Car­la Rauseo

I have Face­book to thank for this week's top­ic. I ad­mit that I am a mem­ber of the "ma­co­ing mass­es" on Face­book, and have for­mu­lat­ed a hum­ble opin­ion based on the re­cent on­slaught of videos, com­ments and dis­cus­sions that have been post­ed by a num­ber of recre­ation­al ath­letes. My opin­ion is al­so based on what I have been see­ing in my prac­tice as a phys­i­cal ther­a­pist at To­tal Re­hab.

Many of our recre­ation­al ath­letes in T&T, my­self in­clud­ed, do a va­ri­ety of sports and dif­fer­ent types of train­ing. These in­clude Cross­Fit train­ing and com­pe­ti­tions, triathlons and duathlons, ad­ven­ture races like Fu­sion, moun­tain bik­ing and road cy­cling events and 5Ks that take place through­out the year.

One would think that these folks must be su­per fit! How­ev­er, Face­book posts fre­quent­ly con­sist of com­ments about pain and in­jury is­sues. And de­spite these com­plaints, many ath­letes still post about "long train­ing runs" and "rides to­mor­row," de­spite painful knees af­ter to­day's killer work­out. Oth­er posts talk of shoul­der ten­donitis, stress frac­tures, an­kle ten­donitis and of at­tempts at treat­ment for these is­sues; yet still they post of "be­ing tough" and "train­ing through the pain."

It all seems to me like a lot of over­train­ing, the signs and symp­toms of which are ig­nored by many ath­letes and coach­es alike in T&T. Au­thor­i­ties in sports med­i­cine be­lieve that over­train­ing is a con­tin­u­um that be­gins with over­reach­ing. The Eu­ro­pean Col­lege of Sports Med­i­cine de­fines over­reach­ing as an ac­cu­mu­la­tion of train­ing load that leads to per­for­mance decre­ments re­quir­ing days to weeks for re­cov­ery. Over­reach­ing, fol­lowed by the cor­rect amount of rest, leads to in­creas­es in per­for­mance. This is known as func­tion­al over­reach­ing. How­ev­er, this can be­come non-func­tion­al over­reach­ing (NFO) when there is not enough re­cov­ery to al­low the body to adapt to the train­ing load. The out­come of this is usu­al­ly a va­ri­ety of mus­cu­loskele­tal, neu­roen­docrine and psy­cho­log­i­cal symp­toms and poor per­for­mance. Re­cov­ery from this takes weeks to months.

The most se­vere on the over­train­ing con­tin­u­um is over­train­ing syn­drome (OTS), which is char­ac­terised by a va­ri­ety of se­vere im­mune, psy­cho­log­i­cal, neu­ro­log­i­cal and oth­er mal­adapt­ed phys­i­ol­o­gy that can end an ath­let­ic ca­reer. OTS is rel­a­tive­ly rare, and I sus­pect that many of the recre­ation­al ath­letes in T&T who have in­juries or pain are prob­a­bly in the non-func­tion­al over­reach­ing cat­e­go­ry. This NFO is al­so a prob­lem with com­pet­i­tive club sports. A re­cent study doc­u­ment­ed non-func­tion­al over­reach­ing in one-third of Eng­lish club ath­letes. De­spite this be­ing an in­ter­na­tion­al study, the re­cent rise of com­pet­i­tive stan­dards and the in­crease in the num­ber of recre­ation­al ath­letes in T&T, make NFO an is­sue of con­cern for our own ath­let­ic pop­u­la­tion.

A spe­cif­ic di­ag­no­sis of non-func­tion­al over­reach­ing and over­train­ing is dif­fi­cult to mea­sure as it in­volves hor­mon­al test­ing and oth­er in­ves­ti­ga­tions that re­quire ex­pen­sive equip­ment. But a good in­di­ca­tion of over­reach­ing can be gained by recog­nis­ing cer­tain signs and symp­toms.

Nig­gling in­juries are a very com­mon symp­tom of NFO. Ran­dom aches and pains that fre­quent­ly present them­selves should be red flags. Stress frac­tures, ten­donitis, knee pains are all typ­i­cal­ly overuse in­juries and should be a hint to in­ves­ti­gate fur­ther. Oth­er signs in­clude fre­quent fa­tigue the day fol­low­ing a com­pe­ti­tion or train­ing ses­sion, el­e­vat­ed rest­ing heart rate, de­layed re­turn to nor­mal heart rate af­ter ex­er­cise, and a feel­ing of heav­i­ness and stiff­ness of the mus­cles on a morn­ing as well as sleep prob­lems at night. An over­reached ath­lete can al­so ex­pe­ri­ence in­creased episodes of the cold or up­per res­pi­ra­to­ry tract in­fec­tions and a loss of ap­petite. Mood­i­ness, lack of con­fi­dence in com­pe­ti­tion, ap­a­thy and lack of en­joy­ment dur­ing train­ing are al­so im­por­tant in­di­ca­tors.

An ath­lete need not have all these signs, but one of the most fre­quent signs I have seen in my prac­tice in Trinidad is the on­set of overuse in­juries. The pres­ence of these should be tak­en very se­ri­ous­ly and should be an in­di­ca­tor to re­think the train­ing sched­ule and in­clude more re­cov­ery days and in­jury pre­ven­tion pro­grammes. It is dur­ing these rest days that the body heals and adapts to the train­ing load. It is dur­ing these days that the body ac­tu­al­ly gains strength and fit­ness, and rest is, there­fore, para­mount in im­prov­ing per­for­mance.

Ac­cord­ing to Jack Daniels, a cross coun­try coach at Cort­land State, "con­sid­er the con­nec­tion be­tween over­train and overkill: If your tar­get is top run­ning per­for­mance, then to over­train means to ap­ply more force than is re­quired to hit that tar­get. In fact, over­train­ing may lit­er­al­ly oblit­er­ate your tar­get (overkill), or at least leave you with­out the will to pur­sue it." So think about it. It may well be bet­ter to en­ter a com­pe­ti­tion ten per cent un­der­trained than one per cent over­trained.

Car­la Rauseo, DPT, CSCS, is a doc­tor of phys­i­cal ther­a­py and cer­ti­fied strength and con­di­tion­ing spe­cial­ist at To­tal Re­ha­bil­i­ta­tion Cen­tre Ltd in El So­cor­ro.