Overtraining and the risk of developing musculoskeletal pain

Symptoms of overtraining include general muscle and joint soreness, fatigue, and reduced concentration. We want our patients to be progressing their exercises in order to maximise their exercise capacity (strength, endurance, flexibility, power, balance etc.), but it is important to consider how to do this safely.

Clinically, we often refer to the “10%” rule in regard to how much a patient can maximally increase their physical activity per week. For example:

1)If someone typically walks 1km a day, they should only increase this to 1.1km maximum per day for the first week, then 1.21km etc.

2)If someone can bench press 50kg, they should only increase this to 55kg maximum.

This rule has its downsides. Firstly, progressing a 5kg dumbbell shoulder press to 5.5kg is not clinically possible. Conversely, progressing a marathon runner’s 30km training run to 33km may be too much. The 10% rule is rather seen as a rough guide and clinical judgement is required to safely progress exercises.

The acute to chronic workload ratio can objectively measure whether someone is overtraining or not, as subjective symptoms such as muscle soreness may not be an accurate reflection of overtraining. To work this out, the clinician utilises an objective exercise measure (e.g. heart rate, distance, weight lifted, rate of intensity of exercise) and multiples this by the time they spent exercising that day.