RED-S and Bone Stress Injuries

When a runner or active person develops a bone stress injury, the focus often goes straight to the painful area. That makes sense, but it is not always the full picture. One of the more important underlying contributors can be RED-S, or Relative Energy Deficiency in Sport.

This matters because if RED-S is present and not addressed, bone stress injuries are more likely to occur and more likely to recur.

At our clinic in Marrickville, we see this most commonly in runners and highly active individuals across the Inner West who are training hard but not always meeting the energy demands of that training.

What is RED-S?

RED-S occurs when energy availability is too low to support both exercise and normal body function. In simple terms, the body is not getting enough fuel for everything it is being asked to do.This does not always mean someone is intentionally under-eating. It can simply mean that training load has increased and nutrition has not kept pace.

Why does it matter for bone health?

Low energy availability can affect:

• bone health
• hormonal function
• recovery
• immune function
• performance

When bone health is compromised, the skeleton becomes less able to adapt to the repeated loads of running and sport. That increases the risk of bone stress injuries.

Common signs that may raise suspicion

Not every person with RED-S will present the same way, but common features can include:

• recurrent bone stress injuries
• persistent fatigue
• poor recovery
• drop in performance
• low mood or irritability
• menstrual irregularity in females
• frequent soft tissue injuries

It is important to note that someone can look outwardly healthy and still have low energy availability.

Why runners are commonly affected

Running has a relatively high energy cost, particularly once volume increases. Add gym training, busy work schedules, poor recovery, or a drive to stay lean, and it becomes easier for a mismatch to develop between output and intake.

How it is managed

If RED-S is suspected, management should go beyond just the painful bone. It often involves:

• temporary modification of training load
• review of nutrition and overall intake
• appropriate medical input where needed
• physio support with load management and return to running
• dietitian involvement

If there is a clear nutrition mismatch, dietitian input can be a particularly useful part of reducing ongoing injury risk.

The key point

If someone keeps developing bone stress issues, there is usually a reason. RED-S is one factor that should not be missed.

If you are a runner or active person in Marrickville, Newtown, Enmore, Stanmore or elsewhere in the Inner West and have had recurrent bone stress injuries, low energy availability may be part of the picture. Identifying it early can make a large difference to both recovery and future injury risk.

Links: Bone Stress Injuries | Dietitian | Sports Injuries