What is RED-S?

RED-S, or Relative Energy Deficiency in Sport, is a syndrome that occurs when individuals, particularly those engaged in high levels of physical activity, do not consume enough fuel to meet the energy demands of their lifestyle and training. This energy imbalance can lead to poor health and a decline in athletic performance. It's not just about training hard—it's about ensuring the body has the fuel it needs to function and recover properly.

Spotting RED-S in Athletes:

Physiotherapists and other health professionals can become suspicious of RED-S when certain signs and symptoms are present. These include:

• Persistent fatigue or injuries related to fatigue
• Frequent illness or compromised immune function
• Gastrointestinal disturbances
• Low mood or signs of depression
• Irregular hormonal cycles (e.g., disrupted menstrual cycles in women)

The Role of the Multidisciplinary Team:

Managing RED-S requires a team effort, involving various health professionals, including:

1. Sports Physicians
   They play a critical role in managing the overall health of the athlete. From monitoring biochemical markers through blood tests to assessing injury recovery, sports physicians ensure that the athlete is returning to a well-balanced state, both physically and metabolically.
2. Sports Dietitians
   Dietitians focus on restoring and maintaining optimal energy intake, ensuring diets are balanced and include key nutrients such as calcium, iron, and vitamin D. They also consider individual sensitivities, such as allergies or cultural dietary restrictions, when formulating nutrition plans.
3. Sports Physiotherapists
   While managing injuries, physiotherapists monitor how the healing process aligns with the athlete's training load. They work closely with other team members to adjust training parameters and prevent re-injury as the athlete transitions back to regular activity.

Managing RED-S in Busy Lives:

For individuals with high-demand jobs and limited time, forward planning is essential to ensure that nutrition isn't neglected. When life is hectic, it’s easy for meal planning and appropriate nutrient intake to fall behind, especially for those training at a high intensity.

Returning to Exercise:

When returning to exercise after experiencing RED-S, both physicians and physiotherapists play key roles in managing the athlete's training load. This is done in conjunction with the dietitian, who ensures that nutrient intake is sufficient for the level of physical activity. Importantly, return-to-play decisions are based on specific criteria, not simply on time elapsed.

Practical Tips for Active People:

1. Prioritising Carbohydrates
   Carbohydrate intake is often lower than the recommended levels for athletes, making it a common focus for improvement. Adequate carbohydrates are essential for fuelling both performance and recovery.
2. Top-Up Strategies
   Dietitians often provide simple strategies to "top up" meals to better match daily training and exercise needs. Timing meals around training sessions is also critical for maximising performance and recovery.

By ensuring a well-rounded approach to nutrition, training, and recovery, athletes can not only avoid RED-S but also enhance their overall performance and long-term health. It's all about creating a balance between energy intake and output, supported by a strong multidisciplinary team.

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Holly Pointon, Physiotherapist
Jessica Rothwell, Sports Dietitian
Dr. Liam West, Specialist Sports and Exercise Physician
Melbourne CBD Physiotherapy and Sports Medicine Clinic

Dr. Liam West, Specialist Sports and Exercise Physician; Jessica Rothwell, Sports Dietitian; and Holly Pointon, Physiotherapist, bring a wealth of expertise and collaborative care to Melbourne CBD Physiotherapy and Sports Medicine Clinic. Dr. West specialises in sports injuries and RED-S, closely monitoring health markers to ensure comprehensive recovery. Jessica focuses on tailored nutrition strategies, considering individual needs and lifestyles to support athletes’ performance and overall health. Holly, with her background in musculoskeletal rehabilitation, emphasises safe return-to-play strategies and empathetic patient support. Together, they deliver holistic and integrated care, helping athletes overcome the challenges of RED-S and achieve sustainable, long-term success.