Mononucleosis, often called “mono,” is a viral infection causing symptoms usually for weeks or months. It’s known as the “kissing disease” due to its transmission through saliva. It often affects teenagers and young adults who are active with exercise and sports. So, what do you have to know about mononucleosis and exercise, and when can you safely return to training and sport after a mono infection?
What is Mononucleosis?
Mono is a common illness caused by the Epstein-Barr virus. Most people get an infection in their lifetime, although it is more common in teenagers and college students. Generally, it takes about a month to show symptoms after exposure to this virus.
How does Mononucleosis present?
Infection can leave teenagers and adults feeling like they’re fighting the worst cold they’ve ever had.
Usually, infection starts with general tiredness, aches, and loss of appetite. As the virus takes hold, it can cause high fever, tonsillitis, and swollen lymph glands. A general body rash can occur in 10-40% of infection cases. Sometimes, infection in the liver causes yellow skin (also called jaundice). The spleen sitting under the left rig cage can also swell, increasing the risk of rupture after trauma or contact sports.
Most symptoms settle within 2-4 weeks, although tiredness can continue for up to a few months. Sometimes, fatigue can last longer, leading to a condition known as chronic fatigue syndrome.
How do we diagnose mono?
Diagnosis typically involves a physical exam, blood tests, and sometimes a mono spot test. Blood tests often show raised white calls, which are abnormal and known as atypical lymphocytes. Specific liver tests may also be abnormal.
Other viruses can cause similar symptoms, so your doctor should check for these. Examples include CMV, HIV, herpes and bacterial tonsillitis.
Recovering from Mononucleosis: Tips to get better faster and safely
There is no specific antiviral treatment for mono. Instead, focus on treating the symptoms:
- Rest: Essential for recovery, as overexertion can prolong symptoms.
- Hydration: Fluids are crucial to prevent dehydration. Doctors often recommend drinking at least 12 cups of fluid daily, including water, soup, and herbal tea. You’ll need to increase your fluids if you have a fever.
- Pain Relief: Over-the-counter pain relievers like ibuprofen or paracetamol can help manage pain and fever. You should avoid aspirin in children or teenagers due to the risk of a rare but dangerous condition called Rey’s syndrome that can cause liver and brain damage.
- Gargling Salt Water: Helps soothe a sore throat.
Mononucleosis and Exercise
The main concerns regarding mononucleosis, exercise and sport are centred around two issues. Firstly, returning to exercise too early can prolong mono symptoms or increase the risk of complications such as pneumonia or liver inflammation. Secondly, mononucleosis causes an enlarged spleen, making it more prone to rupture, particularly after trauma from contact sports.
Mononucleosis and exercise: when can you return to activity safely?
Doctors usually use the ‘neck’ rule when deciding whether you can return to exercise after a mono infection.
If you have symptoms below the neck, such as fever, sweats, muscle aches, or tummy pain, you should rest from all activity, including light exercise. However, you don’t have to be bed-bound. Gentle stretching or a light 5-10 minute walk is still okay.
However, if symptoms are above the neck, such as sore throat or runny nose, and you do not have fever or aches, you are ready to restart an exercise programme. Generally, most people know when they are ready to return to exercise. We usually recommend starting with light exercise, such as walking or gentle yoga for 10-15 minutes. You should listen to your body and stop if you’re feeling fatigued or experiencing pain or discomfort. You can gradually increase the duration and intensity of your exercises. Then, you can transition into moderate-intensity exercises like swimming and cycling. Slowly reintroduce strength training with lighter weights and fewer sets, gradually building to your pre-illness routine.
Mononucleosis and exercise : Sports Restrictions
Returning to sport depends on the type of sport played: contact or non-contact sport.
Athletes in non-contact sports (such as marathon running, triathlon, and cycling) can start sports-specific training once they can tolerate light training and weights without fatigue or the return of symptoms.
However, contact sport is more a concern after mono infection. Mononucleosis infection causes an enlarged splenic. As the spleen gets bigger, it is no longer protected by the ribcage and is prone to trauma and rupture. If athletes return to contact sports (such as rugby, football, netball or basketball) with an enlarged spleen, they are prone to splenic rupture secondary to trauma. Although rare, splenic rupture is a severe condition that could be life-threatening.
We know that spleens enlarge in all patients with acute mono infection. Recent studies suggest that the spleen remains big for 3 1/2 weeks. Moreover, splenic rupture usually occurs within the first three weeks and is rare after four weeks. So, it is better to avoid contact sports for at least four weeks after the start of an acute infection. If you need to go back to contact sport earlier, you should speak to your doctor about getting an ultrasound scan to determine how big the spleen is. Sometimes, repeat ultrasound scans can help the decision to return to contact sports.
Other Frequently Asked Questions about Mononucleosis and Exercise
How long After Mononucleosis can you play sports?
It depends on whether you play non-contact or contact sports. For non-contact sports, you can resume training once fevers, aches and sweats have settled, and you can tolerate lighter activities such as walking, swimming and light weights. For contact sports, you should avoid contact training for four weeks because of the risk of splenic rupture. In some cases, when there is pressure for teams to return athletes early, some doctors use ultrasound to measure the size of the spleen. A large spleen means that the risk of rupture is more significant.
If you develop mono disease, should you isolate to avoid transmission to others?
No. Mononucleosis is transmitted by close contact via saliva, so strict isolation is unnecessary. However, it would be best if you took basic hygiene measures such as washing your hands and not sharing utensils or water bottles.
Are cortisone tablets recommended for acute mono infections?
No. In general, we only use cortisone tablets in complications of mono infection. Examples include severe tonsillitis or heart inflammation. Cortisone tablets are not recommended for most cases and may cause side effects.
How long does tiredness from mono recovery last?
There is some variability. Some people only feel tired for a week, while others can feel exhausted for months. It is critical not to push yourself with exercise early, or your symptoms may persist and not get better.
Final word from Sportdoctorlondon about Mononucleosis and Exercise
Recovering from mononucleosis and returning to exercise is a delicate process that requires patience and careful monitoring. By following a structured plan and listening to your body, you can safely regain your fitness levels. You should use the ‘neck’ rule when deciding whether to return to exercise after mononucleosis infection. Be cautious of returning to contact sport too early due to the risks of splenic rupture.
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