Training your way to bad health

Rachel Gamble-Flint had high hopes, high expectations and talent. She was well on her way to an extremely promising rowing career. Rachel, however, could not understand why she was constantly tired. But then she had trouble sleeping at night, was losing weight and her enthusiasm was waning.

Rachel’s story is not unfamiliar. She represents a classic case of overtraining or as international coach and FISA development director Thor Nilsen prefers to word it: “wrong training”. “It is very complex,” he says. “It’s not easy to define.”

A series of factors led to Rachel’s demise in health. She can look back to when she competed at the World Rowing Junior Championships for Great Britain. While racing Rachel’s forearms seized up. She had compartment syndrome and would need surgery. Following surgery Rachel used, as recommended, non-arm cardio exercises for rehabilitation and to maintain her fitness. Rachel was very conscious of not wanting to lose fitness and when she returned to full training Rachel continued with the extra cardio workouts.

“At first this seemed to work well as I became fitter and leaner. Then,” Rachel says, “I suddenly seemed to lose a lot of strength and I found my energy levels were getting lower as I struggled to maintain the speeds I was used to.” Rachel describes her training at this point as being an obsession.

Rachel made the under-23 team, competed at the championships and at that time was also studying for school exams and was about to move away from home. “I think I had finally run out of adrenaline and crashing was inevitable.”

Rachel then got the opportunity to train alongside the British senior women’s squad. Her volume of training increased. “Making it through three hard sessions a day was just accelerating my decline in health,” Rachel says in hindsight. She was visibly losing weight, which her coaches, family and friends all noticed. Rachel was encouraged to put on weight, but by this stage she had completely lost her appetite. “I had very little enthusiasm for anything and was starting to become very negative,” she says.

Rachel had so little energy that she found it difficult to stay awake even while rowing. Then at night she had trouble sleeping. Finally Rachel’s coach sent her to the British team doctor. Blood tests showed that she was running on empty. “I had completely depleted my body of iron, calcium, red blood cells, white blood cells and several hormones.”

Juergen Steinacker of FISA’s sports medicine commission has collaborated in research on overtraining, or unexplained underperformance syndrome (UPS). He explains that the whole point of training to get better and stronger is designed to lead to exhaustion and fatigue. This is especially true during training camps and other times of increased training loads. Steinacker defines this as overreaching.

Problems for an athlete occur when fatigue from overreaching persists for more than three days or a week. This constant fatigue then turns into overtraining when performance declines. This can persist for more than two weeks and sometimes many months.

Overtraining happens when the training programme is not correct for the athlete’s capacity and circumstances. It is a combination of not enough rest, recovery and nutrition. Steinacker confirms Rachel’s situation as often overtraining occurs when there is additional stress outside of training. Steinacker also thinks there may be some genetic determination, but he notes that data on this is not currently available.

Apart from decreased performance, says Steinacker, an overtrained athlete will show changes in their mood state which can be seen in signs of depression, disturbed sleep and a decrease in well-being. In hindsight Rachel can see all of these symptoms.

The training programme, says Nilsen, has to be designed to fit the individual athlete. “I’ve seen two crews follow the same training programme and both crews utilised it very differently.” The programme worked for one crew but not the other.

What makes matters worse from a medical perspective, says Steinacker, it is that it is very difficult to diagnose overtraining as there is no one consistent pattern or outcome that is observable. As it is often unexpected, athletes and coaches are invariably unprepared.

“The coach is often puzzled by an athlete who has always been good at performing and training,” says Steinacker. Thus diagnosis does not happen quickly and usually occurs after every other possibility has been excluded. Also each individual’s symptoms are so different.

There is also the possibility of a wrong diagnosis. Research has shown that unresolved infections have been diagnosed as overtraining and, according to Steinacker, the lack of diagnostic parameters means it is difficult to define what overtraining is.

Fortunately for Rachel, the team doctor knew exactly what to do – back off completely and replenish the body. Rachel also found that she picked up every illness going around which would put her back to square one.

Recovery is not simple and may take weeks, months or even years for complete recovery. For Rachel it was a four-month process of very careful rehabilitation to a stage where she wasn’t coming down with every cough and cold that was going around.

Coming out the other side Rachel says that within a few weeks of normal training she was back to her previous strength and fitness. Rachel admits, however, that she still has the memory of overtraining hanging over her. “My body still isn’t completely back to normal. Hopefully I will suffer no longterm health issues.” Both bone density and fertility can be impacted.

The overtraining concept is a relatively modern occurrence. The first description of the overtraining syndrome showed up around the 1950s. In the 1970s research by Lehmann et al. first demonstrated that it was endurance training, rather than high intensity training that spawned overtraining. Thus, in rowing the chance of overtraining is highly possible. 

Personally for Rachel the hardest part was realising that her overtraining was essentially self-inflicted. “It was due to my own determination to succeed overriding my common sense and the advice of those around me who were trying to help.”

M.S.B.