The ‘worn-out athlete’: a clinical approach to chronic fatigue in athletes

Chronic fatigue in the athletic population is a common but
difficult diagnostic challenge for the sports physician. While
a degree of fatigue may be normal for any athlete during
periods of high-volume training, the clinician must be able to
differentiate between this physiological fatigue and more
prolonged, severe fatigue which may be due to a pathological
condition. As chronic fatigue can be the presenting symptom of
many curable and harmful diseases, medical conditions which
cause chronic fatigue have to be excluded. The clinician must
then be able to differentiate between chronic fatigue
associated with training or chronic fatigue from other medical
causes, and also between the chronic fatigue syndrome and the
overtraining syndrome. Once the clinician has excluded all of
the above medical conditions which cause chronic fatigue in
athletes, a significant proportion of fatigued athletes remain
without a diagnosis.

Novel data indicate that skeletal muscle disorders may
play a role in the development of symptoms experienced
by the athlete with chronic fatigue. The histological findings
from muscle biopsies of athletes suffering from the 'fatigued
athlete myopathic syndrome' are presented. We have
designed a clinical approach to the diagnosis and work-up
of the athlete presenting with chronic fatigue. The strength
of this approach is that it hinges on the participation of a
multidisciplinary team in the diagnosis and management
of the athlete with chronic fatigue. The athlete, coach,
dietician, exercise physiologist and sport psychologist
all play an important role in enabling the physician to
make the correct diagnosis.

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