Relative energy deficiency in sport and reduced bone health – the role of the physiotherapist in identification and management

Introduction: Low energy availability (LEA) is a condition with potential severe consequences related to health and athletic performance. One such consequence is impaired bone health. The aim of this paper is therefore to describe risk- and associated factors for LEA, and the role of the physiotherapist in identification and management of the syndrome «Relative Energy Deficiency in Sport» (RED-S). Main part: A literature search identified 19 papers that were included in this paper. Both biological, psychological and sociocultural factors are associated with LEA in athletes. Athletes in weight-sensitive sports, female athletes, para-athletes, athletes with certain personality traits, recurrent non-healing injuries, and athletes with a history of dieting, stress fractures and/or menstrual disturbances seem to be at increased risk of LEA. Physiotherapists have great potential for early identification and management of RED-S by implementing and using available screening tools. Collaboration in multidisciplinary teams seems important for the reversing of LEA and its associated health- and performance consequences. Ending: Athletes who seek help from physiotherapists due to bone stress injuries and/or musculoskeletal pain might be at increased risk for RED-S. Physiotherapists therefore play an important role in identifying, and as a collaborative partner in management of the syndrome RED-S.