Physical activity is the best form of health insurance. People who lead active lifestyles tend to live healthier and longer lives. Despite training, though, in-juries can and do occur.

One of Redmond's newest sports-medicine physicians, Ghislaine Robert, has been treating patients who have suffered sports-related injuries for 20 years.

Looking at Robert's medical history, her background reads like a veritable who's who and where's where of international sporting events.

She was part of the Canadian medical team for the 1992 Barcelona and 2000 Sydney Olympics. In 1988, she was a Canadian national track-and-field coach in the Seoul Olympics.

In Montreal, she worked at Canada's National Training Center and helped care for several Olympic athletes, including gold medalists Brun Surin (400-meter sprint relay) and Sebastian Lareau (men's doubles tennis).

She has also helped athletes involved in speed skating, judo, fencing, track and field, women's handball and down-hill skiing.

There are myriad sports-and exercise-related ailments that afflict people, such as overtraining syndrome, exercise-induced asthma and chronic compartmental syndrome, which occurs when a muscle grows and begins compressing blood vessels and nerves.

One of the mistakes that people make is they try to exercise too much, Robert said. They wind up getting in over their heads, get hurt and then stop exercising. For people wanting to stay in shape, it can be discouraging.

"The main reason people get injured is that they try to do too much too soon," Robert said.

There are other factors that contribute to injuries. Athletes oftentimes try to scrimp on their sports equipment, choosing to buy something that is cheap, poorly designed or that doesn't quite fit them.

Choosing the right type of exercise for a person's body is also important, she said. People whose body frames are out of alignment might want to choose a workout regimen that doesn't involve a lot of high-impact running. Those with a slight skeletal frame might want to reconsider their decision to do a lot of weight lifting and body building.

"People have to be aware. Not everyone is cut out body-wise to be a long-distance runner," Robert said, adding that a person has to find the right training program and right technique that fits them.

Many people are reluctant to see a doctor. The same philosophy applies to sports physicians. Robert said that one of the main fears she hears from patients is that they're afraid she will keep them from exercising.

Her main goal is to not only find the injury and treat it, but to find the cause of the injury and correct it.

"People get injured I want to get them back to doing what they love," Robert said.

So far the biggest distraction has been locals asking about her accent. Coming from Montreal, it is distinctly French Canadian. Having to start her practice over again has been difficult at times. She moved to Washington in 2002 when her husband got a job in the area. In Canada, Robert said she would be on television shows and her practice would be booked for two months in advance. Now Robert, whose office is at 22500 N.E. Marketplace Drive. Suite 205 A, is starting over from scratch.

Robert said that she loves the area, though. Moving to the "Bicycle Capital of the Northwest" affords her ample opportunity to engage in one of her favorite sports. She also jogs golfs, kayaks and hikes.

By Dr Ghislaine Robert MD

Published in the Bicycle Paper
April, 2006

Is it just normal soreness or fatigue? Am I doing too much? Am I over-trained? This article will provide clues about when to suspect Overtraining Syndrome, and what to do to treat and prevent it.

There is a misconception that overtraining only effects elite athletes. However, it can happen to anybody, and as a matter of fact, it is frequently seen in beginners who do too much too soon.

What is overtraining? It's a reaction to prolonged stress. The syndrome commonly takes one of two forms. The sympathomimetic form, which is more frequent in young people and/or in anaerobic sports, includes symptoms like "hyper-awakening" (insomnia, irritability and tachycardia), while the parasympathomimetic form (described as apathy), occurs more often in older athletes and in endurance sports, and causes fatigue. Some researchers believe that there is a continuum between the conditions.

Why does it happen? To understand it, we must review the principles of training.

In order to improve performance, one begins with a certain training load that depletes the body's resources. Then, the rest period allows the body to recover and "overcompensate" by providing more resources than it originally used, permitting the athlete to work with a greater load. With a proper recovery time, performance improves as this process repeats. If the athlete doesn't allow adequate recovery time, overcompensation will not happen, resulting in fatigue. If one continues to apply the same charge without enough rest, Overtraining Syndrome occurs. Increasing the intensity or volume too rapidly can precipitate the syndrome. Also, any other stressful factor, parallel to training, might contribute to its emergence (ex: work, family, school, finance...). Other predisposing elements include too many competitions back-to-back, bad nutrition, altitude training, and traveling (jet lag, dehydration, fatigue).

The main symptoms consist of fatigue, muscle pain (feeling of heavy legs) and decreased performance. Other symptoms are sleeping problems (light sleep, frequent awakenings, and nightmares), increased sweating (during exercise or at night), loss of appetite, decreased libido, augmentation of the heart rate upon waking up, increased susceptibility to upper respiratory track infections (URI) and increased size of lymph nodes. The psychological manifestations involve apathy, anxiety, aggression, irritability, trouble concentrating and depression.

There is no test to confirm Overtraining Syndrome, but if a two to three week rest fails to resolve the symptoms, it's important to get a blood test to rule out anemia, iron deficiency, thyroid problems, and other less frequent diseases. A good tool to confirm overtraining is the POMS (Profile of Mood States), since the psychological symptoms are almost always present. Also, the Testosterone/Cortisol ratio will often decrease, but it needs to be compared to previous values obtained when the athlete was performing well.

Another diagnostic tool is to keep track of the heartbeat upon waking. An augmentation of five or more heartbeats/minute for many days in a row, in addition to fatigue and decreased performance, indicates a possible beginning of the syndrome. However, rule out infection, dehydration and lack of sleep first.

If you have access to a VO2max test, the length of time you can sustain 110% of your VO2max will decrease with Overtraining Syndrome. Obviously, frequent testing improves the chances of catching the early signs of overtraining.

Rest is the best treatment. Two to three weeks of complete rest are recommended. If symptoms disappear completely, resume training, but include more recuperation time. If symptoms don't fade, prolong the rest, sometimes for up to a few months. Following three to four weeks of recovery, the athlete can switch to active rest, which involves training but no competition. Practicing a different sport will decrease the pressure to reach former performance standards.

Plenty of carbohydrates, to replenish glycogen reserves, and adequate sleep are integral to recovery. Also, find and treat depression disorders, since a decrease in performance is often seen as a failure for the athlete. Massages, hot tubs and saunas also aid recovery. Acupuncture helps as well, especially for fatigue and insomnia.

Because Overtraining Syndrome might put you at rest for many weeks, and because the diagnosis is not easy, prevention is of great importance. Minimize all stress, whether it is related to training or not. Sleeping is important and during increased intensity phases, add naps. A healthy diet contains 15% protein, 30% lipids and 55% carbohydrates. Good hydration is mandatory.

Training programs should consider sources of stress, and be modified as needed. Recuperation time and a transition period are very important. Finally, a training log helps to monitor improvement, and detect the first signs of overtraining. Record sleeping time, quality of the sleep, wake up heart rate, motivation to train, mood, weight, training, results, effort perception, pain and injuries.

In conclusion, Overtraining Syndrome can happen to any active person. The risk of getting it increases when there are additional stressors and not enough recovery time. There is no specific diagnostic test, and the athlete may need many months to recover. Prevention is the goal.