What is it?
Overtraining syndrome occurs when an athlete’s training schedule is too much to allow for his/her body to recover. It often is the reason that the athlete’s performance declines despite increasing the training schedule and intensity of training. Poor performance continues even after weeks to months of recovery.

Risk Factors
• Early single sport specialization • Significant increase in training over a short period of time • Training for an important event • Excessive parental and/or coach pressure to succeed

Symptoms
• Increased fatigue • Decreasing performance • Sleep problems • Anxiety • More frequent injuries • Frequent illness • Bradycardia or tachycardia • Irritability • Weight loss • Depression • Lack of mental concentration • Vague muscle and/or joint pain

Sports Medicine Evaluation
The sports medicine physician will ask detailed questions about the athlete’s current training schedule and the actions that have been taken to help with the symptoms being experienced. He/ she will also obtain a dietary history. The physician will then perform a comprehensive physical exam. Depending on the findings of the comprehensive history and physical exam, the doctor may order laboratory studies, and ask the athlete to complete a questionnaire about mood and behavior. If overtraining syndrome is suspected and all other diagnoses are ruled out, a period of rest for 3-5 weeks is generally recommended, followed by a gradual return to full training over an additional 3 months. Alternatively, non competitive, low level recreational physical activity may be allowed during this modified rest period to maintain some cardiovascular fitness. Psychotherapy and counseling may also be prescribed as part of the treatment.

Injury Prevention
• A training log should be maintained. • Intense exercises with short rests, and frequent competition, should be avoided. • Weekly and yearly participation time should be limited. • Early morning heart rate should be monitored. • Sudden increases in training load should be avoided and a steady increase of 5% intensity per week should be followed. • Skill development, rather than competition and winning, should be emphasized with young athletes

Return to Play
A period of reduced training and competition stress is generally recommended for up to 4 months.

AMSSM Member Authors
Kristina Wilson, MD

References
Budgett R. Overtraining syndrome. Br J Sport Med 1990;24(4):231-36.

DiFiori JP, Benjamin HJ, Brenner J, Gregory A, Jayanthi N, Landry GL, and Luke A. Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Clin J Sport Med 2014;24:3-20.