What are the symptoms of Low Energy Availability?
What are symptoms of low energy availability for athletes?
You might be reading this if you are–
a female athlete and you have been told to watch out for “female athlete triad” which is what the sports medicine community now calls relative energy deficiency in sport (RED-s)
A parent or coach looking for information to support a young runner in your life who is struggling with exhaustion, poor sports performance after another stress fracture
This is a topic I wish more athletes (and their families) took seriously and this blog will help you understand the signs of RED-S and how to prevent RED-S so that you can stay active and have fun in the sports you love.
What is low energy availability aka relative energy deficiency in sport
It's the fancy term for a collection of problems that occur when energy output exceeds energy input and rest and recovery, basically it means you are working out and training significantly more than your body can recover and get nourished for!
It used to be called, “female athlete triad” when a female athlete was noticing these 3 things
Exhaustion or low energy
Low bone mineral density (seen in stress fractures)
Irregularities of the menstrual cycle
The term was switched to RED-S as research have found that this impacts ALL genders, not just folks who menstruate!
What causes low energy availability?
For most athletes, its not just 1 thing- a problematic lifestyle combined with
Poor knowledge of appropriate nutrition needs
Busy schedules where people don't eat
Limited access to food from food insecurity
Intentional food restriction for weight loss
Sports with weight classes or sports where lower body weight is thought to improve performance
And more!
What are the symptoms or signs of RED-S or low energy availability?
Recognizing RED-s is the job of not just the athlete but the athletes village, which means if you are reading this blog and you are a parent or a coach or trainer or clinician, paying attention to these signs are key-
You aren’t eating enough food for the amount of activity (ex: your activity might be overtraining in the gym or the demands of new parent life!)
Bladder leaks
Frequent injuries
Bone injuries
Sleep issues
Moodiness
Menstrual dysfunction
Sports performance issues
Low libido in any gender
What are the Consequences of RED-s or low energy availability ?
Because athletes can fluctuate in and out of low energy states during the various stages of th training cycle,
Common Consequences of RED-s:
Bone injury & poor bone health
Frequent injuries and illness
Menstrual cycle irregularity or loss of cycle
Digestive problems
Mental health issues
Fatigue
Urinary Incontinence aka bladder leaks
Hormonal Disruption in any gender
(Note: This is not an exhaustive list!)
Case Study A
A college runner started triathlons for fun, but never educated on how important fueling for performance was.
She rapidly lost weight and while her periods stopped, she noticed she was peeing her pants during some runs, her hair started falling out, sex was painful and she had low libido and was stressed out all the time.
A key part of her treatment included strengthening her hips and retraining her pelvic floor muscles as well as helping her plan out more time to rest and recover so she could get her periods back as she was not willing to stop running.
Case study B
A sports PT colleague referred a female runner in her late 30s to my clinic who had been hip pain not responding to traditional PT.
The athlete had run back to back marathons and was having trouble walking!
Other key findings were the complaint of exhaustion, spotting, constipation, and painful sex. I referred the runner to a sports medicine doctor and viola, a stress fracture was found!
Her treatment plan included no running so her bones could heal, connecting the dots to her nutrition as well as planning for recovery so that her body could be well nourished in the next year as she still wanted to run and even dreamed of having another baby someday!
If you are a parent or coach of a teenager, recognizing RED-s early can make a difference in the long term health of your athlete.
Teens are high energy factories with everything going on in their life, small tweaks in lifestyle and recovery practices like sleep, stress management, packing extra snacks for before and after sports practices can make a big difference in health markers like regular menstrual cycles.
As a pelvic floor PT who specializes in female athletes who clocked long training hours in high school or college, many of them wish they had better education about understanding their periods and how eating enough combined with prioritizing their recovery would impact the health in their 30s and 40s.
Bladder leakage are a major sign of RED-S in younger athletes and its so important to know that pelvic health issues occurring through the lifespan that start high school and college careers for female athletes and get ignored- don’t typically go away on their own. For some women this will impact their long term bone health, fertility, and perimenopausal experience.
Get this–
30-80% female athletes that have never given birth report bladder leakage with high impact sports like jump rope, gymnastics, and running having a higher risk
What are other pelvic floor problems associated with low energy availability?
Low energy is associated with low estrogen levels which can contribute bladder urgency, vaginal dryness which could cause difficulty with using a tampon and painful sex.
What are the treatments for low energy availability?
The treatment of low energy of availability depends on how severe the status of the energy deficiency is and the symptoms. For severe cases, athletes will have to stop playing sports and allow the body to recover in milder cases, athletes can manage with improving nutrition.
Because of the complexity of all the body systems involved a robust team including–
Sports psychologist
Sports physician
Sports dietitian
Endocrinologist
Gynecologist
Athletic Trainers
Sports and Pelvic Floor PT
To name a few!
Part of my role as a pelvic floor PT helping athletes is to empower women to understand the unique areas impacting the health holistically of female athletes throughout the lifespan.
If you or the athlete you are supporting is recovering from low energy availability or have been told you have RED-s, it's so important to know - you are not alone!
Healing is possible and you deserve to be well supported so that you can be energized to tackle your busy day and do the sports you love with a well nourished body!
At Radiance PT as part of your care team, treatments for RED-s symptoms include a holistic approach to care addressing pelvic floor health so that you can run without being distracted by leaks or body pain, plus personalized support for your recovery plan. Part of the integrative care I provide is helping-
get to the root of why the athlete might be overtraining and unfueling
address any body image issues
support to improve circadian rhymths to the body can heal its self better
accountability and guidance to to make powerful lifestyle regarding stress management so that those changes stick supporting your energy and long term health.
If you are located in the Durham, Raleigh, or Chapel Hill area reach out to the Durham office for an in person or remote appointment with Dr. Henry today!