Category: Orthopedics
Posted: 5/23/2026 by Brian Corwell, MD
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20yo college swimmer presents to the ED with a constellation of non-specific symptoms such as poor sleep, fatigue, depression/anxiety, weight loss.
Despite regular 2/day practices, his coach tells him his performance is worse than ever.
Overtraining syndrome
A maladaptive response to excessive exercise without adequate functional rest
-Results in disturbances of multiple body systems (neurologic, endocrinologic, immunologic and psychologic) which causes a broad constellation of symptoms
- May be caused by systemic inflammation and resultant neurohormonal changes (hypothalamic-pituitary-adrenal axis)
- Multiple hypotheses exist
The ACSM 2025 consensus statement on the adolescent athlete highlights that overtraining risk is particularly elevated in those who specialize in a single sport early, train more hours per week than their age, or maintain a >2:1 ratio of organized sport to free play.
Symptoms
The ACSM/AMSSM consensus statement categorizes these into physical and psychosocial domains:
Physical symptoms:
Psychosocial symptoms:
Decreased maximal heart rate during exercise testing (-3.6 to -7.5 bpm) is the most consistent cardiovascular finding
ED workup may include: CBC, CMP, iron studies, TSH, CK.
The only treatment is reduction in training combined with optimized nutrition, increased sleep, and stress reduction. Subsequent improvement in symptoms and performance confirms the diagnosis but may take months depending on the severity and duration of maladaptation.
