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Fatigue makes cowards of us all.

Vince Lombardi, NFL coach

Tiredness is a common complaint among both athletes and the general population. Training to improve sporting performance involves stressing the body for adaptation to occur. This leads to acute fatigue, which settles with appropriate recovery. Excessive physical and mental stress can be thought of as anchoring one end of a continuum, where complete inactivity represents the other end. When stress and recovery are in balance the outcome is optimal sporting performance in a healthy body.

More broadly, any negative stressor can lead to fatigue, just as any positive influence assists recovery, rather than just the sum of exercise and rest. If the balance is not right, tiredness can occur, as can other problems. It is therefore easy to conceptualise that the causes of tiredness are endless. This chapter focuses on common non-medical and medical causes. It also covers myalgic encephalomyelitis/chronic fatigue syndrome, which is a debilitating but less common condition. Table 19.1 shows a list of causes of tiredness in the athlete.

Table 19.1Causes of tiredness in the athlete

When assessing a fatigued athlete, the practitioner must have a systematic approach, led with the common causes in mind, while looking for red flags. The common causes are often very obvious and, if reversible with behaviour modification alone, do not need investigation.

When taking a history, it should be noted that particular symptoms are often not specific to one cause. It is also important to understand that many of the causes are interrelated, either being on a spectrum of disease, or by cause and effect. Some of these commonly observed clinical clusters are listed in Table 19.2.

Table 19.2Clusters of pathology associated with tiredness in the athlete



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