Spot The 6 Warn­ing Signs

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South African trail run­ner Ryan San­des won the North Face Trans­granca­naria (a 125km race through the mi­dalti­tude ar­eas of Gran Ca­naria) at the start of the racing sea­son in 2014, he was in the shape of his life. In the same year, he trained for South Africa’s Drak­ens­berg Grand Tra­verse – a 209km Fastest Known Time (FKT) at­tempt – with ad­ven­turer and en­durance ath­lete Ryno Griesel. Mileage is of­ten hard to gauge with trail run­ning, but the pair were train­ing be­tween 15 and 30 hours a week. San­des also scored highly at the Ul­tra Trail World Tour. Then he de­cided to race the Ul­tra Trail Mount Fuji – which meant he would com­pete in a 24-hour event just two weeks af­ter he’d run a record time of 41 hours and 49 min­utes at the Drak­ens­berg Grand Tra­verse. He thought that be­cause the races were fairly slow-go­ing, the dis­tance wouldn’t take it out of him. But the truth is, run­ning three or four ul­tra marathons in a year is ask­ing a great deal. Even the body of an elite ath­lete can be pushed only so far. Soon, the cy­cle of too much racing, and not enough re­cov­ery, be­gan to take its toll – in the most fright­en­ing of ways.

Feel­ing tense and anx­ious be­fore a big race is only nat­u­ral, but the stress San­des felt be­fore his next race, the Western States 100-miler/160km (Cal­i­for­nia, US) in June 2014, was much higher than he was used to. Usu­ally he had a cast-iron stom­ach that noth­ing would af­fect, and good tol­er­ance for high tem­per­a­tures. But dur­ing this race, San­des’ stom­ach didn’t feel right, and he felt like he was over­heat­ing. His legs felt heavy and then they seized up: it was as if – in­ex­pli­ca­bly – they had noth­ing left. De­spite the ef­fort he had made in train­ing, San­des only came fifth.

In De­cem­ber that year, tests re­vealed he had glan­du­lar fever. ‘Even so, I didn’t take it as se­ri­ously as I should have,’ he ad­mits. ‘I backed off, but I thought I would bounce back af­ter two or three months.’ It would take an­other nine months be­fore San­des com­mit­ted to tak­ing proper time off. He wasn’t a new­bie run­ner any more. Trail run­ning was his job and he felt he had to per­form in or­der to keep it. His com­peti­tors were run­ning two or three 100-mile races a year – and on top of that, an­other two or three 50-mil­ers (80km). Some were log­ging 320km of train­ing a week – and they were do­ing re­ally well.

Maybe, San­des thought, he hadn’t won Western States be­cause he hadn’t trained hard enough. Maybe the an­swer was to train even harder. Or maybe he was so pre­oc­cu­pied with try­ing to hit im­pos­si­ble tar­gets that he lost touch with his own body.


IN PREPA­RA­TION for the 2015 racing sea­son, San­des be­gan high-in­ten­sity train­ing, in an at­tempt to in­crease his en­gine’s power. But as soon as he stressed his sys­tem, he fell ill again. ‘I wasn’t full-on sick. I just didn’t have any energy,’ he re­calls. ‘I’d take 10 days off to re­cover, but the mo­ment I re­sumed train­ing again, I felt tired.’ San­des be­came so tired that he even­tu­ally found it dif­fi­cult to get out of bed. He dropped out of a string of races in 2015: Transvul­ca­nia (La Palma, Ca­nary Is­lands), Western States and fi­nally the Ul­tra-trail Du Mont-blanc (UTMB).

There had to be a rea­son. There was: San­des had de­vel­oped overtraining syn­drome (OTS) – a dis­or­der that af­flicts en­durance run­ners. It is de­fined as a last­ing de­crease in ath­letic per­for­mance and changes in mood, which don’t re­solve fol­low­ing a nor­mal pe­riod of rest. And it’s not just elite ath­letes who are at risk. Granted, OTS is most likely to oc­cur in over­achiev­ers, but it also af­fects the ev­ery­day ath­lete. Those who train in

a group where the other run­ners are marginally bet­ter are per­pet­u­ally train­ing a lit­tle harder than they should. Oth­ers at risk in­clude those who set un­re­al­is­tic goals that they think they can achieve sim­ply by train­ing hard, and run­ners who carry on train­ing de­spite ex­ter­nal stres­sors, such as long work­ing hours, re­la­tion­ship prob­lems or sleep de­pri­va­tion.

It took San­des more than 12 months to re­cover. As he dealt with the con­se­quences, he also had to ac­cept that he’d made a big mis­take. Thank­fully, he was one of the lucky ones – he caught OTS in the early stages. There are oth­ers who don’t come back from it at all.

What is OTS? Pro­fes­sor Mike Lam­bert, who works in the Di­vi­sion of Ex­er­cise Sci­ence and Sports Medicine at the Sports Sci­ence In­sti­tute of South Africa, is es­pe­cially in­ter­ested in how the body re­sponds to train­ing.

‘OTS is a very ad­vanced state and it hap­pens when your body fails to adapt,’ he ex­plains. Lam­bert asks us to imag­ine we are curled up on the sofa at home, re­lax­ing with a good book. Our heart rate and breath­ing rate are low and our blood is cir­cu­lat­ing to our or­gans, and not re­ally to our mus­cles that much. Ba­si­cally, our bod­ies are reg­u­lated to the state we’re in now. Then, some­one comes charg­ing into the room scream­ing, and we’re given a big fright. Sud­denly, our sys­tem is dis­turbed: our heart rate shoots up and our breath­ing rate in­creases. ‘From a bi­o­log­i­cal per­spec­tive, our body in­ter­prets ex­er­cise as be­ing just as stress­ful,’ ex­plains Lam­bert.

‘Af­ter high-in­ten­sity train­ing we’ve used up some mus­cle glyco­gen, lac­tate lev­els are high and our breath­ing rate and body tem­per­a­ture have in­creased. When you’re re­cov­er­ing af­ter high-in­ten­sity train­ing, all of those things need time to get back to nor­mal again. If, on the other hand you get sick, train too much and don’t re­cover enough, or adopt poor eat­ing habits, your body is un­able to do that. The con­se­quence is that your body loses the abil­ity to reg­u­late it­self.’ This means that high lev­els of hor­mones such as cor­ti­sol – which is re­leased in re­sponse to ex­er­cise stress – are cir­cu­lat­ing in your body, even when you’re not re­ally stressed.

OTS is dif­fi­cult to di­ag­nose, for two rea­sons. The first is that symp­toms are in­di­vid­ual, and even within an



in­di­vid­ual they might change over time. Se­condly, there are med­i­cal con­di­tions with sim­i­lar symp­toms that could be mis­in­ter­preted as overtraining – not eat­ing enough car­bo­hy­drates or pro­tein, iron de­fi­ciency and al­ler­gies, for ex­am­ple. You have to be sure those aren’t caus­ing the prob­lem first.


AF­TER HE had been di­ag­nosed with glan­du­lar fever, San­des vis­ited his fam­ily hol­i­day home in Cape St Fran­cis, South Africa, for three weeks, where there is an 8km trail called the Wild­side. At first, even walk­ing on it felt dif­fi­cult. When he could fi­nally run on the trail, it was as tough as run­ning 100km. OTS had af­fected the part of the ner­vous sys­tem re­spon­si­ble for con­trol­ling San­des’ heart­beat, and the hor­mones that in­crease heart rate blood pres­sure, breath­ing rate and mental alert­ness when he felt stressed. This meant that when San­des was run­ning at any speed, his heart rate was higher than usual for that speed.

‘ Your per­cep­tion of ef­fort in­creases in tan­dem,’ ex­plains Lam­bert. ‘So if San­des was ac­tu­ally run­ning at 4:35/ km, he prob­a­bly felt like he was run­ning much faster.’ OTS af­fects the per­for­mance of other mus­cles, too. ‘Un­less the energy you get from car­bo­hy­drates is re­placed dur­ing a long-dis­tance run, your mus­cles be­gin to fa­tigue, thus re­duc­ing your abil­ity to pro­duce force,’ Lam­bert wrote in the 1999 book Over­load,per­for­mance In­com­pe­tence­an­dregen­er­a­tionin­sport.

And be­cause your ner­vous sys­tem can’t con­trol your bod­ily func­tions as ef­fec­tively, your mus­cles lose their abil­ity to pro­duce lac­tate. ‘As long as the clear­ance of lac­tate is matched by its pro­duc­tion, it be­comes an im­por­tant source of fuel,’ wrote Michael Hutchin­son, au­thor of Faster:theob­ses­sion,sci­ence­and­luck Be­hindthe­world’sfastest­cy­clists. ‘In the later stages of a marathon – an event in which the ef­fort is con­sis­tently quite high for hours – typ­i­cally, half the energy sup­plied is done by lac­tate trans­port­ing energy from non-used mus­cles. With­out that, you will fa­tigue more quickly.’ In ad­di­tion, high-in­ten­sity ex­er­cise dam­ages your mus­cles. And then, Lam­bert ex­plains, ‘white blood cells pro­mote in­flam­ma­tion and dam­aged mus­cle fi­bres are re­moved, af­ter which the re­gen­er­a­tion of new mus­cle fi­bres be­gins.’

If you run an ul­tra marathon, ob­vi­ously your mus­cles will be sore. Usu­ally, by the fifth day or so af­ter, the pain starts to sub­side. But it takes at least four weeks for your mus­cles to re­gen­er­ate af­ter any­thing over marathon dis­tance – which is why pain isn’t a good

guide to your mus­cles’ state of re­cov­ery. If they aren’t given the chance to heal be­fore your next train­ing ses­sion, you may find you feel tired and that your per­for­mance has dropped.

In more se­vere cases, the new mus­cle fi­bres will at­ro­phy (waste away), caus­ing a loss in mus­cle mass. ‘Look at the mus­cles of an ath­lete suf­fer­ing from an ex­treme case of OTS un­der a mi­cro­scope, and they look like those of some­one much older. By overtraining, you’re ac­cel­er­at­ing the age­ing process,’ says Lam­bert.

San­des kept get­ting sick be­cause the ex­cess cor­ti­sol cir­cu­lat­ing in his body was sup­press­ing his im­mune sys­tem – his body was un­able to pro­duce enough white blood cells. Not only do white blood cells help your mus­cles to heal; they also help to fight in­fec­tion. When San­des had glan­du­lar fever in 2014, his im­mune sys­tem was so rav­aged that his white blood cell count dropped by more than half. ‘Glu­cose (from car­bo­hy­drates) fu­els the im­mune sys­tem. If your cir­cu­lat­ing glu­cose is low, then your im­mune sys­tem ba­si­cally runs out of energy. That means it can’t do its job prop­erly. The re­sult is that you lose your abil­ity to re­sist colds and be­come more sus­cep­ti­ble to al­ler­gies,’ says Lam­bert, who gets a fever blis­ter the mo­ment his im­mune sys­tem is sup­pressed.

‘In ath­letes suf­fer­ing from OTS, sero­tonin [the happy hor­mone] isn’t man­u­fac­tured at the same rate,’ says Lam­bert. Though this has yet to be proven con­clu­sively, the the­ory has been around since the 1980s. Re­searcher Wil­liam Mor­gan pub­lished a study on ath­letes who, dur­ing pe­ri­ods of vig­or­ous train­ing, re­ported in­creased neg­a­tive moods (ten­sion, de­pres­sion, anger, fa­tigue and con­fu­sion) and a de­crease in en­thu­si­asm. This may ex­plain why San­des felt grumpy. ‘I don’t know how much that had to do with the frus­tra­tion of con­stantly hav­ing to drop out of races, but I def­i­nitely ex­pe­ri­enced a lot of low mo­ments,’ he says. ‘In the lead-up to UTMB, I was try­ing to force my train­ing and it wasn’t as ex­cit­ing or en­joy­able as it should have been.’


‘ IT CAN take years to re­cover from the symp­toms of OTS, and re­turn to the level you were at be­fore,’ says Lam­bert. ‘ It all de­pends on what caused it: it takes a long time to come back from a hard race in which heat and ex­haus­tion were defin­ing fac­tors; but less time if your OTS was caused by poor nu­tri­tion. It’s all about re­mov­ing the cause. If it’s nu­tri­tion, for ex­am­ple, you need to fix your diet.’

San­des had to take a break from train­ing and racing. ‘As soon as I ac­cepted that, my white blood cell count bounced back. It could just be co­in­ci­dence, but I be­lieve be­ing in a happy headspace aids re­cov­ery, and try­ing to force it de­lays that process.’ San­des has learned from his ex­pe­ri­ence and has made con­sid­er­able ad­just­ments to his train­ing. These days, he tries to do smaller blocks of train­ing and his re­cov­ery pe­ri­ods are longer. But given the amount of time it took for him to re­cover, there’s no doubt pre­ven­tion would have been bet­ter than this cure.

Does San­des re­gret 2014? Not en­tirely. OTS might have been even harder to ac­cept had it not come off the back of a suc­cess­ful racing sea­son. But he does ac­knowl­edge that he failed his sys­tem by cou­pling hard races with in­ad­e­quate re­cov­ery. ‘There are times when I’m not sure if I’ve truly re­cov­ered,’ he says. ‘I achieved lots of con­sis­tent re­sults in 2016, but no big wins. I don’t know if that’s be­cause I’m get­ting older or if OTS has taken some­thing away.’

San­des has been com­pet­ing in ul­tras for nearly 10 years. A lot of the guys who are new to the scene are do­ing ex­cep­tion­ally high mileage. San­des doesn’t fol­low suit, be­cause he’s knows he can’t sus­tain it. What does San­des’ story teach us? That rest should be taken just as se­ri­ously as train­ing. Re­gard­less of what causes OTS, the con­se­quences of ig­nor­ing it can be huge.

Transvul­ca­nia, in La Palma, was one of a string of races San­des had to drop out of in 2015 be­cause of overtraining syn­drome.

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