DR. PENNY KENDALL-REED, ND 2022-01-25 20:38:44
Overtraining syndrome diagnosis and treatment
Overtraining syndrome (OTS) is becoming increasingly common in athletes at all levels. Part of this increase relates to improved awareness and diagnosis, but a significant factor is the cumulative and synergistic impact of athletic stress and lifestyle stress. The incidence of OTS in elite runners approaches 60% and even in non-elite competitive runners nearly a third will develop OTS at some point. Preventative management and early recognition are essential to ensure the condition does not progress to a potentially dangerous and sport-ending stage. One of the most important challenges in OTS is recognizing it early. Once established, treatment becomes much harder and more prolonged.
Diagnosis relies on several areas of evaluation:
Rule out organic disease
A number of organic diseases can present in a similar way to OTS and are often overlooked as the population tends to be younger and disease uncommon: Undiagnosed lung disease (asthma); Hormonal Disease (Thyroid, Diabetes); Anaemia; Infection (hepatitis, HIV, myocarditis, Lyme, EBV); Malnutrition/Eating Disorder (RED-S).
[RED-S or Relative Energy Deficiency Sport is a low-energy state resulting from inadequate nutrition relative to the degree of training. Originally known as the Female Athlete Triad (anorexia, amenorrhoea, osteoporosis) it is now known to affect both men and women equally. Although similar in presentation, it can be distinguished from OTS. RED-S is predominantly a low-energy rather than low-performance state; there are stronger food anxiety and body image issues; amenorrhea is more common as is low libido and erectile dysfunction; bone injury (stress fractures) occur rather than muscle injury; RED-S is easily reversed with appropriate nutrition.]
Performance testing
Physical and mental testing appears to be the most reliable and useful method of assessing impending or established OTS. Such tests include time-to fatigue tests, sport specific maximum aerobic function tests and strength or power tests in appropriate sports. The Profile of Mood State questionnaire (or POMS) is a simple test with good reliability in diagnosing OTS.
Treatment
Rest, rest and more rest is the key. This is often incredibly difficult for an athlete to accept so involving a sports psychologist can be helpful. Allowing cross training can overcome some of the inevitable despondency resulting from a halted season. Restore sleep, one of the most essential factors in healing and improve nutrition ad hydration. Consider the following supplements: Glutamine – 5 grams per day; Liposomal Glutathione – 250mg twice a day; Resveratrol – 100mg twice a day; Sereniten Plus – 2 capsules twice a day (to address stress pathway imbalance).
Reduction in activity and training needs to be quite profound and surprises most athletes. However, failure to adhere to an appropriate rest and recovery protocol will result in a high likelihood of relapse.
Genetics and OTS
Certain individuals may be faster, stronger, show greater endurance or have better agility and coordination. Part of this relates to training, diet and other external factors that might be termed “nurture.” Fifty to 60%, however, is due to “nature,” essentially our genetic makeup. There is increasing evidence that our coding for certain genes has a profound influence on everything from muscle fibre mass and composition to oxygen utilization and recovery from injury. Knowledge of an athlete’s genetic profile can be tremendously important in terms of training and nutrition. Tuning diet and fitness protocols to make them more suited to an individual’s “nature” will not only improve performance, but also reduce risk of injury and OTS.
Genes affecting risk of OTS: ACTN-3 affects sprint vs. endurance muscle fibres; ACE affects muscle blood flow and nutrition; IL-6 affects inflammation, damage, repair and recovery; TNF-alpha affects inflammation and injury.
In addition, the following genes affect nutrition and tendon function: FTO determines protein requirement; TCF7L2 controls carbohydrate handling; APOA2 determines response to dietary fats; MMP3 and COL1A1 affect sensitive ty of tendons and ligaments to injury.
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