What is it?
Relative Energy Deficiency in Sport (RED-S), formerly known as the ‘Female Athlete Triad’ is a condition of prolonged low energy availability in either female OR males that results in physiological or psychological symptoms. Put simply, your body is not receiving enough energy from food to meet both the demands of exercises and essential daily functions such as breathing, digestion and recovery. This can be the result of under eating or over training.
Energy availability=Energy intake (food)-Energy expenditure (exercise)
This can present in anyone but is often seen among female athletes. Symptoms can vary, but typical manifestation can look like:
- increased injury risk (or increased injury around the time of menstruation)
- menstrual disturbances (absence, irregular or change in cycle)
- decreased bone health
- mood disturbances
More specific symptoms noticed may include:
- decreased muscle strength
- decreased endurance
- increased injuries (such as stress fractures or soft tissue injuries)
- poor recovery (such as longer or more intense muscle soreness)
- decreased training response
- impaired judgement
- decreased coordination
- decreased concentration
- irritability
- depression
- decrerased glycogen stores
Why it matters?
This is a state of low energy availability for the body that can have very negative effects AND be much longer to reverse the longer someone is in it. Among females especially, there can be societal pressures to look a certain way or pressures within their sport to meet a certain weight class, wear figure forming uniforms or focus on leanness. This can all contribute to an increased risk of RED-S or even a more clinical diagnosis of disordered eating.
Many are not even aware they are under eating and contributing to these symptoms! One study by Sim & Burns in 2021 found that 45% of recreational athletes and 56% of elite female athletes were at risk or already experiencing RED-S.
In physical therapy, we can screen for this condition among our clients and refer out to other providers to assist in managing when needed, such as a sports medicine doctor, psychologist, or nutritionist.
While this is often not something on the radar of most females on a day to day basis, it is something to be aware of especially if you are experiencing these symptoms or if you are a clinician treating female athletes.