A Sixteen-Year-Old Female Athlete Case Study – Health Paper
A sixteen-year-old female athlete presents complaining of a gradual reduction in form. In addition, the athlete appears to be susceptible to infections and has had numerous colds and episodes of lethargy. She says she is finding it harder and harder to train and you suspect that she might be suffering from overtraining.
Overtraining syndrome is a serious problem with features of decreased performance; increased fatigue, persistent muscle soreness, mood disturbances, and feeling ‘burnt out’ or ‘stale.’
The diagnosis of overtraining is usually complicated, there are no exact diagnostic criteria, and physicians must rule out other diseases before the diagnosis can be made. Further studies are needed to find a reliable diagnostic test and determine if proposed aids to speed recovery will be effective.
Unlike with diagnoses of most diseases, physicians have no exact criteria for the overtraining state. The diagnosis is based on three points: (1) patient history, (2) carefully ruling out other diseases, and (3) laboratory findings.
History taking includes a careful account of symptoms and signs. Changes in training regimen are of utmost importance. Performance decrement with an increased feeling of fatigue (subjective and objective evaluation) is the main sign of overtraining. The history of running nose, generalise aching and coughing suggest post-viral infection. History of repeated vomiting or induction of vomiting by stimulating of through suggested the possibility of anorexia nervosa.
The overtraining state can only be diagnosed after clinical examination has ruled out other conditions. Diseases such as Addison’s disease, anemia and other nutritional deficiencies, asthma and allergies, cardiac diseases (e.g., hypertrophic cardiomyopathy), diabetes or glucose intolerance, hypo- and hyperthyroidism, infections, muscle diseases, and psychiatric disorders can mimic overtraining.
Laboratory tests for differential diagnosis and laboratory findings that can be connected to decreased performance capacity are helpful. Several laboratory parameters have been proposed to indicate an impending or actual overtraining state: a decrease in testosterone and increase in cortisol concentration, or a decrease in their ratio; decrease in nocturnal catecholamines; changes in catecholamine concentration in blood during rest and after exercise; decrease in maximal blood lactate concentration; decrease in plasma glutamine concentration; increase in uric acid and creatine kinase concentrations (reflecting overload at the muscle level); decrease in the ratio of blood lactate concentration to ratings of perceived exertion; changes in morning heart rate; and changes in initial heart rate response to orthostatic stress.
Laboratory Tests for the Differential Diagnosis of the Overtraining State
Complete blood picture,
Erythrocyte sedimentation rate
Sodium, potassium, calcium
Alanine aminotransferase, alkaline phosphatase
Assessment of anaemia (nutritional problem)
Cortisol and testosterone (free testosterone)
Thyroxine, thyroid-stimulating hormone
Estrogen, follicle-stimulating hormone, luteinizing hormone
Adrenocorticotropic hormone (stimulation test)
Catecholamines (urine) and catecholamine metabolites
Infection assessment to eliminate the possibility of post-viral syndrome.
Differential leukocyte count
Assessment of serious metabolic disorders
Further specific examinations if needed
If there is no disease found, we can assume that the athlete is suffering from overtraining syndrome.
The best treatment for the overtraining syndrome is prevention. Tapering the training regimen combined with rest, proper nutrition, and sleep help the body heal. Recognition and treatment of depression is important. Therapies such as massage and sauna baths can speed recovery.
Periodization of training with enough recovery should prevent overtraining.
Periodization means that correct loads of training stimuli are administered followed by adequate recovery periods. The training and recovery time should be individualized since different persons have his/her individual conditions.
Through the one year, the training can be divided into phases of training emphasis called macrocycles. Each training week is called a microcycle (microcycles can be also longer–up to 10 days), and each microcycle includes both strenuous and recovery days in an appropriate proportion. Three or 4 microcycles compose a mezzocycle. Each mezzocycle consists of 2 to 3 microcycles with higher training loads and 1 recovery microcycle. Macrocycles with different training regimens can be classified as preparation, precompetition, competition, and tapering; all preparing for optimal performance in competition. As noted before, careful follow-up of athletes’ subjective feelings and some objective parameters are also an important part of prevention.
If the overtraining state persists in spite of all efforts to prevent it, effective treatment is needed. The best treatment is to rest and avoid sport activities for approximately 2 weeks. After the resting period, the patient can start light training. Athletes should try different sports, like swimming, ball games, cycling etc. Training should progress very slowly, with the pace determined by carefully listening to the patient’s feelings.
Psychological state of athletes is also important; athletes should forget the past and concentrate on the future. Otherwise, they can easily start comparing their performance and feelings to the time before the overtraining state, inducing a neurotic attempt to recapture the previous feeling. This can delay recovery and highlights the huge role of psychological factors in recovery. Professional psychological help is sometimes recommended for athletes who are seeking to overcome an overtraining problem.
Depression is one of the biggest psychological problems among overtrained athletes, and differentiation between primary depression and overtraining with secondary depression is difficult. Training history, discussions with coaches and other athletes, and a family history can help clarify this question.
Adequate nutrition is one of the most important background factors behind a positive training effect and is also very important for overtrained athletes. If the diet is balanced, additional supplements and nutritional modifications have not been proven to speed recovery. The most common deficiency, especially in female endurance athletes, is iron. Zinc, magnesium, and calcium deficiencies have also been reported in endurance athletes, especially those who deliberately restrict their diets. In those cases, supplementation is needed.
Adequate sleep is important during recovery. All additional stressors should be minimized. Traveling can increase tiredness, but in some cases, changing the environment and finding new hobbies can be good for recovery. Increased sexual activity may aid a recovering athlete, as it relaxes and modulates neurotransmitters beneficiently.