Article published in Compass Sport Magazine, February 2022. 

 

 

The Chronic Fatigue Syndromes, M.E., and Endurance Sports, by Phil Murray INT

 

"Hey, I'm tired too!" Many people feel tired, and many people get poorly. We lead busy lives and that's work, sport, social, peer group expectations, digital media, everything. You can easily fall sick in the current climate, and if you do multi-day orienteering events, it's likely you know what "being knackered" feels like. Some of us were almost relieved the Scottish 6 days was just 3 stages each! But: imagine that you've had no sleep, you've got a terrible hangover, you're going down with the flu, and you're asked to race a 10k. Which you do. This is getting close to what the feeling of having CFS ("Chronic Fatigue Syndrome") is like - except it's not usefully explained by the circumstances listed above, and, when they are removed, you remain feeling terrible, for a long time - and I mean long.

CFS (poorly named, as "fatigue" is only one of a myriad of symptoms that present) is often triggered by a viral infection, striking fast (this happened to me, acutely, in 1997 aged 33, and I was then "off work" on benefits for 4 years, & rehabilitating for the next three. At my worst I could not prepare food. I had a bucket by my bed and I could not hold conversations for more than 10 minutes). At the severe end, it is called "M.E." (Myalgic Encephalomyelitis), which is a diagnosis of dread - bedridden figures lying in darkened rooms with eye masks on comes to mind. However, not all sufferers will end up in bed / housebound for years with no hope or improvement in sight. CFS comprises many more symptoms than *just* fatigue. Overwhelming exhaustion, orthostatic intolerance, digestive problems, myalgia, sleep regulation problems, heartrate issues, skin rashes, nausea/bloating, and (one of the worst) "Brain fog" where you feel just outright terrible/unwell in your head, and it's not a headache, there is no relief anywhere (allopathic medicine has literally nothing to offer). Not even after sleep, as unrefreshing sleep is also a symptom.  Bad hangovers - but without the alcohol. The cardinal symptom of CFS / M.E. is what’s known as "post-exertional malaise". You do a thing, you feel reasonable, but 24-48 hours later, there's a huge spike in symptoms, and you feel utterly rotten (just as everyone else has started recovering normally). So, if you're "really knackered" at the end of the latest Mountain Marathon, that's not CFS - that's normal. 

There are many types of Chronic Fatigue Syndrome, and the end diagnosis/clinical picture tends to be arrived at by often varying paths. I know of at least one elite orienteer/potential elite orienteer who has arrived at this state of sickness via each of the following: post-glandular fever (common among the young, sociable & active); post-virus (that'll be me; plus others I know), post-Lyme infection, overtraining, and post-vaccination. Sadly, the medical profession barely acknowledges some of these - in particular, vaccine injury and chronic Lyme disease. I was lucky - I was taken seriously very quickly & told to go and rest. 

Back in the 1980s there was only one type of fell runner - the tough one. The more you ran, the “harder” you were. Feeling sick? Run it off. Got a cold? Do that race anyway, you'll be "fine" afterwards. Two notable casualties of this attitude were high-end elite level, record breaking, GB-representing athletes - the legend that is Kenny Stuart, and Dave Cannon (for more, see The Fellrunner Summer & Winter 2017). Both also ran superb road marathons (c.2:11), and both had their careers obliterated (never to return) by CFS or M.E. Another top UK marathoner, Sarah Rowell, once the UK record holder, had her career interrupted by CFS symptoms - happily, she moved into fell running, and I gather she's enjoying sport and health again now. Recent Wainwright Round record-holding ultra fell runner/orienteer Steve Birkinshaw also had a period of CFS after his record week-long run (see his blog – 20th Dec 2015) - happily I gather he's not doing badly today! (though he lost that record!). 

Of course, we are now in the era of COVID-19, and this means a new postviral syndrome: "Long COVID" (again, I know someone who has this badly - off work since March 2020). While the sensationalist press announce that Long Covid is "a completely new disease", those of us "in the know" collectively sigh - no, it's not; it's just that these illnesses have been ignored by science for decades (There was a post-SARS spike in M.E. cases too, but many will have forgotten them - some remain sick still today). 

Research into the causes of CFS & M.E. have been appallingly underfunded in recent decades, and have targeted the wrong areas - namely behavioural. The theory being, the more you do (in increments), and the less you "worry" about how utterly, awfully unwell you feel, the "better" you'll get. This, accompanied by a "stay positive!" attitude, has led to many people getting measurably worse, or remaining ill for a very long time. The NICE guidelines (National Institute for Clinical Excellence) for CFS/ME (2007 version) essentially stated that graded exercise and CBT (cognitive behavioural therapy) could successfully treat “many” with CFS.  Had this been the case, we'd have been the first to celebrate. But this is not the case. It is merely a “theory” – one that has been comprehensively discredited in recent years. Fortunately, and after several years of due process, the NICE guidelines have recently reverted back to what they were when I got ill in 1997 - ie. there is no effective treatment. Yes - no treatment for an illness with the worst Quality of Life of *all* chronic illnesses, and with a cost to the UK economy of £3.3billion annually. 

So, what to do?  Well, as someone who has worked on a charity helpline for M.E. sufferers and effected at least three "recoveries" for myself, the best option is: listen to your body, and absolutely rest if you need it. If you feel good one day, do not rush out & do that big run / Brown course / over-celebrate at that Xmas party. Have an easy day. Then one good day might become two… might become three…. But absolutely key to all of this is quality rest. And, by rest, I mean "real" rest. Not scrolling through your phone, "working from home", going to the pictures, or binging on Netflix. I was lucky enough to be advised (in the late 1990s – pre-fast Internet) to rest on my good days as well as my bad, and also, on good days, to stop any activity well *before* feeling rotten (not *just* tired). 

 

What about coming back to one the most demanding of sports (from any viral illness, eg. COVID, flu etc) - endurance running, and (coupled with the mental challenges of navigation), this surely makes orienteering a near-impossibility? Well! I now know it's not just possible, but it can be immensely rewarding, and you can get back to a decent level. You have to start slow and try shorter, easier courses initially. Monitor your reaction to them. Do not launch straight back into a full training & racing program. (After my first Green course post-ME/cfs, in 2005, I felt lousy for days - but the next event, another Green, I only felt rough for a single day - the Monday!). Runs can be at well below threshold pace. As you're going slower, take time to make no mistakes. This will feel good, and also you may sneak past faster runners in the results!  

Early on in my comeback from my illness, I would have to skip Easter Sunday's JK Long Individual Day 2, so I could race the Relay properly. This paid off with some BOK podiums. Later in the 2010s though, I had seemingly recovered 100%, so I was doing all days. And loving it. 

With good management, most people with CFS can and should make substantial improvements, if not total recoveries. I considered myself back in remission *at time of drafting (December 2021)*, but my latest blip (within two weeks of my British Long Distance podium, I was again felled by a postviral reaction) shows that I will likely never be free of CFS/ME. The illness remains a mystery, but there *are* ways to keep your future open & positive.  Just don't try and beat it by ignoring it! No prizes for bravely fighting on here.  And recovery … feels so sweet. 

Note from 25th January: Phil has shelved his early 2022 O plans due to another dip in his chronic fatigue syndrome. 

Phil Murray, Borders, Scotland, M55 / INT / RR

Trustee: www.actionforme.org.uk  #### now ex-Trustee 

Research assistant: www.decodeme.org.uk  #### now ex-research assistant

Edit: sadly I have had to admit defeat again in January 2022, and take time of work to try to recover from another relapse. I have completely cancelled my 2022 spring running / orienteering season. EDIT - lost my job - crash continued.....  

Ref: Chronic Fatigue Syndrome in elite athletes: four cases by Steve Chilton from the 2017 Summer Fellrunner:  https://itsahill.files.wordpress.com/2018/01/cfsarticle.pdf 

 

 

 

1 - https://meassociation.org.uk/wp-content/uploads/ME-Factsheet-What-you-need-to-know.pdf