“Why am I so tired?!” ~ Providing support to the tired athlete

As an athlete, one comes to expect a certain level of tiredness. What happens when that tiredness doesn’t go away. One may be eating right, sleeping right, and feeling like one is doing all the right things, and yet fatigue persists. Persistent tiredness impairs performance and is a frequently presented symptom to healthcare practitioners.

Chapter 57 in Clinical Sports Medicine addresses the tired athlete –the causes and clinical perspective, including a detailed look at overtraining syndrome (OTS). The chapter’s co-author, Karen Holtzer, is a leading sports medicine physician and researcher and she guides the reader through the best course of assessment and management. The chapter provides a valuable reference for any clinician, looking to support the chronically tired athlete.

Photo by Dan4th. Used with permission. All rights reserved. Source: flickr

Photo by Dan4th. Used with permission. All rights reserved. Source: flickr

Tiredness is a way of life for those sportspeople in heavy training. One can usually differentiate though between normal “healthy” tiredness and abnormal fatigue. Healthy tiredness goes away -easily reduced within a day or two of lessened activity or rest.

Causes of persistent tiredness vary from common sources such as viral illness or inadequate protein uptake to less common such as vitamin deficiencies, psychological stress, and medications. Not-to-be missed causes include neuromuscular disorders, malabsorption, and certain infections. For an expanded list of causes turn to Table 57.1 in Clinical Sports Medicine.

The degree of tiredness needs to be established from the history. Is it intermittent or ongoing? At a particular venue (which many indicate allergies) or only in hot weather (dehydration?)? Was the onset associated with any particular event such as travel or a viral illness?  A comprehensive training diary can be crucial to a proper diagnosis and needs to examine the overall training cycle over a number of weeks or months. A full exam may be needed to exclude any possible medical causes. Urine, full blood exam, iron studies, and other routine tests can be invaluable . The table “Summary of history, examination, and investigations of the tired sportsperson” provides examples of key areas to focus on.

Overtraining is a common source of persistent tiredness and can have disastrous consequences. An excessive training load combined with inadequate recovery time produces short-term overtraining. If instead of resting, one increases the intensity of training then impaired performance can result, which may lead an athlete to increase training, creating a perpetual downward spiral and overtraining syndrome.

Physiological variables such as loss of body mass, decreased maximal heart rate, and frequent illnesses, could indicate overtraining. Deterioration in performance is an essential criterion for the diagnosis of overtraining. Check CSM Chapter 57 for other physiological, biochemical, hormonal, and immunological changes associated with overtraining syndrome.

Changes in the central nervous system are key to the development of chronic fatigue and the common signs and symptoms of overtraining.  No one test can determine overtraining syndrome though one can monitor certain parameters to counter its full-blown development. Probably the most critical means of monitoring is self-analysis. Daily documentation of training details, illnesses, causes of stress, etc, along with one’s own personal reflection can provide crucial insights.

In terms of prevention, the most important aspect is awareness of the issue, both the athlete’s and his or her coach’s. This is especially true for those who are new to a sport, or overly zealous or ambitious, striving for success too far beyond their current limits.

Treatment: If overtraining syndrome is not severe, resting as much as possible for 48 hours may be sufficient. If this brief rest period doesn’t work resolution may take weeks or months. In such cases, treatment would likely include further rest, attention to diet and fluid intake, and psychological support.

For more information about how you can support tired athletes turn to Chapter 57 in Clinical Sports Medicine.

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