Overtraining Syndrome

Peter Loescher, MD
Posted May 11th, 2009

A friend recently forwarded a newspaper article to me entitled “Streaking.” Recalling a fad that was popular for a few years in the college town in which I grew up, where streaking meant running naked in large groups through town, I opened the link to see if “streaking” was making a comeback.
Streaking in this article had nothing to do with nudity, but rather was about runners who had not missed a day of running in 10 or more years. The article profiled a 70-year-old physician from Boston, who had just celebrated 30 consecutive years of running at least one mile (his usual run was 10 miles) 365 days of the year. He had run the day of, and the day after, hernia surgery; he had run with pneumonia and bronchitis and influenza; he had run on the days of weddings and funerals for close family members; through summer and winter, rain, sleet, and snow.
As I thought about his story, I was at first impressed by this man’s commitment and resolve, but the more I thought about it, the more I came to feel that pathological compulsion might be a better description of his streak. This man was a physician, and certainly knew better than to run on the day after surgery or with a major respiratory infection. But then I had to admit that his story is just an exaggerated version of so many runners and endurance athletes’ histories. Aren’t we all somewhat compulsive about our workouts? After all, how do you get out the door on the days that you are tired, busy, stressed, and the like, unless you are at least a little bit obsessive about your exercise?
Endurance sports self-select a compulsive membership. I am not talking so much about the 20-minute three-times-a-week treadmill walker who is trying to lose weight and control cholesterol. I am probably talking about you, if you are reading this magazine and are still reading this article—the get-up-before-dawn in below-zero-weather runner, who just has to sneak one in before work… the two-or-three-workout-a-day runner who just has to crack 32 or 31 or 30 or 29 minutes for his next 10K… the athlete who ignores the aching pain in her Achilles tendon, plantar fascia, or knee, and keeps icing, popping ibuprofen, and putting in 70 miles per week to achieve a PR in her next marathon… the student, professional person, or parent who consistently makes personal and professional sacrifices to maintain his or her training schedule… If this is resonating with you, then keep reading.
Overtraining Consequences
Overtraining syndrome (OS) is a real medical condition. Defined most simply as “hard physical training without adequate rest,” OS can lead to prolonged and profound fatigue and decreased athletic performance. Hard workouts push us to our limits and beyond, and break down our bodies. Rest after these workouts allows our bodies to rebuild and grow stronger for our next effort. If we repeatedly stress our bodies with exertion, but without adequate rest intervals, eventually we will begin to disturb our nervous and hormonal systems.
The most common early symptom of overtraining is fatigue. If not corrected with adequate rest, symptoms will progress to include increased resting heart rate and blood pressure, increased sweating, decreased maximal heart rate (which will decrease aerobic performance), chronic muscle pain and fatigue (“heavy” or “dead” legs), decreased immunity and frequent illness (colds, etc…), weight loss, poor sleep, moodiness and irritability, depression, loss of motivation, loss of libido, and poor appetite.
Steps to Recovery
Because there are other medical problems that can present with similar symptoms to those listed above, it is important to be sure that fatigue is not due to conditions such as an under-active thyroid gland, iron deficiency, or other blood problems. Your doctor can rule out these common problems with an examination and some basic blood work. However, there is no blood test that can accurately diagnose overtraining syndrome. If after blood work and evaluation, overtraining syndrome is suspected, then a prescription of complete rest (no exercise) followed by relative rest (allowing light, non-competitive exercise) must be followed. The duration of complete and relative rest, and a timeframe for returning to full training and competition are highly variable, depending on the athlete, the sport, the duration of symptoms, the stressors outside of sport that may be contributing to the condition, and the like.
A coordinated team approach to rehabilitating the athlete suffering from OS is often necessary. If parents and/or coaches are actively involved in creating training programs and competition schedules, then they must understand the nature and potential severity of this problem and the importance of rest and gradual progression back to full activity. Successful recovery depends upon training modification, attention to a healthy diet, sleep patterns, and reduction of overall life stress. Developing a more varied training program, which incorporates ample cross training, periodization and individualization, are important elements of a training program that can help to prevent recurrence of OS.
We all have off days where we don’t feel quite ourselves and our workouts aren’t as crisp or energetic as we would like, but if fatigue, heavy legs, low motivation, and malaise persist for over two weeks, take some time off to rest, and consider seeking help from a knowledgeable coach or sports-oriented health professional. You may put your “streak” in jeopardy, but you may find that your athletic performance and overall health improve dramatically.
Peter Loescher is a board-certified family practitioner and sports medicine physician at the Sharon Health Center in Sharon, VT, an affiliate of Gifford Medical Center. Dr. Loescher completed a residency in family practice at Dartmouth Hitchcock Medical Center and a fellowship in sports medicine at the University of Oklahoma and Eastern Oklahoma Orthopedic Center, Tulsa. He is the sports medicine director at The Cardigan Mountain School and provides medical coverage at many local athletic events, including the Covered Bridges Half Marathon and the Vermont 100 Ultra Marathon. When not at the office, he can be found running, biking, and skiing the byways and trails of northern New England. You can reach him at [email protected].