PT on the Net Research

Training Endurance Athletes

Training endurance athletes can be a goldmine for personal trainers and strength coaches, if you can understand their mentality. The truth is endurance athletes have a lot of qualities that make them desirable clients. They are generally motivated, in need of help and often affluent. In fact, triathletes, runners and rowers far outnumber team sport athletes in the adult population.

The first question you need to ask yourself in order to understand the endurance athlete is, “Why is my client an endurance athlete?” The answer generally comes in one of four parts.

  1. Genetic predisposition – He has always been good at endurance activity.
  2. Mental predisposition – He has always been a Type A personality.
  3. Endurance training provides a competitive outlet into adulthood.
  4. A combination of 1, 2 and 3.

You might ask yourself, “Does it matter why my client is an endurance athlete?” It does matter because personality characteristics and genetic predisposition are at first a positive but can rapidly become a negative. High levels of motivation and drive can initially produce great results. However, often they also produce injuries.

In my opinion, endurance training probably isn’t good for you. However, no endurance athlete wants to hear that. This is what they do and they are not about to change because you or I think the risk of injury is too high. So if you can’t change them, you might as well help them!

In order to train the endurance athlete, you need to understand how he thinks. This involves something I have decided to call The Endurance Cycle (illustrated below).

The Endurance Cycle

Train---> Injury---> Rehab/PT---->
Train---> Injury---> Rehab/PT---->
Train---> Injury---> Rehab/PT---->
Train---> Injury---> Rehab/PT---->

The cycle is simple. Train hard until you get hurt. Call your physical therapist (who by now is like a family friend) rest and repeat. This is so prevalent that I have coined another term “The Endurance Conversation.” This is a typical conversation overheard between two endurance athletes.

Endurance Athlete 1: “Are you training or injured?”

Endurance Athlete 2: “Well, I just got over _ _ _ itis, and I’ve being running in the pool.”

To you or I, this may seem like a strange conversation, but between two endurance athletes, this is as common as you or I talking about the weather. Endurance athletes view injury as a reasonable expectation and are not surprised when it happens. In fact, my theory is that the entire physical therapy profession owes a great debt to the early aerobic proponents of the 70s. As a kid growing up and playing sports, I had never heard of a physical therapist. Physical therapists were put on the map by endurance athletes and their conditions ending in “itis.” Endurance athletes fueled the physical therapy boom, and today they continue to be some of physical therapists’ best patients.

Another thing that has become very common in the endurance world is the revolving door of what I like to call, “The Injury Progression” (illustrated below).

The Injury Progression- The Three Is

Ingestion - Oral anti-inflammatories (no change in training)
Injection - Anti-inflammatories like cortisone (no change in training)
Incision - Surgery, the “let's take a look” conversation (followed by a mandatory long layoff)

I like to call these the three “Is” of endurance athletes because not only are the endurance athletes the PT’s best friend, they may also be the orthopedic surgeons best source of income.

When dealing with endurance athletes, the truth may be hard to say and even harder for them to hear. The truth is that all non-traumatic injuries are training related. All “itises” are overuse. If you didn’t fall off something or get hit by something, you did something wrong in training. Again, talk to an endurance athlete, and rarely will he admit he just plain did too much too soon. Instead, he will blame his shoes or some other inanimate object.

Helping the Endurance Athlete - Pain Site vs Pain Source

The way our medical system is structured makes dealing with overuse injuries very difficult. Most doctors are trained in what I would call the “trauma model.” They are used to repairing a dislocated shoulder or reconstructing a damaged knee. Injuries like these are generally the result of an outside trauma applied to the joint. With the endurance athlete, the pain develops over time, often as a result of a problem far removed from the site of the pain. Our current sports medicine system is still attempting to apply the trauma model to the overuse injury, with limited success. The solution for most endurance athletes is usually far removed from the point of pain. Poor glute function can make the front of the hip hurt. Foot and ankle problems can cause knee, back and hip problems. In the trauma model, we use the three Is to attack the pain site. This results in lots of preventable knee, hip and back surgeries. With endurance athletes, you need to understand that pain is often felt at the attachment points like the patella tendon and Achilles tendon, but the stress may be coming from somewhere else. We illustrate this for our athletes with a simple band example. Place a long elastic band around the athlete’s neck and pull gently. Ask the athlete what he feels. What he feels will be pressure on the back of the neck. Now simply release the band. Voila! The pain is gone. A pain in the neck disappears by letting go of a band being pulled from in front of the face. What does this tell us? This example shows why we should treat the pain source versus the pain site. The big key in training an endurance athlete is to figure where the pain is coming from. Where it hurts is obvious, but if they did not get hit, chances are the pain site and the pain source are separated by at least a foot’s distance.

Reality Therapy

Reality therapy for an endurance athlete is tough but necessary. The first thing I tell an injured endurance athlete it that the question, “Does it hurt?” has a yes/no answer. Any answer other than no is a yes. Statements like, “It loosens up after a while,” “Not if I warm up properly," “Only at the end of my run/bike/swim” are all yes answers and indications that something is wrong. It is amazing how many “speed limpers” I see as I drive. You know the ones I mean. The speed limper has a knee brace on, an altered gait and is limping down the road. This is another Type A on the road to surgery. You will never get better if you run (or bike or swim) with pain. This is the reality therapy so necessary with endurance athletes. If it hurts, don’t do it. The truth is you will never change an endurance athlete’s personality, but you may be able to change the way he trains.

Time and Money

A very wise man once told me that you are going to spend time and money on your health. What endurance athletes need to understand is that it’s up to them to decide how and when. An endurance athlete can pay for a strength coach or personal trainer to help him develop a training program, or he can pay for physical therapy after the injury. He can take a small layoff before something becomes a major issue, or he can take six weeks off after surgery. Healthy or hurt, the athlete gets to decide. As the old saying goes, “There is no such thing as a free lunch.” Speed limping eventually is done at a price of both time and money. Another wise man once told me that an athlete who seeks to coach himself has a fool for a client.

Making Changes

If I could make one change in every endurance athlete’s training program, it would be to add more interval training. Endurance athletes love their long, slow, distance work. However, interval training develops aerobic capacity better than aerobic training. I know that doesn’t make sense, but it’s a fact. Research has told us for years that the fastest way to raise VO2 max, the standard measure of aerobic fitness, is through interval training and not conventional aerobic training. In fact, a 2006 study from McMaster University in Canada illustrated this beyond a shadow of a doubt. The study compared 20 minutes of interval training (30 sec sprint/4 min rest) with 90 to 120 minutes in the “target heart rate zone.” The results showed the same improvement in oxygen utilization. If you could get the same benefit from one hour a week, why run four and a half to six hours a week?

The unfortunate truth is that too much steady state work yields too little benefit and too many injuries. If this is the case, then why do endurance athletes continue to do large volumes of steady state work? There are three possible reasons:

  1. They are good at it.
  2. It’s easy to do.
  3. Everyone has always told them they need to “build a base.”

In reality, many endurance athletes avoid interval training because it is much harder. It’s easy to throw on the shoes and do the same run you have done one thousand times before or jump on the bike for the same ride. However, that does not make it the best way to train.

If I could make two more changes, I would get my endurance athletes to buy a foam roller and begin to work on tissue quality. Most endurance athletes’ bodies are a mess of trigger points and other overuse injuries just waiting to happen. Regular soft tissue work followed by regular stretching would be time much better spent than logging more and more miles. The key to understanding foam rolling and stretching is in understanding the qualities of muscle tissue. Muscle tissue does not just get short, it also gets dense. Dense tissue must be manipulated (rolled or massaged) prior to stretching to get maximum effect. In fact, stretching without rolling is like pulling on a knot in a shoelace. It only gets tighter.

The last and maybe the most critical change would be to get our endurance athletes on a strength program. For an endurance athlete, two days a week of well designed strength work can be life changing. The key as a strength coach or personal trainer is to realize that the endurance athlete views strength training like going to the dentist: he does not look forward to it. Keep the program brief and simple. Think about we have called the “Joint by Joint Approach.” Create mobile ankles, hips and thoracic spine through proper mobility work in the pre workout warm up. Work to stabilize the knees and lumbar spine through a proper core and lower body program. Keep strength work specific. Work on single leg exercises primarily. Also, remember lower body lifting is key. Don’t fall into the “running is enough for my lower body” trap. This could not be further from the truth. I would rather see an endurance athlete neglect the upper body than the lower body.

Parting Advice

A word of caution: Even if you agree, change slowly. Add one interval training session a week. Buy a roller. Add some stretching. Start a strength program. Think about time spent versus potential benefit. Don’t work on strengths. Think about volume versus intensity, quantity or quality. The key for an endurance athlete is not in the quantity of what they do but rather in the quality.


  1. Gibala, M Journal of Physiology, “Short Term Sprint Interval Versus Traditional Endurance Training: Similar Initial Adaptations in Human Skeletal Muscle and Exercise Performance Sept 2006, Vol 575 Issue 3. To view full text go to

Previously Published on PTontheNet