What is overtraining syndrome?

Illustration by Oliver Burston

Whether recent converts or veterans with sacks of finisher’s medals, we expect our training miles to be rewarded with improvement in both how we run and how we feel. But what if those miles don’t deliver? Maybe lately your body has become the in vogue destination for every illness and infection around. Or you can’t shake injuries and niggles, or you’re exhausted by day but can’t sleep at night. And that PB you’ve been chasing is slipping ever further into the distance.

Overtraining, unexplained underperformance, burnout, call it what you will, it’s the athletic equivalent of chronic fatigue syndrome. And while you may think it’s only a concern for elites or ultra-junkies clocking three-figure weekly mileage, you are not immune to it.

Training seriously without paying proper attention to nutrition, sleep and recovery, and failing to factor in the demands of a busy, stressful life outside running could be setting you up for burnout. ‘What we’re seeing is a ‘professionalisation’ of the amateur athlete – a rise in intensity, volume and seriousness – but without removing the life stressors non-pros experience,’ says Greg Whyte, former Olympian and Professor in Applied Sport and Exercise Science at Liverpool John Moores University. This can cause problems, he says, when there are jobs, mortgages/rent and family commitments to be considered. ‘Amateur athletes’ responsibilities mean the external stresses they’re under can be far greater than an elite athlete, who can focus completely on their sport.’

This echoes a growing view among experts looking more holistically at overtraining – that it’s not simply training too much that’s the problem, it’s too much of everything else around it. And the cruel twist is that many runners interpret the symptoms as meaning they need to train harder rather than take a break, locking them into a vicious circle that exacerbates the problem.

First, some terminology: ‘There are several different terms used to cover this condition,’ says Charles Pedlar, a sport scientist at St Mary’s University, Twickenham. ‘Overtraining syndrome [OTS] is the most mainstream, although you’ll also hear unexplained underperformance syndrome.’ We’ll stick with OTS, but the terms are recognised as being fairly interchangeable.

Although OTS has been getting more attention recently, it’s not a new concept. The earliest known scientific reference was made in 1909 by athlete and researcher Robert Tait McKenzie in his book Exercise in Education and Medicine. He wrote of an acute exhaustion and ‘slow poisoning of the nervous system that could last weeks or even months’.

Tim Noakes, the world-renowned University of Cape Town exercise scientist, covered the condition in detail in his seminal book The Lore of Running. First published in 1985, it’s one of the few books to recognise OTS and also points to the fundamental flaw in many people’s approach to training. Noakes writes: ‘We believe that the harder we train, the faster we will run, and ignore the evidence that this is blatantly untrue. We train harder and run worse, and then, in the ultimate act of stupidity, we interpret our poor races as an indication that we have undertrained.’

Noakes’ point goes to the heart of the issue – the question of recognising where the natural, beneficial training cycle of stress, recovery, adaptation and improvement ends, and overtraining begins. ‘There is a very big difference between OTS and overreaching,’ says Whyte. ‘The latter is what we’re trying to do in training: stress the system to cause adaptation. As soon as we remove the stress we get super-compensation and an athlete starts to move well.’

Get it right and a gradual increase in training load will achieve results, but these incrementally harder weeks should be followed by intervals of rest, the strategic downtime to counter soreness and fatigue and give your body the chance to adapt. It’s when the body never gets that rest that OTS rears its very ugly head.

READ: Warning signs of overtraining syndrome

If you’re concerned about OTS, first try to reset yourself. ‘Two weeks off is a standard recovery period before OTS can be diagnosed,’ says Pedlar. ‘A lot of athletes don’t want to hear that, especially if they’ve got races coming up, but not doing it could lead to having a whole lot longer off.’

As many of the initial symptoms of OTS mirror the natural effects of a high training load, a diagnosis can’t be made until you’ve taken this period off. It also allows you to check there’s no medical reason behind the performance loss. This is important, as OTS symptoms can mimic diseases such as leukaemia. ‘It’s vital to rule out any possibility of an underlying disease mechanism before we look at OTS,’ says Pedlar.

If there’s nothing medically untoward going on and the two-week recovery period doesn’t bring your performance back to pre-drop-off levels, then what next? How do you tell that you’re suffering something more serious than simple fatigue? ‘It’s very hard to say at what point the symptoms become a clinical issue,’ says Pedlar. ‘Daytime sleepiness and lethargy, weight loss and constant hunger are good indicators, but the key is whether your performance is what you expect it to be based on your condition.’

Other symptoms may include anaemia, chronic dehydration, hormonal imbalances, mysterious pains, loss of appetite, diminished libido, heart arrhythmias and staleness in the legs, but it varies for each individual. ‘It’s fairly heterogeneous in terms of the symptoms people report,’ says Whyte. ‘Repetitive upper respiratory tract infections are another good indicator – getting coughs and colds in repeated cycles of low-grade infections. Also mood disturbances – athletes with OTS experience low vigour, lethargy and anger. Often this manifests as not enjoying something you have previously loved.’

Psychological symptoms may stem from issues with the sympathetic and parasympathetic nervous system. When the body is stressed the sympathetic nervous system kicks in, moving blood around the body and raising the heart rate. The parasympathetic system is the counterbalance, bringing the body back to a state of equilibrium, but in a cycle of excessive stress and inadequate recovery this balance is thrown out of whack. ‘Because your central nervous system influences your brain as well as your physiology, an athlete with OTS might find their mind going into overdrive, affecting sleep and ability to concentrate, as well as mood,’ says Pedlar.

If you are manifesting such symptoms, you may need to seek professional help to confirm the diagnosis. A blood test can find things such as a deficiency in iron or red blood cells. ‘Another area we’ll look into is oxidative stress,’ says

Pedlar. The body is constantly under assault from free radicals, which are produced particularly when exercising. These free radicals damage cells and DNA and an inability to tolerate them is classed as being under oxidative stress.

READ: Running through stress

While your performance is a litmus test for spotting OTS, when it comes to identifying and addressing the underlying causes, it’s important to widen your focus. ‘To improve, a runner needs to train hard, but also consider how they eat, sleep and recover,’ says Whyte. ‘All those things are considered when chasing improvement, but when things start to go wrong the focus tends to be on one factor: training load.’

And while an imbalance between training load and recovery may be the primary cause, the complex, multifaceted nature of OTS means many other factors need to be considered. ‘We like to assume that athletic performance is all about the physical, but it’s not,’ says Whyte. ‘When I see OTS in runners, invariably it’s not just their training volume that’s the problem, it’s the other stressors in their life that make training volume a problem.’

We can handle the stress caused by upping the volume/intensity of training if we are able to recover. But stress can come from multiple areas. Aside from the physiological stress of training, there are a host of psychological and sociological stresses, and many experts now believe that total recovery needs to take all of them into account.

The impact of this kind of non-physiological stress can also be observed in elite runners. ‘I find there’s often a rise in OTS in athletes before major championships,’ say Whyte. ‘Not because there’s an increase in training load, but because of the psychological stress of competing.’ And though we non-elites may not be packing for Rio, we have more to worry about than races in the diary. ‘For your average runner stress can come from money worries, exams, relationships, work – and these stresses need to be dealt with as much as the physical ones,’ says Whyte.

Start by taking a life inventory, looking at all the external forces around your training and assessing them as you would your training itself. ‘We take a very broad view of the athlete’s life outside of training,’ says Whyte. ‘We look at what’s going on psychologically and the sociological pressures they’re under, and in doing so we identify potential problem areas and source solutions to address the imbalance.’

READ: How to cope with overtraining and loss of motivation

Elite or amateur, expert opinion is shifting to see OTS as a bigger, more prevalent issue than previously thought. Historically, probably the most famous case is that of Alberto Salazar, whose three consecutive victories in the NYC Marathon in the 1980s were followed by a decade of underperformance and disappointment despite – or more likely because of – his infamously hard training regime. By the time he retired in 1998 he was barely able to run for 30 minutes. Though Salazar has been viewed as an anomaly, Whyte believes this is not the case.

‘Over 60 per cent of endurance athletes will be affected at some time in their career,’ says Whyte. ‘It’s been rife in elite sport ever since I’ve been involved, which is almost three decades.’ He suggests OTS has affected many of the UK’s highest profile endurance athletes, including Paula Radcliffe and Jo Pavey.

That OTS has also reared its head recently in ultra athletes may be the result of ultra-distance running morphing from a niche countercultural scene into a professional sport. Cash prizes, sponsorship deals and intense competition are pushing athletes harder, but there’s still little infrastructure to support them. Most top ultra runners oversee their own training and many juggle life commitments and stresses around their training and racing.

In those respects, they are more similar to recreational runners, especially those of us driving the rapidly increasing popularity of ultra-running events. Interestingly, a quarter of those tackling their first ultra event do so after less than three years of serious regular running and it seems more and more are doing so with even less experience. Simply going too far, too soon seems like the most straightforward recipe for OTS, but there have recently been several cases of elite ultra runners suffering from a dramatic decline in performance – athletes such as Anna Frost, Anton Krupicka and Geoff Roes, all of whom have struggled to repeat their greatest performances in events such as the

Leadville 100 and the Western States 100. These are people who are used to crazy mileages, their long-honed physiology mirroring the psychological strength required to train for and complete these events. However, that psychological ‘strength’ may also be the problem at the heart of OTS.

Whether it’s finishing a 100-mile event or beating a 10K PB, your fierce determination is both what gets you through and also what may push you into the OTS danger zone. Echoing Noakes’ ‘ultimate act of stupidity’, Whyte sums up the mindset as follows: ‘If a little is good, then a lot must be better, and if a lot isn’t better that means I have to do even more to make it so.’ This is the vicious circle mentioned earlier and it pays to know if it’s a way of thinking you – like many runners – are prone to.

READ: How to recover from overtraining syndrome

To that end, experienced coaches look for certain characteristics to alert them to a predisposition for OTS. ‘There are those who do things to the letter, as they tend not to listen to their bodies,’ says Pedlar. ‘They may need to take a day off or go easy on a session but their perfectionist approach means the desire to stick to their programme is greater. And you also see the opposite with reckless athletes, who go hard constantly and are then erratic with their dietary intake. You’ve these two extremes that can lead to OTS from different directions.’

To ensure it’s a road you don’t go down, perhaps the best practical advice is to take a step back and look at not just your running in isolation, but how it fits into the bigger picture of your life. ‘It’s laudable to commit a huge amount to your sport,’ concludes Whyte, ‘but the smart thing to do is to think not just about how you structure your training, but about how you structure your life and ensure your recovery is appropriate.’

Going a little deeper, consider the words of elite ultra runner Anna Frost, winner in 2011 of the North Face Endurance Championships. She says that in order to make a successful comeback from OTS she had to, ‘remember the reasons that running made me happy’. If you can focus on the value of your relationship with the sport and all the myriad ways it adds to your health and happiness, rather than being blinded by the pursuit of a certain time or goal, you’ll be far less likely to run the risk of having too much of a good thing.