Return from RED-S/OTS

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  • #64684

    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


Posted In: Injury & Rehab

  • Participant
    Tyler.W.Johnson1 on #64685

    I forgot to mention I also had Omicron variant COVID near the end of January.

    Anonymous on #64707

    Hey Tyler–wow, sorry you’ve been having such a hard time. I can relate somewhat, as I work a chronically stressful job (high school teacher!) and I struggle to stay physically and mentally healthy and injury free, while still enjoying the mountains.

    For what it’s worth (probably very little!) here are some thoughts.

    It’s obvious that you were just trying to do too much; work, training, racing! You held it all together for a while, and then the wheels came off the bus. Predictable in hindsight, but probably felt reasonable enough. OK, so now you know, and you’re faced with a severely depleted and weakened body, and an uncertain path ahead. What to do?

    First, priorities. Look, you’re in the middle of serious work and career training. Maybe it’s just time to say, OK, now I do what I need to do to become a surgeon, and then later I can re-evaluate my athletic life. Can anybody really maintain a serious training program while completing a surgery residency? Should anybody even try? Sure, some will pull it off, but for most people the answer is no.

    Second, I would suggest just let go of all the goal-oriented training, competition, and so on, and I say that knowing exactly how hard that is to do. Who knows if the past COVID 19 infection is playing a role, but it’s certainly possible. As well as all the accumulated stress and fatigue of the medical crisis these last years. Maybe pick a new, relaxing sport. Stand up paddling, easy hiking, light mountain biking, stretching, yoga. Whatever. Just stay generally active, as much as you can, and try to enjoy moving your body outdoors, in an new way, with no expectations and pressures. Give it 6 months. Give it a year. Give it as long as it takes. Your body will tell you when it’s ready to come back to training.

    As an aside, I understand the advice to gain weight, but that weight will put stress on your musculoskeletal system, it will hinder your future athletic performance, and it is not going to be easy to loose. The only way to loose it without radical changes, potentially harming your body further, will be very slowly, over many months. So, maybe try to get through this six-month or year-long recovery phase slowly loosing weight, so you come out at the end closer to where you feel more natural and comfortable.

    Last, when you are ready to get back to training, bear some points in mind. You’re 38. That’s not old, but it’s not young, either. Where are you in your life? You are going to be working a very demanding job. You didn’t mention family, so I don’t know if that’s in the cards, but that could obviously play a huge role. As a starting point, you have to be truly honest about how many hours a week you can devote to training and recovery. 4 hours? 5 hours? 6 hours? Let’s say you can train 5 hours a week. That’s not five hours of running. That’s maybe 2 hours running, 1 hour of strength training, and 2 hours of light cycling, calisthenics, yoga, or whatever active recovery you prefer. And that doesn’t even take into account time to just rest–lie in bed and stare out the window, watch movies, meditate, read, whatever. I know, Type A athlete/doctor/surgeon types don’t really rest, but it’s the most important part of training. As your situations demonstrates.

    Once you have accepted how much time you have in your life to train and recover, let that number determine your realistic goals, and your sustainable athletic life in the future.

    Good luck.

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