What Is Overtraining Syndrome – And How Does It Affect Athletes?

During last week’s U.S. Olympic Trials, news came to light that four-time Olympic medalist Simone Manuel had been diagnosed with Overtraining Syndrome (OTS) around early March, and ended up taking an extended three-week break out of the pool in April.

Manuel spoke openly about her experience with OTS after failing to advance to the final of the women’s 100 freestyle, the event in which she won 2016 Olympic gold and back-to-back World Championship titles in 2017 and 2019.

Manuel ended up qualifying for the U.S. Olympic team in the 50 free on Sunday night. After that victory, the 24-year-old mentioned that she wants to be a voice for other swimmers that have dealt with similar symptoms.

Below, find an overview of exactly what OTS is, and the resulting symptoms, from Shawn Trokhan, M.D. 

Disclaimer: This is not medical advice.

I’ve gotten a lot of questions in and out of the office recently about Simone Manuel and Overtraining Syndrome (OTS). And so I thought it would be helpful to give a quick overview of what happened, and more importantly give insight into what to look for in young athletes as they work hard to achieve success at different levels.

I think the most important thing to discuss from the outset is “What is a Syndrome?”  A syndrome is simply “a group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms.”  A syndrome is not a disease per se. A syndrome is not necessarily testable with simple bloodwork or an x ray. It is just a group of symptoms commonly seen in a situation, many times affecting different body systems. As well, many times one symptom in a syndrome can lead a patient down a path to the other symptoms.

In this situation, Overtraining Syndrome is a constellation of symptoms commonly seen with, simply enough, overtraining. These symptoms include fatigue, faster heart rate even well after practice, and sore muscles, which can lead to decreased performance.  And here is where things get complicated. These symptoms, in an elite athlete with lots of the line, can lead to other symptoms. Decreased performance can lead to depression, loss of motivation, and anxiety. Which can lead to insomnia, leading to irritability, agitation, and weight loss. Which can lead back to fatigue and decreased performance. It’s an extraordinarily tough cycle, and it becomes even more difficult with large, looming deadlines like the Olympic Trials on the horizon.

We have a saying in my office. “Sometimes the fastest way to move forward is to Stop.” And so while I am not her treating physician, it sounds like Simone made a tough but necessary choice. She stopped. She broke the cycle, rested, recalibrated, and came back.

Overtraining Syndrome is something that can be seen at many levels of swimming. And I think we are all lucky to have had an athlete like Simone bring it to our attention, but more importantly, come out the other side successfully.

ABOUT SHAWN TROKHAN

Shawn Trokhan, M.D. graduated from Princeton University where he was an Ivy League Champion swimmer, NCAA All-America award winner three times, and Olympic Trials qualifier.  He studied medicine at the Case School of Medicine and the Cleveland Clinic in Cleveland Ohio, then completed his orthopaedic surgery residency at Mount Sinai in New York City.  Dr. Trokhan is currently in private practice in northern NJ.  You can read more about him at www.Trokhan.com

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SWIMDOG
5 months ago

@Zane Grothe

Khachaturian
Reply to  SWIMDOG
5 months ago

No he just doesn’t eat enough. I handed him a sandwich for lunch but he said he was just fine with a granola bar and a cup of water.

Swimlikefishdrinklikefish
Reply to  Khachaturian
5 months ago

Still can be a sign of over training. When I was working real hard in winter training in college I’d have a hard time finishing my dinner immediately after practice too exhausted to eat a big meal

Virtus
Reply to  Swimlikefishdrinklikefish
5 months ago

Pretty sure it was a joke

Lpman
5 months ago

Sooooooo…what is the name for people that experience all these symptoms but are not athletes?

Maybe Simone should scratch Tokyo to focus on her health

coach
Reply to  Lpman
5 months ago

Wow. Do you make fun of people with depression too?

Lpman
Reply to  coach
5 months ago

Not at all. I am showing concern for her health and you follow that up with a snippy comment.

highswimcoach
Reply to  coach
5 months ago

I read that as a genuine question. She just went through a tough mental and physical time and we are throwing alot on her shoulders performance wise….

Taa
Reply to  Lpman
5 months ago

I feel like there should at least be conversation about her scratching. Instead we are busy discussing how to get her on as many relays as possible. Remember Missy Franklin 2016 it wasn’t pretty.

John Culhane
5 months ago

This is an important article, and I’m glad SwimSwam ran it.

Ger
5 months ago

What I would like to know is what program she was following, who devised it, and was she not being regularly monitored during her training. I’m very confused on the whole matter.

Coach Macgyver
Reply to  Ger
5 months ago

If you are looking to point blame, then you are going to get nowhere. Swimming is a team sport and there are many factors (controllable and uncontrollable) that effect training.

She is one of America’s top athletes who was training for the biggest competition on the planet. Many people were invested in her training and many people made tons of sacrifices to get her through training.

Again it’s a team sport.

What is going to keep athletes like Simone going is her resilience and her ability to bounce back (which she did) after defeat.

I’ve never coached or worked with someone of her caliber, but man, appreciate greatness when it is right in your face. She clearly swam… Read more »

Irish Ringer
Reply to  Coach Macgyver
5 months ago

What about the value in understanding what her training looked like in prior years when compared to the current cycle? For Simone that could be beneficial in understanding what is optimal. It’s not so much about blaming someone rather than understanding OTS, what the signs are, how to avoid it, etc. The story does a good job framing it up, but how does this translate down to the club level to prevent it?

Last edited 5 months ago by Irish Ringer
Coach Macgyver
Reply to  Irish Ringer
5 months ago

A good place to find out more about elite athletes training and what goes on at practice is at the ASCA clinics. Coaches are always sharing what they did, what they learned and what direction they are going. The best time to go is post Olympics. I went in 2012 and 2016 and learned a whole lot from several different coaches.

Ger
Reply to  Coach Macgyver
5 months ago

It’s not an issue of apportioning blame rather than one of understanding the condition, and how it can happen. As you say, she is one of America’s top athletes with a professional team behind her, which makes it more difficult to understand. Her achievements are outstanding but this has nothing to do with what happened during her training. And if you ignore everything that happened than nothing can be learned from it.

Spectatorn
Reply to  Ger
5 months ago

with over-training /burnout /OTS – the learning here is to listen to your body and notice the symptoms (listed in the article), ask for help and take the advise of “stop and rest”. Each person is different so what Simone was doing or what program she was following are not what “not to do” alone. Learn from how she took the diagnosis and accepted treatment suggestion – taking 3 weeks off completely 2 months out of Olympics trial. While OTS and a 3-week break have impact to her preparation, we also see her will to fight get her on the team in 50 free.

All professional athletes and swimmers are hard-workers and often “interpret” some of the signs of over-training… Read more »

Last edited 5 months ago by Spectatorn
Coach Macgyver
Reply to  Ger
5 months ago

How you framed your question gives the impression you are looking to point blame. This after she clearly articulated all that happened this last year and this articles explanation.

If you read below, Mikeh interpreted your question as you were looking to point blame as well.

Mikeh
Reply to  Ger
5 months ago

I agree. It’s clearly her coach’s fault. Simone is an extremely motivated athlete, and prone to training as hard as possible. That’s her coach’s most important job – keep her from defeating herself by overtraining.

“Overtraining Syndrome”, I don’t know if it needs a name, or how to decide what qualifies and what doesn’t, but it’s real.

Deep End
5 months ago

Your dinner is the glue that holds this sport together. Keep training kids ignore the hype!!

Taa
5 months ago

I don’t have any trouble believing what Simone went through but I think it still was just a screw up that she missed finals either she just came out a little flat in Semi’s or she miscalculated her speed and couldn’t make up for it the last part of the race. I believe she still makes finals in this situation 80-90% of the time is what I’m trying to say this was just the time she missed.

Don
5 months ago

Overtraining syndrome is nothing new and there is plenty of research linking its effect on adrenal function. Not sure why some posters think it’s a made up thing,

SwimShark
Reply to  Don
5 months ago

Probably same reason some think covid is a hoax.

Eisenheim
5 months ago

Kudos to SwimSwam for this. I am sure many athletes are dealing with this without even knowing it.