Injury Prevention for Triathlon & Ironman Training

Team M:X member Mike James is a multiple Ironman, Double Ironman and Triple Ironman finisher who has competed and treated novice to elite athletes worldwide. Widely known as ‘The Endurance Physio’, he specialises in teaching athletes, coaches and therapists involved in endurance sports to optimise performance, reduce injury risk and maximise rehabilitation.


The growth of triathlon over the last 20-40 years has been quite remarkable. Worldwide, on a seemingly daily basis, races and events continue to expand, training and technological information constantly allow athletes to learn more about the sport and athletes – new and old, of all abilities – hit the pools, lakes, roads and paths, determined to achieve the next race finish, personal best or goal.

In a sport laden with personal challenges and hurdles, the once almost mythical Ironman (IM) Distance remains the ultimate challenge for many. Whether winning world championships or merely crossing the line and collecting the fabled ‘M Dot’, the 2.4-mile swim, 112-mile bike and 26.2 mile run race is the pinnacle of many athletes’ journeys.

The sheer nature and demands of the event (all triathlon events in fact!) contribute to a high incidence of injury. A 2013 study of 174 long-distance triathletes over a 26-week period found that overuse injury was the prevalent injury amongst iron-distance triathletes. The average prevalence of overuse problem was 56% at any time, with a substantial problem incidence of 20%. The most prevalent sites were the knee (25%), lower leg (23%) and lower back (23%). The acute injury incidence was 0.97 per 1000 hours of training, and 1.02 per 1000 hours of competition.

So, how can we prevent, or more accurately perhaps, reduce the risk of encountering such problems and maximising our chances of getting to the start line and performing to the best of our abilities? These are The Endurance Physio’s top tips:

Goal Setting

This should be the first thing any IM or budding IM does. Ask yourself, what do I want to achieve? Are you aiming to simply get through the 140.6 miles and cross the finish line? Are you aiming for a specific time and/or PB? Some people are primarily entering the race to raise money/awareness for a charity. Before any plans can be formulated, you must understand what it is you are planning for. Every aspect of the coming 4-12 months will be determined by your goals. Duration, intensity, frequency of training, location, climate and course profile of the race may all be driven by timescales and events to do with your goal.

Take home messages:

1) Train wisely – increase the load on the body gradually. Factor in enough recovery – this is where we improve! Quality trumps quantity every time.

2) Get strong and stay strong! It can help performance and possibly injury.

3) Plan everything – the 5 P’s (Prior Planning Prevents Poor Performance!).

4) Be consistent, but flexible – anyone who achieved anything remarkable did it through consistency. Be the bamboo! Be committed and stick to your regime/plans. Always be prepared to bend a little if needed but get back on the plan as soon as possible.

And remember – whatever your goal, whatever your level, however many IM you have completed – enjoy it. It’s fun!


Fluid requirements during exercise in the winter months

We are all aware of our fluid losses during exercise on hot summer days. We often experience sweat dripping from our skin surface, feeling hot, or are even aware of sweat evaporating (leaving salty skin or salty patches on our clothing). This evaporation is what effectively contributes to removing heat from our body allowing us to continue exercising without our body core temperature rising too high. However, we may be less aware of our fluid losses during exercise when it comes to exercising in the winter months. Part of the reason for this reduced awareness is that in cooler environments we are better able to regulate our body temperature (due to less heat stress). So, we sweat less at lower air temperatures. When we sweat less we are not as aware of our losses, although we are still losing fluid through evaporative sweat losses as well as losses of water vapour through our breathing.

Sweat losses

The image below shows sweat rate data when wearing shorts and T-shirt during moderate intensity exercise conducted in different environmental temperatures. It highlights the typical sweat rate response in a group of male recreationally active individuals. We can see that as ambient temperature rises there is also a rise in the sweat rate per hour (no surprises there), but it should be noted that even at cold (4°C) and cool (11°C) ambient temperatures sweat rate can be in the region of 0.5 to 0.6 Litres per hour. These values in the cold (4°C) and cool (11°C) conditions will be higher if more clothing is worn, so with your winter clothing on you could easily reach the sweat rates reported for 21°C or more. It should also be pointed out that these are average data from a group of males. Individuals can have quite different sweat rate responses so it is best to find out your own sweat rate at different temperatures.

Water losses through breathing

Respiratory water losses amount to about 2 to 5 g of water per minute when exercising at a moderate intensity in a dry air environment (equating to 120-300ml per hour). Often in cold damp weather there is greater moisture in the air meaning that respiratory water losses will be lower than this range. However, on clear crisp cold weather days where the air is very dry, respiratory water losses may be nearer the upper end of this range. This water loss of breathing on cold dry days therefore represents a big proportion of total fluid losses when you are sweating less. That is, water loss from breathing could add 50% to your water losses per hour (600ml/h sweat loss plus 300ml respiratory water loss). Therefore, over several hours of outdoor exercise in a cold dry environment respiratory water loss, on top of your sweat loss, means that your total fluid requirements may be greater than you think!

What about sex differences?

Now, you would be right to point out that the observations above were gathered on males and there might be a difference when considering female fluid replacement requirements. Indeed, the majority of research conducted into sweating rates and respiratory water losses has been done on men. However, studies examining women typically report lower whole body sweat rates on average, with women also able to control body core temperature rises equally as well as men. Therefore, this is typically interpreted as women being more efficient at sweating than men. This translates into overall less fluid requirement for exercising women, but again fluid losses / sweat rates should be assessed on an individual basis.

How do I estimate my sweat rate during winter training?

The easiest thing to do to estimate your sweat rate is to weigh yourself in your underwear (or ideally with no clothes on) before and after your exercise sessions. If you also measure how much fluid you have ingested between each weighing time point then you can correct your mass loss to estimate sweat rate and respiratory water losses. For example, if you weighed 68.3kg before going out on your winter bike for 2 hours, you consumed 700ml of fluid from your drinks bottle over that time period, and weighed in at 67.6kg after exercise, then your total water loss (sweat loss plus respiratory water loss) per hour would be: 0.7 Litres per hour

The calculation is: 68.3kg weight before, + 0.7 kg ingested = 69kg. Then subtract weight after exercise (67.6kg) which leaves 1.4kg lost over 2 hours of exercise. Thus, estimated fluid loss is 0.7 L per hour.

You should note that if any urine is passed during the period of time between weighing yourself, this will alter the calculation. In laboratory studies we collect all urine so that the volume can be factored into the estimation of total fluid losses.


Galloway and Maughan (1997) Effects of ambient temperature on the capacity to perform prolonged cycle exercise in man. Med Sci Sports Exerc. 29(9):1240-1249.

Mitchell, Nadel and Stolwijk (1972) Respiratory weight losses during exercise. J Appl Physiol. 32:474-476.

Wickham, McCarthy, Spriet and Cheung (2021) Sex differences in the physiological responses to exercise-induced dehydration: consequences and mechanisms. J Appl Physiol. 131: 504–510

Rodriguez-Giustiniani, Rodriguez-Sanchez and Galloway (2021) Fluid and electrolyte balance considerations for female athletes. Eur J Sort Sci. Jun 17;1-12. doi: 10.1080/17461391.2021.1939428.

Meadows Marathon is back and in-person!

After going virtual for the 2021 event, Meadows Marathon is returning to Edinburgh on Sunday 6th March – and we can’t wait to see you there! M:X has sponsored the student-led fundraising event since 2020, when we gave out our very first samples of Performance M:X Concentrate to runners. This year, we’ll be back on the course to give a refreshing boost to everyone taking on the 5k, 10k, Half Marathon, Full Marathon and Relay races, as well as showcasing our innovative Dual Hydration System.

Co-hosted by Edinburgh RAG and Edinburgh Napier Events Society, Meadows Marathon is a charitable initiative which sees thousands of pounds raised for various causes each year. In addition to supporting the event’s local, national and international charity partners (this year Health in Mind, Rock Trust, and Mercy in Action), all runners are given sponsorship pages to raise funds for their own chosen charities. To top it off, we’ll be donating a special prize to this year’s top fundraiser and all runners will receive a promotion code for use on our website, with freebies up for grabs and a 20% donation of the order value donated to charity. Sound like fun? Find out more and register here

Don’t feel like running but want to be part of the action? You can register to volunteer at the event or make a donation. Don’t forget to join the Facebook event and follow Meadows Marathon’s social below to keep up to date. 

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M:X is a proud sponsor of Meadows Marathon 2021 and we’re very excited to be entering a team to take part in the virtual Half Marathon on the weekend of 20th/21st March. Each of our runners have chosen a charity to support, and you can find out more about each below. You can sponsor our team or individual runners here – any contribution is hugely appreciated!


Katie Wright (@Run_KatieKitten_Run)

Team GB AG Aquathlon Athlete Katie Wright has chosen to support the Royal National Lifeboat Institution (RNLI), the charity that saves lives at sea.


Mike James (@The_Endurance_Physio

Endurance athlete Mike James  – AKA The Endurance Physio – is fundraising for Edinburgh RAG’s partner charities, Saheliya, When You Wish Upon A Star and The Rainforest Trust.


Sarah Booker (@Mia79GBR_)

Team GB AG Triathlon Athlete Sarah Booker is supporting the Birmingham Crisis Centre, which provides a safe haven for female victims of domestic abuse.


Andrew Davidson

M:X Founder Andrew has chosen to fundraise for Maggies, a charity providing free cancer support and information in centres across the UK.


Cameron Hughes

M:X Marketing Manager is fundraising for Finding Your Feet, which supports families affected by amputation or limb absence.


Any donations to any of our chosen charities are hugely appreciated and will go a long way to help people who need it most. You can also show your support online and keep up to date by following us at @MixHydration on Facebook, Instagram and Twitter.

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