Endurance Athletes: How You Can Avoid Injury as You Hit Peak Training

September 13, 2019

By: Dr. Brian Forsythe

Continual, repetitive stress faced by endurance athletes makes injury almost inevitable. The key to disrupting this cycle and preventing injury is to develop a protective routine focused on adequately fueling your body, preparing for and recovering from intense workouts. By incorporating these techniques, you can minimize your risk of injury as you train hard this summer.

Nutrition and hydration

Proper nutrient intake and hydration is key to preventing injury and achieving peak performance. An ideal training diet for endurance athletes is composed largely of carbohydrates and protein, with less than 30 percent coming from fat. This is important, as inadequate intake of carbohydrates and proteins can result in muscle breakdown. In addition, athletes should pay close attention to their body’s fluid balances: each 1 kg lost in water weight should be replaced with 1 L of fluid, as inadequate hydration has been shown to result in compromised blood flow to working muscles. Hydration should begin roughly two hours prior to exercise, continue throughout the workout (6-8 ounces per 15-20 minutes of exercise) and after the workout. Post-exercise nutrition is critical to replenish muscle and liver glycogen stores and facilitate the repair of muscles. Athletes should aim to eat 15-30 minutes after their workouts.


Stretching is an important part of preparing for any workout, as it enhances flexibility and helps to prevent injury. Stretches should be performed prior to warm-ups and following cool-downs. Perform 10 minutes of stretching prior to workouts, hold positions for 30-60 seconds and avoid bouncing. Tailor your stretching regimen to the activity you will be participating in.

Warm-up and cool-down before and after training

Warm-ups are effective means of increasing blood flow to the target muscle groups to prepare them for training, while cool-downs help to prevent the build-up of lactic acid which leads to soreness. The best warm-up and cool-down depends on the specific activity you will be participating in, but should last 10-15 minutes and may include light jogging, cycling or swimming.=

Varying workouts

It is important to avoid overusing one set of muscles, as repetitive stress to a single muscle group is often the source of injuries. Mixing in strength training to your endurance activities is important to reduce muscular fatigue which can predispose to injuries. Strength training should focus on all muscle groups, especially those of the posterior chain (glutes, hamstrings, and lower back) and core.

Progressively increase intensity

One of the keys to preventing injury is gradually increasing training intensity, rather than abruptly increasing the demands on your body. As your muscles tire, other structures, such as your bones, tendons and ligaments begin to take on more stress, placing them at risk for injury. In addition, training beyond your limits often results in detriments in form. Proper technique is crucial to prevent injury. A good rule of thumb is to increase your activity by no more than 10% per week. Doing so will give your body enough time to adapt to the changing stresses and compensate appropriately. Track your progress with smartphone apps or in a journal. You will see your athletic abilities continue to grow, while minimizing risk of injury.

Rest and recover

Physical and mental rest is essential to maintaining peak performance. Athletes should take one day of rest every 7 to 10 days of training. After especially intense training days, focus on giving your body a break by switching up the workout or opting for less-intense training. Ensure adequate sleep (8 to 9.5 hours of sleep each night) to optimize recovery from the prior day and prepare for the day ahead.

The key to avoiding injuries is to develop and follow a robust prevention regimen focused on the elements highlighted above. Listen to your body; avoid pushing it beyond its ability to recover. However, when injuries do occur, it is critical that you seek treatment. Reach out to a physical therapist or sports medicine physician for an evaluation and treatment; ultimately, our goal is to return you to the sport you love quickly.

Dr. Brian Forsythe is an Assistant Professor at Rush University Medical Center in the Department of Orthopaedics, Division of Sports Medicine. He is the Head Orthopedic Officer for the Chicago Fire Soccer Club and team physician for the Chicago White Sox and Chicago Bulls.