Disclaimer: This article is educational and not a substitute for medical advice. Always follow guidance from your clinician/coach and check current anti-doping rules.
Few things derail a training block like waking up with a head full of concrete before intervals. This guide provides the athlete's playbook for sinusitis: understanding what it is, how it affects training and racing, scenario-based management strategies, prevention habits, and a systematic plan for returning to full training.
You'll also find anti-doping notes for common medications and clear warning signs for when to seek urgent care.
What is Sinusitis? Types & Common Causes
Sinusitis (rhinosinusitis) is inflammation of the nose and sinus linings. While usually triggered by a viral upper-respiratory infection, allergies, irritants (like pool chloramines), cold/dry air, anatomical issues (deviated septum/polyps), barotrauma (diving/flying), and dental problems can all contribute.
Types at a Glance
- Acute viral ("common cold"): Sudden onset with symptoms typically improving within 7–10 days.
- Post-viral acute: Worsening after ~5 days or symptoms persisting beyond 10 days.
- Acute bacterial (ABRS): More likely if three or more of the following are present: discoloured/purulent discharge, severe unilateral facial/tooth pain, fever, "double-worsening," or elevated inflammatory markers.
- Recurrent acute: Several distinct acute episodes per year with complete resolution between episodes.
- Chronic (CRS): Symptoms lasting ≥12 weeks plus objective evidence on examination/endoscopy/imaging.
Key Terms Explained
- Rhinitis vs sinusitis: Nose only vs nose + sinuses
- Post-nasal drip: Mucus sensation at the back of the throat
- Decongestant vs antihistamine: Short-term airflow relief vs allergy symptom control
Why Athletes Face Unique Challenges
Training environments and physiological demands create specific risk factors:
Environmental Exposure
- Swimming/Triathlon: Pool chloramines and poor ventilation can irritate nasal lining; repeated water exposure and descents increase barosinusitis risk.
- Endurance (running/cycling): Cold/dry air, pollen, and traffic pollution increase airway irritation.
- CrossFit/Gym training: Dust, chalk, shared equipment, and variable ventilation quality.
- Winter sports: Prolonged cold-air inhalation dries nasal passages.
- Contact sports: Nasal trauma increases risk of complications like septal haematoma (requires urgent care).
Training Stress Factors
Heavy training blocks can create temporary immune suppression, while dehydration and mouth-breathing dry airways. Sleep loss and travel add additional physiological stress.
How Sinusitis Affects Training & Racing
Performance Impact
- Breathing efficiency: Blocked nasal passages force mouth-breathing, which dries airways and often increases perceived effort at normally easy paces.
- Recovery quality: Mouth-breathing and poor sleep elevate effort perception and slow recovery. Expect heart rate drift at usual easy paces.
Training Decision Framework
With mild above-the-neck symptoms and no fever or chest involvement, easy training is usually acceptable. However, fever, systemic symptoms, chest tightness, wheeze, or warning signs require stopping training and seeking medical advice.
Management Strategies by Scenario
A) Mild and Manageable (likely viral; no race imminent)
Training modifications:
- Stick to easy Z1–Z2 zones
- Reduce volume by 20–40%
- Extend warm-up duration
- Aim for comfortable nasal breathing
Self-care routine:
- Saline nasal irrigation
- Maintain hydration
- Use humidified bedroom air (40–50% humidity)
- Prioritize early bedtimes
B) Lingering or Moderate Symptoms
Training approach: Maintain only short aerobic sessions; avoid intervals or maximal lifting.
When to contact your clinician:
- Symptoms persist >10 days without improvement
- "Double-worsening" pattern
- High fever
- Severe unilateral facial/tooth pain
- Foul-smelling discharge
- Dental pain
C) Race-Week Decision Making
- 7–3 days out: Guard sleep and hydration; minimize intensity; test any medications in training, never on race day.
- 72–24 hours: Conduct honest status assessment. DNS (Did Not Start) if fever/systemic or chest symptoms present. If mild symptoms only, adjust race goals accordingly.
- Race morning: You should breathe comfortably, feel steady, and have no severe unilateral pain. If not, don't start.
- During competition: Back off or stop for chest tightness, dizziness, or severe pain.
Prevention: Building Resilient Habits
Consistent small habits prevent larger problems:
Daily Practices
- Maintain consistent hydration (aim for pale-straw colored urine)
- Rinse nose with saline after pool sessions and outdoor training in high-pollen/dusty conditions
- Use a light face covering in cold/dry weather to warm and moisten inhaled air
- Shower and change promptly after pool sessions
- Clean water bottles and swimming equipment regularly
Environmental Management
- Maintain bedroom humidity at 40–50%
- Consider HEPA air purifier if training near busy roads
- Ensure adequate gym ventilation
- Minimize chalk dust exposure
Medication & Anti-Doping Guide
Always verify current anti-doping rules for your sport and consult with your healthcare provider.
| Medication | Primary Use | Competition Status | Performance Notes |
|---|---|---|---|
| Topical decongestants | Short-term nasal obstruction | Generally permitted for nasal use | Limit to ≤3–5 days to avoid rebound; test in training first |
| Oral pseudoephedrine | Short-term congestion | Prohibited above urine threshold in-competition | Can elevate HR/BP and disturb sleep; ensure adequate washout |
| Intranasal corticosteroids | Allergic/non-allergic rhinitis | Permitted at licensed doses | Onset over days; excellent for prevention |
| Antibiotics | Bacterial infection (when criteria met) | Permitted | Most cases are viral; expect potential GI side effects |
Pro tip: Maintain a personal list of tolerated medications with their status and dosing. Never trial new medications on race day.
Warning Signs: When to Stop and Seek Urgent Care
Stop training immediately and seek urgent medical assessment for:
- Eye swelling, displaced globe, double vision, or reduced visual acuity
- Severe frontal headache or swelling with neck stiffness or neurological symptoms
- High fever with systemic toxicity (rigors, confusion)
- Severe unilateral facial or tooth pain, especially with foul discharge
- Facial trauma with suspected septal haematoma (nasal blockage, swelling, tender internal tissue)
When in doubt, sit it out and get medical advice.
Return-to-Training Protocol (3–5 Days)
Once symptoms are improving and you're fever-free, follow this graded progression. Restore easy volume first, add intensity last.
Graded Return Protocol
- Day 1: 20-30 minutes easy aerobic activity. Monitor: comfortable nasal breathing, stable HR, no symptom worsening
- Day 2: 30-45 minutes easy aerobic activity. Include gentle technique work if feeling well
- Day 3: Easy aerobic base + 2-3 short tempo intervals (2-3 minutes each)
- Day 4: Longer aerobic session with sustained tempo work
- Day 5+: Full training resumption if all previous days completed successfully
Stop the progression immediately if you experience: chest symptoms (tightness, wheeze, productive cough), dizziness, severe unilateral facial/tooth pain, significant HR-RPE mismatch (>5-8 bpm drift at easy pace), or sleep deterioration.
Sport-Specific Considerations
CrossFit/Gym Athletes
- Session modifications: Replace max-effort pieces with technique EMOMs, controlled tempo work, or aerobic circuits.
- Environment: Maintain ventilation; position away from chalk-heavy areas; clean shared equipment.
- Return protocol: Re-introduce high-intensity lifts/intervals only after two symptom-stable easy sessions.
Triathletes & Swimmers
- Pool safety: Choose well-ventilated facilities; shower immediately after; perform nasal rinse.
- Session selection: Avoid breath-hold work or aggressive sprints when congested.
- Race preparation: Prioritize sleep during travel; schedule race-pace rehearsal earlier if symptoms developing.
Frequently Asked Questions
Can I train with sinusitis?
With mild above-the-neck symptoms, easy aerobic work is usually acceptable. Avoid intensity until clearly improving, and stop immediately for any warning signs.
How do I differentiate bacterial from viral sinusitis?
Bacterial sinusitis is more likely with three or more of: discolored/purulent discharge, severe unilateral facial/tooth pain, fever, "double-worsening" pattern, or prolonged symptoms. Consult a healthcare provider when uncertain.
Is racing safe with a blocked nose?
Never race with fever, systemic symptoms, or chest involvement. With mild above-the-neck symptoms, consider modified goals, extended warm-up, and strict in-race stopping criteria.
Do nasal rinses help?
They're a low-risk intervention that many athletes find beneficial, especially after pool sessions or polluted outdoor training. Use sterile/distilled/boiled-then-cooled water following product instructions.
Which cold medicines are competition-legal?
Intranasal steroids and many topical decongestants are permitted; pseudoephedrine has competition thresholds; phenylephrine isn't typically prohibited. Always verify current regulations.
When is urgent medical care needed?
For eye/vision changes, severe headache with neck stiffness, high fever with toxicity, severe unilateral facial/tooth pain, or suspected septal haematoma after facial trauma.
How soon can I resume intensity training?
After 1–2 stable easy training days, gradually add controlled intensity (short tempo blocks). If symptoms worsen or HR-RPE don't align, step back immediately.
References & Evidence Base
Methodology: This guide prioritizes clinical guidelines and consensus statements (EPOS, NICE, IDSA; IOC/BJSM), Cochrane systematic reviews, high-quality trials, and athlete-specific research. Evidence strength and uncertainties are noted throughout.
Last evidence review: September 18, 2025
Editorial process: Drafted for everyday athlete clarity; medical review recommended before local publication
Conflicts of interest: None declared
Key Sources
- Fokkens WJ, et al. EPOS 2020: European Position Paper on Rhinosinusitis and Nasal Polyps. Rhinology. 2020.
- NICE NG79. Sinusitis (acute): antimicrobial prescribing. Clinical guideline.
- Chow AW, et al. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis. Clin Infect Dis.
- Schwellnus M, et al. International Olympic Committee consensus on acute respiratory illness in athletes. Br J Sports Med.
- Bhatia RT, et al. Return to sport following acute respiratory illness: systematic review. Br J Sports Med.
- World Anti-Doping Agency (WADA). 2025 Prohibited List & Explanatory Notes.