as heavy squats, deadlifts, and calf raises should be performed at high loads (80% 1RM) for low repetitions (3-6), focusing on the eccentric phase.

Core Stability: "Dynamic core control" is vital. Exercises like the plank or "dead bug" teach the athlete to stabilize the torso while the extremities move, mimicking the demands of swimming and running.¹

Load Management and the Acute:Chronic Workload Ratio

Overuse injuries are fundamentally errors in load management. The Acute:Chronic Workload Ratio (ACWR) is a robust model for monitoring injury risk.

Concept: It compares the workload of the current week (acute) to the average of the last four weeks (chronic).

The "Sweet Spot": A ratio of 0.8 to 1.3 suggests the athlete is safely building fitness.

The "Danger Zone": A ratio >1.5 indicates a spike in training load that significantly increases the risk of injury.

Application: Physiotherapists use this to guide return-to-sport protocols. A triathlete returning from a 2-week holiday cannot simply jump back into their pre-holiday volume, as their chronic tolerance has dropped.¹¹

Case Studies: Clinical Success in the UK Context

The integration of these principles is best illustrated through clinical examples representative of the UK triathlon population.

Case Study 1: Chronic Plantar Fasciitis in an Ironman Athlete

Patient Profile: 42-year-old male, training for Ironman UK.

History: 8 months of progressive heel pain, worse in the morning ("first step pain"). Failed to respond to rest, icing, and generic stretching.

Assessment: Diagnosis of plantar fasciopathy (degenerative change). Biomechanical screen revealed tight gastrocnemius and weak intrinsic foot muscles.

Intervention:

• Shockwave Therapy: A course of 4 sessions of focused shockwave therapy (weekly intervals) to the plantar fascia insertion. This targeted the thickened, degenerated tissue to stimulate neovascularization.¹⁹
• Rehabilitation: High-load strength training for the plantar fascia (modified calf raises with a towel roll under the toes) to stimulate collagen remodeling.

Correction: Custom orthotics prescribed to temporarily offload the fascia, and a transition to shoes with a higher heel drop to reduce strain.
Outcome: Significant reduction in pain (VAS score 8/10 to 2/10) within 6 weeks. The athlete successfully completed the Ironman marathon segment pain-free.

Case Study 2: Recurrent Hamstring Strain in a Sprint Triathlete

Patient Profile: 29-year-old female, competitive age-group sprinter.

History: Recurring "pulls" in the high hamstring area, specifically when transitioning off the bike to the run.

Assessment: Proximal hamstring tendinopathy. Bike fit analysis revealed a saddle position that was too high and too far back, placing the hamstrings in a position of maximal stretch and tension during the pedal stroke.

Intervention:

• Bike Fit: Lowered saddle by 15mm and moved it forward to open the hip angle.⁷
• Physiotherapy Treatment: Deep soft tissue mobilization to the gluteals and hamstring origin.
• Strength: Implementation of eccentric hamstring exercises (Nordic curls) and heavy isometric bridges to build tendon load tolerance.7
  Outcome: No recurrence of injury in the subsequent season. The intervention highlighted that treating the tissue without correcting the biomechanical cause (the bike fit) would have led to failure.

Case Study 3: Post-Operative Knee Rehab with Electro Therapy

Patient Profile: 35-year-old male, recreational triathlete, 6 weeks post-meniscectomy.

History: Atrophy of the quadriceps and difficulty achieving full terminal knee extension due to swelling.

Intervention:

• Electro Therapy (NMES): Application of Neuromuscular Electrical Stimulation to the VMO muscle during active knee extension exercises. This overcame neural inhibition and facilitated muscle recruitment.²⁶
• Electro Therapy (TENS): Used post-session to manage reactive pain and swelling.
• Progression: Gradual re-introduction of cycling (low resistance) to mobilize the joint, followed by aquatic running to reintroduce impact loading in a reduced-gravity environment.

Outcome: Returned to sprint distance racing within 5 months with full quadriceps symmetry.

The Role of the Multi-Disciplinary Team

Effective management of the triathlete often requires a collaborative approach. The physiotherapist acts as the central hub, coordinating with other specialists.

The Coach: To adjust training volumes based on ACWR and injury status.

The Podiatrist: For specialized gait analysis and orthotic prescription in complex foot mechanics issues.¹⁰

The Nutritionist: To ensure adequate protein and energy availability. Relative Energy Deficiency in Sport (RED-S) is a major risk factor for bone stress injuries in triathletes; without adequate nutrition, no amount of physio can heal a stress fracture.³⁸

Medical Consultants: For referral when imaging (MRI, Ultrasound) or injection therapy (corticosteroids, PRP) is indicated.

Future Directions in Sports Physiotherapy

The field of sports physiotherapy is rapidly advancing. Emerging trends in the UK include:

Biopsychosocial Model: Increasing recognition of the psychological impact of injury. Physios are now trained to support the mental health of athletes who lose their primary coping mechanism (exercise) during injury layoffs.³⁹

Wearable Technology: Integration of data from smartwatches and power meters directly into physiotherapy assessment. Physios can now analyze an athlete's cadence, ground contact time, and power output remotely to detect fatigue patterns before injury occurs.

Regenerative Medicine: The combination of shockwave therapy with other regenerative techniques is a growing area of clinical interest, offering new hope for chronic conditions.

Conclusion

‘For the triathlete, the journey to the finish line is paved with physical demands that require a resilient body and a strategic approach to health. Physiotherapy provides the roadmap for this resilience. It is not merely a reactive service for the injured, but a comprehensive system for performance enhancement. By combining proactive screening to identify biomechanical faults, intelligent load management to prevent overuse, and advanced treatments like shockwave therapy and electro therapy for effective recovery, athletes can sustain high training volumes safely.

The integration of these modalities represents the forefront of sports medicine, enabling conditions that once ended seasons to be managed effectively while keeping the athlete active. Whether it is the novice aiming for their first sprint finish or the seasoned Ironman veteran chasing a podium spot, the partnership with a skilled physiotherapist is as essential as the bike or the wetsuit. Ultimately, the goal of modern physiotherapy is to ensure that the only pain a triathlete feels is the satisfying fatigue of a race well run.

Key Takeaways for Triathletes

Note: This report synthesizes current best practices and is intended for informational purposes. Athletes experiencing persistent pain should seek a face-to-face consultation with a Chartered Physiotherapist.

Frequently Asked Questions About Physiotherapy for Triathletes

How much does physiotherapy treatment typically cost in the UK?

Private physiotherapy sessions generally range from £40-80 per session, with initial assessments often costing slightly more; specialized treatments like shockwave therapy may incur additional charges of £50-100 per session.

Can I continue training while receiving physiotherapy treatment?

Most physiotherapists will modify rather than completely stop your training, using cross-training and reduced intensity to maintain fitness while protecting the injured area.

How do I know if I need to see a physiotherapist or can manage an injury myself?

Seek physiotherapy if pain persists beyond 5-7 days, worsens during training, affects your gait or technique, or causes you to compensate with altered movement patterns.

What's the difference between a Chartered Physiotherapist and other practitioners?

Chartered Physiotherapists (members of the CSP) have completed accredited university degrees and maintain continuing professional development, ensuring evidence-based treatment standards.

Is physiotherapy covered by health insurance for triathlon injuries?

Many private health insurance policies in the UK cover physiotherapy, though coverage limits and requirements for GP referrals vary by provider and policy.

How many physiotherapy sessions will I need for a typical overuse injury?

Most overuse injuries require 4-8 sessions over 6-12 weeks, though chronic conditions like tendinopathy may need ongoing management throughout a training season.

Should I use ice or heat for my triathlon injury?

Ice is generally recommended for acute injuries (first 48-72 hours) to control swelling, while heat is better for chronic muscle tightness and before stretching exercises.

Can physiotherapy prevent injuries before they occur?

Yes, preventative physiotherapy through biomechanical screening, movement assessment, and prehabilitation exercises significantly reduces injury risk, especially during high-volume training blocks.

What should I bring to my first physiotherapy appointment?

Bring your training log, details of recent workload changes, your running shoes, and any relevant imaging results (X-rays, MRI scans) if available.

Are online or virtual physiotherapy consultations effective for triathletes?

Virtual consultations work well for initial assessments, exercise programming, and follow-up guidance, though hands-on treatments and detailed biomechanical analysis require in-person visits.

How long after physiotherapy treatment can I return to full training?

Return-to-sport timelines are individualized based on injury severity and tissue healing, typically ranging from 2-3 weeks for minor issues to 3-6 months for significant tendon or bone injuries.

Is foam rolling as effective as professional physiotherapy treatment?

Foam rolling is a useful self-management tool for general muscle tension but cannot replace professional assessment, diagnosis, and targeted treatment of specific musculoskeletal injuries.

Do I need an MRI or ultrasound scan before starting physiotherapy?

Most musculoskeletal conditions can be diagnosed clinically without imaging; your physiotherapist will refer for scans only when necessary to rule out serious pathology or guide treatment decisions.

What's the difference between physiotherapy and sports massage for triathletes?

Physiotherapy provides comprehensive assessment, diagnosis, rehabilitation exercise, and advanced modalities, while sports massage focuses primarily on soft tissue manipulation and recovery.

Can I get physiotherapy treatment on race week?

Light maintenance treatments are generally safe, but avoid deep tissue work or new interventions within 3-5 days of racing to prevent treatment soreness affecting performance.

How often should triathletes have preventative physiotherapy screening?

Annual biomechanical screening during the off-season is recommended, with additional check-ins when significantly increasing training volume or transitioning between training phases.

Will physiotherapy treatment make me weaker or less competitive?

Evidence-based physiotherapy enhances performance by correcting movement dysfunction, improving tissue resilience, and preventing time-loss injuries that compromise training consistency.

Should I stop taking pain medication before physiotherapy treatment?

Continue prescribed medications as normal, but inform your physiotherapist about all pain relief you're using, as complete pain suppression can mask injury severity during assessment.

Works cited

1. Injury prevention for triathletes - The Physio Company, accessed on November 19, 2025, https://thephysiocompany.co.uk/injury-prevention-for-triathletes/
2. Triathlon Participation Statistics 2025 (New Data) - John Gaule Nutrition, accessed on November 19, 2025, https://johngaulenutrition.com/reports/triathlon-participation-statistics/
3. Essential Guide to Injury Prevention and Recovery for Triathlete - Tri Revolution, accessed on November 19, 2025, https://www.tri-revolution.co.uk/resources/essential-guide-to-injury-prevention-and-recovery-for-triathlete/
4. How to warm up for a swim | 220 Triathlon, accessed on November 19, 2025, https://www.220triathlon.com/training/swim-training/how-to-warm-up-for-a-swim
5. Effects of a dry-land strengthening exercise program with elastic bands following the Kabat D2 diagonal flexion pattern for the prevention of shoulder injuries in swimmers - Frontiers, accessed on November 19, 2025, https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2023.1275285/full
6. Key Exercises For Cyclists To Prevent Injury - The Putney Clinic of Physical Therapy, accessed on November 19, 2025, https://putneyclinic.co.uk/key-exercises-for-cyclists-to-prevent-injury/
7. Physiotherapy and Robustness in British Triathlon, accessed on November 19, 2025, https://www.britishtriathlon.org/britain/documents/gb-teams/talent/england/selection-weekend/2018/physiotherapy-and-robustness-in-british-triathlon.pdf
8. Injury and illness in short-course triathletes: A systematic review - PMC - PubMed Central, accessed on November 19, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10980869/
9. (PDF) Triathlon Injuries: A review of the literature and discussion of potential injury mechanisms - ResearchGate, accessed on November 19, 2025, https://www.researchgate.net/publication/228340374_Triathlon_Injuries_A_review_of_the_literature_and_discussion_of_potential_injury_mechanisms
10. A Guide to Sports Injury Prevention | King Edward VII's Hospital, accessed on November 19, 2025, https://www.kingedwardvii.co.uk/health-hub/sports-injury-prevention
11. How to train and not get injured in triathlon and running - West Hampstead Physiotherapy, accessed on November 19, 2025, https://physionw6.co.uk/how-to-train-and-not-get-injured-in-triathlon-and-running/
12. CK Physiotherapy: Expert Physiotherapy Care in London, accessed on November 19, 2025, https://ckphysio.co.uk/
13. ELECTROTHERAPY - Orchard Clinic, accessed on November 19, 2025, https://www.orchardphysio.co.uk/physiotherapy-services/electrotherapy/
14. British Triathlon Coaching Guidelines Contents, accessed on November 19, 2025, https://www.britishtriathlon.org/britain/documents/get-involved/coaching/guidelines-and-insurance/british-triathlon-coaching-guidelines-2019-4.pdf
15. Ross McKenzie's Achilles Recovery: From Injury to HYROX Success - Venn Healthcare, accessed on November 19, 2025, https://www.vennhealthcare.com/ross-mckenzies-achilles-recovery-from-injury-to-hyrox-success/
16. Combined extracorporeal shockwave therapy and exercise for the treatment of tendinopathy: A narrative review - PMC - PubMed Central, accessed on November 19, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9219268/
17. The effectiveness of extracorporeal shock wave therapy on chronic Achilles tendinopathy: a systematic review - NCBI, accessed on November 19, 2025, https://www.ncbi.nlm.nih.gov/books/NBK132041/
18. Effectiveness of reducing tendon compression in the rehabilitation of insertional Achilles tendinopathy: a randomised clinical trial | British Journal of Sports Medicine, accessed on November 19, 2025, https://bjsm.bmj.com/content/59/9/640
19. A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence | British Journal of Sports Medicine, accessed on November 19, 2025, https://bjsm.bmj.com/content/48/21/1538.abstract
20. Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study - PubMed, accessed on November 19, 2025, https://pubmed.ncbi.nlm.nih.gov/21393260/
21. Extracorporeal Shockwave Therapy for Athletes and Physically Active Individuals, accessed on November 19, 2025, https://spauldingrehab.org/about/news/extracorporeal-shockwave-therapy-for-athletes-and-physically-active-individuals
22. Efficacy of ultrasound therapy for the treatment of lateral elbow tendinopathy (the UCICLET Trial): study protocol for a three-arm, prospective, multicentre, randomised controlled trial | BMJ Open, accessed on November 19, 2025, https://bmjopen.bmj.com/content/12/1/e057266
23. Ultrasound therapy for pain reduction in musculoskeletal disorders: a systematic review and meta-analysis - PubMed Central, accessed on November 19, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC11337181/
24. TENS (transcutaneous electrical nerve stimulation) - NHS, accessed on November 19, 2025, https://www.nhs.uk/tests-and-treatments/transcutaneous-electrical-nerve-stimulation-tens/
25. How Does Electrotherapy Help With Injuries? | Sports Therapy - Clear Physio, accessed on November 19, 2025, https://www.clearphysio.co.uk/how-does-electrotherapy-help-with-injuries/
26. A Novel Rehabilitation Program Using Neuromuscular Electrical Stimulation (NMES) and Taping for Shoulder Pain in Swimmers: A Protocol and Case Example - PubMed, accessed on November 19, 2025, https://pubmed.ncbi.nlm.nih.gov/33842053/
27. The role of electrotherapy in contemporary physiotherapy practice - ResearchGate, accessed on November 19, 2025, https://www.researchgate.net/publication/12289301_The_role_of_electrotherapy_in_contemporary_physiotherapy_practice
28. CK Physiotherapy - Bupa Finder, accessed on November 19, 2025, https://www.finder.bupa.co.uk/Consultant/view/164058/ck_physiotherapy
29. CK Physiotherapy in London • Read 5 Reviews - WhatClinic, accessed on November 19, 2025, https://www.whatclinic.com/physiotherapy/uk/london/ck-physiotherapy
30. Physiotherapy Clinics in Ealing • Check Prices & Reviews - WhatClinic, accessed on November 19, 2025, https://www.whatclinic.com/physiotherapy/uk/london/ealing
31. Prevent. Treat. Recover: An Injury Prevention Guide for Long-Distance Elite Triathletes & IronMan Contenders - SLS Therapy, accessed on November 19, 2025, https://sls-therapy.co.uk/injury-prevention-for-triathletes-and-ironman/
32. A4-Achilles-tendinopathy.docx - NHS Borders, accessed on November 19, 2025, https://www.nhsborders.scot.nhs.uk/media/794474/A4-Achilles-tendinopathy.docx
33. Alfredson Protocol for Achilles Tendonitis Explained - Verywell Health, accessed on November 19, 2025, https://www.verywellhealth.com/the-alfredson-protocol-for-achilles-tendonitis-2696560
34. The Effect of Exercise Therapy Interventions on Shoulder Pain and Musculoskeletal Risk Factors for Shoulder Pain in Competitive Swimmers: A Scoping Review in - Human Kinetics Journals, accessed on November 19, 2025, https://journals.humankinetics.com/abstract/journals/jsr/31/5/article-p617.xml
35. Athlete screening: Reduce injury risk and improve performance - Excelsior, accessed on November 19, 2025, https://excelsiorgroup.co.uk/athlete-screening-reduce-injury-risk-and-improve-performance/
36. Strength versus In-Season Conditioning for Runners - Run Wild Missoula, accessed on November 19, 2025, https://www.runwildmissoula.org/strength-versus-in-season-conditioning-for-runners/
37. Shockwave Stories: Chronic Achilles Tendon in 61 year old Marathon Runner - How Osteopathic Clinic Edinburgh, accessed on November 19, 2025, https://www.howclinic.com/project/chronic-achilles-tendon/
38. The Triathlon Zone, Week 1: Injury Prevention Tips - Holland Aquatic Center, accessed on November 19, 2025, https://hollandaquatic.org/therapy-rehab/the-triathlon-zone-week-1-injury-prevention-tips/
39. Army physio overcomes injuries to win her first Ironman competition, accessed on November 19, 2025, https://www.csp.org.uk/news/2018-11-12-army-physio-overcomes-injuries-win-her-first-ironman-competition
40. Physiotherapy and Injury Prevention Tips for Triathletes, accessed on November 19, 2025, https://ckphysio.co.uk/blog/physiotherapy-and-injury-prevention-tips-triathletes