I’m a big fan of simple strategies that can help athletes manage injury or improve performance. We’ve talked recently about the growth in wearable technology for runners and while this can certainly have value there’s a lot to be said about doing the simple things well. One such area is athlete recovery. It’s often neglected and yet simple tactics like improving sleep and nutrition can have a really positive impact. This blog is the first in a series on recovery, starting with key concepts of stress-recovery balance, overreaching and overtraining…

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Training athletes is a complex process that tries to achieve a balance between stress and recovery. I’ve chosen my words carefully here. By using the term ‘stress‘ I refer to both physical and psychological stressors as a growing body of evidence suggests we need to consider both. Physical stressors include our training load (volume, intensity, frequency, type etc), other sports and activities of daily living. Psychological stressors include a wide range of areas including emotional stress, work and family life, mental health and cognitive demands of sport. In truth there is a great deal of overlap between physical and psychological stressors and they are very much interlinked.

If the stress and recovery are sufficient we can improve performance and fitness and gain a host of positive physical and mental adaptations. However, if the stress is too high or the recovery is insufficient we may see impairment in performance and fatigue and it may be a significant factor in the development of running injury.

Now I must say that some fatigue is a normal part of training providing it’s only short term and we allow sufficient recovery. Problems arise when stress remains too high with inadequate recovery and results in prolonged performance impairment and fatigue.

Athletes often place a great deal of importance on training but pay far less attention to recovery. As health professionals we too may be guilty of this. We routinely ask about training and load management but are perhaps less consistent when asking about recovery.

We should be mindful of an athlete’s training beliefs and recognise they may lead to training error and injury. Many runners (and I’ve been guilty of this) think more training always means better performance but without adequate recovery it can actually lead to a drop in performance and an increase in injury risk. Bobby Clay’s recent piece in Athletics Weekly highlights how our drive, our fellow runners, our training and our lack of recovery (in her case under-fuelling) can combine to result in injury;

I was constantly around those who unfortunately were in the grasp of a frightful relationship with food and, ultimately, I also began to under-fuel my body. My under-fuelled body was also being forced into over-training. Like all athletes, I am obsessive. I am obsessed by athletics, with training and with being the best. Looking back now, no amount of training would have ever been enough to satisfy my hunger to do more.

A key point to take away is this, in order to achieve stress-recovery balance we need to assess both the stress (physical and psychological) and the recovery strategies.

Below are some example questions you might ask when working with an athlete;


In addition to questions like this there are several questionnaires we can use in clinic such as the Training Distress Scale (TDS – see also Grove et al 2014) and Multi-Component Training Distress Scale (MTDS – Main et al. 2009). There is also the RESTQ, Recovery-stress questionnaires but I believe a licence is required to use them. Subjective measures (such as questionnaires) can reflect acute and chronic training loads and may be superior to some objective measures (Saw et al. 2015 open access). Nässi et al. (2017) have recently reviewed the use of psychological tools in athlete monitoring and summarise the pros and cons of some of the popular questionnaires below;


Source: Table A1 from Nässi et al. (2017)

Intimately linked to stress-recovery balance are the concepts of overreaching and overtraining. They are thought to exist along a continuum (see below adapted from Meeusen et al. 2013). At one end of this continuum we have acute fatigue following brief training overload, for example one long or intense training session, this usually resolves in a few days with adequate recovery. As training intensity or volume increases we may start overreaching  which is likely to cause an impairment in performance, at least in the short term. This can be functional or non-functional overreaching;

  • Functional overreaching results in a short term performance decrement followed by an improvement or “supercompensation”. A training camp is a good example. The increase in training needs to be matched with an increase in recovery to maintain the stress-recovery balance.
  • Non-functional overreaching leads to longer lasting performance impairments but without the supercompensation or improvement afterwards. It can be hard to differentiate from overtraining syndrome. It may be that this represents a failure to match the demands of training with effective recovery resulting in a loss of stress-recovery balance.

Overtraining syndrome results in longer lasting performance impairments (months or even years) and is associated with fatigue and mood disturbance. It is difficult to diagnose and can only really be diagnosed retrospectively i.e. once a long period of performance decline has been noted. There are no clear objective tests to confirm overtraining syndrome and changes in biological markers are quite variable. It is a diagnosis of exclusion – a diagnosis may be reached once other potential causes of fatigue, altered mood and performance have been ruled out.

Meeusen et al. (2013) provide an excellent detailed review of overreaching and overtraining in their Consensus Statement which is available via ResearchGate. I recommend reading their paper in full. Here are some key points that tie in with the concept of stress-recovery balance;

  • Overtraining may represent the “sum of multiple life stressors” – it’s not just about training load!
  • An unexplainable decrease in performance can be considered a key indicator of overtraining syndrome.
  • Career prevalence of overtraining syndrome varies between studies but is reported to be around 60% in elite runners and 33% in non-elite runners.
  • As much as 80% of overtrained athletes show signs of clinical depression.
  • Sustained heavy training may suppress the immune system and increase risk of infection and illness.
  • Attention and reaction times may be impaired in athletes with overtraining syndrome and may be an early warning sign if tested.

Overtraining syndrome can be difficult to treat and, like many things, prevention is better than cure. Monitoring training and each athlete’s response to it and including effective recovery strategies with optimal nutrition and sleep help to maintain the stress-recovery balance and reduce risk of overtraining. Be vigilant for sustained decreases in performance which may be a warning sign for non-functional overreaching and overtraining.

As this series progresses we’ll be exploring recovery strategies in more detail with simple advice athletes can use to reduce injury risk and improve performance

Closing thoughts: athletes can improve performance and reduce the likelihood of injury by maintaining a balance between stress (both physical and emotional) and recovery. In clinic keep an eye out for runners with high training loads that don’t seem to be progressing or are reporting a decline in performance – these may be warning signs that they’re struggling to achieve a balance and moving towards overtraining. Be mindful too of what drives people to train how they do, simply telling them to do less isn’t likely to work! We have to understand their drives and work together to strike a better balance. 


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