the resilient triathlete case study answer key

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The Resilient Triathlete

Recovery from a Multi-System Traumatic Injury

By Mary Whitwell

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This case study is an account of the injuries sustained by a triathlete who crashed his bike at 44 mph during the 2017 Lake Placid Ironman triathlon. The case is designed for use as a final project in an undergraduate anatomy and physiology course, with an emphasis on injury and repair. Skeletal, respiratory, cardiovascular, neurological, integumentary, and urinary systems are examined. X-rays and CT scans are included both for illustration purposes and for authenticity. The case is entirely factual, based on the recollections of the subject, John (Butch) Luke, and his family members. While coverage is at a fairly superficial level for any one of the six organ systems covered, the case can easily be expanded to include more detailed analysis. Both anatomical information and functional physiology are addressed. The case is recommended for use at the end of a (preferably) two-semester anatomy and physiology course designed for biomedical students and those in health related fields. It could also be expanded for an upper-level physiology or pathophysiology course.

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• Exhibit full comprehension and usage of correct anatomical terminology.
• Demonstrate knowledge of human anatomy with a focus on the axial skeleton, organs of the thoracic cavity, kidneys, skin, and inner ear.
• Demonstrate knowledge of basic physiological principles concerning fracture repair, ventilation, cardiac function, renal function, and the vestibular apparatus.
• Apply those functional principles of human physiology towards an understanding of injury consequences and healing processes.
• Explain the rationale for numerous treatment modalities based on knowledge of the organ or organ system involved.

Traumatic injury; Ironman; triathlon; Glenoid fracture; rib fracture; hemothorax; pneumothorax; flail chest; recovery; lung collapse; bone healing; otoconia; otolith

Subject Headings

EDUCATIONAL LEVEL

Undergraduate lower division

TOPICAL AREAS

TYPE/METHODS

Teaching Notes & Answer Key

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Teaching notes are intended to help teachers select and adopt a case. They typically include a summary of the case, teaching objectives, information about the intended audience, details about how the case may be taught, and a list of references and resources.

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Mental Training: 3 Strategies for Building Resilience

Written By Adrienne Taren July 27, 2015

It’s not the ability to walk through life unscathed – we’re all human (except, maybe, for Sebastian Kienle), and $#^& happens. You crash your bike. Something crashes into you while you’re on your bike. You’re chased by a moose while you’re on your bike. You get the idea – in triathlon, there are plenty of opportunities for adversity. Particularly while on a bicycle.

Cue dramatic music…it’s all about the journey , right? How many times do we hear triathletes talk about their “journey”? I’m pretty sure it’s right up there with all the “journeys” you hear referenced during an episode of The Bachelor .

But anyways, how you react to the stressors during your journey is a factor of how resilient you are as a human being and as an athlete. Do you bounce back? How quickly and effectively? And, are there mental training practices that can help you bounce like a kangaroo instead of 5 cases of expired Clif bars?

Yes. Yes there are.

Wiring Your Brain for Resilience

Here’s why it works: When you work on the mental skills that build resilience, you activate a specific set of regions in your brain. At first, maybe these neurons aren’t used to talking to each other, so the connections between them are weaker – they’re speaking through two paper cups tied together with a piece of string instead of the latest iPhone. So how do we train a neural circuit to make it more efficient? In short, the more frequently those neurons are firing, the stronger the neural pathway between them will become – neurons that fire together, wire together.

The key here is  repetition . Every time you’re practicing those resilience-building thoughts and behaviors, you’re forcing that circuit to fire, until eventually it becomes automatic – and so do those thoughts and actions.

What brain regions are involved in this circuit? A few cool studies can point us toward the brain areas that may be important. In  a study of fire-fighters , subjects heard either a stressful or relaxing script being read while they were in an fMRI scanner. The more resilient they were, the more activity they had in the right amygdala, insula, and left orbitofrontal cortex when they listened to the stressful stimulus. These are regions involved in emotion regulation and interoception (awareness of your physical state) – suggesting that more resilient folks may be better able to call up the appropriate brain circuitry for emotion regulation when they need it .

In  a second study , resilient Special Forces soldiers completed a monetary reward-anticipation task (exactly what it sounds like – you play a game where you think you’re getting money! Then you do or don’t get a lot of money.) Compared to (less resilient) civilians, the soldiers showed less  of a difference in brain activity in 2 regions– the nucleus accumbens and subgenual prefrontal cortex – between high-reward and no-reward conditions.

So, there also seem to be differences in how more resilient people respond to reward (and presumably, failure). Makes sense, right? If your brain has less of a reaction to not receiving a reward it was expecting, you’re going to psychologically experience that as “getting over it faster.”

How do I make my brain work more like a Special Forces soldier or Firefighter’s brain, so that I can get past my bad race/injury/moose chase sooner?

1. train your response to anxiety, fear, and self-doubt.  .

You can do this by acknowledging these feeling when they arise, and then simultaneously calling up a positive feeling, gratitude, calm, & happiness. In other words, go to your happy place. By doing this repeatedly, you wire a positive emotion into a circuit that was previously bringing up distress and helplessness.

This process of rehearsal and reconsolidation is a key part of how your brain encodes memories, and it occurs in a network of regions distributed across your frontal cortex and hippocampus. This technique works well for athletes who maybe having problems performing following a bad race, slump, or injury.

When negative memories – your bike crash, the marathon you tanked – come to mind, hold on to that memory for a few minutes while you also bring in a positive experience – that race where you excelled, and all the great feelings that came with it. Essentially, you’re rewiring bad to good.

2. Build Optimism and Focus on Strengths.

Corny but true. Remind yourself of what you’re great at. (For the stereotypical triathlete, this shouldn’t be that hard.) If you need an objective reminder of this and/or love taking self-assessment tests online, go fill out the Signature Strengths Questionnaire . Remembering the good things that are a fundamental part of  you  helps you separate feelings that arise from a failure from your overall identity.

3. De-Catastrophize.

Minimize catastrophic thinking by first identifying that “worst-case scenario” you’re afraid of when something goes wrong. Then, think about the actual probability of that worst possible outcome playing out. Consider a broader range of possible outcomes, including the best-case scenario. The simple process of thinking about a great outcome can engender positive emotions and thoughts, and  behaviors  tend to stem from those thoughts. Finally, think about what the  most likely  scenario is.

And to hammer things home one last time: repeat, repeat, repeat. Force those happy neurons to talk to each other over and over, until they’re as tightly coupled together as peanut butter & pickles, Ben Hobbs & Dark Mark, and Andrew Messick & the Women for Tri board. Then when the day comes that you need to drag yourself kicking/screaming/crying out of whatever hole you’ve fallen into, you’ll have one nice big resilient brain circuit there making it that much easier. It’s ok to wallow and hide for a bit, but you don’t want to be the dude that goes down and stays down.

The ability to harness techniques such as these is what can separate the resilient athletes who bounce back from setbacks from the less resilient, whose careers sometimes never recover from a slump. It’s all in your head – literally.

About the Author

Adrienne taren, related articles, 8 reasons why you should turn off the tunes while training, brain training for endurance athletes.

Are You Robust Triathlete?- The Answer is KEY for Your Training.

by Kevin Coady | Jun 5, 2020 | TriForce 101

Here at TriForce we believe your triathlon training plan should be customized factors like:

• your current fitness
• your goal races
• time available to train on weekdays vs. weekends
• your athlete history / level in each of the 3 sports
• your injury history
• and your personal robustness

A canned training plan (or a coach with a one size fits all philosophy) can ignore some of these factors, which can set you up to fail.  Today we’ll talk about robustness.

Are You a Robust Triathlete?

Bouncing back and recovering quickly from stress, training and races.    it’s also about how often you get sick, injured or have extended “bad patches” in your training of fatigue or poor performance..

Your physical robustness (or we might call it resilience)  and your ability to bounce back and recover is a critical factor in setting up your training.   If you or your coach are not customizing around your person level of robustness then you are setting yourself up to fail.    

I used to coach Rob Gray– his legendary resilience and ability to bounce back quickly is the big reason he was Ultraman World Champion.  Coaching Rob quickly taught me that you can’t coach highly robust athletes like a “regular” athlete or they won’t come close to reaching their potential.

Which Category Triathlete Are You: High, Low, or Average Robustness?

While we can improve our robustness by working on our foundation for adaption, (sleep, nutrition, etc) some of us are less resilient than others.   Look back at your training logs.   

Which of the following describes you?

Highly Robust Triathlete

• You are the type of person who usually feels almost completely recovered a week after an Ironman or marathon.
• When you look at your history you see you’ve done plenty of big training and virtually always bounce back pretty quickly and rarely have “bad patches” of lousy training that last more than a few days.
• You usually “get away with” breaking training rules (ramping very quickly, stacking hard days close together, going a bit too hard on easy days, etc.).

Low Robustness Triathlete

• Multiple times through the year you have “bad patches” of training that can last as long as 1-2+ weeks where it feels like you can’t train your way out of a paper bag.
• When training at a solid level you have a tendency to have some big swings of low motivation and low energy.
• You might have a tendency to get sick or injured.
• If you jump into training too soon after a race you might feel OK but find your performance stays poor for awhile.
• once you hit a peak and are kicking ass you often find it doesn’t last long and you “peter out” (vs. high resilience athletes who tend to be able to stay near that peak level for a long time).

Average Robustness

• You are in between the 2 extremes.
• You bounce back from races and hard training in an “average” way. E.g. you probably feel 90% recovered a week after an Ironman 70.3 and 80% recovered 2 weeks after an Ironman.
• You might get a tired patch here and there but 1 or 2 easier days (or a planned recovery week) typically gets you back on track quickly.

We won’t go into details about how to coach and average resilience athlete– that’s just “regular” coaching 🙂

(Self) Coaching for the High Robustness Triathlete

Highly robust athletes are relatively rare.   I’m coaching 2 right now and they have both made BIG gains (Kona qualifying multiple times in one case, and going from middle of the pack to top 10 at Ironman  and 70.3 races in the other case).    I’ll keep this short since coaching high resilience athletes is much less complicated than coaching low resilience athletes.  High resilient athletes are fun to coach because there is a much much wider margin of error.  These athletes can handle more load, more ramp and more challenges in general.   If you train them like a low resilience athletes (or average athletes) you are holding them back.     They can and should do more (and they usually WANT to do more).   Don’t hold this athlete back too much but do channel their energy intelligently.    And don’t get complacent- just because they have gotten away with breaking the rules over and over again in the past (e.g. jumping from 20 mile to 40 miles per week of running with no problems) doesn’t mean that they won’t get hurt this time.  No athlete is invincible.

(Self) Coaching for the Low Robustness Triathlete

Low robustness triathletes can’t be coached the same way as highly resilient triathletes (or we will crash and burn), but we CAN be fast.  I’m a low robustness triathlete (susceptible to extended bad patches in training that will go on until I take a relatively long rest unless I’m very careful), but I’ve qualified for Kona almost every year since 2010 and I’ve won my age group at  a couple of Ironman races.  Pete Jacobs was a notoriously low resilience triathlete for a professional, but he won the Ironman Worlds Championship at Kona.  Coaching  a low robustness triathlete to get super fit (e.g. qualifying for  Ironman Kona World Championship)  is, to paraphrase Joe Friel , “like turning a paper cup inside out without ripping it.   It can be done but you need to be careful!”

TriForce rule #1 is consistency and if we are frequently dealing with bad patches, fatigue, injury or sickness then we can’t stay consistent and get fast.  The name of the game for low resilience athletes is PREVENTING problems (deep fatigue, injury, etc).

Pete Jacobs– hero to low robustness triathletes

A handful of guidelines for low robustness athletes:

• Easy days must be kept easy!   If your training plan or coach tells you to keep your heart rate below a certain level, DO IT!    You might feel like you CAN train harder, but these easy days are a chance for your body (including your endocrine system, which is key for resilience) to bounce back and recharge which will prevent bad patches over time.   Stephen Seiler (the father of “polarized training” theory) says that anything above your aerobic threshold (around 30 beats below your anaerobic threshold) can create much of the same stress response as hard training.  That’s a “moderate” effort, but your body process it as stressful.  A pile of stressful days might not fatigue you over a week or two, but if you keep doing it you are setting yourself up for a CRASH.
• Watch your ramp rate.  Consider periods of “consolidation.”    Low resilience athletes need to be careful with how quickly we ramp.  Don’t break the rules (e.g. 10% volume increase rule in running).   Consider planning periods of stable training and not ramping for several weeks — instead let your body show improvement by doing the same training, but having it feel easier and easier.
• No “hero” sessions.  Be satisfied to keep hard days “in range” and back off if you don’t feel good.   Don’t test yourself or push for bests in training.   Be satisfied to complete the workout in the planned intensity range (or even a bit easier if you are tired).  If you have a tendency to carry fatigue you will have days where your pace and power are relatively low– thats’ fine.   It doesn’t mean you lost fitness– it just means you are fatigued.    Don’t target some of the extreme sessions you might see high resilience athletes doing.  You probably won’t bounce back from a 30x 1k run session.   Save the testing for race day.
• Underload Yourself.   Don’t overload your plan with “quality” sessions.   Workout Spacing is Key.   “Stressful” days need to be spaced out well.   For some low resilience athletes one  intervals type workout + a long workout might be all the “stressful” sessions you can absorb on a regular weekly basis for a sport.  That’s fine, build your week around those sessions and keep the rest of your workouts relaxed and low stress.   If you need to change your plan around it’s better to skip a workout or change it to an easier workout than to stack back to back hard sessions.  Better to schedule a bit less and never have a bad week versus  pushing the limits and suffering a bad patch that might last  a week or two.
• Pay Attention to What Has Caused You Problems in the Past.    Does fast running on the track injure or deeply fatigue you?  Never go back to the track again (it’s overrated).   See what happens if you do your intensity on hills instead.   Do you get fatigued from short hard reps?  Or from high volume?   Does a certain workout smoke you?     For low resilience athletes the name of the game is avoiding bad patches so if something causes problems for you– don’t do it!
• Take Recovery– both Proactive AND as Needed.    Build recovery into your plan.  For example, a pattern I love is a sold weekend of training, followed by keeping the run and bike intensity low on Monday and Tuesday to give the legs a break.   Then we have solid run/bike workouts Wed and Thur followed by an easier legs day on Friday to recover before the weekend. (We schedule harder swims on easy legs days).    That way we build recovery into the week and feel good for our harder workouts.    For most athletes we won’t use “recovery weeks”, but low resilience athletes should consider them (an easy M-F every 3rd to 5th week).  In addition to the planned recovery, be willing to take unplanned recovery if you feel a fatigue patch coming on.  Better to skip one hard workout then to tip into deep fatigue followed by a lousy week or two of training.

Remember– your triathlon training plan should be customized factors your current fitness, goal races, time available to train on weekdays vs. weekends, athlete history and your personal robustness.