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Energy, Exercise and Overtraining

The infographic below describes some of the symptoms associated with low energy. See if you recognise any of them.

infographic Energy, Exercise and Overtraining

Most people know that having energy for exercise is important

But what happens if we lack energy when exercising, or consistently train in an energy deficient state? This phenomena is called “Relative Energy Deficiency Syndrome” or “RED-S”.

This article discusses the negative health affects associated with RED-S and what we can do to prevent getting this

What is Relative Energy Deficiency Syndrome (RED-S)?

RED-S is a medical condition that occurs when there is physiological, metabolic or mental health disruption from due to poor energy balance. The resultant affect is that the exerciser becomes “energy deficient”.

In its most simplest form, energy deficiency occurs when “energy availability” (energy going in and available for the body to use) does not meet “energy expenditure” (energy being spent by exercise and routine body functions), across a sustained period of time. This eventually leads to an imbalance in the body.

scales Energy, Exercise and Overtraining

Is RED-S the same as over-training?

Overtraining and energy deficiency can be linked and share very similar signs and symptoms. However, it is possible to over-exercise and still have a positive energy balance. Conversely, it is also possible to under-exercise, but for the body to still be in an energy deficient state.

How does RED-S present?

Musculoskeletal injury is the commonest way RED-S presents. Typical overuse injuries, such as shin splints in runners, can be a subtle sign that the patient is chronically energy deficient. Bone stress and fractures are more severe and indicate that training in an energy deficient state has occurred over a long time.

However, there are many other ways in which RED-S can present. Disruption to menstrual function, poor mental heath, altered bowel habits and increased susceptibility illness and infections are other common ways.

“Poor mental health is often associated with energy deficiency”

female training Energy, Exercise and Overtraining

Who is at risk of RED-S?

Although RED-S can occur in anyone, certain cohorts of people are at higher risk. These high risk groups include;

  • Athletes (professional and amateur)
  • People starting a new exercise regime they are not familiar with
  • Women between the ages of 15-40
  • Elderly people
  • Those recovering from injury, illness or after an operation
  • Patients with mental health conditions such as disordered eating, body dysmorphia
  • Patient with medical conditions that affect absorption of food and nutrients e.g. coeliac disease

Although well recognised in the athletic population, there are still large numbers of everyday exercises, weekend warriors and amateur athletes where this diagnosis is either being missed, or not even considered.

Why is RED-S difficult to detect?

Part of the difficultly in recognising RED-S can be explained by following factors;

  • It can present in people with normal weight. Being energy deficient does not always mean you will have a low Body Mass Index (BMI). People with a high BMI (>30) may also be at risk of over training or under fuelling (for example weight lifters). However, a low BMI of less than 20 is certainly a risk factor.
  • It can present with a large variety of symptoms. This may include musculoskeletal injury, body physiological disruption, illness and poor mental health.
  • Time scales of presentations. It may take weeks and even months for signs and symptoms of RED-S to present. This is because the body’s physiological system are able to adapt to some degree, before they begin to fail.
  • Health care professionals do not really consider it or known enough about it. This may be due to;
    • Lack of time in consultation to discuss energy and training.
    • Lack of knowledge around RED-S or feeling it is ‘out of scope’.
    • Limited access to diagnostic and investigatory tools, such as scans or blood tests
    • Logistical challenges making it difficult for health care professionals to connect and link care pathways, e.g. mental health and bone health.

What to do if you suspect energy deficiency?

If you feel yourself, or someone you know may be suffering from symptoms of energy deficiency, please get in touch with us.

The best way to manage low energy is to firstly understand where the imbalance lies and why it is occurring. Any imbalance could be due to a variety of risk factors. A thorough medical work up and assessment is always required.

Our medical team are experts in recognising and treating energy deficiency. Please let us know if you need support.

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    Orla Mulligan
    Administration and Social Media Manager
    Administration, LBSM

    Orla Mulligan is the administration and social media manager for LBSM. She has a strong background in sport having herself played netball at an elite standard for the U21s Northern Ireland team in the European Championships as well as the U21s competition for Saracen Mavericks.

    She understands youth sport pathways having herself played and training in the netball Kent regional pathway. She has a keen interest in most sports and a good understanding of how injury and illness can impact on the mind and body, as well as rehabilitation pathways.

    She looks forward to speaking and assisting LBSM patients and gives her best support to them during their treatment pathway.

    A day in the life of Orla involves communicating with patients via phone and email, managing and organising clinics, operations and media management.

    Outside of work, Orla is a gym enthusiast, enjoys tennis and still finds the time for an occasional game of netball.

    Maddie Tait
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    Associate, LBSM
    Musculoskeletal and Sports Podiatrist

    Maddie treats and manages complex foot and ankle injuries in London and Surrey.

    She is particularly interested in helping her patients improve their quality of life and achieve their personal goals, working closely with Foot and Ankle Consultants, Sports Medicine Doctors and Physiotherapists.

    Maddie has a sporting background herself having previously represented England in Hockey. She understands the demands of elite sport and the importance of physical and mental health. In her spare time, Maddie continues to enjoy an active lifestyle by running, cycling and attending a Pilates class.

    Having graduated from University of Brighton with a MSc (hons) in Podiatry, Maddie focused her career in Podiatric Sports Injuries and Biomechanics. Previously she completed a BSc (hons) in Sport Science at Loughborough University.

    A day in the life of Maddie involves consulting patients in clinic, performing gait and biomechanical assessments, measuring and fitting orthotics and braces. She also regularly teaches and presents at sports medicine and podiatry conferences.

    Outside of work, Maddie still finds time to play hockey and enjoys running and skiing.

    Mr Prakash Saha
    Consultant Partner, LBSM
    Consultant in Vascular Surgery

    Mr Prakash Saha is a Consultant Vascular Surgeon at LBSM. He takes pride in providing the best possible results for his patients by using the most appropriate non-surgical and surgical methods based on clinical evidence, patient results and satisfaction.

    He treats fit and active people suffering with a range of cardiovascular issues, from painful leg swelling associated with exercise to venous insufficiency, post-thrombotic syndrome and leg ulcers. He also treats people with arterial system problems including poor circulation, compression syndromes and aneurysms. He carries out both endovascular and open aortic repair and has some of the best outcomes in the country.

    Mr Saha studied medicine at the United Medical & Dental Schools at Guy’s and St. Thomas’ Hospitals before completing his higher surgical training in London and the South East. During this time, he was awarded the prestigious NIHR Clinical Lectureship in Vascular Surgery at St. Thomas’ Hospital, giving him comprehensive training in open and endovascular techniques for treating arterial and venous disease. Prakash completed his aortic surgery training at the St. George’s Vascular Institute before carrying out a specialist fellowship at the Royal Prince Alfred Hospital, Sydney.

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    A day in the life of Mr Saha involves seeing patients in clinic, operating in surgical theatre or lecturing at his university. He also regularly teaches and presents at vascular and sports medicine conferences.

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    Consultant Partner, LBSM
    Consultant in Sports and Musculoskeletal Radiology

    Dr Gajan Rajeswaran is a Consultant Musculoskeletal Radiologist at LBSM, with an extensive background of working in elite sport. He is one of the most recognised radiologists in the sports medicine field. He provides top level imaging and medical diagnostic services for patients and athletes.

    Dr Gajan Rajeswaran completed his undergraduate medical training at Imperial College London and his radiology training at Chelsea & Westminster Hospital. He has obtained two post-CCT fellowships in musculoskeletal imaging. He was appointed as a consultant at Chelsea & Westminster Hospital in 2011.

    He has a passion for all sports having worked as a radiologist at the Glasgow Commonwealth Games and London World Athletic Championships and continues to support The Championships, Wimbledon. He also continues to work with a number of Premier League and Championship Football Clubs, Premier League Rugby Clubs, England Sevens Rugby, British Athletics and the Lawn Tennis Association.

    A day in the life of Dr Rajeswaran involves giving his expert opinion on investigations such as MRI and CT scans, x-rays and ultrasound. He also performs injection lists under ultrasound, CT and X-ray including spinal injections. He also regularly teaches and presents at sports medicine conferences.

    Dr Gajan Rajeswaran is an avid football fan and life-long fan of Tottenham Hotspur (for which he offers no apologies!). Outside of work, he spends time with his family and has a keen passion for photography.

    Dr Ajai Seth
    Medical Director, LBSM
    Consultant in Sport and Exercise Medicine

    Dr Ajai Seth is a Sport and Exercise Medicine Physician. He has dedicated his career to helping people with sport and exercise related injury and illness. He consults and treats everyone from the elite athlete to the weekend warrior.

    Dr Ajai Seth is part of the British Tennis Sports Physician team at the LTA and has also provided cover to elite athletes at Wimbledon Tennis, European Tour Golf, Premier League Football, British Athletics, and the Men’s England Football academies as part of the FA.

    He also prides himself for working in disability sport and is currently the Chief Medical Officer for Team GB Wheelchair Tennis which has taken him to the Olympics and Paralympics.

    Dr Ajai Seth is dedicated to education, training and research and is a Senior Lecturer in Sports Medicine at King’s College London where he lectures in all aspects of Sports Medicine and Science.

    He also has a passion for travel and Expedition Medicine, which has seen him accompany medical, scientific and charity expeditions all around the world. He also has vast experience in treating musculoskeletal injuries from children and adolescents to veteran exercisers, both male and female.

    Dr Seth also has positions in leading Sport Medicine organisations, including the non-executive board for the UK’s largest Sports Medicine charity, BASEM and Past President for the Royal Society of Medicine. 

    A day in the working life of Dr Seth involves consulting his patients in clinic, performing diagnostics and ultrasound guided injections. He also regularly lectures and tutors students and presents at sports medicine conferences internationally. He also spends part of the working week at the National Tennis Centre, LTA, supporting British Tennis players.

    Outside of work, Dr Seth enjoys playing club tennis, triathlon, golf, running and skiing (but will give any sport a go!). He enjoys keeping fit and active and good quality family time with his wife and three children.