When and How to Seek Medical Support for REDs
Contents
When an athlete begins to experience symptoms of REDs, early intervention is critical to prevent long-term health consequences and performance decline.
As a member of an athlete's support team, whether you're a coach, teammate, or medical professional, you play a key role in recognizing when an athlete needs medical help and ensuring they get the right kind. Knowing when to intervene and how to collaborate with healthcare professionals can make all the difference.
Signs That Intevention is Needed
While athletes may be hesitant to seek medical attention, there are several key indicators that shouldn’t be ignored:
Irregular or Missing Periods (for female athletes): If an athlete’s menstrual cycle is absent or irregular, it’s a sign that their body may be under stress or not receiving adequate fuel.
Decreased Morning Erections (for male athletes): Fewer than three morning erections per week can indicate hormonal imbalances linked to low energy availability.
Frequent Injuries: Recurrent stress fractures or soft tissue injuries may signal underlying issues related to REDs.
Persistent Fatigue: If an athlete feels constantly drained despite getting adequate sleep, it’s time to investigate further.
Using the REDs Categorisation Tool
Diagnosing REDs can be tricky, as symptoms are often subtle energy availability is difficult to measure. Early detection through self-reported symptoms or objective screenings is crucial for preventing long-term health issues.
The IOC REDs CAT2 is a tool used by medical professionals and athlete support teams to assess whether an athlete has low energy availability and determine their ability to continue training or competing safely. This updated version (2023) should be integrated into routine health checks and recovery strategies. Diagnosis should be made by a sports medicine physician, and treatment plans should involve a multidisciplinary team including doctors, dietitians, and mental health professionals. Check out this article on how to handle a REDs case, step-by-step.
Initiating the Conversation
Approaching an athlete about seeking medical help can be delicate, especially if they are unaware of the severity of their symptoms. You'll find a detailed guide here, but below are some tips for starting that conversation:
Be Supportive, Not Confrontational: Frame the conversation as an act of care, not criticism. For example, you could say, “I’ve noticed you’ve been feeling tired and struggling with recovery. I think it might be worth checking in with a healthcare professional to make sure you’re getting what you need.”
Normalize Seeking Help: Remind them that getting help isn’t a sign of weakness. It’s a proactive step toward staying strong and healthy.
Provide Resources: Offer to connect them with a sports dietitian, team physician, or other trusted medical professional. Let them know you’re available to support them through the process.
Working with Healthcare Professionals
Once the athlete agrees to seek help, your job isn’t over. Collaboration between coaches, medical staff, and dietitians is essential to develop a comprehensive recovery plan. Here’s how to ensure smooth coordination:
Share Observations: As someone who interacts with the athlete regularly, you can provide valuable insight into their training, nutrition habits, and emotional state.
Respect Confidentiality: While it’s important to collaborate, respect the athlete’s privacy and only share relevant information with their consent.
Follow the Plan: Support the athlete by helping them adhere to the recommendations provided by their medical team. This could involve adjusting training loads, monitoring recovery, or ensuring they meet their nutrition targets.
Managing Training and Competition During Recovery
Recovery from REDs requires increasing energy intake (EI), reducing exercise energy expenditure (EEE), or both. However, not all cases require athletes to completely stop competing or training. A thoughtful, individualized approach is essential.
Guidance on Training Adjustments
Using the IOC Diagnostic Criteria, training and competition modifications should be based on the athlete’s health status:
Yellow Category: Full training and competition allowed, provided the athlete actively works with support staff to improve nutrition and health.
Orange Category: Training volume or intensity should be reduced, and competition participation may be limited to allow for adequate recovery.
Red Category: Training and competition should be paused to prioritize medical and nutritional recovery.
Addressing Physical and Psychological Health
REDs isn't just a physiological issue. Research highlights a reciprocal relationship between low energy availability and mental health challenges, addressing how focusing on both aspects is essential for full recovery.
Supporting Athletes Beyond Training Adjustments
Experiencing REDs can feel isolating. Coaches and support staff play a crucial role in ensuring athletes don’t feel alienated. Support strategies include:
Encouraging open, judgment-free communication
Connecting athletes with mental health professionals
Providing alternative team roles (e.g., mentorship, strategy discussions)
Reinforcing their value beyond athletic performance
Ways to Keep Athletes Involved During Recovery
Give the Athlete a Choice: Offer different levels of engagement to avoid pressure
Create Alternative Team Roles: Keep them involved with non-physical roles like mentorship or strategy discussions
Maintain Social Connection: Invite them to team events and check in one-on-one
Normalize Their Situation: Remind them that setbacks are part of sport and do not define their worth
Provide Flexible Engagement: Encourage light activities (if medically advised), such as warm-ups or recovery exercises
Respect Their Boundaries: Some athletes may need space, so avoid guilt-driven language and reassure them they are always welcome
Long-Term Support
In some cases, symptoms may persist or worsen despite initial interventions. If this happens, further medical evaluation or psychological support may be needed. In any case, recovery from REDs isn’t always a quick fix, and ongoing support is often required. Continue to check in with the athlete, encourage them to follow up with their medical team, and monitor their progress over time.
By working closely with healthcare professionals and fostering a supportive environment, you can help athletes navigate the challenges of REDs and return to optimal health and performance.