Overtraining Syndrome, Part One: An Overview

Stay the CourseHappy September! The year is flying by, and the major spring build-up races have ceded to the summer championship races, the Grand Slam of Ultrarunning, the Ultra-Trail du Mount-Blanc, to name a few. These races then cede to even more “championship” races in the fall and winter.

[Editor’s Note: The article was followed up with Part 2: Treatment and Prevention and Part 3: The Trail Ultrarunning Specifics.]

Between all those races, we’re also sneaking in the occasional circumnavigation, and taking on an FKT or two in our spare time. And, of course, we have train hard to prepare for all these events.

Perhaps you can see where I’m going with this.

Ultrarunning is a pursuit built upon the notion that victory, triumph, and accomplishment is borne through suffering: perseverance of tough times, profound fatigue, blown legs, trashed stomach, and punch-drunk minds. We are rewarded–tangibly, electronically, and pharmacologically–when we endure the distance, the suffering, to the finish.

Those rewards–along with the beauty of scenery and the strength and support of the community–provide ample desire and motivation to participate even more.

If suffering and the overcoming of that suffering are so paramount to the ultrarunning experience (and perhaps, not exceeded by any other “sport” in society), how can one objectively discern between good suffering–physical toughness, character-building, and mind-galvanizing–and bad suffering–that which causes severe physical and/or psychological damage, and which may be irreversible?

Overtraining is a topic familiar to most runners: the notion that there is such a thing as too much of a good thing. For most, the consequences of overtraining are straightforward, often tedious, but infrequently disruptive: overuse injuries to muscles, tendons, joints, and bones; or fatigue and flat performance.

What many runners–and perhaps an even greater proportion of ultra-endurance athletes–fail to realize is that prolonged overtraining can have devastating effects not just to run performance but to one’s basic quality of life, stripping them of the energy and vigor to enjoy daily life.

This is part one of a multi-part series on overtraining: the background, physiology, diagnosis, and treatment; and implications for competitive and recreational ultramarathoners.

Overtraining: Definitions and Background

In their review of current literature titled Overtraining syndrome: a practical guide, Doctors Jeffery Kreher and Jennifer Schwartz (2012) define overtraining as, “a maladapted response to excessive exercise without adequate rest, resulting in perturbations of multiple body systems (neurologic, endocrinologic, immunologic) coupled with mood changes.”

This definition of Overtraining Syndrome (OTS), represents the most severe form of maladapted stress/rest response. They make a distinction between OTS and the less-severe condition of overreaching:

Condition Characteristics Duration Effect
Functional Overreaching (FO) Mild excess in training load, resulting in temporary performance decrease, then improved performance after rest Days to weeks* Positive (“Supercompensation”)
Nonfunctional Overreaching (NFO) Intense training resulting in more prolonged performance decrease; presence of neurological, hormonal, and/or psychological effects Weeks to months* Negative: symptoms, time lost in training, competition
Overtraining Syndrome (OTS) Extreme NFO with >2 months performance decrement, severe symptoms and physiological changes (psychological, neurological, endocrine, immune), as well as other stressors, all unexplained by other diseases. Months to years# Negative: severe symptoms, unable to train, affecting activities of daily living, possible end to athletic career

Adapted from Kreher and Schwartz, 2012

(* even with compete rest)

(# some effects may be irreversible)

True overtraining goes beyond simply running–or engaging in any workout modality–to excess. Critical defining qualities of full-blown OTS include a complete inability to physically exert oneself, multi-system physiological responses, and a failure to respond to even prolonged rest.

Unfortunately, there are still many questions about overreaching and overtraining, including the notion that the progression may not be a continuum; some athletes may jump from FO straight to OTS.

Symptoms of OTS

In his all-things-running book, Lore of Running, Tim Noakes (2003) offers a review of evidence-based signs and symptoms of the OTS continuum.

Emotional:

  • Loss of enthusiasm and drive; apathy, loss of joy in life
  • Loss of joy/thirst for competition; increased desire to quit during competition
  • Lethargy, listlessness, tiredness
  • Increased irritability, anxious, depressed, unable to relax, bored
  • Insomnia, changes in sleep patterns
  • Loss of appetite
  • Loss of libido
  • Poor coordination, general clumsiness
  • Increased fluid intake/thirst (namely in p.m.)

Physical:

  • Impaired physical performance; inability to complete routine training
  • Gradual loss of weight
  • Athlete looks drawn, sallow, dejected; sunken eyes
  • Increase in morning heart rate > 5 beats
  • Abnormal heart rate upon standing, during/after routine training
  • Slower recovery in heart rate after exertion
  • Postural hypotension
  • Persistent, progressive muscle soreness
  • Swelling of lymph glands
  • Gastrointestinal disturbances (with, without exertion)
  • Increased susceptibility to infection, allergies, headache, injury
  • Decreased tissue healing (minor scratches)
  • Loss of menstruation
  • Neurological, endocrine insufficiency

Incidence of OTS

While true, diagnosable OTS may be rare (at least in its recognition; it is often misdiagnosed as another disease process), incidence of overreaching, especially amongst runners, is high. One study of distance runners found a NFO lifetime prevalence of nearly 60% in elite male and female runners, and 33% in non-elite female runners (Morgen et al, 1987). Anecdotal evidence, especially within the ultramarathon community, might suggest similar incidences.

Causes of Overtraining

Much research has been conducted into the pathophysiology of OTS: what, exactly, is occurring in various systems to cause it and what perpetuates symptoms, despite periods of prolonged rest. Theories include inadequate muscle energy stores, excess tissue oxidation, and metabolic stresses to nerve and glandular tissue. One leading theory is that systemic inflammation from chronic training excess drives the adverse effects seen with multiple body systems.

Looking at the big picture, OTS and its continuum of conditions is caused by two primary factors:

  • excess training load
  • inadequate rest

However, there is a third factor that seems to be present in the most severe, persistent cases of OTS: additional physical or psychological stressors. Kreher and Schwartz point out that, in cases of OTS, other stress factors are present.

Lower-intensity but repetitive factors:

  • training monotony
  • sleep disturbances
  • altitude exposure
  • life stresses (work, family, relationships)

Lower-frequency, but higher-intensity stress factors:

  • repetitive competitions
  • significant illness
  • heat-injury episodes
  • severe “bonk”

Indeed, it is the addition of another dimension of physiological stress–coupled with an unremitting training load and lack of rest–that most commonly causes the continuum of overtraining syndromes.

Diagnosis of OTS

In order to be diagnosed with OTS, three criteria must be met:

  1. Decreased performance “despite weeks or months of recovery”. This is a critical component of diagnosis of true OTS (versus FO or NFO). A distinguishing factor of OTS–versus other organic disease processes–is that the runner often demonstrates the ability to start a training session, but is unable to finish it.
  2. Disturbances in mood. Pervasive mood changes–both in and out of training–are present, usually coupled with the high workload and other life stressors.
  3. Lack of signs/symptoms of other conditions or disease processes.

It is important for athletes and health-care practitioners alike to rule out other disease processes, including asthma or other lung sensitivities, thyroid or adrenal dysfunctions, diabetes, iron deficiency, infections, and malnutrition.

But the fact of the matter is, when a runner is suffering from an OTS condition, he or she is frequently in denial that simply excessive training (or life) stress coupled with inadequate rest could cause their symptoms. Therefore, they (as many runners do) are apt to consider more sinister disease processes before conceding to OTS.

When symptoms matching OTS present themselves, the single most important first step is to stop running. Period. Only then can an accurate diagnosis be made; and even then, it may take a period of weeks or months of rest for symptoms to abate.

Testing for OTS

Comprehensive blood and metabolic testing may be helpful in ruling out metabolic and/or cardiovascular diseases, especially if the runner is new to the sport or is in the masters-plus age range (>40 years old). However, research into specific testing for OTS has found a lack of consistent markers/testing thresholds, including hematologic (iron, RBCs, CPK, etc.), inflammatory markers (cytokines), oxidative chemicals, immunologic, or hormonal (cortisol, testosterone). All these values can be normal in cases of OTS.

Functional Testing for OTS

Interestingly, the most reliable tests for the OTS continuum are functional: how do basic metrics line up with exercise-based tests? In a laboratory setting, athletes with OTS demonstrate differences in sub-maximal, maximal, and post-exercise recovery rates of heart rate, oxygen uptake (VO2Max), and blood lactate levels.

But it’s even simpler: standard exercise tests–simply running a standard loop or course (in relatively standard environmental conditions) and comparing perceived effort (Rate of Perceived Exertion – RPE), heart rate, and time–can detect both overreaching and overtraining.

Quite simply, are you running slow, trying harder, and is your heart beating faster on a given course than before? If so, you’re overtrained.

Effects of OTS

The effects of overtraining go far beyond being tired, running slow, and getting injured. Below are significant, pathological–and possibly irreversible–effects seen both clinically and in research, as a result of chronic overtraining:

Metabolic and Neurological Effects

The systemic effects of the OTS continuum result in an over-stressing of the very systems used during exercise: the neurological and endocrine systems.

During exercise, the sympathetic nervous system–in charge of “fight or flight” responses–is strongly activated. In response to the demand of training and racing, heart rate elevates, blood pressure rises, and muscles fire more powerfully. Additionally, various “resting” systems (such as the digestive tract) are slowed to prioritize the active fight/flight needs. Metabolically, the hypothalamus, pituitary, and adrenal glands secrete hormones during and after exercise to facilitate performance of the heart and skeletal muscles. They also help moderate inflammatory stresses involved in physical exertions.

Like other overuse conditions–such as Type II Diabetes–overtraining results in two problems with the neurological and endocrine systems: a fatigue-based decrease in output. The nerves fire more weakly; the glands secrete less hormones; and a desensitization–less responsiveness–of the affected tissues occurs. In short, they fire less, and the body needs more of it to react. Indeed, runners with OTS will frequently be diagnosed with Addison’s Disease, insufficient cortisol production or sensitivity. Symptoms include, “depression, progressive weight loss, an inability to maintain blood pressure when standing, and severe physical incapacitation” (Noakes, 2003).

The bulk of both physical and psychological symptoms of OTS are due to compromised nerves and glands. And since these tissues, when damaged or compromised, regenerate extremely slowly (if ever), recovery from a neurological or endocrine injury can take months, or years. Or, these changes may be permanent.

Muscle Tissue Damage

Physiologists have been studying muscle tissue damage in runners for over three decades. The prevailing notion is that training and racing volumes that do not cause soreness, presumably, do not cause significant damage, either short- or long-term. However, the bulk of marathon and ultra training and racing does just that.

Some notable research findings on muscle tissue damage include:

  • Up to 25% of muscle fibers are damaged after marathon and ultramarathon performances. This should surprise no veteran of ultra racing. However, further results may.
  • Muscle cell damage has been shown to take up to 10 to 12 weeks to fully repair.
  • In some studies, many athletes demonstrated “areas of fibrosis”, suggesting incomplete repair or chronic muscle cell damage, even in samples taken pre-competition. This lends support to the theory that muscle cell damage is cumulative and chronic, and possibly impervious to rest, stretching, and myofascial tissue mobilization.
  • Abnormalities of mitochondria in muscle cells exist in severely overtrained athletes. This may indicate systemic changes to how muscle cells function–at their most basic, metabolic levels–with prolonged stress. (Noakes, 2003)

While these findings are troublesome, perhaps most frightening is a recent study by Collins and colleagues (2003) that has shown changes to DNA structure in the muscle cells of chronically overtrained athletes. DNA is critical to efficient and accurate cell replication, namely in repair and regeneration. DNA telomeres are end-caps, protecting the DNA strand from deterioration or alteration. Shortened telomeres are thought to result in significant reduction in cell replication, and may result in slight alterations to subsequent generations of cells.

Simply put, the blueprint to strong, healthy muscle cells loses its protection and possibly its ability to quickly and accurately repair and regenerate muscle cells. Scientists theorize that this telomere shortening is irreversible and permanent.

The bottom line is, prolonged muscle stress may permanently change the DNA structure of muscle cells to weaker, less responsive tissue. And that this skeletal muscle genetic material damage is related to the amount of training and/or racing done on sore muscles.

OTS, Muscle Damage, and “Fatigued Athlete Myopathic Syndrome” (FAMS)

Athletes who suffer from OTS whose dominant symptom is muscle soreness, have been categorized as having a condition called Fatigued Athlete Myopathic Syndrome, defined as, “persistent muscle soreness, unexplained fatigue, and rapid and sustained fall in athletic performance” (Derman et al, 1997). The hallmark of FAMS is that, despite full rest–as well as recovery of the metabolic and neurological symptoms consistent with OTS–the athletes continue to demonstrate what Noakes calls “a catastrophic loss of running ability.” Their muscles will simply not allow for previous running intensities or durations without significant, lasting effects. It is thought that the metabolic and nucleic changes seen in previous studies might explain this phenomenon, but the relationship is uncertain.

What is not uncertain is that FAMS is a legitimate condition that affects an unknown number of previously active, highly competitive runners who are otherwise healthy and disease-free.

To conclude, Noakes adds the following, regarding the sensitivity, and perhaps finite capacity, of muscle tissue:

“Muscle is a fragile organ and can clearly be damaged in ways that we have yet to understand fully”

and

“Skeletal muscle of athletes whose exercise capacity becomes impaired after many years of heavy training lose their capacity to regenerate when re-damaged by training or racing. These changes have occurred at the level of the athletes’ genetic material and are hence irreversible” (Noakes, 2003, p.503)

Conclusion

There is much that is yet unknown about Overtraining Syndrome and its spectrum of conditions. But my hope is that the reader comes away from this missive with the following understanding:

  • Overtraining is more than simply being tired, running poorly, and getting injured.
  • OTS can result in irreversible changes to multiple body systems, causing permanent changes to not only running capacity, but one’s overall quality of non-running life.

It needs to be taken seriously.

The sport of ultramarathon running–namely trail ultramarathons–poses unique and arguably greater challenges to predicting, preventing, and overcoming Overtraining Syndrome. Soft, variable trail surfaces and lower-intensity running masks–but does not prevent–the effects of the extreme load that running 30 to 100-plus miles places on our bodies. Moreover, the psychosocial factors of running in beautiful places amongst our fun-loving, supportive (if not, at times, peer-pressuring) ultrarunning community compounds the drive to do more than the body is willing and able to accept.

In subsequent columns, we will investigate treatment, prevention, and implications for the ultramarathon running community and how concepts of overtraining may affect the future of the sport

Call for Comments (from Meghan)

  • Have you had a doctor’s diagnosis of something on the overreaching and overtraining spectrum? If so, what were your symptoms and how were they treated?
  • For those of you with anecdotal, undiagnosed, first-hand experience with overreaching or overtraining, what did it feel like to you and have you been able to heal yourself?

References

  • Athletes with exercise-associated fatigue have abnormally short muscle DNA telomeres. Collins M, et al. Med Sci Sports Exerc. 2003 Sep;35(9):1524-8.
  • Lore of Running, Noakes. Human Kinetics; 4th Ed. (2003)
  • Overtraining syndrome: a practical guide. Kreher JB, Schwartz JB. Sports Health. 2012 Mar;4(2):128-38.
  • Psychological characterization of the elite female distance runner. Morgan WP, O’Connor PJ, Sparling PB, Pate RR. Int J Sports Med. 1987 Nov; 8 Suppl 2():124-31.
  • The ‘worn-out athlete’: a clinical approach to chronic fatigue in athletes. Derman W, et al. J Sports Sci. 1997 Jun;15(3):341-51.
Joe Uhan

is a physical therapist, coach, and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 20 years. He has a Master’s Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50 Mile in October 2010, was 4th place at the 2015 USATF 100K Trail Championships (and 3rd in 2012), second at the 2014 Waldo 100K, and finished M9 at the 2012 Western States 100. Joe owns and operates Uhan Performance Physiotherapy in Eugene, Oregon, and offers online coaching and running analysis at uhanperformance.com.

There are 45 comments

  1. Ryan Knapp

    Joe – as a coach, this is a fantastic overview of the literature and look forward to seeing the rest of the series.

    I'm curious on one point, which is anecdotal or internal based on motivation. If your motivation is simply to run, explore and competition is not always primary, I wonder if there is less of a chance for OTS due to the less stress placed on ourselves.

    If I look at some of my clients, they are always training. It can't be a fun bike ride or fun run, it's training. I'm training, I'm training, I'm training.

    Instead of someone who may very easily run 50 miles a week, but for them, it's fun. Sure, some of it is training, but the motivation seems to be more internal instead of a larger goal race or event focus.

    I wonder if the constant pressure of training and performance looming is a significant contributor to OTS. Even for a MOP runner, beating their goal time, getting a buckle, etc can have quite the psychological and physiological effect, compared to simply getting out and being active, running for fun (GASP) and, in my case, loving to get into the mountains.

    1. OOJ

      Ryan-

      Thanks for the feedback.

      I do feel like the "fun" element could/should result in decreased stress – if you accept the notion that a day spent in the woods "playing" would carry over into enhanced mood and relaxation throughout the rest of your life.

      However, the sword (see below!) is double-edged: how much does this "fun" – enjoyment of the environment and the company of others – mask the the physiological stress and fatigue of the exercise bout?

      1. Ryan Knapp

        Good question. I'm thinking the motivation and enjoyment would have a large effect, simply due to monitoring how the body feels vs. pushing the body to achieve a certain goal.

        I'll take some time to actually put what I have into more of a coherent thought and post it. Thanks for providing inspiration and look forward to seeing the rest of the series.

  2. Gump

    There are so many Ultra races now that it is easy to get caught up with trying to do too much to keep up with the crowd. The key, at least for me is to pick 6-7 races to do each year with 1 of them as my "A" race if you will. Running ultras is like any other passion…if you overdo it, the joy in you dies…Jefferson Airplane anyone?

  3. Deborah Moss

    This discribes me to a t. I first realized I was suffering from symptoms of overtraining years ago, after attempting to complete the Grand Slam 2 years in a row. I am open to any/all ideas on what to do about lingering symptoms.

  4. Wishtorun Again

    I dropped out of ultrarunning due to OTS. Along with symptoms of OTS (including medical, psycological,and professional), this resulted devastating social consequences: losing contact with ultrarunning friends and the surrounding support system. Those people I see look at and speak to me differently. I am constantly asked the same questions: when will you, why don't you, will you ever, what happened etc. etc. It is hurtful and trying, and adds another source of frustration. If asked about this possibility many years ago when I first started ultrarunning, I'd have laughed it off.

    1. OOJ

      WtRA, Deborah-

      THANK YOU for your contributions. I feel there are TONS of folks like US (yes, I've fell victim to periods of OTS, or at least NFO, myself), yet I feel we're swept under the rug.

      Question for you both: given that OTS has an element of "other triggers", e.g. non-running stresses, do you feel like there was other elements of life stress that contributed to your condition? If so, what were those stressors and how have you (or have you not) been able to address those?

      1. Wishtorun Again

        Given that ultrarunning was my way of dealing with other life stressors, I feel less able to deal with those stressors now. Ultrarunning success provided increased self esteem and an identity that I can no longer lean on. It is this simple: ultrarunning made me feel good. I have been unable to find anything to replace that feeling. I want to run like that and be that person again. I was a better person when I ran ultras.

      2. OOJ

        This brings up an element of interest: when running is [overly?] relied upon as a stress reliever.

        Clearly, the sense of peace and relaxation derived from running (during and after) is a driving force for participation. However, one could say that running, itself, is no less a pharmaceutical than any other pain reliever.

        Given that OTS develops as a result of holistic stress load – and very frequently includes non-running stresses in etiology, then ultimately *stress reduction* – via moderation of those non-running stresses – should be the goal.

        This many include:

        – Adjustment to work and family/relationship demands

        – Personal, relationship or family counseling

        – Meditative techniques

        – Other, non-running, non-aerobically intense activities (e.g. meditation, yoga, etc).

        This notion will be addressed further in the follow-up column.

  5. dogrunner

    Joe,

    Informative and interesting article as always.

    One questions – what is the complete reference for Kreher and Schwartz, 2012 ?

    I may have missed it but always like to read the story in its original.

    thanks

    1. OOJ

      Thanks for the question: we neglected to post the References. A selected list is here, and I'll get BP to post them at the tail-end:

      Athletes with exercise-associated fatigue have abnormally short muscle DNA telomeres. Collins M, Renault V, Grobler LA, St Clair Gibson A, Lambert MI, Wayne Derman E, Butler-Browne GS, Noakes TD, Mouly V. Med Sci Sports Exerc. 2003 Sep;35(9):1524-8.

      Lore of Running, Noakes. Human Kinetics; 4th Ed. (2003)

      Overtraining syndrome: a practical guide. Kreher JB, Schwartz JB. Sports Health. 2012 Mar;4(2):128-38.

      Psychological characterization of the elite female distance runner. Morgan WP, O'Connor PJ, Sparling PB, Pate RR. Int J Sports Med. 1987 Nov; 8 Suppl 2():124-31.

      The 'worn-out athlete': a clinical approach to chronic fatigue in athletes. Derman W, Schwellnus MP, Lambert MI, Emms M, Sinclair-Smith C, Kirby P, Noakes TD. J Sports Sci. 1997 Jun;15(3):341-51.

  6. Anonymous

    Joe, I'm sort of curious: Is it possible expectations/perceptions play at least a semi-significant part in all of this? The reason I ask is my mileage was up all summer (approx. 100M per week) yet I was never sore, tired, uncomfortable, etc., in fact I'd never felt better (and I recently turned 50), and I've done over 30 "ultra distance" runs this year (50K or better, though no 100's — yet!) as well as maybe a dozen marathons and haven't even suffered from a blister…I'm a back of the packer, never "race," just run, I never think of the shorter courses as training, just going shorter, I hardly glance at my times, just look to enjoy myself and maybe have a beer when I'm done…I've been warned several times that I'm headed for a big crash, yet if I follow the golden rule and listen to my body, all I hear is more, more, more! Is this freakish, or does the fact that I don't take the competitive aspect very seriously somehow exempt me from some of these obviously serious problems?

    Curiously,

    JV in SD

    1. OOJ

      JV-

      A possible reason why so many "unconventional runners" are storming the sport is that they do not yet have the cumulative "training stress" that a competitive road marathon runner – with 20 years of consistent training – has on his body. That said, a runner could be 25, 35, or 55 and only be the "training age" of 15 or 20. Tim Noakes makes note of this "cumulative stress theory", proposing that most age-group records will be broken by those runners who "just started running" in the few preceding years before their record-storming performances.

      That said, you've got 30 ultras in 2013 at age 50. How long have you been running at this level? Two years? Three?

      Listening to your body is always important, yet we're not always the best listeners (nor is the body the best communicator). We must balance "feel" with knowledge, science and collective experience. Just as I've counseled runners to "drink to thirst", to not drink for many hours during a race because one "doesn't feel thirsty" just might mean one his "heading for a big crash" – it is ignoring the known and/or observed physiological reality.

      In the UTWT discussion of two weeks ago (http://www.irunfar.com/2013/09/ultra-trail-world-tour-to-launch-in-2014.html), Dave Mackey (as well as Ian Sharman, on a separate forum) noted that running several ultras a year is not overly stressful. However, what I believe they recognize is that consistent high mileage, week after week for months and years, IS stressful. Our bodies will respond to stress when balanced with rest.

      That said, I feel your most significant stressor is not the 30 ultras, but the 100 miles per week you're putting in along with it. And while not being competitive takes the intensity down, the total volume is still prohibitively high, for any age runner.

      Science and experience tells me that you are headed for a crash: just when, and how significant, remains to be seen.

      Balance that science/experience with your own body. But ask yourself, what do you want to be doing when you're 60? If you'd like to continue to have these positive trail and race experiences, you would be wise to consider introducing more rest and less unrelenting mileage into your routine.

      1. Anonymous

        Thank you, Joe, thank you very much, I've been following along and doing a fair amount of reading up on a lot of this, in fact, out at ATY over New Year's, Ian and I chatted about it a bit in the middle of the night, and I will keep this in mind as I go forward…

        JV

  7. Greg

    Fantastic article. All of your articles are packed full of great info.

    I've never had OTS (of which I'm aware, anyway) but am curious nonetheless. I notice that sleep is listed as both a cause and an effect of OTS. I recall reading that Neal Gorman was injured/ill with Cytomegalovirus earlier this year (http://www.nealgorman.com/2013/06/running-with-cytomegalovirus.html). Having never heard of it before then, I got the impression from reading his blog that it had symptoms which were nearly identical to that of overtraining. Are these two things related? Completely different issues caused by two completely different things?

  8. Sarah

    I've been battling what I'm pretty sure is OTS for the last year and a half. I can remember the day it all hit me. I came home from work and collapsed on my bed and cried because I was so tired. It was a different kind of tired than I'd ever felt before. It was complete. I went to my doctor and told him about being tired all the time and how everything hurt. He told me that just about everyone is tired and has muscle soreness. So I gave up on doctors and did a bunch of online research. The worst part was that I had over commited myself last year. When I was feeling good I had signed up for two 100 mi races and got engaged, plus I was working insane 13 hour days at an organic farm. I have no idea how I made it through last year. I managed to finish both 100's and plan my wedding but there was no joy in it. Balance,rest, and recovery has been my mantra for 2013 and I'm finally starting to feel better. I know I still have a bit to go yet and this article is a great reminder that I still need to take it easy even though I'm feeling a little bit better.

  9. Steve Pero

    Good article, Joe, looking forward to the continuing series.

    I'll be 62 in November and for the first time in my 38 years of running I feel something different. I have been averaging around 50 mpw for as long as I can remember, some faster, some slower when tired or recovering from a race…but since running Hardrock in July I can't seem to recover. My legs are always tired, I'm even trying running every other day now after taking several weeks off completely, but no matter what I do if I try running 2 days in a row, my 2nd day is flat and I just want the run to be over with.

    So I think all the stressors are hitting me now…having run for all these years competitively (I was a club racer in the Boston area for 20 years before Ultrarunning), over 60 years old and recovering from a year of ultras. And this was what I would consider an easy year, having only run Quad Rock 50 and Hardrock.

    I was planning/hoping to run a marathon to run a Boston Qualifier, but have bagged that idea and am planning on pushing all competition to 2014.

    I'll be crewing my wife at the Bear…she just seems to have no problems like I do, but she also doesn't care about training as much as I do. She runs when she feels like it, sometime once a week! While I feel the need to follow a set schedule of "training", with easy and hard days. Oh, well, guess I'm just rambling…

  10. Joel Wright

    Two years ago, someone mockingly called me a "racing whore" because I was doing races and/or triathlons about 3 times a month. I laughed it off, but by the end of that year (2011) I had severe Runner's Kneed, and it has taken all of 2012, and most of 2013, to recover from it. I hindsight, it was clearly "too much, too fast".

    For most people, you should not give 100% in a race more than a few times a year. For example, if you watch NBA players, they clearly aren't giving 100% until the playoffs. If they did, they'd burn out after just 20 games. I have found that I am much healthier and happier when I race no more than once every 2 months, and really prepare myself. Of course, I also raced three times just in the month of August. I'm such a hypocrite! But I gave up a race this weekend, and I'm not racing again until the end of October.

  11. GMack

    Since DNA teleromes are affected by oxidative stress, it probably wouldn't hurt to take some supplemental antioxidants during periods of intense training or when racing.

    After 12 years of actively participating in ultrarunning, I've found that training periodization, lots of rest during training, and reduction of impact stress (soft surfaces/shoes) to be significant for longevity in the sport. Pretty obvious to most.

    I've never shown symptoms of OTS, but perhaps have with NFO (and certainly with FO). That's when I complain to my wife that, "100% of me hurts 100% of the time" – like I've joined the running equivalent of Fight Club, only to bounce back in a few days. I'm a 51 y/o and will probably withdraw from ultrarunning after completing the "World Slam" next month.

    Thanks for another great article.

  12. MS

    What do you typically suggest for the off season (i.e. Oct – Dec) to avoid overtraining?

    Do you take your mileage way down as if you are training for a 1/2 marathon and then start to ramp up around Jan 1st to prepare for the summer? Or do you find something other than running to keep your relative fitness?

    Thanks and great article …

    1. OOJ

      MS-

      That's a big, opinionated, question. What I will tell is, in speaking with some veteran ultra runners – guys who have run at the top level for *decades* – they run-trained specifically only from Dec – June, then did "other things" (hiking, biking, skiing…or nothing) for several months. They cite this as critical to their sustainability.

      The scariest element about Kilian Jornet is not that he's so good *despite* his lack of running…but that his lack of running – and love of other sports – is what is going to keep him a top performer in the sport for years, if not decades…based on that theory.

      Given that, you might consider non-running activities that challenge the body – and brain – in significantly different ways.

      Good luck!

  13. OOJ

    In the Keher/Schwartz review, this make special note to discuss the other, non-training "triggers". Yet, in the treatment section, little is mentioned other than: resting from training, then gradual resumption (beginning at 5min/day) of activity.

    Yet, it would seem logical to me that the top priority – after complete rest – would be to make a concerted effort at "trigger reduction". In other words, addressing ANY/ALL non-running stresses and minimizing them: work/family/relationship stresses, sleep, nutrition, to name a few.

    It would seem that, when all stresses are minimized, one stands the best shot at making the fastest and most complete recovery.

    Good luck!

  14. OOJ

    Greg-

    Thank you for sharing that link re: Neal. I intend to talk to Neal, personally, so I won't allude to that, or make assumptions about his condition.

    However, if you read his account, and do some basic research on cytomegalovirus, you may conclude the following:

    – Significant and SEVERE non-running stresses presented themselves in Neal's life, well before any symptoms began to develop.

    – "Most people don't know they have [cytomegalovirus] because it rarely causes symptoms" (http://www.mayoclinic.com/health/cmv/DS00938)

    Until I speak with him, I will allow the reader to draw his/her own conclusions as to whether the virus, or the enormous cumulative stresses that preceded it, caused the malaise he experienced in the spring and summer.

  15. OOJ

    Thanks for sharing, Sarah.

    It's worth noting that an underlying theme is emerging in most of the extreme cases of overtraining: severe non-running stressors. It would appear that a crucial element in your recovery was dealing with your work and life stressors.

    Besides helping those with over-training issues, I feel the silver-lining of this post is the idea that one of the best – if possibly untapped – ways to improve training and racing performance is *comprehensive stress management*. And that one can improve performance and running satisfaction through these means, and not just running more, or harder.

  16. OOJ

    Steve-

    Thanks for the post, and congrats on the Hardrock finish!

    While I've never run it, I consider Hardrock one of the most physically-taxing ultras (at/below 100M) out there. Three significant elements make it extremely stressful: high altitude, elevation gain/loss (38k'?), and "time on feet" (unless your last name is Skaggs, and first initial K., you're not sleeping for a night…in a bed, anyway).

    No true diagnosis of either overtraining (or its younger sibling, "non-functional overreaching") can be made without *complete rest*.

    My advice: bask in your terrific achievement, and instead of running, invest in other parts of your life: flexibility, meditation, relationships (family, friends, others), and do something else until you feel significantly more energy and desire to RUN, not simply train.

    More qualified treatment/prevention advice will be offered in October. Good luck!

  17. OOJ

    Thanks for the comment, Joel!

    At my former employer, my boss and I would run every Monday at lunch. I would run between 40-70 miles over the weekend (Fri-Sun), when he would typically do zero. So on the noon run, he'd be hammering, full of energy. It was brutal trying to keep up.

    The lesson here is that one cannot have their cake and eat it, too…not forever, at least. Based on my reading – and in-depth discussions with veterans of the sport, if someone wants to be a life-long runner, one has two options:

    1.) we run a lot, very easy, or

    2.) we run intensely, with big and frequent periods of rest

    Perhaps that's what those NBA vets realize…

  18. OOJ

    GMack-

    I'm not sure how close we are to knowing what shortens telomeres (and how that affects function). I made a specific point not to delve into nutrition or supplements, because I felt that it would take away from the main thrust of the article: that doing too much without enough rest is far and away the driving force of OTS.

    You seem to demonstrate an effective balance of training and rest, and I would believe this has been a key part of your success in the past dozen years.

    Good luck with the "World Slam"!

  19. Martin

    10-12 weeks for muscle repair after a marathon seems excessive. Maybe after the first one. This has to vary a lot based on the level of fitness.

  20. OOJ

    Martin-

    I agree; there will be huge variability in recovery time (for the same event), because fitness, mechanics, and race intensity all play a role.

    Anecdotally, I would say that sub-elite marathoners incur by far the highest degree of tissue stress. These are the runners who are motivated enough to train high volumes and accumulate significant fitness, yet do not have sufficient mechanical efficiency to be elite. This lack of efficiency also results in them "beating up" their legs to a much higher degree.

    It's like a car with a huge engine but very poor tires, shocks, and alignment: they go fast and far, but beat themselves to hell…

  21. olga

    I was officially diagnosed with OTS – or, in the case of the doctor, adrenal fatigue – last December after having gone through all stages described in 4 months prior, and with blood tests (low cortisol and thyroid function, B12, Iron, D3, something else was there, and a bunch of meds prescribed). It was kind of scary – I raced/trained through a lot of 2 stages before that, but somehow was able to bounce back – or, usually, the Universe would send me an injury just in time to take at least 3 weeks off or so and that would spare me last stage of OTS. It exists, and may be with aging (and hot climate living now??) body reacts more obviously and sooner and violently. I had written a whole article on it myself: http://endurancebuzz.com/2013/01/25/when-too-much
    Waiting for the next article from you, Joe.

  22. Karen

    Thank you so much for this article. For me, I think it is coming just at the right time. The cumulative affect all the ultra running might be/is having since 2008 (and 12 years of marathoning before that) is what really struck home and explains I think why since last fall, even taking short breaks isn't bringing me back to feeling like I did the first few years of ultra running (getting stronger, steadily). This spring I had a blood test and some of the numbers were off, but I attributed it to just having run a 100. It might have been that, but maybe the numbers still would have been off had I not just done that. I still seem to be able to do okay (for me)in ultras and pr'd in the marathon this spring(and 50k in August). But what I have noticed is it taking longer to recover and struggling with the weekly shorter runs. The cycle has been just when I am feeling recovered, I do something long again and there I am, slowly digging a hole for myself. I think in the other comments and response it was mentioned that this can very much affect an average runner, and that helped it hit home too. So this info was very, very helpful to me and I really appreciate it and look forward to the subsequent articles. Thank you.

  23. Naomi

    Interesting article. I always feel like I am not training enough. I push myself to train at least 6 days a week, race several times a month (usually no less than an hour race time, usually multiple hours), and have been feeling more and more "flat", exhausted, diagnosed with low iron levels. The have way overbooked my race season and now have three back to back long races (4+ hours) the next three weekends. I know I need to rest, but even taking two days off makes me feel squirrely. Some friends laugh and call me an "addict". Reading this makes me think taking the month of October to dog walk and "yoga" is probably going to be the best thing for me. That being said, I have enjoyed almost every minute of it, which makes it that much harder to rest.

  24. Corrine

    Hi Joe,

    I found your article fascinating, in part because I think it might hold a lot of answers for me. I'm a high level elite athlete (international) and in a sport that uses hours instead of miles. Over the past three and a half years it has been my job in many ways. I'm however a younger athlete (early twenties) compared to my team mates and was pushed to keep up with them and work to their level. For the past year and a half I've been increasingly tired, my ferritin has slipped from 76 to 20 (despite throwing iron at it), I'm sick more regularly, I have increased anxiety, and was recently tested for both Celiacs and Crohn's disease but both came back negative. I'm grasping at straws at this point. OTS?

    1. OOJ

      Corrine-

      Thanks for the comment – sorry to hear about your situation.

      Per the Kreher/Schwartz 2012 review, any diagnosis of OTS (vs FO and NFO) *cannot be made until complete rest is undertaken*. The difference between those diagnoses is that OTS is present when symptoms do not improve with prolonged rest (at least 1-2 weeks, if not longer).

      That said, diagnosing OTS or any other training-related malady can't be made 'til you rest!

      Have you rested, completely?

      Until you do, to continue to chase diagnoses (in absence of any other notable disease symptoms) is putting the cart in front of the horse.

      Bottom line: you must rest, completely. Then gauge how your body feels. But even then, in the presence of OTS, your symptoms may not reverse for quite some time.

      Good luck!

  25. max

    I'm curious about how the research into OTS takes places. One can't just ask an athlete "now please run yourself to destruction, and don't stop." I suppose volunteers who already got there are too ample, but how does anyone measure baselines and the like?

  26. Corrine

    The rest has happened. We always take April off, atleast two weeks completely off followed by a gradual build into training easy as we roll into our new training year in early May. With May being a month of incremental build into a summer/fall of training.

    I was in a situation where I was hoping my move from a stress burdened environment (and otc) would help and that eliminating these environmental stressors and their additional emotional/mental stressors would help my physical feeling. Unfortunately what I have found is that although I am happy as a clam my physical symptoms have not improved.

  27. Wei

    Hey guys,

    can you give me some advice? i just completed my first year of running (12 months). i ran 8 ultras (2x 100k with +4000m vertical gain) and 10 marathons. i ran 3000km in total. i run 3x a week, either 17 , 17, 30 or 20, 20, 40 or a variety of those numbers). on my rest days i hit the gym. I sleep about 7 hours a night and have a full time job. i really only rest one day a week. my diet is healthy and clean, no processed food, all self-cooked etc. a 40k run for me was not easy but enjoyable enough. for 10 weeks now performance has gone down. i had slight cramps after 35km in a 44km trail event, which is unsual for me. i had no leg power in a marathon and struggled the last 20k to the finish in 3:29. i ran another tough trail marathon yesterday with 1500m vertcial. i had no leg power after 3km (!) and cramps after 15k. i suffered till the end and walked it in. recovery feels good enough, no real muscle soreness the day after. i know i need to take time off, but am unsure of how much time would be sufficient in my case. any tips? hopefully not months off….

    1. OOJ

      That sure is a lot of racing, though it seems off-set by running only every other day.

      The only real metric we have is heart rate. Again, having a standard run (a short run, like <10K) where you can track heart rate vs pace, is one of the few ways we have to determine the body's response to training/racing.

      Some subjective things include sleep quality and overall energy/mood.

      Need for rest is highly variable. What I would say is, there's no such thing as TOO much rest. And notably, when interviewing some of the best ultra runners with 30+ yrs of longevity, they ALL take months off per year, only training/racing 6-8 months out of the year.

      Food for thought.

      Good luck!

  28. Mark

    I would love to hear recommendations on how someone who is completely overtrained and has been for 6 years can get back to somewhat normal running. I overtrained for 6- 8 years from 2001 through 2006 or so. Running every day or twice a day; 120 mile weeks; no days off for six months, etc. Since 2007 I have been running about 2o miles a week at a very reduced pace. One winter I didn’t run at all for six months. Another winter I run just one six mile run per week. This didnt help at all.My entire core is locked tight. I believe I probably did cellular damage to my leg muscles. Has anyone tries acupuncture, cryotherapy, thermotherapy. I know what I need is a muscle transfusion, but I don’t think medicine is offering that yet! I would greatly appreciate any advice. Thanks

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