146. Understanding RED-S: Essential Screening for Physical Therapists

In this episode of the PT Snacks podcast, we dive into the topic of Relative Energy Deficiency in Sport (RED-S). Aimed at physical therapists and students, this discussion covers the basics of RED-S, including its causes, symptoms, and the importance of early detection. We explain how this condition affects various body systems and performance, and highlight the role of physical therapists in screening and referring patients. Additionally, listeners will learn about the types of athletes at risk, signs to watch for in the clinic, and available screening tools. Tune in to enhance your understanding and improve your ability to support patients dealing with RED-S.

00:00 Introduction to PT Sacks Podcast

00:19 Episode Focus: Relative Energy Deficiency in Sport (REDS)

00:56 Importance of Early Detection

02:11 Understanding REDS: Causes and Effects

03:19 Identifying At-Risk Individuals

04:11 Symptoms and Indicators of REDS

05:00 Injury Correlation and Risks

05:45 Screening Tools and Referral

06:20 Final Thoughts and Resources

08:03 Special Offers and Conclusion

1.     Mountjoy M, et al. (2018). IOC consensus statement on RED‑S. Br J Sports Med, 52(11), 687–697. https://bjsm.bmj.com/content/52/11/687

2.     Tenforde AS, et al. (2022). Understanding RED‑S in sport. Current Sports Medicine Reports, 21(1), 30–37.

3.     Ackerman KE, et al. (2020). Prevalence of RED‑S symptoms in athletes. Sports Health, 12(6), 539–546.

4.     Melin A, et al. (2023). Screening tools for RED‑S. Br J Sports Med, 57(17), 1119–1128. https://bjsm.bmj.com/content/57/17/1119

5.     De Souza MJ, et al. (2014). LEA in athletes. J Clin Endocrinol Metab, 99(3), 777–787.

6.     Logue D, et al. (2020). Low energy availability in athletes. BMJ Open Sport & Exercise Medicine, 6(1).

Transcript

0:31

Hey guys. Welcome to PT Sacks podcast. This is Kasey, your host, and if you're tuning in for the very first time, what you need to know is that this podcast is meant for physical therapists and physical therapist students who are looking to grow your fundamentals and bitesize segments of time. Now, today's episode, we are going to talk about reds. More specifically relative energy deficiency in sport. But before we do that, if you've been listening to this show more than three times and you found it to be beneficial, if you would leave a review wherever you listen to this, that would mean the world to me because it really does help make a big difference in helping the show to grow. And if you've already done so, thank you so much. I really, really appreciate you. Now on today's episode, we are talking about. Relative energy deficiency in sport. And just for the sake of ease, I'm gonna call it reds from here on out. And the reason why this is so important is this is something, while we may not directly treat as like a registered dietician or physician, but it is definitely something that we can screen and catch. And the earlier that we catch it the better. Especially if you think about those patients who. They just get injured all the time, or they have a stress fracture and they've had multiple stress fractures and they're just not healing very well. These are things that we can have as little flags in our brain to be like, okay. I feel confident I'm doing everything I can from a physical therapy perspective. What am I missing and do I need to take a step back and bring a bigger medical team on board to help this patient be able to do the things they want to do and be as healthy as possible? So today we're gonna talk about a brief overview of what Reds is. Who tends to get it, what this might look like in a PT clinic and how we screen and really what physical therapy's role is in helping to prevent, detect, and refer. with that, let's dive into what this is. So with Reds, this is a clinical syndrome caused by insufficient. Energy to intake, relative to energy expenditure, and it affects multiple body systems and performance. So it basically expands on female athlete triad, which allows it to encompass not just menstrual and bone health, but also metabolic immune, cardiovascular, psychological, and other systems that are at play. This affects both male and female athletes, especially adolescents are at risk. So it is something important to keep in mind with this. How this happens is we have our energy availability, which is the difference between our daily energy intake, EI minus exercise, energy, expenditure so if someone has inadequate energy availability. Meaning their energy expenditure is greater than their daily energy intake than we say that is. Low energy availability, LEA. Now this could be something that's chronic or it could be severe acute that can cause reds so. When we are looking at who tends to get this, what profile of people, it's not just elite women. It, as I said, it can be men, youth, athletes, recreational athletes are also at risk. Higher risk sports tend to be those that are endurance sports aesthetic or if there's a weight class that someone is required to fit. The type of person that may gravitate towards this might be our perfectionistic individual. Someone you identify. They have compulsive training habits, body image concerns, but doesn't mean that someone has an eating disorder because you can also have this just with. Inadequate nutrition or maybe food security concerns. Maybe someone's not able to get the nutrition that they need for the amount of energy that they are expending. So some symptoms that you can look for would include injury patterns where you're watching for, are they having stress fractures, delayed healing, chronic tendinopathy. Maybe there's performance changes that you're identifying. They have a lot of fatigue, lack of rehab progress, and poor tolerance to load. Behavioral cues like avoiding rest training through pain, fear of weight gain. Hormonal indicators. So irregular, absent periods, low libido, testosterone, And then systemic symptoms, cold intolerance, GI issues, mood swings, poor sleep. These are all things that give us a little cue on, hey, there's probably some something systemic going on. They may even have sudden weight loss, hair loss all those sorts of things. Now in terms of reds and injury correlation, low energy availability may be one of the strongest indicators of injury risk. So there is five times the fracture risk in those with menstrual dysfunction. Low energy availability can lead to tissue breakdown, slowed repair, higher re-injury risk. They're not getting the nutrients that they need as they're breaking down tissues with their workout to replenish those and actually grow stronger from those. So it's going to affect their ability to rebuild, especially chronically over time. It can affect their neuromuscular control. So increased non-contact injuries may be evident. Immune suppression, more illnesses, inconsistent training in rehab. Now there are some screening tools that are more formal. There is a Red's clinical assessment tool or cat and it basically asks about their menstrual history, nutrition habits, mood and stress, fatigue and performance drops. If you're working with a team, they may already have a sports registered dietician or a medicine, sports medicine physician on hand. But if this is an area that you're identifying as a problem. Yeah, refer to a sports registered dietician, a sports medicine physician, mental health professional. People like that are really good at what they do, so let's make sure we're putting the whole team on board to do what they do best. So again, the point of this is just to put reds on your radar. I hope you do further research on this because it is really something that I think we could probably do a better job of screening or just educating your patients but also come at this at a place of non-judgment and love for your patient on wanting to help them the best that you can. And I think that. If you feel like this is an area that you have a hard time talking to people about if it's weight, nutrition period cycles, things like that. I also think that the more that you can work on your communication skills, that is an area that I don't always see a lot of people work on, but everyone can benefit from more, right? So use this as an opportunity to. Yes, have this on your radar, but also make sure that you're setting yourself up in a way where you can help these patients. Be open-minded and hear what you have to say, whether, or whether or not this is intentional. But just making sure that we are helping our patients to put every best effort forward to help them to be healthy and successful in their sport. So what you should have gotten from today is just more of what Reds is. Put it on your radar. What are some things to watch for in the clinic that you may notice, and what do you do about it? Build a good relationship with your patients so that you can have these good conversations. If you guys have any questions at all, feel free to reach out at pt Snacks podcast@gmail.com. So I will add some show notes, for some resources that you can look at. But if you guys have any questions, feel free to reach out to PTs next podcast@gmail.com. If you are trying to maybe just get more resources to continuing education as a whole, maybe not specifically towards Reds med Bridge is actually offering listeners over a hundred dollars off their year subscription, which includes thousands of classes. There's webinars, there's specialty exam prep. I use it for my OC. And depending on what subscription level that you use, they actually have one where you can have an home exercise program builder. So there's a ton of exercises they already have, and you can request some too, where it's filmed, it's got a description. You can type in your reps and sets and put it all together in a program for your patient and you can print it out or you can give'em a QR code and they can watch videos on their phone. It's really nice. So be sure to check that out and the that out in the show notes. And if you're a student, you get an even better discount. So that's it for today, guys, and until next time.