Overtraining Syndrome, Part Two: Treatment and Prevention

Stay the CourseThe term ‘overtraining’ is a bit of a misnomer. It implies that the only way to suffer it is to train excessively. But with running–and ultramarathoning in particular–excess is as relative as it is requisite, a critical component to success, some would argue. Indeed, those who’ve experienced overtraining will frequently note that their malaise developed under the same or less training volume than they’ve logged in previous months or years.

Rather than simply training too much, overtraining syndrome is an imbalance of the stress-rest relationship: too much stress, not enough rest. And it’s not just running that is stressful.

This is part two in three-part series (Part One: An Overview and Part Three: The Trail Ultrarunning Specifics) on overtraining, functional concepts in overtraining treatment and prevention.

Overtraining As Imbalance: ‘Fight and Flight’ Versus ‘Rest and Digest’

A foremost pioneer in holistic, balanced training, Phil Maffetone, has been a powerful voice in endurance sports for over 30 years. Maffetone has worn many professional hats as a chiropractor, acupuncturist, athletic trainer, teacher, and coach. But it was his work with triathletes, namely six-time Ironman Champion Mark Allen, that put Maffetone and his ideas to the forefront of endurance sport.

He is an advocate of holistic training, noting that maximal athletic performance–and general health–lies in the balance of stress and rest. In his book, The Big Book of Endurance Training and Racing, he notes that overtraining syndrome is, quite literally, a stress-rest imbalance. He takes it further, to describe it as a neurological imbalance of the sympathetic and parasympathetic nervous systems. The sympathetic system is responsible for action–it drives our muscles and makes our heart race, both before and during running. Once our exercise ceases, the parasympathetic system takes over to facilitate the ‘rest and digest,’ the restoration and repair. According to Maffetone, overtraining is not simply running too much, but an overall excess of sympathetic and inadequate parasympathetic activity.

That said, that ‘flight’ versus ‘rest’ balance can also be understood as a balance of revenues and expenses. Training is a physiological stressor; all bodily systems are engaged to varying degrees when running. Despite the perceived stress relief we feel from it, running is a taxing expense on the body, which a person must pay for via restorative revenues; sleep and adequate nutrition being the foremost sources of rest.

The intricacies of overtraining appear when you consider that training is not the only expense we incur. We are constantly nickel-and-dimed throughout our day with many other expenses large and small. Work and school, friends and family, travel and illness–to name only a few–all represent secondary expenses. And they add up. Before long, the balance sheet is in the red if we’re not careful.

Maffetone recognizes these multidimensional contributors to both stress expenses and restful revenues. He details how to get the most from your training stresses, maximize restful revenues, and otherwise minimize the non-running expenses, which will be described below.

Striking Balance: Elite Performance in the Real World

Eugene, Oregon has a wealth of resources for runners. Its physical environment is nurturing with cool temperatures and great trails and the University of Oregon draws significant talent in both athletic and intellectual realms.

Examples of that resourcefulness include two women with equally impressive athletic and academic credentials:

Kimber Mattox is a former Oregon High School State Champion in cross country, a school-record holder and All-American at Willamette University (Salem, Oregon) before taking her talents to the University of Oregon, where she registered the second fastest 3,000-meter steeplechase time in school history in 2012. She now holds a Master’s Degree in Human Physiology and is a faculty instructor in the department at the U of O. In her sparse, spare time, she assistant coaches Oregon women’s cross country, and competes post-collegiately, having recently made finals at the USATF Championships in June. Mattox owns a personal best of 9:57 in the steeple.

Brett Ely is an elite marathoner with an impressive resume in and out of running shoes. She has qualified for the past three US Olympic Trials Marathons and has a personal best of 2:38 at Grandma’s Marathon in 2011. Professionally, she has worked at the U.S. Army Research Institute of Environmental Medicine where she worked in thermal physiology and hydration science. She is now a doctoral candidate in Human Physiology at Oregon, studying cardiac physiology and the relationship between elevated sympathetic nervous systems and disease processes. In her spare time, she is aiming to notch her fourth qualifier this fall at the California International Marathon.

These women offer a unique perspective with both and elite running ability as well as expertise in human physiology. Moreover, they are experts at balancing the demands of elite-level running with academic careers. I was able to sit down with them both recently and get their perspective on the art and science of sustainable training.

Treating and Preventing Overtraining

Step 1: Balance Training Expenditures

As stated in part one, brief periods of overreaching can result in performance improvements (a concept referred to as super-compensation), provided that adequate rest follows that period of heavy training or stress load. This rest–either absolute or relative–represents both a decrease in stressful cost and an increase in restful revenue. One or both must occur to avoid overtraining imbalance.

By the time that full-blown overtraining is present, you are beyond unbalanced. You are deeply in debt; the checking account is overdrawn, the loan defaulted, and collections are on their way. That said, simply increasing revenue streams–resting more, decreasing life stress, eating better–is rarely enough.

You must stop training. Period. The systems described in part one–namely the neurological and endocrine–need significant repair and restoration. Any training that stresses these systems represents additional stress that the system cannot handle.

While neither woman has experienced severe OTS, Ely has had her run-ins. She notes that, during her college years, “I had a week where I couldn’t sleep.” That was an obvious sign to her that she was imbalanced, requiring one to two weeks of complete rest from running. Later, repetitive injury issues as a post-collegian have derailed several competitive build-ups, including a DNF at the 2012 Olympic Trials Marathon due to a hip injury. Since then, Ely notes that “maturity” and “going with the ebb and flow” of daily life have been critical to avoidance of overtraining and injury, “I’m flexible; if I’m not feeling it, I’ll try again tomorrow instead of forcing it.” One could argue that her recent success in her mid-30s might also be due to the same philosophy.

Cut training by 75 to 100% of total run volume as well as any other activity that raises the heart rate over 100 beats per minute. Moreover, because of the effects on skeletal muscle, limit impact activity as much as possible.

Cut all high-intensity, anaerobic training. This includes hilly trail running, which spikes heart rate and drives the anaerobic system far more than most runners (without heart-rate monitors) realize.

Switch to non (or minimal)-impact activity. The literature or medical opinion is equivocal on some versus no activity in OTS treatment. Some degree of activity may be helpful to aid in tissue and joint mobility. Maffetone recommends walking, gently generating blood flow with minimal impact stress while also providing low-level aerobic exercise with minimal stress. However, if you experience significant muscle soreness as described by Fatigue Athlete Myopathic Syndrome, avoid all impact activity. Instead, engage in low-impact, low-aerobic mobility exercise such as swimming or yoga.

In their literature review on overtraining, Kreher and Schwartz (2012) note that, with periods of both overreaching and overtraining, resumption of training should only occur when primary physical symptoms fully resolve and motivation to train returns, beginning with a very low intensity and duration,a mere five minutes, and increase gradually, until an hour is tolerated. And only then can relative intensity increase.

Use objective metrics to monitor training stress. Progressive, sustainable training and avoidance of overtraining is all about establishing and maintaining a balanced budget of revenues and expenditures. Where the difficulty arises is when we fail to accurately determine the true value of our expenses and revenues. How much more stress-fully expensive was your long run that you pushed in the final miles? How less valuable is your night’s sleep, disrupted multiple times because of a crying infant or high-maintenance pet?

Maffetone puts heavy emphasis on heart-rate-based training. His ‘Maximum Aerobic Function’ effort, the level at which we still burn fat and avoid stressful anaerobic training intensities. This is an individualized heart rate, estimated using age and other factors (though it can also be measured with functional testing). This specified heart rate represents a level of effort that not only minimizes training stress, but it represents a standardized effort level by which to compare training progression or signs of overtraining.

Maffetone recommends periodically running the same distance on the same training ground (for his protocol, a flat, five-mile route) and monitoring your overall pace while strictly adhering to one’s maximum aerobic heart rate. This represents a way of tracking stress. With sustainable training, one’s average pace should improve within a training block and over years of healthy, balanced training and racing. Decreases in speed at the same heart rate represents a state of over-stress, excessive training or non-running stress and inadequate rest.

Trail runners can accomplish this same metric using known trail routes. Technology such as GPS watches and heart-rate monitors can document effort and performance which one can compare to previous runs in previous weeks, months, or years. For example, with the simple addition of a heart-rate monitor, Timothy Olson can chart his true training progress on the brutally steep, ‘Pete’s Punisher’ route in the foothills outside Ashland, Oregon by comparing his ascent times versus heart rate. Simply running the route faster does not equate to improved fitness; that can be accomplished by learning the best footholds or simply putting forward greater physical and mental effort. Instead, running faster with the same or lower heart rate is the true measure of sustainable fitness.

Step 2: Manage Non-Running Stresses

Training is a significant stress in our lives, but it’s not the only one. We are constantly nickel-and-dimed by other large and small expenses in our lives, and they add up. Most successful runners are dedicated, hardworking, detail-oriented people. This permeates our existence, often making them as successful out of running shoes as in them. But that commitment and ability can become more taxing than you bargained for. Successful training and performance, and preventing overtraining, therefore is about finding balance and prioritizing our activities: maximizing productivity but minimizing the cost.

Maximize sleep and nutrition. This is an easy one, and for the most part, well-executed by ultra trail runners, who might be the most savvy with nutritional excellence amongst endurance athletes. A diet rich in healthy fats, whole fruits, and vegetables, and limitations on processed foods is an integral part of maximizing restorative revenue. Consistent sleep volume and schedules is also important. Conversely, an involuntary sleep disturbance or a loss of quality sleep is a leading indicator of training imbalance.

As part of the active treatment of overtraining, Maffetone recommends the following:

  • Limiting all processed foods, namely processed starches, grains, and sugars which are thought to have strong, pro-inflammatory effects;
  • Consuming smaller, more frequent meals to keep blood sugars consistent and limit metabolic stresses;
  • Maximizing natural anti-inflammatory foods including omega oils, and certain nuts and berries; and
  • Limiting intake of caffeine which drives the sympathetic response.

Active relaxation. For many, running represents our most important stress reliever. But when it become a major stressor, we’re left with few options to calm the system. Besides sleeping, active relaxation techniques can be a powerful brake to a hyperactive sympathetic system, and more quickly activate that restorative parasympathetic system. Examples of active relaxation techniques with minimal physical stress include yoga and meditation; both activities use active, mindful breathing and a present-centered mindset to turn off the many internal stressors and facilitate a restful state.

Meditation and a peaceful, present-centered approach has been a huge part of Timothy Olson’s success over the past three years. Prior to the 2012 Lake Sonoma 50 Mile, he and I were doing a light shake-out jog on the trails above his house in Ashland the day before the race. As we neared the end of the run, he stepped off the trail and said, “You go ahead. I’m going to sit in the woods and meditate for a bit.” While brief, this had a positive, calming effect on him that weekend and was undoubtedly a major contributing factor to his success.

Periodize your life. Too often, we increase our training volume while trying to maintain the same level of non-running activity. Work, family, and relationship desires and obligations pose major contributions to overall life stresses. We want to do well and be generous contributors in all areas of life, but when engaging in heavy training, something has to give.

Ely, a self-proclaimed ‘Type-A’ personality, notes that she had to learn this lesson the hard way on multiple occasions. She notes that two major stress fractures occurred at times when non-running stresses were high: performing home improvements and getting married. “I would do a hard training run, then come home and hang drywall for five hours”, causing one major injury episode. Another occurred while planning her wedding, clearly a positive event but nonetheless a significant time and energy stress.

Periodize your life by planning and performing non-running tasks at down times in your training cycle. This might include things such as home-improvement tasks, major family and social occasions, and work projects. Then, commit to dedicated rest time during periods of heavy training. This, undoubtedly, is best accomplished with clear communication and collaboration with your employer, family, and friends. While this might seem to be a major sacrifice, making the most of your training and the sacrifices involved is what will ultimately make those sacrifices worthwhile for everyone involved.

Prioritize. Keeping perspective and prioritizing your time and activity during serious training is also important. Not every tasks requires or is deserving of your absolute best efforts and energy. Indeed, Ely, despite a clear track record of over-achievement, has come to the same conclusion through her experiences as an elite runner and scientist. After years of struggling to strike a balance and suffering multiple injuries trying to do too much, she’s concluded that, “Not everything worth doing is worth doing well. Some things you just need to get things done.” And those times are when training and resting take top priority, when your ultimate goal is to perform well.

Be present-centered. In her role as coach, Mattox is keenly aware of the multidimensional stresses of her collegiate runners. She and the Oregon coaching staff are advocates of being present-centered, “Sometimes runners will go to class and all they think about is practice, then come to practice and all they think about is class”, noting that, with this state of mind, even easy running can be stress producing. By being present-centered, she notes, “Practice becomes a stress relief rather than a stress-producer.”

Surrender without giving up. When non-running life stressors are too great, sometimes even an easy run is too stressful. For anyone, even professional runners devoid of 40-hour work weeks, this is bound to occur at various times; crazy travel schedules and social commitments, regardless of being positive or negative, drain our system.

Sometimes the best training runs are those we do not do. While Ely cites greater maturity leading to this reality, Mattox, at the tender age of 24, already possesses that wisdom. As a high-school sophomore, she won the Oregon State Cross Country Championship in 2004, which she accomplished less than a day after playing a full play-off game for her high school soccer team. But, interestingly, she quit cross country the next day, “There was a lot of pressure and I hated it; it was too stressful.” She didn’t run competitively again until midway through college.

Since then, she’s been acutely aware of stressors on her athletes at Oregon, noting one instance where, before practice, one of her athletes was showing visibly clear signs of stress and anxiety. “Instead of running, she and I went for a walk.” Indeed, some of the most important workouts are the ones we don’t run.  Both Ely and Mattox cite the concepts of trust, discipline, and faith as critical to successful running and life balance.  Surrender is about having the faith that, if you rest, you’ll come back stronger tomorrow.

Manage expectations. Often the expectations from running and how we perform poses a significant stress, causing not only poor choices in how we train but also driving an ongoing stress cost through elevated anxiety, especially in the days and weeks preceding competition. Moreover, the mounting expectation after poor performance only drives overtraining syndrome even further: more anxiety, more poor training choices, more stress.

Having quit cross country in high school because of the pressure, Mattox’s rise to become the second-fastest steepler Oregon history, a program known for being among the elite track programs in the country, is even more noteworthy. That formative early experience was critical to her rise. When she transferred from Division-III Willamette University to Oregon for her final year of eligibility in 2011, she noted that, “There were no expectations. I just wanted to see what I could do.” That balanced mindset resulted in enormous personal improvement and high achievement, both on and off the track.

Perspective. Ultimately, in order to strike balance with running and life, one must realize that running is only a part of who we are; it can greatly enhance the quality of our lives, but no single training block or race performance will make our lives great. Nor will a poor performance have the opposite effect.

No doubt benefited by their expertise in human physiology, Mattox and Ely know this inside and out, realizing that there are limitations not only to what the body can handle, but as to how their biggest passion can impact their lives. Ely might have put it best when she said, “Running is a passion, but a choice. Sometimes the right choice is not to run.”

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Next month, we will discuss the implications of overtraining on ultramarathon running, as well as the special challenges that ultrarunners face in striking balance in their running. We will also explore two ultrarunning case studies of runners who experienced severe overtraining symptoms.

Call for Comments (from Meghan)

  • What types of non-running stressors do you have? Which of these do you know affect you more than others? Which of these affect your running the most?
  • Have you seen examples in yourself when your stress and rest volumes are imbalanced?
  • How do you know when to take a rest day, when the right choice is not to run?
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.