I wanted to reach out to the Uphill Athlete Brain Trust. I will apologize in advance for the length and thank you in advance for any help. I am a 38 y/o multisport mountain athlete but primarily trail and ultrarunning, I am also in the process of completing my general surgery residency currently year 4/6. I’ve managed to stick with pretty heavy training and competing throughout medical school and residency. I’ve used some uphill athlete training plans, some partial coaching and self coaching after reading TFTUA. I had a big 2021, my training was smooth and consistent without any true injuries. I did my first ever 100-mile training week, I then completed the Transrockies Run (120 miles, 20k of climbing through Colorado over 6 days) in August, then completed the Stumpjump 50k in Chattanooga in October. My interim recovery and training between Transrockies and Stumpjump were complicated by the COVID surge in the SE that saw me covering extra work in the ICU for about 8 weeks(think 36 hr days w/ minimal sleep), despite a drop in training volume if all the body sees is stress regardless of the source, I probably toed the line at Stumpjump in an at least overreached state. The race was unseasonably humid and I suffered severe cramping through the last 8-10 miles particularly in the adductors and hamstrings. Following the race, I backed off for a week then did light aerobic activity in conjunction with a heavy strength cycle in preparation for an off season for around 3 weeks. And this is about the time the wheels completely came off. What I assume and following consultation with two sports med docs, was I was in full on OTS or RED-S. I took a full 3 months November-January with nothing more than walking, flexibility/mobility work as well as nasal breath training. I was instructed to eat additional calories and gain 10-15lbs which I did and am still carrying about 12lbs above my normal weight of the last 10 years. I followed this with a slow buildup in February and March, primarily focusing on strength training, limiting my running to every other day, only around 30 min, alternating biking about the same. Limiting endurance to Z1/2. Despite 2 months of this I’ve made just about zero progress. Running still feels terrible and strength progress has been painfully slow, along with noticing pain in my knees. I just fell ‘off’. My heart rate jumps with low end aerobic activity particularly uphills (usually my forte). I realize that with residency and training for performance I wasn’t just burning the candle at both ends, I through the damn thing straight into the fire. I’ve adjusted my goals for training for the remainder of residency to a much, much lower level. I’ve also been focusing on better diet, and improved sleep (at least as much as a surgery resident can).

There is a question here, and what I am trying to sort out is if I am still in an overtrained state vs just being out of shape/aerobically deficient? Or did my race in October with such terrible cramps and breakdown, cause real and permanent damage? I am still about 12lbs over my normal weight which has to be contributing. I also realize I am getting older but for the last 10 years or so I’ve felt amazing, made steady gains or at least hadn’t lost a step. I may just still be working back up to in “shape” as I haven’t taken this amount of time off in a long time and just forgot how bad being unfit feels. I’ve given up on high performance but I’d certainly like to feel somewhat “normal” and would like to get back to where I can at least enjoy the mountains. Any comments or ideas would be appreciated, thank you team

-Tyler