How to diagnose and treat overtraining syndrome

This article will help you to identify the signs of overtraining and provides some practical advice on how to treat as well as avoid overtraining syndrome.

“Stress and adaptation” – My boyfriend’s favourite mantra when he parks himself on the couch (beer in hand) after a Saturday morning training session. Granted, his main aim is to get out of doing the household tasks and beer may not be the best recovery drink, but he makes a very important point. To take full advantage of a training session one has to allow an adequate period of time for the body to recover and rebuild stronger. In fact, you should view rest or recovery days as an extension of your training days, since the positive gains from training are only realised during these periods.

It is so easy to get carried away when training for a big event and I see the following scenario so often, especially with novice athletes. They download a training programme or even find themselves a coach. They complete every training session to the minute, they can feel themselves getting stronger and fitter and they feel EPIC... This is when they enter the danger zone. The training high they are experiencing often make them push too hard during easy days and they ignore niggles and other signs that their bodies are struggling with the load. Inevitably this leads to injury or decreased performance and overtraining.

Part of the problem is that no one can predict how your body will cope with training demands. The number of years you have been training, your own genetics and your normal lifestyle can all impact on how your body copes with training. That is why a beginner’s programme that works for one person may lead to injury and overtraining for the next.

Inexperience may be the most common driver for overtraining that I see in my practice, but this may just be due to the population I work with. It has been reported that 60% of elite female and 64% of elite male athletes experience at least one episode of overtraining syndrome during their careers. The most likely cause in their case may be the constant pressure to perform at their best.

The literature makes a distinction between overreaching and overtraining. Both conditions occur due to an accumulation of training and/or non-training stress, which results in a long-term decrement in performance. In the case of overreaching this can last a few days or weeks but if you have ignored the signs you may find yourself with full blown overtraining syndrome, which can take months to recover from.

It is generally accepted in the literature that the main cause for overtraining syndrome is excessive training stress (volume, intensity, competition, inadequate recovery, environment e.g. heat), but it has been shown that other sources of stress can also play a significant role e.g. work or school demands, money hassles, pressure from parents or coaches and loss of sleep.

This is because, when you exercise, the body produces some of the same hormones that you produce in reaction to normal life stresses. In the short term these hormones help to bring about the positive effects of training e.g. strength and speed gains, but if their levels remain too high over a long period of time they wear the body out. This is also the reason why some of the signs and symptoms experienced by people suffering from psychological burnout also manifests in athletes suffering from overtraining syndrome.

Perfectionism is a personally trait that may further predispose an athlete to this condition due to the high standards they set themselves.

Signs of overtraining

The most obvious sign that you may be overreaching or overtraining is if you consistently underperform in training sessions and races. More subtle signs include constant physical exhaustion, mental exhaustion, mood disturbances and sleep disturbances.

There are a myriad of other conditions that can cause the same symptoms and the diagnosis of overtraining syndrome should only be made once all other possible causes have been excluded e.g. anaemia, glandular fever, diabetes, thyroid dysfunctions, viral infections or inadequate energy intake (not eating enough).

Several researchers have tried to develop psychological scales to monitor and identify athletes that may be over trained. The most widely researched are the Training-Distress-Scale (see picture below) and Recovery Stress Questionnaire for Athletes.

A relative new tool that measures psychomotor speed is showing some potential in the early detection of overreaching and may therefore be able to prevent overtraining. The test measures reaction and attention, since it has been shown that central fatigue is an early manifestation of overreaching.

Overtraining syndrome treatment

• Consult your GP and have some blood tests done to rule out any other diseases or deficiencies.

• Rest. If you have just temporarily overreached, you may be able to recover through just reducing the training load. If, however, you have ignored the signs for too long you will have to have complete rest in order to recover. Do sport for fun for a while and cross train.

• Check your nutrition. Make sure you are getting enough nutrients and energy in through your diet. Inadequate energy intake has been shown to affect mood negatively and a recent review of the literature has found that athletes tend to have sub-optimal levels of Vitamin D which can lead to a drop in performance.

• Sleep. This is the time the body uses to rebuild itself and you should be getting between 7 and 9 hours of sleep a night.

• Resumption of training should be individualised on the basis of signs and symptoms as there is no definitive indicator of recovery.

How to avoid overtraining syndrome

• Keep accurate records of training and race performances. Be willing to take rest days and decrease training intensity if your performance declines or you experience excessive fatigue. It may help to use the Borg Scale of perceived exertion (picture below) to gauge the intensity of a session.

• Honour rest days.

• Avoid monotony of training.

• Ensure adequate hydration, nutrition and sleep.

• Identify other stressors in your life e.g. work or relationships and try to gauge its effect on your overall state. I use a very simple Stress Assessment Tool (see above), used for performance profiling, to assess the magnitude of different stressors.

• It may help to regularly complete some form of psychological evaluation e.g. the Training-Distress-Scale (see below) to identify changes in mood. Also, take note if your partner complains that you are turning into a grumpy old git. I find that partners are very good at detecting mood swing. :)

• Allow yourself time to recover after illness or injury.

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. You can read more about her here.

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References:

1. Gustafsson, H., Kenttä, G., & Hassmén, P. (2011). Athlete burnout: an integrated model and future research directions. International Review of Sport and Exercise Psychology, 4(1), 3-24.

2. Meeusen, R., Duclos, M., Foster, C., Fry, A., Gleeson, M., Nieman, D., et al. (2012). Prevention, diagnosis and treatment of the overtraining syndrome: Joint consensus statement of the European College of Sport Science (ECSS) and the American College of Sports Medicine (ACSM). European Journal of Sport Science, 13(1), 1-24.