A Review of Overtraining Syndrome-
Recognizing the Signs and Symptoms
ABSTRACT: Overtraining syndrome is
common in athletes. It manifests itself with
both physiological and psychological
symptoms, and can adversely affect an
athlete'sperformance. This article reviews
the physiological and psychological signs
and symptoms ofovertraining syndrome in
order to help the athletic trainer recognize
the condition. With an understanding of
overtraining syndrome, the athletic trainer
can better aid coaches and athletes in
preventing and treating this phenomenon,
and thus maintain the athlete's optimal
performance level.
O vertraining syndrome has been re-
ferredto as "staleness," "overreach-
ing," and "chronic fatigue" (21). It can
result in mental lassitude and/or physical
injury and therefore a declining perfor-
mance (21). Most simply put, overtraining
syndrome is the point at which an athlete
exceeds his/her capacity for exercise (22).
It has both psychological and physiologi-
cal components that should be recognized
by those working with athletes.
The athletic trainer is in a unique
position to recognize symptoms of
overtraining. Acting as a health care
liaison, the athletic trainer can work with
the physician, the coach, and the athlete
toward returning the athlete to optimal
performance levels. The purpose of this
paper is to review the physical and psy-
chological manifestations of overtraining
syndrome and to outline those signs and
symptoms that could be monitored by the
athletic trainer.
Mary Black Johnson is an assistant
professor in the Department of Physical
Education (Athletic Training) at San Di-
ego State University in San Diego, CA.
Steven Thiese holds a master's degree
in athletic management from the Univer-
sity of Utah, Salt Lake City, UT.
352 Volume 27 a Number4 a 1992
Physiological Indicators
Numerous physiological characteris-
tics of overtraining syndrome are docu-
mented in the literature (3,10,14; Table 1).
In an overtrained athlete, an overactive
pituitary gland is primarily responsible for
physiological responses to overtraining.
Stimulation of the hypothalamus causes
the pituitary gland to secrete excess adre-
nocorticotropic hormone. This, in turn,
stimulates cortisol secretion by the adrenal
cortex, which aids the body in adapting to
stress. Barron et al (2) reported that corti-
sol levels were significantly higher in ath-
letes who had overtrained than in the same
athletes after they had4 weeks of rest. The
elevation of cortisol levels in overtrained
athletes in this study was observed imme-
diately following exercise, as well at 15
and 30 minutes postexercise.
The humanreproductive system also
is adversely affected by overtraining syn-
drome, with luteinizing hormone (LH)
levels decreasing when the athlete is
overtrained (5,7,12). In women, LH de-
crease is associated with decreased per-
cent of body fat and associated decreased
levels of estrogen. Overtraining in fe-
males is often manifested by amenorrhea
(7,12). In men, decreased LH results in
decreased testosterone and a resultant in-
ability to build muscle mass (5).
Overtraining also affects the muscu-
loskeletal system. One report documents
that serum creatine kinase (CK), an enzy-
matic marker of muscle tissue injury, is
elevated in athletes on mornings after run-
ning (4). The researchers hypothesized
that the athlete who loses weight andmuscle
girth while training is undergoing catabo-
lism, metabolizing muscle protein stores
for energy. The net result is a decrease in
performance.
The musculoskeletal system also re-
sponds to overtraining with overuse inju-
ries. The three most common overuse
injuries associated with overtraining are:
posterior tibialis syndrome, lower limb
m Journalof Athletic Training
Mary Black Johnson, PhD, ATC
Steven M. Thiese, MS
stress fractures, and tendinitis conditions
in the lower extremities (4, 19). It is un-
clear whether overuse injuries associated
with overtraining are the result of exces-
sively high training loads or the body's
impaired ability to recover from training
bouts.
Still another of the body's systems
affected by overtraining syndrome is the
cardiovascular system. Overtrained ath-
letes exhibit elevated exercise heart rates
and require longer for their heart rate to
return to normal following activity (4).
Early studies found both increased (15)
and decreased (25) resting blood pressure
in overtrained athletes. More recently,
Henschen (10) reported that higher sys-
tolic blood pressure was a physiologic char-
acteristic of overtraining. Verma et al (24)
observed a lengthened time to return to
basal blood pressure levels after exercise
in overtrained athletes.
Finally, overtraining can lead to de-
creased immunity (17). One report docu-
ments a decrease in C-reactive protein af-
ter intense exercise (11). An acute phase
response may be exhibited in overtrained
athletes, detectable as fever, leukocytosis,
a drop in serum iron and zinc, and a rise in
serum copper and erthyrocyte sedimenta-
tionrate. In addition, increasedheadcolds,
allergic reactions, and other infections have
been associated with overtraining.
Psychological Indicators
The psychological factors associated
with overtraining syndrome are more dif-
ficultto detectthan the physiological ones
(9; Table 1). According to one sports
psychologist, psychological overtraining
is characterized by sleep disturbances (and
associated drowsiness), prolonged exces-
sive weariness, chronic fatigue, and loss
of vigor (9,18,23). In addition, loss of
self-confidence, apathy, irritability, de-
pression, anxiety, and confusion also are
exhibited (10,18). An overtrained athlete
may exhibit emotional and motivational
 Table 1.-Physiological and Psychological
Indicators of Overtraining Syndrome
Physiological
1. Higher restng heart rate
2. Changes in normal blood pressure
3. Delayed return to normal heart rate
4. Elevated basal metabolic rate
5. Elevated body temperature
6. Weight loss/excessive thirst
7. Impeded respiration
8. Subcostal aching
9. Bowel disorders
Psychological
1. Sleep disturbances
2. Loss of self-confidence
3. Drowsiness and apathy
4. Irritability
5. Emoiol ad monvato imbaan
6. Excessive, prolonged weariness
7. Lack of appetite (anorexia)
8. Fatigue
9. Depression
10. Anxiety
11. Anger/hostility
12. Confusion
imbalance, anger, and hostility (10,18),
and mood swings are common (13,23).
Eating disorders and generalized loss of
appetite also are observed (16).
Signs and Symptoms
Although manifestations of over-
training syndrome differ from person to
person, five main signs and symptoms com-
monly appear in overtrained athletes. The
first is an alteration in the circulatory sys-
tem. Increased morning (resting) heart
rate, or more specifically, an increase of
more than five beats per minute is indica-
tive of an overtrained state (6,21). Abnor-
mal changes in blood pressure (without
indicating the direction of change), par-
ticularly increased resting blood pressure,
also may indicate overtraining.
A second sign of overtraining syn-
drome is unexplained weight loss. Body
composition is altered by training, with the
lean body mass increasing and the percent-
age of body fat decreasing. An athlete's
body fat is already lower than the
nonathlete's. Thus, an additional decrease
in percent of body fat or a 5-pound weight
change may be indicative of the onset of
overtraining syndrome (21).
Prolonged, excessive thirst also may
be a symptom (21), for example, increased
evening fluid intake. The athlete may
exhibit signs of dehydration and may drink
copious amounts of fluid after practice.
This athlete also may have a lack of perspi-
ration during practice since the body is
attempting to maintain fluid balance by
retaining fluids.
Another symptom of overtraining syn-
drome is an alteration in sleeping patterns
(9,16,20). Sleep is how the body replen-
ishes itself. If an athlete gets inadequate
sleep, the body is denied its optimal re-
covery time. Disruption of normal sleep
patterns-such as time to bed and the
amount and quality of sleep-alters the
ability of the body to adapt to the stress of
training.
The final symptom is general psycho-
logical malaise (1,8,13). An alteration in
the athlete's mood or approach to his/her
sport may be a signal of staleness. An
inability to maintain the training schedule
or to be psychologically prepared for com-
petition may be apparent.
Recognition
The causes of overtraining syndrome
are associated with physical training and
competition (10; Table 2). As has been
mentioned, there are a number of scientific
assays and measures that can indicate
overtraining in an athlete. Many of the
tests that can be employed are either too
expensive or too invasive to be practical.
There are, however, several simple ways
the athletic trainer or coach can watch for
signs of overtraining syndrome.
Table 2.-Causes of Overtraining Syndrome
1. Length of the competitive season
2. Monotony of training
3. Feelings of claustrophobia
4. Lack of positive reinforcement
5. Feelings of helplessness
6. Abusiveness from authorities
7. Stringent rules
8. High levels of competitive stress
Maintaining a written record will help
the athletic trainer or coach detect psycho-
logical andphysiological overtraining. This
involves keeping current and regular
records of weight (particularly pre- and
postpractice weights), as well as periodic
measures of percent body fat and blood
pressure, especially postexercise recovery
blood pressure.
Volume 27 * Number 4 . 1992 . Journal of Athletic Training
The athlete should maintain records
of morning heart rate and records of fluid
and dietary intake throughout the training
and competitive seasons. The amount and
quality of sleep the athlete gets each night
should also be recorded. These records
should be reviewed regularly by the coach
and/or the athletic trainer, as changes in
established baseline levels of these mea-
surements could signify an increased risk
of overtraining for the athlete. In addition,
the athlete should be encouraged to main-
tain a diary assessing his/her emotional
outlook. It may be helpful to have an
objective assessment of the athlete's men-
tal outlook. This can be accomplished
using psychological tests such as the Pro-
file of Mood States (POMS) (9).
These steps, at first, may appear ex-
cessive. It may be impractical to expect
athletic trainers to monitor all athletes for
signs and symptoms of overtraining. In
reality, only periodic review is necessary
to assess changes in the five areas that
indicate overtraining syndrome. Addition-
ally, the athletic trainer is in a unique posi-
tion to educate coaches regarding this syn-
drome. Through these means, the coach
can monitor the athletes and direct their
training toward eliminating and preventing
overtraining syndrome.
Prevention and Treatment
Recognizing overtraining syndrome
may be vital to its prevention; however,
recognition is only afirst step. Treating the
syndrome involves attenuation of both
physical and psychological symptoms.
Physical symptoms should be dealt with
first. This may involve a reduction or
layoff from training to allow adequate re-
covery from ailments such as stress frac-
tures or lingering illnesses. It does not
mean the athlete cannot maintain general
fitness with alternative training. Research
suggests that increases in fitness from re-
training are similar to initial training, but
that the gains are perceived by the athlete
as easier and more rapid (22). This may be
because of familiarity with the training
process, alack of fear, and/or confidence in
the outcome. Observable signs of
overtraining syndrome can be used as
guides for a gradual return to the athlete's
previous training levels.
Psychological overtraining is more
difficult to address. The most effective
way to treat it involves psychological re-
programming. In mild cases, this may be
accomplished by a change in workouts or
353

training routines. Henschen (10) suggests
alterations in training to reduce staleness,
including: 1) scheduling of time-out from
training, even during the competitive sea-
son; 2) allowing the athlete to make some
decisions and control outcomes; 3) plan-
ning mental practice periods as breaks from
physical practice; and 4) devising a way to
handle post- competition tension. With
severe psychological staleness, complete
abstention from training may be necessary
(22).
Overtraining syndrome is a complex
condition with no two cases exhibiting
exactly the same symptoms. Although
elite athletes who train heavily are the most
likely to experience the syndrome, recre-
ational athletes can also overtrain by doing
too much too soon, by failing to get ad-
equate rest between exercise bouts, or by
ignoring early indications of overuse inju-
ries. Five changes commonly appear in
overtrainedathletes: 1) anincrease inmom-
ing (resting) heart rate; 2) unexplained
weight loss; 3) prolonged excessive thirst;
4) an alteration in sleep habits; and 5)
psychological malaise.
Because each athlete has a different
threshold for overtraining, each will re-
spond differently. A training program that
pushes one athlete into severe overtraining
syndrome may produce record-breaking
performances in another. The athletic
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trainer's role always has been, first and
foremost, the prevention of injury. The
athletic trainer can play an effective role in
the prevention of overtraining syndrome
through the education of coaches and by
early recognition of the signs and symp-
toms in athletes. This will allow each
athlete to achieve optimal performance.
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