WHAT IS RED-S?
RED-S stands for ‘relative energy deficiency in sport’ which was previously understood as the "female athlete triad". The understanding of this condition has evolved over the years to be given the more accurate term of RED-S, and we now know that men can also develop this problem.
RED-S is where the function of the body and brain's physiological processes are significantly affected by the combination of an inappropriate diet and over-training. This is simply put as a chronic mis-match from the body having low energy availability and going into ‘power saving mode’. Some of the body processes start to become dysfunctional, which can lead to a wide range of symptoms and affect our health and well-being.
WHAT ARE THE SYMPTOMS OF RED-S?
The condition itself has a wide range of symptoms and health implications affecting the endocrine (hormonal) system; including menstruation problems, immune system, bone health, psychological well-being, growth and development, gastro-intestinal and cardio-vascular health - just to name a few.
Most importantly, for our elite athletes, gymnasts and performing arts dancers, it has a significant impact on their performance. This can lead to further psychological stress and a knock-on effect on their health and well-being.
Physical symptoms or possible signs of RED-S can include:
Amenorrhea (irregular or loss of a women’s monthly period)
Stress fractures and other soft tissue overuse injuries
Significant weight loss
Fatigue, muscle cramps and general weakness
Stomach and gut related problems (gastrointestinal)
Dizziness when changing postures (osteostasis)
Becoming more frequently unwell or finding it hard to shake off common illnesses or infections
Generalised anxiety or depression and also anxiety related to ones sport or performance
Excessive exercise, including not allowing regular periods of rest
Perfectionism with exercise or diet
Becoming tempered or angered easily
Avoiding eating pre or post exercise (fasting) with a belief this will be beneficial
Exercising beyond your capabilities
Preoccupation with weight and eating
Those most are risk of developing RED-S are dancers (specifically ballet), gymnasts, cyclists, medium to long distance runners, rowers, divers and boxers (especially around meeting strict weigh-in targets).
There are a few proposed reasons why these athletes may develop RED-S. These industries and sports often carry pressures regarding aesthetics and body image, where a concept of being lean can be seen as advantageous; hence affecting an athlete's diet and energy intake. Coaching or sponsorship pressures to achieve excellence may also be a factor, contributing to over-training. Historic problems with eating, whether eating disorders or perhaps just an unhealthy relationship with food, especially in adolescence, also place the athlete at risk. This can cause osteoporosis which is strongly related to RED-S along with chronic vitamin D of calcium deficiency.
It also is becoming more common place in recreational athletes, where despite more moderate activity levels, we can still observe energy deficiencies stemming from inappropriate diets or hormonal issues.
WHO IS AT RISK OF DEVELOPING RED-S?
THE LDN PHYSIO
Our RED-S clinic is a specialist service aimed at elite athletes, performing arts and aspiring recreational athletes, who may have developed the condition, most of the time unknowingly to them.
In this specialist clinic, you will be seen by one of our clinical specialists with an expert interest and skill set in identifying the components of RED-S, and the factors required to address your problem. The initial appointment is 60 minutes long as it often goes in much more detail than a typical Physiotherapy or Doctors appointment. Zoom consultations are also available.
You can self-refer to our RED-S clinic, or discuss your case with your GP or healthcare provider who may be able to refer you.
OUR RED-S SPECIALIST TEAM
At LDN PHYSIO we are proud of our holistic approach when assessing and treating each person that comes into our clinic. At our RED-S clinic we have the clinical expertise of Sports Medicine Consultant Dr Farrah Jawad and Clinical Health Psychologist Dr Melanie Rendall. Our very own Senior Physiotherapist Mani Matharu is also a qualified Nutritionist and is able to offer support to challenging dietary demands. In more challenging and complex cases, we will discuss a referral to a Specialist Dietician.
We believe that the experience and opinion across a wide range of specialities is the best way to help manage this complex condition. After all, RED-S symptoms and effects on the body spread far wider than any one professional can be an expert in.
Dr Farah Jawad, Consultant in Sport, Exercise & Musculoskeletal Medicine
Dr Melanie Rendall, Clinical Health Psychologist
Mani Matharu, Specialist Physiotherapist and Sports Nutritionist
Ibby Abucar, Senior Physiotherapist with Pelvic and Women's Health specialist interest
Nic Colombo, Specialist MSK & Sports Physiotherapist
Jonny Sumner, Specialist MSK & Sports Physiotherapist
WHAT TO EXPECT
A full and comprehensive assessment starts at taking a history from adolescence to the day you are in the clinic.
A full Physiotherapy physical examination in relationship to your sports and training which can help to identify and reduce the impact of secondary diagnosis such as stress fractures has from developing RED-S.
Measurements of your height and weight and body composition. This can give us an indication whether you are at a higher risk of developing complications from RED-S.
Analysis precise measurements of body fat percentage and ‘fat free mass’. This can give your clinician very accurate and individualised calorie goals per day.
Energy availability and energy expenditure assessments are challenging and are often set between your first and second appointment to monitor your energy intake and energy expenditure.
When required we will ask your GP for blood tests
We may refer you to our Sports Doc for further investigations
Dietician and Nutritionist advice and guidance is paramount for the majority of RED-S sufferers. This is a very individualised approach and meeting our team early on is always advised.
We will discuss any history of disordered eating or specific and diagnosed eating disorders.
There may be personality traits such as perfectionism or psychological characteristics we may identify. We are then able to refer you directly to our Clinical Health Psychologist for further assessment when needed.
There are often personal conversations about a women’s cycles, whether this is, and always has been, regular and to ask some more questions about pelvic health.
THE LDN DIFFERENCE
TRULY TAILORED INTERVENTION
Our clinicians will go above and beyond to ensure you get the best out of your intervention. With experience as senior clinicians in the NHS, in private clinics, Premiere League clubs and in some of the biggest firms in the City - we're confident with can get you back on track towards achieving your own unique goals as soon as feasible.
INNOVATIVE REHAB EXPERIENCE
Our systems are simple and effective, and our treatments based on the latest evidence. Book, pay, change appointments in 2 secs. Forget stickmen drawings, we'll get you on our exercise app which integrates with your phone, smartwatch and allows communication with your physio when not in clinic.
SUPPORTIVE & LISTENING
We want your experience to be as seamless as possible. Because results only come with commitment, we support you when you leave the clinic too. Stay in touch with your clinician via video, email or messenger; get the answers to your questions as soon as they come up and stay on track in between sessions.