The Silent Threat To Female Athletes
What is RED-S And how CAN physical therapy help?
As a female athlete, you push your body to its limits to perform at your best, but what if your body's silent cry for help goes unheard? What if your dedication to your sport is actually putting you at risk for a condition that impacts not just your performance but your long-term health? This is the reality for many athletes unknowingly suffering from Relative Energy Deficiency in Sport (RED-S).
While you may have heard of the term “Female Athlete Triad,” RED-S offers a broader and more complex picture of how energy deficits can harm the body, affecting everything from bone health to mental well-being. Let’s dive into what RED-S is, why it’s especially critical for female athletes, and how physical therapy can be a key player in prevention and recovery.
What is RED-S?
RED-S is a condition that occurs when an athlete does not consume enough calories to support the energy demands of their sport, daily activities, and basic bodily functions. This energy deficit impacts many bodily systems and can cause long-term consequences if not addressed. While the condition has traditionally been associated with undereating or excessive exercise, it’s important to understand that the risks of RED-S go far beyond weight or caloric intake alone.
RED-S can affect:
Metabolic function
Menstrual health
Bone health (leading to stress fractures or osteoporosis)
Cardiovascular health
Immunity (increased risk of illness and injury)
Mental health (anxiety, depression, and poor concentration)
For female athletes, menstrual irregularities are a red flag. Missing periods or having very light periods might seem like no big deal, but they could be a signal that your body isn't getting the energy it needs to function properly.
Why Are Female Athletes at Higher Risk?
Female athletes face a unique set of challenges that can put them at a higher risk for developing RED-S. Societal pressures to maintain a certain body type, a lack of education around proper nutrition for performance, and the natural fluctuations in energy expenditure associated with sports all contribute to this growing issue.
In sports such as gymnastics, cross-country running, or figure skating, there’s an increased emphasis on aesthetics that can lead to disordered eating, restricted caloric intake, and overtraining. Athletes in other sports can also be vulnerable if they’re training intensely without fueling their bodies adequately to compensate.
The Impact on Performance and Health
The consequences of RED-S go beyond just feeling tired or fatigued. If left unchecked, the imbalance can cause:
Decreased performance: Without enough energy, muscles don’t recover properly, endurance and strength decline, and performance plateaus or even deteriorates.
Increased injury risk: Insufficient bone density and weakened muscles can lead to stress fractures and other injuries that will sideline an athlete.
Decreased immune function: The body is more vulnerable to illness and infections when energy resources are stretched too thin.
Long-term health consequences: Chronic energy deficits can have lasting impacts on bone density, menstrual health, and even mental health.
The good news is that RED-S is preventable, and the earlier it’s recognized, the better the chance for a full recovery. That’s where physical therapy can make a significant impact.
How Physical Therapy Can Help Combat RED-S
Physical therapists are well-positioned to play a pivotal role in managing and preventing RED-S in female athletes. Here’s how physical therapy can help:
Identifying Early Warning Signs: Physical therapists can help identify early signs of RED-S, including decreased performance, chronic fatigue, or pain from stress fractures. Early intervention is key to preventing more severe health issues.
Restoring Function After Injury: If RED-S has led to an injury (such as stress fractures or ligament damage), physical therapy helps athletes regain strength, mobility, and function. A tailored rehab program will focus on gradually returning to sport without risking further injury.
Educating on Proper Nutrition and Recovery: Physical therapists often work closely with nutritionists and sports dietitians to help athletes understand the importance of fueling their bodies for optimal performance and recovery. Proper hydration, fueling before and after workouts, and a balanced diet are crucial elements in managing energy balance.
Promoting Bone Health: Weight-bearing exercises, strength training, and balance work—areas where physical therapists specialize —are crucial for improving bone density and reducing the risk of stress fractures. Physical therapists can provide specific exercises that help build strong bones and prevent the long-term consequences of RED-S.
Mental Health Support: While physical therapists primarily work on the body, they’re also an important source of emotional support. Talking to a physical therapist about physical and mental barriers in training can help athletes address the stress, anxiety, or depression that often accompany the struggles of RED-S.
Key Takeaways for Female Athletes
Fuel your body: Nutrition is key. Be sure your calorie intake aligns with your training demands and daily needs.
Rest is essential: Don’t push through pain. Listen to your body and rest when needed.
Watch for warning signs: If your menstrual cycle is irregular or you’re feeling constantly fatigued, it might be time to seek help.
Seek professional guidance: If you think you might be dealing with RED-S, reach out to a healthcare provider, and don't forget to consult with a physical therapist to get back on track.
Take Control: Prevent and Recover from RED-S with Physical Therapy
RED-S is a condition that can be difficult to spot, especially in its early stages. However, by understanding the signs and seeking the right treatment, female athletes can continue to train and perform at their best—without sacrificing their health.
Whether you’re struggling with the effects of RED-S or working to prevent it, physical therapy is a powerful tool to get you back to your sport and your life, stronger than before. If you suspect you might be dealing with RED-S, it’s time to take action. Your health—and your future—depend on it.
