ATC 342: Overtraining Syndrome – Novel Findings, Remarkable Markers and Recovery Protocol, Plus Knee Pain During MAF Runs and More

July 15, 2022


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On this episode of Ask The Coaches with Lucho and Tawnee:


  • Endurance Planet is making a return to Ragnar SoCal in April 2023!!! Our team is nearly full and we’re open to building a second a team (maybe an ultra team). If you’re interested in joining the Endurance Planet Ragnar Team, and hanging out with Lucho, Tawnee and the rest of the crew you can email us at
  • Update on Lucho’s burnout post-Ironman and how he’s doing a couple months after IM St. George.
  • On coaching youth: the importance of instilling knowledge on the fundamental concept of perceived exertion (RPE), and correlated data (HR, etc) and more.


Swim Erg (Vasa) Training:

Real-life Results in Racing? 

A little anecdotal evidence on a couple of Tawnee’s athletes who almost exclusively used the vasa swim erg trainer for swim training for an ironman-distance race (2.4-mile swim). They started swimming in a pool once a week several months prior to the race, otherwise exclusively used the erg for more than a year. Their swim times were 1:20 & 1:14. We discussed swim erg training in detail on ATC 337, so this is a fun piece of evidence to add in favor of erg training (and stretch cords as Lucho swears by!).


Taylor asks:

Knee Pain During Slower MAF Runs?

Hey all, thanks for being such a great resource. Just started the MAF method to help train for my first 70.3 four months from now. Committed to being patient with it, even at 12+ minute miles. But I am finding that running that slow causes discomfort in my knees after my run is over. It feels like I’m just trudging along and there is more pressure on my knees and quads while running. Thoughts on how to reduce this discomfort? Or will this go away as I build aerobic base and can run at a faster pace again?

What the coaches say:

  • Possible that the knee pain is actually stemming from a poor bike fit.
    • If seat too low, you’ll feel pain under the patella in the front of the knee.
    • If seat is too high, you’ll feel pain/add stress on the backside of the knee.
    • Get a proper, professional bike fit!! Worth it!!
  • Make sure it’s not runner’s knee / excessive quad dominance.
    • One way to help quad/anterior dominance would be more posterior-focused strength training e.g. deadlifts.
  • Cadence during MAF runs matters, it shouldn’t be too slow. Still needs to be 85+. Anything under 80 is trending low.
    • Shorten stride length a bit to help this.
  • Allow heart rate (HR) flexibility!
    • You don’t need to stick to just strict MAF HR running to help pace to quicken and run more efficiently, up to 5-10bpm over your true MAF HR can be ok!
    • A slightly higher but still aerobic (e.g. 5-10 bpm over MAF) often allows more “natural running” in your MAF runs when you’re starting out with this method and MAF pace is relatively slow. The slightly higher HR is still aerobic and usually without detrimental effects, allowing you to find more of a sweet spot of form efficiency and still progress your MAF training and pace.
  • Incorporate intervals of “natural running” or a heart rate of 5-10bpm over that last 1/2 mile to 1 mile.
  • Don’t wear worn out, old shoes! Especially if they are maximalist shoes, as they could contribute to an unnatural foot plant.


Study Discussion:

Diagnosis of Overtraining Syndrome (and recovering from OTS)

“In the present study, innovative tools were proposed for the diagnosis and prevention of OTS that yielded 100% accuracy in distinguishing overtraining syndrome from healthy states. This was done without the need to include the presence of decreased performance or exclude confounding disorders in this sample of athletes. These diagnostic approaches should be reproduced and validated as optional assessment tools for the diagnosis of OTS. Although OTS is highly heterogeneous, a combination of markers rather than a single marker appears to be more appropriate for the diagnosis of OTS, regardless of the proposed method.”

What the coaches say:

  • This study was called the “Endocrine and Metabolic Responses on Overtraining Syndrome (EROS)” study. 
    • Identification of more than 45 novel OTS biomarkers. 
    • Only males in this study between 18-50 y/o.
    • Athletes = training of at least 4x a week and >300min (just ~5hr a week).
    • Suspected OTS = Underperformance of ≥10% of previous performance as verified by certified sports coach, or loss of ≥20% in time-to-fatigue, with self-reported increase in sense of effort in training relative to before OTS. 
    • Compared with healthy athletes and non-athletes. 
  • Novel findings:
    • It’s not about training load alone…
    • It’s never just one thing…
    • Of course excessive training without adequate rest is a risk and/or a rapid progression in volume or intensity. However these researchers found that:
    • OTS occurred independently from excessive training, since insufficient calorie, protein, or carbohydrate intake, poor sleep quality, or concurrent excessive cognitive effort were the found to be prevailing predictors of OTS.” 
    • We think there’s a certain personalist type that is more susceptible to OTS, similar to the type of person who develops an eating disorder.
  • Example of nutrition risks in OTS:
    • Calories <32kcal/kg/day
    • Protein <1.7g/kg/day
      • This is not always easy to do, but an important habit to be mindful of when training.
    • Carbs <5-5.4g/kcal/day
  • Stigmas on body shapes between men and women, yet particularly male and female athletes are still at risk for thinking leaner is better (e.g. watts per kilo makes a difference).
  • Should we food log? It really depends. Tawnee is not a fan of long-term food logging nor food logging at all for certain people; however, for some it can be helpful to highlight any deficits or use to fine tune and optimize nutrition intake.
  • OTS usually resulting in a GAIN of body fat % and LOSS of muscle mass.
  • Also risk factors that can contribute to OTS:
    • Long-term extreme diets (including low carb and intermittent fasting / IF).
    • Stressful work or study in addition to training (cognitive/physical effort concurrent to training).
    • Poor sleep usually related to inability to disconnect from social media or TV.
      • Focusing on sleep hygiene is not that difficult to do but can make a huge difference!
      • A deep dive on binge watching TV shows and social media scrolling… what are these habits telling us? They are not inherently bad but they can become a negative influence in our lives.
      • When some TV is ok, finding the right balance.
    • Doing more than 7-9 hours a day of general life/heavy cognitive activities & stress were risk factors.
      • “Over-life syndrome.”
    • Mood scores are also valuable, in this study they used the POMS questionnaire: “since the active self-perception of feelings and fatigue are underestimated by many athletes, as they tend to avoid perceptions of potential barriers to their trainings.” 
  • “Athletes affected by OTS experience a ‘hyporesponsive’ and ‘hypometabolic’ state, based on the findings of decreased basal metabolic rate and fat burning, paradox adipocyte saving in fat storages, impaired hormonal responses to demands, and decreased testosterone, T-to-oestradiol ratio and GH, and increased catecholamines. These findings suggest an anti-anabolic and pro-catabolic environment.”
  • Standout biomarkers found to be altered in OTS:
    • Creatine kinase (CK)—high; higher CK might have resulted from impaired and prolonged muscle recovery. CK is protein known as an enzyme, released by muscle. (Don’t confuse with creatine supplements, which increase creatine PCR in the cell.)
    • Post-exercise lactate—abnormally lower.
    • Exercise-stimulated prolactin, growth hormone (GH), cortisol and adrenocorticotropic hormone (ACTH) responses—blunted response.
    • Total catecholamines—exacerbated; might have resulted from an attempt to maintain function despite energy depletion.
  • Discussing the biomarkers unaffected by OTS vs. those affected by OTS.
    • This study found some markers to be unchanged or not significant to the diagnosis of OTS, such as thyroid markers (TSH, Free T3), but for some athletes, these specific markers can still be affected and part of their unique presentation of OTS. Keep an open min when diagnosing.
  • Most of the non-similar markers between the overtraining group and normal groups reflected losses of conditioning or adaptive processes that athletes typically undergo, or ‘deconditioning’.
  • Top remarkable markers of ‘deconditioning’ in OTS identified were (quoted):
    • Blunted and late GH, cortisol and prolactin responses to an exercise-independent central stimulation test, which may explain the loss of pace and performance during OTS.
    • Reduced testosterone levels, which may explain the loss of muscle mass in athletes with OTS.
    • Increased oestradiol levels without a concurrent increase in testosterone (reduced testosterone-to-oestradiol ratio), which could cause some of the psychological and body metabolism and composition patterns found in OTS;
    • Worse mood states (particularly fatigue, vigour, depression and confusion), likely correlated with worse sleep quality and hormonal dysfunctions.
    • Changes in body metabolism and composition (lower metabolic rate and fat burning, more body fat, less muscle mass and less hydration), likely due to a hormonal environment that leads to a muscle-specific catabolic state, and reduction of overall metabolism.
  • Recovery from OTS:
  • Researchers then held a 12-week interventional protocol in athletes with actual OTS, with interventions including:
    • Increased food (calorie) intake;
    • Transitory interruption of the trainings;
    • Improvement in sleep quality;
    • Management of stress.
      • You can measure sleep and stress with many available apps these days to better understand where you’re at!
  • What they did and found (quoted material):
    • 50 parameters were assessed during recovery protocol, including hormonal responses to an insulin tolerance test (ITT), basal hormonal and nonhormonal biochemical markers, body metabolism, and composition.
    • After 12 weeks of intervention, early cortisol and early and late GH responses to stimulations improved significantly. Cortisol awakening response (CAR) increased by two times, while nocturnal urinary catecholamines (NUC) and CK reduced by two to three times. Basal estradiol reduced while testosterone/estradiol (T:E) ratio increased.
    • FreeT3 and IGF-1, which were not different than healthy athletes at baseline, disclosed significant increase, whereas ultrasensitive C-reactive protein (usCRP), which was also similar to healthy athletes, has an exacerbated reduction. While all basal parameters and early responses to ITT normalized when compared to healthy athletes, basal metabolic rate, fat oxidation, body fat, muscle mass, and hydration status had partial but non-significant improvements.
    • In conclusion, athletes affected by actual OTS demonstrated substantial improvements after 12 weeks of intervention, in particular IGF-1, freeT3, CAR, estradiol, testosterone/estradiol ratio, CK and NUC, and early cortisol, early prolactin, and overall GH responses to stimulations. FreeT3, usCRP, and IGF-1 seem to be the sentinel markers of recovery from OTS.
  • If in doubt? Things to monitor:
    • Take a few days off more than you’re used to doing.
    • Monitor intensity even if volume is low.
    • Bloodwork if you can, when you can, but we know that’s not always realistic for everyone.
    • Monitor the mental aspect—is your training feeling forced? Are you mentally wasted? How’s quality of life? Perceptions matter.
    • Performance decline is HUGE. (Consistent and reliable testing helps a lot of track and monitor these things.)
    • Are you a more scattered-brained and more clumsy than usual?


One Comment

  • Steev says:

    It’s always a good reminder that over training can be seriously detrimental to your health and fitness. I wish I had known that a decade ago before I trained for my second Ironman in the worst way I possibly could have. I ended up dropping ~10 pounds (which is quite a bit considering I weighed 145ish pounds) and doubling my body fat percentage, and had the bone mineral density of someone 50 years older than me. It took about four months of a sedentary lifestyle to bounce back from that!

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