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SPECIALIST RED-S CLINIC

RELATIVE ENERGY DEFICIENCY

IN SPORTS

Book in London's only private RED-S clinic

Welcome to LDN PHYSIO’s multi-disciplinary specialist clinic designed to treat sufferers of Relative Energy Deficiency in Sport (RED-S)

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 clinical specialists with an expert interest and skill set in identifying the components of RED-S, and the factors required to address your problem. 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.

To find out more about what RED-S is and the range of symptoms click here.

RED-S is a very individual experience for each person who’s experiences traits of the condition. There are different elements of someone’s background, lifestyle, training, psychology and physiology which weights to what proportion the multi-disciplinary team is involved.

How can each RED-S clinician help me?​

Each clinician will have experience in managing your ongoing condition. How we help you utilise their skills will be dependent on your experience with RED-S, which will be discuss in your initial session.

 

Sports & Exercise Medicine (SEM) Consultant​

Dr Kush Joshi

SEM consultants provide medical management for athletes with RED-S, including addressing any medical complications or health concerns arising from energy deficiency. These may include prescribing medications, supplements, or interventions to manage symptoms such as bone stress injuries, menstrual irregularities, cardiovascular issues, or metabolic disturbances.

Higher-risk RED-S care will be guided by your SEM, and their treatment will be coordinated among the appropriate specialists on the team. Often, it may be necessary to inform your GP either at your first appointment with your physiotherapist or at various points throughout your treatment, if deemed important.

 

Sports & Performance Psychologist

Sarah Majid

Understanding an athlete's perspective is crucial as the keystone underlying their experience with RED-S. Exploring underlying factors, addressing disordered eating, and promoting ways to modify behavior and encourage self-care throughout their journey to recovery is just the beginning.

Within the different models of LDN’s RED-S multi-disciplinary team the therapeutic part is weighted more heavily to psychological assessment and support. Often the ingrained and learnt behaviours from our development, social influences and performance pressures can be challenging to turn into a positive experience. A strong collaboration with the other members of the team will be developed from your first session.

 

Sports Nutritionist

Alison Bolch

RED-S at its core is a mismatch of consumed energy versus expended energy, creating an imbalance and deterioration of the condition. Evaluation of your energy needs, tailored dietary recommendations, collaboration with your physiotherapist on training load management and optimising meals and intake, balanced around personal preferences, are some of the key features within RED-S sports nutrition.

 

Specialist Physiotherapists

Jonny Sumner, Alice Hunter, Liz Jones

Guiding and managing your care from the start to the finish, you’ll be assigned one of our specialist RED-S Physiotherapists. Their lead in coordinating your management is crucial for the other clinicians to work along-side.

Their skill set also covers managing training objectives, managing specific injuries or conditions, performance goals, strength and conditioning and optimising training loads and programmes where suitable.

 

 

Is LDN’s RED-S service the right intervention for me?

The design of the service is to ensure that we are accessible and able to signpost you to the most appropriate clinician as soon as possible. The initial session serves as both a screening session and an opportunity to get to know you and your experience.

There are instances where we may assess that RED-S is not the primary cause of your condition, or that you would require further evaluation with our specialist SEM Consultant. We will discuss this with you during the session. Our nutritional and psychological support services may still be useful, and therefore they are open to everyone.

Sometimes, profound and high-risk challenges arise from RED-S. If we find that referring you urgently to another team is required, we will discuss this with you and make recommendations accordingly. This could be via a private or NHS referral through your GP. All care will be managed with your consent.

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8 week ‘light’ RED-S Management

Initially for low-moderate risk patients, with no high-risk factors identified in your assessment. Often there are some smaller modifications required and ongoing support across an 8 week plan which will match the ‘light’ management plan.

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8 week ‘intensive’ RED-S Management

Moderate-high risk individuals with specific factors that may be more heavily ingrained in their lifestyle, training or believes that we would expect a higher level of support over an 8-week period.

With those suffering from a range of more serious physiological challenges of RED-S there is often the strong recommendation to be under a SEM Consultant. See below on how they can help.

Challenging psychological believes and factors for RED-S often take a bias towards more psychological support, which can vary from week 1-4 to 5-8, adjustments to you plan can be made where suitable.

At the end of the 8 weeks, in the case of ongoing strategies needed to be followed up, reduced-cost single sessions can be organised.

12 week ‘standard’ RED-S Management

This model is where we see overall lower risk patients, with development of RED-S often over a long period of time. The signs and traits to RED-S can take a long time to change for the best.

What do the different RED-S Intervention Packages involve?

Which is best for me?

We don’t offer a quick fix solution because often in the world of healthcare, a quick fix is a short-term solution. One thing we’ve learned in the 5 years of operating the RED-S clinic is that there is no ‘standard’ treatment approach. The majority of individuals coming through the clinic are expected to engage in the 12-week standard model detailed below.

The International Olympic Committee categorises individuals into low, moderate, and high-risk categories, which helps in determining the intensity of treatment required. After your initial assessment, your RED-S clinician will guide you in determining the appropriate course of action. All models aim to support individuals in improving their nutritional intake, performance, and psychological well-being over time.

It's important to note that the frequency of appointments with each specialty may vary, and customised plans are always possible.

For instance, in some cases, patients with stabilised eating disorders still require a graded resistance programme to improve bone density, necessitating nutritional and psychological support alongside physiotherapy. Despite the emphasis being on resistance training supervised by physiotherapy, all three inputs—nutritionist, psychology, and physiotherapy— are necessary throughout the program.

In other instances, the initial 4 weeks of the program may be heavily focused on physiotherapy, nutrition, and psychology, with subsequent weeks having a reduced emphasis on physiotherapy. As we provide these treatments in blocks, it is easy to adjust the intensity based on your needs as we progress."

What does the package include?

Combination and mix of the MDT – psychotherapy, nutritionist support, physiotherapy

What does the package not include?

SEM (Doctor) appointments

 

Any plan can be upgraded or downgraded at a point in your care if you feel you’d require a change in support.

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 Kush Joshi and Sports  Performace Psychologist Sarah Majid,

 

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.

Jonny Sumner, Specialist MSK & Sports Physiotherapist

Alice Hunter, Specialist MSK & Sports Physiotherapist

Alison Bolch, Sports Nutritionist

Dr Kush Joshi, Consultant in Sport, Exercise & Musculoskeletal Medicine

Sarah Majid, Sports & Performance Psychologist

WHAT TO EXPECT

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  • 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 organise blood tests

  • We may refer you to our Sports Doc for further investigations

  • 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.

What is RED-S?
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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

  • Dehydration

  • 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

Psychological signs:

  • Generalised anxiety or depression and also anxiety related to ones sport or performance

  • Body dysmorphia

  • Excessive exercise, including not allowing regular periods of rest

  • Perfectionism with exercise or diet

  • Difficulty concentrating

  • 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?

BOOK IN OUR RED-S CLINIC TODAY

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.

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