Based on the advice my wife Joy’s orthopedic doctor gave her after her first knee replacement, I believed that joint replacement meant the end of running.
However, when I spoke with Nikki Austin, I learned that joint replacement need not end your racing career.
Nikki’s orthopedic surgeon had encouraged her to continue swimming, biking, and even running after hip replacement. She followed the doctor’s advice. Nine months after hip replacement surgery, Nikki completed the 2021 Lititz recCenter Triathlon (Lititz, Pennsylvania).
A Triathlon Coach’s Perspective
Last month, a reader of SeniorTriathletes.com asked that we provide more information about training after hip replacement. She is eager to get back to racing, but also wants her new hips to last.
Jenn Reinhart, one of the Senior Triathletes coaches, and I spoke about triathlon after joint replacement. As you will hear in the recording of our conversation, Jenn speaks from experience. She is a senior triathlete and certified triathlon coach who has trained and raced after having both knees replaced.
Listen to what Jenn has learned and to her advice.
Recording of my conversation with triathlon coach and senior triathlete Jenn Reinhart
Additional Information from Jenn Reinhart
Here are links to the additional resources and products Jenn mentioned during our conversation:
Marathon Handbook, a website dedicated to “helping others achieve their health and fitness goals”. This website includes articles specific to running after hip replacement and after knee replacement.
What I Read About Triathlon Training After Joint Replacement
In preparing for our conversation, both Jenn and I did research to learn what medical professionals think about a return to triathlon training after joint replacement surgery. Following is a summary of information I found. You may want to review these as part of your own research.
Concerns About Running After Hip or Knee Replacement
An AAOS (American Academy of Orthopaedic Surgeons) post last reviewed in May 2022 included this statement, “Even though you will be able to resume most activities, you may want to avoid doing things that place excessive stress on your “new” knee, such as participating in high-impact activities like jumping, jogging, or skiing.”
According to a review of research published in European Review of Aging and Physical Activity, this advice comes from concerns about premature failure of a prothesis. The amount of wear and tear depends on individual factors, such as body weight, strength of bone and muscle that support the joint, and the individual’s running technique.
Majority of Replacement Specialists Support a Return to Running . . . After Some Time
One of these is Stone Clinic in San Francisco, California. A post on their website titled Running After Knee Replacement includes the following statement:
“By advising patients to return gradually to running, we build bone density and muscle strength—thereby decreasing the risk of joint loosening. The plastic inserts now used are so durable that there is a very low likelihood of them wearing out. And if they do, they can be relatively easily replaced.”
Reducing the Risk of Running After Joint Replacement
Part of the reason there is controversy is that we are all different. There are things we can do that are risky and things which will reduce the risks. According to sports medicine specialist, Dr. John Hill (age 61),
“You can also take steps post-surgery to reduce the risks associated with running. Keep your weight in check, consider a gait analysis to identify and correct issues with your biomechanics, and ask your surgeon about regular X-rays to monitor the wear rate and positioning of your implant.”
My Conclusion – Joint Replacement Need Not Be The End
Assuming that your orthopedic doctor allows you to return to training, a professional triathlon coach will help you navigate your return to triathlon or other multi-sport endurance racing. This is true whether your next race is your first or a continuation of your multi-sport career.
It’s Time for Your Questions and Comments
What questions and comments do you have about training for triathlon or other multi-sport endurance sports after a joint replacement? Leave this in the Comments section below.
I would also appreciate hearing what you think about the audio-only format for the interview with Jenn Reinhart. Do you prefer audio or text?
Comments: Please note that I review all comments before they are posted. You will be notified by email when your comment is approved. Even if you do not submit a comment, you may subscribe to be notified when a comment is published.
What can older endurance athletes do to minimize injury and speed recovery from injury when it occurs? Triathlon coach John Hansen shares his advice for our community of senior triathletes, duathletes, and other multisport athletes.
Introducing John Hansen
John Hansen is a USA Triathlon Level II, USA Swimming Level I, and USA Cycling Level III Certified coach. He coaches the University of California Davis Collegiate Club Triathlon team. He also has his own coaching business, focusing on long-course athletes, 70.3 and 140.6.
About one month ago, I read an article he had written for USA Triathlon titled Transitioning Back to Training After Injury. The article contained easy to follow guidelines for returning to training after injury. The guidelines he provided differed based on when in a training cycle the injury had occurred.
John’s advice for starting or restarting training is good advice for all of us. However, it is especially good for seniors training for their first triathlon.
The ’40-20 rule’ he described was new to me. This rule combines “training volume that is 40% of the volume you were at prior to the injury” with adding “20% of the new volume every 1-2 weeks”. We can modify the rule to be more conservative or more aggressive, depending upon the severity of the injury.
In the article, John also recommended adjustments to equipment and gear depending on where in the training cycle the athlete is.
How Age Affects One Coach’s Advice
John wrote the article for the general population of endurance athletes, not any specific age group. As I read, I was curious if he would change the approach if focused on the SeniorTriathletes.com demographic. So, I asked him the following question by email:
“How, if any way, might you change your advice if writing to 50-80+ year old triathletes, aqua-bikers, and duathletes?”
Following is John’s response, included here with his permission.
“Thank you for the question. With respect to the article, many of the points, especially the general points I made in the beginning of the article, are easily applied to triathletes in the 50+ age groups. However, there are several key elements this population should focus on to prevent injuries and optimize their transition back to training. All these elements are related to the injury recovery process, which takes longer for triathletes ages 50+. With that in mind, there are a few key prevention pieces of this puzzle to focus on:
Preventing Injury for Senior Endurance Athletes
First is strength training. Strength training for this age group is all about minimizing muscle mass loss, managing the quality of the muscle as it ages and sustaining connective tissue (tendons/ligaments/fascia) strength. Muscle mass decreases approximately 3–8% per decade after the age of 30 for non-active adults.
As triathletes, this population is helping to stem these issues, but the curve can be further reduced if the 50+ population engages in a full body strength routine 3x week. These positive benefits then result in a lower frequency and/or severity of injuries and ultimately a quicker recovery time.
Second is muscle pliability and connective tissue mobility. Muscles that are more pliable and connective tissue that allows for greater joint mobility, leads to lower frequency and/or severity of injuries and ultimately a quicker recovery time.
As we age, our muscles become less pliable because they retain less fluid, making them more rigid. Aging also affects connective tissue, reducing the mobility in our joints. Connective tissue loses fluid and collagen over time, making joints less mobile and more rigid and stiff. However, stretching, rolling, and myofascial release stimulate the production or retention of lubricants between the connective tissue fibers, thus preventing the formation of adhesions, creating more flexibility in muscles and greater mobility in joints.
The most vulnerable time for reinjury is when you feel normal as you return to training.
With respect to returning from an injury, key areas for this population [of senior endurance athletes] to focus on would be the following:
Rebuilding volume and intensity modestly; follow a more conservative plan than what I discussed in the article.
Follow a two-week training cycle instead of a one-week training cycle so the harder and/or long workouts can be spread apart with more rest or light training days in between these efforts.
Follow walk-run protocols and minimize hill training on runs.
Incorporate exercises, such as standing on one foot, standing on a wobble board or Bosu ball, to develop greater balance, coordination and proprioception.
Spend more timing warming up to allow the body (muscles and connective tissue in particular) to be better prepared (enhanced blood flow, fluid in the joints, central nervous system and more) to tackle the main body of the workout.
Do you have questions for John? Or, can you share your experience with recovering from injury? Post these in the Comments below.
Comments: Please note that I review all comments before they are posted. You will be notified by email when your comment is approved. Even if you do not submit a comment, you may subscribe to be notified when a comment is published.
Lack of confidence in swimming in open water is one of the top reasons seniors give for not doing a triathlon. This post contains advice from other seniors who have overcome their fear of open water swimming to finish many triathlons and open water swim races.
Background
In early 2021, I conducted a survey about triathlon’s greatest challenges for seniors, both beginners and experienced triathletes. Nearly one of four respondents identified concern about the swim as a challenge.
My recent conversation with Pat and Joan Hogan about their triathlon journeys reminded me of this statistic. Fortunately, many seniors, including Joan Hogan, have “slain that dragon” to go on and compete in triathlons.
How have they done this?
Approach
I asked three experienced senior triathletes who previously struggled with the open water swim how they had become more confident in open water. The three who generously and openly shared their experiences and advice, making this post as insightful as it is, are (in alphabetical order of last name):
Some Discomfort With Open Water Swimming Is Normal
“You are not alone” was a common phrase I heard during my conversations with Nikki, Donna, and Paul.
The first step is to realize that some anxiety about open water swimming is normal. Truthfully, fear is beneficial when it causes us to avoid self-destructive actions and unnecessarily dangerous situations.
Donna recalled watching from a boat the swim leg of a half Ironman triathlon whose swim was in Savannah River. She was amazed to see the number of triathletes who were on their back, hanging onto a kayak (which is allowed by USAT rules), or showed other signs of struggling.
Swimming is the most technical of the three disciplines of a triathlon. While it requires fitness and endurance, the technique, which includes how your hands and arms enter the water and your posture throughout the stroke, is key to a comfortable swim.
Ways to Develop More Confidence as an Open Water Swimmer
Nikki, Donna, and Paul prove you can become a confident open water swimmer.
What is the secret? Following is the picture they painted as they related their experiences.
First, Become Confident in the Pool
The three contributors to this post each mentioned the need to become confident swimming in a pool before heading into the open water.
What this will require depends on your experience with swimming. Some, who never learned to swim as a child, will need to start from the beginning, often with lessons. (If you are starting from the beginning, the first goal is to learn proper breathing.)
Others will develop confidence by swimming with a Masters swim or triathlon club. For others, hiring a swim coach to help them develop a more efficient swim stroke or kick will be the answer.
Paul said that when he was learning to swim, putting on flippers helped him to get enough forward momentum that he could focus on coordinating his arm movement and breathing. Once breathing during the swim stroke felt natural and relaxed, he put the flippers aside and focused on kicking.
Practice Sighting in the Pool
Once you enter the open water, you will no longer have the lines at the bottom of the pool to follow. So, while you are still in the pool, begin to practice ‘sighting‘.
Sighting is an essential part of the open water swim stroke during which you lift your head out of the water to check your location and surroundings. During a triathlon, proper sighting will keep you on the shortest course to the next turn buoy or to the swim exit.
Stay Focused
Even as you develop confidence in the pool, remember to stay focused on what you are trying to accomplish in each session. Avoid daydreaming.
Whether you are learning to swim or training to improve your stroke, focus is key to becoming a more efficient swimmer.
Joining a swim class or group that swims together regularly will help you improve both confidence and skill as a triathlon swimmer.
Practice with race day nutrition
We often think of muscle cramps as an issue for runners. However, cramps have ended a race for many a triathlete during the swim.
While swimming in the pool, learn of any issues you have with cramps. Some people experience these in their calf or foot muscles. Others can experience them in their lower back. I remember a cramp in one of my hamstring muscles cutting a swim session short.
For most people, preventing cramps is a matter of paying attention to nutrition and hydration before a swim.
Being adequately hydrated before the swim is a must to prevent cramps. Others benefit from eating a banana (potassium) or taking an anti-cramp supplement (e.g. GU gel with electrolytes, Hammer Nutrition Endurolytes) thirty minutes before swimming.
Next, Practice in Open Water
Your next goal is to swim in the open water.
A first principle of triathlon is “never do anything for the first time on race day”. This is especially true for open water swimming.
Start with a short distance. However, aim at eventually swimming a distance at least two times that required in your next triathlon.
If possible, complete this swim in different weather and water conditions. For example, don’t swim only if the water is calm. Practice swimming with wind and more choppy weather. You should even practice sighting with the sun in your eyes, a common situation during early morning races.
If the race will be in the ocean, practice getting past the breaking waves near shore by swimming through them.
Get the Right Gear
Arming yourself with a few items can eliminate some common sources of anxiety. Others can make you more visible while you are sharing the open water with boats and personal watercraft.
Besides a pair of good fitting goggles, including one pair with tinted lenses for those times when you are swimming into the sun, two must-have items for open water swim practice are:
While more expensive than these two items, a triathlon wetsuit is another wise investment. A wetsuit is great when the water or air temperature is cold. In addition, it adds buoyancy to keep your legs at the top of the water, making this one less thing with which to concern yourself.
Join Others to be More Confident as an Open Water Swimmer
When you first swim in open water, do so with other people. If possible, find a triathlon or swim club. If this doesn’t work because of where you live, find a place where experienced swimmers go, such as a public beach, and go with a friend.
Swim only in areas where swimming is specifically allowed. Swimming in “any old place” can mean swimming with unfriendly critters such as alligators, snakes, and jelly fish.
An ideal place to swim is at a public beach with lifeguards. According to the United States Lifesaving Association (USLA), the chance of a person drowning while at a beach protected by USLA affiliated lifeguards is 1 in 18 million.
Swim back and forth between lifeguard towers or, if there is only one, within the distance the single lifeguard covers. You can even inform the lifeguard of your situation.
Then, if possible, swim in water no deeper than that in which you can stand. This will eliminate another possible source of anxiety.
Ways to Maintain and Even Build Confidence in Open Water Swimming
Even after you have become confident in the open water, it is essential that you follow safe practices.
Nikki told me that before she heads out for a swim in the ocean or nearby Chesapeake Bay, she checks the surf forecast for the beach at which she plans to swim. In particular, she looks at the forecast for rip currents and wave height.
“I might still swim if there are waves a couple of feet, maybe more, but that changes the dynamics of the swim. I might not swim a mile but will be happy to work on my sighting, breathing, and other skills. I have actually found it to be quite fun and inspiring to see my skill level increase when swimming in more challenging water conditions.”
To learn more about rip currents, how to identify them, and how to swim in water where they are present; watch this short but information-packed video presentation by a representative of the National Weather Service.
Nikki’s comments on the benefit of swimming in different weather conditions and bodies of water (lakes, rivers, ocean) were echoed by Donna and Paul.
Other advice from the three for growing your confidence in the open water is:
Swim in open water every opportunity you have.
Continue to improve your swim fitness and technique. Learn to swim more efficiently. This does not have to mean swimming faster, but with less effort, using less energy because you are more efficient. Feeling out of breath, on the other hand, can bring on panic.
Finally, train yourself to mute any negative voices in your head. Some swimmers count from 1 to 100 over and over. Others sing. Do what works for you to stay calm.
“Do the thing you fear to do and keep on doing it… that is the quickest and surest way ever yet discovered to conquer fear.”
Dale Carnegie
Race Day Tips
Race day can present its own challenges. There is the almost inevitable contact with other swimmers. A race can also unleash an adrenaline-driven desire to keep up with or pass other racers.
Ways to mitigate these are:
If possible, swim in the open water of the race in the minutes leading up to the start of the race. This falls into the category of minimizing surprises that can come from:
Knowing the condition of the water in which you will walk into and swim. Are there sharp or slippery rocks on the way into the water? Are there weeds that I will touch when swimming? How quickly does the bottom drop-off?
Kick-starting your heart rate. If your heart rate spikes when starting fast, a pre-race swim will help prevent this.
Getting wet. The pre-race swim gets any shock of first entering the water out of the way before the race starts.
If there is a wave start, position yourself to one side of other swimmers or at the back of the pack.
Find and get into a rhythm as quickly as possible and stick to it. Stay calm. Nothing goes well when you tense up. This is just as true for swimming as it is for other sports.
Try to swim near others you can follow. As long as they stay on course, you can follow them, which reduces the amount of sighting you must do.
Since I had arrived at the higher elevation (7,000 feet or 2,100 meters) of this race only two days earlier, I started near the back of the wave. Picture courtesy of Lefrak Photography.
Resources for Becoming a More Confident Open Water Swimmer
Nikki, Donna, and Paul told me of the resources they have found helpful in becoming and staying confident while swimming in the open water.
Thank you to Nikki, Donna, and Paul for sharing your time and insights that are the basis for this post.
If you found this article useful, please add a Comment to thank them.
Is There More You Need to Know to Become a Confident Open Water Swimmer?
What questions do you have? Are there other tips you have learned for becoming a more confident, open water swimmer?
Or, have you found other resources for developing confidence in the swim leg?
Comments: Please note that I review all comments before they are posted. You will be notified by email when your comment is approved. Even if you do not submit a comment, you may subscribe to be notified when a comment is published.
How can you prepare for racing in a triathlon or other multisport endurance event that is at a significantly higher altitude than where you live and train?
While crossing the USA to complete a triathlon in every state, I have raced in western states, where the altitude on the courses was between 4,000 and 7,000 feet above sea level. Having trained in areas well below this, between sea level and 1,000 feet, I felt the effect of the altitude on race day.
“At real altitude (in the mountains), the barometric pressure of the atmosphere is much lower than sea-level environments. The result is that oxygen molecules are spread further apart, lowering the oxygen content of each breath.”
While each air molecule contains the same amount of oxygen no matter the elevation, the density of air molecules decreases with altitude. This effectively reduces the oxygen content.
In other words, we draw in fewer air molecules with each breath at high altitude compared to a lower one. Each breath provides less oxygen for our muscles to burn fuel and create the power to move us through the water or along the road.
The result is that for a particular rate of perceived exertion (RPE), we will have less oxygen with which to power our muscles. We aren’t able to swim, bike, or run as fast as we are with more oxygen.
The 106° West Triathlon, first (and apparently only) held in 2016, was touted as the ‘Highest Triathlon in the World’ held at an elevation of 9,156 feet (2,791 meters). This race included quarter and half distances of the IRONMAN 140.6.
Let me know in the Comments (below) of any triathlons held at an altitude higher than this one.
Dealing With Altitude: Acclimatization and Adaptation
Two words – acclimatization and adaptation – are used to describe what happens when we travel to a higher altitude.
Acclimatization
Acclimatization refers to the immediate and short term (up to two weeks) changes that occur with altitude.
This process begins immediately upon arriving at the higher altitude. The effect we recognize as breathing harder is called ‘respiratory alkalosis’.
Within a day, the hemoglobin concentration increases. We do not have more red blood cells at this point. However, the liquid component of our blood, the plasma, decreases to normalize the oxygen content in our blood. Lower oxygen content divided by lower plasma volume equals normal oxygen concentration (but not volume) in the blood.
Acclimatization continues over about two to three weeks.
Adaptation
Adaptation describes the longer-term effects, ones that take place over several months.
With extended time at altitude, our body will produce additional red blood cells through the production of the erythropoietin (EPO) hormone. Increasing the number of red blood cells increases the amount of oxygen available to our muscles and other organs.
It takes months, typically eight months according to what I have read, for the body to produce all the additional red blood cells and for adaptation to be complete.
‘Sleep High, Train Low’
There is evidence that the ideal adaptation comes from sleeping at high altitude (between 6,600 and 8,200 feet, which is equal to 2,000 and 2,500 meters) and training at or near sea level.
Sleeping high leads to an increase in hemoglobin. Training low allows for more intense training to increase the key parameter for endurance, VO2max.
How Does Age Affect These Changes?
As seniors in the multi-sport community, we know that age changes the way we train compared with our younger competitors. But, does altitude give us an advantage or create a disadvantage on race day?
Altitude may be one of the few factors that are on our side. According to a report titled Effect of High-Altitude Exposure in the Elderly, age does not seem to be a factor in adjusting to the higher elevation. According to the authors of this study:
“Fortunately, the elderly appear to acclimatize well and after 5 days of acclimatization were physiologically almost indistinguishable from sea level. Thus, aging does not appear to impair the physiological adaptive response to either acute or chronic hypoxia, even in the presence of substantial comorbidity.”
Racing in a triathlon at a higher altitude can mean experiencing some of the most awe-inspiring places on this planet.
What Can You Do To Prepare For A Triathlon At Higher Altitude?
The audience for this post is beginner and intermediate age group athletes. Therefore, I am assuming you will not invest the time and money for training at an altitude camp for several weeks.
However, even if you do, there is no guarantee of increased performance, according to many coaches and scientists. Some people do not adapt. And, the training must be tailored to the individual for it to have significant benefit. (Continue reading for more information on high altitude training.)
Nevertheless, there are ways you can prepare for a triathlon at a higher altitude.
1. Arrive at the race altitude from 2 to 14 days before the race
In a paper titled “Timing of Arrival and Pre-acclimatization Strategies for the Endurance Athlete Competing at Moderate to High Altitudes”, authors Robert F. Chapman, Abigail S. Laymon, and Benjamin D. Levine (see the complete reference in the quotation below) conclude that arriving at the race altitude 14 days before the event is the most ideal. However, they also acknowledge that this amount of time will not be practical for most, given the cost and other responsibilities related to family and work.
Arriving the night before the competition, on the other hand, is a risky strategy. This is especially true if you suffer from any disruption in sleep, a critical component of acclimatization.
While longer is better, 2 to 14 days before the race at the altitude of the event reduces performance declines. This comes from settling into a consistent pattern of quality sleep and reducing the deleterious physiological effects of altitude, such as a reduction in plasma volume.
Performance decrement at altitude appears to decline with each day of altitude residence (up to ~14 days).
Chapman, Robert F., Abigail S. Laymon, and Benjamin D. Levine, “Timing of Arrival and Pre-acclimatization Strategies for the Endurance Athlete Competing at Moderate to High Altitudes”, High Altitude Medicine & Biology, Volume 14, Number 4, 2013, pp. 319-324.
Hungry Horse Reservoir and Dam near Glacier National Park in northwestern Montana. By the time I competed in the Montana triathlon, I had stayed above 5,000 feet elevation for over two weeks.
2. Pay extra attention to factors that degrade at altitude
This is in line with the previous point, but worth repeating.
First, stay hydrated. Along with lower effective oxygen, higher altitude also means lower relative humidity of the air. Therefore, fluid loss is greater than in higher humidity regions.
Also, the higher altitude may compromise your sleep. According to this TrainingPeaks article, getting sleep during the initial time at higher altitude can be difficult for some. Some people initially suffer from acute mountain sickness (AMS). Symptoms of AMS include headaches, nausea, dizziness, and fatigue.
Give yourself time to become rested.
3. Pace yourself on race day
According to an article in Triathlete magazine, our VO2max decreases by 7.7 percent for every 1,000 meters of altitude. If you are able, go for a swim, bike, or run before the race to get a sense of how the altitude is affecting your performance. Otherwise, plan to go out slower to avoid having your body put the brakes on unexpectedly.
Remember to ease into the altitude and pace yourself as your body becomes acclimatized.
4. Train to offset performance declines that come with altitude
As we just read, our VO2max decreases with altitude even after several days of acclimatization. However, one strategy for mitigating the decline is to increase your VO2max.
In the last weeks before traveling to the higher altitude, perform harder sessions, like hill repeats, at your typical training altitude. These will simulate the feeling of working harder that will accompany racing at higher altitude.
If you want to learn more about the ins and outs of training at high altitude, I recommend listening to this podcast from Fast Talk Labs.
Final Comments
The human body is amazing in its ability to adapt to different environments. However, the comments on various websites and in academic research papers continually remind me we are all different.
Be sure to discuss with your coach or your doctor any plans to race in a triathlon or other multisport endurance event at higher altitude.
What Has Been Your Experience With Racing At Higher Altitude?
Please share in the Comments below what you have learned about training and racing in a triathlon at higher altitude?
