Step-by-Step Guide to Handling a REDs Case
Handling a REDs case requires awareness, patience, and teamwork. Your support as a coach is invaluable in guiding athletes through recovery and fostering a culture where proper fueling and overall health are prioritized over short-term gains.
This guide outlines a structured approach to handling a REDs case and ensuring the athlete receives the necessary care while maintaining their connection to sport.
Step 1: Identifying REDs
Athlete-Initiated Cases
If an athlete approaches you with concerns about REDs, acknowledge their courage in speaking up and move directly to the collaboration phase (Step 2). Your role is to provide a safe, supportive space and help facilitate the next steps in their recovery.
Coach-Initiated Cases
If you suspect REDs based on observed symptoms, initiate a private, supportive and non-judgmental conversation. Signs to look for include:
Persistent fatigue and frequent injuries (e.g., stress fractures, muscle strains)
Unexplained performance declines
Menstrual irregularities (for female athletes) or hormonal changes (for male athletes)
Mood changes, increased anxiety, or obsessive behaviors around food and training
Conversation Starters
Check out some conversation starters from the Healthy Conversations Guide to approach the topic sensitively.
Step 2: Collaborate with the Support Team
REDs diagnosis and recovery requires a multidisciplinary approach, including:
Athletic Trainers: for monitoring physical health and injury management
Registered Dietitians: to address nutritional deficits and create fueling plans
Sports Medicine Professionals: to diagnose and manage REDs medically
Mental Health Professionals: to support emotional and psychological well-being
Medical professionals should use the International Olympic Committee (IOC) REDs Clinical Assessment Tool (CAT2) to evaluate the athlete’s condition. As a coach, your role is to facilitate connections between the athlete and healthcare providers while maintaining a trusting and supportive relationship. Check out When and How to Seek Medical Support for REDs for more advice on using the REDs CAT2 tool.
Step 3: Supporting the Recovery Process
Once REDs is diagnosed, recovery involves addressing nutritional intake, modifying training, and ongoing monitoring. The process is different for each athlete:
Adjusting Training Load: Some athletes may continue modified training, while others may require full rest based on medical guidance
Implementing Nutritional Changes: The athlete works with a dietitian to correct energy deficits and restore hormonal balance
Recognizing Recovery is Non-Linear: Some athletes improve quickly, while others require longer periods to regain health
Be patient, stay engaged, and check in regularly with the athlete and support team to evaluate progress and adjust plans as needed.
Step 4: Guiding Athletes Back to Full Training and Competition
Athletes recovering from REDs should follow IOC training and competition guidelines:
Yellow Category: Full training and competition are allowed with active monitoring and nutritional support.
Orange Category: Modified training intensity or volume; competition participation may be limited.
Red Category: No training or competition until medical clearance is granted.
Coaches should reinforce long-term health over short-term performance, ensuring athletes return only when fully recovered.
Step 5: Long-Term Support and Prevention
Preventing future cases of REDs involves educating athletes, fostering a positive fueling culture, and maintaining open communication. Strategies include:
Encouraging balanced nutrition and fueling without fear
Monitoring training loads, individual responses to training, and recovery markers
Creating a supportive environment where athletes feel safe discussing concerns