This month is the busiest time of year in my office. Like clockwork, the phone starts ringing off the hook: “Dr. Metzl, I’ve got an achy _______ , and my marathon is in a month. Please help!” Day after day, the same calls come in.

Why? As my friend Ramon, a running coach in New York City, says, “Marathon runners typically get hurt because they violate the rule of too’s: too much, too quickly, too intensely.” In other words, these injuries are the result of overtraining. With thousands of runners training for fall marathons, peak running mileage hits between late summer and midfall. After months of pushing ahead, the body, if not trained properly, starts to break down. There’s a fine line in endurance sports between achieving maximum fitness and going overboard.

As a sports medicine doctor, an endurance athlete, and a fitness professional, I get it! We all want a good result, and we ride the edge to get that result. But when we go overboard, we can end up with overtraining syndrome, a surprisingly common condition characterized by diminished performance. It shows up in three key areas—mental, hormonal, and physical—and the tricky part is: You might not even realize you have it. Let me break it down.

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One of the most common symptoms of overtraining syndrome is burnout. A runner who puts so much stress on his- or herself (think: poor sleep quality, caloric deficiency, and increased anxiety about an upcoming race) will feel spent. Mental fatigue is often overlooked, but it is an important part of training. A tired mind goes hand in hand with a tired body. When the energy is low, breakdown and injuries occur.

To prevent mental burnout from getting the best of you, mind your mind. Get more sleep during long-mileage weeks—resting is when your mind and body have time to heal. Schedule activities that are relaxing, such as getting a massage or taking a “me” day. It’s OK to give yourself license to ease up. Skipping a long run to sleep in is more helpful than pushing yourself and ignoring your body’s cues.


Your body is a finely tuned machine. Hormones, produced by various glands, are responsible for maintaining homeostasis, the body’s delicate balance that controls many of our daily functions, from sleep cycles to hunger cues. When overtraining hits, the hormones get out of whack, some being produced too much and others not enough. This ends up causing problems including decreased immunity and abnormal hunger responses and cravings. It can even cause amenorrhea, the loss of menstruation in women.

If you suspect a hormonal imbalance, it’s time to talk to your doctor and maybe see a sports nutritionist. Your doc can perform blood tests to check for hormonal irregularities and iron levels that give clues for a diagnosis. The most common issues are nutritional—like not taking in enough calories for athletic expenditure—and can be fixed with a smart nutrition plan.


The most obvious component of overtraining is physical injury. Runners limp into my office with injuries that worsen with higher mileage, including aches and pains in the feet, Achilles tendons, shins, knees, and hips. The severity of these injuries range from mild overuse injuries that resolve in weeks to stress fractures that can take several months to heal.

As with mental and hormonal overload, physical overtraining means you’re pushing too hard for your body. Remember that a 10-mile run is a different experience for each runner, depending on body type, gait mechanics, and previous injury history. Pain that changes the way you run and alters your gait mechanics needs to be checked out by a doctor. Small aches and pains can quickly turn into more serious problems if they aren’t properly diagnosed.

Runners with an injury often freak out about missing days or weeks of training. My advice: Take a deep breath, do some cross training, and relax. It’s rare that an injury happens during a race—more than 90 percent of running injuries happen in the buildup phase of training—so it’s better to be slightly undertrained and healthy when you toe the line than develop or worsen an injury due to overtraining.

In the end, structured training plans, smart nutrition, and reliable gear are all important to runners. But they’ll all mean nothing if you don’t pay careful attention to your body. If the signs of overtraining syndrome are caught early, it’s more likely that I’ll see you on the starting line of the marathon and not in my office.

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