All About Overtraining

Dr. Blake Middleton Article Leave a Comment

Dr. Blake Middleton, Board Certified in Family Medicine with a Doctorate of Osteopathy from Oklahoma State University, tells us all about overtraining.With a much needed off-season ahead or already begun for most of us, I thought this would be an ideal first post for me to share as a part of Octane Athletics Training Systems. It is all too common to see “over-trainers” when working with and training endurance athletes. These over-trainers work out at a very high intensity, often accompanied by a high volume and multiple exercise sessions in a single day. It is also quite common that these athletes lack an off-season during the year, scheduling triathlons in warmer months along with marathons in the cooler season, never taking a break from focused training. Does this sound familiar? If so, continue reading.

While high-intensity and high-volume training is not necessarily harmful, weeks to months spent training at this level can lead to inadequate recovery. This works against fitness goals and can be very dangerous to the body. If over-trained for long enough, an athlete can completely crash, become chronically ill and fatigued, have slowing endurance, a lack of drive to train, experience mood swings, depression, anxiety, and irritability, have an inability to sleep or relax, develop a loss of appetite and sex drive, as well as develop menstruation issues in females. Once in this state an athlete can be forced into complete rest anywhere from several weeks, to months, and even years.

I’m sure most of us have heard of and maybe at some point thought we were this over-trainer and experienced the above symptoms of overtraining syndrome. To better figure out overtraining syndrome let’s start with some definitions to define the effects of exercise

Dr. Blake Middleton, Board Certified in Family Medicine with a Doctorate of Osteopathy from Oklahoma State University, tells us all about overtraining.Functional Overreaching: is a good thing athletes and coaches should strive for when designing strength and conditioning programs. This is often done through periodization of training. This type of training produces a temporary decline in performance, “fatigue”. The athlete goes through a workout and they feel fatigued, tired, and creates a temporary state of glycogen depletion. After finishing the workout, the athlete can refuel/recover and feel able to perform again in next 1-2 days. This results in improved/enhanced performance. This is the overall goal of training.

Nonfunctional overreaching: accumulation of training and NONTRAINING STRESS (this is the key) that produces short term decrements in performance or maladaptation that takes several days to weeks (<3 weeks)  to recover. Largest contributor is that so many of us tend to forget the other stressor in life other than stresses from training (metabolic and physiologic). Other stressors include psychosocial (relationships, career/grades, family health, and finances), trauma (injury or illness), and environmental (temperature, humidity, pollution, altitude). All of these are considered non-training stress. All recent journals highlight that we should not neglect/forget about the cumulative stress of this non-sport stress.

Dr. Blake Middleton, Board Certified in Family Medicine with a Doctorate of Osteopathy from Oklahoma State University, tells us all about overtraining.Overtraining Syndrome (OTS): simple definition is accumulation of training with long term decrements in performance. Staleness or burnout after long training period due to accumulation of stress and trauma listed in prior section. Once true OTS is reached, it may take months to years (>3 weeks, sometimes lifelong) to recover fully. This is a very serious diagnosis however it is also a diagnosis of exclusion, meaning you must rule out all other possibilities before concluding OTS as the diagnosis.

Synonyms: overtraining syndrome, staleness, burnout, chronic fatigue, training stress syndrome, adrenal fatigue, failure adaptation, unexplained under recovery syndrome (used in UK to take blame of coaches)

So, let’s summarize these definitions. If performance continues to increase and gains continue to be made then this is a state of functional overreaching. Athletes need to watch for a decline, or more commonly plateau, in performance along with the new onset of injuries or illness. At this point the athlete is likely teetering on the edge of nonfunctional overreaching.

The problem is the moment coaches and athletes start to see a plateau, the 1st thing we want to do as the reflex from is to pick up on the intensity of training. So we often add in some caveat, such as intervals, increasing the intensity, frequency, type, or duration instead of taking a step back and recovering. With this we push ourselves more into the nonfunctional overreaching area and closer to overtraining syndrome.

THIS IS TAKE HOME MESSAGE!!!! Think nonfunctional overreaching early

Still today, there is not a clear consensus on what causes OTS or what is even occurring inside the body of an athlete with OTS. There have been some attempts to better explain it in the following journals:

  • Overtraining syndrome in the athlete: current clinic practice
    • Meta-analysis from European Sports Society
  • Overtraining syndrome: a practical guideAmerican College of Sports Medicine (ACSM) meta-analysis
  • A Review of overtraining syndrome: recognizing the signs and symptoms
    • Athletic Training Journal

In these articles it appears there is debate over at least 7 possible theories of OTS. Each theory has a file full of research but I want to give you the Reader’s Digest version. Understand that not 1 theory is being accepted solely, but that the overall consensus is a combination of the 7 in different doses causes OTS.

  1. Autonomic nervous system imbalance: imbalance between sympathetic (SNS) and parasympathetic (PNS) nervous systems. Also known as parasympathetic overtraining in endurance athletes. You will often see decreases in HRV readings (see future post). The athlete feels sluggish, unable to get going because they cannot activate their SNS. This theory does not account for all symptoms of overtraining syndrome though.
  2. Oxidative stress theory: small doses of oxidative stress is appropriate as it helps regulate cellular repair. But a lot leads to uncontrolled muscle soreness/achiness/fatigue which negatively impacts performance. On a cellular level there is excessive damage to the mitochondria, protein synthesis, and DNA synthesis which creates cycle of more oxidative stress. However, this is not seen as precursor. We only see the cycle in people already with overtraining syndrome. May be what keeps athlete in OTS for months to years because body cannot recover with continual damage. This is related to theory 5 below.
  3. Glycogen depletion: weakest of all 7 theories. Depleted body of glycogen when exercising for long periods and/or at high intensity. Depletion impacts neurotransmitters involved with performance. However, there are plenty of athletes who are not glycogen depleted experiencing OTS and within recent years there are more ketogenic athletes not developing OTS. Alternatively, there are studies showing an increase in recovery time in athletes taking in glycogen during/after exercise.
  4. Central fatigue theory: this explains the mood disturbance, alterations in attitude and motivation, as well as disruption of the sleep/wake cycle. These are very common symptoms with OTS. The theory proposes that the central nervous system is not providing enough drive to recruit muscles. This results from numerous physiologic changes that an athlete goes through when undergoing training cycle including a decrease in tryptophan, decreased BCAA’s, and increased serotonin.
  5. Glutamine disruption: Glutamine plays role in immune function as well as DNA synthesis, acid-base balance, and gluconeogenesis. Low glutamine levels are often found in over-trained athletes. Other contributors of low glutamine include poor nutrition, trauma (emotional or physical), and infection. Low levels of glutamine allow oxidative stress and inflammation in the body to spiral out of control as discussed in theory 2.
  6. Dr. Blake Middleton, Board Certified in Family Medicine with a Doctorate of Osteopathy from Oklahoma State University, tells us all about overtraining.Dysregulation of hypothalamus/hormone response (adrenal fatigue): weaker theory according to research articles but as you know, cortisol, testosterone, and other hormones are regulated by hypothalamus, pituitary, adrenal glands. I actually believe this is a larger component of OTS unlike what the research states. Just an example, decreased ACTH lowers stress capacity, has a negative impact on circadian rhythm creating poor sleep, mood changes, and increased parasympathetic response (not to mention decreased testosterone, insulin, and cortisol levels as well). This is why I recommend lab work in athletes training for endurance events 1-2 times a year to catch any abnormalities early.
  7. Cytokine hypothesis– most evidence behind it and looked at most by scholars/researchers now. This is an accumulation of stress on body then our body kicks into an inflammatory response phase at micro and macro levels. (Again likely from increased oxidative stress and low glutamine). What happens is instead of normal response to inflammation, the body has a maladapted response. Then inflammation becomes AMPLIFIED. This is caused by training at intense levels, for a prolonged time, without rest. The body is stuck with elevated sustained cytokines in the body which interferes with glucose transport, decreases the amount of glycogen the athlete can store in the body, decreases hunger cues (can lead to anorexia), and also decreases tryptophan (increasing levels of depression symptoms).

Again, there is no one theory that accounts for all aspects, but I’m sure you can see the relationship between several of the different theories.

Risks of OTS is positively correlated to skill level, overly ambitious coaches, the lack of an off season, making every race an “A” race, and most importantly the non-straining stresses in life. Remember you need to develop an in- and off-season training plan. Dr. James Andrews, a popular orthopedic surgeon in professional sports, claims that if you train for a specific sport more than 8 months out of the year then you have a 6X greater chance of injury, including OTS.

OTS is often stigmatized as a “toughness” issue, thoughts that the athlete is not mentally strong enough. When in reality, the more difficult thing for most of us Type A personalities is to ignore the social media feed, including what our competition is doing and the workouts we are trying to publicly share, and instead build a plan right for us to perform our best in actual competition.

Athletes are only meant to peak for a few weeks at a time. They are not supposed to be in a high performance state for longer than this, especially not for 8-9 months. This is the reason to listen to your coaches and go through a proper periodization plan without the mentality of always beating your prior workout (Or your social media friend’s recent insane workout which will take them the next 2 weeks to recover from but they had to do in order to increase their comments/likes!!!).

The biggest recommendation for OTS is PREVENTION. This is because once one has OTS the best treatment is REST. During this time it is of most importance to address and lower the stresses outside of training, nutrition, sleep, and recovery.

REST is individualized but what I mean is active rest, involving a significant decrease in intensity. Most of the time it is ok to maintain cardiorespiratory fitness but there should be no competing or competitive mentality about any activity. Research says “rest” must be at least 21 days for OTS and then is individualized thereafter depending on ongoing symptoms.

Again, PREVENTION is KEY: strong periodization, proper recovery including hydration, nutrition and sleep, tapering for competition, adjusting training volume/intensity based on mood and recent performances, resilience coaching. It is important to have frequent assessments on where an athlete is on the “burnout” scale. This might not be because training is too hard but can be from factors outside of training that makes them step over the edge into OTS. You need to monitor for the symptoms previously listed along with other more measurable signs such as heart rate variability, lab values, resting heart rate and blood pressure.

So remember to allow yourself to rest, as the regeneration that occurs during recovery will allow you to see better results from your training and avoid injury, excessive fatigue, and lack of motivation to exercise. Your Octane Athletics Training Systems coach is the best source for giving you the biggest gains while ensuring your health is optimized through training.

To training and health,

Dr. Blake Middleton

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