Overtraining Syndrome (OTS) describes a combination of physical and mental abnormalities that result from cumulative high-level physical activity that is not accompanied by adequate recovery.  OTS is generally used to refer to an abnormal and persistent state characterized by physical, mental, hormonal and immunological dysfunction.  Older terms include “burnout” (more commonly used now for non-athletic stress), staleness, adaption failure, training stress syndrome and unexplained underperformance syndrome.

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.  If you suspect OTS then early assessment by a sports medicine physician or knowledgeable sports therapist or trainer is essential. 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.)

OTS Symptoms

  • Decreased performance
  • Excessive fatigue
  • Muscle pain
  • Mental/Emotional disturbance (agitation, depression, poor concentration, poor motivation)
  • Insomnia
  • Appetite disruption/Thirst
  • Weight loss/gain
  • GI upset
  • Recurring or non-healing injuries
  • Recurrent colds/infections

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.  By assigning values to self-perceived issues including fatigue, vigour, tension, anger, confusion and depression an overall emotional state score can be recorded and monitored.


Once an athlete shows signs of OTS then treatment needs to be instituted quickly and thoroughly in order to be effective.  Ignoring signs or taking half-measures will result in further deterioration and an even longer recovery.

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

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:

All athletes are not created equal!  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”.   50-60%, 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 sensitivity of tendons and ligaments to injury