A discussion of the non-exercise inflammatory causes that can influence overtraining in athletes and fitness enthusiasts

1. Inflammatory Conditions in
Athletics: More Than Just
Overtraining
Charlie Hoolihan, CSCS*D, NASM-CES/PES
Pelican Athletic Club Personal Training Director

2. Welcome to your conference?
Did you cram 40 hours of work into three and a half
days, sleep less, feel irritable, eat out or skip meals
more because you were working so much, plan or
are worrying about next week’s task, increased
your self-medicants (alcohol, comfort food or
others), cut back or double your workout time and
basically live on caffeine, guarana and aspartame
all week. Did you fly or drive six hours here on an
oh so comfortable airline or car seat?

3. Do any of your swimmers sound like
this?
An individual with an allergy/asthma does not get much sleep at
night because he/she is stressed out at work/school that
consists of sitting at a computer terminal/desk and is having
trouble with a friend, relative or significant other.
They are time-crunched at school or work, have big projects due,
been eating fast food five or six meals per week and consider
themselves overweight or out of shape.
They solve this by getting up early before work/school and
commit to more workouts. Right before the workout they
have a fight with a housemate about household divsision of
labor?
AND THE BIG MEET IS IN SIX DAYS!

4. •
Self examination
Do you less than 7-8 hours of sleep per day.
• Do you eat less than five or more servings of vegetables and fruits a
day?
• Do you eat fast food or eat out more than three times per week?
• Are your workouts over 90 minutes?
• Do you have an “itis”?
– Sore joints - Tendonitis?
– Dry or itchy skin or scalp – dermititis?
• Are you allergic to anything? Right now?
• Do you have any aches and pains?
• Any emotional stressors going on with significant others?
• Any increased mental/emotional stressors at work?
• Are you over 50 years old?
• Do you fall asleep with box of Ho Hos, chips and a six pack in your
lap watching TV?
If you answered yes………

5. Inflammation
• Inflammito – Latin for: To set on fire.
• Pro-inflammatory or anti-inflamatory.
• Water or gasoline.
• Turn the heat up or turn the heat down.
• Raging forest fire or boiling cauldron

6. Inflammation is supposed to be a
good thing
• A protective mechanism
• A vital component of our immune system
• A part of our natural defense system against
infection, irritants, toxins.
• Pain or irritation is a warning that something is
amiss.
• It is a very efficient system that must be
acknowledged and cared for proactively.

7. That has evolved into a bad thing
• Modern life style is causing the natural balance of immune
system to shift into a state of chronic inflammation.
• More and more inflammatory conditions that were rare are
becoming common, almost accepted as inevitable.
– Asthma, mood disorders, ADHD, metabolic syndrome, Alzheimers,
obesity, arthritis.
• More and more our society is trying to develop medications for
these maladies rather than choose lifestyle changes.
– Fybromyalgia? CFS? Obesity virus!? Obesity genes!?
• More and more we are opting for surgeries and procedures that
could be substitute with lifestyle changes.
• More and more super-bugs are getting into our system.
• More and more irritants are getting into our system.

8. Chronic vs. Acute Inflammation
• Acute inflammation is a natural body
function to help repair damaged tissue or
ward off viruses and bacteria.
• Chronic inflammation occurs when non-
stop pro-inflammatory conditions maintain
a constant state of low or high grade
inflammation.

9. Ailments directly associated with inflammation
• Cardiovascular disease
• Gingivitis
• Dermatitis
• Rhinitis
• Arthritis
• Allergy - histamines
• Diabetes Mellitis
• Mood disorders
• Cancer *
• Obesity*
• Asthma
• Tendonitis
• Gastritis or IBS
• To name a few.
*Both cancer tumors and adipose tissues develop their own inflammatory system.

10. Inflammation is caused by:
• Tissue damage
– Physical Trauma
• Accidents -Workouts – Repetitive stress –
misalignments.
• Mental and emotional stressors.
– FEAR – false expectations appearing real.
• Lifestyle stressors.
– Sleep
– Nutrition
– Environment

11. Inflammation is regulated by
• Immune system
– Interleukin-1 (IL-1), Interleukin-6 (IL-6) and Tumor Necrosis
Factor alpha (TNF-a). As we will see, these cytokines along with
C-reactive protein
• Nervous system
– Chemicals, physical stress, or mechanical manipulation (pushing
or pressing on the nerve) are all capable of causing inflammation
this way. Adrenaline and Noradrenaline
• Endocrine System –
– controls much of the body’s regulating hormones, the body's pH,
body temperature, and the chemicals in the bloodstream, all of
which have precise relationships to each other that should not be
altered for significant lengths of time. Testosterone, Cortisol GH

12. Inflammation is caused by direct
tissue damage or invasion
• Physical trauma
– Injury or intensive exercise bouts.
– Virus – immune response.
– Allergens - histamines and immune response.
– Toxins – immune and liver response.
– Intra-abdominal fat – develops its own system of pro-
inflammatories - and cytokines – TNF and IL-6 and
CRP which also trigger a cortisol response.
• The body responds in a wonderful way to heal the
trauma or rid our system of invaders.

13. The immune and nervous system
respond to…
Physiological disturbances
1. Allergies – histamines – immune alert that starts
the pro-inflammatory response to a foreign invader.
2. Physical traumas – injuries or muscle damage.
3. Excess intra-abdominal fat – fat cells,
manufacture pro-inflammatory hormones and
cytokines – TNF and IL-6 and CRP which also
trigger a cortisol response.
4. Environmental stressors – pollution, sick
building syndrome.
5. Invading virus, bacteria, fungi etc.

15. Muscle Structure – lots of kindling

16. Figure 1. Proposed mechanism of the relation between the inflammatory response to mechanical
injury and further muscle damage. The initial mechanically induced damage produces myofibre
tearing and inflammatory cell infiltration. Neutrophils may promote further damage through the
release of oxygen free radicals.
Toumi, H et al. Br J Sports Med 2003;37:284-286
Copyright ©2003 BMJ Publishing Group Ltd.

17. Workout stressors
Produce the same systemic response as the
other stressors.
1. High intensity or long workouts are necessary
to improve athletic performance.
2. Working out hard increases inflammation
because muscles are being injured and repaired
in order to come back stronger. The immune
and hormonal responses are similar to physical
injury.
3. Improper posture during workouts – add joint
stress and inflammation to the mix!

18. Muscle Damage Inflammation
• Eccentric weight training
• Lengthy training sessions of 90 minutes or more.
• Excessive cardiovascular sessions.
• High intensity sessions lasting 20 minutes or more

19. Exercise Anabolic Hormones
Good hormones that build
Growth
Testosterone IGF-1 Insulin
Hormone
Blocks Cortisol Stimulates: Stimulates Stimulates:
growth of:
Stimulates Bone Growth Protein
Protein Synthesis Bone Synthesis
Cartilage Growth
Cartilage Glycogen
Protein Synthesis
Repletion
Muscle

20. Exercise Catabolic Hormones
Hormones that breakdown tissue
Glucagon Epinephrine
& Cortisol
Norepinephrine
Stimulates Fat &
Stimulates Fat & Liver Glycogen
Breakdown Stimulates Fat and
Liver Glycogen
Muscle Protein
Breakdown
Breakdown

21. Overtraining:
Too much of
a good thing
releasing to
many bad
things.

22. Repetitive training exercise
inflammation cascade

23. Arthokinetic stressors
2. Misalignment of joints and musculature –
Remember those negative emotions!
Inflammation is nature’s way of fixing the body
when it is injured or irritated. Chronic
misalignment and pain increase inflammation and
all the negative hormonal responses – cortisol,
interleukens, CRP.
There are a lot of procedures and medications that
can be limited or avoided with proper alignment.

24. Musculoskeletal Imbalances
Head Tilt
Shoulder Drop
Arm length and swing
Back midline
Hip drop
Relative “Q” angle
Patellar positioning
Tibial variation
STJ EROM
STJ neutral positioning
Rearfoot position
Forefoot position
Gait Homonculous Observed Relational Tabulator (GHORT) Pelvic tilt short leg syndrome

25. Even if it is “healthy”

26. Knee and foot alignment are
critical to long term health.
Squats with true alignment
develop strength and joint
health.
Muscles:Their Testing and Function,
Kendal. McCrery and Provance,
pg.97

27.  A structure note! Swimmer alert
 Hypermobility is not a good thing
upright and on land
 Muscles: Testing and Function, pg. 96

28. Sciatic nerve impingement

29. Hip flexor impingment

30. Scapular impingements

31. Thoracic Spine flexion
•

32. Weight of the upper body falls on
the sternum. Can gravity win

33. Or will these muscles remain
stressed.
Headaches
Neck aches.
Stretched
and strained nerves
Muscle pulls.
Exercise induced
Injuries.

34. Thoracic Flexion
Elevated or upright posture An extreme example of Another extreme
opens up chest cavity. The how a slouched posture example but
heart and aorta have ample can compress heart, compression can
room to deliver blood and lungs, aorta and also occur in the
oxygen to the body. The interfere with proper lower organs like
lungs can expand to full cardiovascular activity stomach, liver,
capacity. spleen, uterus

35. Lymphatic system and hip
flexors
• Diaphragm stimulates the natural pumping action
of lymphatic system. White blood cells.
– Heart transplant study. Lymphatic system efficiency is
increased by up to 700% via exercise.
• Psoas and QL are attached to the diaphragm via
fascia.
• Restrictions in the thoracic spine, restricts
breathing which restricts lymphatic circulation.
– (Principles of Manual Therapy)

36. Diaprhagm and muscle
attachments

37. Back study
Primary characteristic of most back issues is
the inability to internally rotate at the hip.
Then the pain was differentiated either by
Bilateral limitation – lumbar pain.
Asymmetrical limitation – sacral pain.

38. Shoulder study
• Those with slumped shoulders had a 24
degree reduction in range of movement and
a 12% reduction in strength

39. Inflammation is caused by stressors.
• Mental and emotional external stressors.
– Work related.
– People related.
– Monkey chatter related.
• Constant internal dialogue
• Self-criticism
– Environment – non-stop stimulation.
• A life at 180 BPM

41. What a zebra does with stress

42. What we do with stress

43. Mental stressors
• Mental/Emotional stress.
• Cortisol is produced in the body as a response to stress. But
it is not designed to be a long term stressor.
• Increased cortisol shuts down immune system, decreases
anti-inflammatory hormones and increases insulin production
leading to hyperinsulemia.
• Chronic stress leads to cortisol overloads.
• In experimental studies, cortisol has been shown to decrease levels
of connective-tissue growth factors and inhibit the activity of bone-
building cells (osteoblasts), muscle-building cells (satellite cells),
and cartilage-building cells (chondrocytes).

44. Mental States Related to
Inflammation
• Increased perceived exertion and pain perception
• Delayed onset muscle soreness (24-48 hrs post
ex.)
• Varies with individual training status
• increased resting cortisol and basic metabolic
functioning
• changes in resting cardiovascular parameters
(sympathetic stimulation of norepinephrine)

45. Inflammation is caused by lifestyle
• Sleep habits
• Nutrition
• Environment
• Overstimulation
– Multi-tasking
– No quiet time

47. Sleep stressors
• Decreasing sleep from 8 to 6.5 hours per week increases
cortisol and insulin levels.
• Night shift workers suffer from higher % of CVD, GI
ailments, mood disorders than day shift.
• Reduces immune function.
• Four hours per night for two weeks produced same test
scores as those who stayed up 3 days/nights.
• A six year lifestyle study of one million Americans
determined that 4 hrs per night had highest mortality rate.
Re-confirmed with same pop. 9 years later.
• Study on obesity and sleep
• 4 hours or less per night – 70% chance of being obese.
• 5 hours or less – 50% chance.
• 6 or less – 30% chance.
• Obese, not overweight. Lack of serotonin? growth hormone?

48. Nutrition stressors
• Modern Diet – high glycemic foods
• Increased insulin – increased inflammation.
• Increased production of pro-inflammatory cytokin Interleukin-6
and C-reactive protein. Increased CRP is now a biomarker for
potential heart disease.
• High fructose corn syrup.
• Modern diet – Fats
• Trans-fats and Omega-6 fats – increase pro-inflammatory hormones.
• Vegetable oils – corn, safflower, soy
• Modern diet – nutritional intake patterns.
• Skipping meals – next meal is generally larger than needed.
• Large portions – insulin spikes. Digestive system stressors.
• Hydration concerns.
• Modern diet – food sensitivities and allergies
• Too much of same nutrients
• Corn, dairy, wheat, soy,

49. Inflammation cascade
• Combined factors increase inflammation
which increases physiological disturbance.
– Japanese cedar study
• Pollen for centuries produced no allergic reaction.
• Introduction of diesel exhaust increased levels of allergic
reaction.
– Many mood disorders are combined with a wide variety of
inflammatory ailments.
– Link between gum disease and CVD – CRP.
– Autoimmune disorders. CFS – Rhinitis, mood disorder, fatigue.
• Fibromyalgia – all this and joint pain.
– Soldiers exposed to 5 days of extreme exercise, starvation and
sleep deprivation had increased cortisol levels that did not return
to normal even after 5 days of rest and refueling.

50. Inflammation and muscle loss
• Increased IL-6, TNF, neutrophils and
macrophages limit muscle regeneration
after intense exercise.

51. What are our current solutions to alleviate
chronic inflammation?
• Ignore it till a medical manifestation occurs.
– Medicate.
• Mood meds, corticosteroids, RLS med., obesity virus drug,
fibromyalgia drug, asthma meds.
– Operate
• Back surgery, joint replacements, nerve deadening.
– Vacate
• Quit whatever activity that was painful.

52. Depressed yet?
• Fear not
• Solutions are plentiful

53. Guidelines to lower risks associated
with overtraining
• Keep life stresses to a minimum – or
manage them more effectively.
• Eat well.
• Avoid working out past the reserves during
high stress times.
• Avoid rapid weight loss.
• Sleep.
• Stay fueled during long exercise efforts.

54. Exercise can reduce pro-
inflammatory markers and increase
anti-inflammatory properties
• Exercise efforts lasting 60 minutes or less reduces
inflammation markers.
• Increases positive neurotransmitters and nerve
and circulatory growth factors.
– Serotonin, Noradrenaline.
– Brain Derived Neurotrophic Factor. (BDNF)
– Vascular Endothelial Growth Factor. (VEGF)
– Fibroblast Growth Factor. (FGF)
– Insulin-like Growth Factor (IGF-1)

55. • Keep exercising and training but do it smartly
Initial exercise bout
Muscle damage or injury
Adaptation
Connective Tissue Theory:
Increases intramuscular tissue
Neural Theory:
Changes in Nervous system
Cellular Theory:
strengthen and protect muscle
Repeated bout of exercise
Less muscle damage

56. Strategies to Minimize Muscle
Damage/Inflammation
• Non-Nutritional Strategies
– Heat pad and cold press on sore muscles and joints. 1-2
min each for 10-20 min.
– Massage, foam roll, corrective exercise, flexibility
– Low intensity short duration exercise.
• Nutritional Strategies
– Balance of Nutrients and caloric intake
– Timing of nutrients
– Supplements to aid in recovery

57. Some training strategies
• Assess workout demands and have back-up workouts for
different demands in an athletes life.
• Provide plenty of restorative options – foam rolling,
massage, flexiblity.
• Understand the overtraining model and plan effectively.
• Understand the biomechanical repetitiveness of workouts
and try to diversify them in order to provide proper muscle
balance and alignment.

58. Even high intensity and complex
exercises are helpful
• High intensity of 70% + did better on a
skill test than a 50% steady state group.
• Complex training – change of direction,
agility work – did 20% better on a word
recall list.

59. Balance the workouts
• By and large exercise has an anti-inflammatory
function.
• It’s the duration that seems to be the issue.
– 90 minutes or more has seen the most pro-
inflammatory responses.
• Marathon finisher 24-72 hours later have all the heart attack
markers.
– 60 minutes or less seems to be anti-inflammatory. Even
at high intensities.
– If you have to train athletes longer – develop a solid
fueling strategy during that timeframe to lesson the
stress of the workout.

60. Inflammation continuum solutions
2. Lifestyle:
1. Calm energy vs. Tense energy
A. Develop calming strategies
React calmly to tense situations
Take scenic drive home
Take joy and pleasure in little things
B. Short relaxation techniques
Relaxed breathing with eyes shut
Change view – plants and happy pix
Relaxed and upright posture – tension in
upper body restricts O2 by 30%

61. SLEEEEEP
SLEEEEEP
SLEEEEEP
• Sleep allows the body to heal physically
and mentally.
• Increases Anabolic Growth Hormone which
has an inverse relationship with catabolic
hormones insulin and cortisol.

62. Inflammation continuum solutions
2. Know when to say when: Make adjustments to
allow for inflammatory factors.
3. Back off on some of the things you can control.
Exercise. Do soothing movements, low intensity
head clearing to stay in the groove and get the stress
relief.
4. Improve some of the lifestyle things you can
control.
5. Debilitating injury/illness and death are far worse
options than whatever worry you are trying to
handle.
6. It’s better to be 10% undertrained than 1%
overtrained.

63. The Biology of Belief
Study designed to see what part of a standard knee surgery gave the
most pain relief to individuals with osteoarthritis - shaving cartilage or
flushing material from the joint thought to cause an inflammatory
effect. A shaving group and flushing group were studied along with a
control group that received a procedure complete with incisions
designed to mimic surgery.
All three groups received the same post-operative care.
All three groups improved. One member of the control group who
previously had to walk with a cane was playing basketball with his
grandchildren two years later. (Lipton, 2005)

64. Nutritional Strategies
• Encourage higher quality nutritional intake.
• Provide clients with information on anti-
inflammatory foods and supplements.
• Encourage regular meals.
• Encourage sound pre and post exercise
strategies.
• Encourage client testing of food
sensitivities.
• Encourage hydration. Individual.

65. Nutrition and Muscle Damage
• Objective
– To develop a nutritional strategy to minimize
damage/inflammation
– Sufficient Caloric intake
– Nutrient Timing (Critical)
• Carb/Protein Timing
– Proper Fueling/Hydration (before, during, and after
exercise intense exercise)
– Potential Supplements of Benefit to aid in quicker
recovery

66. During workout- Cortisol levels.
Effect on Cortisol Levels of Supplementation
during Exercise
Change from Pre-exercise Cortisol
60
50
levels (percent)
40
30
20
10
0
Carbohydrate Sports Water
Drink
Nieman, D. et al., Clinicals in Sports Med. (1999)

67. Nutrition timing during exercisers.
• NUTRIENT TIMING
– Before – to be properly fueled
• Individuals must eat every three to four hours.
• Be hydrated coming into the workout.
– During – to minimize muscle damage/inflammation
• Some kind of healthy sugar carbohydrate beverage. Dilute.
• Get protein after at the end or immediately after workout.
– 4:1 carb:protein mix
– Peanut butter and jelly. Apples and almonds. Chocolate milk w-
out HFCS. Trail Mix,
– After – to aid in recovery process
• 2 most important meals (immediately after and 2-3 hours after
workout)

68. Protein Synthesis after workout
Effect of Amino Acids and Carb Mixture on Protein Synthesis
Following Exercise
140
Protein Synthesis (mg/3 hr/leg)
120
100
80
60
40
20
0
Carbohydrate Amion Acids Carb/AA
Nutrition
Tarnopolsky, M et al. J of Applied Phys, 83: 1877-1883, 1997

69. Nutrient Delay and Recovery
Effect of Nutrient Delay on Muscle Anabolic Processes
700
600
500
% Change
400
300
200
100
0
Amino Acid Protein Muscle Mass
Uptake Synthesis
Immediately after exercise
Physiological Change
Delay up to 3 hours after exercise

70. Anti-Inflammatory Foods
• Fish – salmon, tuna, halibut, sardines, mackerel.
• Fresh Fruits and Vegetables – Flavonoids, Anthocyanins, Zeaxanthin,
Lycopene, Beta Carotene.
• Olive Oil.
• Extra-dark chocolate – with at least 70% cocoa content.
• Red Wine – antioxidant Resveratrol.
• Anthocyanin-rich cherries & acai berries.
• Nuts – Almonds, Walnuts, Brazil Nuts, Pecans, and Cashews – high in
Arginine and Omega 3 Fatty Acids.
• Allium Family of Foods – Garlic, onions, leeks, scallions, shallots, and
chives (High in Flavonoids).
• Barley – high in soluble and insoluble fiber, low glycemic.
• Herbs & Spices:
– capsaicin (red pepper)
– green tea
– Ginger – cancer fighting
– turmeric (yellow spice in curry)

71. Inflammation Continuum nutrition solutions
Omega-3’s
Lyon Heart Study of heart attack survivors
One group Omega-6 fats and standard AHA diet
Second group Omega-3 fats.
O-3 group: 70% reduction in number of fatal heart attacks and no
sudden cardiovascular deaths which accounts for 50% of heart
attack mortality rate.

72. Beneficial Supplements
Omega 3’s
• Have anti-inflammatory properties
– Slow muscle damage
– Improve immune system function?
• May reduce joint pain
• Best to take immediately after an exercise session
(2000 mg of DHA/EPA mix)
• Adults
– Can increase Good Cholesterol (HDL)
– Lower Triglycerides
– Possibly lower blood pressure

73. Anti-Inflammatory Dietary
Supplements
• Fish oil/Omega -3.
• Glutamine.
• Ginger - New Chapter’s Zyflamend.
• Turmeric – New Chapter’s Zyflamend.
• Digestive enzyme blends.
• Probiotics – New Chapter.
• Proteins/Aminos for muscle repair.
• Vitamins C/E and other antioxidents.

74. Performance Athletic Supplements
• Glutamine
• Phosphotidylserine
• Vitamins C & E
• Whey & Casein Protein Mix
– Ex. Myoplex Original
• Omega 3 Fatty Acids

75. Know clients/athletes
• Periodization of their workouts according to their
life demands.
• Understand their individual exercise thresholds for
strength and anaerobic capacity. It’s better to be
20% undertrained than 5% overtrained.
• Understand how that some types of motivation are
inflammatory in more ways than one.
• Make sure alignment is correct. Add exercises that
promote alignment.
• Provide them w anti-inflammatory lifestyle
recommendations

76. Thanks!
• My email Charlie@thepac.com
– The Anti-Inflammation Zone, by Barry Sears;
The Inflammation Cure by William Meggs,
Stopping Inflammation by Nancy Appleton,
The Cortisol Connection by Sean Talbot
Beyond Asprin by Thomas Newmark and Paul
Schulick