Part 3: It's all in your head
By Kyla Coates, MSc, PhD student
Over the last two blog posts, my sister and I have tried to define and describe overreaching and overtraining syndrome in order for athletes to better understand where they fit into this discontinuous spectrum. My story is both similar and different to those of other athletes who have recently reached out to us. I hope that in the telling, some of those athletes will feel less alone.
Over the past 8 years, I experienced 4 episodes of severe overtraining syndrome (OTS) that lasted about 4-6 months each. These episodes were followed by a gradual recovery period during which I exhibited symptoms similar to how non-functional overreaching is described. About a year after the OTS onset, I would usually feel normal doing low-intensity exercise again, and would start to test my limits with some intensity by the 18 month mark, only to inevitably trigger another OTS episode.
THE LEAD UP
There were many predisposing factors that likely contributed to my eventual implosion. My twin sister and I have always been bad sleepers, and we were more "fast-twitch" than most, so we didn’t recover well from the all-intensity-all-the-time style of training that was typical of ITU programs. Balancing an undergraduate degree alongside ~20hr training weeks was hard. I passed out from heat stroke 3 times when I was 16 & 17, which is pretty damaging, and that made me more susceptible to heat stroke in the future. I also displayed many signs of RED-S over the years - stress fractures included. However, the summer leading up to my first OTS episode probably put the nail in the coffin.
It was a year out from the 2012 Olympics, and I was (ironically) the training partner that went to all the altitude camps. Every camp went progressively worse for me. By the 2nd camp of the summer, I walked it in from easy runs with my heart rate stuck at 200, and would be off the back, fully maxed out, on easy base rides. By the third camp, I was sleeping 14 hours straight, and could barely get myself out of bed (I was a great training partner). Coming down from altitude presented its own challenges. I was extremely heat intolerant and was sure that I was only avoiding passing out from heat stroke in the indoor pool by scrambling into the ice cold outdoor pool as soon as my coach would allow me to. G.I disturbances and food intolerances started to get worse. Most frustrating of all, I wasn’t able to maintain blood pressure while running hard. We had to perform regular 5km run time trials in order to meet our performance standards to train with the National Training Centre. No matter how good I had being feeling for the first few kilometres, my vision would start to narrow around the 3km mark and suddenly it would take every ounce of concentration and determination to pick up a leg that was now made of concrete. Apparently, I would become very pale and my movements would look robotic, but I would usually make it to the finish line before slipping in and out of consciousness with little memory of the previous kilometres. The consequences were magnified when heat or humidity was involved. At my only opportunity to qualify for Worlds that season, a continental cup in Quebec, I ended up robot-trudging myself into an ambulance ride to the emergency room with heat stroke, severe rhabdomyolysis, and 22 hours of IVs to keep my kidneys going. Weeks later, I did a mini bike and run test in the heat chamber, and by the time I started feeling bad, my diastolic blood pressure had dropped to 30 mmHg. They stopped the test because the blood pressure monitor “wasn’t working” and my core temperature was as high as they could ethically push it. When I did train that year, I wasn’t able to sleep afterwards because of a racing heart rate. I had to take many ‘recovery’ weeks because of fatigue that year. To say that the wheels had fallen off would be an understatement. For some reason I kept trying to train and race throughout that time. Miraculously, it was freezing cold and raining at U23 World Championships in Beijing that year and I managed to put together a surprisingly good race - finishing 12th (aka ~last out of the group of girls below, but I also had to take a 15-sec penalty for missing my gear box with my helmet, so lets blame it on that). So I put the disaster of a year behind me.
Interestingly, my first true bout of OTS occurred approximately 6 months after the disaster year and I do not remember being in an overreaching hole at the time. I was hardly training. My knee had been injured since starting back up after Worlds, so I hadn’t been running and was barely biking. I had taken the semester off of school because we had a lot of training camps planned, so when I woke up one morning feeling like I was coming down with a flu, I obviously didn’t expect that it would stick around for the next year, or that I’d never handle training well again. My “flu” appeared to be triggered by a prolo injection in my knee the day prior. It was meant to bring inflammation to the area to promote healing, but it ended up being the straw that broke the camel’s back. A sudden onset is commonly reported in the chronic fatigue syndrome literature, likely because there comes a point where even the smallest disturbance can be enough to push the nervous system over the edge. Looking back, it obviously hadn’t come out of the blue, but it hadn’t followed a linear progression from non-functional overreaching right into OTS either.
That episode looked much like my future episodes would look. I think of it like a loss of homeostatic control, whereby the autonomic nervous system simply cannot regulate external stimuli effectively. My waking heart rate variability bottomed out. I gained water weight and looked poofy from being in a state of chronic inflammation. I became very sensitive to caffeine and many other stimulants or depressors that you wouldn’t typically notice, such as liquorice tea. My body didn’t respond to exercise appropriately, which is the “exercise intolerance” aspect of OTS/chronic fatigue syndrome. For me, this was characterized by the “whoosh”. An OTS whoosh is a unique full body pain that washes over you when you step over an indeterminate threshold during exercise. It feels like the last 100 meters of an 800m race on the track, with every millimetre of your body screaming in pain - except instead of it gradually developing, it happens all at once. Abrupt wall of pain. The severity of each of my OTS episodes varied, so in the least severe episode, I wouldn’t feel the whoosh until closer to my actual anaerobic threshold, but in my most severe episodes, it would happen when I would encounter a hill while out for a walk. Exercise (or mental concentration in the more severe episodes) would lead to flu-like ‘post-exertional malaise’, which left me curled up on the couch for a day, or several days, with persistent achy muscles and impossibly heavy eyes. In the worst times, the exhaustion and brain fog were so bad that it would take all of my effort to follow a conversation, and to formulate words in return. On these days, it felt like I didn't have enough energy to light up the happiness producing parts of my brain.
A year after my first OTS onset, I tried to get back into training again (I thankfully had a knee surgery which delayed any earlier attempts at returning to training). Without knowing anyone who had experienced something similar (because they had all fallen off the map with diagnoses of depression), I was hopeful that I still had a career ahead of me. As with all of my recovery periods, I experienced symptoms more similar to that of overreaching. As opposed to being in a catatonic state, I would be in more of a highly sympathetic “fight or flight” state, unable to sleep because of a racing heartbeat if I pushed it too hard. My max heart rate had reduced to ~10 beats lower than it had been prior to the OTS, but my submaximal heart rate was often higher than it should have been. I didn’t recover well from training and was often heavily fatigued and depressed after hard sessions. By the time I raced (~18 months after onset), I was able to fake the swim and bike pretty well, but never had the speed that I had always been able to tap into before. Running sucked. I pushed through for 2 years, before I eventually got a stress fracture, biked on it, and triggered the ~4-6 months of OTS, and 6-12 months of NFOR cycle all over again.
I was “retired” by the time I triggered my 3rd episode, so it came as a bit of a surprise. My heart rate variability had been terrible that day, but I had decided to go for a run anyways and ended up feeling the “whoosh” on a hill on the way back home. Not convinced that I was actually experiencing what I thought I was, I tried to push harder. Definitely a whoosh. That bout was the worst OTS I ever experienced (my altitude induced bout of OTS not included), and my best guess is that I just hadn’t allowed myself to recover from the much milder previous bout (that I had more or less trained through... but it wasn’t “training” because I was retired!). The most recent episode (#4) in 2017 was triggered by being an idiot. After 2 years of recovery, I thought that I could do a fun cross-country ski race without trying too hard. Turns out the nature of xc-skiing just makes you cross-eyed. It was the mildest of my episodes though, and I never went into full physiological-hibernation mode. Instead, I was uncharacteristically fight-or-flighty, and once went through 48 hours of what you should probably call an anxiety attack: stuck in a cold sweat with a racing heart rate. It still took about a year for exercise to feel good again.
I am now in my longest recovery stretch ever (3 years). I am exercising 4-5 days a week, and can throw in a little intensity here and there without severe consequences. I finally am quite apprehensive about putting myself in situations where I could accidentally overdo it (racing or exercise testing). It still takes me longer to recover than I think it should. If I push myself in a workout, it will usually take me most of the week before I feel motivated to get out the door again. There is always a little voice in my head trying to convince me that this time it is just because I am out of shape.
If I learnt anything from my experience, and from the experiences of my friends who never fully returned to their former selves following too many years in RED-S/NFOR, is that you HAVE to allow yourself the time to recover. I was always pushing my limits, never admitting to myself that continuing to exercise was doing more harm than good. Allowing a messed up metabolism (RED-S) or neuro-endocrine system (RED-S/NFOR) to recover takes a long time! As athletes we are all so scared of taking time off, but you will never get fit if you are not adapting positively to training. I always wonder whether I could have recovered much more fully if I had never relapsed at all. When I talk to people now who are experiencing something similar to what I experienced, my advice is to not set any goals for a comeback. Goals will put you on a timeline that will only result in a relapse. I recommend avoiding any exercise that causes fatigue. Your limits will always be changing as you gradually begin to tolerate exercise again, so listen to what your body is telling you feels good, not what your brain thinks should feel good. And eat lots of carbs. But yes- there is hope :). Please give me a shout if you have a story to share, or if you would like me to back up any of my comments with scientific evidence :P.
It's not in your head :)