RED-S
Reducing Injury in Female Athletes: Learn to Detect and Prevent Relative Energy Deficiency in Sports (RED-S) to Optimize Athletic Performance
One of our primary goals as therapists is to ensure our athletes are performing at their highest potential and taking care of their bodies!
Relative Energy Deficiency in Sports (RED-S) is a condition that relates to an athlete’s poor health and performance due to not having enough fuel/energy to meet the demands of their sport. This low energy availability (LEA) may be intentional (purposeful restriction of dietary intake) or unintentional. If this condition is not addressed, it can lead to:
Impaired metabolism
Impaired menstrual function
Poor bone health → increasing risk of injury/fractures
Impaired immunity
Impaired protein synthesis
Impaired cardiovascular health
Impaired sports performance
Poor endurance/strength
Poor concentration and coordination
Poor judgment and decision-making while competing
RED-S typically affects females more than males; however, male athletes can still be at risk. The prevalence of the condition in athletes amongst various sports is reported to be between 22-58%.
There are several risk factors for RED-S.
Early detection and prevention is VITAL to prevent complications and promote the highest athletic performance possible! Here are some guidelines on detecting RED-S and returning to sport appropriately:
RED FLAGS
Anorexia nervosa and other serious eating disorders
Extreme weight loss techniques
Psychological/physiological conditions related to low energy expenditure
Management:
No competition
Supervised training allowed when cleared by medical specialists for adapted training
YELLOW FLAGS
Low percent body fat
Substantial weight loss or poor growth
Abnormal hormonal conditions
Poor bone health
Poor nutrition and/or eating behaviors
Management:
May compete once medically cleared
May train as long as it follows the treatment plan
GREEN FLAGS
Healthy eating habits
Normal hormonal/metabolic function
Healthy bone density as expected for sport/age/ethnicity
No musculoskeletal concerns
Management:
Full sport participation
We recommend the following to reduce the risk of RED-S:
Optimize Nutrition
Encourage healthy eating and nutrition
Be aware of the risks of dieting/poor energy availability and how this affects health and performance
Encourage an increase in calorie intake with anticipated increases in calories expenditure/activity
Promote Body Positivity
Reduce emphasis on weight and emphasize nutrition and health
Develop realistic health-promoting goals related to weight and body composition
Avoid critical comments about athletes’ body shape/weight (this includes yourself!)
Health Monitoring
Promote yearly wellness check ups with doctors
Recognize red flags and follow ups with your therapist/physician to ensure optimal health
In summary, learn to recognize the risk factors of RED-S, optimize training by promoting nutrition, and follow up with a physician or therapist if you have any questions or concerns!
REFERENCES:
Burke LM, Lundy B, Fahrenholtz IL, Melin AK. Pitfalls of conducting and interpreting estimates of energy availability in free-living athletes. Int J Sport Nutr Exerc Metab. 2018;28(4):350-363.
Coelho AR, Cardoso G, Brito ME, Gomes IN, Cascais MJ. The female athlete triad/relative energy deficiency in sports(Red-s). Rev Bras Ginecol Obstet. 2021;43(5):395-402.
Johnston K. Sports medicine: relative energy deficiency in sport. FP Essent. 2022;518:18-22.
Logue DM, Madigan SM, Melin A, et al. Low energy availability in athletes 2020: an updated narrative review of prevalence, risk, within-day energy balance, knowledge, and impact on sports performance. Nutrients. 2020;12(3):835.
Mountjoy M, Sundgot-Borgen J, Burke L, et al. The ioc consensus statement: beyond the female athlete triad--relative energy deficiency in sport(Red-s). Br J Sports Med. 2014;48(7):491-497.
Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (Red-s): 2018 update. Br J Sports Med. 2018;52(11):687-697.