At some point in an athlete’s career, he or she may experience overtraining syndrome (OTS). Not limited to professional athletes, any person who trains for sport in excess of their own recovery capabilities can become overtrained.

OTS is, in effect, an inability to adequately recover from training stresses and the neuroendocrine (brain and hormone) imbalances that result from this.

Fitness can be thought of as a spectrum; one can become more and more fit with ongoing training that is continually modified. (For example, one may start out running 2 miles with a goal of running a marathon in time).

In order to achieve and maintain increasing fitness, an athlete must continually balance between the principles of progressive overload (gradual increases in training loads) and the principle of adaptation, wherein the body responds to increasing training stresses in a positive manner.

Successful training involves a delicate balance between these two principles; periods of excessive training with inadequate recovery can result in short term performance decreases (soreness, some fatigue) that eventually result in performance improvements after a period of rest and recovery. This is a normal course in training.

Yet, as soon as the balance between training and recovery is lost, overtraining syndrome can result. Overtraining syndrome is a collection of signs and symptoms, rather than one specific entity. That being said, there is no single definitive physiological parameter that defines the syndrome.

Put simply, OTS is the result of excess physical training and inadequate rest and recovery. “Prolonged maladaptation” is a term that has been used to describe the dysregulation of neurochemical, hormonal and overall biological regulatory systems in OTS.

An important aspect of OTS is accompanying mental emotional symptoms as well, and mental emotional stressors including worry, fear, and personal conflicts compound OTS. When excess mental emotional stressors further draw down energy reserves, the body’s attempt at physiological homeostasis is thwarted and compounds the symptoms of OTS. In other words, mental emotional stressors distract the body from achieving physical recovery and balance!

Overtraining Syndrome is a Diagnosis of Exclusion

Prior to diagnosis, other diseases and conditions must be ruled out. Because OTS can involve so many disparate signs and symptoms, the rule out list can be extensive depending on the complaints of the athlete. Some of the most common rule-outs include:

• Hypothyroidism
• Digestive conditions (celiac disease)
• Infections; viral, bacterial and parasitic
• Dietary caloric restriction (negative energy balance)
• Imbalanced macronutrient intake (protein, carbohydrate, fat)
• Mineral deficiencies (iron, magnesium)
• Allergies
• Excessive mental emotional stress
• Mental emotional disorders (anxiety, depression)

Symptoms of Overtraining Syndrome

Symptoms of OTS can be divided into 3 main categories:

Training Symptoms:

• Decreased strength or stamina
• Early fatigue during workouts
• Easy workouts are more challenging
• Higher heart rate with less effort
• Decreased coordination
• Decreased performance on speed, strength or endurance testing

Physical Symptoms:

• Elevated resting heart rate
• Persistent fatigue
• Ongoing soreness, aches and pains
• Loss of appetite
• Overuse injuries
• Frequent colds and GI infections, diarrhea

Non-Physical Symptoms:

• Insomnia, non-restful sleep, waking feeling unrested
• Depression
• Feelings of anger or irritation
• Unable to focus or concentrate at practice or work
• Lack of motivation
• Fear of competition
• Increased sensitivity to emotional stress, unable to tolerate stress

Part of the puzzle of diagnosis also involves investigation of physiological markers (lab testing) including hormones, psychological testing, performance tests, and various biochemical and immune markers can all be employed to elucidate a diagnosis.

All items on the preceding list are not exclusive to a diagnosis of OTS; however they can serve as a checklist to assist in determining if an athlete is suffering from OTS.

The importance of excluding other conditions cannot be overemphasized as part of the process. Once all other possible causes have been ruled out, then specific treatment for OTS should begin. 

We’ll cover the process of selecting which lab studies are important in diagnosing OTS, proper dietary advice and how to treat it in our upcoming blogs.