The unexpected opponent: Underperformance Syndrome in Sports
An article written by Sophie Herzog, Øyvind Sandbakk, Trond Nystad and Rune Talsnes
The term “unexplained underperformance syndrome” refers to a state where athletes, due to prolonged stress or inadequate recovery, become non-functional and fall short of their expected performance levels in training, tests, and competitions. All athletes have experienced brief periods where they have not been able to perform up to their expected standards. But ignoring warning signs can lead to persistent underperformance and, in severe cases, be career ending.
Unexplained underperformance syndrome (UUPS) is a phenomenon that perplexes experts, coaches, and athletes alike. What causes these periods of underperformance which cause so much frustration and, in the worst case, cause an early career end? What can athletes and coaches do to avoid such a state or at least recognize the signs early and determine subsequent interventions to overcome underperformance? Let's explore this multifaceted issue in the realm of sports.
Unexplained underperformance affects a significant portion of athletes throughout their careers, with prevalence estimates up to 60%[i]. Despite its high prevalence, unexplained underperformance often goes overlooked due to its complexity and the absence of evidence that something is wrong (e.g., medical tests are fine).
High-performance sports demand continual improvement, motivating athletes to endure high training loads over extended periods even to only see marginal gains. However, this is a balancing act and for this level of training to be sustainable, an adequate balance between training load and recovery is necessary. When this balance is missing, it can result in excessive stress on the individual, ultimately leading to a state of underperformance. Stressors also extend beyond training, encompassing factors like general health, nutrition, travel, work/education, and personal life, which can contribute to underperformance.
Underperformance can manifest itself in various forms, but typical signs are performance decline, stagnation, maladaptation, and various physiological, psychological, and behavioral signs and symptoms.
Different terms are used to describe prolonged underperformance. Depending on the duration and the cause of the issues, it can be defined as (functional or non-functional) overreaching or overtraining syndrome or relative energy deficiency in sport syndrome[i],[ii],[iii], which are difficult to disentangle as they can produce similar symptoms. However, what we call it is less important than how we deal with it. To make the athlete functional again and to restore health and performance it is imperative to go through a thorough analysis to try to find the underlying cause(s) of the problem.
Figure 1: States of underperformance exist in a continuum, starting with acute fatigue where recovery is rapid (24-48h) developing into states of overreaching and ultimately overtraining. Overreaching is often distinguished into functional overreaching (FOR) and non-functional overreaching (NFOR). FOR is an often-desired short-term reduction in performance achieved by training overload (e.g., training camps), which needs longer recovery (approx. 2 weeks) but is part of a periodization strategy. NFOR takes weeks, sometimes months to recover from and the supercompensation effect is missing, hence the negatives outweigh the positives. Finally, full-blown overtraining syndrome (OTS) is a very rare state of performance reduction and can take months to years to recover from, often meaning the end of a career. Figure is adapted from Halson et al. (2004) and Haghighat et al. (2024).
While the most obvious intervention is to modify training load in favor of more recovery and placing extra attention on energy restoration via sleep and nutritional interventions, athletes affected by underperformance often tend to do the opposite and train even more, intensify training further and/or eat even less, thereby exacerbating the issue.
Even some of the world’s best athletes are affected by such situations and currently there is no consensus in the scientific literature on how to treat underperformance in (endurance) athletes in a systematic way. However, two recent case studies on two Norwegian cross-country skiers document the process of returning from underperformance to world-class level, which consisted of analyzing their training diaries, looking at training data and (physiological) tests, interviewing the athlete and their head coach[i],[ii]. In this collaborative effort, the athletes were supported by a multidisciplinary team consisting of sport scientists, coaches, doctors, psychologists and nutritionists. In the table below, some of the contributing factors for underperformance identified in those two cases are listed.
Possible contributing factors
Training monotony and no systematic training periodization
Lack of systematic planning, testing and monitoring of training and intensity
Low energy availability due to long fasted/low-carb training sessions
Too much high-intensity training
Lack of intensity control
Lack of systematic and guided technique training
High accumulated stress and mental pressure
Lack of enjoyment and motivation
Lack of responsibility and ownership of the athlete in training planning and execution
Lack of a “shared language” and communication basis between athlete and coach
What is highlighted in both reports is that the findings cannot be generalized. Hence, a holistic and individually tailored approach to “treat” the athlete affected by prolonged underperformance is required. It is also important to recognize that most athletes do not have the support team of a world-class athlete, which underscores the importance of developing systematic and proactive approaches to identify early warning signs and to use different tests and monitoring tools to mitigate the risk of unexplained underperformance, fostering resilience and securing training continuity.
Unexplained Underperformance is a painstaking and frustrating experience for every athlete and all stakeholders around the athlete. Most interventions fail either because the athletes/stakeholders refuse to change or because the process is rushed. Restoring performance begins with acknowledging the problem and committing to address the underlying mechanisms that have caused the issue. Clarity and acceptance pave the way for a comprehensive restoration journey, where no one is to blame, and athletes and stakeholders collaborate to navigate challenges and plot a path to recovery.
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[i] Solli, G. S., Tønnessen, E., Sandbakk, Ø. (2020). The multidisciplinary process leading to return from underperformance and sustainable success in the world’s best crosscountry
skier. Int. J. Sports Physiol. Perform. 15 (5), 663–670. doi:10.1123/ijspp.2019-0608
[ii] Talsnes RK, Moxnes EF, Nystad T and Sandbakk Ø (2023). The return from underperformance to sustainable worldclass level: A case study of a male crosscountry skier. Front. Physiol. 13:1089867. doi: 10.3389/fphys.2022.1089867
[i] Meeusen R, Duclos M, Foster C, et al. (2013). Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the European College of Sport Science and the American College of Sports Medicine. Med Sci Sports Exerc. 45(1), 186–205. doi:10.1249/MSS.0b013e318279a10a
[ii] Stellingwerff, T., Heikura, I. A., Meeusen, R., Bermon, S., Seiler, S., Mountjoy, M. L., et al. (2021). Overtraining syndrome (OTS) and relative energy deficiency in sport (RED-S): Shared pathways, symptoms and complexities. Sports Med. 51 (11), 2251–2280. doi:10.1007/s40279-021-01491-0
[iii] Mountjoy M, Ackerman KE, Bailey DM, et al. (2023). International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine. 57:1073-1098.
