OTS: Over Training Syndrome. Do you have any of these symptoms ? A blog post & 2 podcasts for you on the topic.

photo: courtesy of pixabay.com

Made famous in the beginning, first it was Alberto Salazar.  Now, just in the last decade it has been Anna Frost, Anton Krupicka, Geoff Roes, Kyle Skaggs, even Mike Wolfe. One by one they have fallen, to OTS.  More frighteningly, how many more have fallen to OTS that we never hear about? How many hundreds or thousands walking amongst us have OTS ? If you are a distance or heavy volume training athlete, do not brush off or take lightly what I have complied here today.

OTS, "Overtraining syndrome" is its name, but perhaps a better one would be "Insufficient Recovery Syndrome".  To use the broadest of terms, this is a self-generated, self-perpetuating dis-ease of one's own homeostasis. To be clear, there is a continuum here of multi-system failure, softer less severe forms of OTS. These less damaged states are referred to as Overreaching syndrome (OR). There are two forms of Overreaching syndrome, Functional OR and Nonfunctional OR. Nonfunctional OR shows decreases in performance for weeks to months while OTS being more severe and requiring months to years for recovery despite rest.

Here are 2 podcasts for you on the topic:

Listen to Sweat Science: The Mysterious Syndrome Destroying Top Athletes from Outside Podcast in Podcasts. https://podcasts.apple.com/us/podcast/outside-podcast/id1090500561?i=1000442759399

Listen to Podcast 121: Carrying things, Overtraining Syndrome, Ankle Rocker and more from The Gait Guys Podcast in Podcasts. https://podcasts.apple.com/us/podcast/the-gait-guys-podcast/id559864138?i=1000384117922

Over the past 10 years the best of the best are falling, one by one, victim to "too much".  They have just pushed themselves too much, too far, too long. It is the latest biggest thing in running these days, how far can you run ? Marathons are no longer enough for some, they have to see if 50 miles or 100 miles, or more, are enough and that means running 100-160 miles a week. And what is even more scary, some of these runners are in high school and college, they are still growing kids.

The physiology of these people is failing, truly. Some might suggest they in some respects showing signs of a slow death.  “OTS is one of the scariest things I’ve ever seen in my 30 plus years of working with athletes,” says David Nieman, former vice president of the American College of Sports Medicine. “To watch someone go from that degree of proficiency to a shell of their former self is unbelievably painful and frustrating.” - Meaghen Brown Jun 12, 2015.  Outside online. 

The first reference in which OTS was suggested was by a researcher and athlete named Robert Tait McKenzie.  In his 1909 book, Exercise in Education and Medicine, he mentioned a “slow poisoning of the nervous system which could last weeks or even months.” Then in 1985 South African physiologist professor Timothy Noakes discussed what appears to be the same condition in "The Lore of Running". Runners examined by Noakes had so over exerted themselves that both mind and body were failing.

OTS is truly a deeper problem. This is an immune, inflammatory, neurologic and psychological problem as best as anyone can tell.  In essence it seems the body is slowly dying. The body's parasympathetic nervous system, the system that counteracts the ramping up of the sympathetic nervous system, fails to properly respond to bring the systems back into balance. This means that many of the physiologic responses to activity fail to properly return to baseline. This means that blood pressure, heart rate, breathing, digestion, adrenal and hormonal rhythms amongst many other things go awry. Even other important things begin to decline, things like normal restful sleep, sometimes even insomnia, libido decline, metabolism dysfunction, appetite problems and even heart rate recovery and recurrent colds and viral infections.  We are talking about multi-system failure in these people, and this is serious business. The problem is, these athletes do not listen to the signals until it is too late and they are in full blown multi-system decline or failure. 

Here is likely an incomplete list of things that might be slowing showing up, softly, one by one as multi-system failure ramps up:

- anemia
- chronic dehydration
- increased resting heart rate
- breathing changes
- digestive troubles , bowel troubles (ie. runners diarrhea)
- endocrine problems: adrenal and hormonal shifts
- insomnia and sleeplessness
- blood pressure changes
- libido changes
- metabolism and appetite changes
- recurrent colds and viral infections
- generalized fatigue
- muscle soreness
- recurrent headaches
- inability to relax, listlessness
- swelling of lymph glands
- arrhythmias
- depression (neurotransmitter dysfunction)

There is a way out of OTS. But, one has to wrap their head around the fact that one's goals and mental drive have pushed them to this point. This is one's own fault and they will have to take some hard advice and make some tough decisions, decisions they do not want to make, but ultimately will have no choice but to make. That means changing those goals and habits, otherwise this could get real serious real fast. And wrapping one's head around the toughest part will be the most painful part for most, many months of rest, sometimes a year or more, to fully recover if one hasn't done too much irreparable damage to begin with.  Of course, the immediate course of action is to see a doctor. Hopefully, a doctor who is familiar with elite athletes and one that can rule out any other more serious immediate health concerns and disease processes that can mimic OTS and OR syndromes.

As with solving most problems, one has to first start to realize one is heading towards a problem, and accept responsibility. In this case, over training and under recovering.  One must look at their habits, and the subsequent outcomes, and see if there are signs of impending problems and if so be willing to make behavioral changes. This is a hard thing for endurance athletes, because it is asking them to look at enjoyable, admittedly addictive, endeavors. Endeavors that have always improved many facets of their life, yet ones that have a double edged-sword nature to them which can very quickly chop down all the hard work that has been put in. Ultimately, the answer is balance, balance in all aspects of one's life. But, who is truly good with balance ? Very few of us I am afraid.

Dr. Shawn Allen, one of the gait guys
 

References:

Running on Empty By: Meaghen Brown Jun 12, 2015.  Outside online. 
https://www.outsideonline.com/1986361/running-empty

Sports Health. 2012 Mar; 4(2): 128–138.Overtraining Syndrome. A Practical Guide
Jeffrey B. Kreher, MD†* and Jennifer B. Schwartz, MD‡
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435910/

Med Sci Sports Exerc. 2013 Jan;45(1):186-205. Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the European College of Sport Science and the American College of Sports Medicine.
Meeusen R, Duclos M, Foster C, Fry A, Gleeson M, Nieman D, Raglin J, Rietjens G, Steinacker J, Urhausen A; European College of Sport Science; American College of Sports Medicine.

Open Access J Sports Med. 2016; 7: 115–122. Published online 2016 Sep 8.  Diagnosis and prevention of overtraining syndrome: an opinion on education strategies. Jeffrey B Kreher

Overtraining, Exercise, and Adrenal Insufficiency
KA Brooks, JG Carter
J Nov Physiother. Author manuscript; available in PMC 2013 May 9.
Published in final edited form as: J Nov Physiother. 2013 Feb 16; 3(125): 11717

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