Dr. Bill Sands talks RECOVERY and BASKETBALL

An interview by Art Horne

everything basketball


There has been much talk about CNS fatigue and overtraining recently.  Can you review the most basic signs of overtraining? How does one distinguish the difference between overtraining and a college athlete simply having too much fun at night?

Overtraining has been discussed and studied for over 100 years and we still have no consensus on a marker, mechanism, or treatment (other than rest away from training).  For example, here are some quotations regarding overtraining, please note the dates:

“Overtraining is an old problem in sports.  In 1866 Archibald Maclaren wrote in his book about training: ‘Of course, it is understood that the exertion shall not exceed the powers of recruitement; and of course it is understood that the recruitement shall be facilitated by adequate diet and rest.’” Quoted in (Nilsson, 1987), p 97.

“Maclaren’s athletes trained for 15 to30 minutes per day.  Thorleif Haug and the other top skiers in the nineteen twenties trained 2-3 times per week and yet they feared overtraining.”  (Nilsson, 1987), p 97.
“When the famous Norwegian cross country skier Thorleif Haug was interviewed in Idrætsboken in 1922, he stated that he trained twice a week but when he feared that he was overtrained he decreased the training frequency to once a week.”  Quoted in (Nilsson, 1987), p 97.

“In top sports today the winner seems to be the athlete who manages best the delicate balance between the training load and the body’s capacity to tolerate this load.  It seems as if each athlete has an individual threshold, and when the total load exceeds that threshold it causes a cascade of reactions that can result in overtraining.”  (Nilsson, 1987), p 97.

“Since it inhibits every aspect of performance, some regard overtraining as a protective physiological response to too much stress.”  (Nilsson, 1987), p 97.

“The process of adaptation is the result of a correct interplay of work and recovery.  By using up potentials of function and energy the training session at first releases a process of fatigue which temporarily lowers the functioning ability of the organism.  The decisive stimulus which releases the functional and morphological adaptation process takes place primarily during the recovery phase.  From the biological viewpoint this process not only renews the sources of spent energy (regeneration), but at the same time regenerates beyond the original level (overcompensation).  Overcompensation is the basis for the improvement in function and performance.” (Harre, 1982), p 55

“The fatigue emerging during and following each workout is overcome relatively quickly, and in an ever shorter time after normal training.  It is a physiological process due to the work which is right for the performance capacity of the athlete. 

When the total work of the athlete, through training, profession, study, school requirements, etc., exceeds his performance level and his resistance, the result is an overload.  Overloading cases a progressive worsening of fatigue.  The performance standard is not fully recovered after training and shows a continually declining tendency until the causes of overloading have been removed.  Important changes occur particularly in the activity of the central nervous system due to overloading by disturbing the optimum interrelation between excitation and inhibition.
 Israel therefore distinguished between the basedowoid form condition of overloading (dominance of excitation processes) and the addisonoid condition (dominance of inhibition processes). The occurrence of one or the other form depends on the particular properties of the nervous system as well as on the nature of the overloading.  According to Israel the inhibition processes are intensified particularly under the influence of extended endurance work sustained at a level slightly higher than usual.  Excessive excitation is produced mainly by the sudden incidence of too great an amount and by a major amount of maximum and submaximum intensity compared with normal performance, by a too rapid increase of such demands or by overloading the power of concentration when learning complicated sequences of movement.” (Harre, 1982), p 69

“Fourteen percent of the athletes (14.2%) indicated that they did overtrain for the Olympics and that it was clearly harmful to their performance (M=2.17).” (Gould et al., 2002), p 46. 

“The GDR coaches, and their sports medical support team, are seeking the athletes who have the metabolisms that will take world-class training loads without suffering breakdown.  Physiologically they can find these potential stars fairly quickly.  But then there are the psychological factors to consider too.”  (Gilbert, 1980), p 117.

“Younger athletes especially show earlier symptoms related to overtraining but do not relate those to the training process.  Goss (1994) reported that mood disturbances are related to age.  Older swimmers possessed fewer mood disturbances than younger swimmers did.  Therefore, monitoring is important for everybody but especially for younger athletes such as juniors.”  (Kellmann, 2002), p 17.

“Moreover, these swimmers seem to have no warning system to suggest fatigue and will therefore ‘easily’ swim too fast in training and break down their anaerobic capacity even further so that the above situation becomes exacerbated.” (Olbrecht, 2000), p 32.

“As a consequence for training, the better one regenerates from an intensive workout, the more frequently he can perform specific intensive exercises in a workout, the more frequently he can perform specific intensive exercises in a training cycle without any risk of overtraining.  With respect to competition, faster regeneration will allow the swimmer to achieve several consecutive top performances within a few days.  This becomes more important with the introduction of semi-finals between preliminary and final heats in competition.” (Olbrecht, 2000), p 72.

“There is thus a constant and continuous interaction between the planning process and its execution.  This interaction results in an uninterrupted loop of “planning,” “executing,” “measuring the training effects,” going back to the training plan and verifying whether it has to be “adjusted” for the next mesocycles.  Every loop provides feedback information, which is used to plan the next cycle in order to fit in the training process with the individual trainability and so improve the training efficiency and “return.”  This process is called “training steering”… (Olbrecht, 2000), p 203.

“Bompa suggests that monocycles should be used for novice and junior athletes, bi-cycles for experienced athletes, and tricycles are only recommended for advanced athletes who have extensive training backgrounds.  Too many competitions create significant stress through travel, expectations, social and psychological factors that can lead to under-performance and eventually burnout.”  (Smith, 2003), p 1114

“Overreaching or short-term overtraining is an accumulation of training and non-training stress and is characterized by transient performance incompetence which is reversible within a short-term recovery period of 1-2 weeks and can be rewarded by a state of supercompensation.  Sufficient high level of overload training that push an athlete into an overreached state are a normal and necessary part of the training process.”  (Smith, 2003), p 1118.

“However, if an athlete is not monitored closely, the short-term fatigued state can often turn into long-term overtraining.  Overtraining is a long-lasting performance incompetence which lasts 3 weeks or more due to an imbalance of training load, competition, non-training stressors and recovery.”  (Smith, 2003), p 1118.

“Despite a wide array of markers and tools for diagnosing overtraining, there is currently no single marker.”  (Smith, 2003), p 1119.

“Under-performance is a consistent unexplained performance deficit (recognized and agreed upon by the coach and athlete) despite 2 weeks of relative rest.  However, it cannot be assumed that under-performance is a result of inappropriate physical training alone.  Under-performance can result from either insufficient recovery or from prolonged recovery which can lead to detraining.” (Smith, 2003), p 1119.

“The ultimate goal of monitoring is to give each element the appropriate degree of individual attention while simultaneously watching and guiding all others.”  (Smith, 2003), p 1120.

“It is unfortunate that most scientific studies reported in the literature are relatively short term (6-20 weeks), do not use elite athletes, and suggest that the dose-response (biological impact) is predictable and if repeated will produce the same response.” (Smith, 2003), p 1121

“One of the first questions we faced was, “What has previous research told us about overtraining?”  The short answer seemed to be “nothing conclusive.”  (Richardson, Andersen, & Morris, 2008), p 4.

“Despite research findings that have linked changes in psychological and physiological variables to alterations in intensity and volume of training, the research on OT has not clearly distinguished between markers that identify intense positive training and those that pinpoint incipient OT.”  (Richardson et al., 2008), p 4.

I believe that overtraining has to be linked to performance.  Studies often find that if you induce a fatigue state you’ll get a change in physiological and psychological markers/variables.  Unfortunately, these studies almost always use training volumes and intensities that no reasonable coach would ever employ.  In short, what is really being studied is the stress-response to an unrealistic training demand.  What I want to know is how come athletes will show signs of overtraining when the training stimuli have not been excessive.  In order to be overtrained I believe that first the athlete must show a decrease in performance after a period of relative improvement that is unexplained by reduction in caloric intake, a sudden increase in volume and/or intensity, illness, injury, or a period of rapid growth.  Second, the athlete should show an inability to recover from “normal” training in the same time period while reaching the same state or quality of performance as was achieved prior to the current time when the athlete is not performing to expectations.  Third, the athlete has to have a serious reduction in his/her desire to train.  If an athlete is overtrained, then avoidance behavior is evident along with depression, irritability, and the desire to be somewhere else.  The lack of desire to train must persist for a week or more such that it is not a common reaction to simply being tired in the short-term.
I don’t believe that an athlete can be “overtrained” in one night, nor in one practice, nor in one day.  I think athletes can show rather dramatic fatigue in such short periods, but I choose to leave the term “overtraining” to apply to non-transient states of unexplained decreased performance.  In my view, if the athlete is resurrectable in a week, then he/she is not overtrained.  Sadly, it is common for those of us who deal with athletes on a regular basis to give in to naming things about training before we understand them.  “The time for definitions is after we understand something – not before” Paul Churchland, 1998, There are numerous examples: interval training, cross-training, carbo-loading, anaerobic threshold, plyometrics, and so forth.  Overtraining has a lot of terms associated with it that have attempted to explain something simply by renaming it: chronic fatigue (not the medical syndrome), a slump, staleness, burnout, depression, and the latest – “under-recovery.”  While all may provide interesting slants on the concept, there are some dangers. 

Here are some definitions of overtraining and related terms (emphasis mine):

 Periods when performance plateaus or decreases due to maladaptations to the training program (Smith, 1989).
 The summation of small uncancelled remnants of tiredness that can be recorded only with great difficulty by present equipment (Kereszty, 1971).
 Results in detectable psychophysiological malfunctions and is characterized by easily observable changes in the athlete’s mental orientation and physical performance (Silva, 1990).
 … an imbalance between training and recovery (Kuipers & Keizer, 1988).
 An initial failure of the body’s adaptive mechanisms to cope with the psychophysiological stress created by training stimuli (Silva, 1990).
 The condition under which the performance of an athlete is affected detrimentally for a more or less longer period of time (Councilman, 1955).
 A dysfunction of the neuroendocrine system, localised at the hypothalamic level (Kuipers & Keizer, 1988).
 State of mental, emotional, and physical exhaustion brought on by persistent devotion to a goal (Henschen, 1990).
 Exhaustive psychophysiological response exhibited as a result of frequent, sometimes extreme, but generally ineffective efforts to meet excessive training and competitive demands (Silva, 1990).
 “The clinical patient suffering a reactive depression presents a symptom profile essentially identical to that of the stale or overtrained athlete.”  Dishman, R., Stress Management Procedures. In Ergogenic Aids in Sport, Ed. William, MH. 1983. P277.

As you can see by the above definitions, they all seem to have common elements, but in spite of some agreement we really haven’t progressed very far in the understanding of the underlying mechanisms of fatigue and overtraining.  Some believe that overtraining is completely psychological.  If overtraining is completely psychological then I believe there should be examples of athletes who have been resurrected simply by counseling.  However, I’ve seen athletes who were not changed by counseling and returned to their former level of play.  If overtraining is completely physiological (and admittedly it’s now sometimes hard to separate mind and body), then why haven’t we found a physiological marker that works in all situations? 

Well then, it’s clear we have definitional problems in overtraining, how about symptoms?  Sadly, this doesn’t get us very far either.  I once tabulated more than 300 symptoms of overtraining listed in the literature.  This told me that darn near anything wrong with you could be attributed to “overtraining.”  Moreover, it was common to see contradictory information regarding these symptoms.  These pieces of information led me finally to an idea that I stole from Hans Selye.  Dr. Selye describes the idea of a “syndrome of being sick” (Selye, 1956; Singh, Smith, Fields, & McKenzie, 2008).  He was referring to the common features of an illness, increased temperature, general soreness, fatigue, and others.  He was fascinated not by differential diagnosis, but by those aspects of being sick that were common to all illnesses.  I’ve taken the same idea and now I currently think of overtraining as the “syndrome of being tired.”  I may have fallen into the trap of renaming something too, but I believe that the idea is bigger than just a name – the idea is that all of the previous research efforts are partially correct, and that overtraining is a constellation of symptoms – a syndrome that varies with individuals, their age, their training status, and so forth.  Overtraining as a syndrome is an emergent property involving the athlete, his/her current status (physical and psychological), and the stressors being imposed on him/her.  When the constellation of characteristics of the athlete reach a certain point (self-organized criticality (Bak & Chen, 1991)), then the athlete hits a “tipping point” (Gladwell, 2002) that results in the manifestation of “overtraining” symptoms and an avalanche of fatigue (Gould, 1989; Sands & McNeal, 2000; Shermer, 1993; Shermer, 1995; Shermer, 1996). 
We’ve all seen athletes who tie-one-on the night before a contest and do well, and of course we’ve seen the opposite.  Playing the odds, it is smarter in the long run to get sufficient rest, eat well, and prepare mentally for the contest.  This is difficult to accomplish in a drunken stupor.  The only test of which I’m aware that deals with day-to-day fluctuations is the Rusko test or an orthostatic intolerance test that records heart rate at awakening (before getting out of bed) and then continues to record heart rate upon quickly rising to a stand.  Heart rate will increase on rising, but should then decrease.  If the heart rate stays elevated then the athlete is said to be under-recovered from the previous day’s training and training load should be modified that day to allow for the diminished capacity of the athlete (Norris & Smith, 2002; Rusko, Rahkila, Vihko, & Holappa, 1989).
I’ll bet you’re sorry that you asked that question…

In most colleges where budgets are tight, how would you suggest monitoring and tracking fatigue and overtraining?

Actually, this is an easy one.  I’ll list some citations below, and you can see the articles I’ve written on this topic.  The primary problem with monitoring is not collecting the data, although it has to be fast and daily, but in how you get important information back without much effort.  I worked on the monitoring problem for over 20 years in gymnastics (Kinser, Kimmel, Wurtz, Sands, & Stone, 2007; Sands, 1990a; Sands, 1990b; Sands, 1991a; Sands, 1991b; Sands, 1992; Sands, 1995; Sands, 2002; Sands, Henschen, & Shultz, 1989; Sands, Shultz, & Newman, 1993; Sands & Stone, 2006a; Sands & Stone, 2006b; Sands & Stone, 2006c; Stone, Stone, & Sands, 2007).  I learned that laboratory testing rarely works unless you’re a resident a National Olympic Training Center where access to testing is largely unlimited.  Training diaries are difficult to manage because although they provide a means of recording things, usually paper and pencil, going over them and searching for trends becomes too time consuming and difficult.  What I found worked was to develop a “dot” sheet for entry of daily training data, scan the dot sheets each week, and then software that I wrote stored and extracted the data to create only the graphs I wanted to see.  I tried having athletes enter data on a computer in the gym, but when you have a dozen or so athletes they end up standing in line and it takes too long.  Using dot sheets allows everyone to complete the requested information and the computer can easily read the forms.  Finally, I used artificial intelligence (AI) approaches to create a rule-based system for the identification of anomalies in training records that would alert me (and the coach) to problems by writing an English sentence or two describing the observation, data involved, and what it meant.  The rules were based on analysis of the overtraining and training theory literature and from long-term experience. 

Reference List - Monitoring

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I realize it’s a long list, but if you’re serious about monitoring you have to know how to do it, what’s worth monitoring, and how to interpret the data.  The major downfall of commercially available training log systems is that they don’t have the rule-based expert system that finds the information for you.  You can do lots of cool graphs with data, but you still have to hunt for the relationships.  In the final round of software I developed the computer did all of that work.  Thus, I could hit a key and get an answer rather than a picture, graph, table, or whatever.  Until the training diary software systems embrace AI technology and provide answers rather than just data and “eye candy,” these systems are worthless time wasters.

Other than great planning, what methods would you suggest using to combat overtraining and fatigue?

There is nothing more powerful in preventing overtraining than sound prior planning, intelligent coaching, and vigilant monitoring.  Of course, monitoring is essential.  It is always surprising to me that teams, coaches, etc. will invest enormous amounts of time and money into an athlete and then fail to watch how their investment develops.  What business owner ignores the profit and loss information from accounting?  I recall a beautiful idea from the book The Miracle Machine about East German sport (when there was an East Germany), where the author interviews an East German sport official and the official remarks that they train athletes the way that we train astronauts.  In professional sports in particular, I’m always astonished at how much money an athlete costs and then how very little seems to be done to monitor their status and progress.

Second, I would ensure that recovery methods are an integral part of training.  Most people think of recovery as simply something that gets added on or something that can correct stupid training.  Recovery has gotten new attention simply because it’s one of the few areas left to exploit in preparing champion athletes.  Fact is, recovery is simply the opposite side of the coin of training and should no more be an “add on” than good nutrition.  Perhaps unfortunately, the recovery literature is a mess.  After running the Recovery Center at the USOC for almost three years, I can say that I only found two things that I could say actually work and weren’t just placebo effects.  These were post training nutrition and peristaltic pulse compression. 

Most college basketball programs finish their season with a conference championship where the eventual winner has to win either 3 games in 3 days, or 4 in 4 days. What strategies would you recommend to encourage recovery?

Tapering strategies are probably most important in tournament play.  Inigo Mujica has done most of the best work on tapering (Bonzafi, Sardella, & Lupo, 2000; Fitz-Clarke, Morton, & Banister, 1991; Gibala, MacDougall, & Sale, 1994; Mujika, 1998; Mujika et al., 1996; Mujika et al., 2000; Pyne, Mujika, & Reilly, 2009; Shepley et al., 1992; Taylor, Rogers, & Driver, 1997; Thibault & Marion, 1996).  There are three “Ds” that I think are the most serious errors invoked by coaches.  Distraction – allowing too much access of outside people to the athletes.  Too often just the well-wishers who want to wish the athletes good luck are so numerous that they become overwhelming and the athletes have trouble keeping themselves centered on their preparation.  Diversion – this mostly comes from believing your own press.  The athletes must concentrate on the tasks at hand and not allow their attention to be diverted to things said in the media, trash talk from other teams and fans.  I’ve seen too often when teams get to the tournament, Olympic Games, World Championships, and so forth that they want to be tourists.  You’re not there to be a tourist, you have a job to do.  The third is Division.  If you can divide the team so that they’re not working and thinking as a team then this often shows up on the field of play.  Contact with family, friends, agents, and so forth should be minimized or eliminated until the tournament is over.  I’m not really referring to complete reclusiveness, but pretty close.  In some cases you may have to confiscate cell phones until the competition is over.  Recent experience has shown that cell phones can be a major problem due to people making contact with overt or hidden agendas to employ the 3 Ds, and sometimes there are just well meaning people wanting to say a few words, but the sheer number of these people makes it hard for the athlete to stay focused. 

Finally, if you have to make some kind of change in order to cope with an opponent, try to make only one change.  Once changes begin to mount confusion sets in and people start thinking too much.  The athletes should already be fit so increasing their training load makes little sense, the athletes should already know their game so changing Xs and Os makes little sense with perhaps one exception for a specific team, and athletes should already have their personal “script” of preparation that they can rely on to get themselves ready.  I’m not referring to running a gulag, but all access to the athletes should be strictly controlled and limited.  

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