There are many terms in the literature in use such as over training, fatigue, poor performance, overtraining these all result in an athlete performing at a level  lower than their training expectation would place them.

Strategies to identify the cause of this under performance are multiple, and in female athletes the historical approach was that of the female athlete triad of under eating, low bone density and amennorrhea resulting in illness.

More recent approaches talk of the Relative Energy Deficiency which I think is much more accurate,




So clearly we need to identify the causes behind the problem and  you can hear more on this in my lecture below

Our clinical approach is to take a detailed comprehensive history of training, completion, performance, medical history and clinical examination along with a graduated return to low level aerobic activity, although widely used does not result in optimum return in my experience I use a graduated approach at threshold, using hard intense activity in very short microcycles, once reversible causes are excluded – but critical here is dietary analysis and support, too often athletes are unaware of their macronutrient breakdown and relative energy deficiency is the result understanding of lactate threshold training zones, metabolic cost of exercise and monitoring of heart rate variability, macronutrients and salivary or haematological markers are used where appropriate to level of training.

Symptoms can be: