Welcome to the PT Rebels Podcast.

This is the place to learn how you can become a PT rebel and take charge of your own health and wellness. We will help you find answers to your questions about pain, injury, and the path towards healing in the most efficient and effective way possible.

I’m your host, Dr. Gina F.

On today’s episode, I wanted to discuss a term with you. Many athletes deal with, especially female athletes, it’s called relative energy deficiency in sport or red s some people say reds. This used to be term female athlete triad syndrome, but relative energy deficit in sport affects both male and female athletes. It’s a relatively common but poorly recognized and diagnosed condition that can have a very significant impact on a young athlete’s career and on their health, both short term and long term. Relative energy deficiency in sport can result in a series of potential health and performance consequences as a result of overall low energy availability. The term energy availability refers to. The athlete’s available energy once their energy expended during a workout or competition is subtracted from their overall energy intake through their diet nutrition. This energy is needed for the body systems to function, and red S is a broader term, which includes the female athlete triad. Which was really emphasized just for female athletes. Now, we know affects both males and females, but that’s a disordered eating in females, menstrual abnormalities and issues with low bone density, and acknowledges that the more widespread impacts of energy deficiency beyond menstrual dysfunction. Bone density issues as well as the inclusion of male athletes. So red S is inclusive of both male and female athletes and can affect athletes of any gender and across all sports. It’s more common to see red s in sports in which there’s an emphasis on a lean figure or low body weight, such as when athletes have to meet a certain weight class restriction. Oftentimes we see red s and dancers gymnasts. Runners weight class combat sports athletes, and while it may be associated with or driven by disordered eating behavior or eating disorders, red s may also be the result of just the athletes struggling to meet the high energy demands of their sport, especially in endurance athlete. So what do we see in the clinic when an athlete may be suffering from red S or relative energy deficit syndrome? This is oftentimes related to the overreaching and over training that we talked about in the previous episode, but relative energy deficit syndrome can be because an athlete is just. Unable or unaware of how to take in enough calories and nutrition to meet the demands of their sport, especially when their sports training becomes more intense or ramps up. Oftentimes, I’ve heard female athletes say that they just don’t like the feeling of being full. Oftentimes female athletes or male athletes feel pressure to look a certain way or be a certain weight in order to maintain their speed, and so they’re very. Anxious or cautious about eating a certain amount if they feel like that is going to make them slower or if they’re going to gain weight and have negative impacts. Sometimes athletes experience gastrointestinal disturbances. Because of overreaching or overtraining, but they feel like it’s because of maybe how they’re eating. And so sometimes they often eat less to try to feel better, when in fact they just need to be eating more of the right types of nutritious foods for them. There’s oftentimes a lack of understanding and nutritional education is really vital and essential for these athletes to overcome relative energy deficit syndrome. Athletes with relative en energy deficit syndrome are at an increased risk of hormonal dysfunction in female athletes that this affects their periods. Oftentimes, they have reduced periods or loss of periods or delayed puberty in adolescence. When a young lady presents with irregular periods or absent periods, a diagnosis of red s should always be considered, needs to be a red flag. Also, in male athletes, reduced testosterone levels can occur. We are seeing an increased number of male athletes come into the clinic with relative energy deficit syndrome, as well as bone stress injuries. This last year, in my own personal experience, I saw more male athletes than I’ve ever seen with bone stress injuries, stress fractures in their femur, in their sacrum, in their tibia, in their metatarsal and navicular bones. A really large increase I think will. As the years go by here and there’s more research done, not only with red s, but also with shoe wear and shoe type, I think we’re gonna have a better understanding of why this is happening. We need to all do our due diligence, not only as physical therapists, as coaches, as athletic trainers, as parents, to try to help identify these factors that we can help these athletes prevent because those stress fractures or bone stress injuries and overall relative energy deficit in sport. Have a significant impact on their health, not only in the short term, but in the long term. These athletes, as I mentioned, are at great risk for stress fractures, but also other overuse injuries and illnesses such as respiratory tract and GI illnesses, iron deficiency anemia, red ask can also have a significant psychological effect and poor mental health effect on these athletes, especially when they have to take time outta sport to recover. Failing to identify red S may mean that it is not easy or possible to adequately treat these issues without significant long-term help. Early diagnosis and treatment is essential for preventing long-term impacts, not only to their overall health and wellbeing, but to their mental health as well. The diagnosis of Reds involves a multidisciplinary approach and requires significant medical review from a team of healthcare professionals. A useful screening tool that has been developed to help clinicians identify red s is the Red S Clinician Assessment Tool, or the Red S Cat. The red S Cat uses a traffic light approach, red, yellow, green, to assist identifying at risk athletes and guide return to sport decisions for healthcare professionals. So if you’re concerned whether or not an athlete may be suffering from red s, if you’re a coach, please send them to a healthcare professional. Talk to the athlete, talk to the parent, send them to the athletic trainer or their physician. And get them help immediately for this disorder because the short-term consequences are much easier to treat than the long-term consequences. If this drags on. The treatment of reds can be very challenging and also, as I said, requires a multi-team approach, especially when relative energy deficit. Is intentional. If there’s an intentional deficit of calories, either due to body image or anorexia condition, it can become very challenging. And this is honestly pretty common in these types of athletes that we talked about earlier. So number one, it’s essential to be able to identify it. Number two, once to identify what could be going on. Know what team of medical professionals you need to get involved. And number three, just know that this will be a. Process for the athlete to get through and that you need to be their support staff and help them in dealing with the variety of issues that they may face moving forward in terms of training, body image, mental health and wellbeing and nutrition. So athletes, if you are suffering from fatigue. Difficulty sleeping. Weight loss. If your periods have become more irregular or absent, if you are not enjoying your sport as much as you used to, if you feel like very heavy just trying to complete a workout or a practice or a competition. You may have relative energy deficiency in sport, and you need to talk with your coach, your parents, your athletic trainer, and your healthcare professional about this. These issues are extremely common in elite, collegiate, high school, and recreational athletes, and it can affect a large range of age groups. So just know that. You’re not alone. That many athletes in your caliber and your skill level are dealing with this and that you should seek help. And when you seek help sooner than later, you will have a much better long-term result.