Overtraining Syndrome

What is overtraining syndrome?

Overtraining syndrome (OTS) is a condition that happens when you exercise too often or too intensely for long enough that it starts to hurt your body. It usually affects athletes — especially people training competitively.

It’s important to give your body time to rest and recover after any intense physical activity, especially if you’re trying to push your limits to get better at a sport or activity.

Overtraining syndrome causes physical symptoms, but it can also affect your mental and emotional health. Visit a healthcare provider if you notice symptoms like pain, fatigue and a sudden dip in your performance.

Types of overtraining syndrome

Healthcare providers divide overtraining syndrome into three stages based on where it’s affecting you and which type of symptoms you’re experiencing:

• Stage 1 overtraining syndrome (functional overtraining): Stage 1 OTS causes mild symptoms that may be hard to notice or tell apart from usual aches and pains after training. Your body is giving you warning signs that it’s not recovering properly between sessions of activity.
• Stage 2 overtraining syndrome (sympathetic overtraining syndrome): Stage 2 OTS causes symptoms that affect your sympathetic nervous system, the part of your nervous system that controls your body’s response to stress — your “fight-or-flight” response. Some providers refer to stage 2 OTS as Basedow’s overtraining syndrome.
• Stage 3 overtraining syndrome (parasympathetic OTS): Stage 3 OTS causes symptoms in your parasympathetic nervous system, which relaxes your body’s systems. Stage 3 OTS is usually the most severe and takes the longest to recover from. Some providers call it Addison’s overtraining syndrome.

Overtraining syndrome isn’t always a progressive condition. That means not everyone with OTS starts at stage 1 then develops stage 2 and then 3 in order. It’s possible to have any stage without the others — it depends where you’re experiencing symptoms and how OTS affects you.

How common is overtraining syndrome?

It’s hard to know for sure how many people have overtraining syndrome at any one time. Studies estimate that around two-thirds of elite runners will experience it at some point. Around one-third of all runners (regardless of competitive status) experience it.

Experts think around a third of all competitive or high-level athletes experience OTS at some.

What are overtraining syndrome symptoms?

Overtraining syndrome can cause physical and mental (psychological) symptoms. Which symptoms you experience usually depends on which stage of OTS you have.

Stage 1 overtraining symptoms include:

• Muscle pain and stiffness.
• Unexpected weight loss or weight gain.
• Anxiety.
• Poor sleep, or waking up feeling tired.
• Getting sick more often with minor issues like colds.

Symptoms of stage 2 overtraining syndrome (sympathetic overtraining syndrome) can include:

• Insomnia.
• Mood changes like feeling irritable, agitated or restless more often than usual.
• Tachycardia (an unusually fast heartbeat, more than 100 beats per minute at rest).
• High blood pressure (hypertension).

Symptoms of stage 3 overtraining syndrome (parasympathetic overtraining syndrome) can include:

• Fatigue (feeling extremely tired all the time).
• Depression.
• Losing motivation to train or be active.
• Bradycardia (an unusually slow heartbeat, lower than 60 beats per minute at rest).

What causes overtraining syndrome?

It may seem obvious, but training, practicing or working out too much causes overtraining syndrome. It’s natural to want to improve, especially if you’re a competitive athlete.

Lots of athletes grow up hearing “no pain, no gain,” but that’s actually not the safest way to get better at your sport. Pushing your body past its limit too often, or too much at once, can hurt you more than it helps.

Overtraining can sometimes mean training too often without giving your body enough time to rest and recover between sessions. It can also mean suddenly ramping up how intensely you train. For example, you can develop overtraining syndrome if you’re a runner and go for long runs every single day, even if it hurts or you feel sick afterward. You can also get overtraining syndrome by suddenly doubling how far you go on your regular runs without building up your endurance.

What are the risk factors for overtraining syndrome?

Anyone who’s physically active can develop overtraining syndrome. Competitive or high-level athletes actively trying to improve or maintain an elite performance level have a higher risk, especially if you’re ramping up training before a meet or competition.

Kids and teens who specialize in one sport early have an increased risk for overtraining syndrome. Children who feel pressured to be the best or win no matter what are also more likely to develop it.

Sports that track performance based on races or time trials are more likely to cause overtraining syndrome, including:

• Running.
• Swimming.
• Cycling.

What are the complications of overtraining syndrome?

Sports injuries are the most common complication of overtraining syndrome. If your body is pushed past its limits, you have an increased risk for:

• Repetitive strain injuries.
• Sprains.
• Muscle strains.
• Tendinitis.
• Cartilage tears.
• Joint injuries.

How is overtraining syndrome diagnosed?

A healthcare provider will diagnose overtraining syndrome with a physical exam, discussing your health history and, sometimes, blood tests. They’ll examine your body and discuss your symptoms. Tell your provider when you first noticed symptoms, and if certain training styles or activities make them worse.

Your provider will ask you about your overall health, including your:

• Training regimen (especially if you’ve changed it recently).
• Sleep.
• Nutrition.
• Injury history.
• Mental and emotional health.
• Substance use, including alcohol, prescription medicine and recreational drugs.

Providers may follow a loose checklist to diagnose overtraining syndrome:

• Have you noticed a drop in your performance or ability, even after getting plenty of rest and recovery?
• Are you experiencing mood changes or mental health symptoms?
• Can your symptoms be explained by other health conditions or injuries affecting your performance?

Which tests do providers use to diagnose overtraining syndrome?

There’s not one test that can confirm for sure that you have overtraining syndrome. Diagnosing it is usually part of a differential diagnosis. This means your provider will probably rule out other conditions that can be causing your symptoms before diagnosing you with OTS.

Your provider may use a few tests, including:

• Blood tests to check your blood glucose (blood sugar levels). Blood tests can also show extra levels of certain enzymes in your blood that mean something is damaging your muscles. High urea, uric acid, ammonia or creatine kinase in your blood can be signs of OTS.
• Urine tests (urinalysis) to check your kidney function and examine your pee for signs of infection or other issues that can cause your symptoms. Unusually high levels of cortisol in your pee can mean you have OTS.
• Pulmonary function tests to show if your lungs or respiratory system are affected.
• An electrocardiogram (EKG) to check your heart function.

How is overtraining syndrome treated?

The best way to treat overtraining syndrome is to rest and give your body time to recover. How long you’ll need to stop competing or training depends on how severe your symptoms are. Your provider will suggest a period of rest that matches how much OTS is affecting your body and performance.

You might be able to do light workouts or exercise a little, but don’t push your body. If you ramp up training again before you’ve recovered, you can reset all your progress and make overtraining syndrome worse than it originally was (chronic overtraining syndrome).

Your provider will suggest the best way to reduce your activity, but a general rule is a set of steps, including:

• Stopping high-intensity training (sessions designed to push your limits or max out your performance).
• Reducing your training intensity and how often you do it (usually anywhere from 50% to 70%).
• Complete rest (stop training and competing).

Your provider might suggest you meet with a mental health specialist if you’re experiencing mental or emotional symptoms. Psychotherapy can help you manage your feelings and change unhealthy emotions and thoughts.

How long does overtraining syndrome last?

Everyone’s body is different, and your provider will tell you how long you need to rest. How long you have OTS depends on which stage you have or how severe the overtraining was.

In general, the earlier stages usually last for around few weeks. More severe stages can last for months or longer.

How can I prevent overtraining syndrome?

Giving your body time to rest and recover between sessions of intense activity is the best way to prevent overtraining syndrome. It might sound too simple, but not overtraining will help prevent overtraining syndrome before you develop symptoms.

Listen to your body and learn OTS warning signs. Don’t push through pain or other symptoms. If you’re training for a specific goal or event, consider working with a coach or trainer who can design a customized training regimen for you. They’ll help you reach your goals and improve your limits safely.

What can I expect if I have overtraining syndrome?

You should expect to decrease the intensity of your physical activities while you recover. If you have a more severe stage of OTS, you might need to take a break from your sport or training completely.

Lots of athletes who develop overtraining syndrome are surprised when they find out how long they need to rest. But don’t rush your recovery. Talk to your provider about which kinds of activities are safe to do while you’re recovering.

Once you’re cleared to return to full training, try to avoid pushing your body too hard in the future. It can help to keep a workout journal or diary where you track your performance and any changes or symptoms. Having a record to look back on can help you recognize OTS warning signs before they cause issues.

When should I see my healthcare provider?

Visit a healthcare provider as soon as you notice any overtraining syndrome symptoms. Talk to a provider if you feel like your mood or mental health is different enough for you or your loved ones to notice.

There’s never a bad time to see a provider. Don’t ignore minor symptoms or injuries. Overtraining syndrome warning signs can be subtle and easy to dismiss as “just part of the process,” but it’s better to get small injuries or symptoms checked out before they cause bigger issues.

What questions should I ask my healthcare provider?

You may want to consider asking your provider:

• Do I have overtraining syndrome or another issue?
• Which stage or type of OTS do I have?
• How long will overtraining syndrome last?
• How much should I reduce my training or activity level?
• How long do I need to rest?