When Should You Worry About Overtraining?

Training is something that every athlete is concerned about. Getting in enough workouts and ensuring peak performance. Athletes worry about ensuring they get enough cardio and enough strength training, but when does enough become too much. Over-Training Syndrome (OTS) is a constellation of problems that can occur when athletes push a little too hard and it can lead to some unpleasant outcomes.


OTS is characterized by the following symptoms, and this list is not all inclusive.

  • Decreased performance
  • Slow to recover
  • Fatigue
  • Depression
  • Weight loss
  • Loss of motivation
  • Lack of concentration
  • Awakening unrefreshed or insomnia
  • Hypertension
  • Irritability or other mood changes

OTS is usually typically caused by athletes who go through a brief period of training overload followed by inadequate recovery, usually occurring over weeks. This usually occurs along side a considerable life stress from school, work or a personal relationship.

OTS leads to physiologic changes:

One of these physiologic changes is increased Cytokines.  These are chemical messengers that are essential to our body’s immune and inflammatory responses. Cytokines such as IL-1β, IL-6, and TNF-α are all increased in OTS. This leads to decreased activity in the hypothalamus leading to decreased Cortisol production. This can end up causing chronic fatigue and even adrenal failure if it goes on long enough. TNF-α can lead to decreased glucose uptake by muscle cells leading to increased muscle fatigue. It has also been linked to sleep disturbances and depression. IL-6 can directly lead to an increased risk of iron-deficiency anemia.

This chemical response seen with OTS shares many similarities with Cancer Fatigue. The main contributing factors to Cancer Fatigue are anemia, deconditioning, metabolic/hormonal/endocrine abnormalities, and production of pro-inflammatory cytokines (IL-1 and IL-6). 

What do we do about it?

The big key to treatment of OTS is to get adequate rest. Mild cases tend to resolve within a few weeks or rest or reduced training intensity. Addressing exercise intensity and adjusting periodization will augment some recovery.  So, adding longer light exercise days, off days, adding massage, soft tissue work.  Maximizing their food/fuel intake both quantitatively in caloric balance and composition, enough glycogen, protein/branched chain, hydration. I also advocate creating an 'off-season' in my athletes, even the recreational.  Periodize your sports, and activities.  Macro cycle training with a monthly view is helpful and can make exercise more enjoyable knowing you'll be able to get some relief with upcoming rest periods.  



  1. Black WS, Hosey RG. Overtraining. In: Bracker MD, Achar SA, Pana AL, Taylor KS, editors. the 5-Minute Sports Medicine Consult, 2nd ed. Philadelphia (PA): Lippincott, Williams, and Wilkins, 2011, p 467-7.
  2. Carfagno, D. G., & Hendrix, J. C. (2014). Overtraining Syndrome in the Athlete. Current Sports Medicine Reports, 13(1), 45-51. doi:10.1249/jsr.0000000000000027
  3. Kremer J, Schwartz J. Overtraining syndrome: a practical guide. Sports Health. 2012; 4:128-38 TABLE 2. 

Disclaimer:  Articles are based on real cases seen at Scottsdale Sports Medicine. The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. Please consult your medical professional for individualized healthcare.