Over Traning

OVERTRAINING DIAGNOSIS AND PROGNOSIS

Overtraining,a phenomenon described back in 1866,is the misfortune of athletes and the pitfall of inexperienced coaches and competitors.It is not a well defined entity and is thought to be an .imbalance between loading and recovery The diagnosis is made by ruling out other possible causes for fatigue together with supporting .evidence from the history of the illness and laboratory tests Treatment is based on correcting the primary causes for the development of the syndrom ,good .nutrition and plenty of rest MEDICAL HISTORY The tipical complaint by the athlete or coach is a decrease in the training performance,innability to complete the training session,prolonged recovery time,and disappointing competition results in spite of training harder.Sleep disturbances are often present,an icrease in resting heart rate,low fever and sometimes a higher incidence of upper respiratory tract infections,mostly viral.Loss of weight and .irritability might be present.In women,disturbances of the menstrual cycle is often a joint feature DIAGNOSIS In order to reach the correct diagnosis,several syndromes and diseases have to be ruled out or looked :into.Those are divided into three entities :Common causes for persistent fatigue )1 overtraining syndromeviral disease-: upper respiratory tract infection Infectious Mononucleosus Inadequate carbohydrate intakeDepletion of iron storesInadequate protein intakeInsufficient sleep:Less common causes for persistent fatigue)2 DehydrationExercise induced asthmaMagnesium,Zinc or vitamin B12 deficiencypost viral fatigue syndromeAllergic disordersJet lagAnaemiaPsychological stress:anxiety,depressionMedications: Beta-blockers,anxiolytic,antihystamines,post-concussive syndrome:Not to be missed)3 MalignancyCardiac problemsBacterial endocarditisDiabetes MellitusHypothyroidismRenal failureNeuromuscular disorders-

MalabsorbtionInfections)Hepatitis)A,B,CHIVMalaria)Eating disorders)anorexia nervosa,bolemiaPregnancyAcromegalyMyasthenia GravisTherefore,before pronouncing an athlete a casualty of this syndrome,a thorough anamnesisshould be :taken,looking into the past few month,asking hte following questions ?Does the patient fall asleep during the day ?Is there a constant feeling of fatigue or is it intermitent ?Does it happen on hot weather ?Does it occure during or after training ?How long have the symptomes been present ?Was there any associated disease recently ?Where there any oversease trip lately ?Are there any complaints of chest pain or tightness,weezing or coughing during or after exercise ?Could the athlete recall a sore throat,difficulties swallowing or swollen lymph nodes ?Where there any mental or sentimental problems that might have affected phisical performance .All this should be complemented by a full urine ,blood biochemistry and viral antibodies analysis A full medical examination should be performed to exclude medical causes of the syndrome: anemia or jaundice,presence of enlarged lymph nodes,cardiorespiratory examination,abdominal palpation to exclude liver or spleen enlargement,and a complete neurological examination to rull out the .developmment of a neuromuscular disease Nutrition diary A full three days nutrition diary should be taken in order to measure the nutritional intake of the athlete and to invastigate possible defficiencies in carbohydrate,protein,vitamines and mineral intake.It is not sirprising to reveal many mistakes in daily diets which could have contributed to the .development of overtraining Training diary The daily, weekly, monthly and even yearly training regiment has to be looked into for errors in the relations between stress and recovery.Some of the classical mistakes are found when the program is not tailored to the athlete’s anatomy and physiology. a steep increase in loads,too many competitions .and trying to regain lost form by overtraining Overtraining Short term overtraining occurs mostly as a result of failure to adapt to overload during training:a combination of exessive training load and and inadequate recovery time.At this stage , if the athlete rests and gives himself time to regenerate,the symptoms will disappear. However, in most cases, the reaction to decreased performance is increase in intensity and frequency of training which result in a .vicious cycle and leads to the development of the syndrom :Symptoms usualy associated with overtraining are Chronic fatigueDecreased performanceInability to maintain training loadsProlonged recovery time after exerciseMuscle sorenessHeadachesNauseaLoss of appetiteWeight lossThirst-

Loss of coordinationDecreased muscle strengthOveruse injuriesApathyAnxietyDepressionDecreased self esteemEmotional instabilityImpaired concentrationReccurent viral illnessSleep disturbancePhysiological changes Elevated resting heart rate and blood pressure,E.C.G. changes including increased amplitude of of Q.R.S. complexes and S-T changes,basal cortisol levels are elevated,testosterone levels are lower, a marked reduction in A.C.T.H. release,an elevated level of CPK, a reduced production of lactate,and .sleep patern changes Several immunological defficiencies are found including reduction in CD3,CD4,CD8, and natural killer cell counts which might play a part in the higher susseptibility for viral infections. Prevention of overtraining The most important component of the prevention is awerness of the problem, particularely amongst coaches.Introduction of modern training technics, periodization and use of regenerative methods such as massage, hydrotherapy, relaxation etc is of growing importance. Identifying the overzealus athlete, the athlete who is training without a coach and is basing his workouts on sports magazines publications,and the beginner who have achieved some initial success is of great importance. Viral disease,especialy with fever,have to be taken with due respect as we know that they might lead to serious complications, including cardiomyopathy and overtraining.Therefore,when having a fever, intense training is contraindicated and with mild fever )up to 38 centigrade) only light training is permited. Treatment When the presence of the overtraining syndrome has been established,rest ius the cornerstone of the treatment.In case of acute overtraining,48 to 72 hours would probably be sufficient,but in case of chronic overtraining,sleep, ample nutrition rich in vitamines ,protein ,carbohydrates,and minerals is reccomended.Relaxation and very light exercise could be added at a later phase.Psychological counseling is of great importance and the athlete should be aware tha tthe recovery process could take a very long time, sometimes months.