Physical Therapists play an important role!
As physical therapists, we may serve as the frontline detectives in recognizing LEA(low energy availability)/REDs (Relative Energy Deficiency in Sport) in athletes. For instance, we should consider a patient's history of bone stress injuries, recurring soft tissue injuries, slower-than-expected healing rates for specific injuries, or a history of amenorrhea or low testosterone levels, to name a few. Additionally, we play a crucial role in helping athletes recover from REDs!
The aim of this above-mentioned paper was to discuss the health and performance implications of problematic LEA on the MSK (musculoskeletal) system and examine the potential role that MSK-based training modalities play during an RTP (return to play) REDs treatment plan. The paper also aimed to offer practical guidelines using the available evidence and combined clinical expertise around the safe and effective use of MSK training for athletes recovering from REDs.
First, let’s take a look at the health and performance consequences that affect the musculoskeletal system when an athlete has experienced LEA for a longer period of time (problematic LEA).
The above consequences may leave an athlete vulnerable to injury upon return to their sport or activity.
How can physical therapists help in developing and managing a treatment plan?
For athletes with REDs a treatment plan should aim to prevent long-term health and performance consequences and maximize the likelihood of all full and successful return to performance (RTP). And, we (physical therapists), are uniquely poised to help athletes based on our expertise in managing musculoskeletal injuries.
The FIRST step and goal in treatment is restoration of optimal energy availability + ensuring that the athlete is medically stable. A referral to a qualified registered dietitian + qualified medical provider is essential in ensuring the optimization of this process!
The SECOND step, as long as the athlete is medically stable (no symptoms of cardiovascular compromise such as hypotension or tachycardia), is to implement an athlete-specific MSK treatment plan to help bridge the gap between the musculoskeletal change that occurred during the prolonged period of LEA and the sport specific activity the athlete would like to return to performing in a healthy way!
Why is it important to take a step back from sport-specific cardiovascular training during this period of time?
Cardiorespiratory exercise has a clear physiological relevance for performance yet is energetically expensive (requires a high energy expenditure) and fails to address deficiencies in MSK health caused by REDs.
An alternative approach to prioritizing cardiovascular training or “sport specific” training during the initial stages of REDs rehab is to emphasize musculoskeletal-based exercise. This type of training involves high intensity short-duration bouts of activity which is designed to stimulate adaptations in the musculoskeletal system and neuromuscular control (power).
This exercise is relatively energy efficient and promotes underlying physiological qualities (max strength, power, relative strength) that are important for long-term performance and injury prevention.
Development of MSK capacities during the early stages of the RTP process is therefore likely to support higher volumes of sport-specific preparation and mitigate against injury risk in the long term.
This period of rehab from REDs affords athletes the opportunity to target potential areas of weakness that can provide a refreshing change to their previous training routine.
Below are the Practical Guidelines for the Use of Musculoskeletal-Based Exercise Training (Plyometric and Resistance Training) During Return to Performance Following Relative Energy Deficiency in Sport recommended by the authors:
If you feel you are struggling with symptoms of REDs, please reach out to a qualified medical provider to assist you in recovery. You deserve the best care to guide you back to your sport of choice and I would love to help you in this process!