When things go a little bit wonky – injury and REDS

Updated: Mar 31

It has been a journey! The highs of good races, national lockdowns, a femoral stress fracture and a whole lot of reflection and learning. This read will take two angles, my experience with injury and how it was the catalyst to delve into a whole new world of things that many runners, particularly females, have to navigate. Often, for many people like myself, experience with this happens when it’s much too late. I want to share some of the things that I have learnt.


After a good race, you have a few days off and can’t wait to get back running, right. I ran the Robin Hood 100 in September, it was a great race for me and I couldn’t wait to get back to it. For 10 days I was limping, I couldn’t put a finger on why, it wasn’t particularly painful, I just couldn’t run. Frustrating. I went to see physiotherapist Scott Newton, who was absolutely great. He sent me for an MRI, which revealed what I feared most – a bloody femoral stress fracture!



There were so many emotions involved but one which particularly stood out was disappointment. Running was something which was always there, I could rely on it wherever and whenever, I had every trust in it. Not only did I feel like running had let me down for the first time ever, but I also felt that I, my body, had let running as a sport down. I always shared with others how good running was for you, how much you gain from it, and it felt disheartening losing faith in my own words. I felt guilty. Anyway, enough of that!


In total I had three months off from running. After an initial week or so of just letting myself be sad about it (this was important – fully encourage everyone to let emotions be, feel every one of them, cry it out!), I managed to flip my outlook around. I spent my time doing a hell of a lot of journaling, learnt to swim and a whole lot of reading.



It was also at this time that I brought to light something which I knew was going on but had been brushing under the carpet. I had always tracked my menstrual cycle, mostly because I am quite fascinated by how different cycle stages affect training and recovery. But my cycle length had been long for quite some time, ranging from 40 to 65 days, which meant that I was actually experiencing oligomenorrhea. This is defined clinically as 9 or fewer menstrual cycles per year, or a cycle length of more than 35 days. I didn’t think that this would really be an issue for me, I ate well, I was a healthy weight, that meant I was fine, right?


Naturally after the fracture, I wanted to know what was going on with my body, most importantly what I could do to avoid facing injury again. I knew that estrogen is important in bone health and irregular periods meant my estrogen was probably out of kilter. This is when I began to explore the world of REDS (relative energy deficiency in sport). This condition arises when insufficient food is consumed to support exercise energy expenditure, resulting in compromised physiological processes, such as menstrual irregularities (but also a whole world of other things, such as immune, psychological, metabolic, cardiovascular dysfunctions). I was put in touch with Joasia Zakrzewski who had suffered with stress fractures as a result of REDS and this is something we discuss on the Camino "Legends of Running Endurance" podcast. The shiny side of running is something which is shared everywhere, however this not-quite-so-shiny side is something which is more common than we might think, and often overlooked.

I am very far from an expert but have learnt some things throughout this journey, which I would like to share.


1. Menstrual cycle tracking


If you’re not already using a menstrual tracking app, start! Not only are they great for understanding your cycle, which can enable you to spot any misalignments, but they are also invaluable for better understanding how training and energy levels may vary at different stages in the cycle. Hormones play a real part in motivation, performance, energy levels and recovery. In fact, a study published in 2016 found that more than half of elite female athletes say that hormonal fluctuations during their menstrual cycle hampered their training and performances. Being aware of this means that you can then adjust and optimise training accordingly. I for example find that in those PMS days, running is a real slog, faster speeds seem impossible, I high-5 myself for simply getting out at all.

My favourite app is FitrWoman, you can log symptoms and it also provides information on how best to train, fuel and recover at that stage in your cycle based on the science. Garmin connect also has a great menstrual tracking function!


2. Fasted exercise


When did fasted exercise become trendy? There are many claims that intermittent fasting will allow your body to become more "fat adapted", meaning fasting will help prime your body to burn your fat stores for energy. Longer periods without food keep you in a catabolic state, which for women has been shown to have the ability to disrupt their endocrine system and their resting metabolic rate. Not only this but it has also been shown to drive up cortisol (a stress hormone) which can actually increase fat storage and promote adrenal fatigue. Dr Stacy Sims has a load of great content on this!

At its best, indiscriminate fasted running risks making athletes more efficient at being slightly inefficient. At its worst, fasted running can cause health crises”


3. Your physiology is individual


Unfortunately, objective numbers are not a thing as there are no researched guidelines for your unique body and physiology. A healthy weight for you will be different to a healthy weight for somebody else. Energy requirements for you will be different to somebody else. What excessive training is for you will be different to somebody else. What optimal recovery looks like for you will be different to somebody else. Get to know your normal, your ranges, what works for you.


4. Lets not leave men out!


REDS is not something which is limited to women, men also suffer from this! In fact it is pretty common. A recent study on the prevalence of low energy availability in male endurance athletes found that actually 80% of men were at risk. For men, spotting the symptoms of REDS may not be quite so obvious, but some things to look out for are decreased libido, disrupted sleep, plateau in responses from training, mood changes and recurrent injury.


5. Some handy resources


Instagram pages:

  • @r_mcgregor (Renee McGregor, sports dietician specialising in REDS and the female athlete)

  • @periodoftheperiod

  • @fitrwoman

  • @femaleathletepod

  • @drstacysims (leading female expert on female physiology and endurance training)



Podcasts:

  • TrainBrave

  • The period of the period

  • Female Athlete Podcast

  • The Food Medic

Books:

  • Roar by Stacy Sims


Injury thoughts


Finally, I would like to share a few thoughts on my experience with injury:

  • The thought of the dreaded is often worse than the dreaded itself

  • Feeling and processing all of the emotions is an important part of the process

  • Taking it to the next level and writing everything down is even better, hurrah for journals!

  • Regarding rest and rehab, do it right and do it once!

  • Actually, some time out is good for the mind. A chance to reflect and realign your focus and to appreciate running for what it is and why you do it. Coming back to it with gratitude and a fresh mindset is really great

Much running love,

Kelsey X


Papers referenced:

Fahrenholtz et al (2018). Within-day energy deficiency and reproductive function in female endurance athletes. https://pubmed.ncbi.nlm.nih.gov/29205517/

Lane et al (2019). Prevalence of Low Energy Availability in Competitively Trained Male Endurance Athletes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843850/


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