Functional Conditions

The earliest onset of overtraining can be very elusive. This is an example of a functional problem, often with few, if any, obvious signs or symptoms to let you know something is wrong. Understanding functional conditions is very important especially in relation to understanding the first stage of the overtraining syndrome.

Functional conditions in athletes are common. While some have serious symptoms, such as debilitating pain, even these problems are usually not accompanied by serious conditions, such as a torn tendon or broken bone. Functional problems are sometimes called “subclinical.” This state of dysfunction makes up the majority of complaints by athletes. For example, a cyclist may have low back pain, whether mild or severe, but show no positive neurological, X-ray, or MRI findings. Another person may experience significant fatigue but show normal values in all blood, urine, and other tests. Yet another person has acute diminishing athletic performance but by all standard medical assessments continues to be in the so-called normal ranges. This contributes to serious frustration in the athlete, who as a result often goes from one health-care professional to another looking for a traditional diagnosis. However, a standard diagnosis—a ruptured disc in the case of back pain, pernicious anemia in those very fatigued—is not appropriate for these functional problems. Moreover, there are no common names that can be attached to functional problems. Unfortunately, many patients expect and want a fancy medical name for their problem; when they have one, accurate or not, misdiagnosed or not, they embrace it.

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In my own practice, some patients even listed conditions on the forms they initially filled out before meeting with me that included fancy diagnoses such as Osgood Slaughter’s disease (a childhood condition of the shinbone below the knee). When I asked them about it, they would say that the diagnosis was given to them twenty years earlier; they’ve been holding on to this “condition” for two decades!

Lateral knee pain in an endurance athlete is another example, typically the result of simple muscle imbalance, no matter how serious the pain. But explaining that to some patients is not as reassuring or comforting as calling it “iliotibial band syndrome.” Worse is that western medical practice and health-care insurance companies demand a standard diagnosis, one from a long list of possibilities they provide, for each condition. But explaining the real condition to an insurance company and not playing the name game results in less or, more often, no coverage. This has resulted in doctors coming up with the closest named condition regardless of the accuracy of the diagnosis. I often made fun of this dilemma by saying to athletes, after they didn’t get an expected named condition, that I could make up a name if it would make them feel better. That often produced a nervous laugh. I would then explain my findings, mentioning significant factors such as muscle imbalance and inflammation; how the injury could have occurred (improper bike form); how it could be corrected (through biofeedback and dietary changes); and how soon they’d be free from pain and begin to train again.

Another type of functional problem can occur in many athletes who possess various signs and symptoms not related to an injury or disease. Examples include an elevated resting heart rate, low body temperature, irregular gait, and other abnormal findings. In many cases, these functional problems are not only manifestations of the pre-injury state, but contribute to a lack of endurance progress. They’re much easier to observe in an athlete, rather than for an athlete himself to feel it. Watching an athlete run, bike, or swim, for example, often shows these physical irregularities. This is known as “body language”—observing how the body portrays some imbalance. If left unchecked, it may result in an overtraining related injury, or eventually even disease.

Functional problems make it easier to understand that an injury is not always synonymous with pain, trauma, or obvious debilitation. It is possible for an injury to be an asymptomatic dysfunction, producing no symptoms.

A functional injury is a dysfunction in the body’s structural, chemical, or mental and emotional process. It is somewhere between the state of optimal health or excellent function and specific injury or disease. A common functional problem in an endurance athlete marks the first stage of the overtraining syndrome.