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A Review of Overtraining - Recognizing the

Mary Black Johnson, PhD, ATC Steven M. Thiese, MS

ABSTRACT: Overtraining syndrome is Physiological Indicators stress fractures, and tendinitis conditions common in athletes. Itmanifests itselfwith Numerous physiological characteris- in the lower extremities (4, 19). It is un- both physiological and psychological tics of overtraining syndrome are docu- clear whether overuse injuries associated symptoms, and can adversely affect an mented in the literature (3,10,14; Table 1). with overtraining are the result of exces- athlete'sperformance. Thisarticle reviews In an overtrained athlete, an overactive sively high training loads or the body's the physiological andpsychological signs pituitary gland is primarily responsible for impaired ability to recover from training andsymptoms ofovertraining syndrome in physiological responses to overtraining. bouts. order to help the athletic trainer recognize Stimulation of the hypothalamus causes Still another of the body's systems the condition. With an understanding of the pituitary gland to secrete excess adre- affected by overtraining syndrome is the overtrainingsyndrome, theathletic trainer nocorticotropic hormone. This, in turn, cardiovascular system. Overtrained ath- can better aid coaches and athletes in stimulates cortisol secretion by the adrenal letes exhibit elevated exercise rates preventing and treating this phenomenon, cortex, which aids the body in adapting to and require longer for their to and thus maintain the athlete's optimal stress. Barron et al (2) reported that corti- return to normal following activity (4). performance level. sol levels were significantly higher in ath- Early studies found both increased (15) letes who had overtrained than in the same and decreased (25) resting athletes afterthey had4 weeks ofrest. The in overtrained athletes. More recently, O vertraining syndrome has been re- elevation of cortisol levels in overtrained Henschen (10) reported that higher sys- ferredto as "staleness," "overreach- athletes in this study was observed imme- tolicbloodpressure was aphysiologic char- ing," and "chronic " (21). It can diately following exercise, as well at 15 acteristic of overtraining. Verma et al (24) result in mental lassitude and/or physical and 30 minutes postexercise. observed a lengthened time to return to injury and therefore a declining perfor- The humanreproductive system also basal blood pressure levels after exercise mance (21). Most simply put, overtraining is adversely affected by overtraining syn- in overtrained athletes. syndrome is the point at which an athlete drome, with luteinizing hormone (LH) Finally, overtraining can lead to de- exceeds his/hercapacityfor exercise (22). levels decreasing when the athlete is creased immunity (17). One report docu- It has both psychological and physiologi- overtrained (5,7,12). In women, LH de- ments a decrease in C-reactive protein af- cal components that shouldberecognized crease is associated with decreased per- ter intense exercise (11). An phase by those working with athletes. cent of body fat and associated decreased response may be exhibited in overtrained The athletic trainer is in a unique levels of estrogen. Overtraining in fe- athletes, detectable as , leukocytosis, position to recognize symptoms of males is often manifested by amenorrhea a drop in serum iron and zinc, and arise in overtraining. Acting as a health care (7,12). In men, decreased LH results in serum copper and erthyrocyte sedimenta- liaison, the athletic trainer can work with decreased testosterone and a resultant in- tionrate. In addition,increasedheadcolds, the physician, the coach, and the athlete ability to build muscle mass (5). allergicreactions, and otherinfections have toward returning the athlete to optimal Overtraining also affects the muscu- been associated with overtraining. performance levels. The purpose of this loskeletal system. One report documents paper is to review the physical and psy- that serum creatine kinase (CK), an enzy- Psychological Indicators chological manifestations ofovertraining matic marker of muscle tissue injury, is The psychological factors associated syndrome and to outline those signs and elevated in athletes on mornings after run- with overtraining syndrome are more dif- symptoms that could be monitored by the ning (4). The researchers hypothesized ficultto detectthanthe physiological ones athletic trainer. thattheathletewho losesweightandmuscle (9; Table 1). According to one sports girth while training is undergoing catabo- psychologist, psychological overtraining Mary Black Johnson is an assistant lism, metabolizing muscle protein stores is characterizedby sleepdisturbances (and professor in the Department of Physical for energy. The net result is a decrease in associated drowsiness), prolongedexces- Education (Athletic Training) at San Di- performance. sive weariness, chronic fatigue, and loss ego State University in San Diego, CA. The musculoskeletal system also re- of vigor (9,18,23). In addition, loss of Steven Thiese holds a master's degree sponds to overtraining with overuse inju- self-confidence, , , de- in athletic managementfrom the Univer- ries. The three most common overuse pression, , and also are sity of Utah, SaltLake City, UT. injuries associated with overtraining are: exhibited (10,18). An overtrained athlete posterior tibialis syndrome, lower limb may exhibit emotional and motivational

352 Volume 27 a Number4 a 1992 m JournalofAthletic Training Table 1.-Physiological and Psychological evening fluid intake. The athlete may The athlete should maintain records Indicators of Overtraining Syndrome exhibit signs ofdehydration andmay drink of morning heart rate and records of fluid copious amounts of fluid after practice. and dietary intake throughout the training Physiological This athlete also may have alack ofperspi- and competitive seasons. The amount and 1. Higher restng heart rate ration during practice since the body is quality of sleep the athlete gets each night 2. Changes in normal blood pressure attempting to maintain fluid by should also be recorded. These records 3. Delayed return to normal heart rate retaining fluids. should be reviewed regularly by the coach 4. Elevated basal metabolic rate Another symptom ofovertraining syn- and/or the athletic trainer, as changes in 5. Elevated body drome is an alteration in sleeping patterns established baseline levels of these mea- 6. /excessive thirst (9,16,20). Sleep is how the body replen- surements could signify an increased risk 7. Impeded respiration ishes itself. If an athlete gets inadequate of overtraining for the athlete. In addition, 8. Subcostal aching sleep, the body is denied its optimal re- the athlete should be encouraged to main- 9. Bowel disorders covery time. Disruption of normal sleep tain a diary assessing his/her emotional patterns-such as time to bed and the outlook. It may be helpful to have an Psychological amount and quality of sleep-alters the objective assessment ofthe athlete's men- 1. Sleep disturbances ability ofthe body to adapt to the stress of tal outlook. This can be accomplished 2. Loss of self-confidence training. using psychological tests such as the Pro- 3. Drowsiness and apathy The final symptom is general psycho- file of Mood States (POMS) (9). 4. Irritability logical (1,8,13). An alteration in These steps, at first, may appear ex- 5. Emoiol ad monvato imbaan the athlete's mood or approach to his/her cessive. It may be impractical to expect 6. Excessive, prolonged weariness sport may be a signal of staleness. An athletic trainers to monitor all athletes for 7. Lack of appetite () inability to maintain the training schedule signs and symptoms of overtraining. In 8. Fatigue orto be psychologically prepared for com- reality, only periodic review is necessary 9. petition may be apparent. to assess changes in the five areas that 10. Anxiety indicate overtraining syndrome. Addition- 11. / Recognition ally, the athletic trainer is in a unique posi- 12. Confusion The causes of overtraining syndrome tion to educate coaches regarding this syn- are associated with physical training and drome. Through these means, the coach competition (10; Table 2). As has been can monitor the athletes and direct their imbalance, anger, and hostility (10,18), mentioned, there are anumber ofscientific training toward eliminating andpreventing and mood swings are common (13,23). assays and measures that can indicate overtraining syndrome. Eating disorders and generalized loss of overtraining in an athlete. Many of the appetite also are observed (16). tests that can be employed are either too Prevention and Treatment expensive or too invasive to be practical. Recognizing overtraining syndrome Signs and Symptoms There are, however, several simple ways may be vital to its prevention; however, Although manifestations of over- the athletic trainer or coach can watch for recognition is only afirst step. Treating the training syndrome differ from person to signs of overtraining syndrome. syndrome involves attenuation of both person, fivemainsigns andsymptoms com- physical and psychological symptoms. monly appear in overtrained athletes. The Physical symptoms should be dealt with first is an alteration in the circulatory sys- Table 2.-Causes of Overtraining Syndrome first. This may involve a reduction or tem. Increased morning (resting) heart layoff from training to allow adequate re- rate, or more specifically, an increase of 1. Length of the competitive season covery from ailments such as stress frac- more than five beats per minute is indica- 2. Monotony of training tures or lingering illnesses. It does not tive of an overtrained state (6,21). Abnor- 3. Feelings of claustrophobia mean the athlete cannot maintain general mal changes in blood pressure (without 4. Lack of positive reinforcement fitness with alternative training. Research indicating the direction of change), par- 5. Feelings of helplessness suggests that increases in fitness from re- ticularly increased resting blood pressure, 6. Abusiveness from authorities training are similar to initial training, but also may indicate overtraining. 7. Stringent rules that the gains are perceived by the athlete A second of overtraining syn- 8. High levels of competitive stress as easier and more rapid (22). This may be drome is unexplained weight loss. Body because of familiarity with the training composition is altered by training, with the process, alack offear, and/orconfidence in lean body mass increasing and the percent- Maintaining a written record will help the outcome. Observable signs of age of body fat decreasing. An athlete's the athletic trainer or coach detect psycho- overtraining syndrome can be used as body fat is already lower than the logical andphysiological overtraining. This guides for a gradual return to the athlete's nonathlete's. Thus, an additional decrease involves keeping current and regular previous training levels. in percent of body fat or a 5-pound weight records of weight (particularly pre- and Psychological overtraining is more change may be indicative of the onset of postpractice weights), as well as periodic difficult to address. The most effective overtraining syndrome (21). measures of percent body fat and blood way to treat it involves psychological re- Prolonged, excessive thirst also may pressure, especially postexercise recovery programming. In mild cases, this may be be a symptom (21), for example, increased blood pressure. accomplished by a change in workouts or

Volume 27 * Number 4 . 1992 . Journal ofAthletic Training 353 training routines. Henschen (10) suggests trainer's role always has been, first and 11. Keast D, Cameron K, Morton AR. Exercise and the alterations in training to reduce staleness, foremost, the prevention of injury. The immune response. Sports Med. 1988;5:248-267. 12. Keizer HA, Rogol AD. Physical exercise and men- including: 1) scheduling of time-out from athletic trainer can play an effectiverole in strual cycle alterations. What are the mechanisms? training, even during the competitive sea- the prevention of overtraining syndrome Sports Med. 1990;10:218-235. W. Das Uebertraining-Ausdruck einer some the of coaches and by 13. Kindermann son; 2) allowing the athlete to make through education vegetativen fehisteuerung. Deutsche Zeitschrift fur decisions and control outcomes; 3) plan- early recognition of the signs and symp- Sportsmedizin. 1986;H8: 138-145. ning mentalpractice periods asbreaksfrom toms in athletes. This will allow each 14. Kupiers H, Keizer HA. Overtraining in elite athletes. Review and directions for the future. Sports Med. physical practice; and 4) devising a way to athlete to achieve optimal performance. 1988;6: 79-92. handle post- competition tension. With 15. Mellerowicz H, Barron DK. Overtraining. In: Larson severe psychological staleness, complete References & Leonard, eds. Encyclopedia ofSports Sciences and . New York, NY: MacMillan; 1971:1310- abstention from training may be necessary 1. Anthony J. Psychological aspects of exercise. Clin SportsMed. 1991;10:171-180. 1312. (22). 2. Barren JL, Noakes TD, Levy W, Smith C, Millar, RP. 16. Morgan WP, Brown DR, Raglin JS, O'Connor PI, Overtraining syndrome is a complex Hypothalamic dysfunction in overtrained athletes. J EllicksonKA. Psychologicmonitoring ofovertraining and staleness. BrJ Sports Med. 1987;21:107-114. condition with no two cases exhibiting ClinEndocrinolMetab. 1985;60:803-806. 3. Budgett R. Overtraining syndrome. BrJ Sports Med. 17. Parry-Billings M, Blomstrand E, McAndrew N, exactly the same symptoms. Although 1990;24: 231-236. Newsholrne EA. A communicational link between skeletalmuscle,,and cellsofthe immunesystem. are most 4. Dressendorfer RH, Wade CE. Muscular overuse syn- elite athletes who train heavily the Int JSports Med. 1990;11 (suppl 2):S122-128. to the syndrome, recre- drome in long-distance runners. Phys Sportsmed. likely experience November 1983; 11:117-127. 18. Puffer JC, McShane JM. Depression and chronic fa- ational athletes can also overtrain by doing 5. Dressendorfer RH, Wade CE, Iverson D. Decreased tigue in the college student-athlete. Prim Care. 1991;18:297-308. too much too soon, by failing to get ad- plasma testosterone in overtrained runners. Med Sci 19. Puffer JC, Zachazewski JE. Management of overuse or Sports Exerc. 1987;19:10-14. equate rest between exercise bouts, by 6. Dressendorfer RH, Wade CE, Scaff JH. Increased injuries. Am Fam Physician. 1988;38:225-232. 20. Raglin JS. Exercise and mental health. Beneficial and ignoring early indications of overuse inju- moming heart rate in runners: a valid sign of detrimental effects. Sports Med. 1990;9:323-329. ries. Five changes commonly appear in overtraining? Phys Sportsmed. August 1985;13:77- 86. 21. RyanAJ,BurkeER,FalsettiHL,FrederickEC,Brown overtrainedathletes: 1) anincrease inmom- 7. Feicht CB, Johnson TS, Martin BJ. Secondary RL. Overtraining of athletes (round table). Phys ing (resting) heart rate; 2) unexplained amenorrhoea in athletics. Lancet. 1978;2:1145-1153. Sportsmed. June 1983;1 1:92-1 10. weight loss; 3) prolonged excessive thirst; 8. Girard DE, Arthur RJ, ReuleriB. Psychosocial events 22. Stamford B. Avoiding and recovering from and subsequent illness-a review. West J Med. overtraining. Phys Sportsmed. October 1983;1 1:180. 4) an alteration in sleep habits; and 5) 1985; 142:358-363. 23. Veale DM Psychological aspects of staleness and dependence on exercise. Int J Sports Med. 1991;12 malaise. 9. Henschen KP.Personal growth to a peakperfomnance; psychological (suppl 1):S19-22. Because each athlete has a different athletic staleness and bumout: diagnosis, prevention and treatment. In: Williams JM, ed. Applied Sport 24. Verma SK, Mahindroo ST, Kansal DK. Effect of four threshold for overtraining, each will re- Psychology. MountainView, Calif: MayfieldPublish- weeks ofhardphysical training on certain physiologi- spond differently. A training program that ing; 1986:327-342. cal and morphological parameters ofbasketball play- ers. J Sports Med Phys Fitness. 1978; 18:379-384. one into severe 10. Henschen KP. Prevention and treatment of athletic pushes athlete overtraining staleness and bumout. Sci Period Res Technol Sport. 25. WolfJG. Staleness. In: Larson & Leonard, eds. Ency- syndrome may produce record-breaking May 1990; 10:1-8. clopediaofSportsSciences andMedicine. New York, performances in another. The athletic NY: MacMillan; 1971:1048-1050.

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