When swimmer Simone Manuel, the first Black woman to win an individual gold medal at the Olympics, didn't qualify for the 100-meter freestyle at the Tokyo Games, sports fans were surprised. Later, the 24-year-old revealed the condition that kept her from competing at her best: overtraining syndrome.
While Manuel did qualify for the Olympics in two other events, she said that the condition had affected her training for much of the past few months.
“This was definitely my biggest fight,” Manuel said in a press conference. “[Physically] it started a little bit in January. I think it was something that I didn’t quite notice until my body like completely crashed.”
What is overtraining syndrome?
Dr. Marci Goolsby, co-director of the Women's Sports Medicine Center at the Hospital for Special Surgery, said that the term "overtraining syndrome" is "a little bit vague" since the condition is "hard to always diagnose" but is usually defined as when a person is training too hard to recover properly.
"It can come with a variety of symptoms, but it's essentially where you can't recover and it sort of lingers on, so it's not just like feeling really tired after a hard workout but then by the time you go to your next workout you're fine," Goolsby explained. "It's where you get this progressive loss of energy and a performance impact and there can be a variety of other symptoms that people will get physically."
Those other symptoms could include being more susceptible to mild illnesses like colds, heart palpitations, or changes in heart rate.
"There can be a whole variety of symptoms but usually it's where they noticed they just can't push themselves," Goolsby said.
Any athlete can be diagnosed with the syndrome, but it's more likely to affect higher-level or elite competitors. Goolsby said that recovery from overtraining syndrome is slow, and can have an impact on the careers of professional athletes.
"It can be really difficult, because there's a very fine line. You're constantly trying to push your threshold to improve, but sometimes you accidentally dip into the more negative side of that spectrum and that's when people start to have problems and the unfortunate thing is once it happens, it's not a quick easy fix," Goolsby said. "Whereas if you overreach your training for a less sustained period of time, you can recover from that. It can be very impactful on somebody's career and it can be one of those things that's hard to identify early on."
How can you spot overtraining syndrome?
Goolsby said that many of the early signs of overtraining syndrome are "subjective," based on how an athlete is feeling. Signs can appear across a person's daily routine.
"Are they starting to feel more rundown? Mood changes can be part of it, too, so somebody starting to feel some symptoms of depression," said Goolsby. "Sometimes it can impact things like sleep, like needing to sleep more."
One of the data-driven signs of overtraining syndrome could be a change in the basal heart rate.
"Sometimes we can identify a change in their heart rate or a change in their performance and their coach or performance staff may be able to adjust their training," Goolsby said.
How is overtraining syndrome treated?
Goolsby said that overtraining syndrome treatment might look different depending on the affected individual and their training routine, since "rest and recovery look different for different athletes."
Typically, physicians or trainers will start by having the athlete take about two weeks off from the activity that led to the overtraining syndrome.
"That rest doesn't have to be lying in bed for 24 hours a day," Goolsby said, but instead may focus on modifications like how hard someone trains or how much they move. "You may be able to continue some level of training, but it's going to depend on the individual situation."
Experts will also run other tests to make sure there's nothing else affecting the athlete.
"Overtraining is what we call a diagnosis of exclusion, so we don't want to miss any other medical reasons that people may be having their symptoms," Goolsby said. "We will look for other things, including viral illnesses, nutritional and vitamin deficiencies, that kind of thing."
After the rest period is over, the athlete will start training again, but at a "much lower level" than before. Overtraining syndrome can happen more than once, so trainers and physicians will carefully observe the athlete.
"When we do start back to training, we'll start at a much lower level, in terms of mileage and intensity and volume, than you did when you developed the symptoms," Goolsby explained. "We'll slowly build up and really closely monitor to make sure the athlete is tolerating it appropriately."
How can athletes avoid overtraining syndrome?
Goolsby said that athletes can stave off overtraining syndrome by taking care of their health in every part of their life, not just training.
"Taking general good care of yourself can hopefully decrease your risk of having these issues come up," she said. "Make sure you're getting good sleep and that you're fueling appropriately. ... We can't forget all three components: Training, sleep, and nutrition. ... All of those components are really important for your training, not just how many miles you run in a day. All of that needs to be taken into account when we're looking at treating and preventing overtraining."
It can also help if athletes feel comfortable making their own limits clear.
"It's important for athletes themselves to be able to identify when they might need to have their training adjusted, and this can be difficult, because sometimes the athletes don't ... want to look weak," Goolsby said, noting that some may also not recognize the severity of overtraining syndrome and its symptoms. "Part of sports and training is being strong, always being strong, and so being able to recognize and verbalize to others when you need to have accommodations isn't always as easy as it sounds."