Do I Have Overtraining Syndrome?

Far less straightforward than a torn tendon that shows up on an MRI, overtraining syndrome is a bit nebulous.

Photo: Nils Nilsen

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Far less straightforward than a torn tendon that shows up on an MRI, overtraining syndrome is a bit nebulous. It’s difficult to define but obvious when it happens. Here are some of the most well-known symptoms:


The psychological aspects of overtraining syndrome are typically related to athlete mental burnout. The athlete isn’t having fun, he treats every training session like work and he often dreads his races. Different than performance anxiety, these athletes are just exhausted—and look it.

The treatment for psychological burnout is tougher than the diagnosis. Often friends and training partners, or even spouses, can help dial back the intensity level and inject a dose of realism. In more serious cases, treatment may require the expert help of a mental health professional. The more serious cases tend to come from athletes who focus all their mental energy on triathlon as a means of escaping problems such as divorce or job stress. Health professionals can help make triathlon part of the solution, not the problem. I’d recommend finding someone who is an athlete as well—as a triathlete myself, I know that the worst advice is “stop training.”

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The physical aspects of overtraining syndrome are easier to spot. These include both orthopedic and medical causes.

Orthopedic cases are generally classified as “high risk” overuse injuries. Examples include stress fractures around the hip and high-grade partial tears of tendons from repetitive use. These are different than garden-variety overuse injuries because they take huge amounts of stress and joint loading to occur. Athletes who suffer these types of injuries tend to disregard the body’s cues of pain and make painful injuries much worse. They push and push until injuries go from bad to terrible, often taking many months to heal.

Treatment of orthopedic-related overtraining syndrome includes both backing off the training volume and trying to figure out, with your doc, how to design a training program that is safer for your body.

Medical issues, meaning non-bone-related issues, are very common in overtraining syndrome. These include athletes who are always sick and tired, and just look unhealthy. Again, there are no specific parameters here. But things that I look for in my office include athletes who are sick for weeks on end, complain of exhaustion and drop large amounts of weight too quickly.

Treatment of medical-related overtraining syndrome involves both a reduction in training volume and consultation with a sports nutritionist who can help address the caloric imbalance. Your doc should also send off a series of blood tests to check for anemia, a common cause of fatigue particularly in female endurance athletes.

Overtraining syndrome can show itself differently in different athletes. The keys are to first recognize if you or a fellow athlete is suffering from it, and then to find a team of healthcare professionals who deal with athletes to help address the causes.

Jordan D. Metzl, M.D., is a nationally recognized sports medicine specialist at Hospital for Special Surgery in New York City. Dr. Metzl is a 29-time marathon runner and nine-time Ironman finisher. His new book is titled The Athlete’s Book of Home Remedies.

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