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RED-S, What is it?

RED-S – Relative Energy Deficiency in Sports

RED-S was previously known as the Female Athlete Triad, but was changed to Relative Energy Deficiency in Sports to better reflect the nature of the condition.

RED-S was renamed after a review of the evidence made it obvious that the condition was not just found in females but could also affect men.  It was also found that it did not just affect three areas of health (Bone, energy availability and menstrual health) but was a condition that affected many aspects of physiological function – including

-metabolic rate

-menstrual function

-bone health


-protein synthesis

-cardiovascular health

-psychological health

So, the female athlete triad became RED-S.

The main problem of RED-S is basically not eating enough to provide the amount of energy needed to support the range of body functions involved in optimal health and performance. 

Low energy availability which occurs when a reduction in energy intake(food) and/or increased exercise load, causes adjustments to body systems to reduce energy expenditure, leading to disruption of an array of hormonal, metabolic and functional characteristics, leading to the issues seen above.  It is a serious condition that can have long-term ramifications.  Low bone density in adolescents will impact bone density in later life.  Damage to the cardiovascular system can be permanent.  So it is important that RED-S is identified and effectively managed.

RED-S is a continuum, from low level to severely impacted, thus the effects and management will be different for everyone.

Some of the common symptoms are:

-Altered or absent menstruation

-Low energy levels

-mood changes, poor concentration

-failure to improve in sport, or under-performing

-recurrent injuries

-loss of enjoyment of sports

The important thing is to be aware of it and to try and take steps to stop it happening in the first instance.  If RED-S has been diagnosed, then support must be given to the athlete to ensure they are able to manage their energy intake and expenditure.  This may mean nutritional advice, reducing training loads, looking at sleep patterns, psychological counselling and in severe cases medical intervention may be necessary. 

Physiotherapists can often be the first people to notice issues as clients with RED-S present with bony stress injuries and frequent over training issues.  At Hillcrest Physiotherapy we have clinics in several schools and our physiotherapist will often be screening for RED-S in our clients.  Early diagnosis and intervention can help prevent the condition worsening and prevent ongoing issues.  If you think you or one of your children or someone you coach is a risk of RED-S, we would encourage you to seek professional help.



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